DEPARTMENT

of HEALTH

and HUMAN

SERVICES

Fiscal Year

2012

Administration on Aging

Justification of

Estimates for

Appropriations Committee
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FROM THE ADMINISTRATION ON AGING

I am pleased to present the Administration on Aging (AoA) FY 2012 Congressional Justification. 

AoA and the national aging services network annually serve nearly 11 million seniors and their 

caregivers. AoA’s services are especially critical for the nearly three million seniors who receive 

intensive in-home services, half a million of whom meet the disability criteria for nursing home 

admission. 

From 2010 to 2015, the population age 60 and older will increase by 15 percent, from 57 million 

to 65.7 million. During this period, the number of seniors with severe disabilities who are at 

greatest risk of nursing home admission and Medicaid eligibility will increase by more than 

13 percent. Further, demographic trends indicate at least 300,000 more seniors will be living in 

poverty in FY 2012.

As Assistant Secretary for Aging, my goal is to insure that all older Americans have the 

opportunity to live independently, with dignity, in their homes and communities for as long as 

they are able and choose to do so. I believe that with the FY 2012 budget, we will make 

significant progress toward this goal. The FY 2012 request of $2.2 billion will continue to 

support the vibrant, far reaching array of services and supports for older Americans and their 

caregivers that have been the hallmark of the Older Americans Act, while elevating our focus on 

preventing elder abuse—physical, emotional, financial—and emphasizing elder justice. It will 

encompass a new, voluntary self-directed long-term care insurance resource for American 

workers that will allow participants to purchase community living assistance services and 

supports so that they can remain as independent as possible under a variety of future health 

circumstances. Finally, it will bring two existing programs into the AoA fold, melding activities 

that are already key to helping seniors maintain their health and economic independence with the 

supports provided by AoA’s existing Aging Services programs. The whole promises to be far 

more efficient, effective and beneficial to seniors. 

In light of AoA’s past performance and cost-effectiveness, this budget entrusts AoA with a 

variety of new opportunities to build on our record of success. It is our privilege to continue to 

help prepare the country for the increasing numbers of older Americans and continue to provide 

vital support programs for this country’s most vulnerable citizens so that they can remain in their 

homes and communities for as long as possible, which is what they prefer.

Kathy Greenlee

Assistant Secretary for Aging
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DEPARTMENT OF HEALTH AND HUMAN SERVICES

ADMINISTRATION ON AGING

TABLE OF CONTENTS

Executive Summary:

Organizational Chart .............................................................................................................................................. 7

Executive Summary ............................................................................................................................................... 8

Overview of Performance...................................................................................................................................... 15

All-Purpose Table ................................................................................................................................................ 22

Recovery Act Information .................................................................................................................................... 25

Budget Exhibits:

Appropriations Language ..................................................................................................................................... 27

Language Analysis............................................................................................................................................... 29

Amounts Available for Obligation ........................................................................................................................ 32

Summary of Changes ........................................................................................................................................... 33

Budget Authority by Activity................................................................................................................................ 35

Authorizing Legislation ........................................................................................................................................ 37

Appropriations History......................................................................................................................................... 39

Appropriations Not Authorized by Law ................................................................................................................ 40

Narrative by Activity:

Health and Independence

Summary of Request ..................................................................................................................................... 41

Home and Community-Based Supportive Services......................................................................................... 45

Nutrition Services.......................................................................................................................................... 53

Preventive Health Services ............................................................................................................................ 63

Chronic Disease Self-Management Programs................................................................................................. 71

Community Service Employment for Older Americans.................................................................................. 75

Native American Nutrition and Supportive Services....................................................................................... 79

Aging Network Support Activities................................................................................................................. 83

Caregiver Services

Summary of Request ..................................................................................................................................... 89

Family Caregiver Support Services................................................................................................................ 91

Native American Caregiver Support Services................................................................................................. 99

Alzheimer’s Disease Supportive Services Program....................................................................................... 103

Lifespan Respite Care.................................................................................................................................. 107

Protection of Vulnerable Older Adults

Summary of Request ................................................................................................................................... 111

Adult Protective Services State Demonstrations ........................................................................................... 113

Long-Term Care Ombudsman Program........................................................................................................ 117

Prevention of Elder Abuse and Neglect ........................................................................................................ 123

Senior Medicare Patrol Program .................................................................................................................. 129

Elder Rights Support Activities.................................................................................................................... 133

Consumer Information, Access, and Outreach

Summary of Request ................................................................................................................................... 137

Aging and Disability Resource Centers........................................................................................................ 139

State Health Insurance Assistance Programs................................................................................................. 145

Program Innovations .......................................................................................................................................... 149

Program Administration

Summary of Request ................................................................................................................................... 153

Aging Services Program Administration ...................................................................................................... 155

Community Living Assistance Services and Supports................................................................................... 161
6

Supplementary Tables:

Budget Authority by Object Class....................................................................................................................... 165

Salaries and Expenses......................................................................................................................................... 166

Detail of Full-Time Equivalent Employment (FTE)............................................................................................. 167

Detail of Positions.............................................................................................................................................. 169

Programs Proposed for Elimination..................................................................................................................... 170

Significant Items in House and Senate Appropriations Committee Reports.......................................................... 171
7

Organizational Chart

Office of 

Elder Rights

Barbara Dieker

Director

Office of Home and 

Community-Based 

Services

Greg Case

Acting Director

Office of 

Performance and 

Evaluation

Saadia Greenberg

Director

Office of Program 

Innovation and 

Demonstration

Lori Gerhard

Director

Assistant Secretary 

for Aging

Kathy Greenlee

Office of Outreach 

and Consumer 

Information

Carol Crecy

Director

Office of American 

Indian, Alaskan Native, 

and Native Hawaiian 

Programs

Meg Graves

Acting Director

Office of Information 

Resources Management

Dan Berger

Director

Center for Management 

and Budget

Dan Berger

Acting Director

Office of Budget 

and Finance

G. Steven Hagy

Director

Office of Grants 

Management

Rimas Liogys

Director

Administration on Aging Organizational Chart

National Long-Term 

Care Ombudsman

Becky Kurtz

Principal Deputy 

Assistant Secretary

Cindy Padilla

Regional Support 

Centers

Bob Logan

Office of 

Administration and 

Personnel

Terry Nicolosi

Director

Region I

Kathleen Otte

Regional

Administrator

Center for Policy, 

Planning & Evaluation

Bob Hornyak

Acting Director

Congressional and 

Public Affairs

Moya Thompson

Executive 

Secretariat

Harry Posman

Office of Policy 

Analysis and 

Development

Mimi Toomey

Director

Center for Program 

Operations

Edwin Walker

Director

Region II

Kathleen Otte

Regional

Administrator

Region IV

Costas Miskis

Regional

Administrator

Region V

Jim Varpness

Regional

Administrator

Region VII

Jim Varpness

Regional

Administrator

Region VI

Percy Devine

Regional

Administrator

Region VIII

Percy Devine

Regional

Administrator

Region IX

David Ishida

Regional

Administrator

Region X

David Ishida

Regional

Administrator

Office of Community Living 

Assistance Services & Supports

John Wren

Director
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Executive Summary

Agency Overview

The Administration on Aging (AoA), an Agency of the U.S. Department of Health and Human 

Services (DHHS), is the principal Federal Agency charged with helping elderly individuals 

maintain their dignity and independence in their homes and communities. AoA advances the 

concerns and interests of older people, and works with and through the national aging services 

network to promote the development of comprehensive, coordinated home and community-based 

care that is responsive to the needs and preferences of older people and their caregivers. The 

network, led by AoA at the Federal level, is comprised of 56 State and Territorial Units on Aging 

(SUA), 629 Area Agencies on Aging (AAA), 246 Indian Tribal and Native Hawaiian 

organizations, nearly 20,000 direct service providers, and hundreds of thousands of volunteers.

AoA’s core programs, authorized under the Older Americans Act (OAA) and administered by 

the national aging services network, help families keep their loved ones at home for as long as 

possible. These services complement existing medical and health care systems, help to prevent 

hospital readmissions, provide transport to doctors appointments, and support some of life’s most 

basic functions, such as providing assistance in elders’ homes to help them with bathing or 

providing or preparing food. The network also helps consumers learn about and access the 

services and supports that are available in the community and addresses issues related to 

caregivers. OAA services are less expensive than institutional care and performance data show 

that they are very effective. The most recent data available (FY 2009) show that AoA and its 

national network rendered direct services to nearly 11 million elderly individuals age 60 and over 

(nearly 20 percent of the country’s elderly population) and their caregivers, including nearly 

three million clients who received intensive in-home services. Critical supports, such as respite 

care and a peer support network, were provided to nearly 850,000 caregivers.

AoA is also the agency chosen to administer the Community Living Assistance Services and 

Supports (CLASS), a new self-funded, voluntary insurance program created under the 

Affordable Care Act. AoA’s expertise in the field of aging services as well as its connection to 

the aging services network will help ensure that the CLASS program is solvent and successful as 

it begins to take effect in 2013.

In the ongoing management of its programs and strategic planning process, AoA is guided by a 

set of core values in developing and carrying out its mission. These values include listening to 

older people, their family caregivers, and AoA partners who serve them; responding to the 

changing needs and preferences of our increasingly diverse and rapidly growing elderly 

population; producing measurable outcomes that significantly impact the well-being of older 

people and their family caregivers; and valuing and developing AoA staff.

Vision

In order to serve a growing senior population, AoA envisions ensuring the continuation of a 

vibrant aging services network at State, Territory, local and Tribal levels through funding of 

lower-cost, non-medical services and supports that provide the means by which many more 
EXECUTIVE SUMMARY

10

seniors can remain out of institutions and live independently in their communities for as long as 

possible.

Mission

The mission of AoA is to develop a comprehensive, coordinated and cost-effective system of 

home and community-based services that helps elderly individuals maintain their health and 

independence in their homes and communities. 

Overview of Budget Request

The FY 2012 President’s Budget request for AoA is $2,237,944,000, a net decrease of -

$150,513,000 below the FY 2010 enacted level. This decrease is due to the inclusion in the 

FY 2010 base of one-time, special funding totaling $225,000,000 for Community Service 

Employment for Older Americans, commonly known as Senior Community Service 

Employment Program (SCSEP), that is proposed for transfer to AoA from the Department of 

Labor. After adjusting for this one-time funding, the request provides increases of +$74,487,000 

for AoA. 

The FY 2012 request will continue to support a vibrant, far reaching array of services and 

supports for elderly Americans and their caregivers. The budget proposes new funding for Adult 

Protective Services Demonstration Grants (APS), authorized by the Elder Justice Act of 2010, 

part of a larger enhanced AoA focus on elder rights and elder justice that will focus on 

addressing and combating the many forms of elder abuse. It provides increases for core 

caregiver and supportive services programs that help seniors remain in the community. Existing

AoA programs for seniors will be reinforced in FY 2012 by the transfer to AoA of the State 

Health Insurance Assistance Programs (SHIPs) from the Centers for Medicare & Medicaid 

Services (CMS) and the SCSEP from the Department of Labor. The budget also reflects the 

inclusion of the newly-created Community Living Assistance for Services and Supports 

(CLASS) program created by the Affordable Care Act.

AoA’s enhanced focus on elder rights and elder justice provides increases of +$21.5 million to 

support a variety of programs that address issues of elder abuse and neglect. Research has 

demonstrated that older victims of even modest forms of abuse have dramatically higher 

(300 percent) morbidity and mortality rates than non-abused older people.1 Additional adverse 

health impacts include an increased likelihood of heart attacks, dementia, depression, chronic 

diseases and psychological distress leading a growing number of seniors to access the healthcare 

system more frequently (including emergency room visits and hospital admissions), and 

ultimately to leave their homes and communities prematurely. 2 

 

1 Lachs, M.S., Williams, C.S., O'Brien, S., Pillemer, K.A., & Charlson, M.E. (1998). ―The Mortality of Elder 

Mistreatment.‖ JAMA. 280: 428-432. and Baker, M.W. (2007). ―Elder Mistreatment: Risk, Vulnerability, and 

Early Mortality.‖ Journal of the American Psychiatric Nurses Association, Vol. 12, No. 6, 313-321. 

2 Lachs M. S., Williams C., O'Brien S., Hurst L., Kossack A., Siegal A., et al. (1997). ―ED use by older victims of 

family violence.‖ Annals of Emergency Medicine. 30:448-454.
EXECUTIVE SUMMARY

11

AoA’s enhanced focus on elder justice and elder rights includes $16.5 million to support State 

Adult Protective Services (APS) programs through the Adult Protective Services State 

Demonstrations program, which will allow AoA to provide leadership and program coordination 

functions as well as the development and dissemination of best practices across State and local 

APS agencies. In addition to these APS improvements, the budget provides an additional 

+$5 million to improve resident advocacy to elders who live in long-term care settings through 

increased support to the Long-Term Care Ombudsman Program. 

This enhanced focus on elder justice and elder rights will allow the Protection of Vulnerable 

Adults programs to improve the protection of vulnerable adults living in their communities and 

in long-term care settings; increase the information and technical assistance available to the 

public, States, and localities in preventing and addressing abuse; protect the rights of older adults 

and prevent their exploitation and reduce health-care fraud and abuse. This multifaceted 

approach to preventing, detecting, and resolving elder abuse, neglect, and exploitation is 

essential to successfully fulfilling the shared mission of the Older Americans Act and the Elder 

Justice Act to maintain the health and independence of older Americans and adults with 

disabilities.

The FY 2012 request continues to expand support for existing programs that focus on Health and 

Independence for seniors including Nutrition programs, Preventive Health Programs and Home 

and Community-Based Supportive Services and on its programs that provide caregivers with 

support and respite. These last two programs would receive increases of +$48 million and 

+$40 million respectively compared to FY 2010 enacted levels. The program also increases 

funding for the Lifespan Respite Care Act to $10 million. These increases are in keeping with 

efforts by the White House Task Force on Middle Class Families to focus additional support on 

middle class families struggling to care for their aging relatives. The Task Force has been 

concerned about families that struggle to hold down a job and care for an aging parent; those 

juggling caring for their own children with the need to drive aging parents to doctor 

appointments and the grocery store; and those who provide extensive hands-on care and simply 

need a break. Caregiving responsibilities demand time and money from families who too often 

are already strapped for both, and these increase will help families to balance these dual 

responsibilities so that older adults can remain in the community for as long as possible.

AoA’s expanded emphasis on community living and helping seniors and people with disabilities 

to live independently is further strengthened by the transfer of SHIPs from CMS and the decision 

to establish the CLASS program at AoA. SHIPs, funded at $46,960,000, provide one-on-one 

counseling to help aging and disabled beneficiaries and coming-of-agers navigate complex 

health and long-term care-related topics. Moving this funding to AoA will enable grantees, 

about two-thirds of which are State Units on Aging receiving grants from AoA under other 

programs, to further streamline their interaction within the national aging services network and to 

complement AoA’s existing Aging and Disability Resource Centers (ADRCs) that serve as 

community level ―one stop shop‖ entry points into long-term services and supports for people of 

all ages who have chronic conditions and disabilities. At the same time, the CLASS program, a 

voluntary, self-directed insurance resource for participating adults, for which the FY 2012 budget 

includes $120,000,000 in administrative funding, will allow participants to prepare themselves 
EXECUTIVE SUMMARY

12

financially to be able to afford the services and supports that they may one day need to remain 

independent and in the community. 

Finally, the proposal to shift the Senior Community Service Employment Program (authorized

under Title V of the Older Americans Act) reflects the recognition that the SCSEP program can

be at its most effective when its services are closely integrated with the supports that are 

provided by AoA’s existing aging services programs. At the same time, the wages earned by 

participants while in this program and after finding unsubsidized employment, will be key to 

allowing more seniors to remain independent and in their communities.

Program Increases

 

Health and Independence Programs (Excluding Senior Community Service 

Employment Program) (+57,936,000): 

An additional +$48 million for Home and Community-Based Supportive Services is 

requested to expand services, including adult day care as a respite service for families; 

transportation assistance, case management, minor home modifications, and information 

and referrals that help seniors ability to remain at home; in-home services such as 

personal care, chore, and help with eating, dressing and bathing; and community services 

such as physical fitness programs. Health and Independence Programs will support more 

than six million hours of adult day care; 18.3 million rides for critical daily activities such 

as visiting the doctor, the pharmacy, or grocery stores; and 25 million hours of personal 

care assistance to seniors unable to perform daily activities. The request also includes 

new funding totaling +$10 million to maintain Chronic Disease Self-Management 

programs, an evidence-based model that utilizes state-of-the-art techniques to help those 

with chronic disease to manage their conditions, improve their health status, and reduce 

their need for more costly medical care. 

Caregiver Services Programs (+$47,523,000):

As part of a continuing effort to address the needs of caregivers, an additional 

+$40 million over the FY 2010 enacted level is requested for the core National Family 

Caregiver Support Program (including +$2 million for Native American caregivers). The 

budget also quadruples funding for the Lifespan Respite Care program, an increase of 

+$7.5 million. These programs support family and informal caregivers by providing 

information, assistance, counseling, training, respite, and other services which help them 

care for their loved ones at home. These funds will increase the number of caregivers 

receiving support to 919,000 caregivers. Overall, the $192 million in family caregiver 

funds will provide 7 million hours of respite care or temporary relief from their 

caregiving responsibilities and more than 450,000 sessions of counseling, peer support 

groups, and training to help caregivers better cope with the stresses of caregiving. 

Protection of Vulnerable Older Americans Programs (+$21,033,000): 

In FY 2012, AoA is requesting +$21 million in additional funding for programs that 

provide a range of services designed to ensure the safety and well-being of seniors who 

are in danger of being mistreated or neglected. This budget will direct $16.5 million of 

the $21 million requested to provide first time funding for demonstrations to help develop 
EXECUTIVE SUMMARY

13

best practices and approaches related to Adult Protective Services, newly authorized in 

the Elder Justice Act of 2010 and the Older Americans Act. The outcomes of these 

demonstrations will be made available to States to use in increasing consistency in areas 

such as receipt and investigation of reports of adult abuse; case planning, monitoring, 

reporting and evaluation; and the coordination of services between adult protective 

services (half of which are directly administered by State Units on Aging), and related 

systems including law enforcement, protection and advocacy, licensure and certification, 

and victim assistance. The budget also adds $5 million to expand State support for longterm care Ombudsmen, who advocate on behalf of residents of long-term care facilities to 

ensure the protection of their rights and their welfare. Altogether, nearly

10,000 volunteers participate in the Long-Term Care Ombudsman Program. 

Program Administration (+$124,567,000, +50 FTE): 

Additional resources for Program Administration will be needed in FY 2012 to 

accommodate both the absorption of new programs and creation of others. Of the 

Program Administration increase, +$120,000,000 and +40 FTE is needed to manage 

AoA’s new CLASS program, including significant investments in the development of a 

national IT system and national education and outreach to potential participants and 

employers to explain the opportunities presented by this program. Similar funding will 

not be required in subsequent years as this program becomes self-sustaining once 

participants begin paying enrollment fees. An additional +$4,567,000 and +21 FTE will 

be used to address needs of AoA’s aging services programs, especially regional needs, 

and to provide for costs associated with AoA’s headquarters lease renewal. An additional 

+15 FTE associated with transferred and new programs will be funded from program 

dollars rather than Program Administration, and are reflected in individual programs’ 

requests. 

Program Decreases

Health and Independence Programs—Senior Community Service Employment 

Program (-$375,475,000):

The budget includes a proposal to transfer SCSEP from the Department of Labor to the 

AoA in FY 2012. A total of $450,000,000 in funding would be provided, a decrease of -

$375,475,000 from the comparable FY 2010 enacted level. However, $225,000,000 of 

this reduction represents the expiration of one-time funding that was provided in 

FY 2010. The remaining reduction reflects the tight budget environment in which all 

discretionary programs are operating in FY 2012. Placing this program within AoA will 

better integrate training and job placement for seniors seeking to return to the labor 

market with the supportive services they need to remain independent, while also allowing 

the program to refocus on the provision of community service to a greater degree as was 

originally intended. 

Consumer Information, Access and Outreach (-$10,250,000):

Two reductions in Aging and Disability Resource Center (ADRC) funding are reflected 

in this section. The first is a $10 million decrease to offset additional funding now being 
EXECUTIVE SUMMARY

14

provided through a mandatory Affordable Care Act ADRC appropriation; the second is a 

reduction of $250,000 that reflects projected savings from program contract efficiencies.

 

Program Innovations (-$16,364,000): 

Funding for Program Innovations is reduced both because no funding is requested to 

continue one-time Congressional earmarks and because some funding is being directed to 

other, higher priority program needs. In part, this second reduction necessitated the 

proposed elimination of funding for Community Innovations for Aging in Place. Finally, 

the lower Program Innovations level also includes $500,000 in projected savings as a 

result of greater program contracting efficiencies. 

The Older Americans Act is due for reauthorization in FY 2012. AoA convened three national 

listening sessions, held one joint session with the Department of Labor, and sparked hundreds of 

national, state and local sessions convened by stakeholders and involving all states and area 

agencies. In addition, targeted outreach to national minority aging organization representing 

diverse cultures and populations was conducted. As a result, the critical internal and external 

stakeholders representing thousands of older individuals and their caregivers were engaged in 

providing input and recommendations for the next reauthorization. We look forward to working 

with Congress to strengthen and update these critical programs with an eye towards efficiency 

and effectiveness, and strengthening and building the capacity of the aging services network to 

deliver high-quality services that improve outcomes for seniors.
EXECUTIVE SUMMARY

15

Overview of Performance

AoA program activities have a fundamental common purpose which reflects the legislative intent 

of the Older Americans Act (OAA) and the AoA Mission: to help elderly individuals – and 

increasingly individuals with disabilities - maintain their dignity and independence in their 

homes and communities through comprehensive, coordinated, and cost effective systems of 

long-term care, and livable communities across the U.S. To reflect this unified purpose, AoA 

has aggregated all budget line items into a single Government Performance and Results Act 

(GPRA) program, AoA’s Aging Services Program, for purposes of performance measurement. 

The Aging Services Program’s fundamental purpose, in combination with the legislative intent 

that the national aging services network actively participate in supporting community-based 

services with particular attention to serving economically and socially vulnerable elders, led 

AoA to focus on three measures: 1) improving efficiency; 2) improving client outcomes; and 

3) effectively targeting services to vulnerable elder populations. Each measure is representative 

of several activities across the Aging Services Program budget and progress toward achievement 

of the measure is tracked using a number of indicators. The efficiency measure and 

corresponding indicators are reflective of the Office of Management of Budget (OMB) 

requirements to measure efficiency for all program activities. The client outcome measure 

includes indicators focusing on consumer assessment of service quality and outcome indicators 

focusing on nursing home predictors, successful caregiver program operation and protection of 

the vulnerable elderly. The targeting measure and indicators focus on ensuring that States and 

communities serve the most vulnerable elders, those that are most in need of these services. 

Taken together, the three measurement areas and their corresponding performance indicators are 

designed to reflect AoA’s strategic goals and objectives and in turn measure success in 

accomplishing AoA’s mission.

In addition to the basic performance measurement requirements of GPRA, which are discussed 

in detail below, and in recognition of this Administration’s guidance on transparency and 

accountability, AoA has taken several steps to improve the analysis and availability of 

performance information while also enhancing the rigor of program evaluations that are currently 

in development. To this end, AoA has:

Expanded the availability of performance information via an on-line system that enables 

Aging Network professionals and the public to develop benchmarks and examine trends 

nationally and at the state level (http://www.data.aoa.gov).

Submitted public use data sets to the http://www.data.gov/ system.

Further analyzed the results from the 2008 and 2009 National surveys to help inform 

decision makers. Results show:

o AoA is effectively reaching those most at risk of institutionalization.

o Service recipients report Title III services enable them to remain in their own 

homes.
EXECUTIVE SUMMARY

16

o Comparison of service recipients to the elderly US population 60 and older shows 

that Title III serves older people who are less healthy and have more limitations 

than other older adults even after adjusting for demographic and socioeconomic 

differences between the groups.

Tested through the Performance Outcomes Measurement Project (POMP) several 

methods for measuring the impact of services. Preliminary analysis for administrative 

data sets from four States, using Cox proportional hazards models, show a consistent 

lowering of the relative risk of nursing home placement with an increase in number of 

services utilized; and there was an increase in mean survival time in the community (i.e. 

months before placement) with increases in the total number of services used.

Employed more rigorous program evaluation methods such as longitudinal data 

collection and experimental design.

o The Title III-C Elderly Nutrition Services program evaluation employs a complex 

design that includes three major components and several subcomponents. The 

major components include a process study that surveys each component of the 

Aging Network on a large array of topics; a costs study that measures the actual 

cost of providing a meal by cost category (e.g. labor, food, overhead); and an 

individual outcome study. The individual outcomes study will measure the 

program’s success at meeting the legislative intent of the program (reduce hunger 

and social isolation while improving health and well-being of consumers). In 

addition, AoA and CMS have recently entered into an Inter-Agency Agreement 

that will enhance this evaluation to include prospective analysis of healthcare 

utilization and cost data of program participants compared to a matched group of 

seniors who do not participate in the program.

o The evaluation of the Title III-E National Family Caregiver Support program will 

be the first for this OAA program. It is designed as a longitudinal study with a 

comparison group so that the effects of the five service categories can be 

measured over time.

o AoA is working with AHRQ and research contractors to finalize a design for an 

evaluation of the Chronic Disease Self-Management program utilizing an 

experimental design and working on an evaluation of Aging and Disability 

Resource Centers.

Current Performance Information

An analysis of AoA’s performance trends shows that through FY 2009 most indicators have 

steadily improved. It also points to some key observations about the potential of AoA and the 

national aging services network in meeting the challenges posed by the growth of the vulnerable 

older adult population, the changing care preferences of aging baby boomers, the fiscal 

difficulties faced by State budgets, and the expanding needs of both the elderly and their 

caregivers. Below are some examples of these observations:

OAA programs help older Americans with severe disabilities remain independent and 

in the community: Older adults that have three or more impairments in Activities of Daily 
EXECUTIVE SUMMARY

17

Living are at a high risk for nursing home placement. Measures of the Aging Network’s 

success at serving this vulnerable population is a proxy for success at nursing home delay 

and diversion. In FY 2003, the Aging Network served home-delivered meals to 

280,454 clients with three or more ADL impairments and by FY 2009 that number grew by 

27 percent to 357,403 clients. Another approach to measuring AoA’s success is the newly 

developed nursing home predictor score. The components of this composite score are 

predictive of nursing home placement based on scientific literature and AoA’s POMP which 

develops and tests performance measures. The components include such items as percent of 

clients that are transportation disadvantaged and the percent of congregate meal clients that 

live alone. As the score increases, the prevalence of nursing home predictors in the OAA 

service population increases. In 2003, the nursing home predictor score was 46.57 and has 

increased to 61.0 in FY 2009.This increase indicates that AoA programs are serving a larger 

share of individuals who, without community support, would be more likely to move into 

institutional settings.

OAA programs are efficient: The National aging services network is providing high 

quality services to the neediest elders and doing so in a very prudent and cost-effective 

manner; as an example, AoA has significantly increased the number of clients served per 

million dollars of AoA funding. Without controlling for inflation, OAA programs have 

increased efficiency by over 36 percent between FY 2002 and FY 2009, serving 8,524 clients 

per million dollars of AoA in FY 2009 compared to 6,103 clients served per million dollars 

of AoA funding in FY 2002 without diluting the quality of the services provided. This 

increase in efficiency is understated since the purchasing power of a million dollars in 2009 

is significantly less than in 2002 due to inflation. 

OAA programs build system capacity: OAA programs stay true to their original intent to 

―encourage and assist State agencies and Area Agencies on Aging to concentrate resources in 

order to develop greater capacity and foster the development and implementation of 

comprehensive and coordinated systems.‖ (OAA Section 301). This is evident in the 

leveraging of OAA funds with State/local or other funds (almost $3 in other funds for every 

dollar of OAA funds expended), as well as in the expansion of projects such as the Aging and 

Disability Resource Center initiative, which grew from 24 states to 45 states with 205 sites 

participating in this key program in FY 2009.

OAA clients report that these services contribute in an essential way to maintaining their 

independence and they express a high level of satisfaction with these services. In 2009, over 

96 percent of transportation clients rated services good to excellent and 95 percent of caregivers 

rated services good to excellent. To help ensure the continuation of these trends in core 

programs, AoA makes extensive use of its discretionary funding to test innovative service 

delivery models for State and local program entities to attain measurable improvements in 

program activities. For example, AoA has worked with the Centers for Medicare & Medicaid 

Services and the Department of Veterans Affairs to better integrate funding for long-term care 

service delivery, eliminate duplication and improve access to services through Aging and 

Disability Resource Centers. 
EXECUTIVE SUMMARY

18

Performance for FY 2012

Federal support for Older Americans Act programs is not expected to cover the cost of serving 

every senior. Federal funds for FY 2012 are expected to be the same level as the previous year 

for core programs. These programs have strong partnerships with State and local governments, 

philanthropic organizations, and private donations that contribute funds in greater proportions 

than OAA programs. Despite States only having to match these programs at 15 percent or 

25 percent of their Federal allocation, States have normally leveraged resources of $2 or $3 per 

every Older Americans Act dollar. Therefore, AoA expects a decline in performance for 

nutrition and home and community-based services in FY 2012 compared to FY 2011. 

Substantial declines in performance, in conjunction with a level Federal investment, are 

projected to be largely attributable to declining leveraged funds, as State, local, and private 

budgets face economic hardships.3 

Performance at the FY 2012 budget request level of $2,251,256,000 is expected to remain 

constant or show declines from prior year performance per the assumptions noted above. 

Performance Detail

Taken as a whole, AoA’s performance measures and indicators form an a system of performance 

measurement holding up AoA’s mission and strategic goals, including:

 

1. Empower older people, their families, and other consumers to make informed decisions 

about, and to be able to easily access, existing health and long-term care options;

2. Enable seniors to remain in their own homes with a high quality of life for as long as 

possible through the provision of home and community-based services, including 

supports for family caregivers;

3. Empower older people to stay active and healthy through Older Americans Act services 

and the new prevention benefits under Medicare;

4. Ensure the rights of older people and prevent their abuse, neglect and exploitation; and

5. Maintain effective and responsive management.

Below is a summary of each measurement area, its indicators and their relationship to AoA’s 

strategic goals.

Measure 1: Improve Efficiency 

Program efficiency is a necessary and important measure of the performance of AoA programs 

for two principal reasons. First, it is important to be a responsible steward of Federal funds. 

Second, the OAA intended Federal funds to act as catalyst in generating capacity for these 

program activities at the State and local levels. It is the expectation of the OAA that States and

 

3 AoA’s projections are based on the following assumptions: 1) CPI-U or a CPI index; 2) declining State budgets of 

-8.5 percent each year from FY 2010-2012, consistent with the decline in 2009 state government tax collections 

reported by the U.S. Census in March 2010. 
EXECUTIVE SUMMARY

19

communities increasingly improve their capacity to serve elderly individuals efficiently and 

effectively with both Federal and State funds. 

Improvements in program efficiency support all of AoA’s Strategic Goals. Through optimal 

utilization of resources, improvements in program efficiency ensure that affordable and 

accessible community-based long-term care is available to promote the well-being of seniors and 

their family caregivers. 

For FY 2012, there are four efficiency indicators for AoA program activities. Indicator 1.1 

addresses performance efficiency at all levels of the National aging services network in the 

provision of home and community-based services, including caregiver services. Indicator 1.3 

demonstrates the efficiency of AoA in providing services to Native Americans. Indicator 1.5 

assesses the efficiency of the Senior Medicare Patrol program and Indicator ALZ.1 assesses 

more efficient program operation in the Alzheimer’s Disease Supportive Services Program 

(ADSSP). 

A summary of program efficiency indicators for FY 2012 follows:

Indicator 1.1: For Home and Community-based Services, including Nutrition Services, 

and Caregiver services, increase the number of clients served per million dollars of AoA 

funding. 

Indicator 1.3: Increase the number of units of service provided to Native Americans per 

thousand dollars of AoA funding. 

Indicator 1.5: SMP projects will increase the total dollar amount referred for further 

action because of the potential of fraudulent activity.

Indicator ALZ.1: Increase the percent of ADSSP grant funds dedicated to evidencebased programs.

Measure 2: Improve Client Outcomes 

While improving efficiency, AoA is committed to maintaining quality and improving client 

outcomes. The FY 2012 performance budget includes eight core performance indicators 

supporting AoA’s commitment to improving client outcomes. AoA has multiple quality 

assessment indicators in this plan reflecting separate assessments provided by elders for services 

such as meals, transportation and caregiver assistance. Also, in developing the outcome 

indicators, AoA included measures to assess AoA’s fundamental outcomes: to keep elders at 

home and in the community, and to measure results important to family caregivers. The 

measures for the Ombudsman program focus on the core purposes of this program: advocacy on 

behalf of older adults. 

Although this measurement area supports all of AoA’s Strategic Goals, it is most strongly tied to 

Goal 2 to enable seniors to remain in their own homes with a high quality of life for as long as 
EXECUTIVE SUMMARY

20

possible, Goal 3 to empower older adults to stay active and healthy, and Goal 4 to ensure the 

rights of older people and prevent their abuse, neglect and exploitation. 

A summary of the client outcome indicators for FY 2012 follows: 

Indicator 2.6: Reduce the percent of caregivers who report difficulty in getting services. 

Indicator 2.9a: 90 percent of home delivered meal clients rate services good to excellent. 

Indicator 2.9b: 90 percent of transportation clients rate services good to excellent. 

Indicator 2.9c: 90 percent of National Family Caregiver Support Program clients rate 

services good to excellent. 

Indicator 2.10: Improve well-being and prolong independence for elderly individuals as 

a result of AoA’s Title III home and community-based services.

Indicator 2.11: Increase the percentage of transportation clients who live alone. 

Indicator 2.12: Decrease the number of complaints per long-term care facility.

Indicator 2.13: Decrease the percentage of complaints for abuse, neglect and 

exploitation in nursing homes.

Measure 3: Effectively Target Services to Vulnerable Elderly 

AoA believes that targeting is of equal importance to efficiency and outcomes because it ensures 

that AoA and the national aging services network will focus their services on the neediest, 

especially when resources are scarce. Without targeting measures, efforts to improve efficiency 

and outcomes could result in unintended consequences whereby entities might attempt to focus 

their efforts toward individuals who are not the most vulnerable. Such an outcome would be 

inconsistent with the intent of the OAA, which specifically requires the network to target 

services to the most vulnerable elders. It would also be inconsistent with the mission of AoA, 

which is to help vulnerable elders maintain their independence in the community. To help 

seniors remain independent, AoA and the national aging services network must focus their 

efforts on those who are at the greatest risk of institutionalization: older persons who are 

disabled, poor, and residing in rural areas. 

Effective targeting of OAA services supports AoA’s Strategic Goal 1 by ensuring access to longterm care options for the economically and socially vulnerable; Goal 2 by enabling the most 

vulnerable seniors to remain in their own homes with a high quality of life; Goal 3 by 

empowering those likely to experience health disparities to stay active and healthy through OAA 

services; and Goal 4 by ensuring the rights of vulnerable elders. Thus, AoA’s four indicators for 

effective targeting are crucial for ensuring that services are targeted to the most vulnerable client 

groups. 
EXECUTIVE SUMMARY

21

Indicator 3.1: Increase the number of caregivers served. 

Indicator 3.2: Increase the number of older persons with severe disabilities who receive 

home-delivered meals. 

Indicator 3.3: The percentage of OAA clients served who live in rural areas is at least 

10percent greater than the percent of all US elders who live in rural areas. 

Indicator 3.4: Increase the number of States that serve more elderly living below the 

poverty level than the prior year. 

AoA has invested significant resources and continues to work with national partners including 

Agency for Healthcare Research and Quality, Centers for Disease Control and Prevention, and 

National Institute on Aging in the adoption of evidence-based programs at the community level 

which is reflected in our positive performance results.

Aging Services Program – Performance Summary 

AoA has used a streamlined approach to performance measurement since FY 2005, by design. 

Most of the current performance indicators are cross-cutting and the established performance 

targets are usually dependent on multiple budget line items. The following table provides an 

overview of all targets established for each fiscal year. 

Summary of Performance Targets and Results Table 

Fiscal 

Year

Total 

Targets

Targets with 

Results Reported

Percent of Targets 

with Results 

Reported

Total 

Targets 

Met

Percent of 

Targets Met

2006 15 15 100 percent 13 87 percent

2007 16 16 100 percent 13 81 percent

2008 14 14 100 percent 9 64 percent 

2009 15 14 93 percent 10 71 percent

2010 15 NA NA NA NA 

2011 16 NA NA NA NA

2012 16 NA NA NA NA

Information Technology

AoA’s FY 2012 IT Exhibits 300 may be found at http://itdashboard.gov.
22

Administration on Aging

All-Purpose Table

(Dollars in thousands)

Health and Independence:

Home & Community-Based Supportive Services................................................................... $ 368,290 $ 368,348 $ 416,476 $ 48,186

Congregate Nutrition Services (non-add)............................................................................... 440,718 440,783 440,718 --

Home-Delivered Nutrition Services (non-add)....................................................................... 217,644 217,676 217,644 --

Nutrition Services Incentive Program..................................................................................... 160,991 161,015 160,991 --

Preventive Health Services..................................................................................................... 21,026 21,026 21,026 --

Chronic Disease Self-Management Programs ........................................................................ /3 -- 10,000 --

Community Service Employment for Older Americans.......................................................... 825,425 825,425 450,000 (375,425)

Native American Nutrition & Supportive Services................................................................. 27,704 27,708 27,704 --

Aging Network Support Activities.......................................................................................... 8,198 8,200 7,948 (250.)

Subtotal, Health and Independence..................................................................................... $ 2,069,996 $ 2,070,181 $ 1,752,507 $ (317,489)

Caregiver Services:

Family Caregiver Support Services......................................................................................... $ 154,197 $ 154,220 $ 192,220 $ 38,023

Native American Caregiver Support Services......................................................................... 6,388 6,389 8,388 2,000

Alzheimer's Disease Supportive Services Program................................................................. 11,462 11,464 11,462 --

Lifespan Respite Care............................................................................................................. 2,500 2,500 10,000 7,500

Subtotal, Caregiver Services................................................................................................ $ 174,547 $ 174,573 $ 222,070 $ 47,523

Protection of Vulnerable Adults:

Adult Protective Services........................................................................................................ $ -- $ -- $ 16,500 $ 16,500

Long-Term Care Ombudsman Program.................................................................................. 16,825 16,827 21,825 5,000

Prevention of Elder Abuse & Neglect..................................................................................... 5,055 5,056 5,055 --

Senior Medicare Patrol Program 5/........................................................................................ 13,217 12,751 12,750 (467)

Elder Rights Support Activities 6/......................................................................................... 4,103 4,104 4,103 --

Subtotal, Vulnerable Adults................................................................................................. $ 39,200 $ 38,738 $ 60,233 $ 21,033

Consumer Information, Access & Outreach

Aging and Disability Resource Centers 4/............................................................................. $ 23,684 $ 23,684 $ 13,434 $ (10,250)

State Health Insurance Assistance Program 8/....................................................................... 46,960 46,960 46,960 --

Medicare Enrollment Assistance 9/....................................................................................... 30,000 -- -- (30,000)

Subtotal, Consumer............................................................................................................. $ 100,644 $ 70,644 $ 60,394 $ (40,250)

Program Innovations 7/............................................................................................................. $ 27,873 $ 27,879 $ 11,509 $ (16,364)

Program Administration:

Aging Services Programs Administration............................................................................... $ 19,976 $ 19,979 $ 24,543 $ 4,567

CLASS Administration 10/..................................................................................................... -- -- 120,000 120,000

Subtotal, Program Administration....................................................................................... $ 19,976 $ 19,979 $ 144,543 $ 124,567

Subtotal, Program Level...................................................................................................... $ 2,432,236 $ 2,401,994 $ 2,251,256 $ (180,980)

Less Funds From Other Sources:

Aging and Disability Resource Centers (mandatory) 4/......................................................... (10,000) (10,000) (10,000)

Health Care Fraud and Abuse Control 5/............................................................................... (3,779) 3,312 (3,312) 467

Medicare Enrollment Assistance (mandatory) 9/.................................................................... (30,000) -- -- 30,000

Total, Discretionary Budget Authority.................................................................................. $ 2,388,457 $ 2,395,306 $ 2,237,944 $ (150,513)

FY 2012 +/- 

FY 2010

FY 2012 

President's 

Program Request

FY 2010 

Enacted 1/

FY 2011 

Annualized 

CR
23

1/ Reflects the Secretary's transfer of June 18, 2010 to assist those living with HIV/AIDS on waiting lists for lifesaving medication.

2/ Includes $2,722,303 in FY 2010 budget authority appropriated to AoA and transferred to the Department of Agriculture for 

commodities purchases pursuant to Public Law 110-19. Combines AoA's meal programs consistent with the Older Americans Act 

reauthorization proposal.

3/ In FY 2010, $30 million in Recovery Act funding was transferred from the Centers for Disease Control and Prevention through 

an intra-departmental delegation of authority as part of the Recovery Act’s $650 million ―Prevention and Wellness Fund.‖ 

In FY 2010, an additional $2.5 million was transferred from CDC to CMS for related evaluation and quality improvement purposes.

4/ Includes $10 million in mandatory funds per section 2405 of P.L. 111-148 (Affordable Care Act).

5/ AoA received $3,789,000 from the Health Care Fraud and Abuse Control wedge funds recovered from fighting fraud. 

$3,279,000 is a placeholder amount for FY 2011 and FY 2012. The Secretary and the Attorney General will determine the final amount.

6/ In FY 2010 and FY 2011, activities were previously appropriated and requested in Aging Network Support Activities and 

Program Innovations.

7/ Activities in FY 2010 and FY 2011 were innovation activities requested under the Health and Long-term Care Programs. 

Aging and Disability Resource Centers are requested separately in FY 2012 and comparably adjusted in FY 2010 and FY 2011.

8/ Reflects Secretary's decision to transfer the State Health Insurance Assistance Program from CMS to AoA.

Transfer of discretionary funds from the Federal Hospital Insurance Trust Fund and the Federal Supplementary Medical Insurance 

Trust Fund. 

9/ Transfer of mandatory funds from the Federal Hospital Insurance Trust Fund and the Federal Supplementary Medical Insurance 

Trust Fund for benefits outreach to low-income seniors per section 3306 of P.L. 111-148 (Affordable Care Act).

10/ Activities in FY 2010 and FY 2011 were funded from the Affordable Care Act Implementation Fund.
24

PAGE INTENTIONALLY LEFT BLANK
25

Administration on Aging

Recovery Act Information

(dollars in millions)

ARRA Implementation 

Plan

Total Resources

Available

FY 2009/

FY 2010

Outlays

FY 2011

Outlays

FY 2012

Outlays

Congregate Nutrition 65 60 65 65

Home-Delivered Nutrition 32 30 32 32

Native American Nutrition 3 2.3 3 3

Total Outlays 100 92 100 100

Performance Measures:

Congregate Nutrition

Home-Delivered Meals

Outcome / 

Achievement Units Type 12/31/0910/Q1

9/30/10

10/Q4

12/31/10

11/Q1

3/31/11

11/Q2

Program 

End

(3/31/11)

People Served #

Target 63,213 142,230 144,488 146,746 146,746

Actual 453,037 729,690 763,204

Meals Served #

Target 3,590,525 8,078,681 8,206,914 8,335,147 8,335,147

Actual 6,886,561 12,526,874 13,173,333

Outcome / 

Achievement Units Type 12/31/0910/Q1

9/30/10

10/Q4

12/31/10

11/Q1

3/31/11

11/Q2

Program 

End

(3/31/11)

People served #

Target 15,762 30,538 31,031 31,524 31,524

Actual 143,974 330,791 377,719

Meals served #

Target 2,536,074 4,913,643 4,992,895 5,072,147 5,072,147

Actual 3,881,698 7,916,270 8,684,497
26

Nutrition Services for Native Americans

Outcome / 

Achievement Units Type 12/31/0910/Q1

9/30/10

10/Q4

12/31/10

11/Q1

3/31/11

11/Q2

Program 

End

HomeDelivered meals 

served

#

Target 452,563 678,844 678,844 678,844 678,844

Actual 113,871 408,436 498,616

Congregate 

Meals served #

Target 254,566 381,849 381,849 381,849 381,849

Actual 72,596 358,462 426,264
27

Appropriations Language

Administration on Aging

Aging Services Programs

For carrying out, to the extent not otherwise provided, the Older Americans Act of 1965 

("OAA"), section 398 and title XXIX of the Public Health Service Act, section 119 of the 

Medicare Improvements for Patients and Providers Act of 2008, subtitle B of title XX of the 

Social Security Act, and for necessary administrative expenses to carry out titles XVII and XXXII 

of the Public Health Service Act, $2,190,984,000, together with $46,960,000 to be transferred 

from the Federal Hospital Insurance Trust Fund and the Federal Supplementary Medical 

Insurance Trust Fund to carry out section 4360 of the Omnibus Budget Reconciliation Act of 

1990: Provided, That, of the amount appropriated under this heading, $192,220,000 shall be for 

carrying out part E of title III of the OAA and $8,388,000 shall be for carrying out section 631 of 

such Act: Provided further, That amounts appropriated under this heading may be used for 

grants to States under section 361 of the OAA only for disease prevention and health promotion 

programs and activities which have been demonstrated to the satisfaction of the Secretary of 

Health and Human Services to be evidence-based and effective: Provided further, That,

notwithstanding section 206(g) of the OAA, up to one-percent of amounts appropriated to carry 

out programs authorized under Title III of such Act shall be available for conducting 

evaluations, training and technical assistance: Provided further, That amounts available under 

this heading for the cost of administering the program under title XXXII of the Public Health 

Service Act shall be in addition to any amounts available under such title for such purposes: 

Provided further, That, of the amount under this heading, $450,000,000 shall be available for 

carrying out title V of the OAA: Provided further, That, with respect to the previous proviso, 

such funds shall be available through June 30, 2013, and may be recaptured and reobligated in 

accordance with section 517(c) of the OAA. 

General Provision to transfer Older American Community Service 

Employment Program from Labor to HHS/AoA

SEC. 519 TRANSFER OF OLDER AMERICAN COMMUNITY SERVICE EMPLOYMENT 

PROGRAM TO DEPARTMENT OF HEALTH AND HUMAN SERVICES.

(a) IN GENERAL.—Notwithstanding any other provision of law, the Older American 

Community Service Employment (OACSE) program under title V of the Older Americans Act of 

1965 (42 U.S.C. 3056), and the authority to administer such program, shall be permanently 

transferred from the Secretary of Labor to the Secretary of Health and Human Services, acting 

through the Assistant Secretary for Aging.

(b) TRANSFER OF FUNCTIONS, ASSETS, AND LIABILITIES.—The functions, assets, 

and liabilities of the Secretary of Labor relating to the OACSE program shall be transferred to 

the Secretary of Health and Human Services. 
28

(c) EFFECTIVE DATE OF TRANSFER.---The transfer under this section shall be 

effective no later than the last day of the second full fiscal quarter following the quarter in which 

this section is enacted.
29

Language Analysis

Administration on Aging

Aging Services Programs

Language Provision Explanation

subtitle B of title XX of the Social Security 

Act,

and for necessary administrative expenses 

to carry out titles XVII and XXXII of the 

Public Health Service Act,

Adds subtitle B of title XX of the Social 

Security Act to provide AoA the authority 

to carry out provisions of the Elder Justice 

Act of 2010. Such activities include 

activities of the Advisory Board on Elder 

Abuse, Neglect, and Exploitation and 

Adult Protective Services demonstration 

grants. 

Adds Titles XVII of the Public Health 

Service Act to the activities that can be 

supported with Program Administration 

dollars for the purposes of administering 

funds provided to AoA from the 

Prevention and Wellness Fund of the 

American Recovery and Reinvestment 

Act of 2009. Such activities include 

ongoing lifecycle management of grants, 

contracts, and other awards that will be 

obligated in FY 2010. Also adds Title 

XXXII of the Public Health Service Act to 

provide AoA with the authority to 

administer funds provided for the purpose 

of carrying out the Community Living 

Assistance Services and Supports 

(CLASS) program.

together with $46,960,000 to be 

transferred from the Federal Hospital 

Insurance Trust Fund and the Federal 

Supplementary Medical Insurance Trust 

Fund to carry out section 4360 of the 

Omnibus Budget Reconciliation Act of 

1990:

Provided, That, of the amount 

appropriated under this heading, 

Indicates that in addition to the regular 

appropriation, $46,960,000 will be 

transferred to AoA from the Medicare 

Trust Funds to carry out the State Health 

Insurance Assistance Program (SHIPs) 

which is being transferred from the 

Centers for Medicare and Medicare 

Services (CMS) to AoA.

Adds specific appropriations amounts for 

the National Family Caregiver Support 
30

Language Provision Explanation

$192,220,000 shall be for carrying out 

part E of title III of the OAA and 

$8,388,000 shall be for carrying out 

section 631 of such Act:

Provided further, That amounts 

appropriated under this heading may be 

used for grants to States under section 

361 of the OAA only for disease 

prevention and health promotion 

programs and activities which have been 

demonstrated to the satisfaction of the 

Secretary of Health and Human Services 

to be evidence-based and effective:

Provided further, That, notwithstanding 

section 206(g) of the OAA, up to onepercent of amounts appropriated to carry 

out programs authorized under Title III of 

such Act shall be available for conducting 

evaluations, training and technical 

assistance:

Provided further, That amounts available 

under this heading for the cost of 

administering the program under title 

XXXII of the Public Health Service Act 

shall be in addition to any amounts 

available under such title for such 

purposes:

Provided further, That, of the amount 

under this heading, $450,000,000 shall be 

available for carrying out title V of the 

OAA: Provided further, That, with respect 

to the previous proviso, such funds shall 

be available through June 30, 2013, and 

may be recaptured and reobligated in 

Services and Native American Caregiver 

Support Services programs because the 

requested appropriation amount exceeds 

the authorization levels in the Older 

Americans Act. This language ensures 

AoA will be able to expend these higher 

sums without violating the Antideficiency 

Act.

Requires that States use the amounts that 

are appropriated for Preventive Health 

Services only for evidence-based disease 

prevention and health promotion 

programs and activities that have been 

demonstrated to the Secretary of HHS’s 

satisfaction to be effective.

Allows up to 1% of amounts appropriated 

to carry out Home and Community-Based 

Services programs, Nutrition Programs, 

Preventive Health Programs and 

Caregiver Programs under Title III of the 

Older Americans Act to be used for 

conducting evaluations, training and 

technical assistance related to these 

programs.

Provides that amounts appropriated under 

Aging Services Programs for the 

administration of Community Living 

Assistance Services and Supports 

(CLASS) activities shall be in addition to 

any other amounts otherwise provided for 

this same purpose under the CLASS 

authorizing legislation.

Provides $450,000,000 to carry out the 

Senior Community Service Employment 

Program (SCSEP) which is being 

transferred to AoA from the Department 

of Labor. Additionally, provides that any 

unexpended funds under SCSEP at the 

end of the program year can be recaptured 
31

Language Provision Explanation

accordance with section 517(c) of the 

OAA. 

General Provision:

Transfer of Older American Community 

Service Employment Program to 

Department of Health and Human 

Services.

(a) IN GENERAL.—Notwithstanding any 

other provision of law, the Older 

American Community Service 

Employment (OACSE) program under 

title V of the Older Americans Act of 1965 

(42 U.S.C. 3056), and the authority to 

administer such program, shall be 

permanently transferred from the 

Secretary of Labor to the Secretary of 

Health and Human Services, acting 

through the Assistant Secretary for Aging.

(b) TRANSFER OF FUNCTIONS, 

ASSETS, AND LIABILITIES.—The 

functions, assets, and liabilities of the 

Secretary of Labor relating to the OACSE 

program shall be transferred to the 

Secretary of Health and Human Services. 

(c) EFFECTIVE DATE OF TRANSFER.--

-The transfer under this section shall be 

effective no later than the last day of the 

second full fiscal quarter following the 

quarter in which this section is enacted.

by the Secretary and reobligated within 

the two succeeding program years for 

incentive grants to State or national 

grantees, for technical assistance, or for 

grants or contracts for any other activity 

under this time. Finally, provides that the 

$450,000,000 will be available from the 

time of appropriation through the end of 

the FY 2012 program year on June 30, 

2013. This reflects both the fact that 

SCSEP funds are forward funded and 

appropriated for a fiscal year that begins 

on July 1 rather than October 1. 

A general provision has been drafted to 

effect the transfer of the Older American 

Community Service Employment 

Program, more commonly know as the 

Senior Community Service Employment 

Program (SCSEP) and the authority to 

administer this program from the 

Department of Labor to the 

Administration on Aging within the 

Department of Health and Human 

Services.

Makes clear that the transfer will include 

all existing functions, assets and liabilities 

of the SCSEP program.

Directs that the transfer will be effective 

no later than the end of the second full 

fiscal quarter following the quarter in 

which the provision is enacted. 
32

Administration on Aging

Amounts Available for Obligation

(Dollars in thousands)

General Fund Discretionary Appropriation:

Appropriation (Annual)................................................................. 2,341,721 2,341,722 2,190,984

Secretarial Transfer....................................................................... (224) -- --

Subtotal, adjusted appropriation................................................ 2,341,497 2,341,722 2,190,984

Transfers:......................................................................................

Transfer of Funds to: Department of Agriculture ......................... (2,268) -- --

Subtotal, adjusted general fund discr. appropriation.................. 2,339,229 2,341,722 2,190,984

Trust Fund Discretionary Appropriation:

Appropriation Lines...................................................................... 46,960 46,960 46,960

Subtotal, adjusted trust fund discr. appropriation...................... 46,960 46,960 46,960

Total, Discretionary Appropriation.................................... 2,386,189 2,388,682 2,237,944

Mandatory Appropriation:

Appropriation (PPACA)................................................................ 10,000 10,000 10,000

Subtotal, adjusted mandatory. appropriation............................. 10,000 10,000 10,000

Offsetting collections from:

 Trust Funds: HCFAC.................................................................... 3,779 3,312 3,312

 Trust Funds: MIPPA.................................................................... 30,000 -- --

Unobligated balance, start of year....................................................

Unobligated balance, start of year....................................................

Unobligated balance, end of year.....................................................

Unobligated balance, lapsing............................................................ (268)

Unobligated balance, Recovery Act start of year.............................

Unobligated balance, Recovery Act end of year...............................

 Subtotal, Offsetting Collections.............................................. 33,511 3,312 3,312

Total obligations.......................................................................... 2,429,700 2,401,994 2,251,256

FY 2010 Actual FY 2011 CR FY 2012 PB
33

Administration on Aging

Summary of Changes

(Dollars in thousands)

2010

2,388,457

2012

2,237,944

(150,513)

FY 2010 

Estimate

FY 2010 

Estimate

FY 

2012 

Change 

from 

Base

FY 2012 

Change 

from 

Base

FTE

Budget 

Authority FTE

Budget 

Authority

Increases:

A. Built-in:

1. Aging Services Pgms Admin--Incr in Ext Cost, Taps......

 and Systems Upgrades.................................................... 19,976 1,025

2. Aging Services Pgms Admin--Relocation/Moving/..........

 build-out Costs................................................................. -- 19,976 -- 2,143

Subtotal, Built-in Increases........................................... 3,168

A. Program:

1. Home & Community-Based Supportive Services............ -- 368,290 -- 48,186

2. Chronic Disease Self-Management Programs 1/............ -- -- -- 10,000

3. Family Caregiver Support Services................................. -- 154,197 -- 38,023

4. Native American Caregiver Support Services................. -- 6,388 -- 2,000

5. Lifespan Respite Care..................................................... -- 2,500 -- 7,500

6. Adult Protective Services 2/............................................. -- -- -- 16,500

7. Long-Term Care Ombudsman Program.......................... -- -- -- 5,000

8. Aging Svcs Pgms Admin--Proposed staff increase 3/..... 100 19,976 21 1,399

9. CLASS Act 4/.................................................................. -- -- -- 120,000

Subtotal, Program Increases......................................... 248,608

Total Increases............................................................. 251,776

Decreases:

A. Program:

1. Comm. Service Employment Older Americans 5/........... -- 825,425 -- (375,425)

2. Aging Network Support Activities..................................... -- 8,198 -- (250)

3. Aging and Disability Resource Centers 6/....................... -- 23,684 -- (10,250)

5. Program Innovations 7/.................................................. -- 27,873 -- (16,364)

Total Decreases........................................................... (402,289)

Net Change................................................................ (150,513)

Net Change..........................................................................................................................

Total estimated discretionary budget authority.......................................................................

Total estimated discretionary budget authority.......................................................................
34

1/ In FY 2010, $30 million in Recovery Act funding was transferred from the Centers for Disease Control 

 and Prevention through an intra-departmental delegation of authority as part of the Recovery Act’s

 $650 million “Prevention and Wellness Fund.” In FY 2010, an additional $2.5 million was transferred 

 from CDC to CMS for related evaluation and quality improvement purposes.

2/ Funding was first authorized for this program in the Elder Justice Act of 2012

3/ FY 2011 staff on board through the first quarter of the year approximate 111 FTE. The dollars 

 reflected in this table are only for the additional +10 FTE in 2012.

4/The Community Living Assistance Services and Supports Act (CLASS Act) Activities in FY 2010 

 and FY 2011 were funded from the Affordable Care Act Implementation Fund.

5/ This program will be moving from the Department of Labor to the Administration on Aging starting in 

 FY 2012. The FY 2012 budget request shown here reflects the Administration on Aging budget, and

 the FY 2010 is the actual Department of Labor budget.

6/ Includes $10 million in mandatory funds per section 2405 of P.L. 111-148 (Affordable Care Act).

7/ Activities in FY 2010 and FY 2011 were innovation activities requested under the Health and 

 Long-term Care Programs. Aging and Disability Resource Centers are requested separately

 in FY 2012 and comparably adjusted in FY 2010 and FY 2011.
35

Administration on Aging

Budget Authority by Activity

(Dollars in thousands)

Health and Independence:

Home & Community-Based Supportive Services.............. $ 368,290 $ 368,348 $ 416,476

Nutrition Services 2/.......................................................... 658,362 658,459 658,362

Nutrition Services Incentive Program................................. 160,991 161,015 160,991

Preventive Health Services................................................ 21,026 21,026 21,026

Chronic Disease Self-Management Programs 3/............. -- -- 10,000

Community Service Employment for Older Americans...... 825,425 825,425 450,000

Native American Nutrition & Supportive Services.............. 27,704 27,708 27,704

Aging Network Support Activities....................................... 8,198 8,200 7,948

Subtotal, Health and Independence................................ $2,069,996 $ 2,070,181 $ 1,752,507

Caregiver Services:

Family Caregiver Support Services.................................... $ 154,197 $ 154,220 $ 192,220

Native American Caregiver Support Services.................... 6,388 6,389 8,388

Alzheimer's Disease Supportive Services Program........... 11,462 11,464 11,462

Lifespan Respite Care....................................................... 2,500 2,500 10,000

Subtotal, Caregiver Services........................................... $ 174,547 $ 174,573 $ 222,070

Protection of Vulnerable Adults:

Adult Protective Services................................................... $ -- $ -- $ 15,000

Long-Term Care Ombudsman Program............................ 16,825 16,827 21,825

Prevention of Elder Abuse & Neglect................................. 5,055 5,056 5,055

Native American Elder Rights Program............................. -- -- 1,500

Senior Medicare Patrol Program 5/................................... 9,438 9,439 9,438

Elder Rights Support Activities 6/...................................... 4,103 4,104 4,103

Subtotal, Vulnerable Adults............................................. $ 35,421 $ 35,426 $ 56,921

Consumer Information, Access & Outreach

Aging and Disability Resource Centers 4/......................... $ 13,684 $ 13,684 $ 3,434

State Health Insurance Assistance Program 8/................ 46,960 46,960 46,960

Medicare Enrollment Assistance 9/................................... - - -

Subtotal, Consumer........................................................ $ 60,644 $ 60,644 $ 50,394

Program Innovations 7/........................................................ $ 27,873 $ 27,879 $ 11,509

Program Administration:

Aging Services Programs Administration........................... $ 19,976 $ 19,979 $ 24,543

CLASS Administration 10/................................................. -- -- 120,000

Subtotal, Program Administration................................... $ 19,976 $ 19,979 $ 144,543

Total, Discretionary Budget Authority........................... $2,388,457 $ 2,388,682 $ 2,237,944

Aging and Disability Resource Centers (mandatory) 4/.... 10,000 $ 10,000 $ 10,000

Health Care Fraud and Abuse Control 5/.......................... 3,779 $ 3,312 $ 3,312

Medicare Enrollment Assistance (mandatory) 9/............... 30,000 $ - $ -

Total, Program Level......................................................... $2,432,236 $ 2,401,994 $ 2,251,256

Total, FTE............................................................................ 100 111 176

FY 2010 

Actual FY 2011 CR FY 2012 PB
36

1/ Reflects the Secretary's transfer of June 18, 2010, to assist those living with HIV/AIDS on waiting lists for 

 lifesaving medication.

2/ Includes $2,722,303 in FY 2010 budget authority appropriated to AoA and transferred to the Department 

 of Agriculture for commodities purchases pursuant to Public Law 110-19. Combines AoA's meal

 programs consistent with the Older Americans Act reauthorization proposal.

3/ In FY 2010, $30 million in Recovery Act funding was transferred from the Centers for Disease Control 

 and Prevention through an intra-departmental delegation of authority as part of the Recovery Act’s $650

 million "Prevention and Wellness Fund." In FY 2010, an additional $2.5 million was transferred from CDC

 to CMS for related evaluation and quality improvement purposes.

4/ Includes $10 million in mandatory funds per section 2405 of P.L. 111-148 (Affordable Care Act).

5/ AoA received $3,375,000 in FY 2010 and $3,726,000 in FY 2011 from the Health Care Fraud and Abuse Control wedge 

 funds recovered from fighting fraud. $3,312,000 is a placeholder amount for FY 2012. The Secretary and the

 Attorney General will determine the final amount.

6/ In FY 2010 and FY 2011, activities were previously appropriated and requested in Aging Network Support

 Activities and Program Innovations.

7/ Activities in FY 2010 and FY 2011 were innovation activities requested under the Health and Long-term 

 Care Programs. Aging and Disability Resource Centers are requested separately in FY 2012 and

 comparably adjusted in FY 2010 and FY 2011. 

8/ Reflects Secretary's decision to transfer the State Health Insurance Assistance Program from CMS to 

 AoA. Transfer of discretionary funds from the Federal Hospital Insurance Trust Fund and the Federal 

 Supplementary Medical Insurance Trust Fund. 

9/ Transfer of mandatory funds from the Federal Hospital Insurance Trust Fund and the Federal 

 Supplementary Medical Insurance Trust Fund for benefits outreach to low-income seniors per section 

 3306 of P.L. 111-148 (Affordable Care Act).

10/ Activities in FY 2010 and FY 2011 were funded from the Affordable Care Act Implementation Fund.
37

Administration on Aging

Authorizing Legislation

FY 2010 

Amount 

Authorized

FY 2010 

Appropriation

FY 2012 

Amount 

Authorized

FY 2012 Pres. 

Budget

1) Home and CommunityBased Supportive Services:

OAA Section 321............................................................ Such Sums $368,290,000 Expired $416,476,000

2) Nutrition Services

Services: OAA Sections 331 and 336.............................. Such Sums $658,362,000 Expired $658,362,000

3) Nutrition Services Incentive

Program: OAA Section 311 1/........................................ Such Sums $160,991,000 Expired $160,991,000

4) Preventive Health Services:

OAA Section 361............................................................ Such Sums $21,026,000 Expired $21,026,000

5) Chronic Disease Self-Management Programs

OAA Title IV.................................................................. Such Sums $0 Expired $10,000,000

5) National Family Caregiver 

Support Program: OAA 

Section 371...................................................................... $180,000,000 $154,197,000 Expired $192,220,000

6) Community Service Employment for Older Americans

Title V OAA 

Section 371...................................................................... Such Sums $825,425,000 Expired $450,000,000

6) Native American Nutrition

and Supportive Services: 

OAA Sections 613 and 623............................................. Such Sums $27,704,000 Expired $27,704,000

7) Native American Caregiver

Support Program: OAA

Section 631...................................................................... $7,500,000 $6,388,000 Expired $8,388,000

8) Long-Term Care Ombudsman

Program: OAA Section 712 Such Sums $16,825,000 Expired $21,825,000

9) Prevention of Elder Abuse and

Neglect: OAA Section 721.............................................. Such Sums $5,055,000 Expired $5,055,000

10) Native American Organization

and Elder Justice Provisions:

OAA Sections 751 and 752................... Such Sums $0 Expired $1,500,000
38

FY 2010 

Amount 

Authorized

FY 2010 

Appropriation

FY 2012 

Amount 

Authorized

FY 2012 Pres. 

Budget

11) Senior Medicare Patrol Program

 OAA Sections 201 and 202, as amended....................... Such Sums $13,217,000 Expired $12,750,000

12) Elder Rights Support Activities

 OAA Sections 201, 202, and 411, as amended.............. Such Sums $4,103,000 Expired $4,103,000

13) Program Innovations:

OAA Section 411............................................................ Such Sums $27,873,000 Expired $11,509,000

14) Aging Network Support 

Activities: OAA Sections 202, 

215 and 411..................................................................... Such Sums $8,198,000 Expired $7,948,000

15) Alzheimer's Disease 

Demonstration Grants:

PHSA Section 398........................................................... Expired $11,462,000 Expired $11,462,000

16) Lifespan Respite Care

Lifespan Respite Care Act of 2006.................................. $71,110,000 $2,500,000 Expired $10,000,000

Title XXIX of the Public Health Service Act..................

17) Program Administration:

OAA Section 205............................................................ Such Sums $19,976,000 Expired $24,543,000

18) State Health Insurance Assistance Program:

Omnibus Budget Reconciliation Act of 1990.................. Such Sums $46,960,000 Expired $46,960,000

 Section 4360...................................................................

19) Adult Protective Services

Section 6703, Patient Protection and Affordable Care.... $129,000,000 $0 Unspecified $15,000,000

Act, Subtitle B, Section 2042 ( P.L. 111-148).................

18) Community Living Assistance and Supports Act:

CLASS Act Administration, Implementation Fund......... n/a $0 Unspecified $120,000,000

Health Care and Education Reconciliation Act...............

Patient Protection and Affordable Care Act....................

(P.L. 111-152, P.L. 111-148)..........................................

Total Request Level............................................................... $2,378,552,000 $2,237,822,000

Unfunded Authorizations:

1) Legal Assistance:

OAA Section 731............................................................ Such Sums $0 Such Sums

1/ Includes $2,681,000 in FY 2009 budget authority appropriated to AoA and transferred to the 

Department of Agriculture for commodities purchases pursuant to Public Law 110-19.
39

Administration on Aging

Appropriations History

Budget 

Estimate to 

Congress

House 

Allowance

Senate 

Allowance Appropriation

FY 2003 1,341,344,000 1,355,844,000 1,369,290,000 1,376,001,000

FY 2003 Rescission -- -- -- -8,944,007

FY 2004 1,343,701,000 1,377,421,000 1,361,193,000 1,382,189,000

FY 2004 Rescission /1 -- -- -- -8,271,225

FY 2005 1,376,527,000 1,403,479,000 1,395,117,000 1,404,634,000

FY 2005 Rescission /2 -- -- -- -11,292,624

FY 2006 1,369,028,000 1,376,217,000 1,391,699,000 1,376,624,000

FY 2006 Rescission -- -- -- -13,766,240

FY 2006 Transfer -- -- -- -936,197

FY 2007 1,334,835,000 1,390,306,000 1,380,516,000 1,383,007,000

FY 2008 /3 1,335,146,000 1,417,189,000 1,451,585,000 1,438,567,000

FY 2008 Rescission -- -- -- -25,131,765

FY 2009 /4 1,381,384,000 1,492,741,000 1,478,156,000 1,491,343,000

FY 2009 ARRA /5 -- -- -- 100,000,000

FY 2010 /6 1,491,343,000 1,530,881,000 1,495,038,000 1,516,297,000

FY 2010 Transfer /7 -224,298

FY 2011 1,624,733,000 1,651,178,000 1,659,383,000 /8

FY 2012 2,237,944,000

1/ Reflects two separate rescissions of - $8,154,255 and -$117,000.

2/ Reflects two separate rescissions of - $11,236,624 and -$56,000.

3/ Includes $2,659,000 in FY 2008 budget authority appropriated to AoA and transferred to the 

 Department of Agriculture for commodities purchases pursuant to Public Law 110-19.

4/ Includes $2,681,000 in FY 2009 budget authority appropriated to AoA and transferred to the

 Department of Agriculture for commodities purchases pursuant to Public Law 110-19.

5/ American Recovery and Reinvestment Act of 2009, Public Law 111-5.

6/ Includes $2,544,103,000 in FY 2010 budget authority appropriated to AoA and transferred to the

 Department of Agriculture for commodities purchases pursuant to Public Law 110-19.

7/ Reflects the Secretary's transfer of June 18, 2010 to assist those living with HIV/AIDS 

on waiting lists for lifesaving medication.

8/ Final appropriations have not been made for FY 2011. An annualized CR 

would appropriate $1,516,297,000.
40

Administration on Aging

Appropriations Not Authorized by Law

Program

Last Year of 

Authorization

Authorization 

Level

Appropriations in 

Last Year of 

Authorization

CR 

Appropriations 

in FY 2011

Alzheimer's Disease

 Supportive Services:

 PHSA Section 398 FY 2002 Such Sums $11,483,000 $11,464,000

Older Americans Act FY 2011 Such Sums $2,341,722,000 $2,341,722,000

Lifespan Respite Care:

Lifespan Respite Care FY 2011 $94,810,000 $2,500,000 $2,500,000

Act of 2006

State Health Insurance

Assistance Programs: FY 1996 $10,000,000 N/A $46,960,000

Omnibus Budget

Reconciliation Act of 1990
Health and Independence

Summary of Request

AoA’s Health and Independence Programs provide a foundation of supports that assist older 

individuals to remain healthy and independent in their homes and communities, avoiding more 

expensive nursing home care. For example, 62 percent of congregate and 93 percent of homedelivered meal recipients reported that the meals enabled them to continue living in their own 

homes and 53 percent of seniors using transportation services rely on them for the majority of 

their trips to doctors’ offices, pharmacies, meal sites, and other critical daily activities that help 

them to remain in the community.4

From 2010 to 2015, the number of Americans age 60 and older will increase by 15 percent, from 

57 million to 65.7 million.5 During this period, the number of seniors with severe disabilities 

(defined as 3 or more limitations in activities of daily living) who are at greatest risk of nursing 

home admission and Medicaid eligibility (through the ―spend down‖ provisions) will increase by 

more than 13 percent.6 These programs help seniors in need maintain their health and 

independence.

The FY 2012 funding request for Health and Independence services is $1,752,507,000, a

decrease of $317,489,000 from the FY 2010 enacted level. Of this decrease, $225,000,000 is a 

result of the expiration of a one-time additional appropriation for the SCSEP program in FY 

2010. This request includes additional funding for caregivers and supportive services programs

initially proposed for FY 2011 as a result of the work by the White House Task Force on Middle 

Class Families. Health and Independence Programs include: 

$416,476,000 for Home and Community-Based Supportive Services (HCBS), an increase 

of +$48,185,598 over FY 2010. HCBS provides grants to States to fund a broad array of 

services that enable seniors to remain in their homes for as long as possible, including 

adult day care, transportation, case management, personal care services, chore services, 

and community services such as physical fitness programs. These services also aid 

caregivers, who might otherwise have to be even more intensively relied upon to provide 

care for their loved ones -- taking more time away from their work and other family 

responsibilities. In addition to these services, the HCBS program also funds services at 

multi-purpose senior centers, which coordinate and integrate services for the elderly. 

$819,352,779 for Nutrition Services, the same amount as the FY 2010 enacted level. 

Nutrition Services help over two million older adults receive the meals they need to stay 

healthy and decrease their risk of disability. The meals provided through these programs 

 

4

2009 National Survey of Older Americans Act Participants. http://www.data.aoa.gov, select AGID.

5 U.S. Census Bureau, ―2008 National Population Projections,‖ released August 2008, 

<http://www.census.gov/population/www/projections/2008projections.html>.

6 Data extrapolated by AoA from U.S. Census Bureau, ―2008 National Population Projections,‖ released August 

2008, <http://www.census.gov/population/www/projections/2008projections.html> and Health Data Interactive, 

National Center on Health Statistics, Centers for Disease Control and Prevention, ―Functional limitations among 

Medicare beneficiaries, ages 65+: US, 1992-2006.‖ Accessed 31 August 2009.
HEALTH AND INDEPENDENCE – SUMMARY OF REQUEST

42

fulfill the standards of the Dietary Guidelines for Americans and provide a minimum of 

33 percent of the Dietary Reference Intake. With these funds in FY 2012, the aging 

services network will provide an estimated 193 million meals. This represents 

approximately 36 million fewer home-delivered and congregate meals than at the 

FY 2010 enacted level, primarily due to declining leveraged funds, as State, local, and 

private budgets face economic hardships. These meals are especially critical for the 

health of the 28 percent of meal recipients who report these meals as the only or the 

majority of their food intake for the day. AoA’s budget request reflects a reauthorization 

proposal to consolidate the funding streams from the congregate and home-delivered 

nutrition programs. 

$21,026,000 for Preventive Health Services, the same amount as enacted in FY 2010. 

These services support activities that educate older adults about the importance of healthy 

lifestyles and promote healthy behaviors that can help prevent, delay, or enable seniors to 

better cope with and manage chronic disease and disability, thereby reducing the need for 

more costly medical interventions. AoA is proposing appropriations language that would

require States to use their Preventive Health Services funds in support of one or more 

proven evidence-based models, such as the chronic disease self-management program, 

that enhance the wellness and fitness of the aging community. 

$10,000,000 for Chronic Disease Self-Management Programs (CDSMP). Chronic disease 

self-management programs teach evidence-based disease prevention models that use 

state-of-the-art techniques to help people better self-manage their conditions and reduce 

their need for more costly medical care. CDSMPs have been demonstrated to be 

especially effective and have shown the value of focusing dollars on proven 

interventions. This program was funded in FY 2010 and FY 2011 using funds provided 

under ARRA to CMS and transferred in FY 2010 to AoA for a two-year project period.

$450,000,000 for Community Service Employment for Older Americans, a reduction of -

$375,425,000 from the FY 2010 level ($225,000,000 of which is a result of the expiration 

of a one-time special appropriation). Commonly known as the Senior Community Service 

Employment Program (SCSEP), the program offers part-time, community-service 

employment opportunities at 501(c)(3) non-profits or government agencies (to prepare 

participants to enter or re-enter the workforce. Transferring this program to AoA will 

allow the program to increase the efficiency with which it serves participants by better 

integrating it with other OAA community-based programs, while also refocusing the 

program on community service opportunities.

$27,703,901 for Native American Nutrition and Supportive Services, the same amount as 

the FY 2010 enacted level. These funds will provide approximately 4.5 million meals 

and 800,000 rides for Native American seniors to critical daily activities such as meal 

sites, medical appointments, and grocery stores.

$7,948,000 for Aging Network Support Activities, a reduction of $250,000 from the 

FY 2010 enacted level, reflecting greater contracting efficiencies. While a new grouping 

of existing AoA programs, these funds support competitive grants and contracts for 
HEALTH AND INDEPENDENCE – SUMMARY OF REQUEST

43

eleven ongoing activities which help seniors and their families obtain information about 

their care options and benefits, and which assist States, Tribes, and community providers 

of aging services carry out their mission to help older people remain independent and live 

in their own homes and communities.

In concert with other Older Americans Act (OAA) programs, these services assist nearly 

11.5 million elderly individuals and caregivers. AoA’s services are especially critical for the 

nearly three million seniors who receive intensive in-home services, half a million of whom meet 

the disability criteria for nursing home admission. These services help to keep these individuals 

from joining the 1.7 million seniors who live in nursing homes. These increases will also help 

the national aging services network improve its capacity to assist the rapidly growing senior 

population.

State and Territory Flexibility

Under the core State formula grant programs for Home and Community-Based Supportive 

Services and Nutrition Services, States and Territories have the flexibility to allocate resources to 

best meet local needs through intra-State funding formulas which distribute funds to Area 

Agencies on Aging (AAAs). These formulas vary by State and allow States to take into account 

their own local circumstances to best serve their population. States are required to submit their 

formulas to AoA for approval and must take into account the geographic distribution of older 

persons and the distribution of older persons in greatest social and economic need. AAAs 

administer these grants and provide grants or contracts to local service providers based on 

identified needs.

The OAA allows a State to transfer up to 40 percent of the funds between congregate and homedelivered meals for use as the State considers appropriate to meet the needs of the area served. 

Additionally, for any fiscal year if the transferred funds are insufficient to satisfy the need for 

nutrition services, then the Assistant Secretary for Aging may grant a waiver that permits the 

State to transfer an additional 10 percent of the funds to meet those needs. The OAA provides 

further flexibility to States by allowing them to transfer up to 30 percent for any fiscal year 

between Supportive Services programs and Nutrition Services programs, for use as the State 

considers appropriate. These are options open only to States and Territories. A State agency may 

not delegate to an Area Agency on Aging or any other entity the authority to make such 

transfers.

In 2009, the last year of available data, States transferred over $76 million from congregate 

nutrition to home and community-based services and home-delivered meals, as illustrated in the 

following table. 
HEALTH AND INDEPENDENCE – SUMMARY OF REQUEST

44

Table 1. FY 2009 Transfer of Federal funds within Title III of the OAA

Part B –

Home and CommunityBased Supportive Services

Part C1 –

Congregate Nutrition

Part C2 –

Home-Delivered Meals

Initial Allotment $359,188,415 $431,673,607 $213,177,293

Final Allotment after 

Transfers $407,516,171 $355,106,340 $241,416,804

Net Transfer +$48,327,756 ($76,567,267) +$28,239,511

Net Percent Change 13.45 (17.73) 13.24

Waiting List Information

AoA does not record or require State agencies or area agencies on aging to establish waiting list 

information on Older Americans Act programs. This is done to reduce the reporting burden on 

these entities, and also in recognition of the significant methodological issues in determining and 

maintaining accurate measures on such lists. To optimally provide services to older adults and 

their family caregivers, State agencies and AAAs ensure that available dollars are targeted to 

those seniors in greatest social and economic need and serve as many seniors as possible by 

pulling together Federal, State, local and individual dollars.

State agencies and Area Agencies on Aging may maintain local waiting lists. These lists 

frequently serve as a management tool at the local level to ensure that those most in need are the 

first to receive services. In particular, a survey by the National Association of State Units on 

Aging determined that the Recovery Act funding helped 20 percent of the States eliminate 

waiting lists for seniors requesting home-delivered meals as of November 2009.7

 

7 The Economic Crisis and Its Impact on State Aging Programs. National Association of State Units on Aging. 

November 2009.
Home and Community-Based Supportive Services

FY 2010

Enacted

FY 2011 CR FY 2012 

Request

FY 2012 +/-

FY 2010

Home and Community-based 

Supportive Services ................................ $368,290, ............... 000 $368,348,000 $416,476,000 +$48,186,000

Authorizing Legislation: Section 321 of the Older Americans Act of 1965, as amended

FY 2012 Older Americans Act Authorization................................................................... Expired

Allocation Method .................................................................................................Formula Grant

Program Description and Accomplishments:

The Home and Community-Based Supportive Services (HCBS) program, established in 1973, 

provides grants to States and Territories based on their share of the population age 60 and over to 

fund a broad array of services that enable seniors to remain in their homes for as long as 

possible. AoA programs, like the HCBS program, serve seniors holistically; while each service 

is valuable in and of itself, it is often the combination of supports, when tailored to the needs of 

the individual, that ensures clients remain in their own homes and communities instead of 

entering nursing homes. 

The services provided to seniors through the HCBS program include transportation; case 

management; information and referral; in-home services such as personal care, chore, and 

homemaker assistance; and community services such as adult day care. In addition to these 

services, the HCBS program also funds multi-purpose senior centers, which coordinate and 

integrate services for the elderly.

While age alone does not determine the need for these long-term care supports, statistics show 

that both disability rates and the use of long-term supports increase with advancing age. Among 

those aged 85 and older, 55 percent are unable to perform critical activities of daily living and 

require long-term support. Data also show that over 80 percent of seniors have at least one 

chronic condition and 50 percent have at least two. Providing a variety of supportive services 

that meet the diverse needs of these older individuals is crucial to enabling them to remain 

healthy and independent in their homes and communities, avoiding unnecessary, expensive 

nursing home care. 

Data from AoA’s national surveys of elderly clients show that Home and Community-Based 

Supportive Services are providing seniors with the services and information they need to help 

them remain at home. For example, 48 percent of seniors using transportation services rely on 

them for the majority of their transportation needs and would otherwise be homebound, while 

80 percent of clients receiving case management reported that as a result of the services arranged 
HOME AND COMMUNITY-BASED SUPPORTIVE SERVICES

46

by the case manager that they were better able to care for themselves.8 In addition, a study 

published in the Journal of Aging and Health shows that the services provided by the HCBS 

program, what the article calls ―personal care services,‖ are the critical services that enable frail 

seniors to remain in their homes and out of nursing home care.9 

Services provided by the HCBS program in FY 2009, the most recent available data, include: 

Adult Day Care/Day Health provided nearly eight million hours of care for dependent 

adults in a supervised, protective group setting during some portion of a twenty-four hour 

day (Output E). 

Transportation Services provided nearly 28 million rides to doctor’s offices, grocery 

stores, pharmacies, senior centers, meal sites, and other critical daily activities 

(Output C). 

Personal Care, Homemaker, and Chore Services provided nearly 29 million hours of 

assistance to seniors unable to perform activities of daily living (such as eating, dressing, or 

bathing) or instrumental activities of daily living (such as shopping or light housework) 

(Output D).

Case Management Services provided nearly 4 million hours of assistance in assessing 

needs, developing care plans, and arranging services for older persons or their caregivers 

(Output F). 

In continuing with AoA’s commitment to provide services to those in most need, nearly 

50 percent of riders on OAA-funded transportation are mobility impaired, meaning they do not 

own a car or if they do own a car they do not drive, and are not near public transportation. Many 

of these individuals cannot safely drive a car, as nearly 75 percent of transportation riders have at 

least one of the following chronic conditions that could impair their ability to navigate safely:

67 percent of riders had a doctor tell them they had vision problems (including glaucoma, 

macular degeneration or cataracts); 

7 percent have Alzheimer’s or dementia; 

2 percent have Multiple Sclerosis; 

14 percent have had a stroke; 

3 percent have epilepsy; and 

3 percent have Parkinson’s disease. 

 

 

8

2009 National Survey of Older Americans Act Participants. Which should be posted on AGID by the time the CJ 

comes out http://www.data.aoa.gov, select AGID.

9 Chen, Ya Mei and Elaine Adams Thompson. Understanding Factors That Influence Success of Home- and 

Community-Based Services in Keeping Older Adults in Community Settings. 2010. Journal of Aging and Health. 

V. 22: 267. Available: http://jah.sagepub.com/cgi/content/abstract/22/3/267.
HOME AND COMMUNITY-BASED SUPPORTIVE SERVICES

47

Of the transportation participants 95 percent take daily medications, with 17 percent taking 10 to 

20 medications daily.10 

Funding History:

Funding for Home and Community-Based Supportive Services during the past ten years is as 

follows:

FY 2002..................................$356,981,000

FY 2003..................................$355,673,000

FY 2004..................................$353,889,000

FY 2005..................................$354,136,000

FY 2006..................................$350,354,000

FY 2007..................................$350,595,000

FY 2008..................................$351,348,000

FY 2009..................................$361,348,000

FY 2010..................................$368,290,000

FY 2011 CR............................$368,348,000

Budget Request:

The FY 2012 request for Home and Community-Based Supportive Services is $416,476,000, an 

increase of +$48,186,000 over FY 2010. The +$48 million increase, which continues funding 

originally proposed in FY 2011 by the White House Middle Class Task Force, will expand 

services, including transportation assistance, case management, and information and referrals; inhome services such as personal care, chore, and help with eating, dressing, and bathing; and 

community services such as adult day care and physical fitness programs. These services --

particularly adult day care, personal care, and chore services – also aid caregivers, who might 

otherwise have to be even more intensively involved with the care of their loved ones, taking 

time away from work and their other family responsibilities. The budget request will support 

6.4 million hours of adult day care for older adults; over 18 million rides for critical daily 

activities such as visiting the doctor, the pharmacy, or grocery stores; and more than 25 million 

hours of assistance to seniors who are unable to perform daily activities. 

Funding for these services is a cost-effective means of enabling a growing senior population to 

remain healthy and independent, thereby avoiding more expensive nursing home care and 

medical interventions that increase costs to the Medicaid and Medicare programs. From 2010 to 

2015, the population age 60 and older will increase by 15 percent, from 57 million to 

65.7 million.11 During this period, the number of seniors with severe disabilities (defined as 3 or 

more limitations in activities of daily living) who are at greatest risk of nursing home admission 

 

10 2008 National Survey of Older Americans Act Participants. http://www.data.aoa.gov, select AGID.

11 U.S. Census Bureau, ―2008 National Population Projections,‖ released August 2008, 

<http://www.census.gov/population/www/projections/2008projections.html >.
HOME AND COMMUNITY-BASED SUPPORTIVE SERVICES

48

and Medicaid eligibility (through the ―spend down‖ provisions) will increase by more than 

13 percent.12 

AoA’s core formula grant programs reach one in five seniors, serving over a half million seniors 

in their own communities who meet the disability criteria for nursing home admission, helping to 

keep them from joining the 1.7 million seniors who live in nursing homes. Nationally, about 

26 percent of individuals 60 and older live alone, and in FY 2011 AoA projects 72 percent of the 

Older Americans Act transportation users will be individuals who live alone (Outcome 2.11). 

Living alone is a key predictor of nursing home admission, and HCBS services are critical to 

their ability to remain at home, especially for those who do not have an informal caregiver to 

assist with their care. Additionally, recent research has shown that childless seniors who live in a 

State with higher home and community-based service expenditures had significantly lower risk 

of nursing home admissions.13 

Federal support for Older Americans Act programs is not expected to cover the cost of serving 

every senior. These programs have strong partnerships with State and local governments, 

philanthropic organizations, and private donations that contribute funding. Despite States only 

having to match this program at 25 percent of their Federal allocation, States have normally 

leveraged resources of $2 or $3 per every Older Americans Act dollar. AoA expects a decline in 

performance for home and community-based services in FY 2012 compared to FY 2010. 

Declines in outputs are projected to be largely attributable to declining leveraged funds, as State, 

local, and private budgets face economic hardships.14 

 

12 Data extrapolated by AoA from U.S. Census Bureau, ―2008 National Population Projections,‖ released August 

2008, <http://www.census.gov/population/www/projections/2008projections.html> and Health Data Interactive, 

National Center on Health Statistics, Centers for Disease Control and Prevention, ―Functional limitations among 

Medicare beneficiaries, ages 65+: US, 1992-2006.‖ Accessed 31 August 2009.

13 ―Risk of Nursing Home Admission Among Older Americans: Does States’ Spending on Home and CommunityBased Services Matter?‖ May 2007. Journal of Gerontology: Psychological Sciences.

14 AoA’s projections are based on the following two assumptions: 1) CPI-U or a CPI-specific index and 2) declining 

State budgets of -8.5 percent each year from FY 2010-2012, consistent with the decline in 2009 state government 

tax collections reported by the U.S. Census in March 2010. 
HOME AND COMMUNITY-BASED SUPPORTIVE SERVICES

49

Outputs and Outcomes Table:

Home and Community-Based Supportive Services Outputs and Outcomes

Measure Most Recent 

Result 

FY 2010

Target 

FY 2012 

Target 

FY 2012 

+/- FY 2010 

2.9b: 90% of transportation clients rate 

services good to excellent. (Outcome) FY 2009: 96.7% 90% 90% Maintain

2.11: Increase the percentage of 

transportation clients who live alone.

(Outcome)

FY 2009: 72.4%

(Target 

Exceeded)

70% 72% Maintain

Indicator Most Recent 

Result 

FY 2010

Projection 

FY 2012

Projection 

FY 2012 

+/- FY 2010

Output C: Transportation Services 

units (Output) FY 2009: 27.6 M 25.5 M 18.3 M -7.2 M

Output D: Personal Care, Homemaker 

and Chore Services units (Output) FY 2009: 28.7 M 31.8 M 25.4 M -6.4 M

Output E: Adult Day Care/Day Health 

units (Output) FY 2009: 7.9 M 8 M 6.4 M -1.6 M

Output F: Case Management Services 

units (Output) FY 2009: 3.9 M 4.2 M 3.5 M -.7 M

Note: For presentation within the budget AoA highlighted specific measures that are most directly related to Home 

and Community-Based Supportive Services; however multiple performance outcomes are impacted by this program 

because AoA’s performance measures (efficiency, effective targeting, and client outcomes) assess network-wide 

performance in achieving current strategic objectives.

Grant Awards Tables:

Home and Community-Based Supportive Services Grant Awards

FY 2010 

Enacted FY 2011 CR FY 2012 Request

Number of 

Awards 56 56 56

Average 

Award $6,511,866 $7,360,438 $7,360,438

Range of 

Awards

$227,915 -

$36,241,336

$257,615 -

$41,789,087

$257,615 -

$41,789,087
HOME AND COMMUNITY-BASED SUPPORTIVE SERVICES

50

DEPARTMENT OF HEALTH AND HUMAN SERVICES

ADMINISTRATION ON AGING

FY 2012 DISCRETIONARY STATE FORMULA GRANTS

PROGRAM: Home and Community-Based Supportive Services (CFDA 93.044)

State/Territory

FY 2010

Actual

FY 2011

Estimate

FY 2012

Estimate

Difference

+/-FY 2010

Alabama......................................... 5,655,995 5,593,005 6,486,796 830,801 

Alaska............................................ 1,830,190 1,823,323 2,061,556 231,366 

Arizona .......................................... 7,536,954 7,425,075 8,644,045 1,107,091 

Arkansas........................................ 3,575,124 3,532,379 4,100,269 525,145 

California....................................... 36,448,142 36,119,099 41,801,954 5,353,812 

Colorado ........................................ 4,762,294 4,847,248 5,461,820 699,526 

Connecticut.................................... 4,414,911 4,404,337 4,842,864 427,953 

Delaware........................................ 1,830,190 1,823,323 2,061,556 231,366 

District of Columbia ....................... 1,830,190 1,823,323 2,061,556 231,366 

Florida ........................................... 26,729,390 26,156,381 30,655,629 3,926,239 

Georgia .......................................... 9,120,376 9,165,703 10,460,054 1,339,678 

Hawaii ........................................... 1,830,190 1,823,323 2,061,556 231,366 

Idaho.............................................. 1,830,190 1,823,323 2,061,556 231,366 

Illinois............................................ 14,559,760 14,524,890 15,880,743 1,320,983 

Indiana........................................... 7,178,800 7,142,991 8,233,283 1,054,483 

Iowa............................................... 4,271,107 4,260,878 4,350,292 79,185 

Kansas........................................... 3,441,149 3,432,908 3,658,599 217,450 

Kentucky........................................ 5,039,351 4,973,926 5,779,573 740,222 

Louisiana ....................................... 4,819,982 4,823,336 5,527,982 708,000 

Maine............................................. 1,830,190 1,823,323 2,061,556 231,366 

Maryland........................................ 6,134,814 6,130,571 7,035,948 901,134 

Massachusetts ................................ 8,228,803 8,209,095 8,810,131 581,328 

Michigan........................................ 11,593,775 11,610,075 13,296,767 1,702,992 

Minnesota ...................................... 5,741,350 5,765,773 6,584,688 843,338 

Mississippi..................................... 3,284,196 3,272,711 3,766,606 482,410 

Missouri......................................... 7,135,518 7,118,429 8,103,032 967,514 

Montana......................................... 1,830,190 1,823,323 2,061,556 231,366 

Nebraska........................................ 2,300,448 2,294,938 2,374,748 74,300 

Nevada........................................... 2,749,585 2,746,654 3,153,467 403,882 

New Hampshire.............................. 1,830,190 1,823,323 2,061,556 231,366 
HOME AND COMMUNITY-BASED SUPPORTIVE SERVICES

51

PROGRAM: Home and Community-Based Supportive Services (CFDA 93.044)

State/Territory

FY 2010

Actual

FY 2011

Estimate

FY 2012

Estimate

Difference

+/-FY 2010

New Jersey.................................... 10,287,611 10,262,972 11,614,843 1,327,232 

New Mexico.................................. 2,249,693 2,230,003 2,580,147 330,454 

New York ..................................... 24,341,729 24,283,431 26,256,310 1,914,581 

North Carolina .............................. 10,329,835 10,451,253 11,847,169 1,517,334 

North Dakota................................. 1,830,190 1,823,323 2,061,556 231,366 

Ohio.............................................. 13,849,980 13,816,810 15,753,112 1,903,132 

Oklahoma ..................................... 4,311,211 4,278,286 4,944,479 633,268 

Oregon.......................................... 4,555,027 4,561,952 5,224,108 669,081 

Pennsylvania ................................. 17,922,902 17,879,977 18,804,162 881,260 

Rhode Island ................................. 1,830,190 1,823,323 2,061,556 231,366 

South Carolina .............................. 5,403,971 5,462,652 6,197,752 793,781 

South Dakota................................. 1,830,190 1,823,323 2,061,556 231,366 

Tennessee...................................... 7,355,714 7,341,822 8,436,184 1,080,470 

Texas............................................ 22,369,742 22,369,548 25,655,599 3,285,857 

Utah.............................................. 2,184,965 2,174,299 2,505,911 320,946 

Vermont........................................ 1,830,190 1,823,323 2,061,556 231,366 

Virginia......................................... 8,507,855 8,472,386 9,757,560 1,249,705 

Washington................................... 7,172,705 7,199,310 8,226,292 1,053,587 

West Virginia................................ 2,780,196 2,773,538 2,868,481 88,285 

Wisconsin ..................................... 6,566,139 6,519,059 7,530,629 964,490 

Wyoming ...................................... 1,830,190 1,823,323 2,061,556 231,366

Subtotal, States.............................. 358,703,569 357,330,889 404,012,256 45,308,687

American Samoa ........................... 473,451 472,317 472,317 (1,134)

Guam............................................ 915,095 911,661 1,030,461 115,683 

Northern Mariana Islands.............. 228,774 227,915 257,615 28,921 

Puerto Rico ................................... 4,802,050 4,810,067 5,546,846 705,366 

Virgin Islands................................ 915,095 911,661 1,030,461 115,683 

Subtotal, States and Territories ...... 366,038,034 364,664,520 412,311,240 46,273,206

Undistributed 15/........................... 2,252,368 3,625,480 4,164,760 1,912,392

 

TOTAL 2/ 368,290,402 368,290,000 416,476,000 48,185,598

 

15/ Funds held for statutory related requirements are reflected in the undistributed line.

2/ FY 2010 level reflects the Secretary’s transfer of June 18, 2010 to assist those living with HIV/AIDS on waiting 

lists for lifesaving medication.
HOME AND COMMUNITY-BASED SUPPORTIVE SERVICES

52

PAGE INTENTIONALLY LEFT BLANK
Nutrition Services

FY 2010

Enacted

FY 2011

CR

FY 2012 

Request

FY 2012 +/-

FY 2010

Congregate Nutrition................................ $440,718,000 .............. $440,783,000 $440,718,000 --

Home-Delivered Nutrition ................................ $217,644,000..... $217,676,000 $217,644,000 --

Nutrition Services Incentive 

Program................................................................ $160,991,000 . $161,015,000 $160,991,000 --

 Total BA........................................................... $819,353,000 $819,474,000 $819,353,000 --

Authorizing Legislation: Sections 311, 331, and 336 of the Older Americans Act of 1965, as 

amended

FY 2012 Older Americans Act Authorization................................................................... Expired

Allocation Method .................................................................................................Formula Grant

Program Description and Accomplishments:

Nutrition Services help seniors remain healthy and independent in their communities by 

providing meals and related services in a variety of settings (including congregate facilities such 

as senior centers) and home-delivery to seniors who are homebound due to illness, disability, or 

geographic isolation. Nutrition Services, which help seniors remain healthy and independent in 

their communities, include:

Congregate Nutrition Services (Title III-C1): Provides funding for the provision of meals 

and related services in a variety of congregate settings, which help to keep older 

Americans healthy and prevent the need for more costly medical interventions. 

Established in 1972, the program also presents opportunities for social engagement and 

meaningful volunteer roles, which contribute to overall health and well-being.

Home-Delivered Nutrition Services (Title III-C2): Provides funding for the delivery of 

meals and related services to seniors who are homebound. Established in 1978, 

home-delivered meals are often the first in-home service that an older adult receives and 

serve as a primary access point for other home and community-based services. Homedelivered meals also represent an essential service for many caregivers, by helping them 

maintain their own health and well-being.

Nutrition Services Incentive Program (Title III-A): Provides additional funding to States, 

Territories, and eligible Tribal Organizations that is used exclusively to provide meals 

and cannot be used to pay for other nutrition-related services or for administrative costs. 

Funds are awarded to States and Tribes based on the number of meals served in the prior 
NUTRITION SERVICES

54

Federal fiscal year. States and Tribes have the option to purchase commodities directly 

from the U.S. Department of Agriculture with any portion of their award if they 

determine that doing so will enable them to better meet the needs of seniors. States and 

Tribes elected to spend approximately $2.7 million on commodities, including $182,238 

assessed as administrative expenses by USDA, in FY 2010. 

Formula grants for Congregate Nutrition Services and Home-Delivered Nutrition Services are 

allocated to States and Territories based on their share of the population age 60 and over. 

Nutrition Services Incentive Program grants are provided to States, Territories, and Tribal 

organizations based on the number of meals served in the prior Federal fiscal year. The meals 

provided through these programs fulfill the standards set by the Dietary Guidelines for 

Americans and provide a minimum of 33 percent of the Dietary Reference Intake, as established 

by the Food and Nutrition Board of the Institute of Medicine of the National Academy of 

Sciences. 

Nutrition Services help over two million older adults receive the meals they need to stay healthy 

and decrease their risk of disability. Studies have found that 50 percent of all persons age 85 and 

over are in need of assistance with instrumental activities of daily living (IADLs), including 

obtaining and preparing food; these nutrition programs help address their needs. Serving Elders 

at Risk, a national evaluation of AoA’s nutrition program clients, found that recipients are older, 

poorer, more likely to live alone, more likely to be minorities, are sicker, in poorer health, in

poorer nutritional status, more functionally impaired, and at higher nutritional risk than those in 

the general population. Nutrition Services provide an important opportunity for social interaction 

that helps to improve the general health status of participants, particularly homebound elders. 

A comparison of the number of social contacts of congregate and home-delivered meal 

participants showed that nutrition program clients had significantly more social contacts than 

people who did not participate in the program. 

Data from AoA’s national surveys of elderly clients show that the Nutrition Services are 

effectively helping seniors to improve their nutritional intake and remain at home. For example, 

73 percent of congregate and 85 percent of home-delivered meal recipients say they eat healthier 

meals due to the programs, and 58 percent of congregate and 93 percent of home-delivered meal 

recipients say that the meals enabled them to continue living in their own homes.16 In addition, 

home-delivered meal and congregate meal participants had significantly better food energy 

intake, protein, vitamins A, B6 & D, Riboflavin, Calcium, Phosphorous, Potassium, Magnesium 

and Zinc intakes compared to matched non-participant group of senior citizens.17 Seniors with 

deficiencies of these nutrients can experience osteoporosis, night blindness, decreased resistance 

to infection, fatigue, vasodilatation, and other illnesses. 

AoA’s annual performance data further demonstrate that these programs are an efficient and 

effective means to help seniors remain healthy and independent in their homes and in the 

community. Ninety-one percent of home-delivered meal clients rate service as good to excellent 

(Outcome 2.9a). Also, the number of home-delivered meal recipients with severe disabilities 

(3+ ADL) totaled more than 342,000 in 2009 (Outcome 3.2). This level of disability is 

 

16 2008 National Survey of Older Americans Act Participants. http://www.data.aoa.gov, select AGID.

17 Serving Elders at Risk – National Evaluation of the Elderly Nutrition Program, 1993-1995, pp.117-118
NUTRITION SERVICES

55

frequently associated with nursing home admission, and demonstrates the extreme frailty of a 

significant number of home-delivered meal clients. The most recent data on how these nutrition 

programs are helping seniors remain healthy and independent in their homes include:

Home-Delivered Nutrition Services provided nearly 149 million meals to over 

880,000 individuals in FY 2009 (Output G).

Congregate Nutrition Services provided over 92.4 million meals to nearly 1.7 million 

seniors in a variety of community settings in FY 2009 (Output H).

Funding History:

Comparable funding for Nutrition Services during the past five years is as follows:

FY 2002..................................$716,170,000

FY 2003..................................$714,274,000

FY 2004..................................$714,462,000

FY 2005..................................$718,696,000

FY 2006..................................$714,578,000

FY 2007..................................$735,070,000

FY 2008..................................$758,003,000

FY 2009*.................................$809,743,000

FY 2010..................................$819,353,000

FY 2011 CR............................$819,474,000

* The FY 2009 funding level shown here does not include $97 million in Recovery Act Nutrition Services funding

to States. 

Budget Request:

The FY 2012 request for Nutrition Services is $819,353,000, the same amount as the 2010 level. 

At this level, the budget request will support over 193 million home-delivered and congregate 

meals to approximately two million elderly individuals in a variety of community settings. This 

represents approximately 36 million fewer home-delivered and congregate meals than at the 

FY 2010 appropriation, primarily due to declining leveraged funds, as State, local, and private 

budgets face economic hardships. In FY 2012 these programs are expected to continue to 

provide home-delivered meals that clients rate good to excellent (Outcome 2.9a) ensuring that 

clients continue to receive high quality services; however, as State and local funding tightens, 

some providers may look at cost cutting measures such as reducing menu choices or the 

frequency of deliveries. This could affect client satisfaction with the quality of service.

Consistent with AoA’s commitment to provide services to those in need to help maintain their 

health and independence, approximately 73 percent of home-delivered meal recipients have 

annual incomes at or below $20,000. These meals are especially critical for the survival of the 

28 percent of meal recipients who report these meals as the sole or majority of their food intake 

for the day and for the 297,000 home-delivered meal recipients with severe disabilities who are 
NUTRITION SERVICES

56

projected to be served in FY 2012 (Outcome 3.2). This population with severe disabilities is 

important to serve since this level of disability is frequently an eligibility requirement for more 

costly nursing home admission.

In addition, all too often, caregivers are unable to be continuously available in the homes of those 

in need, particularly as 21 percent of caregivers work full or part time. Home-delivered meals 

ensure proper nutrition for an individual who might otherwise not have access to a meal nor the 

ability to travel to a congregate meal site. 

Federal support for Nutrition Services is not expected to serve every senior. These programs 

have strong partnerships with State and local governments, philanthropic organizations, and 

private donations that contribute funding. In FY 2009, State and local funding comprised 

approximately 66 percent of all the funding for home-delivered meals and congregate meals. 

Though all programs funded through OAA rely on State and local funding in some part, 

congregate and home-delivered meals have a higher rate of State and local support than many 

other OAA services.

AoA expects a decline in congregate and home-delivered meals in FY 2012 compared to 

FY 2010. Declines in meal counts are projected to be largely attributable to declining leveraged 

funds, as State, local, and private budgets face economic hardships and are projected to only 

comprise 57 percent of all the funding for home-delivered meals and congregate meals at the 

FY 2012 request.18 With this budget request, annual Federal funding for congregate meals will 

have increased from FY 2004 to 2012 by over $59 million or 15 percent, while the CPI increased 

15.2 percent between 2004 and 2010. Should State budgets rebound higher than projected in 

FY 2012, States may elect to provide additional support for meals.

 

18 AoA’s projections are based on the following assumptions: 1) 3.2 percent inflationary increase using the U.S. 

Department of Agriculture’s ―food away from home‖ inflation index, consistent with the economic assumptions 

used in preparation of the President’s budget; 2) declining State budgets of -8.5 percent each year from FY 2010-

2012, consistent with the decline in 2009 state government tax collections reported by the U.S. Census in March 

2010. 
NUTRITION SERVICES

57

Outcomes and Outputs Table:

Nutrition Services Outcomes and Outputs

Measure Most Recent Result FY 2010 

Target 

FY 2012 

Target 

FY 2012 

+/- FY 2010

1.1: For Home and Community-based 

Services including Nutrition Services, 

and Caregiver services increase the 

number of clients served per million 

dollars of AoA funding. (Outcome)

FY 2009: 8,544

(Target Exceeded) 7,742 8,650 +908

2.9a: 90% of home delivered meal 

clients rate services good to excellent.

(Outcome)

FY 2009: 91.1%19 

(Target Met) 90% 90% Maintain

3.2: Increase the number of older 

persons with severe disabilities who 

receive home-delivered meals.

(Outcome)

FY 2009: 342,084

(Target Not Met) 325,000 271,000 -54,000

Indicator Most Recent Result FY 2010 

Projection

FY 2012 

Projection 

FY 2012 

+/- FY 2010

Output G: Number of Home-Delivered 

meals served (Output) FY 2009: 149 M 136.5 M 118 M -18.5 M

Output H: Number of Congregate meals 

served (Output) FY 2009: 92.4 M 92.4 M 75.4 M -17 M

Outputs G& H: Total Number of Meals 

(Outputs) FY 2009: 241.4 M 228.9 M 193.4 M -35.5 M

Note: For presentation within the budget AoA highlighted specific measures that are most directly related to 

Nutrition Services, however multiple performance outcomes are impacted by this program because AoA’s 

performance measures (efficiency, effective targeting, and client outcomes) assess network-wide performance in 

achieving current strategic objectives.

 

19 Based on upper range of survey confidence interval.
NUTRITION SERVICES

58

Grant Awards Tables:

Nutrition Programs Grant Awards

FY 2010 

Enacted FY 2011 CR FY 2012 Request

Number of 

Awards 56 56 56

Average 

Award $11,640,614 $11,783,422 $11,783,422

Range of 

Awards

$407,421 -

$65,242,165

$412,420 -

$66,366,137

$412,420 -

$66,884,436

Nutrition Services Incentive Program Grant Awards

FY 2010

Enacted FY 2011 CR FY 2012 Request

Number of 

Awards 299 299 299

Average 

Award $533,12720 $533,12717 $533,12717

Range of 

Awards

$503 -

$16,858,820

$503 -

$16,858,820

$503 -

$16,858,820

 

20 If the 244 awards to Tribal organizations are excluded from the ―average award‖ calculation, the average award to 

States, DC, and the territories is $2,842,854.
NUTRITION SERVICES

59

DEPARTMENT OF HEALTH AND HUMAN SERVICES

ADMINISTRATION ON AGING

FY 2012 DISCRETIONARY STATE FORMULA GRANTS

PROGRAM: Nutrition Services (CFDA 93.045)

State/Territory

FY 2010

Actual

FY 2011

Estimate

FY 2012

Estimate

Difference

+/-FY 2010

Alabama......................................... 10,174,752 10,083,437 10,241,925 67,173 

Alaska............................................ 3,271,659 3,259,372 3,258,892 (12,767)

Arizona .......................................... 13,558,468 13,386,412 13,647,981 89,513 

Arkansas........................................ 6,431,406 6,368,405 6,473,866 42,460 

California....................................... 65,567,733 65,117,886 66,000,609 432,876 

Colorado ........................................ 8,567,043 8,738,937 8,623,602 56,559 

Connecticut.................................... 7,820,541 7,769,943 7,646,341 (174,200)

Delaware........................................ 3,271,659 3,259,372 3,258,892 (12,767)

District of Columbia ....................... 3,271,659 3,259,372 3,258,892 (12,767)

Florida ........................................... 48,084,357 47,156,444 48,401,810 317,453 

Georgia .......................................... 16,406,937 16,524,532 16,515,255 108,318 

Hawaii ........................................... 3,271,659 3,259,372 3,258,892 (12,767)

Idaho.............................................. 3,271,659 3,259,372 3,258,892 (12,767)

Illinois............................................ 25,744,599 25,565,249 25,073,917 (670,682)

Indiana........................................... 12,914,175 12,877,854 12,999,434 85,259 

Iowa............................................... 7,400,901 7,320,373 7,082,927 (317,974)

Kansas........................................... 6,039,225 5,981,237 5,776,519 (262,706)

Kentucky........................................ 9,065,450 8,967,320 9,125,300 59,850 

Louisiana ....................................... 8,670,820 8,695,828 8,728,065 57,245 

Maine............................................. 3,271,659 3,259,372 3,258,892 (12,767)

Maryland........................................ 11,036,114 11,052,598 11,108,975 72,861 

Massachusetts ................................ 14,473,871 14,434,155 13,910,211 (563,660)

Michigan........................................ 20,856,415 20,931,407 20,994,108 137,693 

Minnesota ...................................... 10,328,299 10,394,915 10,396,487 68,188 

Mississippi..................................... 5,908,045 5,845,456 5,947,050 39,005 

Missouri......................................... 12,780,216 12,709,983 12,793,782 13,566 

Montana......................................... 3,271,659 3,259,372 3,258,892 (12,767)

Nebraska........................................ 4,004,674 3,964,201 3,815,132 (189,542)

Nevada........................................... 4,946,316 4,951,849 4,978,972 32,656 

New Hampshire.............................. 3,271,659 3,259,372 3,258,892 (12,767)
NUTRITION SERVICES

60

PROGRAM: Nutrition Services (CFDA 93.045)

State/Territory

FY 2010

Actual

FY 2011

Estimate

FY 2012

Estimate

Difference

+/-FY 2010

New Jersey.................................... 18,373,342 18,251,357 18,338,539 (34,803)

New Mexico.................................. 4,047,045 4,020,397 4,073,764 26,719 

New York ..................................... 42,950,628 42,576,118 41,455,778 (1,494,850)

North Carolina .............................. 18,582,671 18,842,206 18,705,354 122,683 

North Dakota................................. 3,271,659 3,259,372 3,258,892 (12,767)

Ohio.............................................. 24,778,549 24,776,855 24,872,402 93,853 

Oklahoma ..................................... 7,755,577 7,649,076 7,806,779 51,202 

Oregon.......................................... 8,194,185 8,224,587 8,248,283 54,098 

Pennsylvania ................................. 31,300,504 31,114,709 30,057,088 (1,243,416)

Rhode Island ................................. 3,271,659 3,259,372 3,258,892 (12,767)

South Carolina .............................. 9,721,377 9,848,429 9,785,557 64,180 

South Dakota................................. 3,271,659 3,259,372 3,258,892 (12,767)

Tennessee...................................... 13,232,431 13,236,320 13,319,791 87,360 

Texas............................................ 40,241,648 40,329,292 40,507,322 265,674 

Utah.............................................. 3,930,604 3,919,969 3,956,553 25,949 

Vermont........................................ 3,271,659 3,259,372 3,258,892 (12,767)

Virginia......................................... 15,305,053 15,274,576 15,406,097 101,044 

Washington................................... 12,903,209 12,979,390 12,988,395 85,186 

West Virginia................................ 4,834,990 4,797,844 4,625,605 (209,385)

Wisconsin ..................................... 11,812,039 11,752,988 11,890,021 77,982 

Wyoming ...................................... 3,271,659 3,259,372 3,258,892 12,767

Subtotal, States.............................. 641,275,776 638,804,370 638,685,192 (2,590,584) 

American Samoa ........................... 736,859 731,341 731,341 (5,518)

Guam............................................ 1,635,829 1,629,686 1,629,446 (6,383)

Northern Mariana Islands.............. 408,958 407,421 407,361 (1,597)

Puerto Rico ................................... 8,638,563 8,671,906 8,695,594 57,031 

Virgin Islands................................ 1,635,829 1,629,686 1,629,446 (6,383)

Subtotal, States and Territories ...... 654,331,814 651,874,410 651,778,380 (2,553,434)

Undistributed 21/........................... 4,029,783 6,584,590 6,583,620 2,553,837 

 

TOTAL 2/ 658,361,597 658,459,000 658,362,000 403 

 

21/ Funds held for statutory related requirements are reflected in the undistributed line.

2/ FY 2010 level reflects the Secretary’s transfer to assist those living with HIV/AIDS on medication waiting lists
NUTRITION SERVICES

61

DEPARTMENT OF HEALTH AND HUMAN SERVICES

ADMINISTRATION ON AGING

FY 2012 DISCRETIONARY STATE FORMULA GRANTS

PROGRAM: Nutrition Services Incentive Program (CFDA 93.053)

State/Territory

FY 2010

Actual

FY 2011

Estimate

FY 2012

Estimate

Difference

+/-FY 2010

Alabama ........................................ 2,724,877 2,714,445 2,714,033 (10,844)

Alaska ........................................... 320,721 319,493 319,445 (1,276)

Arizona.......................................... 2,266,704 2,258,026 2,257,683 (9,021)

Arkansas........................................ 2,638,692 2,628,590 2,628,191 (10,501)

California ...................................... 12,346,182 12,298,915 12,297,046 (49,136)

Colorado........................................ 1,379,870 1,374,587 1,374,378 (5,492)

Connecticut ................................... 1,456,389 1,450,813 1,450,592 (5,797)

Delaware ....................................... 637,915 635,472 635,376 (2,539)

District of Columbia ...................... 639,886 637,436 637,339 (2,547)

Florida........................................... 6,978,546 6,951,829 6,950,772 (27,774)

Georgia.......................................... 2,725,424 2,714,989 2,714,577 (10,847)

Hawaii........................................... 487,594 485,727 485,654 (1,940)

Idaho............................................. 651,030 648,538 648,439 (2,591)

Illinois........................................... 7,030,610 7,003,693 7,002,628 (27,982)

Indiana .......................................... 1,856,248 1,849,141 1,848,860 (7,388)

Iowa .............................................. 1,896,738 1,889,478 1,889,190 (7,548)

Kansas........................................... 2,264,572 2,255,901 2,255,559 (9,013)

Kentucky....................................... 1,809,827 1,802,898 1,802,624 (7,203)

Louisiana....................................... 3,213,739 3,201,436 3,200,949 (12,790)

Maine............................................ 524,039 522,033 521,953 (2,086)

Maryland....................................... 1,843,421 1,836,363 1,836,084 (7,337)

Massachusetts................................ 5,953,303 5,930,511 5,929,610 (23,693)

Michigan ....................................... 7,439,014 7,410,533 7,409,407 (29,607)

Minnesota...................................... 1,984,038 1,976,442 1,976,142 (7,896)

Mississippi .................................... 2,113,771 2,105,679 2,105,359 (8,412)

Missouri ........................................ 4,199,819 4,183,740 4,183,104 (16,715)

Montana ........................................ 1,147,844 1,143,450 1,143,276 (4,568)

Nebraska ....................................... 1,351,963 1,346,787 1,346,582 (5,381)

Nevada .......................................... 977,863 974,119 973,971 (3,892)

New Hampshire............................. 1,114,365 1,110,099 1,109,930 (4,435)
NUTRITION SERVICES

62

PROGRAM: Nutrition Services Incentive Program (CFDA 93.053)

State/Territory

FY 2010

Actual

FY 2011

Estimate

FY 2012

Estimate

Difference

+/-FY 2010

New Jersey .................................... 3,946,325 3,931,216 3,930,619 (15,706)

New Mexico .................................. 2,054,916 2,047,049 2,046,738 (8,178)

New York...................................... 16,923,613 16,858,820 16,856,258 (67,355)

North Carolina............................... 3,322,232 3,309,513 3,309,010 (13,222)

North Dakota ................................. 809,231 806,133 806,010 (3,221)

Ohio .............................................. 5,716,593 5,694,707 5,693,842 (22,751)

Oklahoma...................................... 2,556,199 2,546,412 2,546,025 (10,174)

Oregon .......................................... 1,765,224 1,758,466 1,758,199 (7,025)

Pennsylvania.................................. 5,980,007 5,957,113 5,956,207 (23,800)

Rhode Island.................................. 501,008 499,090 499,014 (1,994)

South Carolina............................... 1,612,591 1,606,417 1,606,173 (6,418)

South Dakota ................................. 986,347 982,570 982,421 (3,926)

Tennessee...................................... 1,695,578 1,689,086 1,688,830 (6,748)

Texas............................................. 12,180,903 12,134,269 12,132,425 (48,478)

Utah .............................................. 1,426,187 1,420,726 1,420,510 (5,677)

Vermont ........................................ 730,946 728,147 728,037 (2,909)

Virginia ......................................... 2,299,971 2,291,165 2,290,817 (9,154)

Washington ................................... 1,913,507 1,906,181 1,905,892 (7,615)

West Virginia ................................ 1,724,020 1,717,420 1,717,159 (6,861)

Wisconsin...................................... 2,709,222 2,698,849 2,698,439 (10,783)

Wyoming....................................... 760,086 757,176 757,061 (3,025)

Subtotal, States.............................. 153,589,710 153,001,688 152,978,439 (611,271)

American Samoa............................ -- -- -- --

Guam ............................................ 358,586 357,214 357,159 (1,427)

Northern Mariana Islands............... 61,433 61,197 61,188 (245)

Puerto Rico.................................... 2,775,055 2,764,432 2,764,011 (11,044)

Virgin Islands................................ 173,105 172,442 172,416 (689)

Subtotal, States and Territories....... 156,957,889 156,356,973 156,333,213 (624,676)

Tribal Organizations...................... 3,047,877 3,047,877 3,047,877 --

Undistributed 22/........................... 985,416 1,610,150 1,609,910 624,494

TOTAL 160,991,182 161,015,000 160,991,000 (182)

 

22/ Funds held for statutory related requirements are reflected in the undistributed line.
Preventive Health Services

FY 2010

Enacted

FY 2011

CR

FY 2012 

Request

FY 2012 +/-

FY 2010

Preventive Health Services... $21,026,000 $21,026,000 $21,026,000 --

Authorizing Legislation: Section 361 of the Older Americans Act of 1965, as amended

FY 2012 Older Americans Act Authorization................................................................... Expired

Allocation Method .................................................................................................Formula Grant

Program Description and Accomplishments:

Preventive Health Services, established in 1987, provides formula grants to States and 

Territories, based on their share of the population aged 60 and over, to support activities that 

educate older adults about the importance of healthy lifestyles and promote healthy behaviors 

that can help to prevent or delay chronic disease and disability, thereby reducing the need for 

more costly medical interventions. 

Due in large part to advances in public health and medical care, Americans are leading longer 

and more active lives. Average life expectancy has increased from less than 50 years at the turn 

of the 20th century to almost 78 years today. On average an American turning age 65 today can 

expect to live an additional 18.6 years. The population of older Americans is also growing, 

particularly the population age 85 and over, which is growing very rapidly and is projected to 

total 5.8 million by 2010 and 8.7 million by the year 2030. One consequence of this increased 

longevity is the higher incidence of chronic diseases such as obesity, arthritis, diabetes, 

osteoporosis, or depression as well as the greater probability of injury from a fall, which quickly 

limits physical activity. 

In recent years, States and Territories have been statutorily required to use at least a portion of 

this funding for medication management, screening, and education activities, but otherwise have 

had flexibility to allocate resources among the preventive health activities of their choice to best 

meet local needs. Priority has been given to providing services to those elders living in 

medically underserved areas of the state or who have the greatest economic need. Services 

currently provided through the Preventive Health Service program include:

Information and Outreach, including the distribution of information to seniors through 

Aging and Disability Resource Centers, Area Agencies on Aging, senior centers, 

community parks and recreation programs, housing programs, faith based organizations, 

Chronic Disease Self-Management Programs, congregate meal sites, and the homedelivered meals program about healthy lifestyles and behaviors.
PREVENTITIVE HEALTH SERVICES

64

Health Screenings and Risk Assessments for a variety of conditions, including 

hypertension, diabetes, dental issues, high cholesterol, hearing and vision loss, and 

glaucoma.

Evidence-based Prevention Programs, as described below.

Over the last few years, some States have begun to shift their funding to provide greater support 

to evidence-based approaches, especially in helping individuals manage chronic diseases. 

Evidence-based programs are interventions that have been tested through randomized control 

trials and have been shown to be effective at helping participants adopt healthy behaviors, 

improve their health status, and reduce their use of hospital services and emergency room visits. 

Examples of evidence-based models include Enhanced Fitness, Enhanced Wellness, falls 

prevention, and chronic disease self-management programs, all of which have been demonstrated 

to be especially effective and have shown the value of focusing dollars on proven interventions. 

AoA has encouraged States and the aging services network to adopt evidence-based prevention 

programs and more and more States are using these and other resources to do so. Some 

examples of evidence-based interventions are:

Enhanced fitness and enhanced wellness programs: Enhanced fitness is a multicomponent group exercise program designed for community-based organizations and 

intended to promote physical activity among older adults. Strength training using soft 

wrist and ankle weights; cardiovascular workout using dancing, aerobics, or walking; and 

balance and posture exercises are used to increase the physical health of older adults. In 

addition exercise has been proven to improve depression, which studies have shown that 

nearly 20 percent of U.S. adults 65 years and older experience. Exercise may also act as 

a buffer against many illnesses impacted by stress. 

Falls prevention: Falls prevention programs teach participants to improve strength, 

balance, and mobility; provide education on how to avoid falls and reduce fall risk 

factors; involve medication reviews and modifications; provide referrals for medical care 

management for selected fall risk factors; and provide home hazard assessments of ways 

to reduce environmental hazards. Recent studies have shown that in the United States 

more than one-third of adults age 65 and over fall each year. Of those who fall, 20 to 

30 percent will experience serious injuries, such as head trauma, broken bones, or hip 

fractures. These injuries may limit the ability of older adults to get around or live 

independently. Those who are not injured may develop a fear of falling, which may increase 

their actual risk of falling. Many people limit their activity after a fall, which may reduce 

strength, physical fitness, and mobility.23

 

23 Even, Jennifer. 2009. Senior Series. The Ohio State University Extension. 20 May 2009.
PREVENTITIVE HEALTH SERVICES

65

Medication management: Medication management programs focus on reviewing the 

multitude of medications that older adults are prescribed, focusing especially on high-risk 

medications. Medication management programs have been shown to reduce unnecessary 

duplication of prescriptions and cardiovascular problems. These programs have also been 

shown to improve medication usage rates and decrease medication errors among older 

adults.

Chronic disease self-management programs: Older Americans are disproportionately 

affected by a vast array of chronic conditions, including diabetes, obesity, heart disease, 

cancer, arthritis, and depression, that collectively account for seven out of every 

10 deaths and contribute to more than three-quarters of all Medicare expenditures.24 Data 

show that as an individual’s number of chronic conditions increases, there is a 

corresponding escalation in adverse outcomes including mortality, poor functional status, 

unnecessary hospitalizations, adverse drug events, duplicative tests, and conflicting 

medical advice, all of which lead to higher health costs and greater outlays for programs 

like Medicare and Medicaid. Chronic disease self-management programs teach evidencebased disease prevention models that utilize state-of-the-art techniques to help people 

better self-manage their conditions and reduce their need for more costly medical care. 

Programs often consist of a series of workshops in community settings comfortable to 

seniors such as churches, libraries, YW/MCAs, senior centers, public housing programs, 

community health centers, and cooperative extension programs. Workshops are 

facilitated by leaders who are trained and certified and help those with chronic diseases 

learn that they can change their health behaviors through action plans and goal setting.

Preventive Health Services have been carried out at multi-purpose senior centers, meal sites, and 

other community-based settings, as well as through individualized counseling and services for 

vulnerable elders. States reported 5.9 million seniors served in these health-related programs 

which received $16 million in additional funding from States and local entities. 

Funding History:

Funding for Preventive Health Services during the past five years is as follows:

FY 2007............................................... $21,400,000

FY 2008............................................... $21,026,000

FY 2009............................................... $21,026,000

FY 2010............................................... $21,026,000

FY 2011 CR......................................... $21,026,000

 

24 Deaths: Leading Causes for 2004. National Vital Statistics Report, V. 56, No. 5. Centers for Disease Control and 

Prevention. Available at http://www.cdc.gov/nchs/data/nvsr/nvsr56/nvsr56_05.pdf . Accessed December 30, 2009.

Follow the Money -- Controlling Expenditures by Improving Care for Patients Needing Costly Services. 

Bodenheimer, T., and Berry-Millett, R. New England Journal of Medicine. 15 October 2009.
PREVENTITIVE HEALTH SERVICES

66

Budget Request:

The FY 2012 budget request for Preventive Health Services is $21,026,000, the same as the 

FY 2010 enacted level. In appropriations language, AoA proposes a key change for the 

Preventive Health Services program -- the inclusion of language that would require States to use 

their Preventive Health Services funds to support proven evidence-based models that enhance the 

wellness and fitness of the aging community. Recognizing that the development of evidencebased programs is ongoing, AoA will provide guidance regarding what meets the evidence-based 

requirement. 

States are increasingly supporting evidence-based prevention programs, as discussed previously. 

In addition, this key change helps States build on the $27 million in competitive awards 

announced in FY 2010 using Recovery Act Prevention and Wellness funds to support evidencebased chronic disease self-management programs. The grant period for these funds concludes in 

mid-FY 2012. States would continue to have the flexibility to use funding provided under the 

Home and Community-Based Services Program to fund other health services, such as health 

screenings, that do not meet these evidence-based requirements.

States’ ability to support evidence-based programs is further increased by this budget’s request to 

eliminate the appropriations requirement to use a minimally-mandated level of funding for 

medication management, screening, and education activities. Evidence-based medication 

management activities however, would continue to be permissible under this proposal, provided 

the programs meet the evidence-based criteria proposed by AoA.

Performance Measurement

Since AoA is promoting evidence-based systems, the performance measure developed to address 

this area -- the number of States, the District of Columbia, and territories using Title III funds to 

implement evidence-based disease prevention programs -- is especially appropriate. 

Output Table:

Preventive Health Services Output

Indicator Most Recent 

Result 

FY 2010

Projection 

FY 2012

Projection 

FY 2012 

+/- FY 2010 

Output AB: The number of people served with 

health and disease prevention programs 

(Output)

N/A Baseline TBD TBD
PREVENTITIVE HEALTH SERVICES

67

Grant Awards Tables:

Preventive Health Services Grant Awards

FY 2010 

Enacted FY 2011 CR FY 2012 Request

Number of 

Awards 56 56 56

Average 

Award $375,464 $375,464 $375,464

Range of 

Awards

$13,141 -

$2,132,032

$13,141 -

$2,132,032

$13,141 -

$2,132,032
PREVENTITIVE HEALTH SERVICES

68

DEPARTMENT OF HEALTH AND HUMAN SERVICES

ADMINISTRATION ON AGING

FY 2012 DISCRETIONARY STATE FORMULA GRANTS

PROGRAM: Preventive Health Services (CFDA 93.043)

State/Territory

FY 2010

Actual

FY 2011

Estimate

FY 2012

Estimate

Difference

+/-FY 2010

Alabama ........................................ 333,168 333,168 333,168 --

Alaska ........................................... 105,130 105,130 105,130 --

Arizona.......................................... 405,273 405,273 405,273 --

Arkansas........................................ 211,585 211,585 211,585 --

California ...................................... 2,132,032 2,132,032 2,132,032 --

Colorado........................................ 256,172 256,172 256,172 --

Connecticut ................................... 261,174 261,174 261,174 --

Delaware ....................................... 105,130 105,130 105,130 --

District of Columbia ...................... 105,130 105,130 105,130 --

Florida........................................... 1,557,571 1,557,571 1,557,571 --

Georgia.......................................... 487,659 487,659 487,659 --

Hawaii........................................... 105,130 105,130 105,130 --

Idaho............................................. 105,130 105,130 105,130 --

Illinois........................................... 841,161 841,161 841,161 --

Indiana .......................................... 427,123 427,123 427,123 --

Iowa .............................................. 232,252 232,252 232,252 --

Kansas........................................... 191,697 191,697 191,697 --

Kentucky....................................... 292,333 292,333 292,333 --

Louisiana....................................... 295,701 295,701 295,701 --

Maine............................................ 105,333 105,333 105,333 --

Maryland....................................... 361,152 361,152 361,152 --

Massachusetts................................ 465,465 465,465 465,465 --

Michigan ....................................... 693,994 693,994 693,994 --

Minnesota...................................... 339,094 339,094 339,094 --

Mississippi .................................... 196,251 196,251 196,251 --

Missouri ........................................ 423,251 423,251 423,251 --

Montana ........................................ 105,130 105,130 105,130 --

Nebraska ....................................... 124,900 124,900 124,900 --

Nevada .......................................... 151,762 151,762 151,762 --

New Hampshire............................. 105,130 105,130 105,130 --
PREVENTITIVE HEALTH SERVICES

69

PROGRAM: Preventive Health Services (CFDA 93.043)

State/Territory

FY 2010

Actual

FY 2011

Estimate

FY 2012

Estimate

Difference

+/-FY 2010

New Jersey .................................... 620,946 620,946 620,946 --

New Mexico .................................. 127,394 127,394 127,394 --

New York...................................... 1,376,603 1,376,603 1,376,603 --

North Carolina............................... 577,661 577,661 577,661 --

North Dakota ................................. 105,130 105,130 105,130 --

Ohio .............................................. 835,879 835,879 835,879 --

Oklahoma...................................... 257,429 257,429 257,429 --

Oregon .......................................... 254,913 254,913 254,913 --

Pennsylvania.................................. 1,018,552 1,018,552 1,018,552 --

Rhode Island.................................. 105,130 105,130 105,130 --

South Carolina............................... 295,433 295,433 295,433 --

South Dakota ................................. 105,130 105,130 105,130 --

Tennessee...................................... 416,815 416,815 416,815 --

Texas............................................. 1,253,246 1,253,246 1,253,246 --

Utah .............................................. 115,100 115,100 115,100 --

Vermont ........................................ 105,130 105,130 105,130 --

Virginia ......................................... 484,930 484,930 484,930 --

Washington ................................... 397,692 397,692 397,692 --

West Virginia ................................ 153,137 153,137 153,137 --

Wisconsin...................................... 391,448 391,448 391,448 --

Wyoming....................................... 105,130 105,130 105,130 --

Subtotal, States.............................. 20,624,841 20,624,841 20,624,841 --

American Samoa............................ 13,141 13,141 13,141 --

Guam ............................................ 52,565 52,565 52,565 --

Northern Mariana Islands............... 13,141 13,141 13,141 --

Puerto Rico.................................... 269,747 269,747 269,747 --

Virgin Islands................................ 52,565 52,565 52,565 --

Subtotal, States and Territories....... 21,026,000 21,026,000 21,026,000 --

TOTAL 21,026,000 21,026,000 21,026,000 --
PREVENTITIVE HEALTH SERVICES

70

PAGE INTENTIONALLY LEFT BLANK
Chronic Disease Self-Management Programs

FY 2010

Enacted FY 2011 CR

FY 2012 

Request

FY 2012 +/-

FY 2010

Chronic Disease SelfManagement Programs................................ -- .......... -- $10,000,000 +$10,000,000

Authorizing Legislation: Section 411 of the Older Americans Act of 1965, as amended

FY 2011 Authorization..................................................................................................... Expired

Allocation Method .......................... Competitive Grants/Co-operative Agreements and Contracts

Program Description and Accomplishments

Funded by AoA as part of its evidence-based prevention since 2003, the Chronic Disease SelfManagement Program (CDSMP) is a low-cost evidence-based disease prevention model that

utilizes state-of-the-art techniques to help those with chronic disease to manage their conditions, 

improve their health status, and reduce their need for more costly medical care. Older Americans 

are disproportionately affected by a vast array of chronic conditions (including diabetes, obesity, 

cancer, arthritis, and depression) that collectively account for seven out of every 10 deaths and 

more than three-quarters of all health expenditures.25 Data show that as an individual’s number 

of chronic conditions increases, there is a corresponding escalation in adverse outcomes 

including mortality, poor functional status, unnecessary hospitalizations, adverse drug events, 

duplicative tests, and conflicting medical advice, all of which lead to higher health costs and 

greater outlays for programs like Medicare and Medicaid. CDSMP is helping to reduce these 

adverse outcomes by empowering individuals, particularly those who have two or more chronic 

health conditions, to address issues related to the management and treatment of chronic disease. 

CDSMP has been shown repeatedly through multiple studies (including randomized control 

experiments, with both English and Spanish speaking populations) to be effective at helping 

participants to adopt healthy behaviors, improve their health status and reduce their use of 

hospital stays and emergency room visits. The program been shown to significantly improve 

participant health status, reduce the use of hospital care and physician services26 as well as 

reduce health care costs. 

CDSMP was developed by Stanford University and emphasizes a patient’s role in managing 

his/her illness. The program consists of a series of workshops that are conducted once a week 

for two and a half hours over six weeks in community settings such as churches, libraries, 

 

25 National Center for Chronic Disease Prevention and Promotion (NCCDPHP). Physical Activity and Good 

Nutrition: Essential Elements to Prevent Chronic Diseases and Obesity. Available at 

http://www.cdc.gov/nccdphp/aag/aag_dnpa.htm. Accessed September 14, 2004.

26 Sobel, DS, Lorig,KR, Hobbs,M. Chronic Disease Self-Management Program: From Development to 

Dissemination. Permanente Journal; Spring 2002.
CHRONIC DISEASE SELF-MANAGEMENT PROGRAMS

72

YW/MCAs, senior centers, public housing projects, community health centers and cooperative 

extension programs. People with different chronic health problems attend together, and the 

workshops are facilitated by two leaders who are trained and certified by Stanford University, 

one or both of whom are non-health professionals or lay people with chronic diseases 

themselves. Topics covered include: 1) techniques to deal with problems such as frustration, 

fatigue, pain and isolation; 2) appropriate exercise for maintaining and improving strength, 

flexibility, and endurance; 3) appropriate use of medications; 4) communicating effectively with 

health professionals; and 5) nutrition. 

Since 2003, AoA has supported the deployment of CDSMP through its Aging Network, in 

partnership with AHRQ, CDC, CMS, HRSA and over 30 private foundations. In the 2006 

reauthorization of the OAA, the Congress directed AoA to promote the nationwide 

implementation of evidence-based prevention programs through its network of community-based 

service provider organizations; and beginning in FY 2008, the Congress appropriated funding 

specifically to support this initiative. AoA and its partners have invested over $50 million since 

2003 in developing an infrastructure for delivering evidence-based programs at the community 

level. This infrastructure now includes 1,200 community-based delivery sites, a national 

technical assistance center on evidence-based prevention programs for the elderly, a national 

CDSMP training and certification center at Stanford, local program training materials and 

guides, marketing materials, quality assurance mechanisms and fidelity protocols, and a variety 

of technologies, including an AHRQ sponsored Knowledge Transfer Program to support rapid 

diffusion. Over 12,000 individuals have participated in the CDSMP programs offered through 

this infrastructure. 

Funding for CDSMP is awarded in the form of competitive grants to states. Grantees are required 

to provide a match equal to 25 percent of the project’s total cost. External experts review project 

proposals, and project awards are made for periods of one to three years. In FY 2010 AoA 

funded 47 State grants for CDSMPs, with an average award of $574,468, using funding provided 

under the Recovery Act. AoA also funded a Technical Assistance Resource Center through a 

grant to the National Council on Aging. Competitive grants and contracts are also used to 

support evaluation and technical assistance activities.

Funding History

Stand-alone funding for the nationwide deployment of CDSMP through the aging services 

network is requested for the first time in FY 2012.27 In FY 2010, $30 million in Recovery Act 

funding was transferred from the Centers for Disease Control and Prevention through an intradepartmental delegation of authority as part of the Recovery Act’s $650 million ―Prevention and 

Wellness Fund.‖ An additional $2.5 million was also transferred from CDC to CMS for related 

evaluation and quality improvement purposes.

 

27 Evidence-Based Programs including the Chronic Disease Self Management Program, together with Long-Term 

Care Programs (ADRCs and Community Living Programs) were previously and collectively known as the Choices 

for Independence Initiative. Funding for Choices for Independence, which did not break out funding for its 

individual components, was appropriated in FY 2008 and FY 2009.
CHRONIC DISEASE SELF-MANAGEMENT PROGRAMS

73

Budget Request

The FY 2012 request for CDSMP is $10,000,000. This investment will allow AoA, in 

coordination with its existing HHS partners and private philanthropy, to build on AoA’s existing 

service delivery infrastructure and continue to take CDSMP to scale nationwide.

Older Americans are disproportionately affected by a vast array of chronic diseases and 

conditions. Over 80 percent of adults 65 and over have at least one chronic condition, and 

roughly half suffer from two.28 Nearly half of older adults have hypertension and roughly one in 

five has heart disease, with a similar proportion having some type of cancer.29 The average 

75-year old has three chronic conditions and takes 4.5 medications.30 More than 65 percent of 

Americans aged 65 and over have some form of cardiovascular disease. One million adults age 

75+ have diabetes, a number that is expected to grow to 4 million by 2050 if nothing is done to 

change current growth rates.31 Minority elders – the fastest growing segment of the elderly 

population – are especially at risk of chronic illnesses and conditions. For example, among 

adults age 65+, 65 percent of Blacks had hypertension, compared to 47% of Whites; and 25% of 

Hispanics have diabetes, compared to 14% of Whites.

The Stanford University CDSMP represents the state-of-the-art in chronic disease selfmanagement and is ideally suited for delivery through AoA’s network of community based 

organizations, including senior centers, congregate meal programs, faith-based organizations and 

senior housing projects. Nationwide implementation will be accomplished at the community 

level by aging services provider organizations working in collaboration with public health 

agencies and health care providers. Participant referrals to the CDSMP program will come from 

both clinical and community-based organizations. Clinical referrals will come from communityhealth centers, physicians, hospitals, managed care organizations, and other health system 

components. Community referrals will come from a variety of sources, including the Aging and 

Disability Resources Centers that are currently funded by HHS (AoA and CMS). ADRCs serve 

as community-level ―one stop shop‖ entry points into long-term care for people of all ages who 

have chronic conditions. 

In FY 2012, AoA will invest $10 million to support the nationwide implementation and 

expansion of the CDSMP. Funds will help States and Territories to move towards State-wide 

coverage and enable 17,000 individuals to complete this program in the first year. Funds will 

support:

Competitive grants to States;

An interagency agreement with CMS to evaluate the impact of CDSMP on 

participant health care utilization and cost by linking Medicare claims data to 

 

28

 NCCDPHP. Healthy Aging: Preventing Disease and Improving Quality of Life Among Older Americans. 

Available at http://www.cdc.gov/nccdphp/aag/aag_aging.htm. Accessed September 14, 2004.

29

 Centers for Disease Control and Prevention (CDC), National Center for Health Statistics, National Health 

Interview Survey, 2000-2001.

30

 Alliance for Aging Research. Ten Reasons Why America Is Not Ready for the Coming Aging Boom. 2002.

31

 NCCDPHP. Available at http://www.cdc.gov/nccdphp/bb_aging/index.htm. Accessed September 14, 2004.
CHRONIC DISEASE SELF-MANAGEMENT PROGRAMS

74

CDSMP Medicare participants (both elderly and younger people with 

disabilities);

A survey of participants (pre- and post) to evaluate the impact of CDSMP on 

behaviors, health status, and quality of life; and

Continued funding for a National Technical Assistance Center on Evidence-Based 

Prevention Programs.

Accountability and quality assurance will include tracking a combination of inputs and outputs. 

AoA will track via State reports the number of programs being conducted and the number of 

participants completing the program. Participant surveys (pre and post) will be used to track 

self-reported behavioral change and health status. AoA and CMS will establish protocols and 

mechanisms to track CDSMP participants’ Medicare claims data to assess the impact of CDSMP 

on health care utilization. 

AoA will continue to monitor the performance of the CDSMP with the output measure that was 

provided in both the FY 2009 and FY 2010 budget submissions. 

Outputs and Outcomes Table

Evaluation

AoA is partnering with the Agency for Healthcare Research and Quality and the Assistant 

Secretary for Planning and Evaluation to rigorously evaluate the effectiveness of CDSMPs. In 

FY 2010, AoA initiated a design contract for recommendations on how to best carry-out an 

evaluation. The evaluation design recommendations will be completed by spring 2011. AoA 

will seek to begin implementation of an evaluation in late FY 2011 or in FY 2012 based on the 

availability of funds. The results of an evaluation would influence future performance measures 

and indicators of the program.

 

32 The 2012 target takes into account the FY 2010 ARRA grant expenditures, which grants are active until March 

31, 2012, as well as the FY 2012 request.

Measure/Outputs Most Recent 

Result 

FY 2010 

Target 

FY 2012 

Target

Total number of individuals with 

chronic conditions completing the 

CDSMP program (Output)

FY 2009: 

8,426 18,000 20,00032

Percentage of individuals that report 1 

or more health benefits (e.g. improved 

health status, increased physical 

activity, less fatigue, greater mobility, 

etc.) after completing the CDSMP 

program (Outcome) 

N/A N/A Baseline
Community Service Employment for Older Americans

FY 2010

Enacted FY 2011 CR

FY 2012 

Request

FY 2012 +/-

FY 2010

Community Service 

Employment for Older 

Americans33..........................................................

$825,425,000 $825,425,000 $450,000,000 -$375,425,000

FTE ................................................................ -- ...... -- 8 +8

Authorizing Legislation: Section 502 of the Older Americans Act of 1965, as amended

FY 2012 Older Americans Act Authorization................................................................... Expired

Allocation Method ....................................................................... Formula & Competitive Grants

Program Description and Accomplishments

The Community Service Employment for Older Americans (CSEOA) program is authorized by 

Title V of the Older Americans Act. Commonly known as the Senior Community Service 

Employment Program (SCSEP), Title V was the only part of the Older Americans Act that was 

implemented by the Department of Labor instead of the Department of Health and Human 

Services. The budget proposes to transfer the responsibility for Title V to the Administration on 

Aging.

SCSEP was established to increase workers’ incomes and narrow the wage and income 

inequality faced by senior workers. Participants must be unemployed persons 55 years or older 

with incomes no more than 125 percent of the Federal poverty level, which was $13,612 in 

FY 2011. The program offers part-time, community-service employment opportunities at 

501(c)(3) non-profits or government agencies (also referred to as host agencies) to prepare 

participants to enter or re-enter the workforce. Participants are paid the highest of the Federal, 

state, or local minimum wage. 

In addition to wages and benefits, SCSEP provides the following programmatic services to 

participants: 

Orientation and assessments; 

Supportive services; 

Participant training (e.g., on the job or in a classroom setting); and 

Placement assistance into unsubsidized employment. 

 

33 FY 2010 and 2011 include a special appropriation of $225,000,000 to serve low-income seniors affected by the 

recession. 
COMMUNITY SERVICE EMPLOYEMENT FOR OLDER AMERICANS

76

While enrolled in the program, all participants must be covered by workers’ compensation and 

offered an annual physical examination. Each participant’s skills and interests are assessed at 

least twice a year, leading to the development of an Individual Employment Plan (IEP). SCSEP’s 

focus on assuring that workers are equipped with the skills and knowledge necessary to succeed 

will remain in place while HHS shifts the program toward a community service orientation, 

producing better outcomes for seniors.

SCSEP is funded by a formula set forth in Title V of the Older Americans Act. The formula 

allocates funds to every state, the District of Columbia (DC) and Puerto Rico (PR) based on U.S. 

Census data on the number of individuals in that jurisdiction who are 55 and older with low percapita income. Prior to the 2006 reauthorization, funds were allocated to and administered 

through one-year grants to the governor of the state and national non-profit agencies. 

Approximately 22 percent of formula funds are awarded to the governors, with 78 percent 

awarded to national non-profit agencies for services across the country. In 2006, DoL conducted 

a competition for the national grantees. As a result, 18 organizations received CSEOA funds, 

including three organizations under the Indian and Pacific Islands /Asian Americans set-aside. 

Under the OAA 2006 amendments, these grants are to be renewed annually for four years, with 

an optional one year extension. In Program Year (PY) 200834, the 74 national, state, and 

territorial CSEOA grantees enrolled over 89,000 individuals. CSEOA participants provided 

48,611,568 hours of service to their local communities. 

The next competition for national grantees will be conducted in 2011. AoA will collaborate with 

DOL on this competition in order to ensure a smooth transition of the program. Through this 

collaboration AoA will be able to input its suggestions as to priorities, targeting, and with the 

input of OMB and Congress develop appropriate performance measures.

In general, 75 percent of Federal funds must be spent on wages and benefits to participants with 

the remaining funds for other participant costs. There is a cap on administrative expenses of 

13.5 percent. The Federal funds provided each of the 74 grantees can be no more than 90% of the 

total project amount, with the non-federal matching requirement in either cash or in-kind. In 

addition to direct services to eligible individuals, the 2006 amendments also permit up to 

1.5 percent of the program’s appropriation be used for pilot, demonstration and evaluation 

projects. 

Funding History

Funding for Community Service for Older Americans during the past five years is as follows:

FY 2007..................................$483,611,000

FY 2008..................................$521,625,000

FY 2009..................................$571,925,000

FY 201035...............................$825,425,000

FY 201135 CR .........................$825,425,000

 

34 Funding for SCSEP is appropriated from July 1 – June 30, rather than on the typical fiscal year schedule.

35 Includes a one-time special appropriation of $225,000,000 to serve low-income seniors affected by the recession. 
COMMUNITY SERVICE EMPLOYEMENT FOR OLDER AMERICANS

77

Budget Request

The FY 2012 request for SCSEP is $450,000,000, a reduction of -$375,425,000 from the 

FY 2010 level. Of this reduction, -$225,000,000 reflects the non-continuing, one-time special 

appropriation in FY 2010 in response to the economic downturn. The balance of the reduction 

reflects both the tight budgetary environment that currently exists, and the expectation that by 

tying SCSEP services more closely to the supports available through other AoA programs, 

greater efficiencies can be achieved that will offset, in part, these reductions. Funds will be used 

to provide formula grants to States and competitive grants to national contractors, as well as to 

provide necessary administrative support, monitoring, and technical assistance.

The Administration proposes transferring responsibility for Title V of the Older Americans Act 

to the Administration on Aging, which administers all other OAA programs. In an economic 

climate where low-income older workers have fared worse than other segments of the working 

population, SCSEP helps these individuals maintain their economic independence. Transferring 

SCSEP to the Administration on Aging would place the program in an Agency that shares the 

mission of helping older Americans maintain their independence (both economic independence 

and living arrangements) and active participation in communities. This shift reflects the 

recognition that the SCSEP program is most effective when its services are closely integrated 

with the supports provided by AoA’s existing Aging Services programs. AoA’s substantial aging 

services network is an invaluable resource for an effective Title V program, and its mission of 

helping seniors to remain active and in their community makes the program a natural fit. 

Demographic analysis indicates that older workers will account for an increasingly large portion 

of the available workforce in the decades ahead. SCSEP will continue to help employers 

recognize the value of older workers as both needed employees and mentors to younger workers. 

AoA will leverage the experience of the Department of Labor to continue encouraging and 

expanding job opportunities for aging workers, and work with the One-Stop Career Center 

system to place job-ready older workers in unsubsidized employment, helping to break down the 

barriers to fair and diverse workplaces for these senior workers.

AoA will use the requested funds in order to continue the vital work done by SCSEP as well as 

create efficiencies within the context of the aging services network. Millions of hours of 

community service are provided by SCSEP participants each year to non-profit organizations and 

government agencies; more than 45,000,000 hours in each of the last few years. Community 

service is an equally valuable aspect of SCSEP funding that is inextricably linked to the public 

service employment wages and training that seniors receive while in the program. In FY 2012, 

AoA, in cooperation with the aging services network, will continue to explore creative ways to 

highlight the community service aspect of SCSEP that will increase the opportunities for seniors 

to serve their communities and other seniors while they obtain expanded training options.
COMMUNITY SERVICE EMPLOYEMENT FOR OLDER AMERICANS

78

Outcome Table

Measure Most Recent 

Result 

PY 2010 

Projection 

PY 2012

Projection 

FY 2012 

+/- FY 2010 

1.1: Average earnings in the second and third 

quarters after exit (Outcome)

PY 2008: 

$6,795 $6,590 TBD TBD

1.3: Percent of participants employed in the 

first quarter after exit (Outcome)

PY 2008: 

48.1% 46.5% TBD TBD

1.4: Percent of participants employed in the 

first quarter after exit still employed in the 

second and third quarters after exit (Outcome)

PY 2008: 

71.1% 69.9% TBD TBD

These outcomes were developed and the data collected by the Department of Labor. Under the 

proposal to transfer SCSEP, AoA will work with all relevant parties to develop and refine 

performance measures and collect performance data. 
Native American Nutrition and Supportive Services

FY 2010

Enacted

FY 2011

CR

FY 2012 

Request

FY 2012 +/-

FY 2010

Native American Nutrition & 

Supportive Services ................................ $27,70............... 4,000 $27,708,000 $27,704,000 --

Authorizing Legislation: Sections 613 and 623 of the Older Americans Act of 1965, as amended

FY 2012 Older Americans Act Authorization................................................................... Expired

Allocation Method .................................................................................................Formula Grant

Program Description and Accomplishments:

Native American Nutrition and Supportive Services provides grants to eligible Tribal 

organizations to promote the delivery of nutrition and home and community-based supportive 

services to Native American, Alaskan Native, and Native Hawaiian elders. According to the 

2009 American Community Survey, approximately 301,000 persons age 60 and over identified 

themselves as Native Americans or Alaskan Natives, and another 242,000 persons age 60 and 

over identified themselves as part Native Americans or Alaskan Natives. 

Native American Nutrition and Supportive Services grants fund a broad range of services to 

older Native Americans, including adult day care, transportation, congregate and home-delivered 

meals, information and referral, personal care, chore, and other supportive services. Currently, 

AoA’s congregate meal program reaches 32 percent of eligible Native American seniors in 

participating Tribal organizations, home-delivered meals reach 14 percent of such persons, and 

supportive services reach 52 percent of such persons. These programs, which help to reduce the 

need for costly nursing home care and medical interventions, are responsive to the cultural 

diversity of Native American communities and represent an important part of each community’s 

comprehensive services. 

Services provided by this program in FY 2009, the most recent available data, include: 

Transportation Services provided nearly one million rides to meal sites, medical 

appointments, pharmacies, grocery stores, and other critical daily activities (Output L).

Home-Delivered Nutrition Services nearly 2.5 million meals to nearly 20,500 homebound 

Native American elders, as well as critical social contacts that help to reduce the risk of 

depression and isolation experienced by many home-bound elders (Output M).

Congregate Nutrition Services provided 2.1 million meals to more than 45,900 Native 

American elders in community-based settings, as well as an opportunity for elders to 
NATIVE AMERICAN NUTRITION AND SUPPORTIVE SERVICES

80

socialize and participate in a variety of activities, including cultural and wellness 

programs (Output N).

Information, Referral and Outreach Services provided nearly one million hours of 

outreach and information on services and programs to Native American elders and their 

families, thereby empowering them to make informed choices about their service and 

care needs (Output O).

The Native American Nutrition and Supportive Services program also provides training and 

technical assistance to Tribal organizations to support the development of comprehensive and 

coordinated systems of services to meet the needs of Native American elders. Training and 

technical assistance is provided through national meetings, site visits, e-newsletters, telephone 

and written consultation, and through the Native American Resource Centers, funded under 

Aging Network Support Activities.

Eligible Tribal organizations receive nutrition and supportive services formula grants based on 

their share of the American Indian, Alaskan Native, and Native Hawaiian population age 60 and 

over. Tribal organizations must represent at least 50 Native American elders age 60 and over to 

receive funding. There is no requirement for matching funds. In addition, Tribes may decide the 

age at which a member is considered an elder and thus eligible for services. In FY 2010 grants 

were awarded to 246 Tribal organizations (representing 400 Tribes), including two 

organizations serving Native Hawaiian elders, with an average award of $109,499 and a range 

of grant awards from $76,160 to $1,505,000. 

Funding History:

Funding for Native American Nutrition and Supportive Services during the past five years is as 

follows:

FY 2007............................................... $26,134,000

FY 2008............................................... $26,898,000

FY 2009............................................... $27,208,000

FY 2010............................................... $27,704,000

FY 2011 CR......................................... $27,708,000

Budget Request:

The FY 2012 request for Native American Nutrition and Supportive Services is $27,704,000, the 

same as the FY 2010 enacted level. These funds help Tribal organizations provide services, 

including adult day care, transportation assistance, case management, and information and 

referrals; home-delivered meals; in-home services such as personal care, chore, and help with 

eating dressing and bathing; and community services such as physical fitness programs. These 

services - particularly adult day care, personal care, chore services, and home-delivered meals –

also aid caregivers, who might otherwise have to be even more intensively involved with the care 

of their loved ones.
NATIVE AMERICAN NUTRITION AND SUPPORTIVE SERVICES

81

These funds will provide 1 million rides (Output L), 2.4 million meals at home (Output M), and 

2.1 million meals at congregate sites (Output N) to approximately 65,600 Native American 

seniors. These services will allow Native American elders, many of whom have limitations in 

activities of daily living that make it difficult to care for themselves, to remain at home, in the 

community, or on the reservation, which is what they prefer. 

In FY 2011 the targeted number of units of service, such as home-delivered meals and 

transportation trips, provided to Native Americans per thousand dollars of AoA funding is 

projected at 320, a 45 percent increase over the FY 2002 base of 220 (Outcome 1.3). Over the 

past several years Native American services have met or exceeded their efficiency and output 

targets for meals and trips due in part to contributions from tribal organizations which value 

these programs. It should be noted that performance for FY 2012 is expected to decline due to 

the economic downturn impacting Tribal government budgets. For FY 2010 the efficiency 

measure shows performance trends declining because of declining leveraged funds, as State, 

tribal, and private budgets face economic hardships.36 Tribal representatives participating in 

listening sessions have consistently indicated that the types of home and community-based 

supportive services that AoA is able to provide are important for meeting the needs of elderly 

Native Americans. 

Outcome and Outputs Table:

Native American Nutrition & Supportive Services Outcome and Outputs

Measure Most Recent Result FY 2010 

Target 

FY 2012 

Target 

FY 2012 

+/- FY 2010 

1.3: For Title VI Services, increase the 

number of units of service provided to 

Native Americans per thousand dollars of 

AoA funding. (Outcome)

FY 2009: 317

(Target Exceeded) 300 300 Maintain

Indicator Most Recent Result FY 2010 

Projection 

FY 2012 

Projection 

FY 2012 

+/- FY 2010 

Output L: Transportation Services units

(Output) FY 2009: 894,376 798,000 800,000 +2,000

Output M: Home-Delivered Nutrition 

meals (Output) FY 2009: 2.49 M 2.35 M 2.35 M Maintain

Output N: Congregate Nutrition meals

(Output) FY 2009: 2.1 M 1.8 M 1.8 M Maintain

Output O: Information, Referral and 

Outreach units (Output) FY 2009: 987,071 992,000 1.0 M +8,000

Grant Awards Table:

 

36 AoA’s projections are based on the following two assumptions: 1) CPI-U or a CPI-specific index and 2) declining 

State budgets of -8.5 percent each year from FY 2010-2012, consistent with the decline in 2009 state government 

tax collections reported by the U.S. Census in March 2010. 
NATIVE AMERICAN NUTRITION AND SUPPORTIVE SERVICES

82

Native American Nutrition & Supportive Services Grant Awards

FY 2010 

Enacted FY 2011 CR FY 2012 Request

Number of 

Awards 246 246 246

Average 

Award $109,499 $117,424 $117,424

Range of 

Awards

$76,160 -

$1,505,000

$81,301 -

$1,606,588

$81,301 -

$1,606,588
Aging Network Support Activities

FY 2010

Enacted

FY 2011

CR

FY 2012 

Request

FY 2012 +/-

FY 2010

Aging Network Support 

Activities............................................................... $8,198,000 $8,200,000 $7,948,000 -$250,000

Authorizing Legislation: Section 201, 202, 215, and 411 of the Older Americans Act of 1965, as 

amended

FY 2012 Older Americans Act Authorization................................................................... Expired

Allocation Method .......................... Competitive Grants/Co-operative Agreements and Contracts

Program Description and Accomplishments:

Aging Network Support Activities provides competitive grants and contracts to support eleven 

ongoing activities which help seniors and their families obtain information about their care options 

and benefits, and which assist States, Tribes, and community providers of aging services carry out 

their mission to help older people remain independent and live in their own homes and communities. 

These activities provide critical and ongoing support for the national aging services network and help 

support the activities of AoA’s core service delivery programs. 

Competitive grants, cooperative agreements, and contracts for Aging Network Support Activities are 

awarded to eligible public or private agencies and organizations, States and Area Agencies on Aging 

(AAAs), institutions of higher learning, and other organizations representing and/or serving older 

people, including faith-based organizations. Grantees are required to provide a match equal to 

25 percent of the project’s total cost. Project proposals are reviewed by external experts, and project 

awards are made for periods of one to four years. In FY 2010, Aging Network Support Activities 

funded 23 grants with an average award of $346,910 and a range of grant awards from $127,000 to 

$1,112,000.

National Eldercare Locator

Older Americans and their caregivers face a complicated array of choices and decisions about 

health care, pensions, insurance, housing, financial management, and long-term care. The 

Eldercare Locator helps seniors and their families navigate this complex environment by 

connecting those needing assistance with State and local agencies on aging that serve older 

adults and their caregivers. The Eldercare Locator can be accessed through a toll-free nationwide 

telephone line (800-677-1116) or website (http://www.eldercare.gov). The phone line and 

website both connect those in need to providers in every zip code in the nation. The Eldercare 

Locator website continues to grow as a resource tool for older adults and their caregivers, serving 

over 300,000 individuals a year. 
AGING NETWORK SUPPORT ACTIVITIES

84

National Alzheimer’s Call Center

The National Alzheimer’s Call Center is a national information and counseling service for 

persons with Alzheimer’s disease, their family members, and informal caregivers. The National 

Alzheimer’s Call Center is available to people in all States, 24 hours a day, 7 days a week, 

365 days a year to provide expert advice, care consultation, and information and referrals at the 

national and local levels regarding Alzheimer’s disease. Trained professional customer service 

staff and masters degree social workers are available at all times. The Call Center is accessible 

by telephone, website or e-mail at no cost to the caller. In the 12-month period ending 

July 31, 2009, the National Alzheimer’s Call Center handled over 250,000 calls through its 

national and local partners, and its on-line message board community recorded over 4.8 million 

page views, with nearly 75,000 individual postings. Services focus on consumers, not 

professionals. Information provided may include basic information on caregiving; handling legal 

issues; resources for long-distance caregiving; and tips for working with the medical 

community. Local community-based organizations are directly involved to ensure local, on-theground capacity to respond to emergencies and on-going needs of Alzheimer’s patients, their 

families, and informal caregivers. The Call Center has multilingual capacity and responds to 

inquiries in at least 140 languages through its own bilingual staff and with the use of a language 

interpretation service.

Pension Counseling and Information

The Pension Counseling program assists older Americans in accessing information about their 

retirement benefits and helps them negotiate with former employers or pension plans for due 

compensation. Currently, there are more than 700,000 private (as well as thousands of public) 

pension and retirement plans in the United States. Given that an employee may have worked for 

several employers, and these employers may have merged, sold their plans, or gone bankrupt, it 

is very difficult for the average person to know where to go to get help in finding out whether he 

or she is receiving all of their pension benefits. AoA currently funds six regional counseling 

projects covering 27 States. Data for the program shows that:

Pension Counseling projects have successfully obtained a return of more than $5.50 for 

every Federal dollar invested in the program.

Projects have directly served over 35,000 individuals by providing hands-on assistance in 

pursuing claims through administrative appeals processes; helping seniors to locate 

pension plans ―lost‖ as a result of mergers and acquisitions; answering queries about 

complex plan provisions; and making targeted referrals to other professionals for 

assistance.

By producing fact sheets and other publications, hosting websites, and conducting outreach, 

education and awareness efforts, Pension Counseling projects also provide indirect services to 

tens of thousands of seniors and their families. 

National Education and Resource Center on Women and Retirement Planning

The National Education and Resource Center on Women and Retirement Planning provides 

women with access to a one-stop gateway that integrates financial information and resources on 

retirement, health, and planning for long-term care. This project has made user friendly financial 
AGING NETWORK SUPPORT ACTIVITIES

85

education and retirement planning tools available to traditionally hard-to-reach women, 

including average and low-income women, women of color, women with limited English 

speaking proficiency, rural, and other ―underserved‖ women. Information is offered through 

financial and retirement planning programs, workshops tailored to meet women’s special needs, 

and publications in hard copy and Web based formats. Since its establishment, the Center has 

conducted more than 20,000 workshops on strategies to access financial and retirement planning 

information for women and disseminated over 10,000 pieces of financial and retirement planning 

information tailored to the specific needs of hard-to-reach women. 

National Resource Centers on Native American Elders

The National Resource Centers on Native American Elders (Resource Centers) enhance 

knowledge about older Native Americans and thereby increase and improve the delivery of 

services to them. Each Resource Center addresses at least two areas of primary concern which 

are specified in the OAA. These include health issues, long-term care (including in-home care), 

elder abuse, mental health, and other problems and issues facing Native communities. The 

Resource Centers are administered under cooperative agreements by three institutions of higher 

education. The Resource Centers partner with Native American organizations and communities, 

educational institutions including Tribal Colleges and Universities, and professionals and 

paraprofessionals in the field.

National Minority Aging Organizations Technical Assistance Centers

The National Minority Aging Organizations (NMAO) Technical Assistance Centers Program 

works to reduce or eliminate health disparities among racial and ethnic minority older 

individuals. These Centers design and disseminate front line health promotion and disease 

prevention information that is culturally and linguistically appropriate for older individuals of 

African American, Hispanic, Asian American and Pacific Islander descent, and American Indian 

and Alaska Native elders. Each NMAO project pilots a practical, nontraditional, communitybased intervention for reaching older individuals who experience barriers to accessing home and 

community-based services. Strategies are focusing on barriers due to language and low literacy 

as well as those directly related to cultural diversity. Strategies developed under this program 

incorporate the latest technology and facilitate the generation and dissemination of knowledge in 

forms that can assist racial and ethnic minority older individuals to practice positive health 

behaviors and strengthen their capacity to maintain active, independent life styles.

National Technical Assistance Resource Center for LGBT Elders 

Older lesbian, gay, bisexual and transgender (LGBT) adults face a number of unique challenges 

as they strive to maintain their independence. To begin to address the special needs of LGBT 

elders, in FY 2010 AoA funded the National Technical Assistance Resource Center for LGBT 

Elders. The Resource Center strives to meet three primary objectives: educate mainstream aging 

services organizations about the existence and special needs of LGBT elders; sensitize LGBT 

organizations about the existence and special needs of older adults; and educate LGBT 

individuals about the importance of planning ahead for future long-term care needs. The 

national resource center will formally begin services in September 2010 with the launching of a 

website including training curricula and social networking tools. In 2012 it is anticipated that the 

Resource Center will be focused on the provision of training and technical assistance for 

community providers across the country.
AGING NETWORK SUPPORT ACTIVITIES

86

Multigenerational Civic Engagement

The Multi-Generational Civic Engagement (MGCE) initiative enhances discovery, 

documentation and support for existing, exceptional locally-developed program models and 

volunteer engagement strategies. Nineteen model programs in FY 2009 engage older adults in 

civic engagement projects aimed at increasing services to frail elders, families of children with 

special needs, and grandparents raising grandchildren. These model programs are also supported 

by the Corporation of National and Community Service.

Program Performance and Technical Assistance

This program supports cooperative efforts between AoA and selected States and AAAs to 

develop and test outcome measures, various performance measurement instruments, and 

sampling methods that can be used to effectively and efficiently identify the results produced 

through OAA programs on an ongoing basis. It also supports partnerships with National Aging 

Organizations to foster innovation and provide technical assistance to States, AAAs, and Tribal 

organizations in strategic planning, program assessment, and performance measurement.

Funding History:

Comparable funding for Aging Network Support Activities is as follows:

FY 2007................................................. $7,657,280

FY 2008............................................... $10,007,067

FY 2009................................................. $8,200,000

FY 2010................................................. $8,198,000

FY 2011 CR........................................... $8,200,000

Budget Request and Anticipated Accomplishments:

The FY 2012 request for Aging Network Support Activities is $7,948,000, a reduction of 

$250,000 from the FY 2010 appropriation due to increased contracting efficiencies. The 

FY 2012 budget realigns some activities that were previously under Program Innovations and 

Aging Network Support and better classifies them as either Aging Network Support or Elder 

Rights Support Activities. The request continues support very near FY 2010 funding levels for 

these important Aging Network Support activities. In FY 2012, AoA has designated a specific 

line to support the National Technical Assistance Resource Center for LGBT Elders. This 

resource center was supported with existing funds in FY 2010 and FY 2011 and is more clearly 

identified in this request. 

Aging Network Support Activities outcomes are reflected in performance targets for Health and 

Independence and Caregiver Services. 
AGING NETWORK SUPPORT ACTIVITIES

87

Aging Network Support Activities includes funding for the following projects37: 

Activity

FY 2010

Enacted

FY 2011

CR

FY 2012

Request 

Aging Network Support Activities:

National Eldercare Locator................................................................ $ 1,477,820 . $ 1,478,000 $ 1,478,000

National Alzheimer's Call Center........................................................ 999,784 1,000,000 1,000,000

National Education & Resource Center on Women & 

Retirement ......................................................................................... 248,946 249,000 249,000

Pension Information and Counseling Program................................ 1,718,738 ..... 1,719,000 1,719,000

National Resource Centers on Native Americans ................................ 692,851 693,000 693,000

National Minority Aging Organizations: Asian-Pacific 

Americans.......................................................................................... 356,923 357,000 357,000

National Minority Aging Organizations: Native 

Americans.......................................................................................... 128,972 129,000 129,000

National Minority Aging Organizations: Hispanic & 

African-Americans............................................................................. 447,903 448,000 448,000

National Technical Assistance Resource Center for 

LGBT Elders...................................................................................... 300,000 300,000 300,000

Multigenerational Civic Engagement.................................................. 981,788 . 982,000 730,000

Program Performance and Technical Assistance ................................ 844,688 . 845,000 845,000

Total, Aging Network Support Activities................................ $ 8,198,413 ..... $ 8,200,000 $ 7,948,000

 

37 Several projects have been moved to Elder Justice Support Activities and are comparably adjusted.
AGING NETWORK SUPPORT ACTIVITIES

88

PAGE INTENTIONALLY LEFT BLANK
Caregiver Services

Summary of Request

Families are the nation’s primary provider of long-term care, but a number of factors including 

financial constraints, work and family demands, and the many challenges of providing care place 

great pressure on family caregivers. Caregiving responsibilities demand time and money from 

families who too often are already strapped for both. This request provides additional support for 

AoA’s services programs that focus on keeping seniors healthy and independent and address and 

support the needs of their caregivers. 

Better support for caregivers is critical since often it is their availability -- whether they are 

informal family caregivers, paraprofessionals or unrelated friends and neighbors who volunteer 

their time -- that determines whether an older person can remain in his or her home. In 2004, 

approximately 34 million adult caregivers provided uncompensated care to those 50 years of age 

and older.38 The economic value of replacing unpaid caregiving in 2007 was estimated to be 

about $375 billion, an increase from $350 billion in 2006 (cost if that care had to be replaced 

with paid services).39 

The demands of caregiving can lead to a breakdown of the caregiver’s health, and the illness, 

hospitalization, or death of a caregiver increases the risk for institutionalization of the care 

recipient. Caregivers suffer from higher rates of depression than non-caregivers of the same age, 

and research indicates that caregivers suffer a mortality rate that is 63 percent higher than noncaregivers.40

 Providing support that makes caregiving easier for family caregivers, such as 

information, counseling and training, respite care, or supplemental services, is critical to 

sustaining caregivers’ ability to continue in that role. Eighty-three percent of the caregivers 

served by AoA programs report that AoA services allow them to provide care longer than they 

otherwise could.41 

At the same time, AoA recognizes that it must also address the growing need for more caregivers 

every day. By 2015, AoA projects that there will be 12.9 million non-institutionalized seniors 

age 65 and over with 1+ ADL deficits, an increase of almost +2 million seniors or +18 percent 

since 2008, needing caregiver assistance.42 

 

38 National Alliance for Caregiving and AARP. Caregiving in the U.S. Bethesda: National Alliance for Caregiving, 

and Washington, DC: AARP, 2004.

39 Gibson M.J., & Houser, A.N. Valuing the Invaluable: The Economic Value of Family Caregiving, 2008 Update. 

Washington, D.C.: AARP Public Policy Institute: 2008 November, Insight on the Issues #13.

40 Schulz R, Beach SR. Caregiving as a risk factor for mortality. The Caregiver Health Effects study. JAMA 

December 15, 1999;282:2215-9.

41 2009 National Survey of Older Americans Act Participants. http://www.data.aoa.gov, select AGID.

42 Data extrapolated by AoA from U.S. Census Bureau, ―2008 National Population Projections,‖ released August 

2008, <http://www.census.gov/population/www/projections/2008projections.html> and Health Data Interactive, 

National Center on Health Statistics, Centers for Disease Control and Prevention, ―Functional limitations among 

Medicare beneficiaries, ages 65+: US, 1992-2006.‖ Accessed 31 August 2009. 
CAREGIVER SERVICES – SUMMARY OF REQUEST

90

To address these caregiver-related needs, AoA requests a total of $222,070,000, an increase of 

$47,523,000 above the FY2010 enacted level .The request includes:

$192,220,000 for Family Caregiver Support Services, an increase of +$38,023,000 above 

the FY 2010 enacted level. This program makes a range of support services available to 

family and informal caregivers in States, including counseling, respite care, and training, 

that assist family and informal caregivers to care for their loved ones at home for as long 

as possible. Studies have shown that these supports can reduce caregiver depression, 

anxiety, and stress and enable them to provide care longer, thereby avoiding or delaying 

the need for costly nursing home care.

$8,388,000 for Native American Caregiver Support Services, an increase of +$2,000,000 

above the FY 2010 enacted level. This program makes a range of services available to 

Native American caregivers, including information and outreach, access assistance, 

individual counseling, support groups and training, respite care and other supplemental 

services. 

$11,462,000 for Alzheimer’s Disease Supportive Services, the same amount that was 

enacted in FY 2010. One critical focus of this program is to support the family 

caregivers who provide countless hours of unpaid care thereby enabling their family 

members with dementia to continue living in the community. Another focus is to expand 

the availability of diagnostic and support services to those with Alzheimer’s. 

$10,000,000 for Lifespan Respite Care, an increase of +$7,500,000 above the FY 2010 

enacted level. This program funds grants to improve the quality and access to respite 

care for family caregivers of children or adults of any age with special needs. 

As a group, these programs support caregivers and elders by providing critical respite care and 

other support services for family caregivers, training and recruitment of care workers and 

volunteers, information and outreach, counseling, and other supplemental services.
Family Caregiver Support Services

FY 2010

Appropriation

FY 2011

CR

FY 2012

Budget 

Request

FY 2012 + / -

FY 2010

Family Caregiver Support 

Services....................................... $154,197,000 $154,220,000 $192,220,000 +38,023,000

Authorizing Legislation: Section 371 of the Older Americans Act of 1965, as amended

FY 2012 Older Americans Act Authorization................................................................... Expired

Allocation Method .................................................................................................Formula Grant

Program Description and Accomplishments:

Family Caregiver Support Services provides grants to States and Territories, based on their share 

of the population age 70 and over, to fund a range of supports that assist family and informal 

caregivers to care for their loved ones at home for as long as possible. The program includes 

five basic system components: information, access assistance, counseling and training, respite 

care, and supplemental services. These services work in conjunction with Health and 

Independence Services, such as transportation services, homemaker services, home-delivered 

meals, and adult day care, to provide a coordinated set of supports for seniors that caregivers can 

access on their behalf.

Family and other informal caregivers are the backbone of America’s long-term care system. On 

a daily basis, these individuals assist relatives and other loved ones with tasks ranging from 

assisting with personal care and homemaking to more complex health-related interventions like 

medication administration and wound care. The economic value of replacing unpaid caregiving 

in 2007 was estimated to be about $375 billion (cost if that care had to be replaced with paid 

services).43 Caregivers often experience conflicts between work and caregiving, with 25 percent 

reporting that they have had to make adjustments such as retiring or taking time away from work 

due to their caregiving responsibilities.

In 2009, at least 43.5 million adult caregivers, or approximately 19 percent of all adults, provided 

uncompensated care to those 50 years of age and older.44 By 2015, AoA projects that there will 

be 12.9 million non-institutionalized seniors age 65 and over with 1+ ADL deficits, an increase 

of almost +2 million seniors or +18 percent since 2008, needing caregiver assistance.45 

 

43 Gibson M.J., & Houser, A.N. Valuing the Invaluable: The Economic Value of Family Caregiving, 2008 Update. 

Washington, D.C.: AARP Public Policy Institute: 2008 November, Insight on the Issues #13.

44 National Alliance for Caregiving and AARP. Caregiving in the U.S.: A Focused Look at Those Caring for the 

50+. 2009. <http://www.aarp.org/research/surveys/care/ltc/hc/articles/caregiving_09.html>

45 Data extrapolated by AoA from U.S. Census Bureau, ―2008 National Population Projections,‖ released August 

2008, <http://www.census.gov/population/www/projections/2008projections.html> and Health Data Interactive,

National Center on Health Statistics, Centers for Disease Control and Prevention, ―Functional limitations among 

Medicare beneficiaries, ages 65+: US, 1992-2006.‖ Accessed 31 August 2009. 
FAMILY CAREGIVER SUPPORT SERVICES

92

The availability of a skilled caregiver -- whether an informal caregiver, a paraprofessional 

worker or an unrelated volunteer -- all too often determines whether an individual remains 

independent or is admitted to a nursing home. Research has shown that caregiving exacts a 

heavy emotional, physical, and financial toll. As reported in AoA’s 2009 National Survey of 

Older Americans Act (OAA) Participants, 25 percent of caregivers are assisting two or more 

individuals. Sixty-five percent of Title III caregivers are 60 or older, making them more 

vulnerable to a decline in their own health, and nearly one-third describe their own health as fair 

to poor.46 Caregivers also suffer from higher rates of depression than non-caregivers of the same 

age, and research indicates that caregivers suffer a mortality rate that is 63 percent higher than 

non-caregivers.47 The demands of caregiving can lead to a breakdown of the caregiver’s health, 

and the illness, hospitalization, or death of a caregiver increases the risk for institutionalization of 

the care recipient. 

Family Caregiver Support Services provide a variety of supports to family and informal 

caregivers. Based on FY 2009 data, the most recent available, services provided included: 

Access Assistance Services provided over one million contacts to caregivers assisting 

them in locating services from a variety of private and voluntary agencies (Output I).

Counseling and Training Services provided more than 137,000 caregivers with 

counseling, peer support groups, and training to help them better cope with the stresses of 

caregiving (Output J).

Respite Care Services provided more than 69,000 caregivers with 6.4 million hours with 

temporary relief -- at home, or in an adult day care or nursing home setting -- from their 

caregiving responsibilities (Output K).

Studies have shown that these types of supports can reduce caregiver depression, anxiety, and 

stress and enable them to provide care longer, thereby avoiding or delaying the need for costly 

institutional care for their loved ones. A study, Intervention to Delay Nursing Home Placement 

of Patients with Alzheimer’s Disease, indicates that counseling and support for caregivers of 

individuals with Alzheimer’s disease can permit the care recipient to stay at home, at 

significantly less cost, for an additional year before being admitted to a nursing home.

 

46 2009 National Survey of Older Americans Act Participants. http://www.data.aoa.gov, select AGID.

47 Schulz R, Beach SR. Caregiving as a risk factor for mortality. The Caregiver Health Effects study. JAMA 

December 15, 1999;282:2215-9.
FAMILY CAREGIVER SUPPORT SERVICES

93

Additionally, data from AoA’s national surveys of caregivers of elderly clients also shows that 

OAA services, including those provided through Family Caregiver Support Services, are 

effective in helping caregivers keep their loved ones at home. Approximately 83 percent of 

caregivers of program clients reported in 2009 that services enabled them to provide care longer 

than otherwise would have been possible.48 Caregivers receiving services were also asked 

whether the care recipient would have been able to live in the same residence if the services had 

not been available. Nearly half the caregivers of nursing home eligible care recipients indicated 

that the care recipient would be unable to remain at home without the support services. Those 

respondents were then asked to identify where the care recipient would be living without 

services. A significant majority of those caregivers, 70 percent, indicated that the care recipient 

would most likely be living in a nursing home or assisted living (see below). 

Where Care Recipients with 3+ ADL Would Live

If Unable to Have Caregiver Supportive Services 

(based on response with care recipients unable to live independently)

8%

70%

8%

1%

11%

2%

Caregivers home Nursing Home Other Fam.memb. Home They'd die Assisted Living Other 

Funding History:

Funding for Family Caregiver Support Services during the past five years is as follows:

FY 2007............................................. $156,167,000

FY 2008............................................. $153,439,000

FY 2009............................................. $154,220,000

FY 2010............................................. $154,197,000

FY 2011 President’s Budget............... $154,220,000

Budget Request:

The FY 2012 request for Family Caregiver Support Services is $192,220,000, an increase of 

+$38,023,000 above the FY2010 enacted level, which continues funding originally proposed in 

FY 2011 by the White House Middle Class Task Force to aid caregivers. This Support for 

caregivers is critical since often it is their availability -- whether they are informal family 

 

48 2009 National Survey of Older Americans Act Participants. http://www.data.aoa.gov, select AGID.
FAMILY CAREGIVER SUPPORT SERVICES

94

caregivers, paraprofessionals or unrelated friends and neighbors who volunteer their time -- that 

determines whether an older person can remain in his or her home.

With this proposed funding, 919,000 caregivers (Outcome 3.1) will be provided with supportive 

services, including respite care or temporary relief from their caregiving responsibilities. Respite 

care is the service rated by caregivers as the most helpful. Nearly 165,000 caregivers will also 

participate in counseling, peer support groups, and training to help them better cope with the 

stresses of caregiving (Output J). 

A recent MetLife survey shows the average cost in a nursing home is $219 per day. If only 476 

seniors who were unable to receive caregivers services – 0.5% of the nursing home eligible 

seniors who are projected to be helped by this initiative -- move into a nursing home rather than 

remaining in their own home, their annual expenditures would be equivalent to the cost of the 

FY 2012 proposed increase for this program. Caregivers state that these programs help keep 

their loved ones at home, as 83 percent of caregivers report these supportive services enable 

them to provide care longer.

In FY 2012, AoA expects the aging services network to meet or exceed the target of only 

30 percent of caregivers experiencing difficulty obtaining services (Outcome 2.6). This is a 

substantial accomplishment since baseline levels from 2003 showed that 64 percent of caregivers 

had difficulty getting services, and by 2009 that rate had been reduced by more than half to 

30 percent of caregivers reporting difficulty getting services.

For FY 2012, the performance target for Family Caregiver Support Services Program 

participants who rate services good to excellent will remain consistently high at 90 percent 

(Outcome 2.9c). The substantive improvements in program performance can be attributed to 

successful implementation of the National Family Caregiver Support Program. While client 

reported assessment of service quality and program outcomes is expected to remain at high 

levels, many service outputs are expected to decline in FY 2012 compared to FY 2010. Declines 

are projected to be largely attributable to declining leveraged funds, as State, local, and private 

budgets face economic hardships.49 

 

49 AoA’s projections are based on the following two assumptions: 1) CPI-U or a CPI-specific index and 2) declining 

State budgets of -8.5 percent each year from FY 2010-2012, consistent with the decline in 2009 state government 

tax collections reported by the U.S. Census in March 2010. 
FAMILY CAREGIVER SUPPORT SERVICES

95

Outcomes and Outputs Table:

Family Caregiver Support Services Outcomes and Outputs

Measure Most Recent Result FY 2010

Target 

FY 2012 

Target 

FY 2012 

+/- FY 2010

2.6: Reduce the percent of caregivers 

who report difficulty in getting 

services. (Outcome)

FY 2009: 30%

(Target Exceeded) 30% 30% Maintain

2.9c: 90% of NFCSP clients rate 

services good to excellent. (Outcome)

FY 2009: 95.3%

(Target Exceeded) 90% 90% Maintain

3.1: Increase the number of caregivers 

served. (Outcome)

FY 2009: 855,000

(Target Exceeded) 560,000 919,000 +359,000

Indicator Most Recent Result FY 2010 

Projection 

FY 2012 

Target

FY 2012 

+/- FY 2011

Output I: Caregivers access assistance 

units of service. (Output) FY 2009: 1.0 Million 1.2 Million 1.275 Million +75,000

Output J: Caregivers receiving 

counseling and training. (Output) FY 2009: 137,203 137,000 163,000 +26,000

Output K: Caregivers receiving respite 

care services. (Output) FY 2009: 69,017 74,000 67,000 -7,000

Note: For presentation within the budget AoA highlighted specific measures that are most directly related to Family 

Caregiver Support Services, however multiple performance outcomes are impacted by this program because AoA’s 

performance measures (efficiency, effective targeting, and client outcomes) assess network-wide performance in 

achieving current strategic objectives.

Grant Awards Tables:

Family Caregiver Support Services Grant Awards

FY 2010 

Enacted FY 2011 CR FY 2012 Request

Number of 

Awards 56 56 56

Average 

Award $2,736,667 $2,726,389 $3,398,175

Range of 

Awards

$95,783 -

$15,564,926

$95,424 -

$15,325,772

$118,936 -

$19,102,063
FAMILY CAREGIVER SUPPORT SERVICES

96

DEPARTMENT OF HEALTH AND HUMAN SERVICES

ADMINISTRATION ON AGING

FY 2012 DISCRETIONARY STATE FORMULA GRANTS

PROGRAM: Family Caregivers Support Services (CFDA 93.052)

State/Territory

FY 2010

Actual

FY 2011

Estimate

FY 2012

Estimate

Difference

+/-FY 2010

Alabama......................................... $2,394,015 $2,381,771 $2,968,642 $574,627 

Alaska............................................ $766,267 $763,389 $951,489 $185,222 

Arizona .......................................... $3,287,930 $3,221,475 $4,015,252 $727,322 

Arkansas........................................ $1,523,673 $1,515,357 $1,888,743 $365,070 

California....................................... $15,564,926 $15,325,772 $19,102,063 $3,537,137 

Colorado ........................................ $1,863,239 $1,898,595 $2,366,412 $503,173 

Connecticut.................................... $1,828,019 $1,817,374 $2,265,177 $437,158 

Delaware........................................ $766,267 $763,389 $951,489 $185,222 

District of Columbia ....................... $766,267 $763,389 $951,489 $185,222 

Florida ........................................... $12,466,239 $12,230,935 $15,244,653 $2,778,414 

Georgia .......................................... $3,507,709 $3,559,892 $4,437,054 $929,345 

Hawaii ........................................... $766,267 $763,389 $951,489 $185,222 

Idaho.............................................. $766,267 $763,389 $951,489 $185,222 

Illinois............................................ $5,948,072 $5,896,106 $7,348,914 $1,400,842 

Indiana........................................... $3,054,571 $3,053,227 $3,805,546 $750,975 

Iowa............................................... $1,740,403 $1,704,505 $2,124,497 $384,094 

Kansas........................................... $1,418,364 $1,389,793 $1,732,239 $313,875 

Kentucky........................................ $2,082,732 $2,065,766 $2,574,774 $492,042 

Louisiana ....................................... $2,008,607 $2,020,993 $2,518,968 $510,361 

Maine............................................. $766,267 $763,389 $951,489 $185,222 

Maryland........................................ $2,501,853 $2,504,404 $3,121,493 $619,640 

Massachusetts ................................ $3,353,928 $3,349,508 $4,174,831 $820,903 

Michigan........................................ $4,878,303 $4,898,828 $6,105,906 $1,227,603 

Minnesota ...................................... $2,461,149 $2,491,677 $3,105,629 $644,480 

Mississippi..................................... $1,388,506 $1,384,971 $1,726,229 $337,723 

Missouri......................................... $3,035,089 $3,034,328 $3,781,990 $746,901 

Montana......................................... $766,267 $763,389 $951,489 $185,222 

Nebraska........................................ $939,403 $917,695 $1,143,816 $204,413 

Nevada........................................... $1,048,359 $1,064,239 $1,326,469 $278,110 

New Hampshire.............................. $766,267 $763,389 $951,489 $185,222 
FAMILY CAREGIVER SUPPORT SERVICES

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PROGRAM: Family Caregivers Support Services (CFDA 93.052)

State/Territory

FY 2010

Estimate

FY 2011

Estimate

FY 2012

Estimate

Difference

+/-FY 2010

New Jersey.................................... $4,365,417 $4,355,327 $5,428,484 $1,063,067 

New Mexico.................................. $959,260 $942,510 $1,174,744 $215,484 

New York ..................................... $9,906,970 $9,740,093 $12,140,064 $2,233,094 

North Carolina .............................. $4,188,342 $4,297,663 $5,356,613 $1,168,271 

North Dakota................................. $766,267 $763,389 $951,489 $185,222 

Ohio.............................................. $5,957,778 $5,978,699 $7,451,858 $1,494,080 

Oklahoma ..................................... $1,841,367 $1,823,351 $2,272,627 $431,260 

Oregon.......................................... $1,881,639 $1,877,096 $2,339,615 $457,976 

Pennsylvania ................................. $7,449,148 $7,427,164 $9,257,226 $1,808,078 

Rhode Island ................................. $766,267 $763,389 $951,489 $185,222 

South Carolina .............................. $2,180,698 $2,232,779 $2,782,939 $602,241 

South Dakota................................. $766,267 $763,389 $951,489 $185,222 

Tennessee...................................... $3,005,220 $3,027,221 $3,773,132 $767,912 

Texas............................................ $9,149,374 $9,196,791 $11,462,892 $2,313,518 

Utah.............................................. $911,931 $908,202 $1,131,984 $220,053 

Vermont........................................ $766,267 $763,389 $951,489 $185,222 

Virginia......................................... $3,437,386 $3,439,323 $4,286,776 $849,390 

Washington................................... $2,894,555 $2,894,702 $3,607,960 $713,405 

West Virginia................................ $1,073,857 $1,065,631 $1,328,203 $254,346 

Wisconsin ..................................... $2,861,507 $2,847,654 $3,549,320 $687,813 

Wyoming ...................................... $766,267 $763,389 $951,489 $185,222

 --

Subtotal, States.............................. $150,321,009 $149,705,474 $186,593,091 $36,272,082

 --

American Samoa ........................... $95,783 $95,424 $118,936 $23,153 

Guam............................................ $383,133 $381,695 $475,745 $92,612 

Northern Mariana Islands.............. $95,783 $95,424 $118,936 $23,153 

Puerto Rico ................................... $1,974,516 $2,018,088 $2,515,347 $540,831 

Virgin Islands................................ $383,133 $381,695 $475,745 $92,612 

 --

Subtotal, States and Territories ...... $153,253,357 $152,677,800 $190,297,800 $37,044,443

 --

Undistributed 50/........................... $943,830 $1,519,200 $1,922,200 $978,370

 --

TOTAL $154,197,187 $154,197,000 $192,220,000 $38,022,813

 

50/ Funds held for statutory related requirements are reflected in the undistributed line.
FAMILY CAREGIVER SUPPORT SERVICES

98

PAGE INTENTIONALLY LEFT BLANK
Native American Caregiver Support Services

FY 2010

Appropriation

FY 2010

CR

FY 2012

Budget 

Request

FY 2012 +/-

FY 2010

Native American 

Caregiver Support 

Services..................

$6,388,000 $6,389,000 $8,388,000 +2,000,000

Authorizing Legislation: Section 631 of the Older Americans Act of 1965, as amended

FY 2012 Authorization..................................................................................................... Expired

Allocation Method .................................................................................................Formula Grant

Program Description and Accomplishments:

Native American Caregiver Supportive Services provide grants to eligible Tribal organizations to 

provide support for family and informal caregivers of Native American, Alaskan Native and 

Native Hawaiian elders. These programs, which help to reduce the need for costly nursing home 

care and medical interventions, are responsive to the cultural diversity of Native American 

communities and represent an important part of each community’s comprehensive services. 

Formula grants for the Native Americans Caregiver Supportive Services programs are allocated 

to eligible Tribal organizations based on their share of the American Indian, Alaskan Native, and 

Native Hawaiian population aged 60 and over. Tribal organizations must represent at least 

50 Native American elders age 60 and over to receive funding. There is no requirement for 

matching funds. Tribes may also decide the age at which a member is considered an elder and 

thus eligible for services. In addition, there is no limit on the percentage of funds that can be used 

for services to grandparents caring for grandchildren. In FY 2010 grants for Caregiver Support 

Services were awarded to 204 Tribal organizations, including one organization serving Native 

Hawaiian elders, with an average award of $31,240 and a range of grant awards from $14,410 to 

$58,837. 

Grants assist American Indian, Alaskan Native and Native Hawaiian families caring for older 

relatives with chronic illness or disability and grandparents caring for grandchildren. The 

program provides a variety of direct services that meet 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). A core value of the Native American Caregiver Support Services, as 

expressed by Tribal leaders, is that the program should not replace the tradition of families caring 

for their elders. Rather, it provides support that strengthens the family caregiver role. 
NATIVE AMERICAN CAREGIVER SUPPORTIVE SERVICES

100

Funding History:

Funding for the Native American Caregiver Support Services during the past five years is as 

follows:

FY 2007................................................. $6,241,000

FY 2008................................................. $6,316,000

FY 2009................................................. $6,389,000

FY 2010................................................. $6,388,000

FY 2011 CR .......................................... $6,389,000

Budget Request:

The FY 2012 request for Native American Caregiver Support Services is $8,388,000, an increase 

of +$2,000,000 over the FY2010 enacted level which continues funding originally proposed in 

FY 2011 by the White House Middle Class Task Force to aid caregivers. Support for caregivers 

is critical since often it is their availability -- whether they are informal family caregivers, 

paraprofessionals or unrelated friends and neighbors who volunteer their time -- that determines 

whether an older person can remain in his or her home.

In the 2000 Census, approximately 213,000 persons age 60 and over identified themselves as 

American Indians or Alaskan Natives, and another 182,000 persons age 60 and over identified 

themselves as part American Indians or Alaskan Natives. Caregiver support services will help 

Native American elders, many of whom have limitations in activities of daily living that make it 

difficult to care for themselves, to remain at home, in the community, or on the reservation, 

which is what they prefer. Studies have shown that providing assistance to caregivers can help 

them cope with the emotional, physical and financial toll associated with caregiving, thereby 

enabling them to provide care for their loved ones longer and avoid or delay the need for costly 

nursing home care.

Performance data indicates that these programs are an efficient means to help Native American 

Elders remain independent and in the community. It should be noted that performance for 

FY 2010 is expected to decline due to the economic downturn impacting Tribal government 

budgets. For FY 2011 the efficiency measure shows performance trends declining because of 

declining leveraged funds, as State, tribal, and private budgets face economic hardships.51 

In FY 2012 the Native American Caregiver Support Program will continue to assist family 

caregivers, whose assistance is critical to enabling Native American elders with disabilities to 

remain at home, in the community, or on the reservation. It is estimated that in FY 2011 more 

than 320,000 units of caregiver-related services including respite care, information and referral, 

caregiver training, lending closets, and support groups will be provided by Native American 

Tribal organizations.

 

51 AoA’s projections are based on the following two assumptions: 1) CPI-U or a CPI-specific index and 2) declining 

State budgets of -8.5 percent each year from FY 2010-2012, consistent with the decline in 2009 state government 

tax collections reported by the U.S. Census in March 2010. 
NATIVE AMERICAN CAREGIVER SUPPORTIVE SERVICES

101

Outcome Table:

Native American Caregivers Supportive Services Outcome

Measure Most Recent 

Result 

FY 2010

Target 

FY 2012 

Target

FY 2012 

+/- FY 2010

3.1: Increase the number of caregivers 

served. (Outcome)

FY 2009: 855,000

(Target Exceeded) 560,000 919,000 +359,000

Grant Awards Table:

Native American Caregivers Supportive Services Grant Awards

FY 2010 

Enacted

FY 2011 

President’s 

Budget

FY 2012 

Request

Number of 

Awards 204 204 204

Average 

Award $31,240 $34,021 $34,021

Range of 

Awards

$14,410 -

$58,837

$15,692 -

$64,073

$15,692 -

$64,073
NATIVE AMERICAN CAREGIVER SUPPORTIVE SERVICES

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PAGE INTENTIONALLY LEFT BLANK
Alzheimer’s Disease Supportive Services Program

FY 2010

Appropriation

FY 2011

CR

FY 2012

Budget 

Request

FY 2012 +/-

FY 2010

Alzheimer’s Disease 

Supportive Services 

Program..................

$11,462,000 $11,464,000 $11,462,000 --

Authorizing Legislation: Section 398 of the Public Health Services Act, as amended

FY 2012 Authorization..................................................................................................... Expired

Allocation Method .......................... Competitive Grants/Co-operative Agreements and Contracts

Program Description and Accomplishments:

The Alzheimer’s Disease Supportive Services Program (ADSSP) funds competitive grants for 

States to expand the availability of diagnostic and support services that help persons with 

Alzheimer’s and dementia and the family members who care for them. A critical focus of these 

grants is to support the family caregivers who provide countless hours of unpaid care, thereby 

enabling their family members with Alzheimer’s and dementia to continue living in the 

community. In order to maintain the quality of life of the caregiver and their family members, 

the ADSSP provides respite care, personal care, counseling, and informational assistance, using 

proven and innovative direct care practices and enhances the responsiveness and readiness of the 

home and community-based care system by improving service coordination and educating 

service providers about proven dementia care strategies. 

ADSSP grants enable States to develop service and outreach programs that are specific to State 

needs and resources. The primary components of the ADSSP program include:

Delivering supportive services including respite care, home health care, personal care, 

adult day care, and companion services to assist caregivers, families, and persons with 

Alzheimer’s disease.

Translating and replicating evidence-based interventions for dementia caregivers at the 

community level.

Incorporating evidence-based research in the formulation of innovative projects and 

advancing changes to a State’s overall system of home and community-based care.

Providing individualized and public information, education, and referrals about 

diagnostic, treatment and related services; sources of assistance for services; and legal 

rights of people affected by Alzheimer’s disease.
ALZHEIMER’S DISEASE SUPPORTIVE SERVICES PROGRAM

104

Linking public and non-profit agencies that develop and operate respite care and other 

community-based supports, educational, and diagnostic services within the State to 

people who need services.

In 2008, a programmatic review was performed to determine the future direction of the program 

and how to enhance the program’s operation and results. As a result of this review, AoA issued 

two grant funding opportunities in FY 2009 reflecting the new directions of the ADSSP that 

encourage States to 1) translate and replicate evidence-based interventions for people with 

dementia and their caregivers; and 2) develop or expand innovative service models for people 

with dementia and their caregivers, including a focus to expand services available to people in 

the early stages of dementia and to provide chronic care management. 

In FY 2010 the ADSSP funded 32 grants with an average award of $321,625 and a range of 

grant awards from $163,393 to $500,000. Through these grant projects, seven States are in the 

process of translating four evidence-based interventions into practice and nine States are offering 

innovative programming for caregivers and their loved ones with dementia. One example of 

these promising interventions is a spousal caregiver support program in New York City that, in a 

randomized-controlled trial, delayed institutionalization of persons with dementia by an average 

of 557 days.52 In 2009, the average nursing home cost was $219 daily ($79,935 annually), which 

would mean an average savings of nearly $122,000 in institutional costs per person with dementia.53 

Minnesota is translating this intervention now; early results indicate that the project is achieving 

the outcomes that were found in the original study. Other FY 2010 grant projects focus on

innovations in areas of great need, such as programs to identify and provide appropriate services 

for persons in the earliest stages of Alzheimer’s disease. Overall, these demonstrations offer 

direct services and other supports to thousands of families, as well as support the continuous 

quality improvement and evaluation of these services. 

With the FY 2011 grants, AoA will continue to build and expand its portfolio of evidence-based 

interventions that help persons with Alzheimer’s disease and their family caregivers, as well as 

strengthen services in areas where there is less research in these areas – but great need for 

services – through innovative projects. Enhancing Federal, State, and local partnerships will be a 

key focus of these grants, including those with the Veteran’s Administration and its 

constituencies, the Centers for Medicare and Medicaid Services, and state National Family 

Caregiver Support Programs (Older Americans Act, Title III-E). 

 

52 Mittleman M, et al. (1996). ―A Family Intervention to Delay Nursing Home Placement of Patients with 

Alzheimer’s Disease: a randomized, controlled trial,‖ Journal of the American Medical Association, 276; 1725-

1731.

53 Metlife. (October 2009), “MetLife Market Survey of Nursing Home, Assisted Living, Adult Day Services, and 

Home Care Costs‖, p. 4, Accessed August 17, 2010 

from: http://www.metlife.com/assets/cao/mmi/publications/studies/mmi-market-survey-nursing-home-assistedliving.pdf
ALZHEIMER’S DISEASE SUPPORTIVE SERVICES PROGRAM

105

Funding History:

Funding for the ADSSP program during the past five years is as follows:

FY 2007............................................... $11,668,000

FY 2008............................................... $11,464,000

FY 2009............................................... $11,464,000

FY 2010............................................... $11,462,000

FY 2011 CR......................................... $11,464,000

Budget Request and Anticipated Accomplishments:

The FY 2012 request for the ADSSP is $11,462,000, the same as the FY 2010 enacted level. 

Funds will be used to address the needs of a growing population: One study estimates that there 

were 411,000 new cases of Alzheimer’s disease in 2000; by 2030 the number of new cases is 

projected to be 615,000 and by 2050, 959,00054. Consistent with a decision to incorporate 

evidence-based approaches into the ADSSP, this request will fund grants to States to pilot test 

and implement evidence-based and other innovative approaches that help individuals with 

Alzheimer’s disease and their caregivers while also providing funding to demonstrate and 

expand the service delivery of home and community-based services.

While an anticipated $172 billion was expected to be spent in 2010 on care for persons with 

Alzheimer’s disease and related disorders55, family caregivers remain the major source of 

support for most people with Alzheimer’s disease. The nature of the disease -- a slow loss of 

cognitive and functional/physical independence -- means that most people with Alzheimer’s 

disease are cared for in the community for years. They may access a variety of services from 

many different systems including the aging, medical, and mental health service systems. As the 

number of people with Alzheimer’s disease grows, it is increasingly important that service 

delivery and health care systems are responsive to persons with dementia and are effectively 

coordinated. It is also important to ensure the availability of dementia-competent communitybased social and health care services. 

 

54 Alzheimer’s Association, (2010). ―Alzheimer’s Disease Facts and Figures‖., p. 14 and p. 34. Accessed August 17, 

2010 from: http://www.alz.org/alzheimers_disease_facts_figures.asp

55 Id.
ALZHEIMER’S DISEASE SUPPORTIVE SERVICES PROGRAM

106

Outcome and Outputs Table:

Alzheimer’s Disease Supportive Services Program Outcome and Outputs

Note: For presentation within the budget AoA highlighted specific measures that are most directly related to 

Alzheimer’s Disease Supportive Services Programs, however multiple performance outcomes are impacted by this 

program because AoA’s performance measures (efficiency, effective targeting, and client outcomes) assess networkwide performance in achieving current strategic objectives.

Measure Most Recent 

Result 

FY 2010

Target 

FY 2012 

Target 

FY 2012 

+/- FY 2010

ALZ.1: Percent of ADSSP grant 

funds dedicated to implementing 

evidence-based programs 

(Outcome)

FY 2009:

64% 60% 60% Maintain

Indicator Most Recent 

Result 

FY 2010 

Projection 

FY 2012

Projection 

FY 2012 

+/- FY 2010 

Output AC: Number of 

individuals served (Output)

FY 2009: 

3,954 Baseline TBD N/A

Output AD: Percent of 

individuals served that are of a 

racial/ethnic minority (Output)

N/A Baseline TBD N/A
Lifespan Respite Care

FY 2010

Appropriation

FY 2011

CR

FY 2012

Budget 

Request

FY 2012 +/-

FY 2010

Lifespan Respite Care.................. $2,500,000 $2,500,000 $10,000,000 +$7,500,000

Authorizing Legislation: Lifespan Respite Care Act of 2006, Title XXIX of the Public Health 

Service Act

FY 2012 Authorization..................................................................................................... Expired

Allocation Method ......................................................................................... Competitive Grants

Program Description and Accomplishments:

The Lifespan Respite Care program provides grants to eligible State organizations to improve the 

quality and access of respite care for family caregivers of children or adults of any age with 

special needs while promoting the statewide dissemination and coordination of community-based 

respite care services. Respite care services are highly valued by caregivers. In the most recent 

National Survey of Older Americans Act (OAA) service recipients a random sample of 

1,795 caregivers (which represented over 223,626 active caregivers) answered questions about 

the impact of the caregiver program. Eighty-four percent of caregivers received respite care 

within the past twelve months. The respite care service recipients reported that as a result of the 

services they received:

77 percent had less stress; 

81 percent said it was easier to care for their loved one; 

59 percent reported they now know more about caring for their loved one’s condition; 

77 percent reported that it was the most helpful service they received; 

95 percent reported the care recipient benefited from the service; and 

82 percent said that the services enabled them to care longer. 

The activities funded by the Lifespan Respite Care program help to address this growing need,

providing respite care services for family caregivers, training and recruitment of respite care 

workers and volunteers, information and outreach, access assistance, and program development. 

The program also supports a grant to establish a National Lifespan Respite Resource Center to 

maintain a national database on lifespan respite care; provide training and technical assistance to 

State, community, and nonprofit respite care programs; and provide information, referral, and 

education programs to the public on lifespan respite care.

Grants for Lifespan Respite Care are awarded to eligible State organizations with a 25 percent 

matching requirement. Eligible State agencies include any of the following: the State agency that 

administers the State’s OAA programs, the State’s Medicaid program under Title XIX of the 
LIFESPAN RESPITE CARE

108

Social Security Act; or any other State-level agency designated by the Governor. Additionally, 

the eligible State agency must work in collaboration with Aging and Disability Resource Centers 

and a public or private non-profit statewide respite care coalition or organization. Priority 

consideration is given to applicants who demonstrate the greatest likelihood of implementing or 

enhancing lifespan respite care statewide and who are building or improving the capacity of their 

long-term care systems to respond to the comprehensive needs of care recipients. 

The first grants for the program were awarded in FY 2009 to twelve recipients for up to 

$200,000 for three-year project periods. 

Funding History:

Funding for the Lifespan Respite Care program during the past five years is as follows:

FY 2007...............................................................$0

FY 2008...............................................................$0

FY 2009................................................. $2,500,000 

FY 2010................................................. $2,500,000

FY 2011 CR........................................... $2,500,000

Note: Funding for the Lifespan Respite Care Act was appropriated in FY 2009 under the General Departmental 

Management Account in the Office of the Secretary. In FY 2010 funding was appropriated directly to the 

Administration on Aging. 

Budget Request and Anticipated Accomplishments:

The FY 2012 request for the Lifespan Respite Care Program is $10,000,000, an increase of 

+$7,500,000 over the FY2010 enacted level, which continues funding originally proposed in FY 

2011 as part of the White House Middle Class Task Force. The Lifespan Respite Care program 

demonstrates AoA’s commitment to providing caregivers and their families with the support they 

need to continue caring for their loved ones by expanding support to include caregivers of 

children or adults of any age with special needs. 

According to a November 2009 study by the National Alliance for Caregiving, of six national 

policies or programs presented to caregivers as potential ways to help them, 26 percent of 

respondents ranked respite services as either their first or second most preferred option.56 By 

providing opportunities for family caregivers to receive the much needed short-term relief from 

caring for their loved ones, the Lifespan Respite Care program helps to sustain family caregiver 

health and well-being, reduces the likelihood of abuse and neglect, and allows care recipients to 

remain in their own homes for as long as possible. 

 

56 National Alliance for Caregiving and AARP. Caregiving in the U.S. Bethesda: National Alliance for Caregiving, 

and Washington, DC: AARP, 2009.
LIFESPAN RESPITE CARE

109

States providing Lifespan Respite Care will, at a minimum:

Expand and enhance respite care services to family members;

Improve the statewide dissemination and coordination of respite care; and

Provide, supplement, or improve access and quality of respite care services to family 

caregivers, thereby reducing family caregiver strain.

The Lifespan Respite Care Program, together with the National Family Caregiver Support 

program and the Alzheimer’s Disease Supportive Services Program, provides AoA with another 

vehicle to address the needs of caregivers. The Lifespan Respite Care program will build upon 

the existing infrastructure of multi-faceted caregiver services that these two earlier programs now 

provide to leverage training for caregivers, enhance the provision of information about available 

respite and other supportive services, and to further assist caregivers in accessing all services 

available to them, including respite, from across the spectrum of caregiver support. With the 

addition of the Lifespan Respite Care Program, AoA will have new opportunities to further 

elevate the importance of caregiving by supporting the central role of caregivers in the health and 

long-term care delivery system with coordinated, accessible and high quality respite services.

Output Table:

Lifespan Respite Care Output

Indicator Most Recent 

Result 

FY 2010

Projection

FY 2012 

Projection 

FY 2012 

+/- FY 2010 

Output AE: Increase the number 

of people served as a result of 

Lifespan Respite Care (Output)

N/A N/A TBD N/A
LIFESPAN RESPITE CARE

110

PAGE INTENTIONALLY LEFT BLANK
Protection of Vulnerable Adults

Summary of Request

As the population of older Americans age 60 and older increases, the problem of elder abuse, 

neglect, and exploitation continues to grow. While there is no single set of national elder abuse 

prevalence data, the number of reported cases of elder abuse, neglect, and exploitation are on the 

rise. A 2004 national survey of State Adult Protective Services (APS) programs conducted by 

AoA’s National Center on Elder Abuse showed a 16 percent increase in the number of elder 

abuse cases from an identical study conducted in 2000.57 According to a 1998 national incidence 

study (the only such study ever conducted), 84 percent of all elder abuse incidents go unreported, 

meaning that for every reported case of abuse there are over five that go unreported.58 Together, 

these data suggest that a minimum of 2.5 million elders are abused, neglected, and/or exploited 

annually.

The negative effects of abuse, neglect, and exploitation on the health and independence of 

seniors is extensive. Research has demonstrated that older victims of even modest forms of abuse 

have dramatically higher (300 percent) morbidity and mortality rates than non-abused older 

people.59 Additional adverse health impacts include an increased likelihood of heart attacks, 

dementia, depression, chronic diseases and psychological distress. The result of these 

unnecessary health problems is a growing number of seniors who access the healthcare system 

more frequently (including emergency room visits and hospital admissions), and are ultimately 

forced to leave their homes and communities prematurely.60 

Protection of Vulnerable Adults programs address this problem through a full array of services 

designed to prevent, detect, and respond to elder abuse, neglect, and exploitation. The FY 2012 

request for these programs is $60,233,000 (including $3,312,000 in mandatory funding for 

Healthcare Fraud and Abuse Control), an increase of +$21,033,000 above the FY 2010 enacted 

level. The increase includes funding to support AoA’s enhanced focus on elder rights and elder 

justice, including $16.5 million for Adult Protective Services State Demonstrations authorized 

under the Elder Justice Act and the Older Americans Act. Funding will be used to support States 

in improving their APS programs through evaluating interventions designed to detect and 

prevent elder abuse, including financial exploitation, and building the knowledge base about how 

to best implement these important activities. In addition to these APS improvements, the budget

provides resources to improve resident advocacy to elders who live in long-term care settings 

through increased support to the Long-Term Care Ombudsman Program. 

 

57 Teaster, Pamela, et al. The 2004 Survey of State Adult Protective Services: Abuse of Adults 60 Years of Age and 

Older. http://www.ncea.aoa.gov/NCEAroot/Main_Site/pdf/2-14-06%20FINAL%2060+REPORT.pdf

58

 Tatara, Toshio, et al. The National Elder Abuse Incidence Study Final Report. 1998. 

http://www.aoa.gov/AoARoot/AoA_Programs/Elder_Rights/Elder_Abuse/docs/ABuseReport_Full.pdf

59 Lachs, M.S., Williams, C.S., O'Brien, S., Pillemer, K.A., & Charlson, M.E. (1998). ―The Mortality of Elder 

Mistreatment.‖ JAMA. 280: 428-432. and Baker, M.W. (2007). ―Elder Mistreatment: Risk, Vulnerability, and 

Early Mortality.‖ Journal of the American Psychiatric Nurses Association, Vol. 12, No. 6, 313-321. 

60 Lachs M. S., Williams C., O'Brien S., Hurst L., Kossack A., Siegal A., et al. (1997). ―ED use by older victims of 

family violence.‖ Annals of Emergency Medicine. 30:448-454.
PROTECTION OF VULNERABLE OLDER ADULTS – SUMMARY OF REQUEST

112

The enhanced focus on elder rights and elder justice will allow AoA’s Protection of Vulnerable 

Adults programs to expand and improve the protection of individuals living in their communities 

and in long-term care settings; increase the information and technical assistance available to the 

public, States, and localities in preventing and addressing abuse; protect the rights of older adults 

and prevent their exploitation; reduce health-care fraud and abuse; and provide assistance to 

Tribes in developing elder justice systems. This multifaceted approach to preventing, detecting, 

and resolving elder abuse, neglect, and exploitation is essential to successfully fulfilling the 

shared mission of the Older Americans Act and the Elder Justice Act to maintain the health and 

independence of older Americans and adults with disabilities.
Adult Protective Services State Demonstrations

FY 2010

Appropriation

FY 2011

Continuing 

Resolution

FY 2012

Budget 

Request

FY 2012 +/- FY 

2010

Adult Protective Services State 

Demonstrations.....................................................-- -- $16,500,000 +$16,500,000

FTE ......................................................................-- -- 2 +2

Authorizing Legislation: Title XX of the Social Security Act, Subtitle B, Section 2042, as 

amended by the Affordable Care Act, Subtitle H – Elder Justice Act, Sections 6701-6703;

Section 751 of the Older Americans Act, as amended

FY 2012 Social Security Act Authorization............................................................... $25,000,000

Allocation Method ................................................................... Competitive Grants and Contracts

Program Description:

Adult Protective Services (APS) State Demonstrations, as established in Sections 6701-6703 of 

the Affordable Care Act, provide competitive grants to States to test and evaluate innovative 

approaches to preventing, detecting, and responding to elder abuse, neglect, and exploitation.

Current State and local APS programs provide a range of services designed to ensure the safety 

and well-being of elders who are in danger of being mistreated or neglected, are unable to take 

care of themselves or to protect themselves from harm, and who have no one to assist them. 

These services include, but are not limited to, the following:

receiving and investigating reports of elder abuse, neglect, or exploitation;

case planning, monitoring, evaluation, and other case work and services; and

providing, arranging for, or facilitating the provisions of medical, social service, 

economic, legal, housing, law enforcement, or other protective, emergency, or support 

services

As the frequency of elder abuse, neglect, and exploitation continues to rise, the combination of 

shrinking State and local APS budgets and the increasing complexity of elder and adult abuse 

cases has greatly limited the ability of APS programs to effectively meet the growing demand for 

services. 61 APS State Demonstrations will improve the effectiveness and efficiency of State and 

local APS programs by providing funding to test and evaluate innovative approaches to service 

delivery. A number of obstacles have prevented APS programs from evaluating their services, 

including a lack of resources, the increasing number and complexity of abuse cases, and the 

 

61 Teaster, Pamela, et al. The 2004 Survey of State Adult Protective Services: Abuse of Adults 60 Years of Age and 

Older. http://www.ncea.aoa.gov/NCEAroot/Main_Site/pdf/2-14-06%20FINAL%2060+REPORT.pdf
ADULT PROTECTIVE SERVICES STATE DEMONSTRATIONS

114

absence or inadequacy of consistent data systems and uniform reporting requirements needed to 

conduct meaningful program evaluations. Many of these same challenges have limited efforts to 

develop new and innovative approaches to preventing, detecting, and responding to abuse, 

neglect, and exploitation. APS State Demonstrations will provide competitive grant funding to 

APS programs to test new or previously unevaluated approaches and evaluate their effectiveness.

The ability of APS programs to employ tested, proven techniques is essential to ensuring that 

elders are able to receive protection and relief from abuse, neglect, and exploitation. Using the 

results of the APS State demonstrations, AoA will develop a compendium of best practices and 

lessons learned that APS programs across the nation can use to improve their programs. 

Additionally, AoA will present findings at conferences, conduct trainings and webinars to 

disseminate the results, and seek out ways to coordinate with other national, State and local 

entities to distribute the information. The cumulative results of these projects will allow AoA to 

establish a strong evidence-base for current and future projects.

Critical to the success of these efforts, AoA will provide APS State demonstration grantees with 

uniform definitions and reporting requirements to be used to track APS program results and 

compare them with other programs throughout the nation. Currently, APS programs have wide 

ranging definitions of elder abuse, neglect, and exploitation that make the combination of output 

data unreliable and comparative evaluations impossible to conduct. 

Funding History:

FY 2012 would be the first year of funding for this newly authorized program.

Budget Request and Anticipated Accomplishments:

The FY 2012 request for Adult Protective Services State Demonstrations is $16,500,000. The 

request includes funding to support 2 FTE for these activities.

As the size of the aging population continues to grow, so too has the demand for Adult Protective 

Services (APS). However, the ability of State and local APS programs to provide adequate 

assistance has not been able to keep up. This challenge has become even greater as the economic 

downturn has resulted in cuts to State and local APS budgets. 

The FY 2012 request for $16.5 million includes approximately $13 million to fund competitive 

grants to test promising approaches to meeting the growing challenges that State and local APS 

programs face. Abuse, neglect, and exploitation present complex problems that require 

multidisciplinary solutions that employ the most effective and efficient interventions available. 

These competitive grants allow State and local APS programs to develop innovative approaches, 

evaluate promising approaches, and identify best practices that can then be disseminated to APS 

programs nationwide.

Additionally, $1.5 million will support research and demonstration programs for effectively 

preventing and addressing elder abuse within Tribal nations. Tribes will continue to define who 

qualifies as an elder within their community.
ADULT PROTECTIVE SERVICES STATE DEMONSTRATIONS

115

The remaining $2 million will support contracts to evaluate the demonstration’s design and 

related activities, as well as the development of the initial phase of data collection and reporting 

requirements associated with the state-level demonstration grants. An effective evaluation of 

APS will depend upon the quality of work produced at the evaluation design stage. Recent AoA 

experiences with the design phase of program evaluations indicate that developing a rigorous 

design requires adequate funding. This is especially true of an evaluation of a program in which 

significant programmatic variation exists, particularly with regard to the differences in how 

States define elder abuse and the manner in which they conduct their APS programs. 

Additionally, a portion of the $2 million allocated for the evaluation and administration of APS 

State Demonstrations will be used to provide adequate AoA staff resources to support the grants 

management, technical assistance, coordination, and the development and dissemination of best 

practices that are essential to the success of the these demonstration projects. The +2 FTE will 

allow AoA to maximize the value of APS Demonstrations by ensuring the integrity and 

consistency of each project while providing the project coordination necessary to carry out the 

dissemination of best practices and lessons learned from the demonstrations to APS programs 

throughout the nation. 

Lastly, the budget request is consistent with the findings of the recent HHS report to Congress 

assessing the feasibility of establishing uniform standards for data collection, reporting, and 

dissemination of best practices regarding Elder Abuse. This report to Congress included a 

detailed analysis of the significant level of effort required to address the data collection and 

reporting requirements for APS. Taken together, the evaluation and the demonstration grants will 

complement each other, and will advance efforts to develop innovative approaches and best 

practices that can then be disseminated to APS programs nationwide.

Output Table:

Adult Protective Services Output

Indicator Most Recent Result FY 2011 

Projection 

FY 2012 

Projection 

FY 2012 

+/- FY 2010

Output AP.1: Design Adult Protective 

Service evaluation to develop and test 

appropriate methods of addressing elder 

abuse, neglect and exploitation.

N/A N/A Baseline N/A
ADULT PROTECTIVE SERVICES STATE DEMONSTRATIONS

116

PAGE INTENTIONALLY LEFT BLANK
Long-Term Care Ombudsman Program

FY 2010

Appropriation

FY 2011

Continuing 

Resolution

FY 2012

Budget 

Request

FY 2012 +/- FY 

2010

Long-Term Care Ombudsman 

Program................................................................ $16,825,000 . $16,827,000 $21,825,000 +$5,000,000

Authorizing Legislation: Section 712 of the Older Americans Act of 1965, as amended

FY 2012 Older Americans Act Authorization................................................................... Expired

Allocation Method ..........................................................Formula Grants and Competitive Grants

Program Description and Accomplishments:

The Long-Term Care Ombudsman program is a consumer advocacy program that improves the 

quality of care for the estimated 2.5 million residents of over 66,000 long-term care facilities.62 

Formula grants to States and Territories based on the number of seniors age 60 and older provide 

funding for the training, travel, and other operating costs of nearly 10,000 ombudsman staff and 

certified volunteer ombudsmen, who resolve complaints on behalf of residents and routinely 

monitor the condition of long-term care facilities. 

Ombudsmen advocate on behalf of residents to ensure the protection of their rights and to ensure 

their welfare by representing their interests before government and administrative entities, 

providing information to residents and families about the long-term care system, and educating 

the general public about issues related to long-term care policies and regulations. The program 

enables States and communities to investigate and resolve complaints from residents and their 

caregivers related to improper action, inaction, or decisions which may have an adverse affect on 

the health, safety, welfare, or rights of long-term care facility residents. 

Outcome data (displayed in the summary tables at the end of this section) demonstrate the 

success of this program in protecting older Americans in an efficient and effective manner. In 

FY 2009, the number of ombudsmen consultations increased by six percent despite an increase 

in the number of nursing home beds per ombudsman FTEs (Outputs R and AH). Much of the 

efficiency of the Ombudsman Program is due to the strong reliance on volunteers who make up 

the bulk of those who resolve these issues – there was a ratio of seven volunteers to one paid 

staff (FTE) in FY 2009 for this program (the most recent year for which this data is available). 

The percentage of the complaints processed by ombudsmen that were fully or partially resolved 

to the satisfaction of the resident has consistently remained above 75 percent, demonstrating both 

the efficiency of the program and its ability to produce positive outcomes for seniors (Output Q),

 

62 Shaughnessy, Carol V. The Role of Ombudsmen in Assuring Quality for Residents of Long-Term Care Facilities: 

Straining to Make Ends Meet. National Health Policy Forum. December 9, 2009. 

http://www.nhpf.org/library/details.cfm/2767
LONG-TERM CARE OMBUDSMAN PROGRAM

118

FY 2009 output data for the Long-Term Care Ombudsman Program highlights the 

accomplishments achieved by this program and the important role that ombudsmen play in 

ensuring that the rights of long-term care facility residents are respected: 

Over 1,200 staff and 8,600 certified volunteer ombudsmen regularly visited residents in 

over 37,000 facilities, more than 80 percent of all nursing home facilities and nearly 

50 percent of all licensed board and care facilities (Output S). At least another 

2,000 volunteers support these paid staff and certified volunteer ombudsmen.

Ombudsmen investigated and worked to resolve 233,025 complaints (Output Q). 

Ombudsmen provided over 483,000 consultations to individuals and facility managers 

and staff on such topics as residents’ rights, staffing levels, malnutrition, dementia care, 

depression, discharge procedures, financial exploitation and strategies to reduce the use 

of restraints and prevent the abuse and neglect of residents (Output R).

Funding History:

Funding for the Long-term Care Ombudsman Program during the past five years is as follows:

FY 2007............................................... $15,010,000

FY 2008............................................... $15,577,000

FY 2009............................................... $16,327,511

FY 2010............................................... $16,825,000

FY 2011 CR......................................... $16,827,000

Budget Request:

The FY 2012 request for the Long-Term Care Ombudsman program is $21,825,000, an increase 

of +$5,000,000 above the FY 2010 enacted level. 

The number of older Americans is increasing rapidly. This is particularly true among the 

population age 85 and older. As a percentage of the population, the number of older Americans 

age 85 and older is growing faster than any other age cohort and is projected to reach nearly 

20 million by the year 2030. As this population grows, the need for safe, high-quality long-term 

care services will increase greatly. From 1990-2002 the number of licensed residential care and 

nursing home beds increased by 104 percent and continues to rise.63 The resulting need for 

consumer advocates to protect residents’ rights and to ensure the quality of residential long-term 

care will only increase.

 

63 Harrington, et al. Trends in the Supply of Long-Term Care Facilities. Journal of Applied Gerontology, Vol. 24, 

No. 4, 265-282 (2005).
LONG-TERM CARE OMBUDSMAN PROGRAM

119

In order to ensure the continued safety and quality of residential long-term care, the FY 2012 

request of $21,825,000 includes an additional $5,000,000 to provide the additional support that 

the Ombudsman program needs to continue its essential consumer advocacy efforts. The 

FY 2012 request represents an important element of AoA’s enhanced focus on elder rights, 

which expands and improves upon AoA’s successful elder rights programs to create a full array 

of services to prevent, detect, and resolve elder abuse, neglect, and exploitation. The proposed 

increase of $5,000,000 would be distributed through formula grants, consistent with the Older 

Americans Act, to fund interventions which would proactively address potentially problematic 

conditions before they occur, resulting in a projected decrease in the number of complaints per 

long-term care facility to 3.2 (Outcome 2.12); an increase in the capacity of Ombudsman 

programs to provide a projected 500,000 consultations (Output R); and an increased ombudsman 

presence in long-term facilities by increasing the total number of facilities visited regularly to 

37,000 (Output S). These improvements would occur despite the anticipated challenge of 

operating during a period of State and local budget cuts. 

As the complete performance summary demonstrates, State and local budget cuts resulting from 

the economic downturn have had an impact on the overall outcome and output measures of the 

Ombudsman program. Despite these setbacks, the Ombudsman program continues to provide the 

effective resident advocacy that older Americans need to live safe, high-quality lives in longterm care facilities. 

Outcomes and Outputs Table:

Long-Term Care Ombudsman Program Outcomes and Outputs

Measure Most Recent Result FY 2011 

Target 

FY 2012 

Target 

FY 2012 

+/- FY 2010

2.12: Decrease the average number of 

complaints per LTC facility (Outcome)

FY 2009: 3.4 3.9 3.2 -.70

2.13: Decrease the percentage of 

complaints for abuse, gross neglect, and 

exploitation in nursing homes (Outcome)

FY 2009: 20.44% 19.5% 18.5% -1.0%

Indicator Most Recent Result FY 2011 

Projection 

FY 2012 

Projection 

FY 2012 

+/- FY 2010

Output Q: Decrease the Number of 

Complaints (Output) FY 2009: 233,025 230,000 225,000 -5,000

Output R: Number of Ombudsman 

Consultations (Output) FY 2009: 483,306 490,000 500,000 +10,000

Output S: Facilities regularly visited not in 

response to a complaint (Output) FY 2009: 37,202 35,000 37,000 +2,000

Output AH: Decrease the number of 

nursing home beds per Ombudsman FTE 

(Output) 64

 FY 2009: 1,444 1,588 1,588 --

 

64 This measure was previously incorrectly worded as ―Increase the number of Ombudsman FTE per bed.‖ The 

corrected language more accurately describes the measure.
LONG-TERM CARE OMBUDSMAN PROGRAM

120

Grant Awards Table:

Long-Term Care Ombudsman Program Grant Awards

FY 2010 

Enacted

FY 2011 

Continuing 

Resolution

FY 2012 

Request

Number of 

Awards 56 56 56

Average Award $299,811 $297,477 $385,835

Range of 

Awards

$10,439 -

$1,703,142

$10,412 -

$1,684,326

$13,504 -

$2,184,608
LONG-TERM CARE OMBUDSMAN PROGRAM

121

DEPARTMENT OF HEALTH AND HUMAN SERVICES

ADMINISTRATION ON AGING

FY 2012 DISCRETIONARY STATE FORMULA GRANTS

PROGRAM: Long-Term Care Ombudsman Program (CFDA 93.042)

State/Territory

FY 2010

Actual

FY 2011

Continuing 

Resolution

FY 2012 

Request

Difference

+/-FY 2010

Alabama ........................................ 264,292 260,816 338,284 77,468 

Alaska ........................................... 83,947 83,294 108,034 24,740

Arizona.......................................... 352,186 346,250 449,093 102,843

Arkansas........................................ 167,058 164,724 213,650 48,926

California ...................................... 1,703,142 1,684,326 2,184,608 500,282 

Colorado ................................. 222,532 226,039 239,178 67,139 

Connecticut.............................. 197,313 195,462 253,518 58,056

Delaware................................. 83,947 83,294 108,034 24,740

District of Columbia .................. 83,947 83,294 108,034 24,740

Florida.................................... 1,249,006 1,219,737 1,582,027 362,290

Georgia................................... 426,175 427,420 554,373 126,953

Hawaii.................................... 83,947 83,294 108,034 24,740

Idaho...................................... 83,947 83,294 108,034 24,740

Illinois.................................... 647,031 639,974 830,061 190,087

Indiana ................................... 335,450 333,095 432,032 98,937

Iowa....................................... 177,244 173,073 224,480 51,407

Kansas.................................... 149,063 146,207 189,634 43,427

Kentucky................................. 235,478 231,947 300,840 68,893

Louisiana ................................ 225,227 224,924 291,732 66,808

Maine..................................... 83,947 83,294 108,034 24,740

Maryland................................. 286,666 285,884 370,798 +84,914

Massachusetts .......................... 358,952 359,762 466,620 106,858

Michigan................................. 541,752 541,407 702,217 160,810

Minnesota ............................... 268,281 268,872 348,734 79,862

Mississippi .............................. 153,463 151,078 195,951 44,873

Missouri.................................. 330,143 327,994 425,416 97,422

Montana.................................. 83,947 83,294 108,034 24,740

Nebraska................................. 96,755 94,728 122,864 28,136

Nevada ................................... 128,482 128,083 166,127 38,044

New Hampshire ........................ 83,947 83,294 108,034 24,740
LONG-TERM CARE OMBUDSMAN PROGRAM

122

PROGRAM: Long-Term Care Ombudsman Program (CFDA 93.042)

State/Territory

FY 2010

Actual

FY 2011

Continuing 

Resolution

FY 2012 

Request

Difference

+/-FY 2011

New Jersey .............................. 473,225 468,527 607,691 139,164

New Mexico ............................ 105,123 103,990 134,878 30,888

New York................................ 1,069,764 1,052,277 1,364,828 312,551

North Carolina.......................... 482,691 487,368 632,127 144,759

North Dakota ........................... 83,947 83,294 108,034 24,740

Ohio....................................... 641,831 640,872 831,226 190,354

Oklahoma................................ 201,454 197,849 256,615 58,766

Oregon ................................... 212,847 212,735 275,922 63,187

Pennsylvania............................ 766,140 760,281 986,102 225,821

Rhode Island............................ 83,947 83,294 108,034 24,740

South Carolina.......................... 252,516 254,737 330,400 75,663

South Dakota ........................... 83,947 83,294 108,034 24,740

Tennessee................................ 343,717 342,367 444,058 101,691

Texas ..................................... 1,045,289 1,043,148 1,352,987 309,839

Utah....................................... 102,099 101,393 131,509 30,116

Vermont.................................. 83,947 83,294 108,034 24,740

Virginia .................................. 397,554 395,088 512,439 117,351

Washington.............................. 335,165 335,722 435,439 99,717

West Virginia........................... 116,871 115,329 149,584 34,255

Wisconsin ............................... 306,821 304,000 394,295 90,295

Wyoming ................................ 83,947 83,294 108,034 24,740

 

Subtotal, States.............................. 16,460,109 16,330,307 21,180,779 4,850,472

American Samoa....................... 10,493 10,412 13,504 3,092

Guam ..................................... 41,974 41,647 54,017 12,370

Northern Mariana Islands............ 10,493 10,412 13,504 3,092

Puerto Rico.............................. 224,389 224,305 290,929 66,624

Virgin Islands........................... 41,974 41,647 54,017 12,370

 

Subtotal, States and Territories....... 16,789,432 16,658,730 21,606,750 4,817,318

 

Undistributed 65/ .......................... 35,568 168,270 218,250 182,682

 

TOTAL 16,825,000 16,827,000 21,825,000 5,000,000

 

65/ Funds held for statutory related requirements are reflected in the undistributed line.
Prevention of Elder Abuse and Neglect

FY 2010

Appropriation

FY 2011

Continuing 

Resolution

FY 2012

Budget 

Request

FY 2012 +/-

FY 2010

Prevention of Elder Abuse and 

Neglect ................................................................ $5,055,000 . $5,056,000 $5,055,000 --

Authorizing Legislation: Section 721 of the Older Americans Act of 1965, as amended

FY 2012 Authorization..................................................................................................... Expired

Allocation Method .................................................................................................Formula Grant

Program Description and Accomplishments:

The Prevention of Elder Abuse and Neglect program provides State formula grants for training 

and education, promoting public awareness of elder abuse, and supports State and local elder 

abuse prevention coalitions and multi-disciplinary teams. These activities are important elements 

of AoA’s enhanced focus in FY 2012 on elder justice. The program coordinates activities with 

State and local adult protective services programs (over half of which are directly administered 

by State Units on Aging) and other professionals who work to address issues of elder abuse and 

elder justice. The importance of these services at the State and local level is demonstrated by the 

fact that States significantly leverage Older Americans Act (OAA) funds to obtain other funding

for these activities, including Social Services Block Grant and State General Funds. In FY 2009

over $35 million of the Elder Abuse Prevention services expenditures came from non-OAA 

funds, a ratio of approximately $7 of non-OAA funds for every $1 investment of AoA funds.

Examples of State elder abuse prevention activities include:

In Kentucky, the statewide network of Local Coordinating Councils on Elder Abuse has 

developed ―Visor Cards‖ for law enforcement officers, which contain contact information 

and resource information to assist victims of elder abuse. Kentucky also produced 

―Fraud Fighter‖ forms that were distributed to thousands of seniors to help in the 

prevention of exploitation and scam artists. Other public awareness activities included 

renting billboards with elder abuse awareness messages and the State reporting number, 

hosting community trainings on the various forms of elder abuse, as well as other events 

and items to raise awareness in communities.

Lifespan, out of Rochester, New York, used OAA funding to support training of 

non-traditional reporters, such as hairdressers, store clerks, and others who have frequent 

contact with the elderly, on what to look for and how to report suspected cases of elder 

abuse. Additionally, a series of television ads were developed and aired, which have 

resulted in an increased awareness of the problem of elder abuse.
PREVENTION OF ELDER ABUSE AND NEGLECT

124

The Wisconsin Bureau of Aging and Disability Resources developed, in collaboration 

with the National Clearinghouse on Later Life, information designed to raise awareness 

of caregivers who have experienced abuse in the family, as well as of the risks and signs 

of abuse in later life, or ―domestic violence grown old.‖ The information was distributed 

statewide and is available at http://dhfs.wisconsin.gov/aps/Publications/publications.htm.

The Prevention of Elder Abuse and Neglect program demonstrates AoA’s ongoing commitment 

to protecting the rights of vulnerable seniors and promoting their dignity and autonomy. 

Through education efforts, exposing problems that would otherwise be hidden from view, and 

providing a voice for those who cannot act for themselves, the program helps ensure that all 

older Americans are able to age with dignity in a safe environment. 

Funding History:

Funding for Prevention of Elder Abuse and Neglect during the past five years is as follows:

FY 2007................................................. $5,146,000

FY 2008................................................. $5,056,000

FY 2009................................................. $5,056,000

FY 2010................................................. $5,055,000

FY 2011 CR........................................... $5,056,000

Budget Request and Anticipated Accomplishments:

The FY 2012 request for the Prevention of Elder Abuse and Neglect program is $5,055,000, the 

same as the FY 2010 enacted amount. This funding will be distributed to the states as formula 

grants, consistent with the Older Americans Act. 

The FY 2012 request will maintain the ability of States and Territories to train law enforcement 

officials, develop and distribute educational materials, conduct public awareness campaigns, and 

create community coalitions and multidisciplinary teams to investigate and respond to elder 

abuse and neglect. States and AAAs also use this funding to coordinate their activities with 

fraud and crime prevention partnerships organized by sheriffs, police chiefs, and community 

organizations. 

These activities are important elements of AoA’s enhanced focus in FY 2012 on elder justice, 

which seeks to improve upon AoA’s successful elder rights programs, including the Prevention 

of Elder Abuse and Neglect program. This enhanced focus will allow the creation of a full array 

of services to protect elder rights and prevent, detect, and resolve elder abuse, neglect, and 

exploitation. 
PREVENTION OF ELDER ABUSE AND NEGLECT

125

Output Table:

Prevention of Elder Abuse and Neglect Output

Indicator Most Recent Result FY 2010

Projection 

FY 2012 

Projection 

FY 2012 

+/- FY 2011

Output U: Elder Abuse prevention nonOAA service expenditures (Output, 

results in thousands)

 FY 2009: $19,365 $17,992 $20,000 +$2,008

Grant Awards Table:

Prevention of Elder Abuse, Neglect, and Exploitation Grant Awards

FY 2010 

Enacted

FY 2011 

Continuing 

Resolution

FY 2012 

Request

Number of 

Awards 56 56 56

Average Award $89,383 $97,356 $115,034

Range of 

Awards

$3,128 -

$501,013

$3,407 -

$553,052

$4,026 -

$653,479
PREVENTION OF ELDER ABUSE AND NEGLECT

126

DEPARTMENT OF HEALTH AND HUMAN SERVICES

ADMINISTRATION ON AGING

FY 2012 DISCRETIONARY STATE FORMULA GRANTS

PROGRAM: Prevention of Elder Abuse, Neglect, and Exploitation (CFDA 93.041)

State/Territory

FY 2010

Actual

FY 2011

Estimate

FY 2012 

Request

Difference

+/-FY 2010

Alabama ........................................ 78,707 77,249 77,222 (1,485)

Alaska ........................................... 25,224 25,027 25,022 (202)

Arizona.......................................... 104,883 102,553 102,518 (2,365)

Arkansas........................................ 49,751 48,788 48,771 (980)

California ...................................... 507,205 498,865 498,694 (8,511)

Colorado........................................ 66,271 66,949 66,926 655 

Connecticut ................................... 59,907 59,907 59,907 --

Delaware ....................................... 25,224 25,027 25,022 (202)

District of Columbia ...................... 25,224 25,027 25,022 (202)

Florida........................................... 371,960 361,264 361,140 (10,820)

Georgia.......................................... 126,917 126,594 126,551 (366)

Hawaii........................................... 25,224 25,027 25,022 (202)

Idaho............................................. 25,224 25,027 25,022 (202)

Illinois........................................... 197,384 197,384 197,384 --

Indiana .......................................... 99,899 98,657 98,623 (1,276)

Iowa .............................................. 55,927 55,927 55,927 --

Kansas........................................... 45,843 45,843 45,843 --

Kentucky....................................... 70,126 68,698 68,675 (1,451)

Louisiana....................................... 68,518 68,518 68,518 --

Maine............................................ 25,224 25,027 25,022 (202)

Maryland....................................... 85,371 84,674 84,645 (726)

Massachusetts................................ 109,606 109,606 109,606 --

Michigan ....................................... 161,337 160,862 160,862 (475)

Minnesota...................................... 79,895 79,635 79,608 (287)

Mississippi .................................... 45,702 45,198 45,198 (504)

Missouri ........................................ 98,318 97,643 97,643 (675)

Montana ........................................ 25,224 25,027 25,022 (202)

Nebraska ....................................... 29,770 29,770 29,770 --

Nevada .......................................... 38,263 37,936 37,923 (340)

New Hampshire............................. 25,224 25,027 25,022 (202)
PREVENTION OF ELDER ABUSE AND NEGLECT

127

PROGRAM: Prevention of Elder Abuse, Neglect, and Exploitation (CFDA 93.041)

State/Territory

FY 2010

Estimate

FY 2011

Estimate

FY 2012 

Request

Difference

+/-FY 2010

New Jersey .................................... 143,950 143,950 143,950 --

New Mexico .................................. 31,306 30,800 30,790 (516)

New York...................................... 318,581 318,066 318,066 (515)

North Carolina............................... 143,748 144,349 144,300 552 

North Dakota ................................. 25,224 25,027 25,022 (202)

Ohio .............................................. 197,185 197,185 197,185 --

Oklahoma...................................... 60,208 60,208 60,208 --

Oregon .......................................... 63,387 63,008 62,987 (400)

Pennsylvania.................................. 242,944 242,944 242,944 --

Rhode Island.................................. 25,224 25,027 25,022 (202)

South Carolina............................... 75,200 75,448 75,423 223 

South Dakota ................................. 25,224 25,027 25,022 (202)

Tennessee...................................... 102,361 101,403 101,368 (993)

Texas............................................. 311,293 308,961 308,855 (2,438)

Utah .............................................. 30,406 30,030 30,020 (386)

Vermont ........................................ 25,224 25,027 25,022 (202)

Virginia ......................................... 118,394 117,018 116,978 (1,416)

Washington ................................... 99,814 99,435 99,401 (413)

West Virginia ................................ 36,736 36,736 36,736 --

Wisconsin...................................... 91,373 90,309 90,309 (1,064)

Wyoming....................................... 25,224 25,027 25,022 (202)

Subtotal, States.............................. 4,908,148 5,344,991 6,315,572 (39,598)

American Samoa............................ 3,153 3,128 3,128 (25)

Guam ............................................ 12,612 12,514 12,511 (101)

Northern Mariana Islands............... 3,153 3,128 3,128 (25)

Puerto Rico.................................... 66,824 66,435 66,412 (412)

Virgin Islands................................ 12,612 12,514 12,511 (101)

Subtotal, States and Territories....... 5,044,712 5,005,440 5,004,450 (40,262)

 

Undistributed 66/ .......................... 10,540 50,560 50,550 +40,010

TOTAL 5,055,252 5,056,000 5,055,000 (252)

 

66/ Funds held for statutory related requirements are reflected in the undistributed line.
PREVENTION OF ELDER ABUSE AND NEGLECT

128

PAGE INTENTIONALLY LEFT BLANK
Senior Medicare Patrol Program

FY 2010

Appropriation

FY 2011

Continuing 

Resolution

FY 2012

Budget 

Request

FY 2012 +/- FY 

2010

Senior Medicare Patrol Program............................. $13,217,000 $12,751,000 $12,750,000 -$467,000

Healthcare Fraud and Abuse 

Campaign (non-add))............................................. $3,779,000 $3,312,000 $3,312,000 -$467,000

FTE*.....................................................................7 8 8 +1

*FTE are funded out of HCFAC funds.

Authorizing Legislation: Sections 201 and 202 of the Older Americans Act of 1965, as amended

FY 2012 Authorization..................................................................................................... Expired

Allocation Method .................................................................................................Formula Grant

Program Description and Accomplishments:

The Senior Medicare Patrol (SMP) program provides competitive grants to 54 States and 

Territories to support a national volunteer-based network for the purposes of preventing and 

identifying healthcare fraud and abuse. As a program of growing importance to the 

Department’s ongoing fraud prevention activities in conjunction with the Patient Protection and 

Affordable Care Act (P.L. 111-148), AoA is proposing a FY 2012 budget requests that 

strengthens the Senior Medicare Patrol program by converting it to a formula-based grant 

program that will provide a dedicated source of funding while expanding the number of States 

and Territories in which the program operates.

The SMP program serves a unique role in the Department’s fight to identify and prevent 

healthcare fraud in the Medicare and Medicaid programs. Projects use the skills of retired 

professionals as volunteers to conduct community outreach and education and provide toolkits 

that empower beneficiaries and their families to recognize and report suspected cases of 

Medicare and Medicaid fraud. Activities are carried out in partnership with the Centers for 

Medicare & Medicaid Services, the Office of Inspector General (OIG), healthcare providers, and 

other aging and elder rights professionals from around the country.

OIG collects performance data from the SMP projects semiannually. The most recent report, 

dated May 19, 2010, documented the following program outputs and outcomes for the calendar 

year 2009. Data show SMP projects:

Maintained 4,444 active volunteers who worked over 122,000 hours to educate 

beneficiaries about how to prevent Medicare and Medicaid fraud;
SENIOR MEDICARE PATROL PROGRAM

130

Educated 217,227 beneficiaries in 7,177 group education sessions and held 

33,855 one-on-one counseling sessions; 

Conducted 5,684 community outreach education events;

Received 60,242 inquiries for information or assistance from beneficiaries and resolved 

over 99 percent; 

Resolved or referred for further investigation over 4,000 complaints of potential fraud, 

error, or abuse from beneficiaries, their families, or caregivers as a result of educational 

efforts; and 

In addition, the OIG reports that since the program’s inception 12 years ago, SMP projects have:

Educated 2.8 million beneficiaries in 74,668 group education sessions and 

1,042,098 one-on-one sessions; 

Conducted 68,831 community outreach education events; and 

Documented over $105.94 million in savings, including Medicare and Medicaid funds 

recovered, beneficiary savings, and other savings as directly attributable to the project as 

a result of beneficiary complaints. This does not attempt to quantify the savings that may 

occur as a result of SMP program’s impact on fraud deterrence, which are believed to be 

substantial.

Healthcare Fraud and Abuse Control (HCFAC) Funds:

The Health Insurance Portability and Accountability Act of 1996 (HIPAA) created the Health 

Care Fraud and Abuse Control (HCFAC) Program to combat fraud and abuse in health care. 

Under HIPAA, recoveries from health care investigations are set aside in the Medicare Trust 

Fund and distributed at the joint discretion of the Secretary and Attorney General to finance antifraud activities. The SMP program historically has been supported by about $3.2 million in 

HCFAC funding for infrastructure, technical assistance, and other SMP program support and 

capacity-building activities designed to enhance program effectiveness. This includes support for 

project training and technical assistance provided by AoA’s National Consumer Technical 

Resource Center (Center). The Center’s website is maintained as a comprehensive ―one stop‖ 

resource that contains information including current fraud alerts and consumer information, an 

SMP program locator, and the latest best practices information. 

In the past year, the critically important role of the SMP program was recognized by partners in 

Medicare fraud prevention in the private and public sectors. First, the Centers for Medicare & 

Medicaid Services (CMS) announced the award of $9 million in grants to help more than 50 

Senior Medicare Patrol (SMP) programs fight Medicare fraud. This action by CMS is in support 

of President Obama’s mandate to educate seniors and other Medicare beneficiaries about how to 

prevent fraud in Medicare.
SENIOR MEDICARE PATROL PROGRAM

131

More recently, in November 2010, AoA received a national level commendation for the SMP 

program. The National Health Care Anti-Fraud Association (NHCAA), considered the leading 

national organization focused exclusively on the fight against health care fraud, bestowed this 

honor upon AoA and the SMP program. The NHCAA’s members comprise more than 100 

private health insurers and those public sector law enforcement and regulatory agencies having 

jurisdiction over health care fraud committed against both private payers and public programs.

This award is given annually by the NHCAA to an organization or individuals ―who have done 

the most in the past year to raise public awareness about the problem of health care fraud in our 

nation’s health care system.‖ This organization’s decision to award the Administration on 

Aging’s (AoA) Senior Medicare Patrol (SMP) program the NHCAA 2010 Excellence in Public 

Awareness Award is a major achievement, and a notable acknowledgement of the value of the 

SMP program.

Funding History:

Comparable funding for the Senior Medicare Patrol Program is as follows:

FY 2007............................................... $12,718,000

FY 2008............................................... $12,718,000

FY 2009............................................... $12,718,000

FY 2010............................................... $13,217,000

FY 2011 CR......................................... $12,751,000

All years include discretionary appropriations as well as mandatory HCFAC funds.

Budget Request and Anticipated Accomplishments:

The FY 2012 request for the Senior Medicare Patrol (SMP) program is $12,750,000, a reduction 

of -$467,000 from the FY 2010 enacted level. This includes mandatory HCFAC funds in the 

amount of $3,312,000, for a total discretionary request of $9,438,000, the same as in FY 2010. 

This amount will enable AoA to continue the proven fraud prevention activities of the SMP 

program at a time when the Department’s fraud prevention and healthcare program integrity 

efforts have become essential components of the implementation of the Affordable Care Act. 

The SMP program continues to demonstrate its effectiveness even as State and local funding cuts 

have resulted in 5 percent fewer program volunteers in 2009. Despite these challenges, the total 

savings to Medicare, Medicaid, beneficiaries, and others were over three times higher in 2009 

than 2008.67 

Since the program’s inception, SMP projects have educated over 3.84 million beneficiaries and 

received over 170,000 complex issues (complaints) from beneficiaries who have detected billing 

 

67 May 2010 Performance Report for the Senior Medicare Patrol Projects, OEI-02-10-00100. 

http://www.oig.hhs.gov/oei/reports/oei-02-10-00100.pdf
SENIOR MEDICARE PATROL PROGRAM

132

or other discrepancies based on that information. While SMPs make numerous referrals of 

potential fraud to CMS program integrity contractors, there is no mechanism for tracking the 

actions (investigation, prosecution, collection) required to realize actual savings to the 

government as a result of these referrals. Therefore, it is not possible to directly track the 

outcome of most of the cases reported and dollars recovered as a result of SMP program 

activities. Moreover, the impact of the SMP program’s primary activities - education of 

beneficiaries to prevent health care fraud - is difficult to measure and nearly impossible to 

quantify in dollars and cents. As the OIG indicated in the May 2010 report:

―We continue to emphasize that the number of beneficiaries who have learned 

from the Senior Medicare Patrol Projects to detect fraud, waste, and abuse and 

who subsequently call the OIG fraud hotline or other contacts cannot be 

tracked....In addition, the projects are unable to track substantial savings 

derived from a sentinel effect, whereby fraud and errors are reduced in light of 

Medicare beneficiaries scrutiny of their bills.‖ 

Despite these evaluation challenges, the SMP program has documented nearly $106 million in 

savings to Medicare, Medicaid, program beneficiaries, and others since its inception in 1997, 

excluding any deterrent effect. During that same period, the program has educated over 

2.8 million beneficiaries through the work of 19,467 volunteers who contributed a combined 

543,805 hours of their time to preventing, detecting and reporting suspected incidents of fraud 

and educating and training community members about fraud prevention. 

The FY 2012 request of $12,717,000 will improve the ability of the SMP program to prevent, 

detect, and report incidents of fraud and thereby increase the total dollar amount of fraud that is 

reported to the authorities for further action. The FY 2012 request will provide a projected 

increase of $1 million dollars in fraud reported for further action despite an anticipated overall 

decrease in total program funding resulting from State and local budget cuts. 

Outcome Table:

Senior Medicare Patrol Outcome

Indicator Most Recent Result FY 2011 

Target 

FY 2012 

Target 

FY 2012 

+/- FY 2010

1.5: SMP project will increase the total 

dollar amount referred for further action 

(Outcome)

FY 2009: 

$3.76 million 

(Target Exceeded)

$4 million $5 million +$1 million
Elder Rights Support Activities

FY 2010

Appropriation

FY 2011

Continuing 

Resolution

FY 2012

Budget 

Request

FY 2012 +/- FY

2010

Elder Rights Support Activities.............................. $4,103,000 $4,104,000 $4,103,000 --

Authorizing Legislation: Sections 201, 202, and 411 of the Older Americans Act of 1965, as 

amended, and Section 6703 of the Affordable Care Act, Subtitle B, Section 2042 

FY 2012 Older Americans Act Authorization................................................................... Expired

FY 2012 Affordable Care Act Authorization ............................................................... Such Sums

Allocation Method ............................Competitive Grants/Cooperative Agreements and Contracts

Program Description and Accomplishments:

Elder Rights Support Activities consists of a combination of programs and resource centers that 

provide the necessary information, training, and technical assistance support that AoA and States 

need to fulfill their shared mission to maintain the health and independence of older Americans 

by preventing, detecting, and responding to elder abuse, neglect, and exploitation. The 

combination of legal systems development and assistance programs, the National Center on 

Elder Abuse, and the National Long-Term Care Ombudsman Resource Center create a 

supportive framework for AoA’s Protection of Vulnerable Adults programs. The Elder Rights 

Support Activities described below are essential components of AoA’s ongoing elder rights 

programs:

Model Approaches to Statewide Legal Assistance Systems 

Model Approaches to Statewide Legal Assistance Systems helps States develop and implement 

cost-effective, replicable approaches for integrating senior legal helplines into the broader 

tapestry of state legal service delivery networks. The cornerstone of these projects is legal

helplines, which assist seniors in accessing quality legal services to ensure their rights and 

financial security, and to enhance their choice and independence. By ensuring strong leadership 

at the State level, Model Approaches projects create linkages within the existing legal assistance 

community and services providers and professionals in the broader community-based aging and 

elder rights networks, including AAAs, Aging and Disability Resource Centers, State 

Long-Term Care Ombudsmen, and Adult Protective Services. These linkages leverage the 

strengths of both elder rights and aging service networks for the provision of quality service to 

seniors most in need.
ELDER RIGHTS SUPPORT ACTIVITIES

134

National Legal Assistance and Support Projects

National Legal Assistance and Support grants fund a comprehensive national legal assistance 

support system serving professionals and advocates working in legal and aging services 

networks. These grants form the National Legal Resource Center which supports the leadership, 

knowledge, and systems capacity of legal and aging provider organizations in order to enhance 

the quality, cost effectiveness, and accessibility of legal assistance and elder rights protections 

available to older persons with social or economic needs. AoA is funding four projects which 

provide core support functions for aging and legal networks including case consultation, training, 

technical assistance/legal and aging systems development, and information development and 

dissemination.

National Center on Elder Abuse

To support and enhance the activities of State and local programs to prevent Elder Abuse, Neglect, 

and Exploitation, AoA funds the National Center on Elder Abuse (NCEA). NCEA disseminates 

information to professionals and the public and provides technical assistance and training to States 

and community-based organizations. The NCEA makes available news and resources; collaborates 

on research; provides consultation, education, and training; identifies and provides information about 

promising practices and interventions; answers inquiries and requests for information; operates a 

listserv forum for professionals; and advises on program and policy development. NCEA also 

facilitates the exchange of strategies for uncovering and prosecuting fraud in areas such as 

telemarketing and sweepstakes scams. In FY 2009, the NCEA:

 Continued its outreach by serving over 1,700 subscribers to its newsletter and over 

1,600 members to the Elder Abuse Listserv.

 Responded to over 1,000 individual public inquiries and requests for information.

 Effectively utilized technology to provide cost-effective trainings to over 1,177 professionals 

though live Webcast forums on issues relevant to elder rights and consumer protection, and 

maintained the NCEA training library with over 230 resources.

 Supported systems change in 12 local communities by providing funding, training, and 

technical assistance to new elder justice community coalitions to leverage local resources and 

expertise to prevent and combat elder abuse, neglect, and exploitation.

National Long-Term Care Ombudsmen Resource Center

The National Long-Term Care Ombudsman Resource Center provides training and technical 

assistance to support the activities of State and local long-term care ombudsmen. The Center 

works to enhance the skills, knowledge and management capacity of the statewide ombudsman 

programs to enable them to handle resident complaints and represent resident interests. The 

Center also provides information to consumers and links them to ombudsmen, who can help 

consumers navigate the long-term care system and resolve problems in nursing, board and care, 

and assisted living homes. 

Among other accomplishments, the Center’s FY 2009 outcomes included publication and 

distribution of Equipping Long-Term Care Ombudsmen for Effective Advocacy: A Basic 
ELDER RIGHTS SUPPORT ACTIVITIES

135

Curriculum; Self-Evaluation and Continuous Quality Improvement Tools for both State and local 

ombudsman programs; State and local ombudsman training at two national conferences and via 

web-based teleconferences; and continued high utilization (over 40,000 monthly visits) to the 

Center’s website by ombudsmen, consumers, and agencies.

Funding History:

Comparable funding for Elder Rights Support Activities is as follows:

FY 2007................................................. $3,560,877

FY 2008................................................. $3,498,790

FY 2009................................................. $4,104,000

FY 2010................................................. $4,103,000

FY 2011 CR........................................... $4,104,000

Budget Request and Anticipated Accomplishments:

The FY 2012 request for Elder Rights Support Activities is $4,103,000, the same as the FY 2010 

enacted amount. This request reflects the need to continue the current level of support services 

to support AoA’s enhanced focus on elder rights and elder justice, which expands and improves 

upon AoA’s successful elder rights programs to create a full array of services to prevent, detect, 

and resolve elder abuse, neglect, and exploitation. 

The National Center on Elder Abuse, the National Long-Term Care Ombudsman Resource 

Center, and the Statewide Model Approaches and Legal Assistance programs provide the 

technical assistance, information, resources, referrals, and legal systems development and 

assistance activities that support the efforts of the entire spectrum of Protection of Vulnerable 

Adults programs. Continued support for these programs and resource centers will provide the 

best and most efficient services and supports possible to support AoA’s efforts to promote elder 

rights and elder justice.
ELDER RIGHTS SUPPORT ACTIVITIES

136

Elder Rights Support Activities includes funding for the following projects:

Activity

FY 2010

Enacted

FY 2011

CR

FY 2012

Request 

Elder Rights Support Activities:

Model Approaches to Statewide Legal Assistance............................... $ 1,999,569 $ 2,000,000 $ 2,000,000

National Legal Assistance and Support Projects................................ 745,839 .. 746,000 745,000

National Center on Elder Abuse.......................................................... 811,000 811,000 811,000

National Long-Term Care Ombudsman Resource Center .................... 547,000 547,000 547,000

Total, Elder Rights Support Activities................................ $ ......... 4,103,408 $ 4,104,000 $ 4,103,000
Consumer Information, Access, and Outreach

Summary of Request

Older Americans and Americans with disabilities today face a vast array of choices when trying 

to determine the right services and supports to assist them to remain active and independent in 

their communities. As the number of opportunities available to assist them grows, so too does the 

complexity of navigating these programs and choosing among them so as to determine which 

best suit the needs of individuals. 

A key part of AoA’s emphasis on community living is providing consumers with the information 

they need to make decisions about their independence and in connecting consumers with the

right services. Aging and Disability Resource Centers and the State Health Insurance Assistance 

Programs help to address this need by providing information, outreach, and assistance to seniors 

and those with disabilities, in order that they receive the services necessary for their 

independence. ADRCs serve as community-level ―one stop shop‖ entry points into long-term 

care for people of all ages who have chronic conditions and disabilities. SHIPs provide one-onone counseling to help aging and disabled beneficiaries and coming-of-agers navigate complex 

health and long-term care-related topics. 

The FY 2012 request for these programs is $60,394,000, a reduction of $10,250,000 from the 

FY 2010 enacted levels.68 This request includes $13,434,000 ($10 million mandatory as per the 

Affordable Care Act) for Aging and Disability Resource Centers and $46,960,000 for the SHIPs.

In order to further streamline their functionality and increase efficiency, the FY 2012 proposes to 

bring SHIPs (currently administered by the Centers for Medicare & Medicaid Services) under 

AoA. The strong synergies created by the single administration of these often co-located 

programs will create greater efficiency in service delivery while providing more consistent 

information for consumers. The SHIPs program fits naturally within AoA’s mission of 

promoting community living, and will benefit from deeper connection to the aging services 

network from within AoA.

 

68 This does not include the $30,000,000 transfer of mandatory funds from the Federal Hospital Insurance Trust 

Fund and the Federal Supplementary Medical Insurance Trust Fund for benefits outreach to low-income seniors per 

section 3306 of P.L. 111-148 (Affordable Care Act).

 
138

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Aging and Disability Resource Centers

FY 2010

Enacted

FY 2011

Continuing 

Resolution

FY 2012 

Request

FY 2012 +/-

FY 2010

BA................................................................ $13,684,000 ......... $13,684,000 $3,434,000 -$10,000,000

Affordable Care Act................................ $10,000,000 ............... $10,000,000 $10,000,000 --

Total, Program Level................................ $23,684,000...... $23,684,000 $13,434,000 -$10,000,000

Total, FTE...................................................... 3 3 3 --

Authorizing Legislation: Section 202b of the Older Americans Act of 1965, as amended

Mandatory Appropriation: Section 2405 of the Affordable Care Act of 2010

FY 2012 Older Americans Act Authorization................................................................... Expired

Allocation Method .......................... Competitive Grants/Co-operative Agreements and Contracts

Program Description and Accomplishments:

Aging and Disability Resource Centers (ADRCs) support State efforts to develop more efficient, 

cost-effective, and consumer-responsive systems of consumer information and integrated access 

by creating ―one-stop shop‖ entry points into long-term care at the community-level, ranging 

from in-home services to institutional care. ADRCs help States make better use of taxpayer 

dollars by streamlining access to public services, diverting individuals from more costly services 

and supports, and helping to overcome duplication and fragmentation in the long-term care 

system.

ADRCs are a key component in transforming States’ long-term supports and services programs. 

Since 2003 AoA and CMS have provided grants to states to develop a foundational infrastructure 

for delivering person-centered systems of information, counseling, and access that make it easier 

for individuals to learn about and access their health and long-term services and support options. 

ADRCs grew out of best practice innovations known as ―No Wrong Door‖69 and ―Single Points 

of Entry‖ Programs, where people of all ages or disability may turn for objective information on 

their long-term services and support options.

ADRCs serve as integrated access point and ―No Wrong Door – Single Entry Point‖ system for 

individuals of all ages for information and access to the long-term services and support options 

they need. ADRCs provide services including:

 

69 In a ―No Wrong Door‖ entry system, multiple agencies retain responsibility for their respective services while 

coordinating with each other to integrate access to those services through a single, standardized entry process that is 

administered and overseen by a coordinating entity (Allison Armor-Garb, Point of Entry Systems for Long-Term Care: 

State Case Studies, prepared for the New York City Department of Aging, 2004).
AGING AND DISABILITY RESOURCE CENTERS

140

targeted discharge planning, care transition and diversion support that integrates the 

medical and social service systems on behalf of older adults and individuals with 

disabilities to help them remain in their own homes and communities after a hospital, 

rehabilitation or skilled nursing facility visit; 

―one-on-one‖ counseling and advice to help consumers and their caregivers fully 

understand the options available to them, including private pay individuals;

outreach and assistance to Medicare beneficiaries on their Medicare benefits including 

prevention and low-income subsidies;

streamlined access to all publicly supported long-term care services and support 

programs; and

integrated access-point to care transition and diversion support to veterans served through 

the AoA and Veterans Administration (VA) Veterans Directed Home and Community 

Based Services Program partnership.

Effective ADRCs are able to build upon the foundational infrastructure they have developed and 

perform the following five key operational functions:

 

Information, Referral and Awareness: ADRCs serve as a highly visible and trusted place 

that people know they can turn to for objective information on the full range of long term 

service and support options. ADRCs promote awareness of the various options, including 

Medicare benefits, that are available in the community, especially among underserved, 

hard-to-reach and private paying populations, as well as options individuals can use to 

―plan ahead‖ for their long-term care. ADRCs have the capacity to link consumers with 

needed services and supports – both public and private – through appropriate referrals to 

other agencies and organizations.

Options Counseling and Assistance: ADRCs provide counseling and decision support to 

consumers and their family members and/or caregivers by identifying and understanding 

the needs of the clients and assisting them in making informed decisions about 

appropriate long term service and support choices – including their Medicare options – in 

the context of their personal needs, preferences, values and individual circumstances.

 

Streamlined Eligibility Determinations for Public Programs: ADRCs serve as a single 

point of entry to publicly-funded long-term supports, including those funded by 

Medicaid, the Older Americans Act (OAA), and other State and Federal programs and 

services. ADRCs must have the necessary protocols and procedures in place to facilitate 

integrated and/or fully coordinated access (i.e., consumer intake, needs assessment, 

service or care planning, eligibility determination, and ensuring that people get the 

services they need) to publicly supported long-term services and supports – both 

community-based and institutional. The goal is to create a process that is seamless for 

consumers regardless of which service they choose. 
AGING AND DISABILITY RESOURCE CENTERS

141

Person-Centered Care Transitions: ADRCs create formal collaborations between and 

among the major pathways that are used in health care and long-term services and 

supports, including preadmission screening programs for nursing home services, hospital 

discharge planning, physician services, and various community agencies and 

organizations. These linkages ensure that people with chronic conditions and disabilities 

have the information they need to make informed decisions about their service and 

support options as they pass through critical transition points in the health and long-term 

services and support systems that cut across all payers and settings. These critical 

activities can help individuals break the cycle of readmission to the hospital and live 

longer in the community.

Quality Assurance and Continuous Improvement: ADRC must ensure that they are 

person centered and adhere to the highest standard of service in all areas. ADRCs should 

continually monitor the quality of their services and evaluate their own impact on 

consumers’ lives, system efficiencies and public costs. 

AoA and the Centers for Medicare & Medicaid Services (CMS) have invested over $100 million 

in the ADRC program since 2003. As a result of these investments: 

300 ADRC sites have been established across 50 states, 3 territories, and Washington, 

DC, often by expanding existing infrastructure in the aging services network such as 

AAAs, etc. Together these ADRC sites can reach roughly 51 percent of the U.S. 

population.

13 States and Territories are achieving statewide coverage and an additional 13 states 

are achieving 50 percent or more statewide coverage. 

25 States have developed statewide web-based directories available to consumers and 

service providers which improve the quality and consistency of the aging services 

network information and assistance provided across the state. 

Standards have been established to provide guidance to States on the desired end 

result of how an ADRC should perform. For example, the standards require that each 

ADRC has a plan for reducing the average time from initial contact to determination 

of their eligibility for public services.

In FY 2011, AoA, in partnership with CMS, will continue to support the 49 existing 

ADRC grants that are helping States continue to develop programs that reflect the 

five key operational functions specified above and implement plans to reach 

statewide coverage. AoA and CMS also plan to support the 16 existing grants funded 

in FY 2010 to help states further expand and enhance their ADRCs Person Centered 

Care Transitions function. Finally, utilizing the $10 million appropriated for FY 2011 

in the Affordable Care Act, AoA expects to award new competitive grants to 20 to 

25 states to further expand and enhance their ADRC’s Options Counseling and 

Assistance function, which will include activities to jointly develop with AoA and its 
AGING AND DISABILITY RESOURCE CENTERS

142

technical assistance partners minimum national standards for options counseling. 

AoA will also fund a technical assistance resource center to support these activities. 

As a result of these investments, in 2011 it is estimated that ADRCs will respond to 

over three million contacts to help individuals make better informed decisions about 

their health and long-term care options, with the vast majority of these decisions 

resulting in referrals for community-based services. 

Funding History:

Comparable discretionary funding for Aging and Disability Resource Centers is as follows:

FY 2007................................................. $4,516,000 0 FTE

FY 2008................................................. $2,250,000 0 FTE

FY 2009............................................... $13,577,000 3 FTE

FY 2010............................................... $13,684,000 3 FTE

FY 2011 CR......................................... $13,684,000 3 FTE

Note: Discretionary funding for ADRC activities was provided under Aging Network Support Activities in FY 2009 and 

FY 2010 and requested under Health and Long-term Care Programs in FY 2011.

Budget Request and Anticipated Accomplishments:

The FY 2012 discretionary budget request for Aging and Disability Resource Centers is 

$3,684,000, a reduction of -$10,000,000 from the FY 2010 enacted level. Offsetting this 

reduction, an additional $10,000,000 was appropriated to AoA in the Affordable Care Act 

(section 2405 of P.L. 111-148) for each year from FY 2010 to 2014 for ADRC activities. 

Beginning in FY 2012, funding for ADRCs is requested under a separate budget line, reflecting

redistribution of the Health and Long-term Care Programs line in the FY 2012 request. With 

ADRCs established in every State and increasingly statewide with their reach, AoA believes 

ADRCs represent a mature, scalable program.

Funding under this request will help ADRCs to build the infrastructure needed to support 

ongoing operations and create greater integration with the medical system

In FY 2012, AoA plans to make available competitive grants to all States and Territories to 

further develop ADRC programs to reach statewide coverage and ensure the five key operational 

functions of programs are at a fully-functional level. The two Territories that have not received 

ADRC grant funding to date (American Samoa and Virgin Islands) will have the opportunity to 

compete for funding to develop all five key operational functions of an ADRC. All other States 

and Territories will have the opportunity to compete for funding to further bolster their capacity 

in the areas of Options Counseling and Assistance, Streamlined Eligibility Determinations for 

Public Programs, and Person Centered Care Transitions as well as to continue roll-out of their 

plans to achieve statewide coverage (all states who received FY 2009 ADRC grants were 

required to develop 5-year plans starting no later than March 2011).
AGING AND DISABILITY RESOURCE CENTERS

143

Funds will also help continue to support AoA’s partnership with the Department of Veterans 

Affairs. In FY 2008, the Veterans Administration and AoA began working together to develop 

the Veterans Directed Home and Community Based Services Program (VDHCBS), which is 

designed to serve veterans of any age who are at risk of admission to a nursing home by 

providing them the opportunity to self-direct their care and access services to help them remain 

in the community. Rather than build a separate infrastructure to serve veterans, the Veterans 

Administration made a strategic decision to use the aging services network infrastructure –

including using the ADRC as the integrated access point to empower the veterans to set-up their 

own service plan for long-term supports and services – as a delivery vehicle for VDHCBS. In 

FY 2009 the Veterans Administration invested an additional $10 million in the implementation 

of VDHCBS and plans for continued funding in FY 2010. In FY 2009 and FY 2010, the 

implementation of VDHCBS is expected to expand to at least another 10 states, bringing the total 

number of states implementing VDHCBS to at least 20. AoA and the VA envision further 

expansion of the VDHCBS program in FY 2011, FY 2012, and into the future.

Evaluation

With ADRCs in place for nearly a decade, AoA believes it is appropriate to gather new 

information about the impact of ADRCs. AoA is partnering with the Agency for Healthcare 

Research and Quality and the Assistant Secretary for Planning and Evaluation to rigorously 

evaluate the effectiveness of ADRCs. In FY 2009, AoA initiated a design contract for the 

evaluation. In FY 2010, AoA began a roughly $2.1 million evaluation based on 

recommendations from the design contract. Completion of the evaluation may require the use of 

funds already requested in FY 2011, though currently AoA does not anticipate requiring 

FY 2012 funds for the evaluation. The results of this evaluation will influence future 

performance measures and indicators. 
AGING AND DISABILITY RESOURCE CENTERS

144

Outcome and Outputs Table:

Aging and Disability Resource Centers Outcome and Outputs

Note: For presentation within the budget AoA highlighted specific measures that are most directly related to Aging 

and Disability Resource Centers; however multiple performance outcomes are impacted by this program because 

AoA’s performance measures (efficiency, effective targeting, and client outcomes) assess network-wide 

performance in achieving current strategic objectives.

Measure Most Recent 

Result 

FY 2012 

Target 

FY 2012 

+/- FY 2010 

LTC.2: Percent of individuals 

who indicate ADRC information 

and counseling contribute to 

informed decision making 

(Outcome)

N/A TBD N/A

Indicator Most Recent 

Result 

FY 2012 

Projection 

FY 2012 

+/- FY 2010 

Output AF: Total number of 

ADRC contacts (Output)

FY 2010: 

2,857,387 3.25 M +392,613

Output AG: Increase in the 

number of ADRC pilot programs 

(Output)

FY 2010:

300 300 Maintain
State Health Insurance Assistance Programs

FY 2010

Enacted

FY 2011

Enacted

FY 2012 

Request

FY 2012 +/-

FY 2010

State Health Insurance 

Assistance Programs (SHIPs).................................

$46,960,000 $46,960,000 $46,960,000 --

FTE................................................................ -- ....... -- 5 +5

Authorizing Legislation: Section 4360 of the Omnibus Budget Reconciliation Act of 1990 

(42 U.S.C. 1395b-4).

FY 2012 Authorization..................................................................................................... Expired

Allocation Method ..................................................... Formula and Competitive Grants/Contracts

Program Description and Accomplishments:

State Health Insurance Assistance Programs (SHIPs) provide one-on-one counseling to help 

aging and disabled beneficiaries and coming-of-agers navigate complex health and long-term 

care-related topics. SHIP grants to States provide infrastructure, training, and outreach support to 

over 12,000 (mostly volunteer) counselors in over 1,300 community-based organizations in all 

50 States, the District of Columbia, Guam, Puerto Rico, and the Virgin Islands to strengthen their 

capacity to support a community-based network of State and local programs. Under the direction 

and support of State program directors and trainers, SHIP counselors receive extensive training 

and continuous ongoing information updates about health plan options, Medicare entitlement and 

enrollment, Medigap, long-term care insurance, Medicare prescription drug benefits, Medicaid, 

and preventive benefits.

The budget request proposes to transfer the SHIP program from the Centers for Medicare & 

Medicaid Services to the Administration on Aging. This transfer reflects the natural synergies 

between the SHIP programs and the aging services network. Of the 54 SHIP grant programs, 

about two-thirds are administered by state units on aging established by the Older Americans 

Act. Most of the remaining programs are administered by state insurance commissions. At the 

community level, many SHIPs are either housed in or create local partnerships with Area 

Agencies on Aging. Similarly, almost 50 percent of the SHIPs are co-located with the Senior 

Medicare Patrol program, which is administered by AoA. 

SHIP activities align with the AoA mission to develop a comprehensive, coordinated and costeffective system of home and community-based services that helps elderly individuals maintain 

their health and independence in their homes and communities. AoA has been a long-time 

collaborator with CMS in planning and coordinating SHIP activities. In 2007, bimonthly 

meetings between CMS and AoA to coordinate SHIP, SMP and ADRC were also initiated. 

Streamlining the SHIP program into AoA would be a natural extension of programs authorized 
STATE HEALTH INSURANCE ASSISTANCE PROGRAMS

146

through the Older Americans Act including, but not limited to Information and 

Referral/Assistance (I&R/A), Aging and Disability Resource Centers (ADRCs), and Benefits 

Counseling.

Funding History:

Comparable funding for the State Health Insurance Assistance Program is as follows:

FY 2007............................................... $34,187,538

FY 2008............................................... $54,300,000

FY 2009............................................... $52,500,000

FY 2010............................................... $46,960,000

FY 2011 CR......................................... $46,960,000

The following legislative action has taken place since FY 2008 which provided additional 

mandatory funding for the SHIPs:

The Medicare, Medicaid, and SCHIP Extension Act of FY 2007 (MMSEA) provided the 

SHIPs with an additional $15.0 million in FY 2008.

The Medicare Improvements for Patients and Providers Act of 2008 (MIPPA) provided 

the SHIPs with an additional $7.5 million in FY 2009.

The Affordable Care Act provides a total of $15 million to be distributed to states via 

formula grants in FY 2010 – FY 2012.

Budget Request and Anticipated Accomplishments:

The total SHIP budget request for FY 2012 is $46,960,000, the same as the FY 2010 enacted 

level. This includes funding for 5 FTE to administer the program. Funds will be used to make 

SHIP grants to States to continue the personalized counseling that they provide and to make 

further improvements, which are anticipated to include:

Increasing the number of community outreach in public forums to include disabled, 

elderly, and pre-retirees to raise awareness of long-term care related topics.

Increasing the number of individual client contacts to individuals on Medicare under the 

age of 65.

Tracking the number of individual client contacts of pre-retirees

Increasing the number of local and field counselors (paid and unpaid)

Increasing the number of individual personalized counseling sessions.
STATE HEALTH INSURANCE ASSISTANCE PROGRAMS

147

Due to AoA’s unique connections to the aging services network as well as the greater 

efficiencies leveraged by a single point of management of these locations which are often colocated with ADRCs, these increases are anticipated despite the lack of increased funding. Funds 

will also be used to provide administrative support for the SHIPs program.

The SHIP grant year runs from April 1 through March 31 each year. 

Outcomes and Outputs:

In grant year 2006, the total number of clients reached by SHIPs was 3.4 million. In grant year 

2007, the number was 4.2 million. In grant year 2008, the number was 5.2 million. As part of the 

proposed reassignment to AoA, further performance measures will be established and reported in 

future submissions.
STATE HEALTH INSURANCE ASSISTANCE PROGRAMS

148

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Program Innovations

FY 2010

Enacted

FY 2011

CR

FY 2012 

Request

FY 2012 +/-

FY 2010

Program Innovations................................ $27,874,000 ..............$27,879,000 $11,509,000 -$16,395,000

Health & Long-term Care 

Programs (non-add) ..............................................

$16,905,000 $16,905,000 -- --

Authorizing Legislation: Section 411 of the Older Americans Act of 1965, as amended

FY 2012 Authorization..................................................................................................... Expired

Allocation Method .......................... Competitive Grants/Co-operative Agreements and Contracts

Program Description and Accomplishments:

Program Innovations is intended to provide a source of funding for AoA to use as a catalyst for 

tapping new approaches, translating cutting-edge research and evaluation results into practice, 

and demonstrating techniques and best practices that can be replicated across the States and 

communities in the network. It also provides funds to address key AoA priorities to help seniors 

stay healthy, active, independent, and living in their own homes and communities.

These funds provide AoA with the flexibility to innovate and demonstrate practical methods that 

can then be more widely replicated by States and local communities to help strengthen and 

transform OAA core programs. Generally, these innovations are modeled after best practices 

developed within the aging services network that need further support, modeling, and evaluation 

before enabling widespread replication and adoption. This flexibility, for instance, provided the 

seed money for developing Aging and Disability Resource Centers and Evidence-Based Disease 

Prevention projects that are now being successfully implemented in locations across the nation.

Program Innovation grants also provide a vehicle for the exploration of emerging opportunities 

or risks facing seniors and caregivers where the aging services network has limited expertise. In 

these cases, universities, consumer-focused organizations, and other entities may be brought 

collaboratively into the aging network as technical assistance partners to assist with these 

emerging challenges. 
PROGRAM INNOVATIONS

150

Funding History:

Comparable funding for Program Innovations during the past five years is as follows:

FY 2007............................................... $16,533,998

FY 2008............................................... $23,464,781

FY 2009............................................... $19,546,000

FY 2010............................................... $27,874,000

FY 2011 CR......................................... $27,879,000

Budget Request:

The FY 2012 request for Program Innovations is $11,509,000, a decrease of -$11,365,000 from 

the FY 2010 appropriation. 

In recent years, AoA’s program innovations funds have been absorbed to fund ongoing health 

and long-term care programs and lacked the flexibility to address other new priorities. House 

and Senate appropriations committee reports and feedback in Older Americans Act 

reauthorization sessions have consistently called for AoA to fund several initiatives and activities 

that are not presently able to be supported due to the established commitments on these funds 

and standing directions on how they are to be used.

70

 For example, the FY 2012 Senate 

appropriations committee report again encourages AoA to focus on innovations in older adults 

and mental health and section 416 of the Older Americans Act regarding transportation.

With discontinuation of the Community Living Program (CLP) and the creation of a stand-alone 

budget line for Aging and Disability Resource Centers (ADRCs) and Chronic Disease Self 

Management Programs (CDMSP) in the FY 2012 request, AoA needs to rededicate funds to new 

areas of innovation intended to strengthen our core programs. As a result, the Health and Longterm Care Programs line has been eliminated with some of the funding that had previously been 

in this line redirected to elder rights and elder justice, new areas of innovations, and 

administrative needs.

These changes will allow $11 million in funds that previously supported the demonstration of the 

Health and Long-term Care Programs to now be dedicated to Program Innovations for 

exploration of the next series of innovation activities. Among the issues that AoA is interested in 

exploring are:

Best practices that address serious and growing problems of mental health, depression, 

and suicide among seniors. This will begin to address the Senate’s preferences for 

 

70 Program Innovations funding has historically supported a number of ongoing projects of national significance, 

including resource centers and other projects that are national in scope that have provided demonstrated benefits to 

elderly Americans. In FY 2009 to FY 2010, the totality of appropriated Program Innovations funding was devoted 

to these latter types of projects and the FY 2011 Senate mark continues this trend. In FY 2012, AoA has moved 

all of the projects of national significance, except for Community Innovations for Aging in Place, to either Elder 

Justice Support Activities or Aging Network Support Activities, consistent with their established nature of support 

to the aging services network. Those projects of national significance are comparatively funded in this budget. 
PROGRAM INNOVATIONS

151

innovations in mental health for older adults. Seniors face a disproportionate risk of 

suffering from mental illness or committing suicide, but this serious problem often does 

not receive the attention it urgently deserves. We anticipate that the aging services 

network likely has proven best practices for referrals to mental health clinics and other 

care programs for seniors that have not been studied, explored, or replicated.

Helping seniors to navigate the increasingly complex marketplace of new assistive 

technologies that address safety and/or health. A variety of devices have been developed 

and are being developed that claim to allow caregivers or others to monitor seniors’ 

health, location, or other needs and provide feedback or warnings in the event of an 

emergency. However, there is often limited information about how well such technology 

works, what works best, and what could be improved. Funding would support grants to 

study, collect, and disseminate information throughout the national aging services 

network about how and under what conditions currently marketed assistive technologies 

provide the best value for seniors and their caregivers. This information will better 

empower seniors and their caregivers to make informed decisions for their circumstances.

In addition, Community Innovations for Aging in Place has previously been funded at $5 million 

in FY 2010 and FY 2011 in Program Innovations. This new arrangement provides the Assistant 

Secretary with flexibility to fund this activity at a different level in FY 2012.
PROGRAM INNOVATIONS

152

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Program Administration

Summary of Request

Program Administration funds provide the necessary resources for the operation of AoA 

programs. For the first time in FY 2012, AoA has two distinct Program Administration requests, 

totaling $144,543,000. These requests reflect the increased responsibility taken on by the 

organization, and the resulting need for administrative resources to implement these new 

programs effectively.

Aging Services Administration: Funds the direction of programs established under the Older 

Americans Act (OAA), the Alzheimer’s Disease Supportive Services program, and the 

Lifespan Respite program. The FY 2012 request for Aging Services Administration is 

$24,543,000, an increase of +$4,567,000 over the FY 2010 enacted level. This does not 

include resources necessary to carry out new programs, such as SHIPS or SCSEP. These 

resources are requested separately as part of the overall funding being requested for these 

programs.

Community Living Assistance Services and Supports Administration: This request will 

continue to fund the implementation of the CLASS program, a new, voluntary insurance 

program created under Title VIII of the Affordable Care Act. The FY 2012 request for 

CLASS Administration is $120,000,000. This will be the first year that CLASS receives a 

discretionary appropriation. The Affordable Care Act anticipates CLASS’ administrative 

activities being funded from premiums paid by participants, however, CLASS requires funds 

from a discretionary appropriation in FY 2012 to bridge the period between FY 2011 and the 

point at which funding can be drawn statutorily from premiums received.
PROGRAM INNOVATIONS

154

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Aging Services Program Administration

FY 2010

Appropriation

FY 2011

 CR

FY 2012

Budget 

Request

FY 2012 + / -

FY 2010

Program 

Administration.................. $19,976,000 $19,979,000 $24,543,000 +4,567,000

FTE.................. 100 111 121 +21

Note: Neither the dollar nor the FTE request includes resources to carry out new programs to be implemented in 

AoA by FY 2012. Resources for these programs are requested separately in the relevant narratives within this 

document.

Authorizing Legislation: Section 205 of the Older Americans Act of 1965, as amended

FY 2012 Older Americans Act Authorization................................................................... Expired

Allocation Method ................................................................................... Direct Federal/Contract

Program Description and Accomplishments:

Program Administration funds the direction of AoA programs established under the Older 

Americans Act (OAA), as well as the Alzheimer’s Disease Supportive Services program and the 

Lifespan Respite Care program authorized respectively by Section 398 and Title XIX of the 

Public Health Services Act (PHSA). In addition, Program Administration funds are used to 

support oversight and implementation of activities originally funded under the American 

Recovery and Reinvestment Act (ARRA) of 2009, and the Affordable Care Act of 2010. 

Program Administration funding does not include resources necessary to carry out new programs 

that are proposed to come to AoA by FY 2012. Resources necessary to carry out these programs 

are requested separately as part of the overall funding being requested for these programs. In the 

case of programs being transferred to AoA, this is consistent with the authorizing statutes or 

appropriations language for these activities prior to their transfer. These include the State Health 

Insurance Assistance Program that will be transferred to AoA from the Centers for Medicare and 

Medicaid Services, the Senior Community Service Employment Program, that will be transferred 

from the Department of Labor, the Adult Protective Services Demonstration program, and the 

Community Living Assistance Services and Supports program that was embedded in AoA by the 

Secretary on January 5, 2011.

AoA’s mission, as embodied in the OAA, is to develop a comprehensive and cost-effective 

system of services that helps elderly individuals to maintain their health and independence in 

their homes and communities. AoA does this by overseeing the development of coordinated 

systems of community-based care in States and localities that are responsive to the needs and 

preferences of older people and their family caregivers. 
AGING SERVICES PROGRAM ADMINISTRATION

156

AoA is an agency whose finite administrative resources have failed to keep up with its growing 

responsibilities. In the last two years alone, AoA has received new funding under both the 

Affordable Care Act and the American Reinvestment and Recovery Act as well as funding under 

its regular appropriation for new and expanded activities including the implementation of new 

programs such as Lifespan Respite Care; the national implementation and rigorous evaluation of 

programs for reforming health and long-term care, including evidence-based programs such as 

the Chronic Disease Self Management Program (CDSMP) and Aging and Disability Resource 

Centers (ADRCs); and outreach activities to seniors and persons with disabilities to assist them 

in accessing Medicare benefits under the Low-Income Subsidy, Medicare Savings Program, and 

Medicare Part D. While these new mandates’ dramatically expanded program responsibilities, 

AoA has been unable to add additional staff to keep pace; and has in fact seen staffing levels 

decline in the majority of the last eight years. 

Additionally, AoA staff are increasingly being asked to develop and manage funding 

partnerships across multiple agencies, Departments and private philanthropies that support health 

and long-term care reforms related to seniors at the State and local level. These funding 

partnerships include initiatives involving AHRQ, CMS, CDC, HRSA and other Federal agencies, 

including the Departments of Veterans Affairs, Housing and Urban Development, 

Transportation, Agriculture, and the Corporation for National and Community Service, as well as 

a range of private philanthropies. While holding significant promise for improving service 

delivery and quality for seniors and persons with disabilities, insufficient administrative 

resources have made it difficult for staff to devote the time and attention needed to realize the 

full potential of these opportunities while still managing their other responsibilities.

For the agency as a whole, staffing has shrunk to 100 FTE in 2010 compared to 120 FTE in 

2002. Of greater concern, staffing in AoA regional offices has fallen by more than 20 percent 

since 2002 to 31 FTE. AoA is no longer able to maintain a Regional Office in two of the ten 

regions and only maintains a single staff person in a third Region. Yet these are the Offices that 

going forward will be critical to insuring that the national aging services network is prepared to 

address the needs of the coming wave of seniors, and their desire to continue to live within their 

communities. Similarly, these are the Offices that AoA needs to be able to rely on to provide 

the network and through it, millions of seniors, with information about the implementation of 

enhancements to health care and human service programs that affect older individuals. Perhaps 

most importantly, regional offices are the primary points of contact for grantees and States with 

technical assistance questions and oversight issues. These offices are the primary method by 

which AoA interfaces with grantees to ensure program integrity.

AoA cannot successfully carry out its mission, and address the range of new responsibilities the 

agency is taking on, without these resources. To move forward, AoA needs to invest in regional 

staff, human capital development, information technology modernization, and other activities 

that have been delayed but are critically needed to effectively reach out to citizens, promote 

efficiency and innovation, and provide transparency and accountability. 
AGING SERVICES PROGRAM ADMINISTRATION

157

Funding History:

Comparable funding for Program Administration during the past five years is as follows:

FY 2007............................................... $18,379,000 112 FTE

FY 2008 .............................................. $18,064,000 106 FTE

FY 2009 .............................................. $18,696,000 103 FTE

FY 2010 .............................................. $19,976,000 100 FTE

FY 2011 CR ........................................ $19,979,000 111 FTE*

*Includes 3 FTE funded from the mandatory ADRC appropriation. 

Budget Request:

The FY 2012 request for Program Administration is $24,543,000, an increase of +$4,567,000 

and +21 FTE over the FY 2010 enacted level. Sufficient resources are already expected to be 

available in FY 2011 to support +11 of these FTE. The FY 2012 request, therefore, includes 

funding to pay for the remaining +10 FTE, which will allow AoA to increase its regional staff by 

+7 FTE, to begin to bring all regional offices to levels that will allow AoA to meet the increasing 

range of responsibilities that it currently faces. The remaining +3 FTE will be used to address 

other needs related to AoA’s growing responsibilities and enhanced partnerships to promote 

community living. 

Of the additional +$4,567,000 that is in the request over the FY 2010 enacted level: 

$1,399,000 will be used to fund +10 new FTE to help AoA to meet the increased 

workload related to its expanding partnerships and increasing responsibilities;

$1,025,000 will be used for higher costs of external services, taps and for 

accounting systems upgrades; 

$1,243,000 will be used to pay the General Services Administration for costs that 

it will need to incur to relocate AoA’s Headquarters office to a new location. 

$900,000 will be used for tenant improvement/build-out costs related to the 

expiration of AoA’s Headquarters lease in 2012. 

The first priority for additional staffing resources requested for FY 2012 will be to make critical 

investments in the regions. Regional staffing is rapidly approaching the point where the regional 

offices as a whole will be unable to function effectively even as the services they provide will be 

most needed. Today regional staff levels stand at 31 FTE and are continuing to drop. There has

been no regional office in Region III (Philadelphia) since the mid 1990’s; no regional presence in 

Region VII (Kansas City) since 2008, and only a single staff person holding down the regional 

presence in Region X (Seattle). Most of the remaining regions are staffed at levels of three to 

four FTE each. These levels are barely adequate to manage existing regional business, and 
AGING SERVICES PROGRAM ADMINISTRATION

158

wholly inadequate to address the level of responsibilities that the regions will face as AoA 

implements an increasing range of programs to enhance community living for older individuals 

and people with disabilities. 

Lack of staff in the AoA Regional Offices has resulted in a number of serious issues relating to 

program administration at the State and Tribal levels. These issues include limitations on the 

ability of regional staff to work proactively with States and Tribes in program development, 

provide training of newly hired State and Tribal staff, and respond to daily customer service 

requests for technical assistance.

Turnover at the State and Tribal level can be extensive, from State and tribal fiscal staff on up to 

newly hired State Unit Directors. As staff turnover, there is a critical need for regional staff to 

orient, train and work with the new State and Tribal hires. Regional fiscal staff, for example, 

play a critical role in working with States and Tribes to complete audit closeouts, especially as 

increased OIG audit staff from the Department’s Health Care Fraud and Abuse Campaign are 

identifying and working toward necessary systems corrections. While Regional Office staff can 

take a much needed active role to help States and Tribes enhance existing State systems and 

assist them in becoming more efficient, they currently lack the resources to do so. Other areas of

work that have not been improved sufficiently over time because of a lack of regional staff 

include providing additional technical assistance in State Plan Development, continuous quality 

improvement efforts, and consistent and accurate data collection.

Today’s emphasis in the regions is one of putting out fires, rather than preventing them.

Regional staff also have been unable to devote adequate time at the State and Tribal levels to 

advancing new administration policy directions, and to assisting in the program implementation 

of new innovations coming out of the Central Office. Implementation of ADRCs offers one 

example where greater staff involvement at the regional level could have helped to advance the 

initial rollout of this program by helping ensure that these activities were well coordinated with 

AoA’s core programs. 

Not only are more staff needed in existing regional offices, AoA eventually needs to have a 

physical presence in all ten of the HHS regions. The absence of a regional office compromises 

AoA’s ability to work in conjunction with the HHS Regional Directors as part of the larger 

regional team, as envisioned by HHS’s Regions Together Initiative. Lack of physical presence 

also restricts AoA’s ability to work on a range of common issues, including ADRC 

implementation, Chronic Disease Self-Management and implementation of enhancements to 

health care and human services programs that affect seniors with comparable regional staff from 

sister agencies including CMS and CDC. 

AoA Headquarters Lease Renewal Process

The ten year lease on AoA’s Central Office space is scheduled to end in October, 2012. AoA has 

been meeting with HHS Facilities staff regarding next steps. First and foremost, AoA will need to 

provide GSA with upfront good faith money, as required by law.. GSA requires an amount based on 

the number of FTE currently on board multiplied by a per capita cost of between $15,000 and 

$25,000. Using this rule of thumb, AoA estimated it would need $2.4 million in funding; half of this 
AGING SERVICES PROGRAM ADMINISTRATION

159

amount has already been requested in a previous budget. Under either option, there are likely to be 

additional tenant improvement costs that would not be covered under the funding previously 

requested that will go to GSA. In particular, these include tenant improvement and build 

out/renovation costs. AoA continues to work closely with ASFR facilities staff to insure that 

adequate funds have been included in its request.

Performance Measures

Improving program efficiency, improving client outcomes, and effective targeting of services to 

vulnerable elders are the three performance measures used to assess the performance of the 

AoA’s Aging Services programs as a whole. Program Administration is not directly measured 

by AoA’s performance indicators, nor by specific outcomes, and it does not have specific output 

measures. Rather, the program provides the administrative resources that enable AoA to carry 

out its programmatic activities and achieve its performance goals.
AGING SERVICES PROGRAM ADMINISTRATION

160

PAGE INTENTIONALLY LEFT BLANK
Community Living Assistance Services and Supports

FY 2010

Enacted

FY 2011 

Enacted

FY 2012 

Request

FY 2012 +/-

FY 2010

Community Living Assistance 

Services and Supports................................ -- ............ -- $120,000,000 +$120,000,000

FTE................................................................ -- ....... -- 40 +40

Note: Funding for FY 2010 and FY 2011 is provided under Section 1005 of P.L. 111-152. 22 FTE are 

anticipated to be hired in FY 2011 using these funds. FY 2012 is a discretionary appropriations request. 

Authorizing Legislation: Title XXXII of the Public Health Service Act

Allocation Method ................................................................................... Direct Federal/Contract

Program Description and Accomplishments:

The Community Living Assistance Services and Supports (CLASS) is a new self-funded, 

voluntary insurance program created under Title VIII of the Affordable Care Act (P.L. 111-148). 

Participating adults who meet eligibility requirements and have paid premiums for at least five 

years will receive a cash benefit to purchase long-term services and supports to help them remain 

independent. Under the law, benefits may only be paid from the CLASS Independence Fund, a 

trust fund established to manage and invest participants’ premiums.

About 14 million people spend more than $230 billion a year on long-term services and supports 

to assist them with daily living.71 About 56 million rely solely on unpaid care provided by 

family and friends.72 Medicare only covers 100 days of skilled nursing care and only after 

hospitalization and its coverage of home health care is limited. While Medicaid is the largest 

public payer of these services, it is only available for people with very limited resources, often 

leading to middle class families spending their hard-earned resources until they qualify. The 

CLASS program represents a significant new opportunity for working adults to prepare 

financially to remain as independent as possible under a variety of future health circumstances.

To start enrollment, the CLASS program must achieve several objectives: 1) designate an 

actuarially-sound benefit plan by October 1, 2012; 2) increase public awareness and ensure 

public confidence in the benefit; and 3) develop an information technology (IT) and operations 

system capable of enrolling interested, eligible individuals. The CLASS program will develop 

robust, actuarially-sound models that the Secretary can use in the designation of the benefit plan 

to ensure that a fiscally-solvent program is established. 

 

71 Gleckman, Howard. 2010. ―Long-Term Care Financing Reform: Lessons from the U.S. and Abroad.‖ 

Washington, D.C.: Urban Institute.

72 Johnson, Richard, Desmond Toohey and Joshua Weiner. 2007. ―Meeting the Long-Term Care Needs of the Baby 

Boomers: How Changing Families Will Affect Paid Helpers and Institutions.‖ Washington, D.C.: Urban Institute.
COMMUNITY LIVING ASSISTANCE SERVICES AND SUPPORTS

162

The CLASS program is making strides in all of these areas in FY 2011. AoA anticipates 

approximately 30 staff, for a total of 22 full time equivalents or FTEs, will be hired in FY 2011

using funds available from the Affordable Care Act. The staff will focus on the actuarial 

modeling, the design of the benefit, public awareness, IT development, and programmatic 

regulations. 

In FY 2011, AoA anticipates achieving the following milestones:

Begin developing a robust public information campaign;

Seek public comment through the publication of a Notice of Proposed Rulemaking in the 

Federal Register on CLASS enrollment and eligibility criteria;

Design and award contracts for an information technology system that will protect 

personally identifiable information and make it easy and efficient for the public to enroll 

in the program. The IT system design will follow the latest guidance from the Office of 

Management and Budget regarding IT modernization, including cloud computing 

solutions; and

Convene the CLASS Independence Advisory Council to solicit input from experts and 

the public about the program.

Funding History:

Discretionary funding for CLASS during the past five years is as follows:

FY 2007................................................... $0

FY 2008................................................... $0

FY 2009................................................... $0

FY 2010....................................................

73

FY 2011 Continuing Resolution ................

74

Budget Request:

The FY 2012 President’s Budget request for CLASS is $120 million. This will be the first year 

CLASS will receive a discretionary appropriation. Created under the Affordable Care Act, in 

previous years this program had received funding through Section 1005 of P.L. 111-152, which 

provided funding to implement provisions of the Affordable Care Act.

The statute anticipates CLASS primarily funding its administrative operations through the 

CLASS Independence Fund. However, CLASS requires funds from a discretionary 

appropriation in FY 2012 to bridge the period between FY 2011 when funding is covered under 

Section 1005 of P.L. 111-152 and the point at which administrative funding can be drawn 

statutorily from premiums received. The information that follows describes the activities that 

will be necessary to designate a benefit plan by the statutory deadline of October 1, 2012 and 

begin enrollment.

 

73 Funding in FY 2010 and FY 2011 is provided under Section 1005 of P.L. 111-152. 
COMMUNITY LIVING ASSISTANCE SERVICES AND SUPPORTS

163

Information Technology ($13.4 million)

A robust information technology system is critical to ensuring the public enrolls smoothly and 

has confidence in the program. In addition, a quality information technology (IT) system should 

be fully integrated with other HHS IT infrastructure and reduce long-term costs by automating 

processes, allowing for fewer staff and minimizing the pressure on the administrative expenses 

authorized under the law. In FY 2011 the contracting process will begin and in FY 2012 the 

development contracts will continue and operations and maintenance contracts will be 

established to ensure an IT system is in place to begin enrollment. 

Information and Education ($93.5 million)

The program’s financial solvency and viability will depend on the enrollment of large numbers 

of participants. Employers and individuals will need to have access to information about the need 

for long-term services and supports and the benefits of the program. It will be crucial to educate 

employers about how to enroll their employees and to inform individuals about how to enroll 

directly in the program. A significant education initiative will help ensure that an adequate 

number of individuals will enroll to ensure program solvency. Recent Federal efforts have been 

similar in scope and funds. For example, the Census promotional efforts exceeded $350 million 

over two years. The CLASS effort necessitates a similar investment.

Board of Trustees & Advisory Committees ($2 million)

The CLASS statute authorizes two public advisory councils and a Board of Trustees. The 

CLASS Independence advisory council will serve as the policy and programmatic advisory 

council to the CLASS program, and has a short-term statutory charge to review at least three 

plan options and recommend a benefit plan to the Secretary that ensures financial solvency. As 

such, it will be a vital, transparent partner in engaging the public in FY 2012 and building public 

confidence in the program. The Personal Care Attendants Workforce advisory council has an 

intensive responsibility to focus on direct (i.e. ―paid‖ personal care attendants) caregiving 

capacity across the country. The Board of Trustees will meet to ensure the solvency of the 

program. This request anticipates quarterly meetings for the CLASS Independence and the 

Personal Care Attendants Workforce advisory committees and at least one annual meeting of the 

Board of Trustees. 

Staffing and Administrative Overhead ($11.1 million)

The CLASS program anticipates growing from a team of approximately 30 individuals 

(approximately 22 FTE) in FY 2011 to an estimated staff of 50 (approximately 40 FTE) in 

FY 2012. The CLASS program will hire experienced professionals in fields including long-term 

care insurance, education and outreach, information technology, actuarial science, and regulation 

management. The additional staff in FY 2012 is necessary to ensure a successful launch of the 

program. This request also covers overhead associated with staff, such as facilities, travel, and

related support costs. 
COMMUNITY LIVING ASSISTANCE SERVICES AND SUPPORTS

164

Output Table:

CLASS Program Output

Measure Most Recent 

Result 

FY 2012 

Target 

FY 2015 

Target 

CL 1: Increase the number of 

individuals enrolled in CLASS to 

7.7 million by 2015 (Output)

N/A Baseline 7.7 million

The output target is derived from the Congressional Budget Office’s estimates prior to passage of the Affordable 

Care Act. This measure is subject to change based on the actuarial projection that accompanies the benefit plan 

designated by the Secretary. 
Administration on Aging

Budget Authority by Object Class

(Dollars in thousands)

2010 

Estimate

2012 

Estimate

Increase or 

Decrease

Personnel compensation:

Full-time permanent (11.1)................................................ 10,767 15,339 4,572

Other than full-time permanent (11.3)............................... 414 609 195

Other personnel compensation (11.5)................................ 188 277 89

Military personnel (11.7)................................................... - - -

Special personnel services payments (11.8)...................... - - -

Subtotal personnel compensation................................ 11,369 16,225 4,857

Civilian benefits (12.1)......................................................... 2,795 5,587 2,792

Military benefits (12.2)......................................................... - - -

Benefits to former personnel (13.0)..................................... - - -

Total Pay Costs................................................................... 14,163 21,812 7,649

Travel and transportation of persons (21.0).......................... 548 660 112

Transportation of things (22.0)............................................. 8 11 3

Rental payments to GSA (23.1)............................................ 2,180 2,870 690

Communication, utilities, and misc. charges (23.3).............. 155 228 73

Printing and reproduction (24.0)........................................... 27 40 13

Other Contractual Services:

Advisory and assistance services (25.1)............................ 22,099 133,936 111,837

Other services (25.2).......................................................... 39 57 18

Purchase of goods and services from -

government accounts (25.3)........................................... 5,830 17,936 12,106

Operation and maintenance of facilities (25.4).................. 1 1 0

Research and Development Contracts (25.5)..................... - - -

Medical care (25.6)............................................................ - - -

Operation and maintenance of equipment (25.7)............... 65 96 31

Subsistence and support of persons (25.8)......................... - - -

Subtotal Other Contractual Services.......................... 28,034 152,026 123,991

Supplies and materials (26.0)................................................ 73 107 34

Equipment (31.0).................................................................. 76 112 36

Land and Structures (32.0) ................................................... - - -

Investments and Loans (33.0)............................................... - - -

Grants, subsidies, and contributions (41.0)........................... 2,343,193 2,060,078 (283,115)

Interest and dividends (43.0)................................................. - - -

Refunds (44.0)...................................................................... - - -

Total Non-Pay Costs........................................................... 2,374,294 2,216,132 (158,162)

Total Budget Authority by Object Class........................... 2,388,457 2,237,944 (150,513)
166

Administration on Aging

Salaries and Expenses

(Dollars in thousands)

2010 

Estimate

2012 

Estimate

Increase or 

Decrease

Personnel compensation:

Full-time permanent (11.1)................................................ 10,767 15,339 4,572

Other than full-time permanent (11.3)............................... 414 609 195

Other personnel compensation (11.5)................................ 188 277 89

Military personnel (11.7)................................................... - - -

Special personnel services payments (11.8)...................... - - -

Subtotal personnel compensation................................ 11,369 16,225 4,856

Civilian benefits (12.1)......................................................... 2,795 5,587 2,792

Military benefits (12.2)......................................................... - - -

Benefits to former personnel (13.0)..................................... - - -

Total Pay Costs................................................................... 14,163 21,812 7,649

Travel and transportation of persons (21.0).......................... 548 660 112

Transportation of things (22.0)............................................. 8 11 4

Rental payments to Others (23.2).......................................... - - -

Communication, utilities, and misc. charges (23.3).............. 155 228 73

Printing and reproduction (24.0)........................................... 27 40 13

Other Contractual Services:

Advisory and assistance services (25.1)............................ 22,099 133,936 111,837

Other services (25.2).......................................................... 39 57 18

Purchase of goods and services from -

government accounts (25.3)........................................... 5,830 17,936 12,106

Operation and maintenance of facilities (25.4).................. 1 1 0

Research and Development Contracts (25.5)..................... - - -

Medical care (25.6)............................................................ - - -

Operation and maintenance of equipment (25.7)............... 65 96 31

Subsistence and support of persons (25.8)......................... - - -

Subtotal Other Contractual Services.......................... 28,034 152,026 123,992

Supplies and materials (26.0)................................................ 73 107 34

Total Non-Pay Costs........................................................... 28,845 153,072 124,227

Total Salary and Expense................................................... 43,009 174,884 131,875

Direct FTE........................................................................... 93 191 98
167

Administration on Aging

Detail of Full-Time Equivalent Employment (FTE)

2010 

Actual 

Civilian

2010 

Actual 

Military

2010 

Actual 

Total

2011 

Est. 

Civilian

2011 

Est. 

Military

2011 

Est. 

Total

2012 

Est. 

Civilian

2012 

Est. 

Military

2012 

Est. 

Total

1/ 1/ 2/

Immediate Office of the ..................

Assistant Secretary...........................

 Direct:............................................ 8 8 10 10 10 10

 Reimbursable:................................ 0 0 0

 Total:........................................... 8 0 8 10 0 10 10 0 10

Center for Management and ............

Budget..............................................

 Direct:............................................ 17 17 22 22 24 24

 Reimbursable:................................ 0 0 0

 Total:........................................... 17 0 17 22 0 22 24 0 24

Center for Policy, Planning .............

and Evaluation.................................

 Direct:............................................ 22 22 25 25 25 25

 Reimbursable:................................ 0 0 0

 Total:........................................... 22 0 22 25 0 25 25 0 25

Center for Program Operations........

 Direct:............................................ 22 22 20 20 28 28

 Reimbursable:................................ 2 2 3 3 3 3

 Total:........................................... 24 0 24 23 0 23 31 0 31

Office of Community Living ...........

Assistance, Services and .................

Supports...........................................

 Direct:............................................ 0 0 0 40 40

 Reimbursable:................................ 0 0 0 0

 Total:........................................... 0 0 0 0 0 0 40 0 40

Office of Regional Operations.........

 Direct:............................................ 24 24 26 26 41 41

 Reimbursable:................................ 5 5 5 5 5 5

 Total:........................................... 29 0 29 31 0 31 46 0 46

OPDIV FTE Total.......................... 100 0 100 111 0 111 176 0 176
168

Average GS Grade

FY 2007........................................... 12.5

FY 2008........................................... 12.9

FY 2009........................................... 13.0

FY 2010........................................... 12.8

FY 2011........................................... 12.8

1/ FY 2010 and FY 2011 do not include FTE for either the State Health Insurance Assistance Program

 (SHIPs) or the Senior Community Service Employment Program (SCSEP) which are proposed for 

 transfer to AoA. These figures are not currently available as regional staff work on these and 

 multiple other programs. FTE are also not included in these years for the CLASS program since

 they are funded in these years from the $1 billion Health Care Implementation fund and accounted 

 for directly against those dollars.

 2/ In FY 2012, FTE for SHIPs and for SCSEP have been annualized, as is standard, to reflect the fact 

 that not all of these staff will be on board at the beginning of the year. As a result, while AoA anticipates

 filling 10 positions for SHIPs and 16 positions for SCSEP in FY 2012, only 5 FTE and 8 FTE 

 respectively are included in the FTE breakdown above. Similarly, 20 new hires are anticipated over 

 those on board in FY 2011 for CLASS, hired over the couse of FY 2012, and these are reflected 

 above as 10 annualized FTE.
169

Administration on Aging

Detail of Positions

2010

 Actual 1/ 2011 CR 1/

2012 

Estimate

Executive level I ........................................

Executive level II........................................

Executive level III ......................................

Executive level IV....................................... 1 1 1

Executive level V........................................

Subtotal ................................................... 1 1 1

Total - Exec. Level Salaries 2/ $195,200 $195,200 $195,200

ES-0 4/........................................................ 3 3 7

Subtotal ................................................... 3 3 7

 Total - ES Salary 2/ 3/ $571,000 $603,400 $1,485,100

GS-15.......................................................... 20 22 27

GS-14.......................................................... 18 19 36

GS-13.......................................................... 39 39 84

GS-12.......................................................... 9 12 19

GS-11.......................................................... 7 7 10

GS-10.......................................................... 1 2 2

GS-9............................................................ 9 8 10

GS-8............................................................ 0 0 0

GS-7............................................................ 1 2 2

GS-6............................................................ 1 1 1

GS-5............................................................ 0 0 0

GS-4............................................................ 0 0 0

GS-3............................................................ 0 0 0

GS-2............................................................ 0 0 0

GS-1............................................................ 0 0 0

Subtotal ................................................... 105 112 191

 Total - GS Salary

Average ES level ........................................ 0 0 0

Average ES salary....................................... $190,333 $201,133 $212,157

Average GS grade....................................... 12.8 12.8 12.9

Average GS salary...................................... 126,560 124,224 117,960

1/ Comparable numbers are not available in FY 2010 and FY 2011 for the 

 Community Living Assistance for Services and Supports (CLASS) Program, 

 or for the two programs proposed for transfer to AoA in FY 2012, the State

 Health Insurance Assistance Program (SHIPs) or the Senior Community

 Service Employment Program (SCSEP).

2/ Includes Salary and Benefits.

3/ The SES level for FY 2010 is stated at the actual lower level due to the 

 position being vacant for part of the year.

4/ 7 SES in FY 2012 include 2 Senior Level (SL) Staff.
170

Administration on Aging

Programs Proposed for Elimination

No programs are proposed for elimination in FY 2012.
SIGNIFICANT ITEMS IN HOUSE AND SENATE APPROPRIATIONS COMMITTEE 

REPORTS

FY 2012 Senate Appropriations Committee Report Language (Senate Report 111-243)

Item

Civic Engagement - The Committee is aware of new research suggesting that interventions 

designed to promote health and function in seniors through everyday activity may improve the 

brain's plasticity, or the ability to bounce back, in key regions that support executive function. 

The Committee urges AoA to continue its work in advancing the field of civic engagement for 

older Americans by partnering with organizations with proven experience in creating robust, 

innovative opportunities for baby boomers and other older Americans to serve their communities 

while helping them to maintain and improve their health.

Action taken or to be taken

The Administration on Aging continues to support a grant to the National Council on the Aging 

to identify and provide technical assistance and other support to local programs that can become 

national multi-generational and civic engagement models for utilizing older volunteers in 

meaningful direct services. This grant, extended through 2011, focuses on three target 

populations: 1) older relatives caring for grandchildren; 2) families caring for children with 

special needs; and 3) caregivers of frail elderly. As reported in 2009, nineteen local grants were 

awarded. Preliminary evaluation shows that use of the criteria provides an accurate assessment of 

program effectiveness, impact, sustainability and replicability. 

Next steps include synthesis and dissemination of best practices and setting the stage for 

widespread replication of the most promising models, using strategies and on-line tools grounded 

in diffusion of innovations theory and practice. This will be most helpful to the aging services 

network, which is heavily dependent on volunteers in providing its services. 

In 2010, AoA announced a grant competition to fund a National Aging Civic Engagement 

Technical Center (the Center). The National Association of Area Agencies on Aging was 

awarded the grant. The Center will help AoA and the Aging Network use volunteers, especially 

Boomers, more effectively; develop AoA’s and the Aging Network’s leadership in civic 

engagement; and expand the Aging Network’s existing use of volunteers. The Center, working 

together with the AARP Foundation, the National Association of State Units on Aging and 

Disabilities and Senior Service America Incorporated, will 1) conduct a systematic inquiry on 

civic engagement; 2) recommend an Action Plan in civic engagement for AoA and the Aging 

Network; 3) develop a national communication and outreach strategy; 4) provide training and 

technical assistance; 5) identify effective practices, develop and promote models; and 6) create a 

continuous quality improvement strategy. Outcomes include measurable change in Network’s 

ability to meet needs and preferences of volunteers. Products include Action Plans, volunteer 

management toolkits, model practice fact sheets, conferences, website widgets, and a final 

report. 
SIGNIFICANT ITEMS

172

In addition to the above, AoA continues its relationship and coordination with the Corporation 

for National and Community Service. We expect to work closely with the Corporation as we 

expand our civic engagement efforts.

Item

Older Adults and Mental Health - The Committee notes that approximately 20 to 25 percent of 

older adults have a mental or behavioral health problem. Older white males (age 85 and over) 

currently have the highest rates of suicide of any group in the United States. The Committee 

acknowledges the importance of addressing the mental and behavioral health needs of older 

adults and encourages AoA to implement the Older Americans Act provisions related to mental 

and behavioral health. Specifically, the Committee urges AoA to designate an officer to 

administer the mental health services authorized under the act, work to improve the delivery of 

mental health screening and treatment services for older individuals, and increase public 

awareness and reduce the stigma associated with mental disorders in older individuals

Action taken or to be taken

The Administration on Aging is an active partner with the Substance Abuse and Mental Health 

Services Administration (SAMHSA) on a variety of initiatives. Through the SAMHSA Mental 

Health Transformation (MHT) initiative, AoA participates in the Federal Executive Steering 

Committee, the Federal Partner Senior Workgroup, and the Rural Mental Health Workgroup, as 

well as serving in an advisory capacity on a study to examine sustainability among SAMSHA 

MHT grantees. AoA also participates in the HHS Behavioral Health Coordinating Committee, as 

well as its Prescription Drug Abuse sub-committee. In addition, AoA also sits on a SAMSHAconvened workgroup currently developing a Model State Plan to assist State Agencies on Aging 

and State Mental Health Departments in enhancing their partnerships around older adult 

activities. 

Through its health programs, AoA has also encouraged States and Area Agencies on Aging to 

use evidence-based programs designed to reduce reduce/prevent depression and improve quality 

of life in older adults including Healthy IDEAS (Identifying Depression, Empowering Activities 

for Seniors) and PEARLS (Program to Encourage Rewarding Lives for Seniors. State plan 

guidance developed by AoA for FY 2011, similar to past guidance, will direct States and Area 

Agencies on Aging to implement the provisions related to mental and behavioral health that were 

signed into law as part of the Older Americans Act Amendments of 2006.

Item

Transportation - The Committee is aware of the rapidly growing need for transportation services 

for older Americans. In order to expand resources to meet this need, the Committee encourages 

AoA to fund section 416 of the Older Americans Act. Such funding could support successful, 

entrepreneurial models of economically sustainable transportation that supplement publicly 

funded services by accessing private resources and voluntary local community support, and that 

do not rely on Federal or other public financial assistance after 5 years.
SIGNIFICANT ITEMS

173

Action taken or to be taken

While section 416 of the Older Americans Act was not funded in FY 2010, the Administration 

on Aging recognizes the importance of supporting and fostering innovation in serving older 

consumers and their caregivers. Since 2004, AoA has been a key partner in the United We Ride 

initiative, to promote the participation of the aging services network in the coordination of 

transportation services at the Federal, State and local levels. AoA has provided guidance to State 

Units on Aging in the development of their State plans on aging and have encouraged their 

describing coordination activities and discussions with State and local transportation entities.

AoA continues to be involved in United We Ride, chairing the Health, Wellness, and 

Transportation workgroup. This workgroup focuses on ensuring that 1) transportation is not a 

barrier for transportation-disadvantaged populations seeking to access their health care, general 

health, and wellness needs (i.e. preventive care, hospitals, nutritional resources, and exercise) 

and 2) transportation options provide these populations the mobility that keeps them active and 

healthier, and therefore out of expensive nursing home care and acute treatment. To support our 

collaboration, maximize flexibility of funding and enhance services to older adults, Older 

Americans Act grantees have the option to use Title III B funds to meet the match requirements 

for programs administered by the Federal Transit Administration.

AoA has issued guidance allowing OAA Title III-B funds be used as match for FTA programs. 

AoA continues to be involved in the development and ongoing operation of the National Center 

on Senior Transportation (NCST) (http://www.seniortransportation.net), a Technical Assistance 

center funded by the Federal Transit Administration and administered by Easter Seals Project 

Action and the National Association of Area Agencies on Aging. AoA is an active member of 

NCST’s National Steering Committee. One of the major activities of the NCST has been the 

funding of demonstration grants to promote innovations in the coordination and delivery of 

transportation services to older adults and their caregivers.

Item

Aging Network Support Activities - The Committee believes that AoA should use the funds 

previously allocated to ADRCs to focus on other programs that will help seniors remain healthy 

and live independently in their own communities. Specifically the Committee directs AoA to 

prioritize evidence-based disease prevention activities, such as the chronic disease selfmanagement program (CDSMP). The Committee notes that Recovery Act funding provided to 

AoA for the CDSMP will end this year, and encourages AoA to use fiscal year 2011 funding to 

continue this program, which has been proven to reduce the effects of chronic conditions, 

improve health status and reduce unnecessary healthcare use among seniors.

Action taken or to be taken

The Aging and Disability Resource Center (ADRC) grant program is a critical vehicle for 

achieving streamlined, integrated access to State systems of long-term services and supports. 

ADRCs have been funded jointly by the Administration on Aging (AoA) and the Centers for 

Medicare & Medicaid Services (CMS). These grants provide infrastructure support to implement 

ADRC programs.
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Funding for chronic disease self-management programs (CDSMP) for FY 2010 is sufficient to 

carry AoA CDSMP programs through FY 2011. In FY 2012, $10 million in new funding is 

requested for CDSMP. Therefore, there is no need for AoA to prioritize evidence-based disease 

prevention activities, such as the chronic disease self-management program (CDSMP) and fund 

these instead of ADRC activities.

Item

Alzheimer's Disease Demonstration Grants to States - The Committee recommends a funding 

level of $11,464,000 for Alzheimer's disease demonstration grants to States. This amount is the 

same as the administration request. The comparable funding level for fiscal year 2010 is 

$11,462,000. This program provides competitively awarded matching grants to States to 

encourage program innovation and coordination of public and private services for individuals 

with Alzheimer's disease and their families. The Committee urges the AoA to continue this 

program's focus on expanding services to people in the early stages of dementia and providing 

chronic care management.

Action taken or to be taken

The Administration on Aging continues to expand the availability of coordinated supportive 

services for persons with Alzheimer’s disease and their families. In FY 2010, 32 cooperative 

agreements were awarded to 22 states, the District of Columbia and Puerto Rico to deliver 

evidence-based and innovative care coordination for persons with Alzheimer’s disease and their 

families through the aging services network, community-based organizations, and partnerships 

with institutions of higher education. In particular, AoA awarded innovation grants for 

supportive services that enable individuals with Alzheimer’s disease to remain in the community 

longer, promote early intervention and chronic care management, and enhance the ability of state 

systems to provide effective and cost-efficient supportive services for persons with Alzheimer’s 

disease and their families. A key focus of the evaluation criteria for awarding Alzheimer’s 

disease supportive services grants is reaching underserved and culturally-diverse populations. 

In FY 2011, grants will expand the repertoire of evidence-based and innovative Alzheimer’s 

disease interventions, particularly those that promote early intervention and chronic care 

management, and promote the embedding of successful interventions into State health and longterm services and supports systems across the country. 

Item

Lifespan Respite Care - The Committee recommends $7,000,000 for the Lifespan Respite Care 

program. The administration requested $5,000,000 for this activity and the comparable fiscal 

year 2010 level is $2,500,000. The Lifespan Respite Care program provides grants to States to 

expand respite care services to family caregivers, improve the local coordination of respite care 

resources, and improve access and quality of respite care services, thereby reducing family 

caregiver strain. The Committee has provided additional funds to the Lifespan Respite Care 

program as part of the administration's Caregiver Initiative. In carrying out the program, the 
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Committee urges AoA to ensure that State agencies and ADRCs serve all age groups, chronic 

conditions and disability categories.

Action taken or to be taken

The Administration on Aging began implementation of the Lifespan Respite Care Program in 

FY 2009 and those activities continued into FY 2010. Throughout the program development 

process, AoA has carefully considered the requirements of the Lifespan Respite Care Act as well 

as Congressional intent as specified in the Committee Report accompanying the authorizing 

statute.

In 2009 and 2010, both the Statute and Committee Report were consulted during the 

development of the program announcements making competitive grant opportunities available to 

eligible state agencies. Further, AoA has worked closely with representatives of the National 

Lifespan Respite Taskforce to ensure that the needs of various age groups, disability categories 

and chronic conditions were understood and addressed by applicants. 

To help ensure that State agencies and Aging and Disability Resource Centers use the funds to 

serve all age and disability groups, AoA employed the following strategies in FYs 2009 and 

2010 and will continue to employ these strategies in future years: 

First, applications from eligible State agencies are minimally required to:

1. Demonstrate the support and active involvement of a range of government and 

non-government, private, nonprofit and other organizations with a stake in serving 

all populations eligible to receive services under the Lifespan Respite Care Act; 

2. Demonstrate thorough understanding of the population to be served, including 

knowledge of the family caregiver population for whom lifespan respite program 

services are to be provided, or for whom respite care workers and volunteers will 

be recruited and trained;

3. Demonstrate a meaningful and active inclusion of the state’s Respite Coalition or 

organization to ensure statewide implementation of Lifespan Respite Programs 

across all age and disability categories; and

4. Demonstrate the broadest possible collaboration with relevant respite stakeholders 

from across the age and disability spectrum. Further, applicants must propose a 

program that immediately addresses the respite needs of all ages and special needs 

categories. No phase-in or preferences for age groups or disability categories are 

permitted. 

Second, grantees are being monitored via semi-annual and annual reports as well as through 

ongoing communication with the AoA Program Officer to ensure the required elements outlined 

above are being fulfilled. Additionally, AoA facilitates regular email and telephone 

communications with the individual grantees and the group to share information and strategies 

related to program development and implementation.
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Finally, AoA recognizes the necessity of providing technical assistance (TA) to the grantees as 

well as States yet to be funded under the Lifespan Respite Program. To that end, AoA has a 

Cooperative Agreement with the Family Caregiver Alliance in San Francisco with a sub-contract 

to the ARCH National Respite Network and Resource Center (ARCH) to design and disseminate 

training materials and TA on a range of issues associated with Lifespan Respite Care Program 

development and implementation.

During the first year of funded TA, ARCH assessed grantee training and TA needs, conducting 

individual consultations via phone, email and in person with each of the grantees to identify 

specific training needs and to address specific program development issues. Additionally, 

ARCH has developed and archived webinars on Lifespan Respite programs, the importance of 

collaboration, and working with faith-based communities to develop respite programs. ARCH 

has developed and/or updated numerous fact sheets and publications on a range of issues of 

interest to grantees as they develop their programs. These activities will continue in FY 2010 

and FY 2011 in close collaboration with the AoA Program Officer.