Putting Data to Work for Older People

RESEARCH BRIEF NUMBER 3 • SEPTEMBER 2010

Multiple Service Use Among 

OAA Title III Program Participants 

by Allison Barrett and Jody Schimmel, Mathematica Policy Research

Since the Older Americans Act (OAA) was passed in 1965, the Administration on Aging (AoA) has provided services to 

elderly Americans, helping them maintain independence and remain in their own homes. Through its “Aging Services Network,” including State Units on Aging (SUAs), Area Agencies on Aging (AAAs), and tribal partners, AoA works to provide 

services designed to mitigate the effects of declining physical health and functioning experienced by frail older adults. This 

brief, the third in a series that presents findings from AoA’s National Survey of OAA Program Participants, investigates the 

patterns of multiple service use among AoA participants, including the number and type of services received.

The Aging Services Network provides a range of 

community-based services—home-delivered and 

congregate meals, case management, transportation, and homemaker and caregiver support. Such 

services enhance both the quality of life and social 

interaction, and reduce the effects of disability for 

homebound and more active seniors. Funded under 

Title III of the OAA, services are available to individuals age 60 and older, though delivery is targeted 

to the most vulnerable elderly. 

Background What Is The Aging Services Network?

Certain groups of Title III participants are less healthy, 

have lower incomes, have more functional limitations, 

and are at higher risk of nursing home placement than 

others (Altshuler and Schimmel 2010; Barrett and 

Schimmel 2010). Consequently, these participants 

may have greater need for—or be more likely to benefit 

from—a variety of AoA services or services funded by 

other federal, state, or local agencies. 

Information about multiple service use by AoA participants may indicate the extent to which Title III 

program participants rely on more than one service 

to help them remain in the community, and help AoA 

service providers determine which combinations of 

services are typically used together. Respondents to the 

Fifth National Survey of OAA Program Participants 

provided in-depth answers about services received 

from one particular Title III program, but also shared 

information about other services they received from 

other AoA programs in the year prior to being interviewed. To assess multiple service use, we analyzed 

responses from participants in six Title III programs 

about AoA services received, as well as other services 

they reported receiving. 

Most Participants Receive Multiple 

Title III Services

With the exception of congregate meals participants, 

over half of Title III program participants reported 

receiving multiple services during the year preceding 

the survey.1 The percentage of participants who received 

two or more Title III services during the year ranged 

from a low of 44 percent, in the congregate meals program, to a high of 96 percent among those in the case 

management program (Figure 1). A substantial number of participants received three or more services: 16 

percent of participants in the congregate meal program; 

about one-third of care recipients2

 and participants in 

the transportation and home-delivered meal programs; 

and more than 60 percent of all participants in the case 

management and homemaker services programs. 

1

Survey respondents were asked whether they received any of 10 Title 

III services: congregate meals, home-delivered meals, transportation, 

case management, homemaker services, adult day care, personal care, 

chore assistance, legal assistance, or information and assistance (I&A). 

2

Care recipients are individuals whose caregivers receive Title IIIfunded caregiver services. Many of these individuals directly receive 

other services, but a substantial fraction (21 percent) only receive AoA 

services indirectly, through the services provided to their caregivers. 

This issue brief only considers Title III services that are received 

directly, and as a result, care recipients who receive no other services 

are counted as receiving zero services.
2

Depending on the program through which Title III participants received services, they received between two 

and four Title III services on average during the year 

(Figure 1). Individuals in the congregate meals program 

received the fewest services, only 1.7 on average. Participants in the home-delivered meals and transportation 

programs received an average of 2.4 and 2.5 services, 

respectively; those in the homemaker and case management programs received more than 3 services, on average. The larger numbers of AoA services received by 

participants in the home-delivered meals, transportation, 

homemaker, and case management programs are likely 

due to participants in these programs being less healthy, 

having more functional limitations (Barrett and Schimmel 2010), and therefore requiring more supportive 

services to remain in the community. 

Figure 1: Proportion of Title III Participants Using Multiple AoA Services

28%

36%

26%

21%

14%

26% 30%

50%

30%

63%

2%

7% 6% 10% 6%

12%

40%

50%

60%

70%

80%

90%

100%

Fi     i f i     i U      

6 or more services

3 to 5 services

2 services

1 service

0 services (care

21%

56%

31%

39%

11%

22%

4%

29%

21%

0%

10%

20%

30%

Congregate meals

(average = 1.7)

Transportation

(average = 2.5)

Home-delivered

meals

(average = 2.4)

Homemaker services

(average = 3.2)

Care recipients

(average = 2.1)

Case management

(average = 3.5)

recipients only)

Community‐based services In‐home services Indirect services

Source: Calculations based on the Fifth National Survey of OAA Program Participants, 2009.

Receipt of Other Services Varies 

by Program 

Although some Title III services were used by a similar 

proportion of participants in each program, the use of 

other services varied sharply among programs (Figure 2). 

For example, fewer than 10 percent of participants in 

each program received legal assistance services, and 

between 17 and 26 percent received information and 

assistance services (I&A).3 In contrast, participants in 

the case management program were nearly 10 times 

more likely to use homemaker services than those in the 

congregate meals program (56 percent and 6 percent, 

respectively). Figure 2 highlights the combinations or 

sets of services more likely to be found among AoA 

participants using multiple services; larger circles in 

each column correspond to services that are more often 

delivered in tandem. 

The other Title III services most commonly received 

by participants in the congregate meals program were 

also community-based services, such as transportation 

(18 percent of congregate meals participants) and I&A 

(26 percent). Similarly, participants in the transportation 

program who participated in other Title III programs 

most commonly received congregate meals (44 percent of transportation program participants) and I&A 

services (21 percent). Fewer than 1 in 5 participants in 

the transportation program and fewer than 1 in 10 in the 

3

Legal assistance services and I&A not shown in Figure 2.
3

congregate meals program received in-home services 

like home-delivered meals, homemaker services, personal care, and chore assistance within the twelve-month 

period covered by the survey. While older and in poorer 

health than older adults nationally, participants in the 

congregate meals and transportation programs have 

fewer functional limitations and report lower rates of 

serious chronic illness compared to in-home program 

participants (Barrett and Schimmel 2010). The overlap 

of community-based services suggests that individuals in these programs need fewer in-home services to 

continue living independently. 

In contrast, the most common Title III services received 

by care recipients and participants in the home-delivered 

meals, case management, or homemaker services programs were case management and homemaker services, 

with a high proportion also receiving personal care 

services and home-delivered meals. Case management 

services are intended to assess an individual’s need for 

a broad range of services and ensure access to them. 

Thus, it is unsurprising that the vast majority of participants in the case management program were receiving 

multiple other in-home Title III services, and that 

recipients of in-home and indirect services were likely 

to also have received case management. Participants in 

these programs were less likely to use transportation 

than they were to use other Title III services, but still 

used transportation services more often than participants 

in the congregate meals program, reflecting their higher 

use of Title III services overall. However, participants in 

these programs were less likely than participants in other 

programs to receive congregate meals, perhaps reflecting difficulty using congregate meals settings due to 

functional and health limitations. 

Figure 2: Percentage of Program Participants Receiving Selected Other Title III Services

8%

6%

3%

6%

18%

17%

10%

17%

100%

29%

16%

31%

42%

100%

33%

54%

23%

31%

30%

43%

56%

56%

39%

100%

Personal care

services

Case

management

Homemaker

services

Home‐

delivered

meals

100%

18%

44%

100%

11%

20%

16%

30%

16%

19%

14%

28%

Congregate meals

(1,643,052

participants)

Transportation

(279,556

participants)

Case management

(475,833

participants)

Homemaker

services(162,343

participants)

Care recipients

(223,475

recipients)

Home‐delivered

meals

(899,224 participants)

Congregate

meals

Transportation

services

Community‐based services In‐home services Indirect services

Source: Calculations based on the Fifth National Survey of OAA Program Participants, 2009.

Some Groups Use More Title III Services

The use of multiple services is not uniform across 

participants in each Title III program (not shown). 

For example, in three of the six programs examined 

(congregate meals, transportation, and home-delivered 

meals), having difficulty with three or more activities 

of daily living (ADLs) was significantly associated with 

using a higher average number of Title III services. In 

the congregate meals program, participants who lived 
4

in poverty, lived alone, or were unmarried used significantly more Title III services than participants not in 

poverty, living with others, or married. Participants in 

the home-delivered meals program who were unmarried 

or who had a nursing home or overnight hospital stay 

within the past year used more services on average than 

those who were married or did not have a recent hospital 

or nursing home stay. 

Other demographic factors were generally not significantly associated with use of more services. For example, neither age nor race was a significant factor in the 

number of Title III services received by participants in 

any program. 

Most Also Receive Non-Title III Services

The percentage of participants who reported receiving 

other supportive services not funded by AoA Title III is 

relatively constant across most programs, although the 

types of services they received varied (Table 1). Survey 

respondents reported receiving two types of services: (1) 

health, social, and housing services funded by federal 

agencies other than AoA, including Medicaid, energy 

assistance, food stamps, and housing subsidies; and (2) 

preventive health services for which the funding sources 

are unknown or not specified, including nutritional 

counseling, health screenings, and immunizations. 

The receipt of federally funded services ranged from a 

low of 28 percent of congregate meals program participants to a high of 55 percent in the case management 

program (Table 1). Medicaid was the most commonly 

received federally funded service, followed by energy 

assistance and food stamps. Individuals in the congregate meals program were less likely to live in poverty 

than participants in other programs (Barrett and Schimmel 2010), which may explain their lower rate of participation in federally funded programs, many of which are 

means tested. 

Participants in Title III programs that provide in-home 

services, such as home-delivered meals and homemaker 

services, were less likely to report receiving preventive 

health services. Only 35 percent of participants in the 

home-delivered meals program and 36 percent in the 

homemaker program received preventive health services, compared to 47 percent in the transportation program and 58 percent in the congregate meals program. 

Individuals receiving in-home services are not likely to 

have less need for health screenings, immunizations, and 

nutritional counseling, but may be less able to access 

such services. This may suggest the need for further 

study to determine why these participants are not getting 

the services they need, and to identify ways to improve 

preventive health access to vulnerable populations. 

Conclusions and Implications 

Of the nearly 3.7 million Title III clients represented 

in the Fifth National Survey data, 2.2 million reported 

receiving multiple Title III services in the 12 months prior 

to the survey. The participants in the transportation, homedelivered, and congregate meals programs who were in 

poverty, unmarried, living alone, or had difficulty with 

multiple ADLs were the most likely to use multiple serTable 1: Percentage of Program Participants Receiving Non-Title III Services, by Program

Congregate 

meals

Transportation

Homedelivered 

meals

Homemaker 

services

Care 

recipients

Case 

management

Receiving non-Title III services 69 68 60 66 59 78

Receiving federally funded services 28 44 43 54 35 55

 Medicaid 18 29 29 32 26 41

 Energy assistance 11 16 17 22 13 25

 Food stamps 7 19 16 15 7 22

 Housing assistance 8 18 11 14 5 19

Receiving preventive health services 58 47 35 36 41 48

 Health screening 39 32 20 29 30 38

 Immunizations 34 25 19 12 18 18

 Nutritional counseling 10 12 11 7 8 10

Source: Calculations based on the Fifth National Survey of OAA Program Participants, 2009.
5

vices. In other analyses (Altshuler and Schimmel 2010), 

these characteristics were shown to be associated with a 

higher risk of nursing home admission. 

AoA’s Performance Outcomes Measures project (POMP) 

helps states and AAAs assess their own program performance while assisting AoA to meet its accountability 

provisions. Preliminary evidence from POMP studies suggest that the receipt of multiple services may lessen the 

likelihood of nursing home placement and increase time 

living in the community. 

The likelihood that multiple services are used in combination—particularly in-home services such as homedelivered meals and homemaker services—suggests that 

AAAs and other AoA service providers can consider 

whether those receiving one service might also benefit 

from another service with which it is often used. Future 

research could help shed light on the combination of 

services most beneficial to helping individuals to remain 

living in the community. 

Data Sources

Information on Title III participants was drawn from the 

Fifth National Survey of OAA Program Participants. 

This survey was conducted in 2009 by Westat, Inc., via 

telephone and administered to nearly 5,500 individuals 

who reported receiving Title III services. The survey 

used a two-stage sample design, first selecting a sample 

of AAAs, then randomly sampling participants from 

each selected AAA by service type. The number of 

participants selected from each AAA was proportional 

to the number of participants served in that particular 

service by the sampled AAA. All analyses in this brief 

apply sample weights to account for this design. Additional data from and more detailed documentation for 

the Fifth National Survey and other AoA data sources 

are available on the new interactive AGing Interactive 

Database (AGID) at http://data.aoa.gov. 

This brief includes data for participants in six of the 

service types included in the survey: home-delivered 

meals (1,030 respondents), homemaker services (459 

respondents), transportation services (824 respondents), 

congregate meals (903 respondents), case management 

(486 respondents), and caregivers (1,793 respondents). 

Individuals are categorized as program participants 

based on the program for which they were surveyed; 

multiple service use is gauged by considering responses 

regarding services received other than those in the program for which individuals were surveyed. 

References

Altshuler, N., and J. Schimmel. “Aging in Place: Do 

Older Americans Act Title III Services Reach Those 

Most Likely to Enter Nursing Homes?” Washington, 

DC: Mathematica Policy Research, July 2010. 

Barrett, A., and J. Schimmel. “OAA Title III Services 

Target the Most Vulnerable Elderly in the United 

States.” Washington, DC: Mathematica Policy Research, 

August 2010. 

About This Series

This series is funded by AoA, and presents analyses 

conducted by Mathematica Policy Research using 

data from AoA’s National Surveys of Program 

Participants. These surveys collect information 

from Title III participants about their demographics, 

socioeconomic status, health, and functioning, as 

well as their service use and client-reported service 

impact and quality. 

For more information about this study, please contact 

Jody Schimmel, senior researcher at Mathematica, 

jschimmel@mathematica-mpr.com.

Visit our website at http://results.aoa.go v