Overview of 

OLDER AMERICANS ACT 

Title III, VI, and VII Programs 

2020 SUMMARY 

OF HIGHLIGHTS AND 

ACCOMPLISHMENTS 
 

Acknowledgment 

Jennifer Tillery, Senior Aging and Disability Program 

Coordinator in the Ofce of Performance and Evaluation (OPE), Center for Policy and Evaluation, Administration for Community Living (ACL) assisted with 

preparation of the report. U.S. Department of Health 

and Human Services (HHS), in partnership with New 

Editions Consulting, Inc., under contract number 

HHSP233201500113I/HHSP23337002T. 

Disclaimer 

The views, opinions, and content of this publication 

are those of the authors and do not necessarily reflect 

the views, opinions, or policies of OPE, ACL, or HHS. 

Nothing in this document constitutes a direct or 

indirect endorsement by ACL of any nonfederal entity’s products, services, or policies, and any reference 

to nonfederal entity’s products, services, or policies 

should not be construed as such. 

Public Domain Notice 

All material appearing in this publication is in the public 

domain and may be reproduced or copied without 

permission from ACL. Citation of the source is required. 

However, this publication may not be reproduced or 

distributed for a fee without the specifc, written 

authorization by ACL. 

Electronic Access 

This publication may be downloaded from https://acl. 

gov/aging-and-disability-in-america/data-and-research. 

Recommended Citation 

Administration for Community Living (2022). Overview 

of Older Americans Act Title III, VI, and VII Programs: 

2020 Summary of Highlights and Accomplishments. 

U.S. Department of Health and Human Services. 

https://acl.gov/aging-and-disability-in-america/data-and-research 
Overview on Older Americans Act Title III, VI, and VII Programs | 1 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Table of Contents 

OVERVIEW 

Foreword 3 

Administration for Community Living 6 

Abbreviations and Acronyms 7 

List of Graphs, Figures, and Tables 8 

Introduction 9 

Mission and Vision of the Administration 

for Community Living 9 

Older Americans Act 10 

Time Line of Programs for Older Americans, 12 

Projected Growth of the Aging Population 19 

The Aging Network 21 

Older Americans Act Funding 24 

Background Title III 27 

Older Americans Act Title III Services 27 

Background Title VI 37 

Older Americans Act Title VI Services 37 

Background Title VII 44 

Older Americans Act Title VII Services 44 

Older Americans Act Data Collection and Access 50 

Data Collection Tools 50 

Data Reporting System 51 

Data Portal 51 

Using Title III, VI, and VII Data 52 

Impact of COVID-19 Pandemic on OAA Programs 54 

Impact on OAA Funding and Spending 54 

Impact on OAA Providers and Stafng 54 

Impact on OAA Services and Service Delivery 55 

Impact on OAA Program Data Collection 

and Reporting 56 

References 57 

TITLE III PROGRAMS 

Title III Program Highlights 

and Accomplishments III-2 

List of Exhibits III-4 

Abbreviations and Acronyms III-4 

Impact of Coronavirus Disease of 2019 

Pandemic on Title III Services III-5 

Funding Use III-5 

Title III Services III-5 

Part 1 | 2020 State Performance Report 

Data Highlights III-7 

State Performance Report Data Categories III-7 

Number of Agencies and Providers III-8 

Number and Characteristics of 

Service Recipients III-11 

Service Units III-25 

Part 2 | 2019 National Survey of Area 

Agencies on Aging III-30 

Program Structure III-30 

Programs III-32 

Partnerships III-33 

Services III-35 

Appendix A: Title III Defnitions III-37 

References III-41 
 

 

 

 

2 

TITLE VI PROGRAMS 

Program Highlights and Accomplishments VI-2

List of Exhibits VI-4

Abbreviations and Acronyms VI-4

Impact of COVID-19 Pandemic on 

Title VI Services VI-5

Funding Use VI-5

Title VI Services VI-5

Part 1 | 2020 PPR Data Highlights VI-7

Stafng VI-7

Service Recipients VI-8

Service Units VI-11

Service Units: Nutrition Services VI-11

Service Units: Supportive Services— 

Access Services VI-12

Service Units: Supportive Services— 

In-Home Services VI-13

Service Units: Supportive Services— 

Other Services VI-14

Service Units: Caregiver Support 

Services—Services for Caregivers VI-14

Service Units: Caregiver Support 

Services—Respite Care for Caregivers VI-15

Part 2 | 2020 National Survey of 

Title VI Programs VI-16

Program Structure VI-17

Partnerships VI-18

Services VI-20

Unmet Needs VI-21

Appendix A: Title VI Defnitions VI-22

References VI-26

TITLE VII LONG-TERM CARE OMBUDSMAN PROGRAM 

Title VII | Program Highlights and 

Accomplishments VII-2

List of Exhibits VII-4

Abbreviations and Acronyms VII-4

Impact of COVID-19 Pandemic on Title VII 

LTCOP Services VII-5

Funding Use VII-5

Title VII LTCOP Services VII-6

2020 National Ombudsman Reporting System 

(NORS) Data Highlights VII-7

Program Structure, Stafng, and Scope VII-7

Case Summary VII-10

Program Activities VII-17

Appendix A: Title VII NORS Defnitions VII-18

References VII-21

2 || 
FOREWORD 

The United States is facing a surge in the aging population. By 2030, 73 million— 

or one in fve—people in the United States will be 65 or older, and between 2020 

and 2030 the number of people 85 and older is projected to rise by 35%.1 As result, 

we will experience an increase in the demand for health care services as well 

as long-term services and supports that enable older adults to successfully 

age in place.2,3 

Enacted in 1965, the Older Americans Act (OAA) created the foundation for a 

comprehensive system of services and supports that enables millions of older 

adults in this country to continue to live independently as they age. Today, 

programs funded by the OAA provide essential services to older adults (i.e., 

generally age 60 and older), targeting those with the greatest economic or social 

need, particularly low-income and minority persons, older individuals with limited 

English profciency, and older persons living in rural areas. The programs play a 

vital role in helping to maintain the health and well-being of millions of seniors 

and their caregivers, reaching one in fve older adults. 

BY 2030 BETWEEN 2020-2030 

THERE IS A 1IN 5 

PEOPLE IN U.S. 35%

WILL BE OVER AGE 65 PROJECTED RISE IN 

PEOPLE OVER AGE 85 

Overview on Older Americans Act Title III, VI, and VII Programs | 3 
4 | 

 

 

-

-

-

IN 2020 MORE THAN 

10.1 MILLION 

OLDER PERSONS RECEIVED TITLE III SERVICES 

OAA FUNDED 

56 

STATE & TERRITORIAL 

AGENCIES 

OAA FUNDED 

625 

LOCAL AGENCIES 

OAA FUNDED 

30,000 

SERVICE PROVIDERS 

THRU AGENCIES 

Older Americans Act Title III services account 

for the largest portion of the Act’s funding, 

supporting a comprehensive national network 

of federal, state, and local agencies that 

plan and provide an average of 27 services to 

help older adults live independently in their 

homes and communities. These supportive 

services include case management, communi 

ty services, in-home services, transportation, 

information and referral, and legal assistance; 

nutrition programs; family caregiver support; 

and health promotion and disease prevention 

services. Title VI authorizes grants to Indian 

tribal organizations, Alaskan Native organi 

zations, and nonproft groups representing 

Native Hawaiians to provide nutrition, sup 

portive, and caregivers services that enhance 

the independence and well-being of tribal 

elders while being responsive to the cultural 

diversity of Native American communities. 
 

 

 

 

 

 

-

-

-

-

-

IN 2020 

> 200,000 ~200,000 

INDIVIDUALS WERE SERVED VISITS TO LONG TERM CARE FACILITIES 

BY TITLE VI GRANTEES IN WERE CONDUCTED BY TITLE VII LTCOP 

TRIBAL COMMUNITIES STAFF AND VOLUNTEERS 

Title VII focuses exclusively on the advocacy 

responsibility of states to protect and enhance 

rights, benefts, and independence of the 

nation’s most vulnerable elders by provid 

ing state grants for “vulnerable elder rights 

protection” programs. Programs include the 

Long Term Care Ombudsman Program (LTCOP); 

programs dedicated to the prevention of

 elder abuse, neglect, and exploitation; and 

activities focused on elder rights and legal 

assistance development. 

As the primary federal agency administering 

the OAA, the Administration for Community 

Living (ACL) collects reports and data on the 

Title III, VI, and VII programs. These data 

provide information about the performance 

of each program but also show the wide reach 

and positive impact the programs have on 

millions of older adults. 

In 2020, Title III funded 56 state and territorial 

agencies on aging, 625 local agencies that 

coordinated and ofered services to older 

adults, 6,072 senior centers, and almost 

30,000 service providers. More than 10.1 

million older persons received Title III services. 

In the 2020–2023 grant cycle, there were 

282 Title VI grantees providing nutrition and 

supportive services and 251 Title VI grantees 

providing caregiver support services to tribal 

communities. Through their eforts, Title 

VI grantees were able to serve more than 

200,000 individuals, including 198,591 indi 

viduals who received nutrition and supportive 

services and 7,873 individuals who received 

caregiver support services. Staf and volun 

teers for the Title VII LTCOP conducted almost 

200,000 visits in 39,984 long-term care 

facilities and investigated more than 150,000 

complaints. 

This report is the frst comprehensive report 

on the OAA Title III, VI, and VII programs, 

summarizing highlights and accomplish 

ments in 2020. It shows the immense value 

the programs have for reaching millions of 

older adults and providing much needed 

services and support in their communities. 

Overview on Older Americans Act Title III, VI, and VII Programs | 5 
 

 

Administration for Community Living 

IMPROVING THE LIVES OF OLDER ADULTS AND PEOPLE WITH DISABILITIES 

THROUGH SERVICES, RESEARCH, AND EDUCATION 

WHAT IS COMMUNITY LIVING? 

Older Adults and People with Disabilities Have 

the Same Opportunities as Everyone Else to: 

■ Choose where to live 

■ Earn a living 

■ Participate in society 

■ Make decisions about their lives 

HOW DOES ACL SUPPORT 

COMMUNITY LIVING? 

■ Funds services that help people live 

independently 

■ Invests in research, innovation, training, 

and education 

■ Advocates for people with disabilities 

and older adults 

WHY IS COMMUNITY LIVING 

IMPORTANT? 

■ People prefer it 

■ It costs less 

■ It’s a legal rRight 

■ Everyone benefts when everyone 

can contribute 

WHO ARE ACL’S PARTNERS? 

■ Nationwide aging and disability networks 

■ States, tribes, and communities 

■ Colleges and universities 

■ Nonproft, faith-based, and industry partners 

■ Other federal agencies 

6 | 
Overview on Older Americans Act Title III, VI, and VII Programs | 7 

Abbreviations and Acronyms 

AAA Area agency on aging 

ACL Administration for Community Living 

AI/AN American Indians and Alaskan Natives 

AoA Administration on Aging 

CARES Act Coronavirus Aid, Relief, and Economic Security Act 

COVID-19 Coronavirus disease 2019 

DRI Dietary Reference Intakes 

FY Fiscal year 

HHS U.S. Department of Health and Human Services 

IADLs Instrumental activities of daily living 

LAD Legal assistance developer 

LTCO Long-term care ombudsman 

LTCOP Long-Term Care Ombudsman Program 

NFCSP National Family Caregiver Support Program 

NORS National Ombudsman Reporting System (OAA Title VII Chapter 2) 

NSOAAP National Survey of Older Americans Act Participants (OAA Title III) 

OAA Older Americans Act 

OAAPS Older Americans Act Performance System 

PPR Program Performance Report (OAA Title VI) 

SPR State Performance Report (OAA Title III) 

SUA State Unit on Aging 

USDA U.S. Department of Agriculture 
8 | 

 

 

List of Graphs, Figures, and Tables 

Graphs 

Graph 1. Current and projected population of adults 

ages 60+, 65+, and 85+: 2018 – 2060 19 

Graph 2. Population and projections of American Indians and 

Alaskan Natives 65 and over: 2020 – 2060 20 

Graph 3. Percentage change in projected population of adults 

ages 60+, 65+, and 85+: 2020 – 2060 20 

Figures 

Figure 1. Growth of the Older Population 19 

Figure 2. The Aging Network 22 

Tables 

Table 1. Older Americans Act Title III Services, Part B 28 

Table 2. Older Americans Act Title III Services, Part C 31 

Table 3 Older Americans Act Title III Services, Part D 34 

Table 4. Older Americans Act Title III Services, Part E 35 

Table 5. Older Americans Act Title VI Services, Parts A/B (Nutrition Services) 38 

Table 6. Older Americans Act Title VI Services, Part A/B (Supportive Services) 39 

Table 7. Older Americans Act Title VI Services, Part C 42 

Table 8. Older Americans Act Title VII Services, Chapter 2 45 

Table 9. Older Americans Act Title VII Services, Chapter 3 48 
Introduction 

Mission and Vision of the Administration for Community Living 

Established in 2012, the Administration for Community Living (ACL) is one 

of 11 operating divisions within the U.S. Department of Health and Human 

Services (HHS). Its mission is to “maximize the independence, well-being, 

and health of older adults, people with disabilities across the lifespan, and 

their families and caregivers.”4 Therefore, all ACL programs are designed 

based on this principle: 

All people, regardless of age or disability, should be able 

to live independently and participate fully in their communities. Every person should have the right to make 

choices and to control the decisions in and about their 

lives. This right to self-determination includes decisions 

about their homes and work, as well as all the other daily 

choices most adults make without a second thought.5 

Programs of ACL support state, tribal, and local community eforts to meet the 

needs of older adults and persons with disabilities and their families through 

advocacy, research, systems change, and capacity building. These eforts 

help individuals to access needed community services and other kinds of 

assistance so that they can maintain self-determination, independence, 

productivity, and inclusion in all facets of community life.6 

Among ACL’s many roles, it is the primary federal agency responsible for 

administering the Older Americans Act (OAA), the country’s leading vehicle 

for delivering services and supports to older people nationwide. Importantly, 

this responsibility includes supporting the national aging services network 

and the millions of older adults and individuals with disabilities who depend 

on it for their health, safety, well-being, and independence. 

In order to understand the reach, activities, and efectiveness of these 

programs, ACL conducts a number of program operations, management, and 

oversight activities, including requiring grantee reporting which allow ACL 

to regularly evaluate and report on grantee program performance. These 

activities produce rich data that can inform program staf and policy makers 

at federal, state, and local levels. The data also can fuel needed research to 

help us understand how efectively these programs reach older adults and 

individuals with disabilities in our communities and improve their lives. 

| 9 
 

Older Americans Act 

Originally enacted in 1965, the OAA was the frst 

federal-level initiative aimed at comprehensively 

addressing the need for community social services 

for older adults. The act supports a range of essential 

home- and community-based services and elder abuse 

prevention services, including the Long-Term Care 

Ombudsman Program (LTCOP), designed to advocate 

for residents of long-term care facilities through resolution of problems on individual and system levels. 

Home-delivered and congregate meals, family caregiver support, in-home assistance, preventive health 

services, transportation, job training, promotion of 

long-term care residents’ rights and protection from 

abuse, and other supportive services are ways that 

OAA programs help millions of older adults live as 

independently as possible in their homes and communities.7 In addition, OAA services play a key role 

in preventing more costly institutional services and 

hospitalizations by helping people remain in their own 

homes and assisting family caregivers. While the program is open to all older individuals, generally defned 

as 60 and older, states must target “older individuals 

with the greatest economic need and older individuals 

with the greatest social need, with particular attention 

to low-income minority individuals, older individuals 

residing in rural areas, low-income individuals, and 

frail individuals.”8 

As part of the OAA, the Administration on Aging (AoA) 

was created to coordinate the OAA programs. The 

agency became part of ACL in 2012. Over the past 

5 decades, Congress has amended and reauthorized 

the act. As a result, the act has created an infrastructure, known as the national aging services network, 

that coordinates the delivery of comprehensive home 

and community-based supportive services in every 

state. At present, the network consists of 56 state units 

on aging (SUAs), 281 tribal organizations, 1 Native 

Hawaiian organization representing 400 tribes, 618 

area agencies on aging (AAAs), 53 state long-term care 

ombudsman programs, nearly 20,000 local service 

providers, and thousands of volunteers.9 Today’s OAA 

statutory language contains seven titles10: 

■ Title I declares the act’s objectives and provides 

defnitions for various terms under the act. 

■ Title II establishes the AoA to carry out the provisions of the act and establishes AAAs as local entities which, either directly or through contract with 

local service providers, oversee a comprehensive 

and coordinated service system to deliver social, 

nutrition, and long-term services and supports to 

older individuals, and to promote elder justice. 

■ Title III authorizes and provides grants to states 

and territories to advocate on behalf of older persons and their family caregiver and to coordinate 

programs for them. It covers supportive services, 

such as case management, community services, 

in-home services, transportation, information and 

referral, and legal assistance; nutrition programs, 

such as home-delivered meals and congregate 

10 | 
Overview on Older Americans Act Title III, VI, and VII Programs | 11 

 -

meals; family caregiver support; and health 

promotion and disease prevention services. 

■ Title IV authorizes and provides support for training, research, and demonstration projects in the 

feld of aging. 

■ Title V authorizes the Senior Community Service 

Employment Program, managed by the Department of Labor, and provides support for part-time 

employment for individuals 55 and over who are 

low-income and unemployed and have poor 

employment potential. 

■ Title VI authorizes and provides grants directly from 

ACL to Indian tribal organizations, Native Alaskan 

organizations, and nonproft groups representing 

Native Hawaiians—grants enabling them to advocate on behalf of older persons and their family 

caregivers and to coordinate programs for them. 

These programs provide supportive services, such 

as case management, community services, in-home 

services, transportation, and information and 

referral; nutrition programs, such as home-delivered meals and congregate meals; family caregiver 

support; and health promotion. 

■ Title VII authorizes and provides grants to states to 

operate the long-term care ombudsman programs, 

designed to promote and protect the rights of individuals living in nursing homes, assisted living, 

and similar residential care settings, and to implement programs for the prevention of elder abuse, 

neglect, and exploitation as well as programs for 

legal assistance development. 

OAA programs help millions of older adults live as independently as possible in 

their homes and communities. In addition, OAA services play a key role in pre 

venting more costly institutional services and hospitalizations by helping people 

remain in their own homes and assisting family caregivers. 
Time Line of Programs for Older Americans11,12

1920’s – 

1930’s 

1920 

The Civil Service Retirement Act 

provided a retirement system for 

many governmental employees. 

1935 

The Social Security Act passed; it 

provided for old age assistance and 

old age survivors’ insurance. 

1937 

Railroad Retirement Act provided 

pensions for retired railroad employees and spouses. 

1950’s

1950 

President Truman initiated the frst 

National Conference on Aging, sponsored by the Federal Security Agency. 

1952 

First federal funds were appropriated 

for social service programs for older 

persons underthe Social Security Act. 

1956 

Special staf on aging were 

established within the Ofce of the 

Secretary of Health, Education, and 

Welfare to coordinate responsibilities 

for aging. 

Federal Council on Aging was created by President Eisenhower. 

1958 

Legislation was introduced in 

Congress, calling for a White House 

Conference on Aging. 

1959 

Housing Act authorized a direct 

loan program for nonproft rental 

projects for the elderly at low interest rates, and it lowered eligibility 

ages for public low-rent housing for 

low-income women up to age 62. 

1960’s 

1960 

Social Security Administration 

eliminated age 50 as minimum for 

qualifying for disability benefts 

and liberalized the retirement 

test and the requirement for fully 

insured status. 

1961 

First White House Conference on 

Aging was held in Washington, D.C. 

Social Security Amendments 

lowered the retirement age for 

men from 65 to 62, liberalized the 

retirement test, and increased 

minimum benefts and benefts to 

aged widows. 

1962 

Legislation was introduced in Congress to establish an independent 

and permanent Commission on 

Aging. 

1965 

The OAA was signed into law on 

July 14, 1965. It established the AoA 

within the Department of Health, 

Education, and Welfare and called 

for the creation of SUAs. 

12 | 
 

William Bechill was named frst 

Commissioner on Aging. 

Medicare, Title XVIII, a health 

insurance program for the elderly, 

was established as part of the Social 

Security Act. 

Medicaid, Title XIX, a health insurance program for low-income 

persons, was added to the Social 

Security Act. 

1967 

The OAA was extended for 2 years, 

and provisions were made for the 

AoA to study the personnel needs 

in the aging feld. 

Age Discrimination Act was signed 

into law. 

Administration on Aging was 

moved from the Ofce of the 

Secretary of Department of Health, 

Education, and Welfare and placed 

in the newly created Social and Rehabilitative Service Agency within 

the department. 

1968 

John Martin was named Commissioner on Aging. 

1969 

Amendments to OAA provided 

grants for model demonstration 

projects, Foster Grandparents 

Program, and Retired and Senior 

Volunteer Program (RSVP). 

The Inaugural White House 

Conference on Aging in 1961 

1970’s

1971 

Second White House Conference on 

Aging was held in Washington, D.C. 

1972 

A new Title VII was created under the 

OAA, authorizing funds for a national nutrition program for the elderly.

On July 1, 1972, President Nixon 

signed Public Law 92-336, a bill 

to extend the public debt limit. 

The legislation also contained an 

amendment to the Social Security 

Act, raising the amount of monthly 

cash benefts and revising several 

fnancing provisions. 

The LTCOP was established to represent the rights and advocate on 

behalf of older residents living in 

Overview on Older Americans Act Title III, VI, and VII Programs | 13 
 

 

 

 

nursing homes, assisted living, and 

other residential settings. 

1973 

Comprehensive Services Amendments to OAA established AAAs. 

The amendments added a new Title 

V, which authorized grants to local 

community agencies for multipurpose senior centers and created the 

Community Service Employment 

grant program for low-income 

persons age 55 and older, administered by the Department of Labor. 

Arthur S. Flemming was named 

Commissioner on Aging. 

Comprehensive Employment and 

Training Act was enacted; it included older persons. 

1974 

Title XX of the Social Security 

Amendments authorized grants to 

states for social services. These 

programs included protective services, homemaker services, transportation services, adult day care 

services, training for employment, 

information and referral, nutrition 

assistance, and health support. 

Amendments to OAA added transportation under Title III model projects. 

Housing and Community Development Act was enacted; it provided 

for low-income housing for the 

 to conduct research and training related to the 

aging process and the diseases and problems 

of an aging population. 

elderly and handicapped, pursuant 

to the Housing Act of 1937. 

National Institute on Aging was 

created to conduct research and 

training related to the aging 

process and the diseases and problems of an aging population. 

Title V of the Farm and Rural Housing 

Program of 1949 was expanded to 

include the rural elderly as a 

target group. 

In 1974, the National Institute on Aging was created

1975 

Amendments to OAA authorized 

grants under Title III to Indian tribal 

organizations. Transportation, 

home care, legal services, and 

home renovation/repair were mandated as priority services. 

1977 

Amendments to OAA required changes in the Title VII nutrition program, 

primarily related to the availability 

of surplus commodities through the 

Department of Agriculture. 

1978 

Amendments to OAA consolidated 

the Title III AAA administration and 

social services, the Title VII nutrition 

services, and the Title V multipurpose senior centers, into a new 

Title III and added a new Title VI for 

grants to Indian tribal organizations. 

The old Title V became the Community Service Employment grant 

program for low-income persons, 

age 55 and older (created under the 

1978 amendments as Title IX). 

Robert G. Benedict was named 

Commissioner on Aging. 

Congregate Housing Services Act 

authorized contracts with local public 

housing agencies and nonproft 

corporations to provide congregate 

independent living service programs. 

Amendments to OAA required 

each state to establish a longterm care ombudsman program to 

cover nursing homes. 

14 | 
1980’s 

1981 

Third White House Conference on 

Aging was held in Washington, D.C. 

Lennie-Marie Tolliver was named 

Commissioner on Aging. 

The OAA was reauthorized; it 

emphasized supportive services to 

help older persons remain independent in the community. The act 

expanded ombudsman coverage to 

board and care homes. 

The home- and community-based 

services waiver program was 

established by Section 2176 of the 

Omnibus Budget Reconciliation 

Act of 1981. 

1984 

The reauthorization of the OAA was 

clarifed, and the accountability of 

SUAs and AAAs for coordinating 

community-based services and funding national priority services (legal, 

access, & in-home) was reafrmed. 

The 1984 amendments to the act 

replaced the term “legal assistance” with “legal services” and 

defned “older individual” for Title 

III purposes as “any individual who 

is 60 years of age or older.” The 

amendments also required that, 

in the delivery of services, particular attention be paid to minority 

low-income individuals. “Greatest 

economic need” was defned as 

“income below the poverty threshold as established by the Bureau 

of the Census,” and “greatest 

social need” was defned in terms 

of “noneconomic factors which include physical and mental disabilities, language barriers, and cultural 

or social isolation including that 

caused by racial or ethnic status 

and which restrain an individual’s 

ability to perform normal daily 

tasks or which threaten his or her 

ability to live independently.” 

Carol Fraser Fisk was named 

Commissioner on Aging. 

1987 

The reauthorization of the OAA 

authorized appropriations for six 

additional services: in-home services for the frail elderly; long-term 

care ombudsman; assistance for 

special needs; health education 

and promotion; prevention of elder 

abuse, neglect, and exploitation; 

and outreach activities for persons 

who may be eligible for benefts 

under supplemental security income, Medicaid, and food stamps. 

Additional emphasis was given to 

serving those in the greatest economic and social need, including 

low-income minorities. 

The Nursing Home Reform Act 

(Omnibus Budget Reconciliation 

Act) mandated that nursing facility 

residents have “direct and immediate access to ombudspersons when 

protection and advocacy services 

become necessary.” Simultaneously, the OAA reauthorization charged 

states to guarantee ombudsman 

access to facilities and patient 

records, provided important legal 

protections, authorized state 

ombudsmen to designate local ombudsman programs, and required 

that ombudsman programs have 

adequate legal counsel. 

In 1987, with the reauthorization of the OAA, 

additional emphasis was given to serving those in 

the greatest economic and social need, including 

low-income minorities. 

1989 

Joyce Berry was named 

Commissioner on Aging. 

Overview on Older Americans Act Title III, VI, and VII Programs | 15 
 

 

 

 

 

1990’s 

In 1990, the Age Discrimination in Employment 

Act made it illegal, in most circumstances, for 

companies to discriminate against older workers 

in employee benefts. 

1990 

The State Health Insurance Assistance Program was created under 

the Omnibus Budget Reconciliation 

Act of 1990. 

The Americans with Disabilities Act 

extended protection from discrimination in employment and public 

accommodations to persons with 

disabilities. 

Cranston–Gonzalez National 

Afordable Housing Act reauthorized the HUD Section 202 Elderly 

Housing program and provided for 

supportive service demonstration 

programs. 

Age Discrimination in Employment Act made it illegal, in most 

circumstances, for companies to 

discriminate against older workers 

in employee benefts. 

1992 

Reauthorization of the OAA placed 

increased focus on caregivers, intergenerational programs, protection 

of elder rights, and calls for a 1995 

White House Conference on Aging. 

The Commissioner on Aging was 

elevated to Assistant Secretary 

for Aging. 

Amendments to OAA added a 

new Title VII, “Vulnerable Elder 

Rights Activities,” which included 

the long-term care ombudsman; 

prevention of elder abuse, neglect, 

and exploitation; elder rights and 

legal assistance development; and 

benefts outreach, counseling, and 

assistance programs. The legislation emphasized the value of the 

four programs coordinating their 

eforts. The amendments highlighted the role of local ombudsman 

programs and the state ombudsman’s role as leader of the statewide program and advocate and 

agent for systemwide change. 

1993 

Fernando M. Torres-Gil was sworn 

in as the frst Assistant Secretary 

for Aging in the Department of 

Health and Human Services on 

May 6, 1993. 

1995 

White House Conference on Aging 

was held in Washington, D.C. 

The OAA, Medicare, Medicaid, and 

the Foster Grandparent Program 

observed 30th anniversaries. 

This year was the 60th anniversary 

of Social Security. 

Operation Restore Trust 

was initiated. 

1997 

Jeanette C. Takamura, Ph.D., was 

sworn in as Assistant Secretary 

for Aging in the U.S. Department 

of Health and Human Services on 

December 8, 1997. 

1999 

The U.S. Supreme Court’s 1999 landmark decision in Olmstead v. L.C. 

found the unjustifed segregation of 

people with disabilities is a form of 

unlawful discrimination under the 

Americans with Disabilities Act. 

This year was the International 

Year of Older Persons: A Society 

for All Ages. 

16 | 
 

 

 

2000’s

2000 

Amendments of 2000 to OAA were 

signed into law (P.L. 106-501), establishing the new National Family 

Caregiver Support Program and 

reauthorizing the OAA for 5 years 

on November 13, 2000. 

2001 

Secretary of HHS Tommy G. 

Thompson released $113 million 

for frst National Family Caregiver 

Support Programs grants to states 

on February 15, 2001. 

Josefna G. Carbonell was sworn in 

as Assistant Secretary for Aging on 

August 8, 2001. 

2002 

Kick-of of the 30th Anniversary 

of the OAA Nutrition Program took 

place in March. 

2003 

The Medicare Prescription Drug, 

Improvement, and Modernization 

Act (MMA) was enacted. 

2005 

The ffh White House Conference on 

Aging was held in Washington, D.C. 

2006 

Medicare Part D prescription drug 

program (part of the Medicare Prescription Drug, Improvement, and 

Modernization Act) went into efect. 

The Lifespan Respite Care Act 

(administered by AoA) was enacted. 

Amendments of 2006 to OAA were 

signed into law (P.L. 109-365), reaffrming the principles of consumer 

information for long-term care 

planning, evidence-based prevention programs, and self-directed 

community-based services to older 

individuals at risk of institutionalization. Reauthorization added “assisted living facilities” to the defnition 

of “long-term care facility,” ensuring 

that the LTCOP provided services to 

residents of assisted living facilities. The OAA was reauthorized for 

5 years on October 17, 2006. The 

2006 amendments also created 

new responsibilities for the Assistant Secretary for Aging to serve as 

the efective and visible advocate 

throughout the federal government 

on elder justice issues, and to develop objectives, priorities, policies, 

and a long-term plan for facilitating 

the development, implementation, 

and continuous improvement of a 

coordinated, multidisciplinary elder 

justice system in the United States. 

Expansion of home- and community-based long-term services and 

supports and evidence-based 

disease prevention and health 

promotion services was enacted. 

2009 

Kathy Greenlee was appointed by 

President Obama as fourth Assistant Secretary for Aging. 

2010 

The Patient Protection and Afordable Care Act, which contained 

the Elder Justice Act of 2009, 

was enacted. 

2011 

Authorization of the OAA expired 

on September 30, 2011. Although 

the authorization of appropriations 

under the OAA expired at the end of 

fscal year (FY) 2011, Congress continued to appropriate funding for 

OAA-authorized activities through 

FY 2016. 

2012 

On April 18, 2012, ACL was established, bringing together the AoA, 

the Ofce on Disability, and the 

Administration on Developmental 

Disabilities. 

Overview on Older Americans Act Title III, VI, and VII Programs | 17 
 

 

 

 

 

 

 

 

2014 

The State Health Insurance 

Assistance Program was 

transferred to ACL. 

The Workforce Innovation and 

Opportunity Act was signed into 

law, transferring three programs 

to ACL from the U.S. Department of 

Education: the Independent Living 

Services program; the Assistive 

Technology Act programs; and the 

National Institute on Disability, 

Independent Living, and Rehabilitation Research. 

2015 

The ACL issued the frst comprehensive regulation for state long-term 

care ombudsman programs to further reinforce the authority of the 

ofce of the state long-term care 

ombudsman (LTCO) in each state, 

the District of Columbia, 

and territories. 

2016 

On April 19, 2016, President Obama 

signed the OAA Reauthorization Act 

of 2016 into law to further improve 

access and quality of comprehensive services to older adults in our 

country. The 2016 OAA reauthorized 

programs for FY 2017 through FY 

2019. It included provisions to protect vulnerable elders by strengthening the LTCOP and elder abuse 

screening and prevention eforts. 

It also promoted the delivery of 

evidence-based programs, such as 

falls prevention and chronic disease 

self-management programs. 

2019 

Lance Robertson was appointed 

by President Trump as Assistant 

Secretary for Aging and ACL’s 

Administrator. 

The OAA expired on 

September 30, 2019. 

2020 

On March 18, 2020, President Trump 

signed into law the Families First 

Coronavirus Response Act, which 

provided additional funding for OAA 

programs (among other activities) to 

respond to the coronavirus disease 

2019 (COVID-19) pandemic. 

On March 25, 2020, President 

Trump signed H.R. 4334, the Supporting Older Americans Act, into 

law. The act reauthorized the OAA 

for 5 years and included a 7% increase in funding in the initial year 

and a 6% increase annually for the 

remainder through FY 2024. Along 

with these increases, the act 

established a new Research, 

Demonstration, and Evaluation 

Center for the Aging Network 

within the AoA, required additional 

research into the impact of social 

isolation on senior health, and 

afrmed the importance of local 

control and flexibility in the administration of OAA programs. 

On March 27, 2020, President 

Trump signed the Coronavirus 

Aid, Relief, and Economic Security 

(CARES) Act, and on December 27, 

2020, he signed the Consolidated 

Appropriations Act, 2021, which 

provided additional funding for 

select OAA programs to respond to 

the COVID-19 pandemic. 

2021 

On March 12, 2021, President Biden 

signed the American Rescue Plan 

Act of 2021, which provided 

additional funding for select 

OAA programs to respond to the 

COVID-19 pandemic. 

“One of the best measures of a country

 is how it treats its older citizens.”

 Former President Barack Obama, 

speaking at the 2015 White House 

Conference on Aging 

18 | 
Projected Growth of the Aging Population 

Today, the mission of the OAA is even more imperative 

than when the act was signed into law 5 decades ago, 

as the large U.S. baby boom generation (those born 

between 1946 and 1964) drives an unprecedented 

growth of the population age 65 and older. As shown in 

the graphs below, the number of older adults, including American Indian and Alaskan Native (AI/AN) elders, 

is projected to increase substantially over the next 40 

years. The number of adults 60 and older will increase 

by more than 41 million, the number of adults 65 and 

older will increase by more than 38 million, and the 

number of adults 85 and older will increase by more 

than 12 million. These fgures represent population 

increases of 53%, 69%, and 184%, respectively, for 

these three groups of older adults between 2020 and 

2060. The number of non-Hispanic AI/AN elders age 65 

and older is projected to more than double in the next 

30 years, from 308,627 in 2020 to 648,555, making up 

0.7% of the older American population, by 2060.13 

Given the growth of the aging population, the number 

of individuals in long-term care settings is also 

expected to increase signifcantly. Specifcally, by 

2050, the number of individuals using paid long-term 

care services in any setting (e.g., at home, residential 

care such as assisted living, or skilled nursing facilities) is expected to double from the 15 million in 2000 

to 27 million people.14 

Figure 1. Growth of the Older Population 

2010 2030 

One in Eight One in Five 

Adults 65+ Adults 65+ 

Source: ADvancing States Infographic: Aging in America http://www. 

advancingstates.org 

Graph 1. Current and projected population of adults ages 60+, 65+, and 85+: 2018 – 206015 

120 118

■ 60+ ■ 65+ ■ 85+ 108 

100 

100 

93 

80 77 

81 

86 

95 

N

73 

LIO

60 

MIL

56

40

19 19 20 14 

9 7 

 2020 2025 2030 2035 2040 2045 2050 2055 2060 

Note. Percent reflects the change in population in reference to 2020. 

Overview on Older Americans Act Title III, VI, and VII Programs | 19 
 

 

Graph 2. Population and projections of American Indians and Alaskan Natives 65 and over: 2020–2060 jjjj jjjj

700,000 

648,555 

Projections 

503,300 

550,023 

500,000 442,824 

308,627 

300,000 272,250 

100,000 

0 

2017 2020 2030 2040 2050 2060 

16 

Source: U.S. Census Bureau, Population Estimates, 2017 and Population Projections, 2017 (revised) 

Note: Increments in years are uneven. Solid bars indicate projections. The terms American Indians and Alaska Natives 

refer to American Indians and Alaska Natives who are not Hispanic and do not identify as more than one race. 

Graph 3. Percentage change in projected population of adults ages 60+, 65+, and 85+: 2020–206017 

200% 

184%

177% 

■ 60+ ■ 65+ ■ 85+ 160% 

115% 

120% 

80% 69% 

53% 44% 35% 53% 40% 

30% 41% 

30% 20% 

0% 

2020 2025 2030 2035 2040 2045 2050 2055 2060 

Note. Percent reflects the change in population in reference to 2020. 

20 | 
Overview on Older Americans Act Title III, VI, and VII Programs | 21 

 

 

 

The Aging Network 

The OAA established a national network of federal, 

state, and local agencies to provide services that 

maximize the independence and well-being of older 

adults in their homes and communities. The functions 

of the network are designed to be carried out through 

a community-focused planning process, which ensures 

that local communities have a role in the prioritization 

and implementation of services. Thus, while the overarching OAA program goals are determined nationally, 

it was designed to be state administered with a great 

deal of state and local flexibility. The flexibility given to 

states and local agencies has also led to wide variability in the design, implementation, and scope of aging 

services programs they administer, both within and 

outside the federally authorized OAA programs.18 

U.S. Department of Health and Human Services: 

The HHS has designated ACL to carry out the 

provisions of the OAA and to administer the OAA 

programs. The department also provides funding 

for the OAA programs. 

Administration for Community Living: As the primary 

federal agency responsible for administering the OAA 

programs, ACL authorizes grants to SUAs and AAAs 

to act as advocates on behalf of older persons and to 

coordinate programs and services for older persons. 

The ACL cherishes the continued collaboration with the 

aging services network, consisting of the SUAs, AAAs, 

tribal organizations, and local service providers. 

State Units on Aging19: The SUAs are designated 

state-level agencies that are responsible for the 

planning and policy development as well as the 

administration of OAA activities. In that role, SUAs 

develop and administer multiyear state plans that 

advocate for and aid older residents, their families, 

and, in many states, adults with physical disabilities. 

The 56 SUAs are in each of the 50 states, the District 

of Columbia, and U.S. territories (Guam, Puerto Rico, 

American Samoa, the Northern Mariana Islands, 

and the Virgin Islands). “State unit on aging” is a 

general term. The specifc title and organization of 

the governmental unit varies, and it may be called a 

department, ofce, bureau, commission, council, or 

board for the elderly, seniors, aging, older adults, 

and/or adults with physical disabilities. The SUAs 

also coordinate with AAAs to collect and report state 

performance data to ACL on program performance. 

Tribal and Native Hawaiian Organizations: Federally 

recognized tribes are sovereign nations that have direct political relationships with the U.S. government 

and the states within which they are geographically 

located. A federally recognized tribe is an AI/AN tribal 

entity that is both recognized as having a government-to-government relationship with the United 

States—with the responsibilities, powers, limitations, 

and obligations attached to that designation—and 

eligible for funding and services from the Bureau of 

Indian Afairs. Federally recognized tribes possess 

certain inherent rights of self-government (i.e., tribal 

sovereignty), and they are entitled to receive certain 

federal benefts, services, and protections because 

of their special relationship with the United States. 

At present, there are 574 federally recognized AI/AN 

tribes and villages. Native Hawaiians are not currently 

recognized as a sovereign nation or group.20 Tribal 

and Native Hawaiian organizations are the grant 

recipients and direct service providers responsible for 

their planning and service areas, which may be reservations, native villages, single counties, multicounty 

districts, or, in the case of Hawaii, multiple islands. 

The functions of the network are 

designed to be carried out through 

a community-focused planning 

process, which ensures that local 

communities have a role in the 

prioritization and implementation 

of services. 

Area Agencies on Aging21: The AAAs serve as local 

entities that, either directly or through contract with 
22 | 

 

local service providers, oversee a comprehensive 

and coordinated service system for the delivery of 

home- and community-based services. An AAA is a 

public or private nonproft agency designated by a 

state to address the needs and concerns of all older 

persons at the local level. “Area agency on aging” is a 

general term; names of local AAAs may vary. They are 

“on-the-ground” organizations primarily responsible 

for a geographic area, also known as a planning and 

service area, that may be a city, a single county, or a 

multicounty district. An AAA may be categorized as 

representing a county, city, regional planning council, 

or council of governments. The AAAs vary widely in 

size as each state determines how many service areas 

to establish, which then determines the number of 

operating AAAs. 

Figure 2. The Aging Network22 

FEDERAL 

U.S. Department of Health and Human Services 

Administration for Aging/Administration 

for Community Living 

STATES AND TERRITORIES 

State Agencies Indian Tribal and 

on Aging Native Hawaiian 

(56) Organizations 

(574) 

Area Agencies 

on Aging (625) 

LOCAL 

Service Providers/Direct Services 

(nearly 30,000) 

CONSUMERS 

The AAAs coordinate and ofer services that help older 

adults remain in their homes, if that is their preference, aided by services such as home-delivered meals, 

homemaker assistance, and other services that make 

independent living a viable option. By making a range 

of supports available, AAAs make it possible for older 

adults to choose the services and living arrangements 

that suit them best. The agencies focus on adults 60 

years of age or older, regardless of income, assets, 

or ability to pay. Priority for services must be given to 

older individuals with greatest economic need and older 

individuals with greatest social need (with particular 

attention to low-income older individuals, including 

low-income minority older individuals; older individuals 

with limited English profciency; and older individuals 

residing in rural areas). 

In coordination with consumers, service providers, and 

other interested stakeholders, each AAA also develops 

an Area Plan that outlines the needs and proposed 

recommendations for programs and services targeted 

to the needs of older adults. It then updates the plan 

every few years to reflect emerging trends. The AAAs are 

also tasked by the OAA to serve as advocates for older 

adults, enabling the agency’s leaders to engage on local 

and state issues beyond the programs and services they 

fund or deliver.23 

The OAA does not address specifc implementation 

issues. It is the responsibility of the SUA to develop regulations, policies, procedures, guidance, and technical 
Overview on Older Americans Act Title III, VI, and VII Programs | 23 

 

assistance to address program accountability. The OAA 

requires that an SUA or AAA consult with local service 

providers to develop the best method of program 

administration. Administrative procedures should not 

prevent or discourage participation. 

Local Service Providers or Vendors: Local service 

providers or vendors deliver aging services, such as 

meals, transportation, and in-home services. 

Consumers: Consumers are older adults and caregivers 

receiving Title III, Title VI, and Title VII services. The OAA 

provides funding for programs that serve adults age 60 

and over. However, AI/AN and Native Hawaiian grantees are allowed to determine at what age a person may 

receive services, which is ofen under the age of 60.* 

* This allowance is made because of the diferences in health status 

and life expectancy among elders, compared to their peers in 

other groups. That is, AI/AN populations also have the lowest life 

expectancy compared to the average for the overall population. 

The LTCOP services people of all ages who reside in 

long-term care facilities. 

Some OAA services also expand eligibility to other 

groups. For example, under Title III Part C (see description below), programs also ofer meals to spouses (of 

any age) of older adults and may ofer meals to people 

who provide volunteer services during meal hours, 

people with disabilities who live in housing facilities 

where mainly older adults live and which also provide 

congregate nutrition services, and people with disabilities who reside with eligible older adults. 

Note: By congressional intent, the administration and functions of the LTCOP are in many ways 

distinct from other programs administered by SUAs. Therefore, state long-term care ombudsman 

programs do not easily ft into aging network structure. Specifcally, while the state ombudsman 

may work as a state employee or under the direction of a state agency director, the state ombudsman does have specifc functions that require independence and autonomy. The state ombudsman collaborates with the SUA to design and implement an elder rights agenda within the aging 

network but must represent long-term care residents autonomously. 

Source: National Association of States United for Aging and Disabilities. (2019). State Long-Term Care Ombudsman 

Program. https://ltcombudsman.org/uploads/fles/support/nasuad-ombudsman-acl-rpt-0319-web-fnal.pdf 
24 | 

 

Older Americans Act Funding 

Unfortunately, funding for OAA programs has not kept 

pace with the increase in the aging population, leaving 

many older adults without the essential services they 

need to remain independent in their communities. 

Annual HHS appropriations provide funding for most 

OAA programs, with the exception of Title V, which is 

supported by annual Department of Labor appropriations. However, programs under OAA are discretionary 

and subject to the annual appropriations process, 

meaning Congress may not provide the full increase 

allowed for in the reauthorization. 

States are also required to provide a nonfederal match 

of 25% for family caregiver support and 15% for supportive services, preventive health, and meals.24 No 

match is required for Title VI programs and long-term 

care ombudsman programs. Federal funding of OAA 

also allows states to leverage additional funds (e.g., 

state general revenue, Medicaid, block grants, donations).25 In fact, the law was not intended to meet all 

the community service needs of older people. Instead, 

federal funding is intended to serve as a catalyst, or 

“seed money,” to also draw in state and local funds to 

beneft older adults.26 

In FY 2021, Title III accounted for 73.2% of the OAA’s 

total funding ($1.558 billion out of $2.129 billion). Title 

VI programs received $46.0 million (2% of the total 

funding): $35.2 million for supportive and nutrition 

service, and $10.8 million for family caregivers), and 

Title VII programs were funded at a total of $23.7 

million (1% of the total funding), with the majority of 

Title VII funding ($18.9 million, or 80%) directed at 

the LTCOP.27 Ombudsman programs also receive funds 

as part of Title III-B supportive services funding. (In 

FY 2020, states reported $32,766,301 of Title III funds 

expended for LTCOPs.) 

In response to the COVID-19 pandemic, Congress has 

passed several laws providing additional funding for 

OAA programs, among other activities:28,29 

■ Families First Coronavirus Response Act — On 

March 18, 2020, the President signed the Families 

First Coronavirus Response Act (P.L. 116–127), which 

provides $200 million in discretionary supplemental funding for home- and community-based 

services, $480 million for nutrition programs, 

and $100 million for the National Family Caregiver 

Support Program under Title III; $20 million for 

nutrition and related services for Native American 

Programs under Title VI; and $20 million for the 

long-term ombudsman program under Title VII. 

■ CARES Act—On March 27, 2020, the President 

signed the CARES Act (P.L. 116-136), which provides 

$870 million in discretionary supplemental funding 

for OAA nutrition services, supportive services, 

family caregiver services, Aging and Disability 

Resource Centers, long-term care ombudsman 

programs, and elder rights protection activities. 

Programs under OAA are discretionary 

and subject to the annual appropriations process, meaning Congress may 

not provide the full increase allowed 

for in the reauthorization. 

■ Consolidated Appropriations Act, 2021—On December 27, 2020, the President signed the Consolidated 

Appropriations Act, 2021 (P.L. 116-260). Division N 

provides $175 million in additional mandatory funding for OAA nutrition services to states and tribal 

organizations. 

■ The Coronavirus Response & Relief Supplemental 

Appropriations Act—This act became law in December 2020 as part of the Consolidated Appropriations 

Act of 2021. It directed $100 million to ACL programs 

to prevent, prepare for, and response to coronavirus 

domestically and internationally through activities 

authorized under Subtitle B of Title XX of the Social 

Security Act, with not less than $50 million for implementation of Section 2042(b) of the Social Security 
Overview on Older Americans Act Title III, VI, and VII Programs | 25 

 

Act, also known as the Elder Justice Act. The following Elder Justice Act programs were funded: $93.88 

million for adult protective services and $4 million 

for long-term care ombudsmen. 

■ American Rescue Plan Act of 2021—On March 12, 

2021, the President signed the American Rescue 

Plan Act of 2021 (P.L. 117-2). Title II, Subtitle L 

provides $1.434 billion in mandatory funding for 

OAA nutrition services, supportive services (among 

which are COVID-19 vaccination outreach, including 

transportation to vaccination sites, and activities 

to prevent and mitigate social isolation related to 

COVID-19), family caregiver services, health promotion and disease prevention, grants for tribal organizations, and the LTCOP. This act also provides $188 

million for Elder Justice Act programs, including adult 

protective services and LTCOP, in FY 2022.30 

In addition, states and tribes that received approval 

for a major disaster declaration were permitted to use 

any portion of the funds made available under sections of the OAA for disaster relief for older individuals. In this regard, flexibility was provided for states— 

without the need for a separate application, transfer 

request, or request for a waiver—to use existing 

allocations already made to them under the OAA for 

disaster relief. ACL considered disaster relief services 

for older individuals to be any services during the 

period covered by the state’s major disaster declaration that are provided to eligible older individuals or 

family caregivers as defned under the OAA.31 

Older Americans Act Distribution of Funding 

The majority of funding for Title III, VI, and VII programs 

flows from the federal to the state level and from there 

to the local level. 

Title III. The ACL allots formula grants to SUAs in all 50 

states, the District of Columbia, Puerto Rico, and the 

U.S. territories. Funds for Title III programs are distributed 

to each state and its aging network according to a formula 

based on the state’s share of the U.S. population age 60 

or older or, in the case of caregiver support programs, 

age 70 or older. The formula takes into account the 

geographical distribution of older individuals as well as 

the distribution of older individuals with the greatest 

economic and social need among specifed planning 

and service areas. 

The states and territories, in turn, award funds to the 

618 regional programs known as AAAs, which facilitate 

the delivery of services to local areas. Eligible individuals 

can obtain a range of services to provide them with the 

help they need. States, the District of Columbia, and 
 

 

territories use their federal program income and other 

income to pay for these important services. Services 

in Title III programs are also supported by funding from 

other sources, such as Medicare and Medicaid, states, 

private donations, and voluntary contributions from 

seniors for services received.32 

Title VI. Funds are allocated by ACL to Indian tribal organizations, Native Alaskan organizations, and nonproft 

groups representing Native Hawaiians, based on their 

share of the AI/AN and Native Hawaiian population 

aged 60 and over in their service area. To be eligible for 

funding, a tribal organization of federally recognized 

tribes must represent at least 50 Native Americans 

aged 60 and older. Unlike Title III and Title VII grantees, 

eligible tribal organizations must submit an application 

for funding. There is no requirement for matching funds. 

Separate formula grant awards are made for nutrition 

and supportive services (Part A/B grants) and caregiver 

support services (Part C grants). Title VI funds are ofen 

supplemented by the tribes themselves to ensure better 

service coverage for Native elders. Tribes may also decide the age at which a member is considered an elder 

and thus is eligible for services. 

Title VII. As part of Title VII, each state is required to 

establish and operate a statewide Ofce of the State 

Long-Term Care Ombudsman, headed by a full-time 

state ombudsman. Long-term care ombudsman 

programs currently operate in all 50 states, the District 

of Columbia, Puerto Rico, and Guam. Funding for 

the LTCOP (Chapter 2) is to be used exclusively for 

ombudsman program services. Funds appropriated 

for Title VII activities are awarded to states based on a 

formula that takes into account the state’s population 

age 60 or older compared to all states. States may 

implement the activities directly or through contracts 

or agreements with public agencies—such as other 

state agencies, AAAs, county governments, institutions 

of higher education, or Indian tribes—or private nonproft service providers or volunteer organizations.33 

ACL allocates grants for programs for the prevention of 

elder abuse, neglect, and exploitation (Chapter 3) by 

formula to states and territories based on their share 

of the population age 60 and over. States and territories have the discretion to allocate funding among the 

various activities authorized under the program. They 

also may choose to distribute funds to AAAs and local 

service providers.34 

26 | 
Overview on Older Americans Act Title III, VI, and VII Programs | 27 

 

 

Background Title III 

Older Americans Act Title III Services 

Title III provides four categories of services, designated under Parts B, C, D, and E: 

■ Part B covers supportive services and senior centers, 

including case management; transportation; help 

with homemaker tasks, chores, and personal care; 

adult day care; and legal assistance.35 

■ Part C covers nutrition services, including homedelivered and congregate meals.36 

■ Part D covers evidence-based prevention and health 

promotion services.37 

■ Part E authorizes the National Family Caregiver 

Support Program, which provides counseling, 

support groups, and relief from caregiver duties 

(respite services) for caregivers.38 

Title III services are available to all people age 60 and 

over who need assistance. Priority for services must 

be given to those with the greatest economic or social 

need, including those with low income, members of 

minority or ethnic groups, older people living in rural 

areas, those at risk for institutional care, and those 

with limited English profciency. 

Title III Part B: Support Services 

and Senior Centers 

Purpose of the Support Services and Senior Centers 

Program: Support services and senior centers that 

provide for a wide range of social services, including 

ombudsman activities, are authorized under Title III-B 

of the OAA. The program is designed to ensure that 

local communities can meet the individual needs of 

older adults and caregivers in their communities. The 

services are intended to help older adults remain independent in their own homes and communities. 

Priority for Title III Services 

“Greatest social need” is defned in 

law as need caused by noneconomic 

factors, which include physical and 

mental disabilities; language barriers; and cultural, social, or geographical isolation, including isolation 

caused by racial or ethnic status, that 

restricts the ability of an individual to 

perform normal daily tasks or threatens the capacity of the individual to 

live independently. 

“Greatest economic need” is defned 

as having an income at or below the 

ofcial poverty level. 

Older Americans Act, as amended through P.L. 116–131, 

enacted March 25, 2020. 

Local Support Services and Senior Centers Programs: 

The funding for services provided through Title III-B is 

flexible, allowing agencies to develop programming to 

reflect community needs and provide tailored supports 

for older adults. There are more than 25 authorized 

services that local agencies can fund through Title III-B. 

They include services to help older people access 

supports such as transportation, case management, 

legal assistance, home- and community-based longterm services, and personal care and adult day care 

services as well as ombudsman program activities 

performed under the authority of Title VII. The program 

also funds multipurpose senior centers.39 

Senior centers are the most visible presence of 

OAA programs and services in local neighborhoods. 

They are important gathering places, where people 
28 | 

 

 

participate in educational, nutrition, social, and cultural programs as well as physical activities, health education, and health screenings. Though senior centers 

vary widely, they are all community centers that bring 

together older adults and provide critical programs 

and services.40 

Target Populations and Eligibility: Except for recipients 

of information services and ombudsman services,† 

† Ombudsman programs serve consumers of all ages. 

those receiving senior services must be 60 years of age 

or older, regardless of income, assets, or ability to pay. 

Table 1. Older Americans Act Title III Services, Part B41 

Service Category Description of Services 

Adult Day Care/Health Personal care for dependent older adults in a supervised, protective, and 

congregate setting (group setting) during some portion of a day. Services ofered 

typically include social and recreational activities, training, counseling, and 

services such as rehabilitation, medications assistance, and home health aide 

services for adult day health. 

Assisted Transportation Assistance and transportation, including escort, for a person who has difculties 

(physical or cognitive) using regular transportation. 

Transportation Transportation from one location to another (e.g., to a medical appointment or 

grocery store). Does not include any other activity. 

Case Management Assistance with access or care coordination for an older person who has 

diminished functioning capacities, personal conditions, or other characteristics 

and so needs to receive services from formal service providers or family caregivers. 

Activities of case management include assessing needs, developing care plans, 

authorizing and coordinating services among providers, and conducting followup and reassessment as required. 

Chore Services Assistance with such activities as heavy housework, yard work, or sidewalk 

maintenance. 

Health Promotion and 

Disease Prevention 

Services that include health screenings and assessments; organized physical 

ftness activities; evidence-based health promotion programs; medication 

management; home injury control services; and/or information, education, and 

prevention strategies for chronic disease and other health conditions that would 

reduce the length or quality of life of a person 60 or older. 

Homemaker A service assisting a consumer with routine tasks to achieve and maintain a clean, 

safe, and healthy environment—e.g., preparing meals, shopping for personal 

items, managing money, using the telephone, or doing light housework. 
 

 

 

Table 1. continued 

Information and 

Assistance 

A service that provides individuals with information on services available within 

communities; links individuals to services and opportunities available within communities; and, as much as possible, establishes adequate follow-up procedures. 

Legal Assistance Legal advice, counseling and representation by an attorney or other person 

acting under the supervision of an attorney, by qualifed providers contracted 

through AAAs. Legal assistance providers enable older Americans to assert their 

rights and remove barriers to economic and personal independence and selfdetermination. Legal assistance interventions address the social determinants 

of health and wellbeing to preserve older Americans’ access to appropriate 

services and support their rights to live free from or recover from the experience 

of abuse, neglect, and fnancial exploitation.‡ 

‡ Administration for Community Living. (2020, September 21). Legal Assistance Enhancement Program. https://acl.gov/grants/legalassistance-enhancement-program 

Outreach Intervention with individuals initiated by an agency or organization for the 

purpose of identifying potential clients (or their caregivers) and encouraging 

them to use existing services and benefts. 

Personal Care A service that helps a consumer to achieve optimal functioning with activities 

of daily living and/or IADLs—e.g., personal assistance, stand-by assistance, 

supervision, or cues. 

Self-Directed Care An approach to providing services (including programs, benefts, supports, and 

technology) under this act intended to assist an individual with activities of daily 

living, in which 

■ the services (including the amount, duration, scope, provider, and location 

of those services) are planned, budgeted, and purchased under the direction 

and control of the person served; 

■ the service recipient is given the appropriate information and assistance 

necessary to make informed decisions about his or her care options; and 

■ the AAA (or AAA-designated agency) assesses the service needs, capabilities, 

and preferences of the individual to be served as well as that individual’s 

ability to direct and control the receipt of services. 

Other Services A service provided using Older Americans Act funds that does not fall into the 

listed service categories. 

Overview on Older Americans Act Title III, VI, and VII Programs | 29 
30 | 

Priority for services must be given to older individuals 

with greatest economic need and older individuals 

with greatest social need (with particular attention to 

low-income older individuals, including low-income 

minority older individuals; older individuals with limited 

English profciency; and older individuals residing in 

rural areas). In addition, the following criteria are used 

to reach older adults with the greatest need for chore, 

homemaker, and assisted transportation services: 

■ Chore services are targeted toward individuals who 

have difculty with heavy housework, yard work, or 

sidewalk maintenance. 

■ Homemaker services are targeted toward individuals 

who have difculty with one or more instrumental 

activities of daily living (IADLs), such as preparing 

meals, shopping for food or other personal items, 

managing money, using the telephone, or light 

housekeeping. 

■ Assisted transportation services are targeted toward 

individuals who have difculty (physical or cognitive) 

with using private or public transportation. 

Program Highlights: Millions of older adults rely on 

the supportive services provided under Title III-B. For 

example, in 2020, almost half a million older adults 

received case management services, and more than 

190,000 older adults received homemaker services.42 

Programs provides millions of services to eligible 

older adults, including almost 30 million hours of 

personal care services, more than 20 million hours 

of homemaker services, and more than 13.5 million 

one-way trips. On average, clients received about 

200 hours of adult day care/health services and 

about 15 hours of chore services. 

Title III Part C: Nutrition Services 

Purpose of the Nutrition Program: Nutrition services 

are authorized under Title III-C of the OAA. The programs are designed to promote the general health and 

well-being of older individuals, and the services aim to 

■ reduce hunger, food insecurity and malnutrition 

of older adults, 

■ promote socialization of older individuals, and 

■ promote the health and well-being of older people 

• by assisting them in gaining access to nutrition 

and other disease prevention and health 

promotion services and 

• to delay the onset of adverse health conditions 

resulting from poor nutritional health or 

sedentary behavior. 

Local Nutrition Programs: Through the OAA nutrition 

program, ACL’s AoA provides grants to states to help 

support nutrition services for older people throughout the country. The nutrition program is the oldest, 

largest, and best-known of all OAA programs. It is 

funded (in part) by AoA, as well as state and local governments, foundations, direct payment for services, 

fundraising, and participants’ voluntary contributions 

(time and/or money). 

Program services at the local level include the 

Congregate Nutrition Program and the Home-Delivered 

Nutrition Program, which provide healthy meals in 

group settings such as senior centers and faith-based 

locations, as well as in the homes of at-risk older 

adults. Through the aging network’s meal providers, 

the programs provide a range of services, including 
Table 2. Older Americans Act Title III Services, Part C43 

Service Category Description of Services 

Congregate Meals Meals provided to an eligible individual in a group setting (e.g., senior center, 

senior housing sites, restaurant programs, faith-based locations). 

Meals must comply with the U.S. Department of Agriculture (USDA)/HHS Dietary 

Guidelines for Americans and provide a minimum of 33.3% of the Dietary Reference Intakes (DRI) if one meal is served, 66.6% if two meals are served for 1 day, 

and 100% if three meals are served for 1 day. Programs are encouraged to meet 

any special dietary needs of program participants, including meals adjusted for 

cultural considerations and preferences and medically tailored meals. The SUAs 

are encouraged to provide flexibility to local nutrition providers in designing 

meals that are appealing to program participants. 

Home-Delivered Meals A meal provided by a qualifed nutrition project provider to an eligible individual 

and consumed in the individual’s place of residence. Meals may be provided via 

home delivery, pick-up, carry-out, or drive-through. 

Meals must comply with the USDA/HHS Dietary Guidelines for Americans and 

provides a minimum of 33.3% of the DRI if one meal is served, 66.6% if two 

meals are served for 1 day, and 100% if three meals are served for 1 day. Programs are encouraged to meet any special dietary needs of program participants, including meals adjusted for cultural considerations and preferences and 

medically tailored meals. The SUAs are encouraged to provide flexibility to local 

nutrition providers in designing meals that are appealing to program participants. 

Nutrition Counseling A standardized service as defned by the Academy of Nutrition and Dietetics 

that provides individualized guidance to individuals who are at nutritional risk 

because of their health or nutrition history, dietary intake, chronic illness, or 

medication use, or to caregivers. One-on-one counseling provided by a registered dietitian addresses the options and methods for improving nutrition status 

with a measurable goal. 

Nutrition Education An intervention targeting OAA participants and caregivers that uses information 

dissemination, instruction, or training with the intent to support food, nutrition, 

and physical activity choices and behaviors (related to nutritional status) in 

order to maintain or improve health and address nutrition-related conditions. 

Content is consistent with the Dietary Guidelines for Americans; is accurate, 

culturally sensitive, regionally appropriate, and considers personal preferences; 

and is overseen by a registered dietitian or individual of comparable expertise as 

defned in the OAA. 

Overview on Older Americans Act Title III, VI, and VII Programs | 31 
 

 

 

 

 

nutrition screening and assessment as well as nutrition education and counseling.44 Title III also funds the 

Nutrition Services Incentive Program, which provides incentives to encourage and reward efective performance 

by states in the efcient delivery of nutritious meals to 

older individuals. In addition, nutrition services provide 

an important link to other supportive in-home and community-based supports, such as homemaker and home 

health aide services, transportation, physical activity 

and chronic disease self-management programs, home 

repair and modifcation, and falls prevention programs. 

Congregate Nutrition Services 

(OAA Section 331, sometimes called C1) 

The Congregate Nutrition Services section of the OAA 

authorizes meals and related nutrition services in 

group settings, which help to keep older Americans 

healthy and prevent the need for more costly medical 

interventions. The Congregate Nutrition Program, established in 1972, serves healthy meals while also presenting opportunities for social engagement, health 

and wellness activities, and meaningful volunteer 

roles, all of which contribute to health and well-being. 

The program serves individuals age 60 and older, their 

spouses, and, in some cases, their caregivers and/or 

persons with disabilities who are not older individuals, 

but who reside in housing facilities occupied primarily by older individuals at which congregate nutrition 

services are provided. Meals may also be provided to 

volunteers during meal hours. 

Home-Delivered Nutrition Services 

(OAA Section 336, sometimes called C2) 

Established in 1978, The Home-Delivered Nutrition Services section of the OAA authorizes meals and related 

nutrition services for older individuals and their spouses of any age. Home-delivered meals are ofen the frst 

in-home service that an older adult receives, and the 

program is a primary access point for other home- and 

community-based services. The program ofen serves 

frail, food-insecure, or isolated individuals age 60 and 

over, their spouses, and, in some cases, their caregivers, and/or persons with disabilities. This program 

serves much more than food. It provides a safety check 

and sometimes the only opportunity for face-to-face 

contact or conversation that day. 

Congregate Meal Programs: 

A Value Proposition 

CONGREGATE MEAL PROGRAMS 

■ Serve adults 60+ (and in some cases, 

caregivers, spouses, and/or younger 

people with disabilities) 

■ Provide meals in senior centers, schools, 

churches, farmer markets, and other 

community settings 

■ Ofer healthy meals, social engagement, 

access to community resources, volunteer roles 

DEMAND ON THE HEALTH CARE SYSTEM 

WILL GROW WITH THE POPULATION 

Nutrition/malnutrition 

have a tremendous 

impact on overall 

health and health 

care utilization 

Population 

of Americans

60+ 

69M 77M 102M 

*Projected 

2016 2020* 2040* 

HOW THE HEALTH CARE SYSTEM 

BENEFITS 

FEWER ER VISITS 

leading to admissions 

5.4% 

vs. 10.4% 

FEWER HOSPITAL 

ADMISSIONS 

8.5% 

vs. 13.7% 

Participants vs. non-participants 

32 | 
Overview on Older Americans Act Title III, VI, and VII Programs | 33 

The OAA requires that all OAA-funded meals adhere to 

the current Dietary Guidelines for Americans, provide 

at least one third of the DRI, meet state and local food 

safety and sanitation requirements, and be appealing 

to older adults. Because services are state administered, each SUA has the responsibility and authority 

(OAA Section 305) to implement the nutritional standards (OAA Section 339) to best meet the needs of 

the older adults that they serve. For example, a state 

may choose to use its funds to provide meals that focus 

nutrient standards on prevalent statewide chronic 

disease(s) or predominant health issues afecting older 

individuals. In practice, some states may require that 

menus for meals served using OAA funds be developed 

using nutrient analysis, meal patterns, or a combination. Projects must, when feasible, encourage the use 

of locally grown foods in meal programs and identify 

potential partnerships and contracts with local producers and providers of locally grown foods. 

Nutrition Services Incentive Program (OAA Section 311)45 

The Nutrition Services Incentive Program of the OAA 

provides grants to states, territories, and eligible tribal 

organizations to support the Congregate and HomeDelivered Nutrition Programs by providing an incentive 

to serve more meals. Grantees can choose to receive 

their grants as cash, commodities (food) from the 

United States Department of Agriculture, or a 

combination of cash and commodities. 

Target Population and Eligibility: Services are not 

intended to reach every individual in the community. 

In general, under the OAA, a person must be 60 

years of age or older to be eligible for the nutrition 

programs. However, the programs specifcally target 

adults age 60 and older who are in greatest social and 

economic need, with particular attention to the 

following groups46: 

■ Low-income older adults 

■ Minority older individuals 

■ Older adults in rural communities 

■ Older individuals with limited English 

language ability 

■ Older adults at risk of institutional care 

Program Highlights47: In 2020 over 4,000 providers 

served congregate meals and over 3,800 providers 

delivered home-delivered meals to over 2.7 million 

recipients. That year, almost 200 million meals were 

delivered to individual homes, and almost 40 million 

meals were served at congregate meal sites. On 

average, individuals received about 137 homedelivered meals and 47 congregate meals. In addition, 

more than 22,000 individuals received nutrition counseling for a total of over 38,000 counseling session. 

Programs also provided more than 3 million session of 

nutrition education. 
 

Table 3. Older Americans Act Title III Services, Part D 

Service Category Description of Services 

Evidence-Based 

Disease Prevention 

and Health Promotion 

Services 

Funds are provided for evidence-based disease prevention and health promotion 

services, including programs related to physical ftness, medication management, chronic disease self-management education, psychosocial behavioral 

health intervention, human immunodefciency virus, arthritis, brain health, 

diabetes, falls prevention, depression, and chronic pain. 

Title III Part D: Evidence-Based Disease Prevention 

and Health Promotion Services 

Purpose of the Program: Title III-D of the OAA was 

established in 1987. It provides grants to states and territories, based on their share of the population aged 60 

and older and other factors, for programs that support 

healthy lifestyles and promote healthy behaviors. The 

FY 2012 congressional appropriations law included, for 

the frst time, an evidence-based practice requirement 

related to Title III-D funds. As a result, states that receive 

OAA funds under Title III are required to spend those 

funds on evidence-based programs§

§ ACL defnes evidence-based programs as those demonstrated 

through evaluation to be efective for improving the health and 

well-being or reducing disease, disability, and/or injury among older 

adults; and proven efective with the older adult population, using 

experimental or quasiexperimental design; and documented by 

research results published in a peer-review journal; and fully carried 

out in a real-world community setting with fdelity to the published 

research; and including developed dissemination products that are 

available to the public. 

 to improve health 

and well-being and reduce disease and injury. 

Evidence-Based Programs: Since 2003, the aging services network has been steadily moving toward wider 

implementation of disease prevention and health 

promotion programs based on scientifc evidence that 

have been demonstrated to improve the health of older 

adults as they reduce the need for more costly medical 

interventions. Service activities may include programs 

related preventing and mitigating the efects of chronic 

diseases, including osteoporosis, hypertension, 

obesity, diabetes, and cardiovascular disease; 

reducing alcohol and substance abuse; and promoting 

smoking cessation, weight loss and control, stress 

management, falls prevention, physical activity, and 

improved nutrition. 

Specifc programs ofered vary widely but include 

chronic disease self-management, falls prevention, 

medication management, ftness activities, mental 

health supports, and other interventions shown to 

be efective in enhancing health.48 

The ACL National Chronic Disease Self-Management 

Education Resource Center maintains a database of 

evidence-based programs that meet ACL’s criteria for 

evidence-based programs under Title III-D.¶

¶ https://www.ncoa.org/evidence-based-programs 

 The database is updated periodically based on the results of an 

Evidence-Based Program Review Process. More information about that process is available here.

** 

** https://www.ncoa.org/article/apply-to-become-an-evidencebased-program 

Target Population and Eligibility: Priority is given to 

serving older adults living in medically underserved 

areas of the state and those with the greatest economic 

need. Title III-D funds must be used to provide evidence-based disease prevention and health promotion 

programs at senior centers, at congregate meal sites, 

and/or through home-delivered meal programs in the 

client’s home or at other appropriate sites. 

Program Highlights: Evidence-based programs empower 

older adults to take control of their health by maintaining a healthy lifestyle through increased self-efcacy 

34 | 
 

 

 

and self-management. These programs are based on 

research and provide documented health benefts. 

Specifcally, they demonstrate reliable and consistently positive changes in important health-related and 

functional measures, such as improved balance and 

strength as a result of attending a physical 

activity program or reduced chronic disease symptomatology as a result of a self-management program. In 

2020, there were over 2,000 providers supported by 

Title III-D delivering disease prevention and health 

promotion services. 

Title III Part E: Caregiver Services 

Purpose of the Caregiver Programs: Family caregivers 

are the backbone of America’s long-term care system, 

with more than 65 million Americans, or nearly 30% 

of the general population, caring for an older adult 

or someone living with an illness or disability.49 

Family members are the people most likely to serve as 

caregivers to older adults, and when these caregivers 

become overwhelmed by the physical and emotional 

burdens of caregiving, their older loved ones are at 

increased risk of institutionalization. 

Table 4. Older Americans Act Title III Services, Part E50 

Service Category Description of Services 

Information for 

Caregivers About 

Available Services 

A service for caregivers that provides them with information on resources and 

services available within their communities. 

Assistance to 

Caregivers in Gaining 

Access to Services 

A service that assists caregivers in obtaining access to the services and resources available to them within their communities. As much as possible, it ensures 

that the individuals receive the services needed by establishing adequate 

follow-up procedures. 

Caregiver Training/ 

Education, Individual 

Counseling, Support 

Groups 

Counseling to caregivers to assist them in making decisions and solving problems relating to their caregiver roles. Services include counseling to individuals, 

support groups, and caregiver training (of individual caregivers and families). 

These services help caregivers better manage their responsibilities and cope 

with the stress of caregiving. 

Respite Care Services which ofer temporary, substitute supports or living arrangements for 

care recipients in order to provide a brief period of relief or rest for caregivers. 

Respite care includes in-home respite (personal care, homemaker, and other inhome respite); respite provided as the care recipient attends a senior center or 

other nonresidential program; institutional respite provided by placing the care 

recipient in an institutional setting such as a nursing home for a short period 

of time as a respite service to the caregiver; and, for grandparents caring for 

children, summer camps. 

Supplemental Services Services provided on a limited basis to complement the care provided by caregivers (e.g., transportation, home modifcations, medical equipment, assistive 

technologies, legal and fnancial counseling, and emergency response systems). 

Overview on Older Americans Act Title III, VI, and VII Programs | 35 
 

 

 

 

Recognizing the critical role families play in the 

nation’s system of long-term services and supports, 

Congress established the National Family Caregiver 

Support Program (NFCSP) in 2000 as part of the reauthorization of the OAA. It was the frst federal program 

making it possible for every state and community 

to provide family caregivers with a flexible base of 

services and supports to assist them in keeping their 

loved ones in the settings of their choice for as long as 

possible. Today, the NFCSP is an integral component 

of our nation’s fabric of long-term services and supports. It is a trusted and reliable resource to support 

the needs of family or other informal caregivers as they 

lend assistance to aging adults, as well as the needs 

of grandparents and older relatives caring for minor 

children or adults with disabilities.51 

Caregiver Programs: Through the NFCSP, states and 

territories ofer fve core services for caregivers, in 

partnership with AAAs and local service providers: 

■ information for caregivers about available services; 

■ assistance to caregivers in gaining access 

to services; 

■ caregiver education/training, individual 

counseling, and support groups; 

■ respite care; and 

■ supplemental services. 

The NFCSP provides grants to state and territories to 

fund supports that help caregivers of all ages balance 

caregiving with other responsibilities. This assistance, 

in turn, helps ensure more adults can remain in their 

homes and communities.52 

Target Population and Eligibility: The NFCSP was 

established in 2000 and is available for the following 

individuals: 

■ Adult family members or other informal caregivers 

age 18 and older providing care to individuals 60 

years of age and older or to individuals of any age 

with Alzheimer’s disease and related disorders 

■ Older relatives (not parents), age 55 and older, 

providing care to children under the age of 18 

■ Older relatives, including parents, age 55 and 

older, providing care to adults ages 18–59 with 

disabilities53 

Program Highlights.54 In 2020, there were more 

providers (9,263) for caregiver services to older adults 

than for any of the other Title III services categories. 

They provided support to over 186,000 caregivers 

serving elderly individuals, delivering more than 5 

million hours of respite care and more than 530,000 

counseling /support groups/caregiver training 

sessions to these caregivers. They also provided 

support to over 12,000 caregivers serving children, 

delivering more than 100,000 hours of respite care 

and approximately 64,000 contacts to assist these 

caregivers with access to assistance. 

36 | 
 

 

 

Background Title VI 

Older Americans Act Title VI Services 

Services for Native American programs were frst 

established in 1978 with the provision of the nutrition 

and supportive services program. Today, Title VI authorizes grants to Indian tribal organizations, Alaskan 

Native organizations, and nonproft groups representing Native Hawaiians to provide nutrition, supportive, 

and caregivers services for elders. Under Title VI, 

programs provided to AI/AN and Native Hawaiians are 

comparable to services provided under Title III.55 

Title VI provides services through three programs: 

Part A (Indian Program), Part B (Native Hawaiian 

Program), and Part C (Native American Caregiver 

Support Program). Title VI Parts A and B authorize 

grants to Indian tribal, public, or non-proft organizations representing federally recognized tribes, Alaskan 

villages, and Native Hawaiians to provide nutrition and 

supportive services. Title VI Part C authorizes grants to 

Indian tribal, public, or nonproft organizations representing federally recognized tribes, Alaskan villages, 

and Native Hawaiians to provide caregiver support 

services. Part C serves all programs within Parts A and 

B. To qualify for Title VI grants, tribes must have at 

least 50 Native members ages 60 year and above. Parts 

A/B (nutrition and supportive services) are considered 

the base grant, and programs have to have Parts A and 

B to quality for Part C (caregiver support services).56 

For the 2020–2023 grant cycle, ACL awarded 282 threeyear grants for nutrition and supportive services, and 

251 three-year grants for caregiver support services.57 

Title VI Parts A/B: Nutrition and 

Supportive Services 

Purpose of the Nutrition and Support Services 

Programs: The purpose of nutrition and supportive 

services programs is to help reduce the need for costly 

institutional care and medical interventions, support 

the independence and well-being of tribal elders, and 

be responsive to the cultural diversity of Native 

American communities. 

Nutrition and Supportive Services Programs: These programs provide funding for services such congregate and 

home-delivered meals, information referral services, 

transportation, information and referral, and a wide 

range of home care services. Required nutrition services 

include congregate meals and home-delivered meals. 

Other nutrition-related services that grantees may provide include nutrition counseling, nutrition education, 

sponsorship of farmer’s market programs, and distribution centers for food banks and charitable organizations. Required supportive services include information 

and assistance, but grantees may also use funds to 

provide transportation, chore services, and many other 

services that contribute to the well-being of elders. Afer 

meeting program requirements, tribal organizations 

have flexibility to allocate resources among the various 

allowable activities funded by each program.58 

Overview on Older Americans Act Title III, VI, and VII Programs | 37 
38 | 

Table 5. Older Americans Act Title VI Services, Parts A/B (Nutrition Services)59 

Service Category Description of Services 

Congregate Meals A meal provided to an eligible person at a nutrition site, senior center, or 

other congregate/group setting. The meal meets all the requirements of the 

OAA and state/local laws. Including complying with the USDA/HHS Dietary 

Guidelines for Americans, and provides a minimum of 33.3% of the DRI if one 

meal is served, 66.6% if two meals are served for 1 day, and 100% if three 

meals are served for 1 day. 

Home-Delivered Meal A meal provided to a qualifed eligible person (one who is frail, isolated, or 

homebound due to illness or incapacitating disability) in their place of residence. The meal meets all the requirements of the OAA and State/Local laws. 

Including complying with the USDA/HHS Dietary Guidelines for Americans; and 

provides a minimum of 33.3% of the DRI if one meal is served, 66.6% if two 

meals are served for 1 day, and 100% if three meals are served for 1 day. 

Nutrition Education A targeted educational program provided by a dietitian or a similarly knowledgeable person. The program will promote better health by providing accurate and 

culturally sensitive nutrition, physical ftness, or health (as it relates to nutrition) 

information and instruction to participants, caregivers, or participants and caregivers in a group setting (two or more participants). 

Nutrition Counseling Provision of individualized advice and guidance to individuals, who are at 

nutritional risk—because of their health or nutritional history, dietary intake, 

medication use, or chronic illnesses—about options and methods for improving their nutritional status. Counseling is performed by a registered dietitian or 

other health professional and addresses the options and methods for improving 

nutrition status with a measurable goal. 

Note. Congregate meals and home-delivered meals are required services. 
Overview on Older Americans Act Title III, VI, and VII Programs | 39 

 

Table 6. Older Americans Act Title VI Services, Part A/B (Supportive Services)60 

Service Category Description of Services 

Information/ 

Assistance 

A service that: 

■ provides the individual with current information on opportunities and 

services available within their communities, including information relating 

to assistive technology; 

■ assesses the problems and capacities of the individual; 

■ links the individual to the opportunities and services that are available; 

■ ensures that the individual receives the services needed and is aware of the 

opportunities available to them by establishing adequate follow-up procedures; and 

■ serves the entire community of older individuals. 

Outreach Conducting public outreach activities and providing information directed at 

individuals and groups to encourage potential elders (or their caregivers) to use 

existing services and benefts. 

Case Management A service provided to an elder, at the direction of the elder or a family member 

or caregiver. 

■ The service should be provided by a trained or experienced person with case 

or care management skills. 

■ The service includes assessing individual needs and developing a service 

plan for, arranging, coordinating, and monitoring services to meet the needs 

of the elder. The service should include periodic reassessment and revision 

based on the needs of the elder. 

Transportation Services or activities that provide or arrange for travel of individuals from one 

location to another, including travel costs. This service may include escort or 

other appropriate assistance for a person who has difculties using regular 

transportation. 

Homemaker Service Providing light housekeeping tasks in an elder’s place of residence. Tasks may 

include, but are not limited to, preparing meals, shopping for personal items, 

laundry, managing money, or using the telephone, in addition to other light 

housework. 
Table 6. continued 

Service Category Description of Services 

Personal Care/Home 

Health Aid Service 

Providing assistance with activities of daily living, such as eating, dressing, and 

bathing, toileting, transferring in and out of bed/chair or walking. Assistance may 

also include health-related tasks, such as checking blood pressure and blood 

glucose, and assistance with personal care. Personal care may include IADLs, such 

as cleaning and maintaining the house, managing money, preparing meals. 

Chore Service Performance of heavy household tasks provided in a person’s home. In addition 

to heavy housework, such as heavy cleaning, tasks may include yard work, sidewalk maintenance, minor home repair, wood chopping, water hauling, and other 

heavy-duty activities which the elder is unable to handle on their own and which 

do not require the services of a trained homemaker or other specialist. 

Visiting Going to see an elder to reduce social isolation, provide a wellness check (a 

visual check of an elder to see if they need anything), etc. Visiting services would 

include visiting in a personal home. Visiting may include a minimum of 15 minutes talking with an elder or an adequate amount of time to make an informed 

decision about the elder’s well-being. 

Telephoning Phoning in order to provide comfort or check up on the elder. 

Social Events Events involving a public performance or entertainment function. 

Health Promotion 

and Wellness 

Activities conducted to improve the mental and physical health of persons, including walking groups, exercise classes, and other types of recreation. 

Visits to Persons in 

Nursing Facilities/ 

Homes or Residential 

Care Communities 

Visits* conducted to persons living in skilled nursing homes or facilities or living in 

a long-term care facility that provides, at a minimum, room and board and aroundthe-clock on-site supervision as well as help with personal care, such as bathing 

and dressing, or health-related services, such as medication management. Facility 

types include, but are not limited to, assisted living; board and care home; congregate care; enriched housing programs; homes for the aged; personal care homes; 

adult foster/ family homes; and shared housing establishments that are licensed, 

registered, listed, certifed, or otherwise regulated by a state. 

*These visits should not be counted as part of the long-term care ombudsman 

programs which report their visits to the state. 

Note: Information and assistance services are required services. 

40 | 
Target Populations and Eligibility: Title VI Part A is the 

Indian program and serves federally recognized tribes 

with at least 50 members age 60 years and above; 

Part B is the Native Hawaiian program, serving public 

or nonproft private organizations that serve Native 

Hawaiians and represent at least 50 individuals age 

60 years and above. Tribal organizations are allowed 

to determine the age at which a member is considered 

an elder and thus is eligible for services.61 An eligible 

person is an elder; a spouse of an elder; an individual 

providing volunteer services for the Title VI program; 

or a nonelder person with a disability who resides 

at home with an elder and accompanies the elder to 

receive nutrition services, or who resides in a housing 

facility occupied primarily by older adults. 

Program Highlights: An evaluation conducted with 

Title VI grantees found that nutrition services fulfll a 

critical need for elders. Specifcally, for many recipients, the meal programs provide their only hot and 

nutritious meal of the day; congregate meal programs 

provide an opportunity to make social connections and 

provide a sense of belong to the community; and, for 

homebound elders, a visit from a meal delivery driver 

provides an opportunity for social contact and checking in regarding their health and overall well-being.62 

Support services have also been shown to be critical 

for elders. As a result, elders receiving any Title VI 

services were found to experience signifcantly fewer 

hospitalizations and falls per year and report more 

instances of social activity than elders who did not 

receive or participate in Title VI services, and to 

engage in cultural practices on a monthly basis. 63 

Title VI Part C: Caregiver Support Services 

Purpose of the Caregiver Support Services Programs: 

The Title VI Part C program assists AI/AN and Native 

Hawaiian families caring for older relatives with 

chronic illness or disability, grandparents caring for 

grandchildren, and elders caring for adult children 

with disabilities. In addition, the program helps tribes 

provide locally determined systems of support services 

for family caregivers. Specifcally, a core value of the 

programs, as expressed by tribal leaders, is that they 

should not replace the tradition of families caring for 

their elders. Rather, Part C programs provide support 

that strengthens the family’s caregiving role.64 

Caregiver Support Services Programs: These programs 

ofer a variety of services that address a range of caregiver needs, including information and outreach, access 

assistance, individual counseling, support groups and 

training, respite care, and other supplemental services. 

Tribal organizations coordinate with other programs, 

including the Volunteers in Service to America (VISTA) 

program, to help support and create sustainable caregiver programs in Native American communities, many 

of which are geographically isolated. 

Target Populations and Eligibility: Title VI Part C 

authorizes grants to Indian tribal, public, or nonproft 

organizations representing federally recognized tribes, 

Alaskan villages, and Native Hawaiians to enable them 

to provide caregiver support services. Eligible 

caregivers include 

■ informal caregivers, 

■ caregivers to elders of individuals of any age with 

Alzheimer’s disease and related disorders, 

■ elder caregivers caring for children under the age 

of 18, and 

■ elder caregivers providing care to adults ages 

18–59 with disabilities. 

Program Highlights: An evaluation conducted with 

Title VI grantees found that caregiver support services 

help caregivers in important ways, particularly by providing relief from the stress of caregiving and helping 

to improve their overall quality of life. Specifcally, 

resources and information about available caregiver 

services and referrals help ensure better care for their 

family members; support groups help caregivers learn 

from other caregivers who face similar issues and give 

them renewed strength to continue providing care; 

respite services provide an opportunity to take a needed break from the challenging work of caregiving and 

attend to other aspects of their lives; and supplemental services, such as the provision of wheelchairs or 

walkers, provide critical resources that help caregivers 

support their care recipients to remain as independent 

as possible.65 

Overview on Older Americans Act Title III, VI, and VII Programs | 41 
 

Table 7. Older Americans Act Title VI Services, Part C66 

Service Category Description of Services 

Information 

Services 

Public and media activities that conveys information to caregivers about available services. Information services activities might include making an in-person 

interactive presentation to the public or putting together a social media post or a 

radio announcement that is shared with the 

broader community. 

Information and 

Assistance 

A service that 

■ provides the individual with current information on opportunities and services available within their communities, including information relating to 

assistive technology; 

■ assesses the problems and capacities of the individual; 

■ links the individual to the opportunities and services that are available; 

■ ensures that the individual receives the services needed and is aware of the 

opportunities available to them, by establishing adequate follow-up procedures; and 

■ serves the entire community of caregivers. 

Counseling A service designed to support caregivers and assist them in their decision-making and problem solving. Counselors may be degreed service providers, trained 

to work with individuals, older adults, and families and specifcally understanding and addressing the complex physical, behavioral, and emotional problems 

related to their caregiver roles. Informal counselors, like a peer who is or has 

been an informal caregiver, may also be used for this service. The service includes counseling provided to individuals or in group meetings. Counseling is a 

separate function from support group activities or training. The caregiver support 

services are eligible to those caring for older adults, persons with disabilities, 

or children not their own by birth or adoption. Counseling with an individual 

or group may be provided via phone, text, email, webinar, video chat, or other 

means to help participants navigate physical, behavioral, and emotional issues 

related to caregiving. 

Support Group A service that is led by an individual, moderator, or professional to facilitate 

caregivers discussing their common experiences and concerns and developing a 

mutual support system. Support groups are typically held on a regularly scheduled basis and may be conducted in person, over the telephone, or online. Caregiver support groups would not include caregiver education/training groups or 

other groups primarily aimed at teaching skills or meeting on an informal basis 

without a facilitator. Support groups are intended to facilitate caregivers sharing 

their experiences with each other and fnding support within the group. 

42 | 
 

Table 7. continued 

Service Category Description of Services 

Caregiver 

Training 

A service that provides family caregivers with instruction to improve knowledge 

and performance of specifc skills relating to their caregiving roles and responsibilities. Skills may include activities related to health, nutrition, and fnancial 

management; providing personal care; and communicating with health care providers and other family members. Training may include use of evidence-based 

programs, be conducted in-person or on-line, and be provided in individual or 

group settings. 

Supplemental 

Services 

Services provided on a limited basis to informal caregivers to complement the 

care these caregivers provide. These are services intended to support the 

caregiver so that they might continue to provide care to the elder, person with 

Alzheimer’s disease or related disorder of any age, person with disability age 

18–59, or grandchild under the age of 18. Service categories for supplemental 

services are the following: 

■ Home modifcation/repairs: putting in ramps or handrails into a home 

■ Consumable items: single use items such as incontinence supplies, Ensure, 

school supplies, uniforms for school or sports, cleaning supplies, groceries, 

etc. 

■ Lending closet: items returnable to the Title VI program—clothing exchange; 

durable medical equipment (chair lifs, wheelchairs, walkers, emergency 

response systems); telephone; tablet; anything lent on a short-term basis 

■ Homemaker/chore/personal care service: chopping wood, mowing a lawn, 

snow clearing 

■ Financial support: limited (emergency) help with utility bills 

■ Other: any services provided that do not ft into the program performance 

report services listed 

Respite Care A service for caregivers which ofers temporary, substitute supports or living 

arrangements for care recipients in order to provide the caregivers a brief period 

of relief or rest. Respite care is to assist the informal caregiver. 

Overview on Older Americans Act Title III, VI, and VII Programs | 43 
 

Background Title VII 

Older Americans Act Title VII Services 

Title VII focuses exclusively on the advocacy responsibility of states to protect and enhance rights, benefts, 

and independence of the nation’s most vulnerable 

elders by providing state grants for “vulnerable elder 

rights protection” programs. Programs include the 

LTCOP (Chapter 2); programs dedicated to the prevention 

of elder abuse, neglect, and exploitation (Chapter 3); and 

activities focused on elder rights and legal assistance 

development (Chapter 4). Title VII strongly emphasizes 

coordination and linkage among these programs to 

support statewide systems change. 

It is important to note that Title III contains some 

important funding requirements of relevance to Title 

VII programs. For example, funding for ombudsman 

services and local legal assistance providers is provided through AAAs under Title III, requiring all AAAs 

to fund legal assistance as a priority service. The Title 

VII requirements and responsibilities for development 

of legal assistance and elder rights advocacy are at 

the state level. Thus, unlike Title III programs, a state 

agency is not required to allot Title VII Chapter 3 funds 

to AAAs. A state agency may administer vulnerable 

elder rights protection activities (Chapters 3 & 4) either 

directly or through contracts or agreements with a 

variety of agencies, including public agencies, such 

as other state agencies and county governments; 

nonproft private organizations; institutions of higher 

education; Indian tribes; or nonproft service providers 

or volunteer organizations, as well as AAAs.67,68, 

Chapter 2. Long-Term Care Ombudsman Program 

As part of Title VII Chapter 2, each state is required to 

establish and operate a statewide ofce of the state 

LTCO, headed by a full-time state LTCO. Most state 

LTCOs are state employees, and their roles and responsibilities are clearly stated in the OAA and the LTCOP 

regulation. Although the state LTCO must comply with 

federal direction in fulflling the duties of the ofce, 

the organizational structure can afect the execution 

of those responsibilities. 

State long-term care ombudsman programs may be 

centralized or decentralized. A centralized structure is 

generally defned as an organizational arrangement 

in which the state ombudsman and all regional/district/local ombudsman representatives of the ofce 

are employees of a single entity. In this structure, the 

state LTCO is responsible for the management of the 

entire program, including staf and all activities. A 

decentralized structure is defned as an organizational 

arrangement in which the state LTCO is an employee 

of the state, or a contracted entity, but the regional/ 

district/local ombudsman representatives of the ofce 

are employed by another contracted entity (ofen the 

AAAs) designated by the state LTCO. In this structure, 

the state LTCO has programmatic oversight, but not 

personnel oversight. The local ombudsman entity con44 | 
 

sists of representatives of the ofce of the state LTCO 

(i.e., staf and volunteers), but it is usually an entity 

within a larger “host agency.”69 †† 

†† For additional details about structure, function, and responsibilities of long-term care ombudsman programs, see the National 

Association of States United for Aging and Disabilities. (2019). State 

Long-Term Care Ombudsman Program: 2019 revised primer for state 

agencies. https://ltcombudsman.org/uploads/fles/support/nasuad-ombudsman-acl-rpt-0319-web-fnal.pdf 

Purpose of the LTCOP: The purpose of the LTCOP is to 

improve quality of life and care for residents of longterm care facilities by helping to resolve problems related to the health, safety, welfare, and individual rights. 

Services of Long-Term Care Ombudsman Programs: 

Ombudsman programs promote policies and consumer 

protections to improve long-term services and supports 

at the facility, local, state, and national levels. All states, 

the District of Columbia, Puerto Rico, and Guam have an 

ofce of the LTCO, headed by a full-time state LTCO. 

The state LTCO manages all aspects of the statewide 

program. Ombudsman staf and volunteers 

serving as designated representatives of the ofce 

of the LTCO assist in performing the activities and 

fulflling the responsibilities of the program, including 

advocating on behalf of residents in long-term care 

settings. Across the nation, staf and thousands of 

volunteers are designated by state ombudsmen as 

representatives to directly assist residents to voice 

concerns, secure their rights, and resolve conditions 

afecting their care. 

The purpose of the LTCOP is to 

improve quality of life and care for 

residents of long-term care facilities 

by helping to resolve problems 

related to the health, safety, welfare, 

and individual rights. 

Table 8. Older Americans Act Title VII Services, Chapter 2 

Service Category Description of Services 

Facility Visits Visits to nursing facilities or residential care communities (e.g., assisted living) 

by representatives of the ofce of the state LTCO as part of a regular presence. 

Investigations in 

Response to 

Complaints 

Requested ombudsman program complaint investigation services regarding one 

or more complaints made by, or on behalf of, residents. Anyone, including an 

ombudsman representative, may initiate a complaint on behalf of residents. 

Complaint Resolution Through a variety of strategies, resolving a problem to the satisfaction 

of the resident. 

Training Training provided to 

■ individuals (paid or volunteers) to achieve certifcation which allows an 

individual to be eligible for designation as a representative of the ofce of the 

state LTCO 

■ Nursing facility and residential care community staf to ofer learning on a 

variety of topics (e.g., abuse prevention, residents’ rights) 

Overview on Older Americans Act Title III, VI, and VII Programs | 45 
 

Table 8. continued 

Service Category Description of Services 

Information and 

Assistance 

Information provided about issues impacting residents (e.g., resident rights, 

care issues, services) and/or assistance provided to access services without 

opening a case and working to resolve a complaint. Also, consultation provided 

to facilities, including technical support and the provision of resource information. Information and assistance may be provided to 

■ nursing facility staf, 

■ residential care community staf, or 

■ individuals. 

Participation in 

Facility Surveys 

Participation in both standard surveys and complaint surveys, or similar state 

surveys or inspections conducted in residential care communities. Survey 

participation includes, but is not limited to, providing presurvey information to 

surveyors, sharing complaint summary reports, and participating in resident 

group interviews and exit conferences and informal dispute resolution. 

Council Participation Participation in resident councils (at nursing facilities and residential care community facilities) or family councils. Participation includes meeting with council 

leadership, training the council, and/or attending a council meeting. 

Community Education Community education outreach sessions by ombudsman program, including 

outreach conducted at health fairs and community events. 

State and Local Level 

Coordination Activities 

Leadership activities and/or state/local-level coordination, where the state LTCO 

provides state-level coordination and support for coordination between local 

ombudsman programs and other entities with responsibilities relevant to the 

health, safety, well-being, or rights of residents of long-term care facilities. 

Systems Advocacy Analysis, commenting on, and monitoring the development and implementation 

of public policies, including facilitating public comment; recommending changes; and providing information to public and private agencies, legislators, the 

media, and others. 

Target Populations and Eligibility: Funds for long-term 

care ombudsman programs are allocated to SUAs, 

which may award funds for program activities to a 

variety of organizations, including other state agencies, 

AAAs, county governments, nonproft service providers, 

and volunteer organizations. The program is the only 

OAA program that focuses solely on the needs of institutionalized persons. The law requires that ombudsmen 

serve residents of all long-term care settings, regardless of age. Such settings include nursing facilities, 

board and care settings, and other adult care homes, 

including assisted living or other similar settings. 

46 | 
 

 

 

Program Highlights: In 2020, long-term care ombudsman 

programs had 1,700 paid staf and 6,621 volunteer staf 

who conducted almost 200,000 visits in 39,984 longterm care facilities, investigated 153,324 complaints, and 

provided more than 640,000 instances of information 

and assistance to individuals and facility staf. 

Chapter 3. Programs for the Prevention 

of Elder Abuse, Neglect, and Exploitation70 

Purpose of Programs for the Prevention of Elder 

Abuse, Neglect, and Exploitation: The purpose of programs for the prevention of elder abuse, neglect, and 

exploitation is to develop and strengthen prevention 

eforts at the state and local level. 

Elder Abuse, Neglect, and Exploitation Prevention 

Program Services: The programs provide formula 

grants to states and territories, based on their share 

of the population 60 and over, for the prevention, 

detection, assessment, and treatment of, intervention 

in, investigation of, and response to elder abuse, 

neglect, and exploitation. Services include funding 

for state and local public awareness campaigns, 

training programs, and multidisciplinary teams. 

These activities are important elements of ACL’s 

activities related to elder rights and elder justice. 

The program coordinates activities with state and 

local adult protective services programs, over half of 

which are directly administered by SUAs, and other 

professionals who work to address issues of elder 

abuse and elder justice. 

Target Populations and Eligibility: Funds are allocated to states to assists SUAs and AAAs in carrying out 

programs to prevent abuse, neglect, and exploitation 

of older adults, including developing and strengthening the service systems through designated SUAs and 

AAAs. The program provides education that benefts a 

broad spectrum of older populations, aging services 

providers, and the general public. Like all OAA services, 

programs must address underserved populations of 

older individuals, including elders with greatest 

economic or social need, such as older individuals living 

in rural locations, older individuals in minority populations, and low-income older individuals. 

The purpose of programs for the 

prevention of elder abuse, neglect, 

and exploitation is to develop and 

strengthen prevention eforts at the 

state and local level. The program 

provides education that benefts 

a broad spectrum of older populations, aging services providers, 

and the general public. 

Program Highlights: Accomplishments reported by 

grantees highlight programs having implemented 

a wide range of activities in FY 2020 to support the 

prevention of abuse, neglect, and exploitation of older 

adults. For example, programs have continued to build 

partnerships with other government and nonproft 

agencies, which facilitate sharing information, ideas, 

and strategies to better recognize incidents of abuse, 

neglect, and exploitation, and to coordinate eforts to 

serve the victims. Programs also have held legal assistance clinics and educational sessions to increase public awareness regarding issues such as advance directives/life care planning, general estate planning, fair 

housing rights, and fnancial abuse prevention. Other 

outreach activities have focused on adult protective 

services and have been provided to skilled nursing and 

senior home staf and residents, adult day care staf 

and participants, and conference attendees. These 

outreach activities helped to disseminate information 

and materials on aging services and to strengthen 

programs’ relationship with key partner agencies. 

Other activities have focused on, among other things, 

data collection and analysis, such as enhancing the 

collection of demographic data, which has enhanced 

transparency and evaluation of equity issues. 

Overview on Older Americans Act Title III, VI, and VII Programs | 47 
 

Table 9. Older Americans Act Title VII Services, Chapter 371 

Service Category Description of Services 

Public Education and 

Outreach 

Public education and outreach to identify and prevent elder abuse, neglect, and 

exploitation, and to promote fnancial literacy and prevent identity thef and 

fnancial exploitation of older individuals. 

Coordination 

of Services 

Provision to AAAs of services instituted under the state adult protection service program, state and local law enforcement systems, and courts of competent jurisdiction. 

Development of Information and 

Data Systems 

Promotion of development of information and data systems, including elder 

abuse reporting systems, to quantify the extent of elder abuse, neglect, and 

exploitation in the state. 

Data Submission 

and Analysis 

Promotion of submission of data on elder abuse, neglect, and exploitation for the 

appropriate database of the Administration or another database specifed by the 

Assistant Secretary; conducting analyses of state information concerning elder 

abuse, neglect, and exploitation and identifying unmet service, enforcement, or 

intervention needs. 

Training Conducting of training for individuals, including caregivers described in Part E 

of Title III, professionals, and paraprofessionals, in relevant felds on the identifcation, prevention, and treatment of elder abuse, neglect, and exploitation, 

with particular focus on prevention and enhancement of self-determination and 

autonomy. Conducting of special and ongoing training for individuals involved 

in serving victims of elder abuse, neglect, and exploitation, on the topics of 

self-determination, individual rights, state and federal requirements concerning 

confdentiality, and other topics determined by a state agency to be appropriate. 

Technical Assistance Provision of technical assistance to programs that provide or have the potential 

to provide services for victims of elder abuse, neglect, and exploitation, and for 

family members of the victims. 

Elder Abuse, Neglect, 

and Exploitation 

System 

Promotion of development of an elder abuse, neglect, and exploitation system 

to facilitate reporting and investigation of suspected instance of elder abuse, 

neglect, or exploitation. 

Examination and 

Testing 

Examination of various types of shelters serving older individuals, and testing of 

various models for establishing safe havens (at home or elsewhere) that recognize autonomy and self-determination and fully protect the due process rights of 

older individuals. 

Multidisciplinary 

Activities 

Support for multidisciplinary elder justice activities, such as supporting and studying team approaches for bringing a coordinated multidisciplinary or interdisciplinary response to elder abuse, neglect, and exploitation, including a response from 

individuals in social service, health care, public safety, and legal disciplines. 

48 | 
 

Chapter 4. State Legal Assistance 

Development Program72 

Purpose of the State Legal Assistance Development 

Program: This chapter establishes that each state 

identifes a person to serve as the state legal assistance developer (LAD)‡‡

‡‡ The OAA calls for states to provide state leadership by designating an LAD. Title III requires that “(t)he plan shall provide assurances 

that each state will assign personnel (one of whom shall be known 

as a LAD) to provide state leadership in developing legal assistance 

programs for older individuals throughout the state.” Chapter 4 of 

Title VII reinforces this mandate with very similar language and provides guidance on the role of the LAD. Source: https://acl.gov/sites/ 

default/fles/about-acl/2020-04/Older%20Americans%20Act%20 

Of%201965%20as%20amended%20by%20Public%20Law%20116-

131%20on%203-25-2020.pdf 

. The LAD is intended to play a 

key role in statewide eforts to promote and preserve 

the autonomy, dignity, independence, and fnancial 

security of older persons, provide access to the system 

of justice, and advocate for the preservation of the 

rights and benefts of older persons. The person in this 

position has the opportunity to work with the SUA to 

set a vision for an efective legal services delivery system for older adults. The LAD is an important advocate 

for legal services and a strategic connector, working 

across the network to strengthen the legal services 

delivery system. From advocating for resources essential to legal providers to helping older adults fnd an 

attorney with proper expertise, the developer is critical 

to championing the rights of older adults and ensuring 

that the promise of the OAA is fulflled.73 

State LAD Program Services: Legal assistance developers provide leadership at the state level to coordinate 

certain elder rights activities in the state to ensure 

■ state leadership in securing and maintaining 

the legal rights of older individuals; 

■ state capacity for coordinating the provision 

of legal assistance; 

■ state capacity to provide technical assistance, 

training, and other supportive functions to area 

agencies on aging, legal assistance providers, 

ombudsmen, and other persons, as appropriate; 

■ state capacity to promote fnancial management 

services to older individuals at risk 

of conservatorship; 

■ state capacity to assist older individuals in understanding their rights, exercising choices, benefting 

from services and opportunities authorized by law, 

and maintaining the rights of older individuals at 

risk of guardianship; and 

■ state capacity to improve the quality and quantity of 

legal services provided to older individuals.74 

Target Populations and Eligibility: Activities of the 

program are intended to coordinate the availability of 

legal information, advice, assistance, and advocacy 

to persons 60 years of age and older in greatest social 

and economic need, as well as to caregivers of older 

adults. 

Program Highlights: No funds have been appropriated 

under this section, and no data are collected on activities of LADs. 

Subtitle B—Native American Organization and 

Elder Justice Provisions 

Purpose of the Native American Organization and 

Elder Justice Provisions: Sections 751 and 752 under 

this subtitle establish programs to promote elder 

justice in Indian country, similar to the provisions in 

Section 721, including promoting a comprehensive 

elder justice system and multidisciplinary teams. 

Services: Activities and services authorized under this 

subtitle include establishment of a coordinating council, support to multidisciplinary teams, data collection, 

promotion of public awareness, and training. 

Target Population and Eligibility: Eligible entities 

under Subtitle B are identifed as Indian tribes or 

organizations serving older individuals who are 

Native Americans. 

Program Highlights: No funds have been appropriated 

under this subtitle. Tribal elder justice activities are 

carried out under Title VI. 

Overview on Older Americans Act Title III, VI, and VII Programs | 49 
 

 

Older Americans Act Data Collection and Access 

As the primary federal agency responsible for administering the OAA, ACL collects information and reports 

on the performance of Title III, VI, and VII programs 

using grantee data collection tools, a centralized 

reporting system, and a publicly available program 

data portal. In compliance with the Government 

Performance and Results Act of 1993, the OAA and 

ACL’s AoA, all 50 states, the District of Columbia, 

Guam, Puerto Rico, American Samoa, the Northern 

Mariana Islands, and the U.S. Virgin Islands report 

detailed information on OAA program participants, 

services, and expenditures annually. 

Data Collection Tools 

Title III 

State Performance Report75 

The SUAs and AAAs use the state performance report 

(SPR) to collect data and report on the activities carried 

out under Title III. The SPR includes demographic data, 

performance data on programs and services, and data 

on the infrastructure of home- and community-based 

services. Fiscal year 2021 was the fnal reporting year 

§§

§§ https://acl.gov/sites/default/fles/programs/2020-01/State_ 

Program_Report_0985-0008_Expires12312022.pdf 

using the current version of the SPR. 

Starting October 1, 2021, Title III grantees will begin 

¶¶

¶¶ https://omb.report/icr/202105-0985-002/doc/111857300 

collecting data using a new version of the SPR, 

along with new defnitions of terms in the SPR. The 

new version of the SPR reduces the number of data 

elements that grantees must collect and report by 

70% compared to the current version of the SPR. 

Beginning in January 2023, Title III grantees will submit 

SPR data to ACL using the new version of the SPR. Grantees will submit the data through ACL’s new data reporting system, the Older Americans Act Performance76 

Reporting System (OAAPS; more information on OAAPS 

provided below). 

National Survey of Older Americans Act Participants77 

Since 2003, ACL has conducted the National Survey of 

Older Americans Act Participants (NSOAAP), an annual, 

nationally representative survey of OAA participants 

that assesses the efectiveness of Title III programs. 

Data from the NSOAAP help ACL to maintain program 

accountability and demonstrate the program’s success 

in achieving legislative goals. The survey instruments 

include questions that measure client opinions of 

service quality and outcomes and also capture client 

characteristics, such as demographics and physical 

and social functioning. 

The NSOAAP uses a two-stage sample design. First, a 

national sample of AAAs is selected. Second, a random 

sample of clients served by these AAAs is selected to 

participate in the survey. The NSOAAP consists of six 

separate surveys, one for each of the following Title III 

service areas: caregiver, home-delivered meals, congregate meals, homemaker, transportation, and case management. Types of measures within each service area 

include the length of time and frequency of service use, 

ratings of service quality, perceived benefts of services, 

social and physical function, and demographics. 

Please note, the NSOAAP was suspended in 2020 due 

to the COVID-19 pandemic. Skipping data collection for 

that year eliminated a potential additional burden on 

AAAs, which faced signifcant demands adjusting their 

programming and responding to new reporting requirements. For more information, see the section, “Impact 

of COVID-19 Pandemic on OAA Programs.” 

National Survey of Areas Agencies on Aging 

Since 2007, ACL, in collaboration with the National 

Association of Area Agencies on Aging (n4a), also 

conducts an online survey every 2 to 3 years to gather 

information about AAAs. The survey tracks important 

50 | 
 

 

 

 

 

 

new trends in programs, services, and funding afecting older adults in communities across the United 

States. Topic areas include programs, services, stafing, budgets, and sources of funding. The most recent 

survey was completed in September 2019, receiving 

485 responses from the 618 AAAs, which represented 

a response rate of 78.5%. For a detailed report on the 

2020 survey fndings, see this fnal report.*** 

*** https://www.usaging.org/Files/AAA-Survey-Report-2020%20 

Update-508.pdf 

Title VI 

Annual Program Performance Report 

Title VI grantees use ACL’s Annual Program Performance 

Report††† 

††† https://oaaps.acl.gov/api/upload/download?title=VI&downloadType=NewPPRForm 

(PPR) to report on the activities carried out 

under Title VI. The PPR consists of two major parts. 

Part A/B collects information on clients and service 

units for Title VI nutrition and supportive services. Part 

C collects information on Title VI caregiver services. All 

Title VI grantees receive Parts A/B funding and therefore submit data for Parts A/B. Those Title VI grantees 

that also receive Part C funding submit data for both 

Part A/B and Part C of the PPR. 

National Survey of Title VI Programs 

Approximately every 3 years (2009, 2014, 2017, 2020), 

ACL helps support the National Title VI Program Survey 

to explore trends, new directions, and evolving needs 

of Title VI programs across the country. Topic areas 

include Title VI program budgets, staf, administration, 

service provision, and partnerships. In 2020, ACL 

conducted the survey for the fourth time, distributing 

the web-based version to 276 Title VI grantees. For a 

detailed report on the 2020 survey fndings, see this 

fnal report.‡‡‡ 

‡‡‡ https://www.usaging.org/Files/TitleVI-Survey-Report-508.pdf 

See the State Annual Long-Term Care OMBudsman 

Report, OMB 0985-0005,

Title VII 

Annual Performance Report 

Data for Title VII Chapter 2 are collected and reported using the National Ombudsman Reporting System (NORS). 

§§§

§§§ https://omb.report/omb/0985-0005 

 for more information about 

NORS. Information on the eforts of long-term care 

ombudsman programs, including data on funding, stafing, facilities and beds, detail about complaints handled, and other program activities are reported annually 

by each state long-term care ombudsman program. 

State Performance Report78 

Data for Title VII Chapters 3 and 4 grants are collected using ACL’s SPR (see details in Title III section 

above).¶¶¶ Data about program expenditures and 

elder rights accomplishments are collected. 

Data Reporting System 

This year, ACL has launched a new data reporting 

system (sofware tool): the Older Americans Act 

Performance System (OAAPS) , which is a centralized 

system for use by Title III, VI, and VII grantees to submit 

their annual performance/program reports. Access is 

restricted to authorized users (i.e., ACL staf members, 

ACL grantees). Grantees can upload their data to the 

system using an OAAPS upload template (available in 

CSV, XLSX, and XML fle formats) or through manual 

data entry directly in the system. The OAAPS also allows 

grantees and ACL to validate data uploads and run 

reports on data housed in the system. 

Data Portal79 

Data submitted to ACL by grantees via OAAPS is 

reviewed and processed by ACL and then published for 

public access on the AGing, Independence, and 

Disability (AGID) Program Data Portal†††† website. 

The AGID website ofers an online query system of 

aging and disability data from ACL and the U.S. Census 

Bureau. It ofers four diferent data views: Data-at-aGlance, State Profles, Custom Tables, and Data Files. 

¶¶¶ When states give Chapter 3 funding to ombudsman programs, 

the activity funded with those grants is reported in NORS. 

** ** https://oaaps.acl.gov/welcome 

†††† https://agid.acl.gov/ 

Overview on Older Americans Act Title III, VI, and VII Programs | 51 
 

Using Title III, VI, and VII Data 

Policy makers, state leaders, advocates, and other 

stakeholders need accurate and timely information 

about Title III, VI, and VII programs to assess their 

reach, efectiveness, and potential impact. Data are 

key for monitoring ACL’s progress toward achieving its 

strategic goals, objectives, and priorities; for supporting 

ACL’s budget justifcations; for monitoring program 

performance; and for supporting program improvement.80 In addition, information about OAA programs 

can be used for research and analysis to inform federal, 

state, and local aging and social services policy. 

The OAA programs produce rich data about Title III, VI, 

and VII clients and services. These data can help answer 

key questions about the programs, such as the following: 

■ How much funding is allocated to individual service 

types? 

■ How do expenditures difer by service type? 

■ How many individuals receive services? 

■ How many units of service (e.g., meals, hours of 

assistance) are delivered? 

■ What are the characteristics of service recipients? 

■ What is the health status of service recipients? 

■ How helpful are the services? 

Although the OAA provides minimum requirements and 

guidance to the aging services network, states have 

flexibility to tailor programs and services to best meet 

the needs of older adults they serve. When interpreting 

OAA data, it is important to consider similarities and 

diferences across states, such as the following: 

■ Structure. The structural organization of the state 

long-term care ombudsman program difers across 

states, which may afect the management and 

efciency of programs, including how data are 

collected and reported. Specifcally, programs may 

be centralized or decentralized, impacting who 

has programmatic and personnel oversight. In addition, state long-term care ombudsman programs 

may be located in diferent ofces (e.g., SUA, an 

independent agency within state government, or a 

contracted entity outside state government). Thus, 

program data should be considered withing these 

structural diferences. 

52 | 
 

■ Services. Although authorized services under 

Titles III and VI are defned in the OAA, specifc 

service design and implementation vary from state 

to state. The ACL provides detailed defnitions to 

programs on services for which data are collected; 

however, these defnitions are reasonably flexible 

to allow for variation at the local level. For example, “supplemental service” recipients can receive 

items such as wheelchairs, adjustable beds, 

personal emergency response systems, and a 

number of various medical equipment or supplies 

to support caregivers. Although this level of flexibility does not apply to all services, it is important 

to note when considering state level comparisons. 

Additionally, not all states provide data for all the 

services measured in the SPR. 

■ Data systems. Grantees difer in how they collect and 

maintain OAA program data. Depending on the age 

and sophistication of their data management systems, states may collect additional information, such 

as age and living arrangement sizes and types across 

funding authorities. Budget and stafng limitations 

are ofen mentioned among the top difculties with 

collecting and extracting OAA program data. 

■ Funding options. Some states administer services 

and programs in cooperation with local governments and with the contribution of state and county dollars. This constitutes a distinct diference in 

funding that has implications for interpreting data 

on measures like the number of individuals served 

and availability of services. 

■ Client feedback. The NSOAAP provides nationally 

representative data about Title III services participants; however, these data are not representative 

for smaller geographic areas, such as individual 

states. Currently, data can only be stratifed by the 

four regions identifed by the U.S. Census Bureau 

(i.e., Northeast, Midwest, South, West). 

We encourage readers to review data in light of these 

complexities. Detailed information about the surveys 

and operational defnitions used for Title III, VI, and 

VII data can be found on the AGID program data portal 

website. It may also be helpful to check your state’s 

website or check with your SUA director if you need 

further clarifcation on data issues. 

Overview on Older Americans Act Title III, VI, and VII Programs | 53 
Impact of COVID-19 Pandemic on OAA Programs 

As a result of the COVID-19 pandemic, decision makers at all levels of government had to adjust to a “new 

normal” that balances the need to prevent the spread 

of COVID-19 with eforts to continue to support the 

health, well-being, and independence of older adults. 

Just like other service programs, OAA programs had to 

adjust and transform to respond to changes in the type 

and number of services needed and in the ways services could be safely delivered. Given these changes, 

the data reported by OAA grantees—such as number of 

clients served, number of service units provided, and 

types of services provided—may be diferent from data 

reported in previous years. It is also important to note 

that some of the changes to OAA programs may outlast 

the virus itself, thus leading to a “new normal” not 

only for what services are provided and how they are 

provided, but also for how data are reported and for 

what kind of story the data tell. 

The following sections briefly describe the impact 

of the COVID-19 pandemic on general OAA program 

factors. Additional details about the impact of the 

pandemic on services for Title III, VI, and VII LTCOP are 

provided in the specifc program results modules. 

Impact on OAA Funding and Spending 

As highlighted in the introduction of this report, Congress 

passed several laws providing additional funding for 

OAA programs to help meet the needs of older adults 

during the COVID-19 pandemic.81,82 As a result of these 

new laws, millions of dollars in additional funding were 

provided for nutrition programs, caregiver support 

programs, disease prevention, grants for tribal organizations, and long-term care ombudsman programs and 

other elder rights protection activities. 

In addition, Congress allowed for flexibility to meet 

needs as they arose and to do so based on the unique 

needs in communities. For example, the CARES Act 

contained a provision allowing for transfers up to 100%, 

without prior approval, between funding under Subparts 

1 (congregate nutrition services) and 2 (homedelivered nutrition services) of Title III-C; amended the 

defnition of “homebound” for purposes of homedelivered meals eligibility to include an individual who 

is “unable to obtain nutrition because the individual is 

practicing social distancing”; and waived the nutrition 

requirements under these nutrition programs, while 

encouraging nutritious meals to be served. It also gave 

tribes flexibility to use Title VI Parts A/B and/or Part C 

for any disaster relief activities for older individuals or 

family caregivers served under the OAA. In addition, the 

CARES Act transfer flexibility allowed states to use OAA 

funding for operational changes needed to accommodate a shif from in-person to socially distanced service 

delivery, such as contactless home delivered meals, 

drive-through meals, phoned well-being checks, and 

expanded grocery/pharmacy/supply delivery. 

However, the additional funding also required state 

and local agencies and providers to document and 

report how these funds were allocated and spent. 

Given the diferent funding streams, tracking the exact 

funding source used for each service and reporting on 

all activities created challenges for agencies and providers. (See section on impact on OAA program data 

collection below for more details.) 

Impact on OAA Providers and Stafng 

Some providers had to close their doors for some period of time during the pandemic, with some reopening 

and closing again, in response to local COVID-19 positivity rates. Other programs were deemed essential 

and continued to provide essential services. To ensure 

staf were kept as safe as possible, providers developed and implemented safety protocols. For example, 

entities provided personal protective equipment, staf 

had to wears masks, and many providers switched to 

remote work and stopped in-person visits with clients. 

54 | 
 

Individuals of color and tribal elders 

were especially vulnerable during 

the pandemic and potentially 

required more services than other 

populations, and residents living in 

nursing homes were not able to 

receive in-person visits for an 

extended period of time. 

Providers also assigned new job functions for staf to 

focus on the most urgent client priorities and expanded their provider networks to work with nontraditional 

partners, such as community groups, in more formal 

ways. However, providers also had to adjust to reductions in their numbers of paid staf and volunteer staf, 

due in part to staf being out sick, leaving their positions, or being laid of because of program closures. 

Given that the OAA service delivery system is heavily 

reliant on volunteers to deliver services, providers 

have likely faced challenges for continuing to meet the 

needs in their communities. 

Impact on OAA Services and Service Delivery 

The AAAs’ role as conduits for federal funding allowed 

them to receive additional funds quickly, while their 

role as community leaders and innovators aforded 

them flexibility in how they used the aid. In a survey 

administered to AAAs in May, 2020, 93% of respondents reported they were serving more clients since 

the pandemic began, and 69% saw an increased need 

for AAA services among clients they were already 

serving.83 In addition, types of service needs by existing OAA clients, including those who receive services 

from AAAs, tribal organizations, and other community 

providers, shifed: there was greater demand for meal 

services and telephone reassurance and wellness 

checks but less demand for other services, such as 

transportation services. For legal assistance providers, 

case types changed with providers seeing an increase 

in eviction cases and cases related to the termination 

of benefts and essential services. 

Due to structural and systemic inequities, which were 

exacerbated during the pandemic, service needs may 

also have changed across populations. Individuals 

of color and tribal elders were especially vulnerable 

during the pandemic and potentially required more 

services than other populations, and residents living in 

nursing homes were not able to receive in-person visits 

for an extended period of time. 

Given changes in services needs and restrictions in 

providing in-person services, many providers also 

adjusted their methods of delivering services and tried 

new ways to continue to provide services. For example, 

many meal providers (funded under Title III and Title VI) 

shifed their congregate meal services to grab-and-go 

and home-delivery distribution or provided new supports, such delivering medication. Ombudsmen adjusted by contacting facilities, families, and residents by 

phone, email, or video calls while restrictions for entering nursing homes were in place. Court-based legal 

services were forced to become remote and provided 

remote access to communication tools, fles, documents, case management systems, and mechanisms 

to have remote meetings. Other providers shifed from 

Overview on Older Americans Act Title III, VI, and VII Programs | 55 
in-person programs (e.g., health and wellness classes) 

to the virtual delivery of programs.84 

Many providers also reduced the frequency or duration of in-home services; reserved in-home services 

for the most at-risk or vulnerable; prioritized personal 

care over chore support; and made other alterations 

to balance COVID-19 realities with their clients’ very 

individual and signifcant needs. 

Impact on OAA Program Data Collection 

and Reporting85 

States began receiving supplemental COVID-19 funds 

midway through FY 2020, which required ACL to 

quickly update its existing SPR guidance to include 

reporting requirements for states’ use of supplemental funds. ACL asked states to report on their use of 

COVID-19 funds by including an open response “narrative” with their annual SPR. The COVID-19 narratives 

ACL received from states had varying levels of detail, 

due in part to the flexibility of ACL’s reporting format. 

Data on numbers of clients served and services unit 

were difcult to obtain due to grantees’ challenges and 

additional burden related to collecting and managing 

OAA program data during the pandemic. For example, 

some grantees did not track clients and service units 

for the supplemental funds separately. Some providers changed what types of services they provided 

and how, and they may have experienced challenges 

aligning services with current data variables. (For 

example, should a boxed lunch be counted as a meal 

or a consumable supply?) Existing systems may not 

have provided sufcient flexibility to track additional 

and new data, and data for some service areas may not 

have been captured because some services had to be 

suspended during the pandemic. 

Despite the challenges presented by the pandemic, 

OAA Title III, VI, & VII grantees and providers adjusted 

successfully to continue to serve their communities 

and provide much needed services. Grantees showed 

great creativity, flexibility, and resilience to use existing and new OAA funding to provide services to individuals with the greatest social and economic needs. 

56 | 
Overview on Older Americans Act Title III, VI, and VII Programs | 57 

 

 

References 

1 U.S. Census Bureau. (2018, September). Projected 

population by single year of age, sex, race, and 

Hispanic origin for the United States: 2016 to 2060. 

https://www.census.gov/data/datasets/2017/ 

demo/popproj/2017-popproj.html 

2 Khalfani-Cox, L. (2017, February 14). Can you aford 

to age in place? AARP. https://www.aarp.org/ 

money/budgeting-saving/info-2017/costs-ofaging-in-place.html 

3 Knickman, J. R., & Snell, E. K. (2002). The 2030 

problem: Caring for aging baby boomers. Health 

Services Research, 37(4), 849–894 

4 Administration for Community Living. (2020, 

September 29). About ACL. https://acl.gov/aboutacl. 

5 Administration for Community Living. (2020, 

September 29). About community living. https://acl. 

gov/about-community-living. 

6 Statement of Organization, Functions, and 

Delegations of Authority; Administration 

for Community Living. 80 FR 38319. 

https://www.federalregister.gov/ 

documents/2015/06/02/2015-13351/statementof-organization-functionsand-delegations-ofauthority-administration-for-community-living 

7 AARP Public Policy Institute. (2019, February). 

Spotlight: Older Americans Act. https://www. 

aarp.org/content/dam/aarp/ppi/2019/02/olderamericans-act.pdf 

8 Older Americans Act, 42 U.S.C. § 3018. 

9 Administration for Community Living. (2021, July 

8). Older Americans Act. https://acl.gov/about-acl/ 

authorizing-statutes/older-americans-act 

10 Congressional Research Service. (2018, November 

14). Older Americans Act: Overview and funding. 

https://fas.org/sgp/crs/misc/R43414.pdf 

11 Administration for Community Living. (2021, July 

8). Historical evolution of programs for older 

Americans. https://acl.gov/about-acl/authorizingstatutes/older-americans-act 

12 O’Shaughnessy, V. (n.d.). Older Americans Act: The 

foundation of the aging services network. ADvancing 

States. http://www.advancingstates.org/sites/ 

nasuad/fles/Older%20Americans%20Act%20 

The%20Foundation%20of%20the%20Aging%20 

Services%20Network%20-%20Updated.pdf 

13 Administration for Community Living. (2018). Profle 

of American Indians and Alaska Natives age 65 and 

over. https://acl.gov/sites/default/fles/Aging%20 

and%20Disability%20in%20America/2018AIAN_ 

OAProfle.pdf 

14 Department of Health and Human Services’ 

Ofce of the Assistant Secretary for Planning and 

Evaluation; Centers for Medicare and Medicaid 

Services; Health Resources and Services 

Administration; & Department of Labor’s Ofce 

of the Assistant Secretary for Policy, Bureau of 

Labor Statistics and Employment and Training 

Administration. (2003). The future supply of 

long-term care workers in relation to the aging 

baby boom generation. Report to Congress. 

https://aspe.hhs.gov/sites/default/fles/private/ 

pdf/72961/ltcwork.pdf 

15 U.S. Census Bureau. (2018, September). Projected 

population by single year of age, sex, race, and 

Hispanic origin for the United States: 2016 to 2060. 

https://www.census.gov/data/datasets/2017/ 

demo/popproj/2017-popproj.html 

16 Administration for Community Living. (2018). 

Profle of American Indians and Alaska Natives 

age 65 and over. https://acl.gov/sites/default/ 

fles/Aging%20and%20Disability%20in%20 

America/2018AIAN_OAProfle.pdf 
58 | 

17 U.S. Census Bureau. (2018, September). Projected 

population by single year of age, sex, race, and 

Hispanic origin for the United States: 2016 to 2060. 

https://www.census.gov/data/datasets/2017/ 

demo/popproj/2017-popproj.html 

18 O’Shaughnessy, V. (n.d.). Older Americans Act: 

The foundation of the aging services network. 

ADvancing States. http://www.advancingstates. 

org/sites/nasuad/fles/Older%20Americans%20 

Act%20The%20Foundation%20of%20the%20 

Aging%20Services%20Network%20-%20 

Updated.pdf 

19 Administration for Community Living. (2022, 

February). Eldercare Locator. https://eldercare.acl. 

gov/Public/Index.aspx 

20 Tilly, J., & Hudgins, K. (2017, October). Community 

living for American Indian, Alaskan Native, 

and Native Hawaiian elders. Administration for 

Community Living. https://ltcombudsman.org/ 

uploads/fles/issues/native-communities-issuebrief.pdf 

21 Administration for Community Living. (2022, 

February). Eldercare Locator. https://eldercare.acl. 

gov/Public/Index.aspx 

22 Congressional Research Service. (2018, November 

14). Older Americans Act: Overview and funding. 

https://crsreports.congress.gov/product/pdf/R/ 

R43414 

23 National Association of Area Agencies on Aging. 

(2017, March). Area agencies on aging: Local 

leaders in aging and community living. https:// 

www.n4a.org/Files/LocalLeadersAAA2017.pdf 

24 AARP Public Policy Institute. (2019, February). 

Spotlight: Older Americans Act. https://www. 

aarp.org/content/dam/aarp/ppi/2019/02/olderamericans-act.pdf 

25 AARP Public Policy Institute. (2019, February). 

Spotlight: Older Americans Act. https://www. 

aarp.org/content/dam/aarp/ppi/2019/02/olderamericans-act.pdf 

26 O’Shaughnessy, V. (n.d.). Older Americans Act: The 

foundation of the aging services network. ADvancing 

States. http://www.advancingstates.org/sites/ 

nasuad/fles/Older%20Americans%20Act%20 

The%20Foundation%20of%20the%20Aging%20 

Services%20Network%20-%20Updated.pdf 

27 Congressional Research Service. (2018, November 

14). Older Americans Act: Overview and funding. 

https://crsreports.congress.gov/product/pdf/R/ 

R43414 

28 Administration for Community Living. (2021, April 

5). Older Americans Act (OAA). https://acl.gov/ 

about-acl/older-americans-act-oaa 

29 Congressional Research Service. (2018, November 

14). Older Americans Act: Overview and funding. 

https://crsreports.congress.gov/product/pdf/R/ 

R43414 

30 Administration for Community Living. (2021, 

September 17). Elder Justice Act mandatory grants. 

https://acl.gov/grants/elder-justice-mandatorygrants 

31 Administration for Community Living. (2020, 

July 8). Older Americans Act COVID-19 response. 

https://acl.gov/sites/default/fles/common/ 

Posted%20-%20COVID-19%20AoA_Guidance%20 

Collections%20from%20ACL%20website_ 

Final_07082020.pdf 

32 Brown, K. E. (2010, September 7). Older Americans 

Act: Preliminary observations on services requested 

by seniors and challenges in providing assistance. 

Government Accountability Ofce. https://www. 

gao.gov/new.items/d101024t.pdf 

33 National Academy of Sciences. (1995). Older 

Americans Act: A staf summary (a publication of the 

Select Committee on Aging). https://www.ncbi.nlm. 

nih.gov/books/NBK231086/ 

34 Administration for Community Living. (2019, 

January 31). Prevention of elder abuse, neglect, 

and exploitation. https://acl.gov/programs/ 

elder-justice/prevention-elder-abuse-neglect-andexploitation 
Overview on Older Americans Act Title III, VI, and VII Programs | 59 

35 Older Americans Act of 1965, 42 U.S.C. § 3030d. 

36 Older Americans Act of 1965, 42 U.S.C. §§ 

3030e–3030g-22. 

37 Administration for Community Living. (2021, July 

12). Health promotion. https://acl.gov/programs/ 

health-wellness/disease-prevention 

38 Older Americans Act of 1965, 42 U.S.C. §§ 

3030s–3030s-2. 

39 Administration for Community Living. (n.d.). The 

Older Americans Act: Aging well since 1965. http:// 

www.ma4web.org/wp-content/uploads/2015/06/ 

OAA-Brief-Final.pdf 

40 Godfrey, D. M. (2015). The Older Americans Act: 

Seeking to improve lives. BIFOCAL: A Journal of the 

ABA Commission on Law and Aging, 36(6), 123–144. 

https://www.americanbar.org/content/dam/aba/ 

publications/bifocal/BIFOCALJuly-August2015.pdf 

41 Administration for Community Living. (n.d.). Title III 

and VII state program report data elements, state 

program report transmittal requirements, state 

program report defnitions. https://acl.gov/sites/ 

default/fles/programs/2020-01/State_Program_ 

Report_0985-0008_Expires12312022.pdf 

42 Administration for Community Living. (n.d.). AGing, 

Independence, and Disability (AGID) Program Data 

Portal. Custom tables, state program reports (SPR). 

https://agid.acl.gov/CustomTables/SPR/Year/ 

43 Administration for Community Living. (n.d.). Title III 

and VII state program report data elements, state 

program report transmittal requirements, state 

program report defnitions. https://acl.gov/sites/ 

default/fles/programs/2020-01/State_Program_ 

Report_0985-0008_Expires12312022.pdf 

44 Administration for Community Living. (n.d.) The 

Older Americans Act: Aging well since 1965. http:// 

www.ma4web.org/wp-content/uploads/2015/06/ 

OAA-Brief-Final.pdf 

45 Nutrition and Aging Resource Center. (2023, 

March 28). Nutrition and Aging Resource Center: 

Building the capacity of senior nutrition programs. 

https://nutritionandaging.org/wp-content/ 

uploads/2020/03/Nutrition-Services-IncentiveProgram-of-the-Older-Americans-Act.-FINAL-3.30. 

pdf 

46 Administration for Community Living. (2022, March 

28). Nutrition services. https://acl.gov/programs/ 

health-wellness/nutrition-services 

47 Administration for Community Living. (n.d.). AGing, 

Independence, and Disability (AGID) Program Data 

Portal. Custom tables, state program reports (SPR). 

https://agid.acl.gov/CustomTables/SPR/Year/ 

48 Administration for Community Living. The Older 

Americans Act: Aging well since 1965. http://www. 

ma4web.org/wp-content/uploads/2015/06/OAABrief-Final.pdf 

49 Administration for Community Living. (n.d.). 

National Family Caregiver Support Program (NFCSP) 

process evaluation: Aging network webinar. https:// 

acl.gov/sites/default/fles/programs/2017-02/ 

NFCSP_Final_Report-briefng.pdf 

50 Westat. (2018). Outcome Evaluation of the National 

Family Caregiver Support Program. https://acl.gov/ 

sites/default/fles/programs/2018-12/Caregiver_ 

Outcome_Evaluation_Final_Report.pdf 

51 Administration for Community Living. (n.d.). Title III 

and VII state program report data elements, state 

program report transmittal requirements, state 

program report defnitions. https://acl.gov/sites/ 

default/fles/programs/2020-01/State_Program_ 

Report_0985-0008_Expires12312022.pdf 

52 Administration for Community Living. (n.d.). The 

Older Americans Act: Aging well since 1965. http:// 

www.ma4web.org/wp-content/uploads/2015/06/ 

OAA-Brief-Final.pdf 

53 Administration for Community Living. (2021, October 

5). National Family Caregiver Support Program. 

https://acl.gov/programs/support-caregivers/ 

national-family-caregiver-support-program 
60 | 

 

54 Administration for Community Living. (n.d.). AGing, 

Independence, and Disability (AGID) Program Data 

Portal. Custom tables, state program reports (SPR). 

https://agid.acl.gov/CustomTables/SPR/Year/ 

55 Older Americans Act of 1965, Section 601, 42 U.S.C. 

3057a. 

56 Administration for Community Living. (2020, October 

19). Services for Native Americans (OAA Title VI). 

https://acl.gov/programs/services-native-americansoaa-title-vi#:~:text=The%20Administration%20 

for%20Community%20Living,used%20to%20 

refne%20program%20services. 

57 Administration for Community Living. (2021). 

Evaluation of the ACL Title VI Programs: Final 

report. https://acl.gov/sites/default/fles/ 

programs/2021-05/ACL_TitleVI_Evaluation_Final_ 

Report_508.pdf 

58 O’Shaughnessy, V. (n.d.). Older Americans Act: 

The foundation of the aging services network. 

ADvancing States. http://www.advancingstates. 

org/sites/nasuad/fles/Older%20Americans%20 

Act%20The%20Foundation%20of%20the%20 

Aging%20Services%20Network%20-%20Updated. 

pdf 

59 Administration for Community Living. (n.d.). Older 

Americans Act Performance System. https://oaaps. 

acl.gov/Resources/techDocs 

60 Administration for Community Living. (n.d.). Older 

Americans Act Performance System. https://oaaps. 

acl.gov/Resources/techDocs 

61 Administration for Community Living. (2020, October 

19). Services for Native Americans (OAA Title VI). 

https://acl.gov/programs/services-native-americansoaa-title-vi#:~:text=The%20Administration%20 

for%20Community%20Living,used%20to%20 

refne%20program%20services. 

62 Administration for Community Living. (2019). 

Evaluation of the ACL Title VI programs: Year 2 

interim report. https://acl.gov/sites/default/fles/ 

programs/2019-03/16004_ACL_TitleVI_Year2_ 

Report_012219_508v2.pdf 

63 Administration for Community Living. (2021). 

Evaluation of the ACL Title VI programs: Final 

report. https://acl.gov/sites/default/fles/ 

programs/2021-05/ACL_TitleVI_Evaluation_Final_ 

Report_508.pdf 

64 Administration for Community Living. (2020, 

October 19). Services for Native Americans (OAA 

Title VI). https://acl.gov/programs/servicesnative-americans-oaa-title-vi#:~:text=The%20 

Administration%20for%20Community%20 

Living,used%20to%20refne%20program%20 

services. 

65 Administration for Community Living. (2020). 

Evaluation of the ACL Title VI programs: Year 3 

interim report. https://acl.gov/sites/default/fles/ 

programs/2020-03/ACL_TitleVI_EvaluationYear3_ 

InterimReport_1_2020_508.pdf 

66 Administration for Community Living. (n.d.). Older 

Americans Act Performance System. https://oaaps. 

acl.gov/Resources/techDocs 

67 Administration on Aging. (2003). Older 

Americans Act: A layman’s guide. https://www. 

piercecountywa.gov/DocumentCenter/View/1031/ 

pierceseniorinfoolderamericansactguide?bidId= 

68 O’Shaughnessy, V. (n.d.). Older Americans Act: 

The foundation of the aging services network. 

ADvancing States. http://www.advancingstates. 

org/sites/nasuad/fles/Older%20Americans%20 

Act%20The%20Foundation%20of%20the%20 

Aging%20Services%20Network%20-%20Updated. 

pdf 

69 National Association of States United for Aging 

and Disabilities. (2019). State Long-Term Care 

Ombudsman Program: 2019 revised primer for state 

agencies. https://ltcombudsman.org/uploads/ 

fles/support/nasuad-ombudsman-acl-rpt-0319-

web-fnal.pdf 

70 Older Americans Act Reauthorization Act of 2016, 

Pub. L. No. 114-144, Section 721. (2016). https:// 

www.congress.gov/bill/114th-congress/senatebill/192/text 
 

 

 

 

 

71 Older Americans Act pf 1965. 42 U.S.C. § 3018. 

72 Administration for Community Living. (n.d.). Elder 

rights: Safeguards for the most vulnerable among 

us. https://acl.gov/sites/default/fles/news%20 

2017-03/Elder_Rights_Safeguards_for_the_Most_ 

Vulnerable_Among_Us_1.pdf 

73 National Center on Law & Elder Rights. (2018). The 

essential role of the state Legal Assistance Developer. 

https://ncler.acl.gov/Files/Essential-Role-of-theLAD-Issue-Brief.aspx 

74 State Legal Assistance Development, 42 U.S.C. § 

3058j. 

75 Administration for Community Living. (2020, 

January 17). Performance of Older Americans Act 

programs. https://acl.gov/programs/performanceolder-americans-act-programs 

76 Administration for Community Living. (2021, 

October 19). Title III Older Americans Act (OAA) state 

performance report (SPR) and Older Americans 

Act performance system (OAAPS). https://acl. 

gov/news-and-events/announcements/olderamericans-act-oaa-state-program-performancereport-spr-redesign 

77 Administration for Community Living. (2020, 

October 17). Performance of Older Americans Act 

programs. https://acl.gov/programs/performanceolder-americans-act-programs 

78 Administration for Community Living. (2020, 

October 17). Performance of Older Americans Act 

programs. https://acl.gov/programs/performanceolder-americans-act-programs 

79 Administration forCommunity Living. (n.d.). 

Navigating ACL’s AGing, Independence, and 

Disability (AGID) program data portal. https://acl. 

gov/sites/default/fles/news%202017-03/Elder_ 

Rights_Safeguards_for_the_Most_Vulnerable_ 

Among_Us_1.pdf 

80 Administration for Community Living. (2019). 

Department of Health and Humans Services. 

Fiscal year 2020: Administration for Community 

Living: Justifcation of estimates for appropriations 

committees. https://acl.gov/sites/default/fles/ 

about-acl/2019-04/FY2020%20ACL%20CJ%20508. 

pdf 

81 Administration for Community Living. (2021, April 5). 

Older Americans Act (OAA). https://acl.gov/aboutacl/older-americans-act-oaa 

82 Congressional Research Service. (2021). Older 

Americans Act: Overview and funding. https:// 

crsreports.congress.gov/product/pdf/R/R43414/30 

83 National Association for Area Agencies on 

Aging. (2020). #AAAsAtWork for older adults: A 

snapshot of area agency on aging responses to 

COVID-19. https://www.usaging.org/Files/n4a_ 

MemberSurveyReport2020_Web_07July2020.pdf 

84 National Association for Area Agencies on 

Aging. (2020). #AAAsAtWork for older adults: A 

snapshot of area agency on aging responses to 

COVID-19. https://www.usaging.org/Files/n4a_ 

MemberSurveyReport2020_Web_07July2020.pdf 

85 United States Government Accountability Ofce. 

(2021). COVID-19: Selected states modifed meal 

provision and other Older Americans Act services to 

prioritize safety. https://www.gao.gov/assets/gao22-104425.pdf 

OLDER AMERICANS ACT 

Title III Programs 

2020 PROGRAM 

RESULTS 
 

Acknowledgment 

Jennifer Tillery, Senior Aging and Disability Program 

Coordinator, in the Ofce of Performance and 

Evaluation, Center for Policy and Evaluation, 

Administration for Community Living (ACL) assisted 

with preparation of the module. U.S. Department of 

Health and Human Services (HHS) in partnership with 

New Editions Consulting, Inc., under contract number 

HHSP233201500113I/HHSP23337002T. 

Disclaimer 

The views, opinions, and content of this publication are 

those of the authors and do not necessarily reflect the 

views, opinions, or policies of OPE, ACL, or HHS. Nothing in 

this document constitutes a direct or indirect endorsement 

by ACL of any nonfederal entity’s products, services, or 

policies, and any reference to nonfederal entity’s products, 

services, or policies should not be construed as such. 

Public Domain Notice 

All material appearing in this publication is in the public 

domain and may be reproduced or copied without permission from ACL. Citation of the source is required. However, this publication may not be reproduced or distributed 

for a fee without specifc, written authorization by ACL. 

Electronic Access 

This publication may be downloaded from https://acl. 

gov/aging-and-disability-in-america/data-and-research 

or https://agid.acl.gov. 

Recommended Citation 

Administration for Community Living (2022). Overview 

of Older Americans Act Title III, VI, and VII Programs: 

2020 Summary of Highlights and Accomplishments. U.S. 

Department of Health and Human Services. https://acl. 

gov/aging-and-disability-in-america/data-and-research. 
Title III | Table of Contents 

Title III Program Highlights and Accomplishments III-2 

List of Exhibits III-4 

Abbreviations and Acronyms III-4 

Impact of Coronavirus Disease of 2019 Pandemic on Title III Services III-5 

Funding Use III-5 

Title III Services III-5 

Part 1 | 2020 State Performance Report Data Highlights III-7 

State Performance Report Data Categories III-7 

Number of Agencies and Providers III-8 

Number and Characteristics of Service Recipients III-11 

Service Units III-25 

Part 2 | 2019 National Survey of Area Agencies on Aging III-30 

Program Structure III-30 

Programs III-32 

Partnerships III-33 

Services III-35 

Appendix A: Title III Defnitions III-37 

References III-41 

Older Americans Act Title III | 2020 Program Results | III-1 
| 

Title III 

Program Highlights and Accomplishments 

Older Americans Act (OAA) Title III programs are comprehensive and provide 

essential supports for older adults. In fact, one way or another, OAA programs 

and services touch almost every older American’s life, directly or indirectly. For 

instance, senior centers are important gathering places where adults participate 

in essential programs focused on health, wellness, education, and social participation. The nutrition programs support food security for thousands of low-income 

and food-insecure people each day. Caregiver support programs help ensure that 

older adults can stay in their homes.1

 At the local level, older adults, caregivers, 

and other community stakeholders directly determine how current and future 

programs are implemented, based on the needs of each community. 

Overall, the programs ofer an impressive return 

on investment by leveraging state, local, and 

private dollars and mobilizing volunteers to 

help millions of older adults and caregivers 

age in their homes and communities every 

year. Also, because people aging in place are 

less likely to need more costly hospital and 

institutional care paid for through Medicare 

and Medicaid, the programs save taxpayer 

dollars as they enable older adults to remain 

independent and healthy in their own homes, 

where they prefer to be.2 

In 2020, OAA Title III program data shows 

Title III funded 56 state agencies, 625 local 

agencies that coordinated and ofered services to older adults, 6,072 senior centers, 

and almost 30,000 service providers. More 

than 10.1 million older persons received 

Title III services, including more than 198.6 

million home-delivered meals; 39.6 million 

congregate meals; 26.9 million hours of personal care; 21.3 million hours of homemaker 

services; and 13.6 million rides to medical 

appointments, grocery stores, and other 

activities. In addition, Title III programs 

provided support to over 186,000 caregivers 

serving elderly individuals, delivering more 

than 5 million hours of respite care to these 

caregivers and more than 530,000 counseling/ 

support groups/caregiver training sessions. 

One of the key goals of the OAA Title III 

programs is ensuring the nation’s most 

III-2 | 
Older Americans Act Title III 

vulnerable older adults have the services 

they need to remain independent in their 

communities. Thus, even though all Americans over the age of 60 are eligible to receive 

OAA services, states must target individuals 

with the greatest economic and social need, 

with a particular emphasis on those who are 

most vulnerable. The 2020 OAA Title III program data show services are indeed reaching the most vulnerable older adults in the 

nation—those most in need of services to 

remain independent. Specifcally, the data 

reported by service recipients show that 

Title III services reached the following 

populations in 2020: 

■ Older adults living in poverty—over one 

third of service recipients 

■ Older adults living alone—almost half of 

service recipients 

■ Older adults living in rural areas—about 

one third of service recipients 

■ Older adults who require assistance with 

activities of daily living (ADLs) or instrumental activities of daily living (IADLs)— 

more than half of service recipients requiring assistance with ADLs, about three out 

of four requiring assistance with IADLs 

■ The oldest of the older adults—almost a 

quarter of service recipients age 85+ 

> 1/3 

OLDER ADULT 

SERVICE RECIPIENTS 

LIVE IN POVERTY 

1/2 

OLDER ADULT 

SERVICE RECIPIENTS 

LIVE ALONE 

1/3 

OLDER ADULT 

SERVICE RECIPIENTS 

LIVE IN RURAL AREAS 

1/4 

OLDER ADULT 

SERVICE RECIPIENTS 

ARE AGE 85+ 

Older Americans Act Title VII LTCOP | 2020 Program Results | III-3 
III-4 | 

 

 

 

 

 

 

 

 

List of Exhibits 

Exhibit 1. Number of Providers by Service Type III-10 

Exhibit 2. Number of Unduplicated Persons Served by Service Type III-12 

Exhibit 3. Title III Service Recipients by Gender III-13 

Exhibit 4. Title III Service Recipients by Age III-14 

Exhibit 5. Title III Service Recipients by Race/Ethnicity III-16 

Exhibit 6. Number of Clients With Difculty Performing Three or More ADLs 

by Cluster 1 Registered Service III-22 

Exhibit 7. Number of Clients With Difculty Performing Three or More IADLs 

by Cluster 1 Registered Service III-24 

Exhibit 8. Total Service Units, by Service Type III-27 

Exhibit 9. Units of Services, Caregivers Serving Older Adults III-28 

Exhibit 11. Average Number of Services Units Provided per Client by Service III-29 

Exhibit 12. AAA Structures (n=487) III-30 

Exhibit 13. Area Served by AAAs III-31 

Exhibit 14. Type of Entities AAAs Partner With III-33 

Exhibit 15. Most Commonly Services Provided by AAA III-35 

Abbreviations and Acronyms 

AAA Area Agency on Aging 

ADLs Activities of Daily Living 

COVID-19 Coronavirus Disease of 2019 

IADLs Instrumental Activities of Daily Living 

OAA Older Americans Act 

OMB Ofce of Management and Budget 

SHIP State Health Insurance 

Assistance Program 

SPR State Program Report 

SUA State Unit on Aging 
Impact of Coronavirus Disease of 2019 Pandemic on Title III Services 

Funding Use 

The president declared the coronavirus disease of 

2019 (COVID-19) pandemic as a national emergency on 

March 13, 2020, authorizing states to use OAA Title III 

funds for disaster relief as they saw ft without having 

to submit a transfer request to ACL.3 As a result, states 

were allowed to use Title III-B, C, D, and/or E funds 

for any disaster relief activities for older individuals 

or family caregivers served under the OAA, such as 

providing 

■ drive-through, take-out, or home-delivered meals; 

■ well-being checks via phone, in person, or via 

virtual means; and 

■ homemaker, chore, grocery/pharmacy/supply 

delivery, or other services. 

Title III Services 

Over the last year, OAA Title III grantees have 

described how the COVID-19 pandemic has impacted 

their programs.4,5 The bullets below provide a summary 

of the information shared by grantees for how the 

pandemic impacted Title III service needs and 

service provision. 

■ Shifed to remote work. Many providers, such as legal assistance providers, shifed to remote work to 

continue operations and keep clients and staf safe. 

For remote legal work, this shif entailed ensuring 

access to communication tools, fles, documents, 

case management systems, and mechanisms to 

have meetings. 

■ Experienced increase/decrease in demand for services. In Fiscal Year (FY) 2020, states overall provided about 24 million more meals overall and about 

32% more home-delivered meals—using COVID-19 

and other funds—compared to FY 2019. Grantees 

also reported a large increase in calls for information, assistance, and referrals to services during 

the pandemic. The demand for in-home services 

decreased early in the pandemic, and public health 

orders led to the suspension of many in-person 

services, such adult day care centers. 

■ Changed spending patterns. Grantees reported 

spending more funds for meal programs as food 

costs increased and providers needed to purchase 

additional supplies, such as personal protective 

equipment and food delivery containers. Expenditures for some in-person services, such as homemaker services, remained steady, but expenditures 

for adult day care and transportation decreased. 

■ Transformed meal programs. Most states replaced 

congregate meals with home-delivered meals 

during the pandemic. While the number of congregate meals dropped, some states continued to 

provide congregate meals during the pandemic, 

and some providers replaced meals in traditional 

congregate settings with grab-and-go meals paired 

Older Americans Act Title III | 2020 Program Results | III-5 
III-6 | 

with in-person or virtual socialization. Grantees also 

adjusted meal delivery approaches. For instance, 

some localities made single deliveries with multiple 

days’ worth of meals, and some provided frozen 

meals instead of hot meals to limit the number of 

times they needed to make contact with the client. 

■ Delivered food boxes and groceries and care 

packages. Grantees provided groceries, food 

boxes, and care packages to their clients as either 

a supplement or an alternative to home-delivered 

meals. Care packages included shelf-stable foods 

and household items such as toilet paper, along 

with puzzles and games to provide their clients with 

activities during the stay-at-home order. 

■ Experienced staf shortages. Grantees reported 

experiencing shortages of staf and volunteers and 

implementing alternative solutions to continue 

providing essential services. For instance, some 

grantees reported that many of their traditional 

volunteers, ofen older adults themselves, no longer felt comfortable serving during the pandemic 

or were directed by state or local orders to stay at 

home. In response, grantees shifed staf roles to 

address most critical needs, used COVID-19 funding 

to hire additional delivery drivers for their home-delivered meals, or used their transportation services’ 

vans to deliver meals to their clients. 

■ Modifed transportation services. Many grantees 

reported suspending or signifcantly reducing 

their transportation services early in the pandemic 

due to safety concerns. However, as the pandemic 

continued, some localities modifed transportation 

services to comply with social distancing measures 

and ensure older adults were able to get to their 

medical appointments. Once COVID-19 vaccines 

were available for older adults, grantees provided 

transportation services for older adults going to 

and from their vaccination appointments. 

■ Cancelled in-person activities. Evidence-based disease prevention and health promotion services program grantees reported having to cancel workshops 

that had already been initiated and were scheduled 

to be provided. 

■ Shifed to virtual programs: Programs provided 

virtual activities, including trainings, workshops, 

and wellness classes (e.g., tai chi, chronic disease 

self-management, diabetes self-management). 

As part of this efort, grantees tested diferent 

platforms to determine whether programs were 

accessible to older adults. Grantees also developed 

statewide marketing tools to promote the use of 

technology and to reach target audiences, engaged 

a range of existing and new partners to deliver virtual programs, and developed materials to support 

activities and enhance communication with clients. 

■ Temporarily suspended or reduced in-home care 

services. Grantees reported temporarily stopping or 

reducing in-home supportive services for clients at 

the beginning of the pandemic. 

■ Conducted phone/virtual check-ins. Most programs 

reported conducting well-being checks via telephone instead of going into clients’ homes. These 

calls allowed them to assess the needs of their 

clients and make sure clients had the support they 

needed during stay-at-home orders. 

■ Temporarily suspended or reduced caregiver support services. Early during the pandemic, several 

grantees reported shutting down caregiver support 

groups and respite care services. As the pandemic 

continued, most programs shifed to provide virtual 

support groups for caregivers and resumed ofering 

limited respite care services to caregivers. 
Older Americans Act Title III | 2020 Program Results | III-7 

 

 

Part 1 | 2020 State Performance Report Data Highlights* 

* Reporting year 2020 for SPRs was 

October 1, 2019–September 30, 2020. 

State Performance Report Data Categories 

Data in State Performance Reports (SPRs) are 

categorized into registered and unregistered services. 

Registered services are services that require demographic and client characteristics to be reported. 

Cluster 1 registered services require detailed client 

profles to be reported, whereas cluster 2 registered 

services require summary client profles only. 

■ Cluster 1 Registered Services: Personal care, 

homemaker, chore, home-delivered meals, adult 

day care/health services, and case management. 

■ Cluster 2 Registered Services: Assisted transportation, congregate meals, and nutrition 

counseling. 

Unregistered services, also known as a cluster 3 

non-registered service, do not require demographic 

and consumer characteristics to be reported. 

■ Cluster 3 Non-registered Services: Transportation, 

legal assistance, nutrition education, information 

and assistance, outreach, other services, health 

promotion, and cash and counseling. 

The SPRs also include Title III, Part E services (caregiver services) data. Data on caregiver services are 

grouped into two categories: 

■ caregivers serving elderly individuals (hereinafer 

“caregivers serving older adults”) and 

■ grandparents and other elderly caregivers 

serving children (hereinafer “caregivers 

serving children”). 
III-8 | 

 

 

Number of Agencies and Providers 

The majority of funding for OAA programs flows from 

the federal to the state level and from there to the local 

level. Most states and territories have a state-level 

ofce on aging (State Unit on Aging, or SUA), responsible for developing and administering multiyear state 

plans that advocate for and aid older residents, their 

families, and, in many states, adults with physical 

disabilities. Most states and territories also have Area 

Agencies on Aging (AAAs).6 These are public or private 

nonproft agencies designated by a state to address 

the needs and concerns of all older persons at the 

regional and local levels. The AAAs work with service 

providers, such as senior centers, to deliver the 

services to eligible clients. 

Number of Agencies and Providers 

■ Total number of SUAs = 56 

■ Total number of AAAs = 625 

■ Total number of senior centers = 6,072 

■ Total number of service providers†

† Excluding AAAs providing direct services. 

= 29,258 

• Minority = 2,775 

• Rural = 7,102 

Number of SUA Agency Staf 

■ Total number of paid staf = 5,212 

Number of AAA Staf 

■ Total number of staf = 47,722 

• Paid staf = 25,976 

• Volunteers = 21,746 

56 | State Units 

on Aging 625 | Area Agencies 

on Aging 
Older Americans Act Title III | 2020 Program Results | III-9 

Number of Providers by Service Type 

In 2020, caregivers serving older adults programs 

reported by far the largest number of providers (10,877), 

followed by personal care programs (4,150), and 

congregate meal programs (4,076). Nutrition counseling 

program and adult day care/health care programs had 

the fewest providers (340 and 774, respectively). 

Congregate Meal Programs 

4,076 Caregiver Programs 

10,877 Nutrition Counseling 

Programs 

Personal Care Programs 340 

4,150 Adult Day Care/ 

Health Care Programs 

774 

6,072 Senior 

Centers 29,258 Service Providers: | | Minority = 2,775 | Rural = 7,102 
III-10 | 

 

Exhibit 1. Number of Providers by Service Type 

Caregivers Serving Older Adults 9,263 

Personal Care 4,150 

Congregate Meals 4,076 

Home-Delivered Meals 3,862 

Homemaker 3,725 

Transportation 3,119 

Information and Assistance 2,421 

Health Promotion and 

Disease Prevention 2,133 

Nutrition Education 2,099 

Caregivers Serving Children 1,642 

Case Management 1,395 

Outreach 1,381 

Chore 1,032 

Legal Assistance 976 

Assisted Transportation 778 

Adult Day Care/Health 774 

Nutrition Counseling 340 

0 2,000 4,000 6,000 8,000 10,000 12,000 

Notes: Counts include registered and unregistered services as well as caregiver services. 
Older Americans Act Title III | 2020 Program Results | III-11 

 

 

 

Number and Characteristics of Service Recipients 

Number of Title III Service Recipients‡ 

‡ Number does not include caregivers served. 

In 2020, states and territories reported an estimated 

total of more than 10 million (10,186,166) unduplicated 

Title III service recipients (including registered and 

unregistered service recipients). Of those, 2,740,755 

were recipients of registered services, and 8,419,937 

were recipients of unregistered services§

§ Count of registered and unregistered services recipients does 

not sum to 19,186,166 since individuals may be receiving both 

types of services. 

. Among 

clients receiving registered services, approximately 33% 

(908,174) represented ethnic/racial minority populations. 

The following sections provide data for registered 

services. When available, data on service recipients 

for Title III, Part E (caregiver services) are provided 

separately. 

Number of Title III Service Recipients by Service Type 

In 2020, home-delivered meal programs reported the 

highest number of service recipients (1,447,910), followed by congregate meal programs (1,329,203), and 

case management programs (487,548). 

Total Service Recipients 

10,186,166 

Number of Service Recipients by Service Type 

Home-delivered meals 

1,447,910 

Congregate meals 

1,329,203 

Case Management 

487,548 
III-12 | 

 

 

Exhibit 2. Number of Unduplicated Persons Served by Service Type 

Home-Delivered Meals 1,447,910 

Congregate Meals 1,329,203 

Case Management 487,548 

Homemaker 193,958 

Caregivers Serving 

Older Adults 186,052 

Personal Care 122,614 

Assisted Transportation 48,722 

Chore 27,677 

Nutrition Counseling 22,221 

Adult Day Care/Health 16,776 

Caregivers Serving Children 12,237 

0 300,000 600,000 900,000 1,200,000 1,500,000 

Notes: Clients may be receiving more than one service. Counts include those from all registered services and caregiver services (unduplicated 

number of caregivers). Counts for unregistered services (cluster 3 services) are not collected and thus not included. Caregiver services do not 

include data from the service categories of access assistance and information services. 
Older Americans Act Title III | 2020 Program Results | III-13 

Number of Title III Service Recipients by Gender 

In 2020, more than three out of fve (61.5%) service recipients were female. The majority of caregivers serving 

older adults or children in 2020 (66.8% and 83.8%, respectively) were female also. 

Exhibit 3. Title III Service Recipients by Gender 3.3% 

35.2% 

Male 

955,484 

61.5% 

Female 

1,671,728 

Missing 

90,553 

TOTAL 

2,717,765 

Notes: Counts include those 

from all registered services. 

Counts do not include data 

from caregiver services. 

Caregivers Serving Older Adults by Gender 

Gender Number of Caregivers Percent 

Caregivers Serving Older Adults – Male 37,280 25.4 

Caregivers Serving Older Adults – Female 97,825 66.8 

Missing 11,405 7.8 

TOTAL 146,510 100 

Caregivers Serving Children – Male 1,328 14.0 

Caregivers Serving Children – Female 7,962 83.8 

Missing 208 2.2 

TOTAL 9,498 100 

Notes: Data are for Title III Part E Group 1 services only. Group 1 services include counseling/support groups/caregiver training, respite care, 

supplemental services, and self-directed care. 
III-14 | 

Number of Title III Service Recipients by Age 

41% | In 2020, 41.3% of service recipients were between ages 60 and 74. One third (33.3%) of 

service recipients were between ages 75 and 80, and almost a quarter (23.6%) of service 

recipients were 85 years and older. 

Exhibit 4. Title III Service Recipients by Age 

Age 60–74 1,098,933 

Age 75–84 886,370 

Age 85+ 628,362 

0 200,000 400,000 600,000 800,000 100,000 1,200,000 

Notes: Clients may be receiving more than one service. Counts include those from all registered services. Age was missing for 48,603 

service recipients. 
Older Americans Act Title III | 2020 Program Results | III-15 

 

Caregivers Serving Older Adults by Age 

35% Most caregivers serving older adults (161,384 caregivers) were in the age range of 60–74 

years (35%). Most caregivers serving children (9,713 caregivers) were in the age range of | 55–74 years (75.6%). 

Age Range Number of Caregivers Percent 

Caregivers Serving Individuals – Age < 60 39,926 24.7 

Caregivers Serving Older Adults – Age 60–74 56,536 35.0 

Caregivers Serving Older Adults – Age 75–84 27,465 17.0 

Caregivers Serving Older Adults – Age 85+ 10,650 6.6 

Missing 26,807 16.6 

TOTAL 161,384 100 

Caregivers Serving Children – Age 55–74 7,346 75.6 

Caregivers Serving Children – Age 75–84 1,154 11.9 

Caregivers Serving Children – Age 85+ 335 3.4 

Missing 599 9.0 

TOTAL 9,434 100 

Notes: Data are for Title III Part E Group 1 services only. Group 1 services include counseling/support groups/caregiver 

training, respite care, supplemental services, and self-directed care. 
III-16 | 

 

Number of Title III Service Recipients by Race/Ethnicity 

70% | The majority of service recipients, approximately 70%, were white alone (Hispanic and not 

Hispanic), making up approximately 70% of service recipients. 

Exhibit 5. Title III Service Recipients by Race/Ethnicity 

American Indian or 

Alaska Native Alone 

1.3% 

Two or More Races 

1.7% 

Other Race 

1.9% 

Asian Alone, 

4.6% 

White Alone, 

Hispanic 

10.5% 

Black/African American 

Alone 

13.2% 

White Alone, 

Not Hispanic 

58.1% 

Missing 

8.3% 

Hawaiian Pacifc 

Islander Alone 

0.4% 

Notes: Counts include those from all registered services. “Alone,” when appended to a racial category, means that the individual designated 

only one race category. 
Race/Ethnicity Number of Service Recipients Percent 

White Alone, Not Hispanic 1,570,420 58.1 

Black/African American Alone 357,110 13.2 

White Alone, Hispanic 283,378 10.5 

Asian Alone 123,365 4.6 

Other Race 50,222 1.9 

Two or More Races 46,578 1.7 

American Indian or Alaska Native Alone 35,678 1.3 

Native Hawaiian/Pacifc Islander Alone 11,843 0.4 

Missing 224,278 8.3 

TOTAL 2,702,872 100 

Caregivers Serving Older Adults 

60% |

A majority of the caregivers serving older adults (60%) were white alone 

(Hispanic and not Hispanic). 

Race/Ethnicity Number of Caregivers Percent 

White Alone, Not Hispanic 80,513 49.9 

Black/African American Alone 20,238 12.5 

White Alone, Hispanic 16,130 10.0 

Asian Alone 4,992 3.1 

Other Race 2,758 1.7 

Two or More Races 1,566 1.0 

American Indian or Alaska Native Alone 610 0.4 

Native Hawaiian/Pacifc Islander Alone 483 0.3 

Missing 34,113 21.1 

TOTAL 161,403 100 

Notes: Data are for Title III Part E Group 1 services only. Group 1 services include counseling/support groups/caregiver training, respite care, 

supplemental services, and self-directed care.

 | III-17 
III-18 | 

Caregivers Serving Children 

30% The largest racial/ethnic minority group of grandparents and other older caregivers serving 

children were Black/African American, making up over 30% of these caregivers. | 

Race/Ethnicity Number of Caregivers Percent 

White Alone, Not Hispanic 4,361 45.8 

Black/African American Alone 3,074 32.3 

White Alone, Hispanic 1,058 11.1 

American Indian or Alaska Native Alone 149 1.6 

Other Race 119 1.3 

Two or More Races 101 1.1 

Asian Alone 58 0.6 

Native Hawaiian/Pacifc Islander Alone 47 0.5 

Missing 545 5.7 

TOTAL 9,512 100 

Notes: Data are for Title III Part E Group 1 services only. Group 1 services include counseling/support groups/caregiver training, respite care, 

supplemental services, and self-directed care. 
Older Americans Act Title III | 2020 Program Results | III-19 

Number of Title III Service Recipients by Living Alone Status 

44% People who live by themselves are at higher risk of nursing home entry because they may 

be isolated or lack supports to assist with ADLs. In part because of this risk, OAA targets | services to those who live alone, and participants in many Title III programs are more likely 

to live by themselves than older Americans nationally.7 

In 2020, approximately equal percentages of service recipients reported living alone 

(44%) and not living alone (45.4%). 

TOTAL 

2,740,755 

10.6% 

Missing 

45.4% 

Not Living Alone¶ 

¶ Number of service recipients not living 

alone was calculated by taking the total 

number of service recipients and subtracting the number of service recipients who 

reported they lived alone and the number 

of service recipients for whom “living 44% alone” data were missing. 

Living 

Alone 

Notes: Counts include those 

from all registered services. 

Number of Title III Service Recipients by Poverty Status 

36% About one third (35.8%) of Title III service recipients in 2020 lived in poverty. | 

TOTAL 

2,740,755 

17.1% 

Missing 

47.6% 

With income above 

poverty line** 

** Number of service recipients 

with an income above the poverty 

line was calculated by taking the 

total number of service recipients 

and subtracting the number of 

service recipients who reported 

income below the poverty line and 

the number of service recipients from 

whom poverty data were missing. 

35.3% 

With income below 

poverty line 

Notes: Counts include those 

from all registered services. 
III-20 | 

 

Number of Title III Service Recipients by Rurality 

33% In 2020, about one third (33.2%) of service recipients reported living in rural areas. | 

TOTAL 

2,740,755 

4.4% 

Missing 

62.5%

 Nonrural†† 

†† Number of non-rural service 

recipients was calculated by taking 

the total number of service recipients 

and subtracting the number of service 

recipients who reported living in 

rural areas and the number of service 

recipients from whom rurality data 

were missing. 

33.2% 

Rural 

Notes: Counts include those 

from all registered services. 

23% In 2020, almost one in four caregivers serving older adults (23.1%) reported living in rural 

settings. Among grandparents and other older caregivers serving children, 27.9% reported 

living in rural settings. | 

TOTAL 

161,403 

67.9% 

Caregivers Serving 

Older Adults – Nonrural‡‡ 

‡‡ Number of non-rural service 

recipients was calculated by taking 

the total number of service recipients and subtracting the number 

of service recipients who reported 

living in rural areas and the number 

of service recipients from whom 

rurality data were missing. 

9% 

Missing 

23.1% 

Caregivers Serving 

Older Adults – Rural 

Notes: Data are for Title III Part E Group 1 

services only. Group 1 services include 

counseling/support groups/caregiver 

training, respite care, supplemental 

services, and self-directed care. 
Older Americans Act Title III | 2020 Program Results | III-21 

 

TOTAL 

10,312 

5.4% 

Missing 

66.8% 

Caregivers Serving Children 

– Nonrural* 

* Number of non-rural service recipients was calculated by taking the 

total number of service recipients and 

subtracting the number of service 

recipients who reported living in 

rural areas and the number of service 

recipients from whom rurality data 

were missing. 

27.9% 

Caregivers Serving Children 

– Rural 

Notes: Counts include those 

from all registered services. 

Need for Assistance With ADLs for Title III Service Recipients 

31% | People who have difculty performing three or more ADL or IADLs are at increased risk of 

nursing home placement. Among ADLs are eating, dressing, bathing, toileting, transferring in 

and out of bed/chair, and walking. Among IADLs are preparing meals, shopping for personal 

items, medication management, managing money, using telephone, doing heavy housework, 

doing light housework, and transportation ability (i.e., the individual’s ability to make use of 

available transportation without assistance).8 Thus, it is critical that people who need assistance with ADLs or IADLS receive services that allow them to remain in their homes. 

Almost one third of service recipients (31.1%) reported requiring assistance with three 

or more ADLs. Most clients who had difculty performing three or more ADLs were 

home-delivered meal service recipients (406,466). 

ADL Group Number of Service Recipients Percent 

0 ADLs 536,945 30.8 

1 ADL 166,471 9.6 

2 ADLs 155,447 8.9 

3+ ADLs 541,676 31.1 

Missing 341,772 19.6 

Notes: Results include clients receiving Cluster 1 registered services. Cluster 1 registered services include personal care, homemaker, chore, 

home-delivered meals, adult day care/health, and case management. Counts of impairment in ADLs are based on the inability to perform 

one or more of the following six ADLs without personal assistance or stand-by assistance, supervision, or cues: eating, dressing, bathing, 

toileting, transferring in and out of bed/ chair, and walking.9 
III-22 | 

Exhibit 6. Number of Clients With Difculty Performing Three or More ADLs by Cluster 1 Registered Service 

800,000 

600,000 

400,000 

200,000 

0 

jjjj jjjj jjjj 

Homemaker 

93,265 

llllllllnnn nnn nnn 

Home-Delivered 

Meals 

406,466 

Case Management 

171,050 

Notes: Results include clients receiving Cluster 1 registered services. Cluster 1 registered services include personal care, homemaker, chore, 

home-delivered meals, adult day care/health, and case management. Counts of impairment in ADLs are based on the inability to perform 

one or more of the following six ADLs without personal assistance or stand-by assistance, supervision, or cues: eating, dressing, bathing, 

toileting, transferring in and out of bed/chair, and walking.10 
Older Americans Act Title III | 2020 Program Results | III-23 

 

Need for Assistance With IADLs for Title III Service Recipients 

56% | More than half of service recipients (56.2%) reported requiring assistance with three or 

more IADLs. Most clients who required assistance with three or more IADLS were recipients 

of home-delivered meal services (764,948). 

IADL Group Number of Service Recipients Percent 

0 IADLs 254,448 14.6 

1 IADL 85,467 4.9 

2 IADLs 77,291 4.4 

3+ IADLs 981,131 56.2 

Missing 348,019 19.9 

Notes: Results include clients receiving Cluster 1 registered services. Cluster 1 registered services include personal care, homemaker, chore, 

home-delivered meals, adult day care/health, and case management. Counts of impairment in IADLs are based on the inability to perform 

one or more of the following eight IADLs without personal assistance, stand-by assistance, supervision, or cues: preparing meals, shopping 

for personal items, medication management, managing money, using telephone, doing heavy housework, doing light housework, and 

transportation ability (the individual’s ability to make use of available transportation without assistance).11 
III-24 |

Exhibit 7. Number of Clients With Difculty Performing Three or More IADLs by Cluster 1 Registered Service 

1,400,000 

1,200,000 

1,000,000 

800,000 

600,000 

400,000 

200,000 

0 

Homemaker 

150,789 

Case Management 

320,405 

jjjjjjjj jjjjjjjj jjjjjjjjllll llll llll llllnnnnnn

Home-Delivered 

Meals 

764,984 

Notes: Results include Cluster 1 registered services. Cluster 1 registered services include personal care, homemaker, chore, home-delivered 

meals, adult day care/health, and case management. Counts of impairment in IADLs are based on the inability to perform one or more of the 

following eight IADLs without personal assistance, stand-by assistance, supervision, or cues: preparing meals, shopping for personal items, 

medication management, managing money, using telephone, doing heavy housework, doing light housework, and transportation ability (the 

individual’s ability to make use of available transportation without assistance).12 
Older Americans Act Title III | 2020 Program Results | III-25 

 

Service Units 

The following section provides data highlights for 

delivered Title III service units. Service units refer to a 

specifed quantity of a service. 

Defnition of Service Units for Diferent Services 

■ Access Assistance (1 contact) – A service that assists 

caregivers in obtaining access to the services and 

resources that are available within their communities. To the maximum extent practicable, it ensures 

that the individuals receive the services needed by 

establishing adequate follow-up procedures. 

■ Adult Day Care/Adult Day Health (1 hour) – Personal 

care for dependent elders in a supervised, protective, and congregate setting during some portion 

of a day. Services ofered in conjunction with adult 

day care/adult day health typically include social 

and recreational activities; training; counseling; 

and services such as rehabilitation, medications 

assistance, and home health aide services for adult 

day health. 

■ Assisted Transportation (1 one-way trip) – Assistance and transportation, including escort, provided to a person who has difculties (physical or 

cognitive) using regular vehicular transportation. 

■ Case Management (1 hour) – Assistance in the form 

of either access or care coordination in circumstances where the older person is experiencing diminished functioning capacities, personal conditions, 

or other characteristics which require the provision 

of services by formal service providers or family 

caregivers. Activities of case management include 

such practices as assessing needs, developing care 

plans, authorizing and coordinating services among 

providers, and providing follow-up and reassessment, as required. 

■ Chore (1 hour) – Assistance such as heavy housework, 

yard work, or sidewalk maintenance for a person. 

■ Congregate Meal (1 meal) – A meal provided to an 

eligible individual in a congregate or group setting. 

The meal as served meets all requirements of the 

OAA and state/local laws. 

■ Counseling (1 session per caregiver) – Counseling 

to caregivers to assist them in making decisions 

and solving problems relating to their caregiver 

roles. This service includes counseling to individuals, support groups, and caregiver training (of 

individual caregivers and families). 

■ Homemaker (1 hour) – Assistance such as preparing 

meals, shopping for personal items, managing money, using the telephone, or doing light housework. 

■ Home-Delivered Meal (1 meal) – A meal provided 

to an eligible individual in their place of residence. 

The meal is served in a program administered by 

SUAs and/or AAAs and meets all requirements of 

the OAA and state/local laws. 

■ Information Services (1 activity) – A service for 

caregivers that provides the public and individuals 

with information on resources and services available to the individuals within their communities. 

Note: Service units for information services are for 

activities directed to large audiences of current or 

potential caregivers, such as disseminating publications, conducting media campaigns, and other 

similar activities. 

■ Legal Assistance (1 hour) – Legal advice, counseling 

and representation by an attorney or other person 

acting under the supervision of an attorney. 

■ Nutrition Education (1 session per participant) – 

A program to promote better health by providing 

accurate and culturally sensitive information about 

nutrition, physical ftness, or health (as it relates 

to nutrition) and instruction to participants, caregivers, or participants and caregivers in a group or 

individual setting overseen by a dietician or individual of comparable expertise. 

■ Nutrition Counseling (1 session per participant) 

– Individualized guidance to individuals who are at 
III-26 | 

nutritional risk because of their health or nutrition history, dietary intake, chronic illnesses, or medications 

use, or to caregivers. Counseling is provided oneon-one by a registered dietician and addresses the 

options and methods for improving nutrition status. 

■ Outreach (1 contact) – Intervention with individuals initiated by an agency or organization for the 

purpose of identifying potential clients (or their 

caregivers) and encouraging their use of existing 

services and benefts. 

■ Personal Care (1 hour) – Personal assistance, standby assistance, supervision, or cues. 

■ Respite Care (1 hour) – Services which ofer temporary, substitute supports or living arrangements for 

care recipients in order to provide a brief period of 

relief or rest for caregivers. Respite care includes Inhome respite (personal care, homemaker, and other 

in-home respite); respite provided by attendance of 

the care recipient at a senior center or other nonresidential program; institutional respite provided by 

placing the care recipient in an institutional setting 

such as a nursing home for a short period of time as 

a respite service to the caregiver; and (for grandparents caring for children) summer camps. 

■ Services for caregivers – Counseling (1 session 

per participant); respite care (1 hour); supplemental services; information services (1 activity); and 

access assistance (1 contact). 

■ Supplemental services – Services provided on a 

limited basis to complement the care provided by 

caregivers. Examples of supplemental services 

include, but are not limited to, home modifcations, 

assistive technologies, emergency response systems, and incontinence supplies. 

■ Transportation (1 one-way trip) – Transportation 

from one location to another. Does not include any 

other activity. 
Older Americans Act Title III | 2020 Program Results | III-27 

 

Number of Service Units by Service Type 

In 2020, the largest number of service units by far 

was provided for home-delivered meal programs 

(198,643,363), followed by congregate meal 

programs (48,849,070). The fewest service units 

were provided for nutrition counseling (38,644). 

Exhibit 8. Total Service Units, by Service Type 

Home-Delivered Meals 198,643,363 

Congregate Meals 48,849,070 

Personal Care 26,992,021

Homemaker 21,360,688 

Transportation 13,696,714 

Services for Caregivers 

Older Adults 8,673,083 

Adult Day Care/Health 7,585,833 

Case Management 3,391,290 

Nutrition Education 3,194,701 

Outreach 2,693,168

Assisted Transportation 1,820,428 

Legal Assistance 906,953 

Chore 632,459 

Services for Caregivers 

Serving Children 312,690

Nutrition Counseling 38,644 

0 50M 100M 150M 200M 

Notes: Counts include those from all registered and unregistered services and caregiver services (except self-directed care). 
III-28 | 

 

 

Number of Service Units by Caregiver Services 

For caregivers serving older adults, programs provided 

more than 5 million hours of respite care, approximately 1.5 million contacts to assist caregivers with access 

to assistance, 719,000 activities to provide information 

services, and over 530,000 counseling/support group/ 

caregiver training sessions. Programs also provided 

more than 825,000 supplemental services. 

Exhibit 9. Units of Services, Caregivers Serving Older Adults 

Respite Care 5,028,432 

Access Assistance 1,561,633 

Supplemental Services 825,925 

Information Services 719,203 

Counseling/Support Groups/ 

Caregiver Training 

0 

537,890 

1.5M 3M 4.5M 6M 

Exhibit 10. Units of Services, Caregivers Serving Children 

Respite Care 107,012 

Supplemental Services 92,886 

Access Assistance 64,739 

Counseling/Support Groups/ 

Caregiver Training 42,023 

Information Services 6,030 

0 40,000 80,000 120,000 
Older Americans Act Title III | 2020 Program Results | III-29 

 

For caregivers serving children, programs provided 

more than 100,000 hours of respite care, approximately 64,000 contacts to assist caregivers with access to 

assistance, over 42,000 counseling/support group/ 

caregiver training sessions, and 6,000 activities to 

provide information services. Programs also provided 

more than 92,000 supplemental services. 

Total Units per Client by Service Type 

The most service units per client were provided for 

adult day care/health programs (204 units per client 

on average), followed by home-delivered meal programs (137.8 units per client on average). The fewest 

service units per client were provided for nutrition 

counseling (0.8 units per client on average) and case 

management (6.1 units per client on average). 

Exhibit 11. Average Number of Services Units Provided per Client by Service 

0 50 100 150 200 250 

Adult Day Care/Health 204.0 

Home-Delivered Meals 137.8 

Personal Care 72.5 

Homemaker 52.1 

Congregate Meals 47.2 

Assisted Transportation 41.6 

Chore 15.3 

Case Management 6.1 

Nutrition Counseling 0.8 
III-30 | 

 

Part 2 | 2019§§

§§ The survey is conducted every 2 years in odd-numbered years (i.e., 2013, 2015, 2017, 2019). The 2019 survey was administered from 

June 2019 to September 2019. 

 National Survey of Area Agencies on Aging 

With a grant from ACL, the National Association of Area 

Agencies on Aging partnered with Scripps Gerontology 

Center of Excellence to conduct the 2019 national survey 

of AAAs. The results presented in Part 2 of this report 

are directly taking from the AAA National Survey Report: 

Meeting the Needs of Today’s Older Adults. The complete 

report can be accessed here¶¶

¶¶ https://www.usaging.org/Files/AAA-Survey-Report-2020%20Update-508.pdf 

. 

The web-based survey was distributed to 618 AAAs with 

78.5% of AAAs (n=485) responding. Some questions were 

asked of every respondent, and other questions were 

shown to a subset based on their responses to earlier 

questions. The number of respondents to a particular 

question (n) is always reported in all tables. In the 

cases of text without accompanying tables, the n can 

be assumed to be the number of respondents overall, 

485, unless noted otherwise. 

Program Structure 

Program Location 

39% |

More than one third (39%) of 

AAAs are independent nonproft 

agencies. A little over one 

quarter (27%) are housed in 

councils of government or 

regional planning and development agencies, and 

the same percentage is located within parts of county 

government. Few AAAs are part of city government 

(2%) or other structures (5%). 

Exhibit 12. AAA Structures (n=487) 5% 

Other 

27% 

Part of a council 

of governments or 

regional planning 

and development 

agency 

27% 

Part of county

 government 

2% 

Part of city 

government 

39% 

Independent 

nonprofit 

agency 
Older Americans Act Title III | 2020 Program Results | III-31 

 

Areas Served by Area Agencies on Aging*** 

*** Survey respondents were asked to choose the type of area they believed best represented their region. 

82% |

Area Agencies on Aging vary in terms of the type of areas they serve. Reflecting the OAA 

requirement that AAAs target those with the highest economic and social need, a large proportion of AAAs (82%) serve rural, remote, or frontier areas. The largest proportion of AAAs 

(43%) serve a predominantly rural area, with 25% serving a mixture of urban, suburban, 

and rural areas. 

Exhibit 13. Area Served by AAAs 

Type of Area Served Percent of AAAs Serving 

That Type of Area (n=478) 

Predominantly rural 43% 

A mix of urban, suburban, and rural 25% 

A mix of suburban and rural 11% 

A mix of urban and suburban 11% 

Predominantly urban 4% 

Predominantly suburban 4% 

Predominantly remote or frontier 3% 
III-32 | 

Programs 

Sixty-fve percent of AAAs lead or take part in Aging 

and Disability Resource Centers (ADRCs), which take 

a No Wrong Door approach to coordinating long-term 

resources and supports. This approach helps ensure 

that all individuals can fnd the information and help 

they need, regardless of where they start their search.13 

Sixty-two percent of AAAs administer local State 

Health Insurance Assistance Programs (SHIPs), which 

help Medicare-eligible consumers and their caregivers 

make decisions about their health insurance coverage 

through no-cost and unbiased counseling, assistance, 

and outreach. 

Fify-three percent of AAAs operate local long-term 

care ombudsman programs (LTCOP), which advocate 

for the rights of residents of nursing homes, assisted 

living facilities, and other adult care facilities. They 

also investigate and mediate any problems with or 

concerns about residents’ care. 

65% 

Lead or take part in Aging 

and Disability Resource 

Centers 

AAAs 

62% 

Administer local State 

Health Insurance Assistance 

Programs 

53% 

Operate local long-term 

care ombudsman programs 
Older Americans Act Title III | 2020 Program Results | III-33 

Partnerships 

Type of Partners 

Creating and strengthening partnerships is a hallmark 

of the way that AAAs operate in the community. The 

survey results showed that, on average, AAAs leverage 

17 formal and informal partnerships with other agencies and organizations to expand the reach and impact 

of their programs in their communities. 

Consistent with their core focus on elder justice, nearly 

all AAAs (92%) partner with adult protective services 

programs. Other common partners include transportation agencies (88%), SHIPs (86%), emergency 

preparedness agencies (83%), and federal programs/ 

departments (81%). Additional partnership types are 

shown in Exhibit 14. 

Exhibit 14. Type of Entities AAAs Partner With 

Type of Entity Percent of AAAs That Partner 

With Entity (n=482) 

Adult protective services 92% 

Transportation agencies 88% 

SHIPs 86% 

Emergency preparedness agencies 83% 

Federal programs/departments (e.g., Social Security, Veterans Health 

Administration Medical Center, Bureau of Indian Afairs) 81% 

Medicaid 80% 

Mental health/behavioral health organization 80% 

Public housing authority of other housing programs 79% 

Disability service organizations (e.g., Centers for Independent Living) 78% 

Long-term care facilities (e.g., nursing homes, skilled nursing facilities, 

assisted living residences) 78% 

Advocacy organizations 77% 

Hospitals and health care systems 74% 

Exhibit 14 continued on page 34 
III-34 | 

Exhibit 14 continued from page 33 

Type of Entity Percent of AAAs That Partner 

With Entity (n=482) 

Charitable organizations (e.g., United Way, Easter Seals, Red Cross) 72% 

Department of health 72% 

Law enforcement/frst responders 72% 

Other social service organizations 70% 

Faith-based organizations 68% 

Educational institutions 66% 

Health plans (e.g., commercial health plan, Medicaid managed care) 62% 

Community health clinics (e.g., Federally Qualifed Health Centers) 60% 
Older Americans Act Title III | 2020 Program Results | III-35 

 

Services 

Area Agencies on Aging ofer a set of core services as 

required by the OAA. These services fall in the service 

categories of Title III and VII. For Title III, AAAs ofer supportive services (Title III, Part B), nutrition services (Title 

III, Part C), and evidence-based prevention and health 

promotion services (Title III, Part D). Title VII services include, among others, training to help providers identify 

elder abuse, outreach and education campaigns, and 

support for coalitions or multidisciplinary teams. 

Survey results showed that, on average, AAAs provide 

27 services. Many of the most common AAA services are 

provided through Title III, Part B funding, which allows 

AAAs to provide supportive services that can be tailored 

to meet individual needs. Exhibit 15 shows the services 

most commonly ofered by AAAs, not including the core 

services previously mentioned. 

Exhibit 15. Most Commonly Services Provided by AAA 

Service Percent of AAAs That Provide 

the Service (n=489) 

Transportation 89% 

Case management 86% 

Other meals/nutrition programs (e.g., nutrition counseling, senior farmers’ 

market program) 84% 

Benefts/health insurance counseling 83% 

Homemaker 81% 

Benefts/health insurance enrollment assistance 80% 

Options counseling 79% 

Other health promotion services/programs (e.g., health screening, health 

fairs) 79% 

Personal assistance/personal care 79% 

Assessment for care planning 73% 

Elder abuse prevention/intervention 69% 

Senior center programming and activities 67% 

Chore services 66% 

Long-term care ombudsman 66% 

Assessment of long-term care service eligibility 64% 

Exhibit 15 continued on page 36 
III-36 | 

Exhibit 15 continued from page 35 

Service Percent of AAAs That Provide 

the Service (n=489) 

Home modifcation and repair 61% 

Adult day care 57% 

Personal emergency response systems 57% 

Telephone reassurance/friendly visiting 55% 

Translator/interpreter assistance 53% 
Appendix A: Title III Defnitions14 

Adult Day Care/Adult Day Health: Personal care for 

dependent elders in a supervised, protective, and congregate setting during some portion of a day. Services 

ofered in conjunction with adult day care/adult day 

health typically include social and recreational activities, training, counseling, and services such as rehabilitation, medications assistance, and home health aide 

services for adult day health. 

American Indian or Alaskan Native: A person who has 

origins in any of the original peoples of North America 

(including Central America) and who maintains tribal 

afliation or community attachment. 

Area Agency on Aging (AAA): Public or private nonprofit agency designated by a state to address the needs 

and concerns of all older persons at the regional and 

local levels. The term AAA is a general one; names of 

local AAAs may vary. The AAAs coordinate and ofer 

services that help older adults remain in their homes, 

if that is their preference, aided by services such as 

home-delivered meals, homemaker assistance, and 

whatever else it may take to make independent living a 

viable option. 

Asian: A person having origins in any of the original 

peoples of the Far East, Southeast Asia or the Indian 

subcontinent, including, for example, Cambodia, 

China, India, Japan, Korea, Malaysia, Pakistan, the 

Philippine Islands, Thailand, and Vietnam. 

Assisted Transportation: Assistance and transportation, including escort, to a person who has difculties 

(physical or cognitive) using regular vehicular transportation. 

Black or African American: A person having origins in 

any of the black racial groups of Africa. 

Caregiver: An adult family member or another individual who is an “informal” provider of in-home and 

community care to an older individual. “Informal” 

means that the care is not provided as part of a public 

or private formal service program. 

Case Management: Assistance in the form of either 

access or care coordination in circumstances where the 

older person is experiencing diminished functioning 

capacities, personal conditions, or other characteristics which require the provision of services by formal 

service providers or family caregivers. Activities of 

case management include such practices as assessing needs, developing care plans, authorizing and 

coordinating services among providers, and providing 

follow-up and reassessment, as required. 

Child: An individual who is not more than 18 years of 

age or an individual 19–59 years of age who has a disability. The term relates to a grandparent or other older 

relative who is a caregiver of a child. 

Chore Service: Assistance such as heavy housework, 

yard work, or sidewalk maintenance for a person. 

Congregate Meals: Meals provided to an eligible 

individual in a congregate or group setting. The meal 

as served meets all of the requirements of the OAA and 

state/local laws. 

Elderly Client: An eligible elderly individual (60 years 

of age or older, or who is less than 60 and has a 

diagnosis of early onset dementia) who receives OAA 

services. 

Grandparent or Other Older Relative Caregiver of a 

Child: A grandparent, step-grandparent or other relative of a child, by blood or marriage, who is 55 years of 

age or older and 

■ lives with the child; 

■ is the primary caregiver of the child because the biological or adoptive parents are unable or unwilling 

to serve as the primary caregiver of the child; and 

■ has a legal relationship to the child, as such legal 

custody or guardianship, or is raising the child 

informally. 

Health Promotion and Disease Prevention: Services 

that include health screenings and assessments; 

Older Americans Act Title III | 2020 Program Results | III-37 
organized physical ftness activities; evidence-based 

health promotion programs; medication management; 

home injury control services; and/or information, education, and prevention strategies for chronic disease 

and other health conditions that would reduce the 

length or quality of life of the person 60 or older. 

Hispanic or Latino: A person of Cuban, Mexican, Puerto 

Rican, South or Central American, or other Spanish 

culture or origin, regardless of race. 

Home-Delivered Meals: Meals provided to an eligible 

individual in his/her place of residence. The meal is 

served in a program administered by SUAs and/or 

AAAs and meets all of the requirements of the OAA and 

state/local laws. 

Homemaker: Assistance such as preparing meals, 

shopping for personal items, managing money, using 

the telephone, or doing light housework. 

Information and Assistance: A service that provides 

individuals with information on services available 

within the communities and links individuals to those 

services and opportunities, establishing adequate follow-up procedures to the maximum extent practicable. 

Web site “hits” are to be counted only if information is 

requested and supplied. 

Impairment in Activities of Daily Living (ADLs): The inability to perform one or more of the following six ADLs 

without personal assistance, stand-by assistance, supervision, or cues: eating, dressing, bathing, toileting, 

transferring in and out of bed/chair, and walking. 

Impairment in Instrumental Activities of Daily Living 

(IADLs): The inability to perform one or more of the following eight IADLs without personal assistance, standby assistance, supervision, or cues: preparing meals, 

shopping for personal items, medication management, 

managing money, using telephone, doing heavy 

housework, doing light housework, and transportation 

ability (the ability to make use of available transportation without assistance). 

Legal Assistance: Legal advice, counseling, and representation by an attorney or other person acting under 

the supervision of an attorney. 

Living Alone: A one-person household (using the census defnition of household) where the householder 

lives by themself in an owned or rented place of residence not in an institutional setting, such as a board 

and care facility, assisted living unit, or group home. 

Native Hawaiian or Other Pacifc Islander: A person 

having origins in any of the original peoples of Hawaii, 

Guam, Samoa, or other Pacifc Islands. 

Nutrition Counseling: Individualized guidance to 

individuals who are at nutritional risk because of their 

health or nutrition history, dietary intake, chronic 

illnesses, or medications use, or to caregivers. Counseling is provided one-on-one by a registered dietician 

and addresses the options and methods for improving 

nutrition status. 

Nutrition Education: A program to promote better 

health by providing accurate and culturally sensitive 

information on nutrition, physical ftness, or health (as 

it relates to nutrition) and instruction to participants, 

caregivers, or participants and caregivers in a group or 

individual setting overseen by a dietician or individual 

of comparable expertise. 

Outreach: Intervention with individuals initiated by an 

agency or organization for the purpose of identifying 

potential clients (or their caregivers) and encouraging 

their use of existing services and benefts. 

Personal Care: Personal assistance, stand-by assistance, supervision, or cues. 

Poverty: Persons considered to be in poverty are those 

whose income is below the ofcial poverty guideline 

(as defned each year by the Ofce of Management and 

Budget (OMB)and adjusted by the Secretary of Health 

and Human Services [HHS]) in accordance with subsection 673 (2) of the Community Services Block Grant Act 

III-38 | 
(42 U.S.C. 9902 (2)). The annual HHS poverty guidelines provide dollar thresholds representing poverty 

levels for households of various sizes. 

Provider: An organization or person which provides 

services to clients under a formal contractual arrangement with an AAA or SUA. Under Title III-E, in cases 

where direct cash payment is made to a caregiver and 

the ultimate provider is unknown, the number of providers may be omitted. 

Race/Ethnicity Status: The following reflects the 

requirements of OMB for obtaining information from 

individuals regarding race and ethnicity. It constitutes 

what OMB classifes as the “two-question format.” 

When questions on race and ethnicity are administered, 

respondents are to be asked about their ethnicity and 

race as two separate questions. Respondents should 

ideally be given the opportunity for self-identifcation 

and are to be allowed to designate all categories that 

apply to them. Consistent with OMB requirements, the 

following are the race and ethnicity categories to be 

used for information collection purposes: 

Ethnicity: 

■ Hispanic or Latino 

■ Not Hispanic or Latino 

Race: 

■ American Indian or Alaska Native 

■ Asian 

■ Black or African American 

■ Native Hawaiian or Other Pacifc Islander 

■ White 

Registered Client: A registered client is an individual who received at least one unit of the following 

specifed services within the reported fscal year: 

congregate meals, nutrition counseling, assisted 

transportation, personal care, homemaker, chore, 

home-delivered meals, adult day care/health, or case 

management. The count of registered clients does not 

include caregivers. 

Registered Services: Services that require demographic and client characteristics to be reported: personal 

care, homemaker, chore, home-delivered meals, adult 

day care/health, case management, congregate meals, 

nutrition counseling, or assisted transportation. Does 

not include caregiver services. 

Cluster 1 Registered Services: Personal care, 

homemaker, chore, home-delivered meals, adult 

day care/health, and case management. 

Cluster 2 Registered Services: Assisted transportation, congregate meals, and nutrition counseling. 

Rural: A rural area is any area that is not defned as 

urban. Urban areas comprise urbanized areas—with a 

central place and adjacent densely settled territories 

having a combined minimum population of 50,000— 

and incorporated places or census-designated places 

with 20,000 or more inhabitants. 

Senior Centers: Serve as a gateway to the nation’s 

aging network, connecting older adults to vital community services that can help them stay healthy and 

independent. More than 60% of senior centers are 

designated focal points for delivery of OAA services, 

allowing older adults to access multiple services in one 

place. Senior centers ofer a wide variety of programs 

and services, including meal and nutrition programs; 

Information and assistance; health, ftness, and wellness programs, transportation services public benefts 

counseling; employment assistance; volunteer and 

civic engagement opportunities; social and recreational activities; educational and arts programs; and 

intergenerational programs. To maintain operations, 

senior centers must leverage resources from a variety 

of sources. They include federal, state, and local governments; special events; public and private grants; 

businesses; bequests; participant contributions; inkind donations; and volunteer hours. Most centers rely 

on three to eight diferent funding sources. 

Older Americans Act Title III | 2020 Program Results | III-39 
 

 

Services to Caregivers: 

■ Access Assistance: A service that assists caregivers in obtaining access to the services and resources that are available within their communities. To 

the maximum extent practicable, it ensures that 

the individuals receive the services needed by 

establishing adequate follow-up procedures. 

■ Counseling: Counseling to caregivers to assist 

them in making decisions and solving problems 

relating to their caregiver roles. This service 

includes counseling to individuals, support 

groups, and caregiver training (of individual 

caregivers and families). 

■ Information Services: A service for caregivers 

that provides the public and individuals with information on resources and services available to 

the individuals within their communities. (Note: 

Service units for information services are for 

activities directed to large audiences of current 

or potential caregivers, such as disseminating 

publications, conducting media campaigns, and 

other similar activities.) 

■ Respite Care: Services which ofer temporary, 

substitute supports or living arrangements for 

care recipients in order to provide a brief period of 

relief or rest for caregivers. Respite care includes 

In-home respite (personal care, homemaker, 

and other in-home respite); respite provided by 

attendance of the care recipient at a senior center 

or other nonresidential program; institutional 

respite provided by placing the care recipient in 

an institutional setting, such as a nursing home, 

for a short period of time as a respite service to 

the caregiver; and (for grandparents caring for 

children) summer camps. If the specifc service 

units purchased via a direct payment (cash or 

voucher) can be tracked or estimated, report 

those service unit hours. If not, a unit of service in 

a direct payment is one payment. 

■ Supplemental Services: Services provided on a 

limited basis to complement the care provided 

by caregivers. Examples of supplemental services include, but are not limited to, home modifcations, assistive technologies, emergency 

response systems, and incontinence supplies. 

Transportation: Transportation from one location to 

another. Does not include any other activity. 

Unduplicated refers to individual people counted only 

once a year for a service. 

Unregistered Services (also known as a non-registered 

services): Services that do not require demographic 

and consumer characteristics to be reported. They 

include transportation, legal assistance, nutrition 

education, information and assistance, outreach, other 

services, health promotion, and cash and counseling. 

Volunteer: An uncompensated individual who provides 

services or support on behalf of older individuals. Only 

staf working under the AAA, not the AAA contractors, 

shall be included. 

White: A person having origins in any of the peoples 

of Europe, the Middle East, or North Africa. “Alone,” 

when appended to a racial category—e.g., “white 

alone”—means that the individual designated only 

one race category. 

III-40 | 
 

 

References 

1 Godfrey, M. D. (2015). Celebrating 50 years of the 

OAA: The Older Americans Act: Seeking to improve 

lives BIFOCAL: A Journal of the ABA Commission 

on Law and Aging, 36(6), 134–135. https://www. 

americanbar.org/content/dam/aba/publications/ 

bifocal/BIFOCALJuly-August2015.pdf 

2 National Association of Area Agencies on Aging. 

(2019, March). Recommendations for the reauthorization of the Older Americans Act [Policy brief). 

https://www.n4a.org/Files/n4a_PolicyBrief_OAA_ 

Reauth_2019_FinalWeb.pdf 

3 Administration for Community Living. (2020). 

Older Americans Act disaster relief. https://acl. 

gov/sites/default/fles/COVID19/OAADisasterRelief_2020-03-16.pdf 

4 National Council on Aging. (2021). Navigatiwng Older Americans Act Title IIID during the 

COVID-19 pandemic. https://www.ncoa.org/ 

article/navigating-older-americans-act-title-iiid-during-the-covid-19-pandemic 

5 U.S. Government Accountability Ofce. (2021). 

COVID-19: Selected states modifed meal provisions and other Older Americans Act services to 

prioritize safety. https://www.gao.gov/assets/ 

gao-22-104425.pdf 

6 Godfrey, D. M. (2015). Celebrating 50 years of the 

OAA: The Older Americans Act: Seeking to improve 

lives. BIFOCAL: A Journal of the ABA Commission 

on Law and Aging, 36(6), 134–135. https://www. 

americanbar.org/content/dam/aba/publications/ 

bifocal/BIFOCALJuly-August2015.pdf 

7 Altshuler, N., & Schimmel, J. (2010, July). Aging 

in place: Do Older Americans Act Title III services 

reach those most likely to enter nursing homes? 

(Research Brief Number 1). Administration on 

Aging. https://acl.gov/sites/default/fles/programs/2017-01/AoA_1_NursingHomes_041311.pdf 

8 Administration for Community Living. (2020). Title 

III and VII state program report data elements, state 

program report transmittal requirements, state 

program report defnitions. https://acl.gov/sites/ 

default/fles/programs/2020-01/State_Program_ 

Report_0985-0008_Expires12312022.pdf 

9 Administration for Community Living. (2020). Title 

III and VII state program report data elements, state 

program report transmittal requirements, state 

program report defnitions. https://acl.gov/sites/ 

default/fles/programs/2020-01/State_Program_ 

Report_0985-0008_Expires12312022.pdf 

10 Administration for Community Living. (2020). Title 

III and VII state program report data elements, state 

program report transmittal requirements, state 

program report defnitions. https://acl.gov/sites/ 

default/fles/programs/2020-01/State_Program_ 

Report_0985-0008_Expires12312022.pdf 

11 Administration for Community Living. (2020). Title 

III and VII state program report data elements, state 

program report transmittal requirements, state 

program report defnitions. https://acl.gov/sites/ 

default/fles/programs/2020-01/State_Program_ 

Report_0985-0008_Expires12312022.pdf 

12 Administration for Community Living. (2020). Title 

III and VII state program report data elements, state 

program report transmittal requirements, state 

program report defnitions. https://acl.gov/sites/ 

default/fles/programs/2020-01/State_Program_ 

Report_0985-0008_Expires12312022.pdf 

13 U.S. Administration for Community Living. (2017). 

Aging and disability resource centers. https://acl. 

gov/programs/aging-and-disability-networks/aging-and-disability-resource-centers 

14 Administration for Community Living. (2020). Title 

III and VII state program report data elements, state 

program report transmittal requirements, state 

program report defnitions. https://acl.gov/sites/ 

default/fles/programs/2020-01/State_Program_ 

Report_0985-0008_Expires12312022.pdf 

Older Americans Act Title III | 2020 Program Results | 41 

OLDER AMERICANS ACT 

Title VI Programs 

2020 PROGRAM 

RESULTS 
Acknowledgment 

Kristen Hudgins, Senior Social Science Analyst in the Offce of Performance and Evaluation (OPE), Center for Policy and Evaluation; and Leslie Green, Deputy Director in 

the Ofce for American Indian, Alaskan Native, and Native 

Hawaiian Programs, Administration on Aging, Administration for Community Living (ACL) assisted with preparation 

of the module. U.S. Department of Health and Human 

Services (HHS) in partnership with New Editions Consulting, Inc., under contract number HHSP233201500113I/ 

HHSP23337002T. 

Disclaimer 

The views, opinions, and content of this publication are 

those of the authors and do not necessarily reflect the 

views, opinions, or policies of OPE, ACL, or HHS. Nothing in 

this document constitutes a direct or indirect endorsement 

by ACL of any nonfederal entity’s products, services, or 

policies, and any reference to nonfederal entity’s products, 

services, or policies should not be construed as such. 

Public Domain Notice 

All material appearing in this publication is in the public 

domain and may be reproduced or copied without permission from ACL. Citation of the source is required. However, 

this publication may not be reproduced or distributed for a 

fee without the specifc, written authorization by ACL. 

Electronic Access 

This publication may be downloaded from https://acl.gov/ 

aging-and-disability-in-america/data-and-research. 

Recommended Citation 

Administration for Community Living (2022). Overview of 

Older Americans Act Title III, VI, and VII Programs: 2020 

Summary of Highlights and Accomplishments. U.S. Department of Health and Human Services. https://acl.gov/ 

aging-and-disability-in-america/data-and-research. 
 

 

 

 

Title VI | Table of Contents 

Program Highlights and Accomplishments VI-2 

List of Exhibits VI-4 

Abbreviations and Acronyms VI-4 

Impact of COVID-19 Pandemic on Title VI Services VI-5 

Funding Use VI-5 

Title VI Services VI-5 

Part 1 | 2020 PPR Data Highlights VI-7 

Stafng VI-7 

Service Recipients VI-8 

Service Units VI-11 

Service Units: Nutrition Services VI-11 

Service Units: Supportive Services— 

Access Services VI-12 

Service Units: Supportive Services— 

In-Home Services VI-13 

Service Units: Supportive Services— 

Other Services VI-14 

Service Units: Caregiver Support Services— 

Services for Caregivers VI-14 

Service Units: Caregiver Support Services— 

Respite Care for Caregivers VI-15 

Part 2 | 2020 National Survey of Title VI Programs VI-16 

Program Structure VI-17 

Partnerships VI-18 

Services VI-20 

Unmet Needs VI-21 

Appendix A: Title VI Defnitions VI-22 

References VI-26 

Older Americans Act Title VI | 2020 Program Results | VI-1 
| 

 

 

 

-

-

-

-

VI-2 

Title VI 

Program Highlights and Accomplishments 

A component of the Administration for Community Living’s (ACL’s) mission is to 

support American Indian, Alaskan Native (AI/AN), and Native Hawaiian elders in 

living with dignity and choice, while participating fully in their communities. ACL 

implements this mission in part through its Older Americans Act (OAA) Title VI 

programs. The programs help assure successful outcomes in part by recognizing 

the strengths and resiliency of tribal elders across the United States and respecting Native communities’ sovereignty, culture, and self-determination.1 

These programs are essential, especially in 

light of health disparities AI/AN and Native 

Hawaiian populations face. For example, 

in comparison with members of the overall 

population of the U.S., American Indians and 

Alaskan Natives have shorter life spans and 

higher death rates, experience more prevent 

able causes of death, and have more chronic 

conditions.2,3 They also experience dispropor 

tionately high rates of certain mental health 

conditions, such as depression and substance 

abuse.4 Combining federal funds, such as OAA 

Title VI funds, with state, local, and tribal funds, 

allows service providers to work collaboratively 

with tribal communities to address the needs 

of these communities while recognizing the 

health disparities they face. 

In the 2020-2023 grant cycle, there are 282 

Title VI grantees providing nutrition and 

supportive services and 251 Title VI grantees 

providing caregiver support services to 

tribal communities*.

* In the 2017-2020 grant cycle, there were 272 Title VI grantees 

providing nutrition and supportive services and 238 Title VI grantees 

providing caregiver support services to tribal communities. 

Results from the 2020 National Survey of Title 

VI Programs showed that the majority of Title VI 

programs served elders in rural or frontier 

areas.5 In addition, Title VI grantees partnered 

with a range of entities, including those within 

and external to their tribes. Survey respondents 

noted partnering with more than 20 diferent 

types of entities, such as Indian Health Services, 

the Veterans Administration, transportation 

agencies, and nontribal health care providers. 

Importantly, grantees, in collaboration with 

partners, provided an average of 26 services and 

supports to tribal communities that enabled trib 

al elders to live with independence and dignity 

in their homes and communities. 

Given these eforts, Title VI grantees were able 

to serve more than 200,000 individuals, includ 

ing 198,591 individuals who received nutrition 

and supportive services and 7,873 individuals 

who received caregiver support services. In 

2020 alone, providers ... 

VI-2 | 
Older Americans Act Title VI | 2020 Program Results | VI-3

TITLE VI GRANTEES SERVED MORE THAN 

200,000 

INDIVIDUALS WITH SERVICES SUCH AS ... 

DELIVERED MORE THAN 

6.4 M 

MEALS TO 

INDIVIDUALS’ HOMES 

MADE MORE THAN 

550,000 

CONTACTS TO PROVIDE 

INFORMATION/ASSISTANCE 

to access needed services 

CONDUCTED MORE THAN 

450,000 

VISITS TO ELDERS 

IN THEIR HOMES 

and more than 2,700 visits 

to elders in nursing facilities or 

residential care communities 

PROVIDED MORE THAN 

200,000+ 

ONE -WAY TRIPS 

to the grocery store, pharmacy, 

doctors’ ofce or other critical errands, 

to support elders’ independence 

PROVIDED MORE THAN 

113,000+ 

COUNSELING SESSIONS 

and more than 76,000 hours of respite care 

to caregivers who cared for elders or individuals 

of any age with Alzheimer’s disease and 

related disorders 

Older Americans Act Title VI | 2020 Program Results | VI-3 
VI-4 |

 

 

 

 

 

 

 

List of Exhibits 

Exhibit 1. Number of Title VI Service Recipients by Supportive Services Type VI-8

Exhibit 2. Number of Title VI Service Recipients by Nutrition Services Type VI-9

Exhibit 3. Number of Title VI Caregiver Services Recipients by Caregiver Type VI-9

Exhibit 4. Number of Title VI Service Recipients by Caregiver Support Services Type VI-10

Exhibit 5. Total Service Units, by Nutrition Service Type VI-11

Exhibit 6. Total Service Units, by Access Service Type VI-12

Exhibit 7. Total Service Units, by In-Home Service Type VI-13

Exhibit 8. Total Service Units, by Caregiver Service Type VI-15

Exhibit 9. Total Respite Service Units, by Caregiver Type VI-15

Exhibit 10. Title VI Program Location (n=230) VI-16

Exhibit 11. Area Served by Title VI Programs VI-17

Exhibit 12. Type of Entities Title VI Programs Partner With VI-18

Exhibit 13. Partnership Activities VI-19

Exhibit 14. Services Provided Exclusively Through Title VI Funds VI-20

Exhibit 15. Unmet Needs Among Elders (n=231) VI-21

Abbreviations and Acronyms 

AAA Area Agency on Aging 

ACL Administration for 

Community Living 

AI/AN American Indian and 

Alaskan Native 

COVID-19 Coronavirus disease of 2019 

HHS U.S. Department of Health 

and Human Services 

OAA Older Americans Act 

OPE Ofce of Performance 

and Evaluation 

PPR Program Performance Report 
Impact of COVID-19 Pandemic on Title VI Services 

Funding Use 

With the President declaring the coronavirus disease 

of 2019 (COVID-19) pandemic a national emergency on 

March 13, 2000, flexibility was provided for tribes— 

without the need for a separate application or request 

for a waiver—to use existing allocations already made 

to them under Title VI Part A/B and Part C for disaster 

relief.6 As a result, tribes could use Title VI Part A/B 

and/or Part C for any disaster relief activities for older 

individuals or family caregivers served under the OAA, 

which may have included providing: 

■ drive through, take out, or home-delivered meals, 

■ well-being checks via phone, in-person, or virtual 

means, and 

■ homemaker, chore, grocery/pharmacy/supply 

delivery, or other services. 

Title VI Services 

As part of an evaluation conducted by ACL in 2020 

with a select number of ACL Title VI program grantees, 

participating grantee staf described their experiences related to the COVID-19 pandemic, including the 

impact the pandemic had on services and the strategies they implemented to continue to meet needs in 

their communities. For the full report, use this link.

† 

† https://acl.gov/sites/default/fles/programs/2021-05/ACL_TitleVI_Evaluation_Final_Report_508.pdf 

In addition, as part of their fscal year 2020 Annual 

Program Performance Report (PPR), Title VI grantees 

provided examples of how the Title VI program has 

helped individuals and their communities, including 

how programs have adjusted to meet needs of AI/AN 

and Native Hawaiian elders during the pandemic. The 

bullets below provide a summary of the information 

shared by grantees about the challenges they experienced during the pandemic in meeting Title VI service 

needs and the ways they met those challenges. 

Older Americans Act Title VI | 2020 Program Results | VI-5 
VI-6 | 

 

■ Increased demand for meals. Many grantees reported a signifcant increase in the overall demand 

for meals. 

■ Experienced limited availability of supplies. Several grantees reported a loss of critical resources and 

supplies from vendors, such as food containers, 

paper products, and Styrofoam food trays, making meal provision more difcult. Others reported 

shortages of supplies for elders, such as tissues, 

paper towels, toilet paper, and cleaning products. 

■ Delivered food boxes and groceries and care packages. To continue meeting essential needs, grantees packaged and delivered food boxes and care 

packages (containing items such as toilet paper, 

face masks, hand sanitizer, gloves, etc.) to elders 

and worked with local grocery stores to order and 

deliver basic grocery items. Grantees also provided 

craf or activity care packages to elders to help keep 

them engaged. 

■ Suspended congregate meals. Grantees suspended 

in-person congregate meals for elders and caregivers. 

■ Transformed and expanded home-delivered meals. 

Grantees transformed the home-delivered meal program during the pandemic by establishing a socially distanced drive-up/pickup and take-out service 

approach that allowed elders to safely collect meals 

to take home. Some grantees also expanded their 

home-delivered meal program to include elders 

who normally participated in congregate meals and 

elders who had not previously participated in the 

nutrition program. 

■ Suspended in-person activities and events. Grantees suspended in-person activities and events, 

such as educational events, physical activity 

programs, and community events (e.g., holiday 

celebrations, powwows) for elders and caregivers. 

■ Implemented virtual and socially distanced activities. Grantees implemented virtual and socially 

distanced activities, such as nutritional counseling 

done by phone, virtual bingo and parking lot bingo, 

and virtual elders’ talking circle. Some grantees 

also purchased phones and tablets for elders so 

they could participate in virtual activities. 

■ Suspended or limited transportation for elders. 

Grantees who normally provided transportation 

services for elders (e.g., taking elders to medical 

appointments, the post ofce, the senior center, 

and shopping), had to either suspend or limit these 

services. 

■ Reduced caregiver program services. Most grantees reported that caregiver support services, such 

as respite care and other in-home services, were 

suspended. 

■ Increased check-ins. To address elders’ emotional 

well-being, including feelings of isolation, grantees 

conducted check-ins via phone or in person while 

maintaining social distance. Grantees also provided 

newsletters and used other innovative strategies to 

stay connected with elders (e.g., leaving notes in 

food boxes and care packages). 

■ Provided support for obtaining vaccines. Grantees 

also helped elders register for appointments to receive their COVID-19 vaccinations and arranged for 

transportation to and from these appointments. 
Older Americans Act Title VI | 2020 Program Results | VI-7 

 

Part 1 | 2020 PPR Data Highlights‡ 

‡ 

Stafng 

The majority of funding for OAA programs flows from 

the federal to the state level and from there to the local 

level. However, for OAA Title VI programs, funds are 

allocated by ACL directly to Indian tribal organizations, 

Native Alaskan organizations, and nonproft groups 

representing Native Hawaiians. To be eligible for funding, a tribal organization of federally recognized tribes 

must represent at least 50 Native Americans aged 60 

and older. Separate formula grant awards are made for 

nutrition and supportive services (Part A and B), and 

caregiver support services (Part C). 

For the 2020–2023 grant cycle, more grants were 

awarded to nutrition and supportive services (282) than 

to caregiver support services (251). In 2020, nutrition 

and supportive services had more than twice as many 

staf (1,209) as caregiver support services (553). 

PPR reporting year 2020: April 1, 2020–March 31, 2021 

Number of Grantees 

For the 2020–2023 grant cycle, ACL awarded 

282 | 3-year grants for nutrition 

and supportive services 

251 | 3-year grants for 

caregiver support services 

Number of Grantee Staf*

* Grantee staf are defned as staf that are fully or partially paid by 

Title VI funding. 

— 

Nutrition and Supportive Services 

Full time 

754 

Part time 

464 

Number of Grantee Staf— 

Caregiver Support Services 

Full time 

329 

Part time 

224 
VI-8 | 

 

 

 

 

Service Recipients 

In 2020, OAA Title VI grantees served more than 

206,464 persons. (Service recipients may be receiving 

more than one service and may be counted more than 

once.) They provided nutrition and supportive services 

to 198,591 persons§

§ Persons served received the following services: congregate 

meals, home-delivered meals, nutrition counseling, case manage

 and caregiver support services to 

7,873 caregivers. 

-

ment, transportation, homemaker, personal care/home health aide, 

chore, and/or health promotion and wellness activities. 

Number of Title VI Service Recipients 

by Supportive Services Type 

In 2020, 98,603 persons received supportive services. 

The largest number of persons received other services. 

That number includes 58,141 who received health promotion and wellness activities; 27,631 who received 

access related services, including case management 

and/or transportation services; and 12,831 who received in-home related services, including homemaker, 

personal care/home health aide, and/or chore services. 

Number of persons 

served by grantees 

> 206,464 

Exhibit 1. Number of Title VI Service Recipients by Supportive Services Type 

Other 58,141 

Transportation 13,905 

Case Management 13,726 

Chore 4,373 

Homemaker 4,273 

Personal Care/ 

Home Health Aide 4,185 

0 20,000 40,000 60,000 

Notes: Service recipients may be receiving more than one service. Other = health and promotion wellness activities. 
Older Americans Act Title VI | 2020 Program Results | VI-9 

 

 

 

 

 

Number of Title VI Service Recipients 

by Nutrition Services Type 

In 2020, 99,988 persons received nutrition services. 

Home-delivered meal programs served the most 

persons (76,062), followed by nutrition counseling 

programs (14,336 persons). The number served via 

congregate meal programs was smaller (9,590 

persons) than the numbers served via the other 

two service types due to COVID-19. 

Number of Title VI Caregiver Support Services 

Recipients by Caregiver Type 

In 2020, the caregiver support services program 

served 7,873 caregivers. Most caregivers who received 

services cared for elders or individuals of any age with 

Alzheimer’s disease and related disorders (4,149), followed by those who cared for children under the age of 

18 (2,521) and those who cared for adults 18–59 years 

old with disabilities (1,203). 

Exhibit 2. Number of Title VI Service Recipients by Nutrition Services Type 

Home-Delivered Meals 76,062 

Nutrition Counseling 14,336 

Congregate Meals 9,590 

0 20,000 40,000 60,000 80,000 

Notes: Service recipients may be receiving more than one service. 

Exhibit 3. Number of Title VI Caregiver Services Recipients by Caregiver Type 

Elders or Individuals with 

AD and Related Disorders 4,149 

Children Under 18 2,521 

Adults 18-59 with 

Disabilities 1,203

0 2,500 5,000

Notes: AD = Alzheimer’s Disease. 
VI-10 | 

 

 

 

 

 

Number of Title VI Service Recipients 

by Caregivers Support Services Type 

In 2020, the largest number of persons received supplemental services (15,279), which consist of homemaker/chore/personal care services (5,558 persons), 

the provision of consumable items (4,375 persons), 

other¶

¶ For example, care packages 

 (3,295 persons), lending closets (1,292 persons), fnancial support (418 persons), and/or home 

modifcations or repairs (341 persons). Caregivers 

also received counseling (2,735 persons), caregiver 

training (1,365 persons), and/or respite services 

(1,916 persons). 

Number of persons who received 

supplemental services 

15,279 

Exhibit 4. Number of Title VI Service Recipients by Caregiver Support Services Type 

Homemake/Chore/ 

Personal Care 5,558 

Consumable Items 4,375 

Other 3,295 

Counseling 2,735 

Respite Care 1,916 

Caregiver Training 1,365 

Lending Closet 1,292 

Financial Support 418 

Home Modifcations/ 

Repairs 

341 

0 2,000 4,000 6,000 8,000 

Notes: Service recipients may be receiving more than one service. Other = health and promotion wellness activities. 
Older Americans Act Title VI | 2020 Program Results | VI-11 

 

 

 

 

Service Units 

The following section provides data highlights 

for delivered Title VI service units. A service unit 

denotes a specifed quantity of a service. 

Number of Service Units by Nutrition Service Type 

In 2020, the largest number of service units for nutrition services was provided for home-delivered meal 

services (6,426,032), followed by congregate meal 

services (321,095), and nutrition education services 

(44,897). The fewest service units were provided for 

nutrition counseling services (12,186). 

6,426,032 

Service Units provided for 

home-delivered meals 

Service Units: Nutrition Services 

Defnition of Nutrition Service Units 

■ Home-delivered meal (1 meal): A meal 

provided to an eligible individual in their 

place of residence. 

■ Congregate meal (1 meal): A meal provided to an eligible individual in a congregate or group setting. 

■ Nutrition education (1 session): A 

session spent with an elder to provide 

nutrition education. The session may be 

a meeting or a gathering dedicated to a 

specifc activity. A nutrition education 

session does not include the time spent 

on preparing the program or compiling 

the information. 

■ Nutrition counseling (1 hour): An hour 

spent with an elder to provide nutrition 

counseling. A nutrition counseling hour 

does not include the time spent on 

preparing for the counseling meeting or 

compiling the advice or guidance. 

Exhibit 5. Total Service Units, by Nutrition Service Type 

Home-Delivered Meals 6,426,032 

Congregate Meals 321,095 

Nutrition Education 44,897 

Nutrition Counseling 12,186 

0 2,000,000 4,000,000 6,000,000 8,000,000 
VI-12 | 

 

 

Service Units: Supportive Services— 

Access Services 

Defnition of Access Service Units 

■ Information/assistance (1 contact): A contact with an eligible individual to provide 

information or assistance to access services. 

■ Outreach (1 activity): A public outreach 

activity and providing information directed 

at individuals and groups to encourage 

potential elders (or their caregivers) to use 

existing services and benefts. 

■ Case management (1 hour): An hour spent 

on providing case management. Case management includes such activities as assessing needs and developing service plans— 

arranging, coordinating, and monitoring 

services to meet the needs of the elder. The 

service includes periodic reassessment and 

revision based on the needs of the elder. 

■ Transportation (1 one-way trip): One-way 

trip of transportation for an eligible person. 

A round trip is considered two one-way trips. 

587,098 

Service Units provided for 

information/access services 

Number of Service Units by Access Service Type 

In 2020, the largest number of service units for access 

services was provided for information/assistance 

services (587,098), followed by transportation services 

(202,512), outreach services (111,392), and case management services (90,991). 

Exhibit 6. Total Service Units, by Access Service Type 

Information/ 

Assistance 587,098 

Transportation 202,515 

Outreach 111,392 

Case Management 90,991 

0 200,000 400,000 600,000 
Older Americans Act Title VI | 2020 Program Results | VI-13 

Service Units: Supportive Services— 

In-Home Services 

Defnition of In-Home Service Units 

■ Homemaker (1 hour): One hour spent providing homemaker services for an elder. 

■ Personal care/home health aide (1 hour): 

One hour spent with an elder to provide 

personal care/home health aide services. 

■ Chore (1 hour): An hour spent with an elder 

to provide chore services. 

■ Visiting (1 contact): A visit provided to an 

elder in their place of residence. Visit contacts are for visits in personal homes only. 

■ Telephoning (1 contact): A telephone call to 

an elder at their place of residence, including a call to a housing facility like a nursing 

home or assisted living facility or a call 

directly to their personal cell phone. 

461,858 

Service Units provided for 

visiting services 

Number of Service Units by In-Home Service Type 

In 2020, the largest number of service units for 

in-home services was provided for visiting services 

(461,858), followed by telephoning services (363,352), 

homemaker services (66,900), and chore services 

(48,278). The fewest service units were provided for 

personal care/home health aide services (35,851). 

Exhibit 7. Total Service Units, by In-Home Service Type 

Visiting 

Telephoning 

Homemaker 

Chore 

Personal Care/Home 

Health Aide 

461,858 

363,352 

66,900 

48,278 

35,851 

0 200,000 400,000 600,000 
VI-14 | 

 

 

Service Units: Supportive Services— 

Other Services 

Defnition of Other Service Units 

■ Social event (1 event): An event held for 

elders. 

■ Nursing facilities/home or residential care 

communities visit (1 visit): A visit provided 

to an elder living in a nursing home or 

assisted living facility 

Number of Service Units by Other Service Type 

In 2020, 2,771 visits to nursing facilities/homes or 

residential care communities were conducted under 

Title VI (compared to 461,858 visits to personal 

homes). Title VI providers also held 2,201 social 

events for elders. 

Service Units: Caregiver Support Services— 

Services for Caregivers 

Defnition of Caregiver Service Units 

■ Information services (1 activity): An 

informational activity held for caregivers. 

Information services activities can include 

an in-person interactive presentation to 

the public or a social media post or radio 

announcement that is shared with the 

broader community. 

■ Information and assistance (1 contact): 

A contact with an eligible caregiver to 

provide information and assistance. 

■ Counseling (1 hour): An hour spent on 

providing counseling to a caregiver. 

■ Support group (1 session): A session 

spent on providing a support group to 

caregivers. It may be a meeting or a 

gathering dedicated to a specifc activity. 

A support group session does not include 

the time spent on preparing the program 

or compiling the information. 

■ Caregiver training (1 hour): An hour spent 

on providing caregiver training to informal 

caregivers. 

Number of Service Units by Caregiver Service Type 

In 2020, the largest number of service units for services for caregivers was provided for information and 

assistance (134,945), followed by counseling (113,042) 

and information services (96,481). The fewest service 

units were provided for caregiver training (1,365) and 

support groups (1,120). 
Older Americans Act Title VI | 2020 Program Results | VI-15 

 

 

 

 

Service Units: Caregiver Support Services— 

Respite Care for Caregivers 

Defnition of Respite Service Units 

■ Respite care for caregivers (1 hour): 

An hour spent on providing respite care 

for eligible caregivers. 

Number of Respite Service Units by Caregiver Type 

In 2020, the largest number of respite service units was 

provided to caregivers who cared for elders or individuals of any age with Alzheimer’s disease and related 

disorders (76,282), followed by those who cared for children under the age of 18 (21,568) and those who cared 

for adults 18–59 years old with disabilities (14,471). 

Exhibit 8. Total Service Units, by Caregiver Service Type 

Information 

and Assistance 134,945 

Counseling 113,042 

Information Services 96,481 

Caregiver Training 1,365 

Support Group 1,120 

0 20,000 40,000 60,000 80,000 100,000 120,000 140,000 

Exhibit 9. Total Respite Service Units, by Caregiver Type 

Elders or Individual with 

AD and Related 

Disorders 76,282 

Children Under 18 21,568 

Adults 18-59 with 

Disabilities 14,471 

0 

Notes: AD = Alzheimer’s Disease. 

20,000 40,000 60,000 80,000 
VI-16 | 

Part 2 | 2020 National Survey of Title VI Programs ** 

** The data do not represent data from the National Survey of Older Americans Act Participants. 

With a grant from ACL, the National Association of Area 

Agencies on Aging partnered with Scripps Gerontology 

Center of Excellence to conduct the 2020 Title VI Native 

American aging program survey, which was the fourth 

comprehensive survey of Title VI programs. The results 

presented in Part 2 of this report are directly taken 

from the National Survey of Title VI Programs 2020 

Report: Serving Tribal Elders Across the United States. 

The complete report can be accessed here.

†† 

†† https://www.usaging.org/Files/TitleVI-Survey-Report-508.pdf 

The web-based survey was distributed to 276 Title VI 

grantees in 2020, with 84% (n=231) of Title VI programs responding. Some questions were asked of 

every respondent, and other questions were shown to 

a subset based on their responses to earlier questions. 

The number of respondents to a particular question 

(n) is reported in all tables. In the cases of text without 

accompanying tables, the n can be assumed to be of 

the respondents overall, 231, unless noted otherwise. 

Exhibit 10. Title VI Program Location (n=230) 

Intertribal 

Council 

5% 

Tribal 

Consortium 

17% 

Other 

1% 

Individual 

Tribe 

77% 
Older Americans Act Title VI | 2020 Program Results | VI-17 

 

Program Structure 

Program Location 

Title VI grants are awarded to tribal entities in federally 

recognized tribes, as well as to organizations representing Native Hawaiian elders. Survey respondents 

noted that Title VI programs are most frequently part 

of an individual tribe (77%), with 17% being part of 

a tribal consortium,‡‡

‡‡ Grantees comprised of a group of federally recognized tribes or 

villages that do not meet the eligibility requirements of 50 elders age 

60 or older may combine their smaller elder populations to form a 

population that is large enough to apply for the grants. A tribe or village that has enough elders to meet the eligibility requirements may 

choose to band together with other tribes/villages and authorize an 

administrative body to apply for and administer their grant on behalf 

of the tribe/village. 

 5% being part of an intertribal 

council,§§

§§ Intertribal councils are similar to consortia in that they are made 

up of multiple tribes/villages and have authorized a representative 

body to apply for and administer the grant on their behalf. 

 and 1% being part of other administrative 

structures. Exhibit 10 shows this distribution of administrative locations. 

Area Served by Program¶¶ 

¶¶ Survey respondents were asked to choose the type of area they 

believed best represented their region. 

Reflecting the location of tribal lands, approximately 

92% of Title VI programs serve regions that include 

rural areas. Nearly two-thirds (64%) of programs serve 

an area that is predominantly rural, remote, or frontier. 

Only about 9% of programs serve an area that is predominantly urban or suburban. 

Exhibit 11. Area Served by Title VI Programs 

Type of Area Served 

Percent of Title VI programs 

that serve type of area 

(n=230) 

Predominantly rural 58% 

A mix of suburban and rural 16% 

A mix of urban, suburban and rural 12% 

Predominantly urban, predominantly suburban, or a mix 9% 

Predominantly remote or frontier 6% 
VI-18 | 

Partnerships 

Type of Partners 

Title VI programs partner with other entities both within and external to their tribes or organizations to meet 

the needs of elders. The most common partnerships 

are with tribal health care and the Indian Health 

Service (both 81%), tribal housing (80%), adult protective services (79%), tribal health department/tribal 

public health (77%) and the local Area Agencies on 

Aging or Title III providers (76%). Additional partnership types are shown in Exhibit 12. 

Exhibit 12. Type of Entities Title VI Programs Partner With 

Type of Entity 

Percent of Title VI programs 

that partner with entity 

(n=218) 

Tribal health care (e.g., tribal health clinic or center) 81% 

Indian Health Service 81% 

Tribal housing 80% 

Adult Protective Services 79% 

Tribal health department/tribal public health 77% 

Area Agency on Aging/Title III provider 76% 

Veterans Administration 70% 

State unit or department of aging 68% 

Medicaid 67% 

Medicare 66% 

Disability service organizations 65% 

Nursing home, assisted living facility or group home 65% 

Transportation agencies 64% 

Bureau of Indian Afairs 62% 

Nontribal health care providers (e.g., hospital, clinic, physician ofce) 62% 

Nontribal health department/nontribal public health 61% 

County government 61% 

State Health Insurance Assistance Program 60% 

Charitable organizations 60% 

Churches 59% 

Bureau of Indian Education 51% 

Tribal colleges 46% 

Other colleges and universities 46% 
Older Americans Act Title VI | 2020 Program Results | VI-19 

Partnership Activities 

Title VI programs partner with tribal health care departments or entities to support the health needs of elders. 

The most common health care support activities that 

Title VI programs collaborate on with partners are shown 

in Exhibit 13. They include activities to provide nutrition 

and/or health education (78%), wellness checks (73%), 

and transportation (70%). Title VI programs also partner with entities to provide services such as diabetes 

wellness programs (67%), COVID-19 preparedness and 

response (67%), and annual health fairs (63%). 

Exhibit 13. Partnership Activities 

Activity 

Percent of Title VI programs 

that implement activity with 

partners (n=194) 

Provide nutrition and/or health education 78% 

Conduct wellness checks 73% 

Provide transportation 70% 

Coordinate on diabetes wellness programs 67% 

Coordinate COVID-19 preparedness and response 67% 

Coordinate on annual health fair 63% 

Make home visits or deliver meals 58% 

Coordinate on flu clinic 58% 

Deliver medications 56% 

Approve meals and/or help with menu planning 55% 
VI-20 | 

Services 

Title VI program directors noted that, overall, elders in 

their tribal communities have access to an average of 26 

services. These services are funded fully through Title 

VI, or partially through Title VI, or through other funding 

sources. Exhibit 14 shows the services most likely to be 

delivered entirely with Title VI dollars. More than half of 

Title VI recipients fund their home-delivered and congregate meals programs only with Title VI funds. More 

than one-third provide family caregiver support and 

respite services that rely wholly on Title VI funding. 

Exhibit 14. Services Provided Exclusively Through Title VI Funds 

Service 

Percent of Title VI programs 

that deliver the service 

through Title VI funds only 

(n=231) 

Home-delivered meals 55% 

Congregate meals 54% 

Information and referral/assistance 39% 

Family caregiver support services 37% 

Outreach 37% 

Respite care 36% 

Telephone reassurance/friendly visiting 36% 

Senior center activities 29% 

Assistive devices or loan closet 27% 

Special events for elders 25% 

Homemaker help 24% 

Care/case management 24% 

Transportation (medical or nonmedical) 22% 

Help in home/personal care 22% 

Supportive services for grandparents raising grandchildren 20% 
Older Americans Act Title VI | 2020 Program Results | VI-21 

 

 

Unmet Needs 

Title VI grantees provide a wide range of services to 

elders, but available funding and/or staf levels cannot always meet every need. As shown in Exhibit 15, 

the most common signifcant unmet need reported by 

Title VI program directors was for home repair services 

(46%). Other commonly reported signifcant unmet 

needs are money management (42%) and legal 

assistance (36%), with more than 80% of Title VI 

programs reporting at least some unmet need in each 

of these areas. 

Exhibit 15. Unmet Needs Among Elders (n=231) 

Percent with 

signifcant unmet need Unmet Need Percent with some unmet need 

46% Home repair (e.g., replacing a 

broken window, repairing leaks) 89% 

42% Money management 89% 

36% Help in home/personal care 89% 

36% Home modifcation (e.g., ramps, 

grab bars, widened doorways) 86% 

36% Legal assistance 80% 

33% Chore services (e.g., yard work) 79%

32% Emergency response system 75% 

29% Mental health services 76% 

28% Homemaker help 81% 

27% Help with medication 74% 

25% Supportive services for grandparents 

raising grandchildren 77% 

24% Dementia awareness 77% 
VI-22 | 

Appendix A: Title VI Defnitions7 

American Indian or Alaskan Native: A person having 

origins in any of the original peoples of North America 

(including Central America) and who maintains tribal 

afliation or community attachment. 

Area Agency on Aging (AAA): Public or private nonprofit agency designated by a state to address the needs 

and concerns of all older persons at the regional and 

local levels. The term AAA is a general one; names 

of local AAAs may vary. To help older adults remain 

in their homes, if that is their preference, AAAs coordinate and ofer services including home-delivered 

meals, homemaker assistance, and whatever else it 

may take to make independent living a viable option. 

Caregiver to elders or Individuals of any age with 

Alzheimer’s disease and related disorders: An informal 

caregiver who 

■ is 18 years or older and 

■ provides services or support to an elder or elders 

(tribally determined age) or an individual or individuals of any age with Alzheimer’s disease and 

related disorders (such as dementia). 

Caregiver training: A service that provides family caregivers with instruction to improve knowledge and performance of specifc skills related to their caregiving 

roles and responsibilities. Skills may include activities 

related to health, nutrition, and fnancial management; 

providing personal care; and communicating with 

health care providers and other family members. Training may include use of evidence-based programs and 

may be conducted in person or online, in individual or 

group settings. 

Case management: A service provided to an elder, at the 

direction of the elder or a family member or caregiver. 

■ The service should be provided by a trained or experienced person with case or care management skills. 

■ The service includes individual needs assessment 

and developing a service plan for, arranging, 

coordinating, and monitoring services to meet the 

needs of the elder. The service should include periodic reassessment and revision based on the needs 

of the elder. 

Chore service: Performance of heavy household tasks 

provided in an elder’s home. Tasks may include yard 

work or sidewalk maintenance in addition to heavy 

housework—tasks such as heavy cleaning, yard work, 

walk maintenance, minor home repair, wood chopping, 

hauling water, and other heavy-duty activities which 

the elder is unable to handle on their own and which 

do not require the services of a trained homemaker or 

other specialist. 

Congregate meal: A meal provided to and consumed 

by an eligible person at a nutrition site, senior center, 

or other congregate/group setting. The meal meets all 

the requirements of the OAA and state and local laws. 

Congregate meal eligible person: An eligible person is 

an elder, a spouse of an elder, or an individual providing volunteer services for the Title VI program during 

the meal hour. It may also be a nonelder person with a 

disability who resides at home with and accompanies 

an elder to the meal or who resides in a housing facility occupied primarily by older adults. 

Consumable items: Single-use items, such as incontinence supplies, Ensure®, school supplies, uniforms for 

school or sports, cleaning supplies, groceries, etc. 

Counseling: A service designed to support caregivers 

and assist them in their decision-making and problem 

solving. Counselors may be degreed service providers, 

trained to work with individuals, older adults, and families and specifcally understanding and addressing 

the complex physical, behavioral, and emotional problems related to their caregiver roles. Informal counselors, like peers who are or have been informal caregivers, may also be used for this service. Counseling 

may be provided to individuals or in group meetings. 

Counseling is a separate function from support group 

activities or training. Caregivers eligible to receive 

counseling are those caring for older adults, persons 
Older Americans Act Title VI | 2020 Program Results | VI-23 

 

 

 

with disabilities, or children not their own by birth 

or adoption. Counseling may be provided via phone, 

text, email, webinar, video chat, or other means with 

an individual or a group to help participants navigate 

physical, behavioral, and emotional issues related 

to caregiving. 

Elder caregivers caring for children under the age of 18: 

An informal caregiver who 

■ is an elder, 

■ provides care for a child or children not their own by 

birth or adoption, and 

■ is caring for a child or children under the age of 18. 

Elder caregivers providing care to adults 18–59 with 

disabilities: An informal caregiver who 

■ is an elder, 

■ may be the parent of the adult with disabilities, and 

■ provides care to an adult or adults 18–59 years old 

with disabilities. 

An individual with a disability is defned by the 

Americans with Disabilities Act as a person who has 

a physical or mental impairment that substantially 

limits one or more major life activities, a person 

who has a history or record of such an impairment, 

or a person who is perceived by others as having 

such an impairment. 

Financial support: Limited (emergency) help with 

utility bills. 

Full-time staf: People who work 35 hours or more per 

week in paid positions for the Title VI program, paid 

fully or partially with Title VI A/B or C funds. The term 

refers to the number of full-time positions in the Part 

A/B or C program. These positions may be permanent 

or temporary in nature. 

Health promotion and wellness: Activities conducted 

to improve the mental and physical health of persons, 

including walking groups, exercise classes, and presentations on health and wellness topics. 

Home-delivered meal: A meal provided to a qualifed eligible person in their place of residence or via 

carry-out or drive-through. Does not include meals 

supported by other funds (e.g., Title III, Medicaid Title 

XIX waiver, state-funded means-tested programs). 

Home-delivered meal eligible person: An eligible person is a qualifed elder, a spouse of a qualifed elder, a 

volunteer providing services during the meal hours, a 

nonelder person with a disability who resides at home 

with a qualifed elder, or a person with a disability who 

resides in a housing facility occupied primarily by 

older adults. 

Home modifcation/repairs: Putting ramps or handrails 

into a home. 

Homemaker service: Providing light housekeeping tasks 

in an elder’s place of residence. Tasks may include, 

but are not limited to, preparing meals, shopping for 

personal items, laundry, managing money, or using the 

telephone in addition to other light housework. 

Informal caregiver: An unpaid provider of in-home and 

community care who may be a family member, neighbor, friend, or someone else. 

Information services: A public or media activity that 

conveys information to caregivers about available 

services. Information services activities may include 

an in-person interactive presentation to the public, 

a social media post, or a radio announcement that is 

shared with the broader community. 

Information and assistance: A service for caregivers that 

■ provides the individual with current information on 

opportunities and services available within their 

community, including information related to assistive technology; 

■ assesses the problems and capacities of the 

individual; 

■ links the individual to the opportunities and 

services that are available; and 
 

 

■ ensures, by establishing adequate follow-up procedures, that the individual receives the services 

needed and is aware of the opportunities available 

to them and serving the entire community 

of caregivers. 

Lending closet: Items returnable to the Title VI program: clothing exchange; durable medical equipment 

(chair lifs, wheelchairs, walkers, emergency response 

systems), telephone, tablet, anything else lent on a 

short-term basis. 

Native Hawaiian or other Pacifc Islander: A person 

having origins in any of the original peoples of Hawaii, 

Guam, Samoa, or other Pacifc islands that are U.S. 

territories. 

Nutrition counseling: Provision of individualized advice and guidance to individuals who are at nutritional 

risk—because of their health or nutritional history, 

dietary intake, medication use, or chronic illnesses— 

about options and methods for improving their nutritional status. Counseling is performed by a registered 

dietitian or other health professional and addresses 

the options and methods for improving nutrition status 

with a measurable goal. Nutrition counseling can be 

provided in person or virtually to counsel older adults 

on an individual basis (via phone, text, email, webinar, 

video chat, or other means). 

Nutrition education: A targeted educational program 

provided by a dietitian or a similarly knowledgeable 

person. The program promotes better health by providing accurate and culturally sensitive nutrition, physical 

ftness, or health (as it relates to nutrition) information 

and instruction to participants, caregivers, or participants and caregivers in a group setting (two or more 

participants). Sessions include distribution of printed 

materials, provided in person or virtually by conducting 

a group call or online meeting (via phone, text, email, 

webinar, video chat, or other means) around how to 

continue to eat healthily and stay physically active. 

One-way trips: When transporting an elder, every stop 

that is made is considered a one-way trip. 

Other supportive service: Any additional supportive 

service the Title VI program ofers that was not listed in 

the Program Performance Report form. It may include, 

but is not limited to, services such as consumable 

items or lending closet. 

Outreach: Conducting public outreach activities and 

providing information directed at individuals and 

groups to encourage potential elders (or their caregivers) to use existing services and benefts. 

Part-time staf: People who work less than 35 hours 

per week in a paid position for the Title VI program, 

paid fully or partially with Title VI A/B or C funds. The 

term refers to the number of part-time positions in a 

Part A/B or C program, whether permanent or temporary in nature. 

Personal care/home health aide service: Providing an 

elder assistance with activities of daily living, such as 

eating, dressing, and bathing, toileting, transferring in 

and out of bed/chair, or walking. This service may also 

include assistance with an elder’s health-related tasks, 

such as checking blood pressure and blood glucose, 

and assistance with personal care. Personal care may 

include assistance with instrumental activities of daily 

living, such as cleaning and maintaining the home, 

managing money, or preparing meals. 

Respite care: A service for caregivers which ofers temporary, substitute supports or living arrangements for 

care recipients in order to provide them a brief period 

of relief or rest. Respite care is provided to assist the 

informal caregiver. 

Social event: An event involving a public performance 

or entertainment or a function to promote social 

interaction and decrease isolation. A social event 

should involve contact among more than two people, 

via phone, text, email, webinar, video chat, or other 

means, to provide reassurance and/or socialization to 

older adults. 

Supplemental services: Services provided on a limited 

basis to support informal caregivers so that they might 

continue to provide care to the elder, person with 

Alzheimer’s Disease and related disorder of any age, 

person 18–59 years old with disability, or grandchild 

under the age of 18. Examples are home modifcations/repairs, consumable items, lending closet, 

homemaker/chore/personal care service, and 

fnancial support. 

VI-24 | 
Support group: A service led by an individual, moderator, or professional to facilitate caregivers discussing 

their common experiences and concerns and developing a mutual support system. Support groups are 

typically held on a regularly scheduled basis and may 

be conducted in person, over the telephone, or online. 

Caregiver support groups would not include caregiver 

education/training groups or other groups primarily 

aimed at teaching skills or meeting on an informal basis without a facilitator. Support groups are intended 

to facilitate caregivers sharing their experiences with 

each other and fnding support within the group. 

Telephoning: Telephone services include phoning 

to provide comfort or check in on the elder. The elder 

should be reached and spoken to for the contact to 

be counted. 

Transportation: Services or activities that provide 

or arrange for travel of an elder, including costs of 

individuals’ travel from one location to another. This 

service may include escort or other appropriate assistance for a person who has difculties using regular 

transportation. 

Visiting: Visiting services include going to see an elder 

to reduce social isolation and/or perform a wellness 

check (a visual check of an elder to see if they need 

anything), etc. This service would include visiting in 

a personal home. Visiting involves a minimum of 15 

minutes talking with an elder or an adequate amount 

of time to make an informed decision about the elder’s 

well-being. 

Visits to persons in nursing facilities/homes or 

residential care communities: Visits conducted to 

persons living in skilled nursing homes or facilities, 

or living in a long-term care facility that provides, at 

a minimum, room and board, around-the-clock onsite supervision, and help with personal care such as 

bathing and dressing or health-related services such 

as medication management. Facility types include, 

but are not limited to, assisted living, board and care 

homes, congregate care, enriched housing programs, 

homes for the aged, personal care homes, adult foster/ 

family homes, and shared housing establishments that 

are licensed, registered, listed, certifed, or otherwise 

regulated by a state. 

Older Americans Act Title VI | 2020 Program Results | VI-25 
 

References 

1 Administration for Community Living. (2017, October 27). New issue briefng on community living for 

American Indian, Alaskan Native, and Native Hawaiian elders. https://acl.gov/news-and-events/ 

announcements/new-issue-briefng-community-living-american-indian-alaskan-native 

2 Espey, D. K., Jim, M. A., Cobb, N., Bartholomew, M., 

Becker, T., Haverkamp, D., & Plescia, M. (2014). 

Leading causes of death and all-cause mortality 

in American Indians and Alaska Natives. American 

Journal of Public Health, 104(S3), S303–S311. 

3 Urban Indian Health Institute, Seattle Indian 

Health Board. (2016). Community health profle: 

National aggregate of Urban Indian Health Program service areas. Urban Indian Health Institute. 

4 Indian Health Service, U.S. Department of Health 

and Human Services. (2015, March). Trends in 

Indian health: 2014 edition. https://www.ihs.gov/ 

dps/publications/trends2014/ 

5 National Association of Area Agencies on Aging. (n.d.). National Survey of Title VI Programs 

2020 report: Serving tribal elders across the 

United States. https://www.usaging.org/Files/ 

TitleVI-Survey-Report-508.pdf 

6 Administration for Community Living. (2020, March 

16). Older Americans Act disaster relief. https:// 

acl.gov/sites/default/fles/COVID19/OAADisasterRelief_2020-03-16.pdf 

7 Administration for Community Living. (2021). Title 

VI Program Performance Report (PPR) reporting 

defnitions for the grant year April 1, 2020–March 

31, 2023. https://oaaps.acl.gov/api/upload/ 

download?title=VI&downloadType=VIComponentsAndDefs 

VI-26 | 


OLDER AMERICANS ACT 

Title VII | Long-Term Care Ombudsman Program 

2020 PROGRAM 

RESULTS 
Acknowledgment 

Beverley Laubert, National Ombudsman Program 

Coordinator, in the Ofce of Long-Term Care Ombudsman 

Programs, Administration on Aging, Administration 

for Community Living (ACL) assisted with preparation 

of the module. U.S. Department of Health and Human 

Services (HHS) in partnership with New Editions Consulting, Inc., under contract number HHSP233201500113I/ 

HHSP23337002T. 

Disclaimer 

The views, opinions, and content of this publication are 

those of the authors and do not necessarily reflect the 

views, opinions, or policies of OPE, ACL, or HHS. Nothing in 

this document constitutes a direct or indirect endorsement 

by ACL of any nonfederal entity’s products, services, or 

policies, and any reference to nonfederal entity’s products, 

services, or policies should not be construed as such. 

Public Domain Notice 

All material appearing in this publication is in the public 

domain and may be reproduced or copied without permission from ACL. Citation of the source is required. However, this publication may not be reproduced or distributed 

for a fee without specifc, written authorization by ACL. 

Electronic Access 

This publication may be downloaded from https://acl. 

gov/aging-and-disability-in-america/data-and-research. 

Recommended Citation 

Administration for Community Living (2022). Overview of 

Older Americans Act Title III, VI, and VII Programs: 2020 

Summary of Highlights and Accomplishments. U.S. Department of Health and Human Services. https://acl.gov/ 

aging-and-disability-in-america/data-and-research. 
Title VII | Table of Contents 

Title VII | Program Highlights and Accomplishments VII-2 

List of Exhibits VII-4 

Abbreviations and Acronyms VII-4 

Impact of COVID-19 Pandemic on Title VII LTCOP Services VII-5 

Funding Use VII-5 

Title VII LTCOP Services VII-6 

2020 National Ombudsman Reporting System (NORS) 

Data Highlights VII-7 

Program Structure, Stafng, and Scope VII-7 

Case Summary VII-10 

Program Activities VII-17 

Appendix A: Title VII NORS Defnitions VII-18 

References VII-21 

Older Americans Act Title VII LTCOP | 2020 Program Results | VII-1 
| 

Title VII 

Program Highlights and Accomplishments 

The Long-Term Care Ombudsman Program (LTCOP) is designed to protect and 

promote the health, safety, welfare, and rights of long-term care residents in all 

50 states, as well as the District of Columbia, Puerto Rico, and Guam. Long-term 

care facilities include nursing homes, board and care and assisted living facilities, and other residential care communities. To achieve their mission, state 

and local long-term care ombudsman (LTCO) programs, with the help of paid 

staf and thousands of volunteers, engage in a range of activities at the 

individual, system, and community level. 

At the individual level, Ombudsmen assist residents by resolving complaints about their care, 

and help ensure that their rights are protected. 

In addition to investigating and resolving problems, Ombudsmen play a sentinel role through 

the facility and resident visits they routinely 

conduct. Serving as the “eyes and ears” of the 

program, Ombudsman representatives help 

address residents’ concerns before they rise to 

the level of complaints requiring intervention 

by preventing actions or inactions that unfavorably impact residents’ care, rights, and quality of life. At the systems level, Ombudsmen 

advocate at the local, state, and federal levels 

for improvements in the long-term care system 

that beneft residents. These activities are not 

limited to legislative advocacy, but include coalition-building, speaking to the media, and other strategies that broadly advance residents’ 

rights and well-being. To help build capacity 

for both individual and systems advocacy, the 

program also carries out education and outreach activities. These activities include providing information and consultation to facilities, 

residents and their families, collaborating with 

other agencies, supporting family and resident 

councils, developing citizen organizations, and 

empowering residents as well as their families 

and caregivers to be efective advocates.1 

Data reported by state ombudsman programs 

in 2020 demonstrate these eforts: 

VII-2 | 
PAID STAFF 

1,700 

VOLUNTEER STAFF 

6,621 

CONDUCTED ALMOST 

200,000 

VISITS IN 39,894 

LONG-TERM CARE 

FACILITIES 

INVESTIGATED 

153,324 

COMPLAINTS 

PROVIDED MORE THAN 

640,000

INSTANCES OF INFORMATION 

AND ASSISTANCE TO INDIVIDUALS 

AND FACILITY STAFF 

X 

X 

X 

Older Americans Act Title VII LTCOP | 2020 Program Results | VII-3 
VII-4 | 

 

 

List of Exhibits 

Exhibit 1. Location of State LTCO Ofce VII-8 

Exhibit 2. Location of Local Ombudsman Entities VII-8 

Exhibit 3. Complaints by Type of Facility VII-11 

Exhibit 4. Complaints by Verifcation Status for Each Type of Facility VII-11 

Exhibit 5. Complaints by Disposition for Each Type of Setting VII-12 

Exhibit 6. Complaints by Complaint Category, Nursing Facilities VII-13 

Exhibit 7. Complaints by Complaint Category, Residential Care Communities VII-14 

Exhibit 8. Complaints by Complaint Category, Other Settings VII-15 

Exhibit 9. Perpetrator Type for Abuse Complaints VII-16 

Exhibit 10. Program Activities to Improve Quality of Life VII-17 

Abbreviations and Acronyms 

AAA Area agency on aging 

ACL Administration for Community Living 

COVID-19 Coronavirus disease 2019 

FY Fiscal year 

HHS U.S. Department of Health and 

Human Services 

LTCO Long-term care ombudsman 

LTCOP Long-Term Care Ombudsman Program 

OAA Older Americans Act 
Impact of COVID-19 Pandemic on Title VII LTCOP Services 

Funding Use 

Ombudsman programs are required to expend coronavirus disease 2019 (COVID-19) funds on allowable activities as defned by the Elder Justice Act, Coronavirus 

Aid, Relief, and. Economic Security (CARES) Act, and 

American Rescue Plan Act in accordance with state and 

local policy. This funding is intended to support the 

capacity of ombudsman programs as well as enhance, 

improve, and expand the ability to investigate allegations of abuse, neglect, and exploitation in the context 

of COVID-19 (called COVID for short). For example, 

funds could be used to 

■ enhance ombudsman program complaint investigations during the COVID public health emergency to 

address complaints related to abuse, neglect, and 

poor care; 

■ resume in-person visitation at such time as visitation is permitted, such as when the COVID vaccine 

is accessible to residents, facility staf, and individuals working for the LTCO program; 

■ conduct education and outreach on abuse and 

neglect identifcation and prevention during the 

COVID public health emergency to residents, their 

families, and facility staf; 

■ enable travel for representatives of the LTCO ofce 

to ensure all residents have access to an LTCO representative; 

■ continue purchase of needed personal protective 

equipment; 

■ continue purchase of technology as needed; 

■ enable participation in state-level “strike teams” to 

address complaints related to care and neglect; and 

■ provide information and assistance on transitions 

from long-term care facilities to community-based, 

home care settings, consistent with section 712(a) 

(3) of the Older Americans Act (OAA).2 

Older Americans Act Title VII LTCOP | 2020 Program Results | VII-5 
VII-6 | 

 

Title VII LTCOP Services 

In-person visits with residents are a core part of 

ombudsman program outreach and advocacy. However, during the COVID-19 pandemic, visits have been 

dramatically curtailed, signifcantly restricting LTCO 

programs in pursuing their mission. The bullets below 

provide an overview of how the pandemic impacted 

Title VII LTCOP service needs and service provision.3,4,5 

■ Suspended and modifed facility visits. On March 

13, 2020, the Centers for Medicare & Medicaid 

Services issued guidance restricting everyone but 

essential personnel from entering nursing homes. 

As a result, the state ombudsman and ombudsman staf and volunteers serving as designated 

representatives of the ofce of the LTCO generally 

stopped visiting facilities in person during that 

time. When in-person visits slowly resumed, they 

would take place through windows, outdoors, or 

in a designated safe space until it was determined 

that in-room visits would resume. Since states and 

facilities had diferent protocols and policies for 

visits, ombudsmen had to spend extensive time to 

determine the requirements for visits and the most 

recent COVID-19 testing results to know if a visit 

could take place safely. 

■ Contacted facilities and residents remotely. While 

restrictions were in place, ombudsmen contacted 

facilities, families, and residents by phone, email, 

or video calls. Since restrictions were eased, ombudsmen have made contact with residents through 

a combination of phone contacts, virtual visits, and 

in-person visits. 

■ Experienced reduced number of complaints. Ombudsman programs have seen drops in the number 

of cases and number of complaints during the pandemic, which can be attributed to the lack of direct 

contact with residents by families and ombudsmen. 

■ Continued to investigate complaints. Ombudsman 

programs have continued to investigate complaints 

they receive and to provide information and assistance to residents, family members, the public, and 

long-term care staf, despite access to in-person 

visits having been restricted. Ombudsman programs have proactively reached out to residents 

and family members as well as facility staf by 

phone, email, and/or video calls to check in. 

■ Experienced an increase in information and assistance. Much of the ombudsman work this past year 

consisted of listening to stories of the impact of the 

COVID-19 pandemic and restrictions on facilities, 

staf, and residents. In addition, ombudsmen spent 

more time providing education on COVID-19 regulations and guidance. Consultations were conducted 

in person, by phone, or by email. 

■ Conducted virtual meetings. Ombudsman programs 

reported hosting virtual meetings (e.g., Facebook 

live, Zoom meeting) for family members of individuals living in long-term care facilities and the public 

to share information and respond to questions 

about COVID-19 and long-term care issues. Resident 

and family councils sometimes have used telecommunication platforms to hold their meetings rather 

than meeting in person. 
Older Americans Act Title VII LTCOP | 2020 Program Results | VII-7 

 

| 

 

October 1, 2019 - September 30, 2020.

2020 National Ombudsman Reporting System Data Highlights* 

* Program Performance Report reporting year 2020: 

October 1, 2019 - September 30, 2020. 

As part of Title VII Chapter 2 (LTCOP), each state is 

required to establish and operate a statewide ofce 

of the state LTCO, headed by a full-time state LTCO. 

These ombudsman programs currently operate in all 

50 states, the District of Columbia, Puerto Rico, and 

Guam. The state LTCO manages all aspects of the 

statewide program. Ombudsman staf and volunteers 

serving as designated representatives of the ofce 

of the LTCO at the local level assist in performing the 

activities and fulflling the responsibilities of the program, including advocating on behalf of residents in 

long-term care settings. 

Funds are awarded to states based on a formula that 

takes into account the state’s population age 60 or older compared to all states. States may implement LTCOP 

activities directly or through contracts or agreements 

with public or nonproft private agencies or organizations, such as other state agencies, area agencies 

on aging (AAAs), county governments, institutions of 

higher education, Indian tribes, or nonproft service 

providers or volunteer organizations.6 

Program Structure, Stafng, and Scope 

Number of Ombudsman Entities 

Reporting data in FY 2020 were 

■ 52 state LTCO ofces (all 50 states, the District 

of Columbia, and Puerto Rico)†

† Guam has an ombudsman but does not report data. Guam has 

only one nursing home and an unknown number of assisted living 

facilities. 

 and 

■ 438 local ombudsman entities. 

The majority (n=31) of state LTCO ofces were located within state units on aging which served as the 

contracting entity for the state. Thirteen of the 52 state 

LTCO ofces were located inside state government, 

either within another agency (n=10) or as stand-alone 

agencies (n=3). Eight state LTCO ofces were located 

outside state government as part of a nonproft agency 

(n=5) or representing its own stand-alone nonproft 

agency (n=3). 

52 | State LTCO 

ofces 438 Local ombudsmen 

entities
VII-8 | 

 

 

Exhibit 1. Location of State LTCO Ofce 

State unit on aging 31 

Inside state government 

other agency 10 

Inside state government, 

stand-alone agency 3 

Outside state government 

within a nonproft agency 5 

Outside state government in a 

stand-alone nonproft agency 3 

0 5 10 15 20 25 30 35 

Exhibit 2. Location of Local Ombudsman Entities 

The majority (n=308) of local ombudsman entities were 

located within AAAs, with the local ombudsman representatives of the ofce being employed by the AAA. In 

20 instances there were no local ombudsman entities. 

Area agency on aging (AAA) 308 

Nonproft agency, 

with 501(c)(3) status 76

There are no local ombudsman 

entities 20

Legal services provider 19 

Stand-alone non-proft agency 12 

Other 3 

0 50 100 150 200 250 300 350 
Older Americans Act Title VII LTCOP | 2020 Program Results | VII-9 

 

 

Number of Staf and Volunteers 

In FY 2020, the majority of LTCO program staf were volunteers (n=6,621), with 78% of volunteers (n=5,152) serving 

as certifed ombudsman and 22% of volunteers (n=1,469) 

serving in other roles.‡ 

‡ Volunteers who serve on a program advisory or governing board, 

assist with fund raising, provide other in-kind services such as 

accounting or strategic planning, etc. 

The majority of certifed volunteer 

ombudsmen (79%, n= 4,075) and the majority of paid 

staf (75%, n= 1,283) worked at the local level. The other 

certifed volunteer ombudsmen (21%, n= 1,077) and paid 

staf (25%, n= 417) worked at the state level. 

Paid staf 

1,700 

Certifed volunteer ombudsmen 

5,125 

Other volunteers 

(not ombudsmen representatives) 

1,469 

Of 6,621 Volunteers 

78% 

Served as 

certifed 

ombudsman 

22% 

Served in 

other roles 

Majority of certifed ombudsman and 

paid staf worked at the local level 

Certifed 

ombudsman 

Paid 

Staf 

79% 75% Local 

Level = 

21% 25% State 

= Level 
VII-10 | 

 | 

Number of Facilities and Capacity 

In FY 2020, LTCO programs and their representatives 

served more than 75,000 nursing homes and assisted 

living and similar residential care facilities, promoting and protecting the rights of more than 

3 million residents. 

Facilities 

75,795 

Residents 

3,192,209 

Case Summary 

Number of Complaints 

153,324 

In FY 2020, there were a total of 153,324 complaints which required LTCOP 

investigation and resolution on behalf of one or more residents of a longterm care facility. Of the 153,324 complaints, the majority (n=108,648; 71%) 

originated in nursing facilities. 

Complaint Verifcation Status 

71% | Almost three quarters of all complaints (n=109,555; 71%) were verifed, meaning that ombudsmen confrmed that most or all facts alleged by the complainant were likely to be true. 

In nursing facilities, 72% of complaints (n=78,358) were verifed; in residential care facilities, 69% of complaints (n=28,763) were verifed; and in other settings, 77% of complaints 

(n=2,434) were verifed. 
Older Americans Act Title VII LTCOP | 2020 Program Results | VII-11 

Exhibit 3. Complaints by Type of Facility 

Other 

3,165 

Residential Care 

Communities 

41,511 

Nursing Facilities 

108,648 

Exhibit 4. Complaints by Verifcation Status for Each Type of Facility 

78,358 80,000 jjjjjj

j Nursing Other n

Residential 

Facilities Care Facilities 

l 

60,000 

40,000 

20,000 

0 

nnn

l

jjjnn

l

2,434 

28,768 30,290 

12,748 

731 

Verifed Not Verifed 
VII-12 | 

 

Complaint Dispositions 

70% | More than two thirds of all complaints (n=107,310; 70%) were either partially or fully 

resolved.§

§ Verifcation and resolution were both afected by the pandemic. 

 For another 20% (n=29,976), no action was needed or the complaint was withdrawn. In about 10% of cases (n=16,038), the complaints were not resolved.¶

¶ Resolution is based on the satisfaction of the resident, and some problems just cannot be resolved. For example, a resident might complain about insufcient staf, which may be resolved by the ombudsman working with 

the facility on a staf assignment plan (resolved). However, other times it may be about not having enough people 

to hire (not resolved). 

 In nursing 

facilities, 71% of complaints (n=76,917) were partially or fully resolved; in residential care 

facilities, 67% of complaints (n=27,979) were partially or fully resolved; and in other 

settings, 77% of complaints (n=2,414) were partially or fully resolved. 

Exhibit 5. Complaints by Disposition for Each Type of Setting 

76,917 80,000 jjjjjj

l2,414 

nnn27,979 

j Other 

Facilities 

Nursing n

Residential 

Care Facilities 

jj20,614 

l 

60,000 

40,000 

20,000 

n

404 l

8,958 j

n4,574 

11,117 

347 

0

 Partially or fully resolved Withdrawn or Not resolved 

no action needed 
Older Americans Act Title VII LTCOP | 2020 Program Results | VII-13 

 

Complaints Categories 

The largest number of complaints in nursing facilities 

(n=32,680; 30%) was related to care issues, including 

facility staf failure to provide care or providing poor 

quality care. The second most complaints (n=16,645; 

15%) were related to facility staf failure to honor and 

promote a resident’s autonomy, choice, and rights. 

There were also many complaints in nursing facilities 

(n=13,349; 12%) related to abuse, gross neglect, and 

exploitation—which involves the willful mistreatment 

of residents by facility staf, resident representative/ 

family/friend, other residents, or an outside individual—as well as many complaints against nursing facilities (n=10,935; 10%) involving admission, transfer, 

discharge, and/or eviction. 

Exhibit 6. Complaints by Complaint Category, Nursing Facilities 

Care 32,680 

Autonomy, choice, rights 16,645 

Abuse, gross neglect, 

exploitation 13,349 

Admission, transfer, 

discharge, eviction 10,935 

Environment 6,585 

Financial, property 6,096 

Dietary 5,620 

Activities and community 

integration and social services 4,489 

Facility policies, procedures, and 

practices 4,305 

Access to information 3,378 

System and others (nonfacility) 3,319 

Complaints about an outside 

agency (nonfacility) 1,247 

0 10,000 20,000 30,000 40,000 
VII-14 | 

 

20% |

Complaints in residential care communities followed a pattern similar to those in nursing 

facilities, with the largest number of complaints related to care issues (n=8,461; 20%), 

followed by complaints related to autonomy, choice, and rights (n=6,905; 17%) and abuse, 

gross neglect, and exploitation (n=5,352; 13%). 

Exhibit 7. Complaints by Complaint Category, Residential Care Communities 

Care 8,461 

Autonomy, choice, rights 6,905 

Abuse, gross neglect, 

exploitation 5,352 

Admission, transfer, 

discharge, eviction 3,963 

Environment 3,686 

Financial, property 2,879 

Facility policies, procedures, and 

practices 2,754 

Dietary 2,436 

Activities and community 

integration and social services 1,760 

System and others (nonfacility) 1,716 

Access to information 1,080 

Complaints about an outside 

agency (nonfacility) 519 

0 2,000 4,000 6,000 8,000 10,000 
Older Americans Act Title VII LTCOP | 2020 Program Results | VII-15 

 

19% | In other settings, too, the largest number of complaints (n=590; 19%) was related to care 

issues. The second largest number (n=533; 17%) was complaints about an outside agency, 

followed by complaints related to abuse, gross neglect, and exploitation (n=500; 16%). 

Exhibit 8. Complaints by Complaint Category, Other Settings 

Care 590 

Complaints about an outside 

agency (nonfacility 533 

Abuse, gross neglect, 

exploitation 500 

Admission, transfer, 

discharge, eviction 394 

Autonomy, choice, rights 331 

System and others (nonfacility) 317 

Facility policies, procedures, and 

practices 146 

Activities and community 

integration and social services 83 

Financial, property 82 

Environment 79 

Access to information 55 

Dietary 55 

0 200 400 600 
VII-16 | 

 

Perpetrator Type** 

** Perpetrator type is reported for complaints related to abuse only. An ombudsman may select more than one 

type of perpetrator for a single abuse complaint. Thus, there are more perpetrators (n=19,303) than abuse complaints (19,201). 

55% | For complaints related to abuse (physical, sexual, psychological), more than half of the 

complaints (n=10,644; 55%) involved a facility staf member, and almost a quarter of the 

complaints (n=4,416; 23%) involved another resident. 

Exhibit 9. Perpetrator Type for Abuse Complaints 

Other 

1,733 Family, Resident 

Representative, 

Friend 

2,511 

Another 

Resident 

4,416 

Facility Staf 

10,644 
Older Americans Act Title VII LTCOP | 2020 Program Results | VII-17 

 

Program Activities 

In addition to investigating complaints, LTCO programs 

engage in a range of activities to improve quality of 

life and care for residents of long-term care facilities. 

In FY 2020, the largest number of activities completed 

by LTCO programs focused on information and assistance to individuals (n=381,174 instances) or resident 

staf (n=261,989 instances). These activities may 

include providing information about issues that impact 

residents (e.g., resident rights, care issues, services) 

and/or providing assistance to access services without 

opening a case and working to resolve a complaint. 

LTCO programs also completed almost 200,000 visits 

to 39,984 long-term care facilities, no matter the purpose of visit (complaint or noncomplaint related).†† 

†† These activities were also highly influenced by the pandemic. 

Exhibit 10. Program Activities to Improve Quality of Life 

Information and 

assistance to individuals 381,724 

Information and 

assistance to staf 261,989 

Number of visits 191,214 

Facilities visited 39,984 

Facility surveys 12,230 

Resident councils 10,737 

Community education 8,323 

Training sessions for 

facility staf 2,121 

Family councils 1,208 

Routine access 298 

0 100,000 200,000 300,000 400,000 
VII-18 | 

 

Appendix A: Title VII National Ombudsman 

Reporting System Defnitions7 

Abuse: Physical abuse: The intentional use of physical 

force that results in acute or chronic illness, bodily injury, physical pain, functional impairment, distress, or 

death. Sexual abuse: Forced and/or unwanted sexual 

interaction (touching and nontouching acts) of any 

kind. Psychological abuse: The infliction of anguish, 

pain, or distress through verbal or nonverbal acts, 

including but not limited to verbal assaults, insults, 

threats, intimidation, humiliation, and harassment. 

Abuse, Gross Neglect, Exploitation (Code A): Serious 

complaints of willful mistreatment of residents by 

facility staf, resident representatives/ family/friends, 

other residents, or outside individuals. Indicate who 

appears to be the cause of the abuse, neglect or 

exploitation: (1) facility staf; (2) another resident; (3) 

resident representative, family, friend; or (4) other. 

Access to Information (Code B): Complaints against 

the facility regarding access to information made by or 

on behalf of the resident. Use for willful interference 

with ombudsman duties. 

Activities, Community Integration and Social Services 

(Code G): Complaint involving activities, community 

integration, or social services. 

Admission, Transfer, Discharge, Eviction (Code C): 

Complaints against the facility involving issues regarding admission, transfer, discharge, and/or eviction. 

Area Agency on Aging (AAA): Public or private nonproft 

agency designated by a state to address the needs and 

concerns of all older persons at the regional and local 

levels. The term AAA is a general one; names of local 

AAAs may vary. The AAAs coordinate and ofer services 

that help older adults remain in their homes, if that is 

their preference, aided by services such as home-delivered meals, homemaker assistance, and whatever else 

it may take to make independent living a viable option. 

Autonomy, Choice, Rights (Code D): Complaints 

involving facility staf failure to honor and promote a 

resident’s right or preferences. 

Care (Code F): Complaints involving facility staf failure 

to provide care, including poor quality care, planning, 

and delivery. 

Certifed Volunteer Ombudsmen: Volunteers designated as representatives of the LTCO ofce. 

Community Education: Community education outreach 

sessions by ombudsman program—e.g., attendance at 

health fairs, community events, general presentations, 

etc. 

Complaint: An expression of dissatisfaction or concern 

brought to, or initiated by, the ombudsman program 

which requires ombudsman program investigation and 

resolution on behalf of one or more residents of a longterm care facility. 

Complaints About an Outside Agency (Nonfacility; 

Code K): Complaints involving decisions, policies, 

actions, or inactions by programs and agencies—including private and public benefts. 

Complainant: An individual who requests ombudsman 

program complaint investigation services regarding 

one or more complaints made by, or on behalf of, 

residents. 

Complaint Disposition: Final resolution or outcome of 

the complaint. 

Complaint Verifcation: A confrmation that most or all 

facts alleged by the complainant are likely to be true. 

Dietary (Code H): Complaints regarding food service, 

assistance. 

Environment (Code I): Complaints involving the physical environment of the facility, including the resident’s 

space. 

Facilities Visited: Total number of facilities that 

received at least one visit by a representative of the 

LTCO ofce during the reporting year, regardless of the 

purpose of the visit. 
Older Americans Act Title VII LTCOP | 2020 Program Results | VII-19 

Facility Capacity: Number of beds for which the facility 

is licensed, certifed, or registered. 

Facility Policies, Procedures, and Practices (Code J): Acts 

of commission or omission by facility leadership/owners, 

including administrators, resident managers, etc. 

Facility Staf: Any employee or contractor of a longterm care facility who brings a complaint to the ombudsman program regarding one or more residents. 

Facility Surveys: Participation in survey activity 

conducted by regulatory agencies, including participation in both standard surveys and complaint surveys. 

Survey participation includes, but is not limited to, 

providing presurvey information to surveyors, sharing 

complaint summary reports, and participating in exit 

conferences and informal dispute resolution. 

Financial, Property (Code E): Complaints involving 

facility staf mismanagement of residents’ funds and 

property or billing problems. 

Gross Neglect: Failure to protect a resident from harm 

or the failure to meet needs for essential medical care, 

nutrition, hydration, hygiene, clothing, basic activities 

of daily living, or shelter, which results in a serious risk 

of compromised health and/or safety relative to age, 

health status, and cultural norms. 

Information and Assistance: Providing information 

about issues that impact residents (e.g., resident 

rights, care issues, services) and/or providing assistance to access services without opening a case 

and working to resolve a complaint. Information and 

assistance may be provided through various means, 

including but not limited to by telephone, by written 

correspondence such as email, or in person. 

Nursing Facility: Any skilled nursing facility, as defned in section 1819(a) of the Social Security Act (42 

U.S.C. 1395i–3(a)), or any nursing facility, as defned 

in section 1919(a) of the Social Security Act (42 U.S.C. 

1396r(a)). May also include noncertifed nursing homes 

licensed by the state. 

Ombudsman Program: The program through which the 

functions and duties of the LTCO ofce are carried out, 

consisting of the ombudsman, the ofce headed by the 

ombudsman, and the representatives of the ofce. 

Other Settings: Settings beyond those defned as longterm care facilities in the Older Americans Act (OAA). 

Other Volunteers: Other types of volunteers who are 

not representatives of the ofce. 

Perpetrator: Person who appears to have caused the 

abuse or neglect or exploitation. 

Resident: An individual who resides in a long-term care 

facility. 

Residential Care Community: A type of long-term care 

facility as described in the OAA that, regardless of setting, provides, at a minimum, room and board, aroundthe-clock on-site supervision, and help with personal 

care such as bathing and dressing or health-related 

services such as medication management. Facility 

types include, but are not limited to, assisted living; 

board and care homes; congregate care; enriched 

housing programs; homes for the aged; personal 

care homes; adult foster/ family homes; and shared 

housing establishments that are licensed, registered, 

listed, certifed, or otherwise regulated by a state. 

Resident or Family Council: Organized, self-governing, 

decision-making group of long-term care residents 

(resident council) or families (family council) who meet 

regularly to voice their needs and concerns and to have 

input into the activities, policies, and issues afecting 

the facility. 

Resident Representative, Friend, Family: Resident representative, as defned in 45 CFR 1324.1, may be 

■ an individual chosen by the resident to act on behalf of the resident in order to support the resident 

in decision-making; access medical, social or other 

personal information of the resident; manage fnancial matters; or receive notifcations; 
VII-20 | 

 

■ a person authorized by state or federal law (including but not limited to agents under power of attorney, representative payees, and other fduciaries) 

to act on behalf of the resident in order to support 

the resident in decision-making; access medical, 

social or other personal information of the resident; 

manage fnancial matters; or receive notifcations; 

■ a legal representative, as used in section 712 

of the Act; or 

■ the court-appointed guardian or conservator 

of a resident. 

Friend is a nonrelative with a personal relationship 

with the resident as identifed by the resident or complainant. Family is spouse, sibling, other relative, or as 

identifed by the resident or complainant. 

Routine Access: Facilities visited, not in response to a 

complaint, in all four quarters by representatives of the 

LTCO ofce. 

State Units on Aging: Designated state-level agencies 

that are responsible for the planning and policy development as well as the administration of OAA activities. 

System: Others (Nonfacility; Code L): Other complaints, including resident representative or family 

member interfering with the resident’s decision-making and preferences related to health, welfare, safety, 

or rights, but not rising to the level of abuse, gross neglect or exploitation; problems with services provided 

to a resident from an individual or entity not associated with or arranged by the facility; and barriers to 

transition to community—inadequate assistance with 

accessing housing, services, and supports not related 

to facility action or inaction. 

Training: Training sessions provided by representatives of the LTCO ofce to facility staf. Training may 

be in person or web-based and typically includes an 

agenda and learning outcome(s). 

Visits: Facility visits, no matter the purpose of visit 

(complaint or noncomplaint related), by representatives of the LTCO ofce. 
Older Americans Act Title VII LTCOP | 2020 Program Results | VII-21 

 

 

References 

1 NORC. (2019). Final report: Process evaluation 

of the Long-Term Care Ombudsman Program 

(LTCOP). https://acl.gov/sites/default/fles/programs/2020-10/LTCOPProcessEvaluationFinalReport_2.pdf 

2 Administration for Community Living. (2021, February 1). Long-Term Care Ombudsman Programs 

Coronavirus Response and Relief Supplemental 

Appropriations Act of 2021. https://acl.gov/sites/ 

default/fles/common/LTCOP%20Coronavirus%20 

RR%20Sup%20Aprop%20Act%202-1-21-%20Final.pdf 

3 North Dakota Department of Human Services, Aging Services Division. (2021). 2021 annual report 

of the ND Long-Term Care Ombudsman Program. 

https://www.nd.gov/dhs/info/pubs/docs/aging/ 

ombudsman-program-annual-report.pdf 

4 The National Long-Term Care Ombudsman Resource Center. (2021). NORS FAQs: COVID-19. 

https://ltcombudsman.org/uploads/fles/support/nors-faqs-covid.pdf 

5 State of Illinois, Department on Aging. (n.d.). 

Illinois Long-Term Care Ombudsman Program. 

Frequently asked questions – COVID-19. https:// 

www2.illinois.gov/aging/programs/LTCOmbudsman/Documents/LTCOP_COVID_FAQ.pdf 

6 National Academy of Sciences. (1995). Older 

Americans Act: A staf summary (a publication of 

the Select Committee on Aging). https://www.ncbi. 

nlm.nih.gov/books/NBK231086/ 

7 Administration for Community Living. (n.d.). NORS 

technical documents. https://oaaps.acl.gov/Resources/techDocs