ATTACHMENT D 

CHOICES FOR INDEPENDENCE 
CHOICES FOR 

INDEPENDENCE

MARCH 9, 2006

 MODERNIZING THE 

 OLDER AMERICANS ACT
Choices for Independence 

Reauthorization of the Older Americans Act includes a proposal to pilot Choices for 

Independence, a $28 million demonstration project to promote consumer-directed and 

community-based long term care options. Choices aims to strengthen the nation’s 

capacity to promote the dignity and independence of older people and meet the 

challenges associated with the aging of the baby boom generation. It also aims to 

supplement the President’s New Freedom Initiative and the Administration’s policy for 

modernizing Medicare and Medicaid by strengthening the Act’s role in promoting 

consumer choice, control, and independence in long-term care. 

The Older Americans Act supports a Federal, state, tribal and local partnership known as 

the national aging services network, which includes 56 state units on aging, 655 area 

agencies on aging, 243 tribal organizations, 29,000 community-based organizations, and 

over 500,000 volunteers. The network uses $1.4 billion in federal funds each year to 

leverage an additional $4 billion from other public and private sources to provide home 

and community-based services to over 8 million elderly individuals. Services include 

home-delivered meals, nutrition services in congregate settings, transportation, adult day 

care, health promotion, and support for family caregivers. 

Choices for Independence builds on the mission and success of the Older Americans Act. 

It also builds on recent HHS initiatives, including: the Aging and Disability Resource 

Center Initiative; the Own Your Future Long Term Care Awareness Campaign; the Cash 

& Counseling Demonstration Program; and, the Evidence-Based Disease Prevention for 

the Elderly Program. Choices integrates best practices from these initiatives into a threepronged strategy focused on: empowering individuals to make informed decisions about 

their long-term support options; providing more choices for individuals at high-risk of 

nursing home placement; and enabling older people to make behavioral changes that will 

reduce their risk of disease, disability, and injury. 

The Older Americans Act is uniquely positioned to advance these changes. It has a 

statutory focus on keeping older people independent and living in their own homes and 

communities for as long as possible, and a successful history of providing low-cost, nonmedical supports through a federal, state and local partnership under a capped federal 

appropriation. 

Empowering Individuals to Make Informed Choices 

Choices aims to empower individuals – both those in immediate need and those who have 

the ability to plan ahead for their long-term care – to make informed decisions about their 

support options. To promote ownership over long-term care planning, Choices will 

conduct a public education campaign and provide individual support through “one stop” 

resource centers, known as Aging and Disability Resource Centers. These resource 
centers will be “visible and trusted” sources that people can turn to for information on all 

available support options, including private financing options such as long-term care 

insurance and home equity instruments. This will reduce the confusion and frustration 

consumers and their families often face as they explore long-term care options. It will 

also improve government efficiency by integrating the multiple eligibility forms and 

procedures for various public programs that help finance long-term support options. 

Providing More Choices for High-Risk Individuals 

Choices will give states and communities greater flexibility under the Older Americans 

Act to help moderate and low-income individuals to remain in their homes and delay 

their premature entry into nursing homes. Choices will provide flexible funding that will 

be targeted at individuals, not at service categories as with the current titles under the 

Act. This will make it easier for states to respond to people’s individualized needs and 

preferences. It also will promote the use of consumer-directed approaches, including 

“cash and counseling” models which give consumers more control over the care they 

receive. 

Building Prevention into Community-Living 

Choices will empower older individuals to make lifestyle changes that will reduce their 

risk of disease, disability, and injury. There is a growing body of scientific evidence on 

the efficacy of low-cost programs that can empower older individuals, including 

functionally impaired individuals, to better maintain their health. These programs focus 

on interventions such as chronic disease self-management, falls prevention, exercise, and 

nutrition. Choices will strengthen the role of the Older Americans Act in translating 

research into practice by promoting the use of evidence-based health promotion and 

disease prevention programs at the community-level through local aging services 

provider organizations such as senior centers, nutrition programs, senior housing projects, 

and faith-based groups. The nation-wide deployment of these programs will improve 

quality of life, reduce health care costs, and complement the increasing focus on 

prevention in our health care system. 

Implementing the Choices Demonstration 

Choices will provide competitive matching grants to states and will entail a rigorous 

program evaluation. Participating states will be required to track outcomes based on 

performance measures that will be established by AoA. Such measures may include 

promotion of consumer health and well-being, and reductions in the unnecessary use of 

costly hospital and nursing home care. AoA will establish a national technical assistance 

program for Choices to support state implementation activities. Finally, AoA will 

involve the Centers for Medicare and Medicaid Services, the Centers for Disease Control 
and Prevention, the National Institute on Aging, the Agency for Healthcare Research and 

Quality, and other HHS agencies in the implementation of Choices. 
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