DEPARTMENT

of HEALTH

and HUMAN

SERVICES

ADMINISTRATION 

ON AGING

FY 2009 Report to Congress
i

Introduction and Mission

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

Services (HHS), 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 (aging 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 aging 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’s), 244 tribal organizations,

and two Native Hawaiian organizations, nearly 20,000 direct service providers, and thousands of

volunteers.

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

the aging network, help seniors remain in their homes for as long as possible. These services 

complement existing medical and health care systems and support some of life’s most basic 

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

food. The aging network also helps consumers learn about and access the services and supports 

that are available in the community and addresses issues related to caregivers. FY 2009 data

show that AoA and its national network of aging service providers rendered direct services to 

nearly 11.5 million elderly individuals age 60 and over (nearly 20 percent of the elderly 

population) and their caregivers, including nearly three million clients who received intensive inhome services. Critical supports, such as respite care and a peer support network, were provided 

to more than 825,000 caregivers.

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 wellbeing 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, tribal and local levels through funding of lowercost, non-medical services and supports that provide the means by which many more seniors can 

maintain their independence. 

Mission

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

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

independence in their homes and communities.
ii

Table of Contents

 Page Number

 

• Introduction and Mission i

• Executive Summary – Overview of Performance 1

Part I: Health and Independence 7

• Home and Community-Based Services 7

• Nutrition Services 9

• Persons Served, Units of Service and Expenditures 12

• Preventive Health Services 13

Part II: Caregiver Services 16

• Family Caregiver Support Services 17

• Lifespan Respite Care 18

• Alzheimer’s Disease Supportive Services Program 19

Part III: Older American Indians, Alaska Natives & 22

Native Hawaiians

Part IV: Protection of Vulnerable Older Americans 27

• Prevention of Elder Abuse & Neglect 28

• Model Approaches to Statewide Legal Assistance Systems 29

• National Legal Assistance and Support Projects 31

• Pension Counseling and Information 32

• Senior Medicare Patrol Program 33

• Long-Term Care Ombudsman Program 36

Part V: Supporting the National Aging Services Network 44

• Outreach and Information on Long-Term Care in 44

 Home- and Community-Based Settings 

• Aging and Disability Resource Centers 45

• National Eldercare Locator 47

• National Minority Aging Organizations Technical 47

Assistance Centers

• Civic Engagement 48

• Meeting the Need for Trained Personnel in Aging 48

• Preparing for and Responding to Disasters 51

Part VI: Program Innovations 53

• Community Innovations for Aging in Place 53

Appendix: Formula Grant Funding Allocation by 58

State, Territory and Tribal Organization
1

Executive Summary

Overview of Performance

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

of the OAA and AoA’s mission: to help elderly individuals 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 aging network actively participate in supporting community-based services with 

particular attention to serving economically and socially vulnerable elders, led AoA to focus on 

three performance measurement areas: 1) improving efficiency; 2) improving client outcomes; 

and 3) effectively targeting services to vulnerable elder populations. Each measurement area is 

representative of several activities across the Aging Services Program structure, and progress in 

that area is tracked using a number of indicators. The efficiency measurement and 

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

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

area 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 measurement area 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 AoA’s 2008 and 2009 national surveys of OAA 

program participants 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.

o Comparison of service recipients to the elderly U.S. population 60 and older 

shows that Title III serves older people who are less healthy and have more 
2

limitations than other older adults, even after adjusting for demographic and 

socioeconomic differences between the groups.

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 

aging 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 who have three or more impairments in Activities of Daily 

Living (ADLs) are at a high risk for nursing home admission. Measures of the aging 

network’s success at serving this vulnerable population is a proxy for success of nursing 

home delay and diversion. In FY 2003, the aging network served home-delivered meals to 

280,454 individuals with three or more ADL impairments. By FY 2009, that number has 

grown by 27 percent to 357,403 individuals. 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 admission based on scientific literature and AoA’s 

Performance Outcome Measurement Project (POMP) which develops and tests performance 

measures. The components include such items as percent of program recipients who are 

transportation disadvantaged and the percent of congregate meal individuals who 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. In FY 2009, this 

score has increased to 61.0.

• OAA programs are efficient: The aging network is providing high-quality services to the 

neediest elders, and is doing so in a prudent and cost-effective manner. As an example, AoA

and the aging network have significantly increased the number of persons served per million 

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

AoA funding in FY 2002. 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 three dollars in other funds 

are leveraged 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, in FY 2009, 

operates in 50 states, three territories, and Washington, D.C. at 290 locations.

OAA program participants 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 service recipients rated services as good to excellent; 
3

while 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 providers 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.

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

performance measurement akin to the three legs of a stool (efficiency, outcomes and targeting) 

holding up AoA’s mission and strategic goals that include:

 

1. Empowering 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. Enabling 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. Empowering older people to stay active and healthy through Older Americans Act 

services and the prevention benefits under Medicare;

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

5. Maintaining effective and responsive management.

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
4

Supporting Community-Based Long-Term Care for Frail Seniors

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

57 million to 65.7 million.1

 During this period, the number of seniors with severe disabilities 

(defined as three 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.

2

 

AoA’s 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, 58 percent of congregate and 93 percent of home-delivered meal recipients report 

that the meals helped enable them to continue living in their own homes and 48 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.3

 These programs help seniors in need to maintain their health and independence.

OAA programs are assisting 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. 

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 them to take into account 

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 funds

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 Nutrition Services 

(congregate and home-delivered meals) in order to meet the local needs of older adults. 

Additionally, for any fiscal year, if the transferred funds are insufficient to satisfy the need for 

nutrition services, 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 of OAA funds for any fiscal 

year between Supportive Services programs and Nutrition Services programs. These are options 

 1 U.S. Census Bureau, “2008 National Population Projections,” released August 2008, 

<http://www.census.gov/population/www/projections/2008projections.html>. 2 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.

3 2008 National Survey of Older Americans Act Participants. http://www.data.aoa.gov, select AGID.
5

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 FY 2009, states transferred over $77 million from congregate nutrition to home and 

community-based services and home-delivered meals, as illustrated in the following table. 

Table 1. FY 2009 Transfer of Federal funds within Title III of the OAA

Part B –

Home and CommunityBased Supportive ServicesPart 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

Outreach and Targeting

The aging network conducted significant outreach activities in FY 2009. More than 4.5 million 

contacts were made. In addition, states and AAA’s obtained substantial match from other 

funding sources obtaining an additional $1.50 for each federal dollar used in outreach. The 

effectiveness of these outreach efforts, in accordance with the OAA mandate to serve older 

adults in greatest social and economic need, is demonstrated by the substantial number of lowincome, minority, rural and isolated individuals who receive OAA services, as outlined in the 

table below.

US Population 60+ Years OAA Service Recipients

Seniors at or below the 

HHS Poverty Guideline

9.3%* 30.5%

Rural 22%** 35.7%

Minority 19.8%* 25.0%

 * Based on 2007 American Communities Surveys

 ** Based on 2000 Census

Program Evaluations in Progress

Program evaluations are complimentary to performance measurement. Their objective is to 

provide data that can relate program services to client outcomes and explain how and why 

program results are accomplished. The goal of these evaluations is to help inform budget 

decisions, policies and practices so that the AoA and the aging network may better serve more 

elders in the most efficient and effective manner. 

AoA’s program evaluation framework is an approach that places assessment of program 

effectiveness and efficiency as the primary focus, regardless of the program activity. All 

evaluations are designed to examine client outcomes as a key measure of program effectiveness 

along with a process evaluation component that collects data on each level of the aging network. 
6

A Title III-C Elderly Nutrition Services program evaluation, currently in progress, will employ 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 the Centers for Medicare & Medicaid Services (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.

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. 

AoA is working with the Agency for Health Care Research and Quality (AHRQ) and research 

contractors to finalize a design for an evaluation of the Chronic Disease Self-Management 

program utilizing an experimental design and is also working on an evaluation of the Aging and 

Disability Resource Centers.

The multi-year, comprehensive evaluation activities outlined above are anticipated to collect and 

analyze data over the course of the following five years. Several of these project evaluations

include rolling recruitment of study participants and comparison groups over an extended period 

of time, with up to a 12-month follow-up period that includes additional data collection. The 

necessary time lag to obtain longitudinal Medicare data to measure healthcare utilization and 

costs may extend the timeframe for final analyses and reporting that incorporates these 

outcomes.
7

Part I: Health and Independence

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, 58 percent of congregate and 93 percent of homedelivered meal recipients reported that the meals enabled them to continue living in their own 

homes and 48 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.

Home and Community-Based Supportive Services

The Home and Community-Based Supportive Services 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 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, which helps to ensure that 

frail, elderly persons are able to remain in their own homes and communities instead of entering 

nursing homes. 

The services provided to seniors through the Home and Community-Based Supportive Services

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, these programs also fund multi-purpose senior centers, 

which coordinate and integrate services for the elderly. In FY 2009, states reported that 10,942 

senior centers were in operation nationwide, 5,900 of which receive OAA funding to help 

support their operations and activities. 

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 

 4 2008 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.
8

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 report that as a result of the services arranged 

by the case manager that they are better able to care for themselves.7

 In addition, a study 

published in the Journal of Aging and Health shows that these services, 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.8

 

Services provided by the program in FY 2009, 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.

• Transportation Services provided nearly 28 million rides to doctor’s offices, grocery 

stores, pharmacies, senior centers, meal sites, and other critical daily activities. 

• 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).

• 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. 

In continuing with AoA’s and the aging network’s commitment to providing services to those 

most in 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); 

• 14 percent have had a stroke; 

• 7 percent have Alzheimer’s disease or dementia; 

• 3 percent have epilepsy; 

• 3 percent have Parkinson’s disease; and

 7 2009 National Survey of Older Americans Act Participants. http://www.data.aoa.gov. 8 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.
9

• 2 percent have Multiple Sclerosis.

 

Of the transportation participants, 95 percent take daily medications, with 17 percent taking 10 to 

20 medications daily.

9

 

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.10 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.

11 

AoA’s core formula grant programs reach one in five seniors, serving over a half million 

individuals 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. 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 have significantly lower risk of nursing home 

admissions.

12 

Federal support for Older Americans Act programs is not intended 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 the fact that

states are only required to match this program at 25 percent of their federal allocation, states 

have normally leveraged resources of two or three dollars for every OAA dollar received. 

Nutrition Services

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. As currently authorized, Nutrition Services include:

 9 2008 National Survey of Older Americans Act Participants. http://www.data.aoa.gov, select AGID. 10 U.S. Census Bureau, “2008 National Population Projections,” released August 2008, 

<http://www.census.gov/population/www/projections/2008projections.html >. 11 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. 12 “Risk of Nursing Home Admission Among Older Americans: Does States’ Spending on Home and CommunityBased Services Matter?” May 2007. Journal of Gerontology: Psychological Sciences.
10

• 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 (NSIP) (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 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. 

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. 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 have significantly more social contacts than people who did not 

participate in the program. In addition, home-delivered meal and congregate meal participants 

have significantly better food energy intake, protein, vitamins A, B6 & D, Riboflavin, Calcium, 

Phosphorous, Potassium, Magnesium and Zinc intakes compared to matched non-participant 
11

group of senior citizens.13 Seniors with deficiencies of these nutrients can experience 

osteoporosis, night blindness, decreased resistance to infection, fatigue, vasodilatation, and other 

illnesses.

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.14

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. 

In addition, the number of home-delivered meal recipients with severe disabilities (3+ ADL) 

totaled more than 357,000 in FY 2009. This level of disability is frequently associated with 

nursing home admission, and demonstrates the extreme frailty of a significant number of homedelivered 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.

• Congregate Nutrition Services provided over 92.4 million meals to nearly 1.7 million 

seniors in a variety of community settings in FY 2009.

More detailed information about persons served, units of service and expenditures can be found 

in the table on the following page:

 13 Serving Elders at Risk – National Evaluation of the Elderly Nutrition Program, 1993-1995, pp.117-118 14 2008 National Survey of Older Americans Act Participants. http://www.data.aoa.gov, select AGID.
12

FY 2009 National Program Services Summary Report

FY 2009

Total Clients 11,476,655

Total Registered Clients 2,964,061

% Minority Clients 24.98%

% Rural Clients 35.67%

% Clients Below Poverty 30.51%

# Clients with 3+ ADLs 508,442

# of Persons Served at High Nutrition Risk 764,748

# Senior Centers 10,942 (5,900 receive OAA funding)

Service Persons 

Served

Units of 

Service15

Title IIIE 

Expenditure

Total 

Expenditure

Personal Care 108,887 14,833,984 $11,194,758 $270,336,077

Homemaker 160,510 12,660,912 $28,222,264 $239,661,872

Chore 39,266 1,213,920 $5,751,464 $21,061,578

Home Delivered 880,135 149,188,917 $224,389,216 $790,488,570

Adult Day Care 23,547 7,909,015 $11,720,328 $84,376,141

Case 491,481 3,941,408 $31,251,465 $264,708,053

Assisted Trans. 38,103 1,421,668 $3,551,476 $15,143,273

Congregate 1,686,093 92,492,669 $263,999,420 $643,914,615

Nutrition 

Counseling

23,900 58,193 $1,368,862 $3,124,931

Transportation 26,175,683 $68,731,181 $199,084,035

Legal Assistance 931,776 $25,159,733 $50,491,019

Nutr. Education 1,988,487 $3,914,260 $6,819,616

I&A 12,406,397 $56,153,108 $151,056,286

Outreach 4,225,060 $10,524,273 $23,870,849

Other $110,946,638 $628,075,076

 15 Title III-C service units definition:

Personal Care = 1 Hour

Homemaker = 1 Hour

Chore = 1 Hour 

Home-Delivered Meal = 1 Meal. 

Adult Day Care/Adult Day Health = 1 Hour 

Case Management = 1 Hour 

Assisted Transportation = 1 One Way Trip 

Congregate Meal = 1 Meal

Nutrition Counseling = 1 session per participant

Transportation = 1 One Way Trip

Legal Assistance = 1 hour

Nutrition Education = 1 session per participant

Information and Assistance = 1 Contact
13

Caregivers Serving Elderly Individuals

Service Caregivers 

Served

Service 

Units16

Title III 

Expenditure

Total 

Expenditure

Counseling, Support Groups, Training 137,203 456,537 $18,406,540 $26,213,647

Respite 69,017 6,406,159 $56,258,419 $94,572,799

Supplemental Services 47,426 1,322,240 $13,779,929 $21,124,526

Access Assistance 619,389 1,024,261 $32,105,954 $44,921,099

Unduplicated Caregivers 

Provided Service or 

Access

828,505

Preventive Health Services

Preventive Health Services, established in 1987, provides formula grants to states and territories, 

based on their share of the population aged 60 and over. These services 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 persons aged 85 and over, which 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 those who have the greatest economic and social needs. 

Services currently provided through the Preventive Health Service program include:

• Information and Outreach, including the distribution of information about healthy 

lifestyles and behaviors to seniors through Aging and Disability Resource Centers, 

 16 Title III-E service units definition:

Counseling = 1 session per participant

Respite Care = 1 hour

Supplemental services = variable

Access Assistance = 1 contact
14

AAAs, senior centers, community parks and recreation programs, housing programs, 

faith-based organizations, chronic disease self-management programs, congregate meal 

sites, and the home-delivered meals program.

• Health Screenings and Risk Assessments for a variety of conditions, including 

hypertension, diabetes and glaucoma, as well as dental, cholesterol, hearing, and vision.

• Evidence-based Prevention Programs, as described below.

Over the last few years, a number of states have chosen to use this funding to provide greater 

support to evidence-based approaches, especially in helping individuals manage chronic 

diseases. Examples of evidence-based models include enhanced fitness, enhanced wellness, falls 

prevention, and chronic disease self-management programs that have been demonstrated to be 

especially effective. Evidence-based programs are interventions that have been rigorously 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. AoA continues to encourage states and the aging 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 that is 

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 decrease 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 U.S. 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 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.

17

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.18

 17 Even, Jennifer. 2009. Senior Series. The Ohio State University Extension. 20 May 2009.

 Data 

18 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.
15

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 that are facilitated 

by leaders who are trained and certified to help persons with chronic diseases learn that 

they can change their health behaviors through action plans and goal setting.

In 2009, more than 400 services, such as blood pressure screening, walking clubs, yoga sessions, 

etc., were identified by states as being designed to improve seniors’ health. Activities were

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 report that 

5.9 million seniors were served in these health-related programs, which received $16 million in 

additional funding from states and local entities. 
16

Part II: Caregiver Services

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. 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. 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.

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.19 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 continuing in that role. Seventy-seven percent of the caregivers 

served by AoA’s programs report that the OAA services allow them to provide care longer than 

they otherwise could.20 

At the same time, AoA recognizes that it must also address the growing need for more caregivers 

every day. 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.21 By 2015, AoA 

projects that there will be 12.9 million non-institutionalized seniors age 65 and over with 1+ 

Activities of Daily Living (ADL) deficits, an increase of almost 2 million seniors or 18 percent 

since 2008, needing caregiver assistance.22 

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. 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).23 

 19 Schulz R, Beach SR. Caregiving as a risk factor for mortality. The Caregiver Health Effects study. JAMA 

December 15, 1999;282:2215-9. 20 Ibid. 21 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> 22 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. 23 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.
17

Family Caregiver Support Services Program

The Family Caregiver Support Services program 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, homedelivered meals, and adult day care, to provide a coordinated set of supports for seniors that 

caregivers can access on their behalf.

Family Caregiver Support Services provide a variety of supports to family and informal 

caregivers. 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.

Based on FY 2009 data, more than half a million caregivers (507,292) received services provided 

through this program, including:

• Access Assistance Services provided 619,389 contacts to caregivers assisting them in 

locating services from a variety of private and voluntary agencies.

• 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.

• 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.

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 81 percent of 

caregivers of program clients reported in 2009 that services enabled them to provide care longer 

than otherwise would have been possible.24 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, 81 percent, indicated that the care recipient 

would most likely be living in a nursing home or assisted living (see the chart on the next page).

 24 2008 National Survey of Older Americans Act Participants. http://www.data.aoa.gov, select AGID.
18

As reported in AoA’s 2008 National Survey of Older Americans Act 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.25

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 published in the Journal of the American Medical 

Association, Intervention to Delay Nursing Home Placement of Patients with Alzheimer’s 

Disease26, 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.

Lifespan Respite Care Program

The Lifespan Respite Care program was created by Congress in 2006 under Title XXIX of the 

Public Health Service Act (42 U.S.C. 201). It 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 

 25 2008 National Survey of Older Americans Act Participants. http://www.data.aoa.gov, select AGID. 26 Mittelman, Mary S., et al, Journal of the American Medical Association (JAMA), Vol. 276, No. 21, December 4, 

1996.

Where Care Recipients with 3+ ADL Would Live If Their Caregivers 

Were Unable to Have Title III-E Caregiver Supportive Services

8%

70%

8%

1%

11%

2%

Caregivers home Nursing Home Other Fam.memb. Home They'd die Assisted Living Other 

Source: 2008 National Survey of Older Americans Act Participants. http://www.data.aoa.gov, select AGID.
19

the most recent National Survey of Older Americans Act 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 include 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.

The first grants for the program were awarded in FY 2009 to twelve recipients for up to 

$200,000 for three-year project periods. 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 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 Lifespan Respite Care program builds upon the

existing infrastructure of multi-faceted caregiver services, providing training for caregivers, 

enhancing the provision of information about available respite and other supportive services, and 

assisting caregivers in accessing all services available to them, including respite, from across the 

spectrum of caregiver support. 

Alzheimer’s Disease Supportive Services Program

The Alzheimer’s Disease Supportive Services Program (ADSSP), created by Congress in 1991 

under Section 398 of the Public Health Service Act (P.L. 78-410; 42 U.S.C. 280c-3), 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 
20

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.

• 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.

AoA issued grant funding opportunities in FY 2009 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 2009, the ADSSP funded 16 grants with an average award of $646,764 and a range of 

grant awards from $203,155 to $1,000,000. 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 a 

promising intervention 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.27

 27 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.

In 2009, the average nursing home cost was $219 daily ($79,935 annually), which 
21

would mean an average savings of nearly $122,000 in institutional costs per person with dementia.28 

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 2009 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. 

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 the 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 through the use of a 

language interpretation service.

 28 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
22

Part III: Older American Indians, Alaska Natives, and 

Native Hawaiians

The number of older American Indian, Alaska Native, and Native Hawaiian (AI/AN/NH) is 

increasing. According to Census Bureau projections, there were about 225,000 American 

Indians and Alaska Natives age 55 and older in 2008. This represents about 16 percent of the 

AI/AN population. By the year 2020, about 22 percent, or nearly 811,000 individuals, of the 

American Indian and Alaska Native population will be age 55 and older.

29 The older Native 

Hawaiian population is expected to also increase, but at a lower rate. In 2008, about 14 percent 

(about 40,000 individuals) of the Native Hawaiian population in the state of Hawaii was age 55 

and older. This is expected to increase to 16 percent (53,500 individuals) by 2020.

30 This 

increase in the older population of AI/AN/NH is the result of both the increased life expectancy 

and the aging of the baby boom generation. 

Health and Functional Status

While it is good news that AI/AN/NH are living longer, increasing age also increases the risk of 

developing multiple chronic diseases and functional limitations which influence a person’s 

ability to live independently. The National Resource Center on Native American Aging 

(NRCNAA) at the University of North Dakota has been collecting general information on health 

status, chronic diseases, activity limitations, health risks, social support, and demographics on 

Tribal elders since 1997.

31 Their data indicate that native elders have a greater prevalence of 

arthritis, asthma, breast cancer, congestive heart failure, diabetes, high blood pressure, prostate 

cancer, and stroke as compared to the U.S. general population over age 55. Their data also

indicate that as the native elder population ages, there is generally an increasing prevalence of 

arthritis, cataracts, colon/rectal cancer, congestive heart failure, high blood pressure, prostate 

cancer, and stroke. In contrast, the prevalence of asthma and diabetes decreases with increasing 

age. One possible reason for this is that those with asthma or diabetes do not live as long as 

those without the diseases. 

Older adults are at disproportionate risk for poor nutrition with corresponding adverse effects on 

their health and quality of life. Of the 9,416 AI/AN elders who completed a ten-question 

nutrition screening questionnaire to determine their nutritional risk in 2005, 22.3 percent were at 

high nutrition risk and 31.8 percent were at moderate risk.32

 29 Population Division, U.S. Census Bureau. Table 16. Projections of the American Indian and Alaska Native 

Alone Population by Age and Sex for the United States: 2010 to 2050. August 14, 2008. 

 Nutrition risk helps to identify 

warning signs for poor nutrition.

30 Malone, J.J. Laupa’I kanaka: Native Hawaiian population forecasts for 2000 to 2050. Honolulu: Kamehameha 

Schools – PASE. 2005

31 Moulton, P.L., McDonald, L.R., Muus, K.J., Knudson, A.D., and Ludtke, R.L. Chronic Disease in American 

Indian/Alaska Native Elders. IHS Primary Care Provider. 30:120-123, 2005.

32Jackson, M.Y. and Beard, H. Nutrition related health concerns for American Indian and Alaska Native elders. J. 

Native Aging and Health 1(1):15-19, 2005.
23

A decline in functionality is a normal part of aging but appears to be exacerbated with the 

presence of a chronic disease. The NRCNAA data indicate 13 percent of AI/AN elders reported 

three or more activities of daily living (ADL) limitations, which is the screening level for entry 

into a skilled nursing facility. Another seven percent indicated moderately severe functional 

limitations which would indicate assisted living level of care. Twenty-one percent indicated 

moderate functional limitations which may require home and community based services. 

Increased age, lower income, and lower educational level were all associated with the likelihood 

of more functional limitations.33

Home and Community-Based Long-Term Care Services

In general, American Indian reservations, Alaska Native villages, and Native Hawaiian 

homelands are located in rural areas and are often many miles from cities. This geographic 

isolation impacts the ability to access programs and services that are available in urban areas. 

Most AI/AN/NH elders wish to remain at home and in their communities in order to continue to 

participate in their cultural and religious ceremonies and traditions. They are unable to relocate 

in order to receive available home and community-based long-term care services. Thus, tribal 

governments are seeking ways to provide these necessary services in Indian Country.

Two studies on the status and need for long-term care services have recently been completed. 

One of the studies asked tribal health directors, community health representative directors, social 

service directors, Title VI directors and other service providers about long-term care planning, 

strengths and barriers to providing services, and interest in developing long-term care services.34 

A total of 68 percent of the 305 tribes that received the questionnaire responded to it. The major 

findings of the study included:

• Nearly two-thirds reported discussions within the past 12 months on developing longterm care services.

• The most commonly available long-term care services currently being provided were a 

senior center, nutrition/meals, transportation, information and referral, home 

maintenance/repair/modification, and wellness/disease management.

• Strengths in program development included leadership support, acknowledgement of the 

need for long-term care services, ability to secure funding, and community respect for 

elders.

• Common barriers to program development were related to funding issues. 

The second study, conducted by Scripps Gerontology Center for the National Association of 

Area Agencies on Aging in 2007-2008, assessed Title VI involvement in home and community 

based long-term care services, including funding sources, partnerships, and challenges faced in 

 33 McDonald, L.R., Ludtke, R.L., and Muus, K.J. Chronic disease and functional limitation among American Indian 

and Alaska Native elders. J Native Aging and Health 1(1):7-13, 2005.

34 Goins, R.T. Results from the National Tribal Long-Term Care Study. West Virginia University Center on Aging. 

December 2008.
24

providing services.35 Nearly 86 percent of the 246 Title VI program directors responded to the 

survey. The results indicated that the majority of Title VI programs also receive services funding 

from the tribe (76 percent) and the Indian Health Service (IHS) (71 percent) and many receive 

funding or services from Title III (38 percent) and the state (31 percent). At least 23 percent

receive some gaming revenue to fund their services. The high rate of involvement between IHS 

and OAA Title VI programs reflect the complementary areas of focus and increased 

collaboration between AoA and IHS to support the critical needs of tribal members and families 

across the lifespan. 

The survey also indicated Title VI programs partner with many other federal, tribal, state and 

local programs in order to provide home and community-based long-term care services. The 

most common partnerships are with IHS (89 percent); health care providers (84 percent); tribal, 

state, and local health departments (75 percent); housing programs (75 percent); and adult 

protective services (73 percent). Although many services are being provided and numerous 

partnerships have been developed, there are barriers to expanding service or developing new 

services. The greatest challenges to providing home and community-based long-term care 

services were identified as: 1) increasing expenses limit expanding services (94 percent); 2) 

tribal decisions limit what can be done (71 percent); and 3) the state, either through rules or 

legislation, limit our role in long-term care (58 percent).

Service Delivery, Outreach and Coordination

Outreach and coordination between Title III – Grants for State and Community Programs on 

Aging and Title VI – Grants for Native Americans have been assessed in a variety of ways. Both 

Title III state plans and Title VI applications were reviewed to assure provisions were included 

for outreach and coordination. Additionally, with a grant from the Administration on Aging, the 

National Association of Area Agencies on Aging partnered with Scripps Gerontology Center to 

assess Title VI and area agencies on aging involvement in home and community based long-term 

care services and programs. Nearly 71 percent of the Title VI directors responding to questions 

about Title VI and Title III coordination indicated they currently had, or were developing, 

collaborations with their local area agency on aging. Examples of outreach and collaborations 

include:

• Some states have established tribal liaison positions to help increase coordination and 

inclusion of tribal populations in state programs.

• Some states include tribal representatives on their Governors’ Committees on Aging.

• Title VI programs, state units on aging and area agencies on aging have collaborated to

provide a variety of training programs. For example, in 2009, the Oneida Tribe in 

Wisconsin partnered with the Milwaukee County Area Agency on Aging to train several 

tribal members as lay leaders for their chronic disease self management program. 

Additionally, the Wisconsin State Unit on Aging contracted with the Great Lakes InterTribal Council to be the technical assistance center to meet the unique needs of the eleven 

tribal aging programs in a culturally competent manner.

 35 McGrew, K.B., Kunkel, S., Lackmeyer, A., and Straker, J.K. Preparing the Aging Network for choices for 

Independence: Title VI Survey Results. Scripps Gerontology Center. July 2008. 
25

Nutrition and Supportive Services

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. 

The 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 2009 grants 

were awarded to 246 tribal organizations (representing 400 tribes), including two organizations 

serving Native Hawaiian elders, with an average award of $107,477 and a range of grant 

awards from $74,650 to $1,505,000. 

Caregiver Support Services

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. 

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, 
26

respite care, and other supplemental services. AoA also partnered with the Admnistration for 

Native Americans and the Corporation for National and Community Service to work with tribal 

organizations 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. 

Priority Needs

Although the needs of AI/AN/NH elders are similar to the needs of the general older adult 

population in the United States, there are challenges in accessing services. The geographical 

isolation, socio-economic situation of native elders, and limited availability of programs and 

services in AI/AN/NH communities creates unique challenges in addressing their needs. From 

needs assessment and other surveys and testimony from tribal leaders and program directors at 

both the FY 2009 AoA Tribal Listening Session and the Department of Health and Human 

Service Tribal Budget Consultation, the priority needs of AI/AN/NH elders are:

• Health promotion, disease prevention, and chronic disease management;

• Home and community-based long-term care in Native communities;

• Supportive services, especially transportation and housing; 

• Elder protection; and

• Caregiver support, including respite.
27

Part IV: Protection of Vulnerable Older Americans

As the population of Americans age 60 and older increases, the problem of elder abuse, neglect, 

and exploitation continues to grow. Despite the absence 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 (NCEA) showed a 16 percent increase in the number of elder abuse cases 

from an identical study conducted in 2000. 36 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.37 Together, these 

data suggest that at least two million Americans age 65 or older are injured, exploited, or 

otherwise mistreated by someone on whom they depend for care or protection. Perpetrators of 

elder abuse may be paid attendants, family members, or employees of long-term care facilities. 

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. 38 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 that a growing number of seniors who access the healthcare 

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

ultimately forced to leave their homes and communities prematurely. 39 

In addition, the population age 85 and older is growing rapidly and is projected to reach nearly 

20 million by the year 2030. As this population grows, the need for effective long-term care 

services will increase greatly. Many of these seniors will rely on the support of family and other 

informal caregivers to remain at home and in the community, while for others a nursing home 

may represent the best option for receiving the care they need. Regardless of the setting in which 

these vulnerable elders reside, one of the consequences of this growing population of frail elders 

is the likelihood of an increase in the instances of elder abuse. 

The OAA’s Protection of Vulnerable Older Americans programs provide a combination of 

training, outreach, and information dissemination activities that promote the rights of older 

people, help improve the quality of care for residents of long-term care facilities, and increase 

public and professional awareness of the problem of elder abuse. 

 36 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 37 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 38 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. 

39 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.
28

Prevention of Elder Abuse and Neglect

Grants for the Prevention of Elder Abuse, Neglect and Exploitation are allocated by formula to 

the 56 states and territories based on their share of the population aged 60 and over. States and 

territories then have discretion to further allocate funding among the various activities authorized 

under each program and may choose to provide funding to area agencies on aging and local 

service providers. Section 721 activities of the OAA are focused primarily on protecting 

vulnerable adults residing at home, or in community-based settings.

Grants provide funding for training and education, promoting public awareness of elder abuse,

and supporting state and local elder abuse prevention coalitions and multi-disciplinary teams. 

The program coordinates activities with adult protective services programs (over half of which 

are directly administered by state offices on aging) and other professionals who work to address

issues of elder abuse and elder justice. 

In FY 2009, the Prevention of Elder Abuse, Neglect and Exploitation program continued its 

efforts to support state and local efforts to train law enforcement officials, develop and distribute 

educational materials, conduct public awareness campaigns, and create community coalitions.

States and area agencies on aging also use this funding to coordinate their activities with fraud 

and crime prevention partnerships organized by sheriffs, police chiefs, and community 

organizations.

Examples of elder abuse prevention activities initiated through these grants at the state level

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 

for, and resource information to assist, victims of elder abuse. “Fraud Fighter” forms 

were produced and 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 statewide number for reporting 

information, hosting community trainings on the various forms of elder abuse, as well as 

other events and items to raise awareness in communities.

• Lifespan, located in Rochester, New York, used OAA funding to support training of nontraditional 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.

• 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.
29

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.

Model Approaches to Statewide Legal Assistance Systems

The Model Approaches to Statewide Legal Assistance Systems demonstration grants represent an 

innovative departure from AoA’s past approach to the funding of Senior Legal Helplines (SLH). 

Model Approaches seeks to address the nationwide challenge of what are often fragmented and 

inefficient legal service delivery systems that fail to achieve optimal access to quality service for 

older adults most in need. Model Approaches helps states develop and implement cost-effective, 

replicable approaches for integrating SLHs into the broader array of state legal service delivery 

networks. Ultimately, legal assistance provided through well integrated and cost-effective 

service delivery systems as demonstrated through Model Approaches directly impacts the ability 

of seniors most in need to remain independent, healthy, and financially secure in their homes and 

communities.

Model Approaches features strong leadership at the state level to achieve its service delivery 

integration objectives. State Legal Assistance Developers can take the lead in incorporating the 

use of legal helplines and other low-cost mechanisms into the state legal services planning and 

development process. Key project partners and service delivery components also include Title 

III-B legal services providers, private bar pro-bono attorneys, law school clinics, and self-help 

sites. By promoting the seamless integration of these vital legal service delivery components, 

Model Approaches enables seniors most in need to access quality legal services in priority legal 

issue areas involving income security, healthcare financing, consumer fraud, housing and 
30

foreclosure prevention, and elder abuse. This approach is also designed to increase the 

leveraging of limited resources within service delivery systems.

In addition, by ensuring strong leadership at the state level, Model Approaches projects have 

created important linkages between the existing legal assistance community and 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. 

As a centerpiece of the Model Approaches projects, SLHs assist seniors in accessing quality 

legal services to ensure their rights and enhance their independence and financial security. In FY 

2009, SLHs within Model Approaches projects assisted 39,247 older consumers in the most 

social or economic need on a wide range of priority legal issues related to public benefits, health 

care, housing, advance planning, and consumer protection.

Through effective targeting and outreach efforts, SLHs under Model Approaches have been very 

successful in reaching low income populations with 63% of older clients falling within 150

percent of federal poverty guidelines. Also, total minority clients receiving assistance through 

SLH in FY 2009 constituted 28 percent of all clients served. These figures illustrate the 

effectiveness of Model Approaches states in reaching key target populations under the Older 

Americans Act with much needed “priority” legal assistance.

An important purpose of the Model Approaches demonstrations is to position SLHs as 

coordinated and essential components of high quality and high impact legal service delivery 

systems that effectively target scarce resources to older persons most in need. Model Approaches 

partners across the country recognize the enormous value of the network relationships that have 

been forged in pursuit of essential project goals and objectives. Early indications show that some 

Model Approaches states (despite highly adverse economic conditions) are already beginning to 

adopt SLHs as permanent and essential components of their legal and aging service delivery 

systems. Key examples have emerged in North Dakota, Nevada, and Iowa, illustrating the 

sustainability of these projects beyond the demonstration period.

Other outcomes achieved in FY 2009 and anticipated for all Model Approaches projects include:

• Comprehensive statewide legal needs assessments that identify the legal issues impacting 

seniors in target populations and assess the capacity of existing service delivery systems to 

meet those identified needs;

• Enhanced collaboration among area agencies on aging, ADRCs, SLHs, and legal providers in 

identifying and serving seniors most in need of assistance on priority legal issues; 

• Enhanced service delivery capacity of legal services programs and SLHs through the 

leveraging of low cost service delivery mechanisms such as SLHs, private bar pro-bono 

attorneys, law school clinics, and self-help sites; and

• Strengthened systems that reach underserved and hard-to-reach seniors most in need through 

effective targeting and outreach methodologies.
31

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 (NLRC) which provides 

resource support through a strategic combination of case consultation, training, and technical 

assistance on a broad range of legal and systems development issues. Types of pervasive legal 

issues include preventing the loss of a senior’s home through foreclosure; protecting against 

consumer scams and creditor harassment; addressing elder abuse in the community and in longterm care facilities; and difficulties in accessing public benefits essential to financial security, 

independence, and health. The NLRC partners also provide technical assistance on the efficient, 

cost-effective, and targeted provision of state-wide legal and elder rights advocacy services.

As a streamlined and accessible point of entry, the NLRC 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. The audience targeted to receive support services 

through the NLRC includes a broad range of legal, elder rights, and aging services professionals 

and advocates. These include legal assistance providers, legal assistance developers, long-term 

care ombudsmen, state unit on aging directors, area agency on aging and ADRC personnel, 

senior legal helplines, and others involved in protecting the rights of older persons.

In FY 2009, economic circumstances gave rise to a host of legal challenges for older consumers 

and the legal providers who serve them. In response to an increasing demand for legal resource 

support, the NLRC provided training and case consultation to over 4,100 aging and legal service 

professionals nationwide. In addition, NLRC partners provided important technical support in 

the implementation of the Model Approaches projects in 18 states, featuring the provision of 

expertise in legal needs and capacity assessments, effective targeting of outreach methodologies, 

SLH operations, statewide reporting systems, and legal service delivery standards.

In addition, work on NLRC website in FY 2009 paved the way to the creation of single entry 

point into a national legal assistance support system providing high quality resources and 

expertise on a broad range of legal and systems development issues. The NLRC is now 

accessible through http://www.nlrc.gov.

An essential foundational premise of the NLRC is that the combined efforts of several partnering 

organizations with high levels of subject matter expertise is required to achieve its broad 

resource support objectives. Through effective collaborations, interlocking work plans, and the 

leveraging of organizational resources, NLRC partners have demonstrated the ability to achieve 

effective national coverage. In FY 2009, nearly 100 percent of professionals responding to 

surveys rated the quality and usefulness of the support service provided by the NLRC as either 

good or excellent. 
32

Pension Counseling and Information Program

In 1992, Congress directed AoA to develop demonstration projects specifically designed to help 

individuals with pension problems. These demonstrations were so successful that Congress 

established pension counseling as a permanent program under Title II of the OAA in 2000. 

Today, there are more than 700,000 private (as well as thousands of public) pension and 

retirement plans in the United States. Thousands of Americans reach retirement age each year, 

only to be told that they will not receive the pension benefits they expected. Because individuals 

have generally worked for several employers, which may have merged, sold their plans, or gone 

bankrupt, it is very difficult for most persons to know where to get help in finding out whether or 

not they are receiving all of the pension benefits to which they are entitled. 

Benefits from employer-sponsored pensions and retirement savings plans are as critical today to 

the retirement security of Americans as they were when the pension counseling program was

first established. The pension questions which people face are just as complex, and good help is 

just as hard to find – even more so for those with only modest benefits at stake. The role of the 

Pension Counseling and Information Program is to help ensure that older Americans have access 

to the employer-sponsoredretirement benefits they’ve earned --- benefits that are critical to their 

ability to live independently and with dignity after a lifetime of productive employment. The 

Pension Counseling & Information Program provides help to individuals that would be otherwise 

unavailable, by assisting them in understanding and exercising their pension rights. The program 

promotes the financial security of older individuals by offering them the help they need to 

receive the pension benefits they have earned. The income, in turn, provides increased 

opportunities for choice and independence. 

AoA currently funds six regional counseling projects covering 27 states and a technical 

assistance resource center to assist older Americans in accessing information about their 

retirement benefits and to help them negotiate with former employers or pension plans for due 

compensation. Data for the program shows that:

• Since the Program’s inception in 1993, the Pension Counseling projects have recovered 

nearly $120 million in retirement benefits for individual claimants, representing a return 

of more than $5.50 for every Federal dollar invested in the program. These recoveries 

demonstrate that pension counseling is not only necessary, but that it can be provided 

efficiently and effectively.

• 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 the laws that govern them; and making targeted referrals to 

other professionals for assistance. 

• Even when Pension Counseling projects are unable to secure benefits for clients, the 

information and assistance the projects provide can bring peace of mind to vulnerable 

elderly individuals, often after months or even years of searching for answers.
33

• Through the distribution of fact sheets and other publications, websites, and conducting 

outreach, education and awareness efforts, Pension Counseling projects have also 

provided indirect services to tens of thousands of seniors and their families. 

A critical component of the AoA Program is the National Pension Assistance Resource Center 

(the Center) which provides substantive training and back-up services to the counseling projects, 

SUAs, AAAs, and legal services providers. In addition to providing pension assistance to 

individuals in states not currently served by AoA’s pension counseling projects, in FY 2009 the 

Center enhanced its focus on development of a comprehensive, nationwide dataset of pensionrelated information and assistance resources, providing nationwide information and referral 

services to consumers, legal and aging services providers, and others, free of charge.

Senior Medicare Patrol (SMP) Program

In 1995, AoA became a partner in a government-led effort to fight fraud, error and abuse in the 

Medicare and Medicaid programs through the implementation of a demonstration project called 

Operation Restore Trust (ORT). During its demonstration phase, ORT returned $23 for every $1 

spent looking at the fastest growing areas of Medicare fraud, including home health care, skilled 

nursing facilities and providers of durable medical equipment.

Since FY 1997, AoA has also received funds from the Heath Care Fraud & Abuse Control 

Account (HCFAC) (as created by the Health Insurance Portability and Accountability Act of 

1996; P.L. 104-191), to support the effective training and mobilization of senior volunteers and 

professionals to provide consumer education to beneficiaries. The volunteer program became 

commonly known as the Senior Medicare Patrol or SMP.

The SMP program serves a unique role in the effort to identify and prevent health care fraud in 

the Medicare and Medicaid programs. Projects utilize the skills of retired professionals as 

volunteers to conduct community outreach and education and provide information that 

empowers 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 (CMS), the Office of Inspector General (OIG), healthcare providers, and 

other aging and elder rights professionals from around the country. In FY 2009, 54 SMP 

discretionary grants were awarded to fund projects in all 50 states, the District of Columbia, 

Guam, Puerto Rico, and the Virgin Islands.

The National Consumer Protection Technical Resource Center (the Center), provided technical 

assistance, support and training to the SMP projects, ensuring a fully consolidated national 

approach to reaching Medicare and Medicaid beneficiaries. The Center promoted and 

disseminated the work of the projects during national forums and provided technical assistance 

through on-line training, workshops, and the SMP mentoring program. 

AoA collaborated with the CMS Program Integrity Group to facilitate referrals of fraud 

complaints directly from SMP projects to the CMS fraud contractors (Program Safeguard 

Contractors—PSCs, Medicare Drug Integrity Contractors—MEDICs, and ZPICs--Zone Program 

Integrity Contractors).
34

AoA funded seven SMP Integration Grants, awarded in 2008, to develop innovations that could 

be successfully replicated by the SMP community to expand and integrate program outreach 

within rural and tribal areas. Additionally, funding was awarded to the National Hispanic SMP 

(NHSMP) to develop culturally appropriate outreach strategies for the Hispanic senior 

population. Due to cultural isolation and language barriers, Hispanic seniors are often at 

increased risk to be victimized by health care fraud.

The HHS Office of Inspector General (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 calendar year 2009. Data show SMP projects:

• Maintained 4,444 active volunteers who worked almost 122,410 hours to educate 

beneficiaries about how to prevent Medicare and Medicaid fraud;

• 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 and over 311,377 media 

activities;

• Received 60,242 inquiries for information or assistance from beneficiaries; 

• Resolved 2,588 complaints of potential fraud, error, or abuse from beneficiaries,

families, or caregivers as a result of educational efforts; and 

• Referred complaints of potential fraud, worth over $3,762,448, to the Centers for 

Medicare & Medicaid Services or other appropriate agencies for further investigation.

In addition, the OIG reports that since the program’s inception 13 years ago, SMP projects have:

• Educated 2.8 million beneficiaries in almost 75,000 group education sessions and over 1 

million one-on-one counseling sessions; 

• Conducted close to1.3 million media outreach events and almost 69,000 community 

outreach education events; and 

• Documented $105.937 million in savings, including Medicare and Medicaid funds 

recovered, beneficiary savings, and other savings attributable to the project as a result of 

beneficiary complaints, which does not attempt to quantify the savings that may occur 

from the SMP program deterring fraud. 
35

provides core resource support through a strategic combination of case consultation, training, and 

technical assistance on a broad range of legal issues and systems development issues. Types of 

pervasive legal issues include preventing the loss of a senior’s home through foreclosure;

protecting against consumer scams and creditor harassment; addressing elder abuse in the 

community and in long-term care facilities; and difficulties in accessing public benefits essential 

to financial security, independence, and health. The NLRC partners also provide technical 

assistance on the efficient, cost-effective, and targeted provision of state-wide legal and elder 

rights advocacy services.
36

Long-Term Care Ombudsman Program

The Long-Term Care Ombudsman Program advocates for residents of long-term care facilities, 

including nursing facilities, board and care homes, assisted living, and similar adult care 

facilities. The program resolves problems of individual residents and works at the local, state and 

national levels to improve residents’ care and quality of life. 

Each state has an Office of the State Long-Term Care Ombudsman, headed by a full-time State 

Long-Term Care Ombudsman who directs the program statewide. Thousands of local 

ombudsman staff and volunteers, designated by the State Ombudsman as representatives, assist

residents and their families by resolving complaints and providing information related to longterm care. 

Section 712 of the Older Americans Act requires State Long-Term Care Ombudsmen to:

• Identify, investigate and resolve complaints made by or on behalf of residents;

• Provide information to residents about long-term care services; 

• Ensure that residents have regular and timely access to ombudsman services;

• Represent the interests of residents before governmental agencies and seek 

administrative, legal and other remedies to protect residents; and

• Analyze, comment on and recommend changes in laws and regulations pertaining to the 

health, safety, welfare and rights of residents.

The following FY 2009 data and information are collected annually by AoA from State LongTerm Care Ombudsmen through the National Ombudsman Reporting System (NORS). The data 

are gathered from the Long-Term Care Ombudsman Program recipients nationwide and are 

based on state and local level activities. 

Complaint Investigation and Resolution

Long-Term Care Ombudsmen provide an alternative dispute resolution service, resolving 

complaints for or on behalf of long-term care facility residents. 

• Ombudsmen nationwide worked to resolve 233,025 complaints in FY 2009, opening 

161,222 new cases (a case contains one or more complaints originating from the same 

person(s)). 

• Ombudsmen resolved or partially resolved 75 percent of all closed complaints to the 

satisfaction of the resident or complainant. 

• Of the cases closed, 122,857 (78 percent) were associated with nursing facility settings. 

Of the remaining cases, 33,766 (21 percent) were related to board and care, assisted 

living, residential care, and other facilities; and 1,207 (one percent) were associated with 

other settings or services to residents by an outside provider. 

• Most cases were initiated by residents or friends and relatives of residents, with residents 

initiating over 38 percent of cases in nursing facilities and over 32 percent in board and 

care, assisted living, residential care, and other similar facilities (see Figures 1 and 2 

below). Nearly 18 percent of complaints were issues identified proactively by 

ombudsmen, primarily by being present in facilities on a regular basis. 
37

Figure 1:

Types of Complainants for Nursing Facilities

0

5

10

15

20

25

30

35

40

45

2005 2006 2007 2008 2009

Year

Percentage of Total Complaintants

Resident

Relative/Friend

Ombudsman, Volunteer

Facility Administration, Staff

Other Medical: Physician/Staff

or Other Agency Rep.

Unknow n/Anonymous

Other or Non-Relative

Guardian, Legal Rep.

Source: 2009 National Ombudsman Reporting System (NORS) Data

Figure 2:

Types of Complainants for B&C, ALF, RCF, and Similar 

Facilities

0

5

10

15

20

25

30

35

2005 2006 2007 2008 2009

Year

Percentage of Total Complaintants

Resident

Relative/Friend

Ombudsman, Volunteer

Facility Administration, Staff

Other Medical: Physician/Staff

or Other Agency Rep.

Unknow n/Anonymous

Other or Non-Relative

Guardian, Legal Rep.

Source: 2009 National Ombudsman Reporting System (NORS) Data
38

• The five most frequent nursing facility complaints in 2009 were: 

o unanswered requests for assistance;

o inadequate or no discharge/eviction notice or planning;

o lack of respect for residents, poor staff attitudes;

o quality, quantity, variation and choice of food; and

o medications – administration, organization.

• The five most frequent board and care and similar facilities complaints were:

o quality, quantity, variation and choice of food;

o medications – administration, organization;

o inadequate or no discharge/eviction notice or planning;

o equipment or building hazards; and

o lack of respect for residents, poor staff attitudes.

Ombudsman Presence in Facilities and Empowerment of Families and Residents

•Ombudsman staff and volunteers provided a regular presence to facility residents, visiting 

residents of 81 percent of nursing facilities and 45 percent of board and care and similar 

homes (including assisted living) at least quarterly.

•Ombudsmen provided 343,043 consultations to individuals in 2009. These consultations 

have increased by almost 82 percent since FY 1996. Consultations most frequently 

addressed such topics as alternatives to institutional care, how to select and pay for a longterm care facility, residents’ rights, and federal and state rules and policies.

•Ombudsmen provided 140,263 consultations to long-term care facility staff in FY 2009 on a 

wide range of issues, including residents’ rights, observations about care, working with 

resident behavioral issues, and transfer and discharge issues.

•In FY 2009, ombudsmen nationwide: 

o provided information to resident councils (21,273 sessions) and family councils 

(3,942 sessions);

o provided 6,063 training sessions to facility staff;

o facilitated or conducted 13,169 community education sessions; and

Ombudsman Program in Action: Board and Care Residents

When a state’s mental health agency initiated an emergency closure of a 

residential facility due to infestation of bed bugs, lack of staff supervision, 

and other quality of care issues, the ombudsman learned that some

residents had been transferred to unsafe or inappropriate locations. She

visited the facility where she found three residents, but no staff, present.

Not only did the ombudsman assure that these residents were safely

transferred to another facility, but she filed a formal complaint with the

state agency. The complaint led to improved processes and coordination 

and better outcomes for residents in the agency’s subsequent facility

closure actions.
39

o participated as resident advocates in 17,856 facility surveys conducted by 

regulatory agencies.

• A vital long-term care ombudsman function is systemic advocacy: analyzing, commenting 

on and recommending changes in laws, regulations, and government policies and actions 

to benefit long-term care residents. In 2009, such work accounted for 20 percent or more 

of state staff time in almost half the states and 30 percent or more of state staff time in 17 

of those states. 

Providing Ombudsman Services

There are 53 state ombudsmen (50 

states, plus the District of Columbia, 

Puerto Rico, and Guam). In most states, 

the Office of the State Long-Term Care 

Ombudsman is housed within the state 

unit on aging or another state agency. 

In others, the office is housed in a 

private non-profit agency. Most states 

have contracts with or through area 

agencies on aging to provide direct 

ombudsman services to residents 

locally. There are 573 designated local 

entities across the nation.

In FY 2009, long-term care ombudsman 

services to residents were provided by 

1,203 full-time equivalent staff and 

8,661 volunteers, trained and certified to 

investigate and resolve complaints. 

Another 2,322 volunteers served 

residents or assisted the program in 

Ombudsman Program in Action: 

Outside Services to Facility Residents

Residents of a rural nursing facility who required 

specialized medical care often had to travel long 

distances by ambulance. The nursing facility had 

contracted with the area’s only ambulance company to 

provide transportation services. When scheduled rides

were repeatedly cancelled and residents missed

medical appointments, a complaint was brought to the 

ombudsman. 

The ombudsman initiated meetings with the 

ambulance service, the nursing facility administrator, 

and local government officials to seek a resolution. As 

a result of this collaboration, long-term care residents 

in this rural county now have better access to 

ambulances and an improved scheduling and 

reservation system. Today, these residents have more 

reliable transportation and better access to needed 

medical care. 

Ombudsman Program in Action:

Culture Change and Resident-Centered Care

As resident advocates, long-term care ombudsmen have the 

opportunity to engage in both individual and systemic advocacy that 

supports the resident-centered principles of the culture change 

movement. Recognizing the dynamic interrelationship between 

quality of care and quality of life, culture change emphasizes the 

importance of identifying and responding to the unique life 

experiences, needs, and care preferences of each resident. Long-term 

care ombudsmen throughout the country have become vocal 

advocates for culture change, identifiers of good practices, and 

proponents for making culture change a reality in the facilities they 

visit. 
40

ways other than complaint resolution.

Program Funding

• Total FY 2009 funding from all sources for the Ombudsman Program nationwide was 

$84,843,109, an overall decrease of $1,519,897 from the FY 2008 total. 

• The federal government continued to be the primary entity funding the Ombudsman 

Program, providing 60 percent of total funding in 2009. States provided 32 percent of 

funds, and other non-federal sources funded the remaining 8 percent. Figure 3 below 

shows the percentage of total program funding by source.

Figure 3:

 

2009 Sources of Funding

20%

3%

13%

19% 5%

32%

8%

OAA Title VII, Chapter 2

(Ombudsman)

OAA Title VII, Chapter 3 (Elder

Abuse)

OAA Title III State Agency

OAA Title III Area Agency

Other Federal

State

Other Non-Federal

 Source: 2009 National Ombudsman Reporting System (NORS) Data

Where Long-Term Care Facility Residents Reside

Increasingly, long-term care residents live in residential settings other than nursing homes, 

including board and care homes and assisted living (known by various names under state laws). 

While the number of beds and facilities in nursing homes are relatively stagnant, the growth of 

beds in these other residential settings is steadily increasing. Federal policy continues to 

accelerate the growth of home and community-based long-term care services. In many states, 

Medicaid funding provides services in these non-nursing home residential settings as part of the 

“home and community based services” continuum. 

• In the last five years, the number of board and care, assisted living, residential care and 

similar facilities increased by 14 percent to 52,371, while the number of nursing facilities 

slightly decreased by 1 percent from a high of 16,862 in 2005 to 16,653 in 2009. Figure 
41

4 below shows the growth in non-nursing home facilities relative to nursing homes.

Figure 4:

Number of Facilities by Type of Facility

15,000

20,000

25,000

30,000

35,000

40,000

45,000

50,000

55,000

2005 2006 2007 2008 2009

B&C, ALF,

RCF & Similar

Nursing

Facilities

 Source: 2009 National Ombudsman Reporting System (NORS) Data

• The numbers of nursing facility beds remained relatively level during this period 

(1.7 million), decreasing by 1 percent, while the number of board and care and similar 

type facilities beds increased by 9 percent (to over 1.1 million), as shown in Figure 5.

Figure 5:

 

Number of Facilities by Type of Facility

900,000

1,000,000

1,100,000

1,200,000

1,300,000

1,400,000

1,500,000

1,600,000

1,700,000

1,800,000

2005 2006 2007 2008 2009

B&C, ALF,

RCF & Similar

Nursing

Facilities

 Source: 2009 National Ombudsman Reporting System (NORS) Data
42

National Long-Term Care Ombudsman Resource Center Activities:

In order to be effective advocates for residents, ombudsmen must remain up-to-date on the latest 

long-term care developments. Therefore, AoA supports the National Ombudsman Resource 

Center (NORC), which provides training, technical assistance, and program management 

expertise to state and local ombudsmen. In FY 2009, the NORC was operated by The National 

Consumer Voice for Quality Long-Term Care (formerly NCCNHR), in conjunction with the 

National Association of States United for Aging and Disabilities (NASUAD).

In FY 2009, NORC provided ombudsmen with training from national experts on such issues as:

• The Changing Long-Term Care System;

• Managing Program Goals and Priorities During Fiscal Crises;

• Culture Change and Person-Centered Care;

• Advocacy in Assisted Living; and

• The Advancing Excellence Campaign and Consumer Involvement.

The NORC provided access to quarterly orientation training activities for all new state 

ombudsmen and developed resource materials, the NORC website 

(http://www.ltcombudsman.org), and monthly newsletters, customized for long-term care 

ombudsman staff and volunteers.

Ombudsman Program in Action: Nursing Facility Resident

When a nursing facility threatened to discharge a resident without a discharge plan to meet his 

significant care needs, the ombudsman was contacted for assistance. The ombudsman assisted 

the resident in appealing the discharge notice.

While the resident claimed that he had no financial resources and was prepared to seek Medicaid 

eligibility, the facility did not assist the resident in seeking Medicaid, instead claiming that he 

had sufficient financial resources to pay the nursing facility bill. The facility hired an attorney to 

claim guardianship of the resident in an attempt to access the resident’s supposed resources. 

Since the resident did not lack capacity to make his own decisions, guardianship was 

inappropriate. Next, the attorney asked the resident to provide the facility with a financial power 

of attorney, which the resident refused to sign. When the facility finally sued the resident, the 

ombudsman assisted the resident in accessing legal representation and in applying for Medicaid. 

Ultimately, the resident was determined to be Medicaid-eligible. He asked the ombudsman for 

information about other nursing homes in the area, and he relocated to another nursing home 

where his health and well-being are significantly improving.
43

Conclusions

Residents rely on ombudsmen to resolve their problems -- Long-term care ombudsman programs 

resolve hundreds of thousands of complaints every year on behalf of long-term care facility 

residents. The largest group that requested ombudsman assistance in resolving complaints were 

residents themselves, indicating that residents depend on ombudsmen to help them resolve their 

concerns. By resolving the vast majority of these complaints to the satisfaction of the resident or 

complainant, ombudsman work improved the quality of life and quality of care for many 

residents of our nation’s long-term care facilities.

Long-Term Care Ombudsman Programs are credible sources of consumer information --

Ombudsman programs served provided individualized consumer information more than 343,000 

times in FY 2009, in addition to providing information to resident councils, family councils, and 

facility staff. Based on their extensive experience resolving resident problems, ombudsmen 

represented resident interests to policymakers, influencing public policy related to long-term 

care.

Ombudsman programs leverage non-federal dollars -- Federal funds leveraged resources from 

other sources for ombudsman programs. More than 40 percent of program funds came from 

non-federal sources during FY 2009. In addition, thousands of volunteer ombudsmen donated 

their time to assist long-term care residents.

Home and community-based services are increasing demands for ombudsman services --

Originally created a service for nursing facility residents in 1978, providing a regular presence 

for this population continued to be a priority for ombudsman programs. Since the program 

authority expanded to other types of long-term care facilities in 1981, and as the number of 

residents in these settings (often considered part of the home and community-based services 

continuum) has been rapidly increasing since that time, ombudsman programs were challenged 

to also serve individuals living in board and care, assisted living, residential care and other 

similar facilities.
44

Part V: Supporting the National Aging Services Network

AoA provides national leadership, funding, technical support and oversight to the national aging 

services network (aging network) which is charged under the OAA with the responsibility for 

promoting the development of a comprehensive and coordinated system of home and 

community-based services for older people and their family caregivers. The aging network 

consists of a variety of national organizations, 56 state units on aging, 629 area agencies on 

aging, over 244 tribal organizations, over 20,000 community services provider organizations, 

and 500,000 senior volunteers. This network reaches into every community in the nation and 

plays an important role in delivering services and supporting consumer-centered systems of care 

that enable older individuals to remain living in their own homes and communities for as long as 

possible. 

Outreach on Long-Term Care in Home- and Community-Based Settings

AoA, through the aging network, broadly disseminated information and provided technical 

assistance and mobilization strategies to community and health care providers as they work with 

Medicare beneficiaries to fully understand their options in the Part D prescription drug program 

Low-Income Subsidy (LIS), including opportunities for the LIS and the Medicare preventative 

benefits in coordination with the Centers for Medicare & Medicaid Services (CMS). AoA 

leveraged resources within the aging network to develop true collaborative partnerships to 

directly engage beneficiaries to maximize personalized assistance, healthy living and promoting 

home and community-based living. 

On June 1, 2009, HHS Secretary Kathleen Sebelius released $25 million in grants to the aging 

network to help older people, individuals with disabilities and their caregivers apply for special 

assistance through Medicare. These grants, made possible by the Medicare Improvements for 

Patients and Providers Act of 2008 (MIPPA), provided valuable support at the state and 

community levels for organizations involved in finding and providing enrollment assistance to 

people likely to be eligible for the Medicare Part D Extra Help/Low-Income Subsidy, Medicare 

Savings Program (MSP), the Medicare Part D Prescription Drug Program, and other important 

public benefits such as the Supplemental Nutrition Assistance Program (SNAP), the LowIncome Home Energy Assistance Program (LIHEAP), and more. This initiative also included 

special targeting efforts to rural areas of the country and to Native American elders. AoA 

provided ongoing coordination with the CMS- funded State Health Insurance Assistance 

Program (SHIP) and funded a resource center (the National Center for Benefits Outreach and 

Enrollment) to support these valuable outreach and enrollment efforts.

Through an inter-agency agreement with CMS, AoA funded ten pilot programs to develop 

projects in the field for testing alternative methods of communication among generations about 

Medicare and Medicaid including but not limited to, activities that integrate technology and 

social interaction between people. Specifically, ten pilots were conducted at locations/agencies 

experienced in innovative services and programs to younger retirees and older persons receptive 

to new forms of communication. The projects demonstrated the creativity and versatility of the 

aging network in reaching a growing number of baby boomers, future retirees, and their families. 
45

These project strategies are designed to be available for other members of the network to 

replicate and localize for their particular service areas and culture and reduce duplicative efforts. 

A consistent key driver in assisting older adults to make long-term care services and support 

decisions is the ability to provide one-on-one counseling sessions by trained and trusted staff 

members. The aging network developed and utilized many successful practices, including 

targeted media campaigns, developing new messages to reach local seniors and strengthening 

local partnerships and referrals. Creating new uses for data and screening tools increased the 

agencies’ abilities to target the most vulnerable populations. The activities performed to help in 

Medicare outreach was also successful in raising state and local awareness of the availability of 

other long-term services and supports programs under the OAA. 

AoA and CMS have partnered closely on Medicare outreach to beneficiaries and their family 

members since 2004 and have participated either directly or in partnership in 90 percent of the 

outreach events, educational programs and one-on-one counseling sessions.

Aging and Disability Resource Centers

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 to streamline access to public services and 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 stemmed from best practice innovations known as “No Wrong Door”40

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 in 50 states, 3 territories 

and Washington, DC.

Over the next decade, AoA envisions ADRCs or some equivalent operation becoming every 

states’ 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. 

Further, AoA envisions ADRCs expanding their role and building upon their foundational 

infrastructure to include:

• 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, 

 40 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).
46

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 services and support programs;

and,

• integrated access-point to care transition and diversion support to veterans served through 

the Department of Veterans Affairs, the Veterans Health Administration (VHA) 

partnership, “Veterans Directed Home and Community-Based Services Program.”

To achieve this goal, a well-established, effective ADRC needs to be able to build upon the 

foundational infrastructure that have successfully been 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 

care 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 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. 

• 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 
47

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: ADRCs 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 CMS have invested over $70 million in the ADRC program since 2003. As a result of 

these investments: 

• Over 290 ADRC sites have been established in 50 states, 3 territories, and 

Washington, DC, often by expanding existing infrastructure in the aging network. 

Together these ADRC sites cover 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 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.

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. 

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 
48

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.

Civic Engagement

The National Council on the Aging (NCOA) has been awarded a grant from AoA for a threeyear project to create a National Center on Multi-Generational and Civic Engagement (the 

Center). The purpose of the Center is to identify and provide technical assistance and other 

support to local programs that can become national multi-generational and civic engagement 

models for using older volunteers in meaningful direct services.

The Center has identified 19 local projects which focus on three target populations: 1) older 

relatives caring for grandchildren; 2) families caring for children with special needs; and 3) 

caregivers of frail elderly. The projects are being examined for possible national replication 

based on four criteria: program effectiveness; impact; sustainability and ease of replicability in 

other communities. Throughout FY 2009, the Center conducted site visits and developed online 

training and webinars on a number of topics. 

Additionally, as part of this initiative, AoA has entered into a Memorandum of Understanding 

with the Corporation for National and Community Service to provide twelve VISTA members to 

augment the project and work with six of the community models. Additional funding has also 

been leveraged and provided by The Atlantic Philanthropies and the Metlife Foundation. 

Partners to the grant are tasked with specific responsibilities designed to expand the capabilities 

of all. For example, Temple University focuses on training, while Easter Seals serves as the 

expert on caregiving and helps the projects develop plans and identify models of care.

One example of a team model that has proven to be beneficial to other projects is the Center’s

“Wisdom Works” program. Using this self-directed team model, the GRANDS Program, a 

grandparent raising grandchildren program, has been able to expand and promote its services 

throughout the city of Boston. The volunteers are always setting new goals for themselves, and 

using their creativity to provide engaging programming and services to the grandparents 

throughout the neighborhoods of Boston.

Next steps for this initiative include synthesis and dissemination of best practice approaches and 

on-line tools to test replication of the most promising models in other communities. The goal is 

to develop strategies that will be most helpful to the aging network, which is heavily dependent 

on the use of volunteers in providing community-based services. 

Meeting the Need for Trained Personnel in Aging

The aging of America is creating new challenges and opportunities for the aging services 

network. The number of older people is increasing rapidly, and those reaching age 65 are living 

longer than ever before. By 2050, it is estimated that there will be over 85 million people age 65 
49

and over living in the United States. This shift in our nation’s demography has profound 

implications for the assistance the aging network provides people with long-term services and 

support needs. 

The aging network, and in particular state and area agencies on aging, play an important role in 

planning, developing and managing the state’s home and community-based service systems. In 

addition, most states have lead responsibly for home and community-based services for the 

elderly in their state and area agencies on aging, including responsibility for managing statefunded programs as well as Medicaid waivers.

AoA and other HHS agencies have been offering a variety of opportunities to the aging network 

in recent years to position them to take a lead role in the provision of long-term supports and 

services including home and community-based services for older adults and populations of nonelderly persons with disabilities. Through these opportunities, many state aging networks have 

created systems of care that are a recognized, accessible and person-centered source of 

information, options counseling, streamlined access to benefits and services, and seamless 

linkages to all available supports and services for older adults, their caregivers, and other 

populations of people with disabilities. In other states, the aging network is in earlier stages of 

the process of building their capacity to position themselves to play a lead role in the 

development of a modernized system of long-term care. Some states have not advanced along 

with the best available science on the delivery of long-term supports and services. 

In recognition of the need to create more consistently prepared aging network organizations 

nationwide, AoA has awarded several training and technical assistance grants focused on 

training aging network personnel in key areas including aging, long-term supports and services, 

leadership and change management. 

The National Long-Term Care Business Institute (NLTCBI) is a program funded by a grant from 

AoA to the National Association of Area Agencies on Aging (n4a) in partnership with the 

Scripps Gerontology Center (Scripps) at Miami University; Oxford, Ohio to provide business 

concepts and practices to area agencies on aging and Title VI Native American programs.

The NLTCBI frames its strategy around three central concepts: knowledge, application, and 

practice. The National Center teaches participants how to apply knowledge, strategies, and skills 

in their everyday operations in an intensive day and a half seminar. The curriculum of the 

NLTCBI is shaped by: (1) a comprehensive review of the literature on strategic planning for 

long-term care; (2) a key informant study in which experts, identified by the n4a, Scripps, and 

the AoA, participate in interviews and focus groups to help shape the curriculum for the training 

program; and (3) a web-based survey, conducted through the n4a website of AAA/Title VI 

Program senior staff to ascertain their current practices in, and perceptions of, strategic planning 

and the future of long-term care in the aging network. Curriculum encompasses the following 

areas:

• Using data to plan for growth and change in the older population, especially as related to 

needs for long-term care options;

• Change management and innovation in long-term care services;

• Quality improvement versus compliance models in long-term care;
50

• Business and strategic planning for long-term care; and

• Leadership and advocacy for community-based long-term care.

This training is aimed toward providing the tools necessary to conduct the business of the local

aging network at the highest levels of effectiveness and professionalism possible

During FY 2009, a number of training and technical assistance initiatives were funded by AoA 

with the overall goal of ensuring an aging network workforce prepared to meet the needs of the 

nation’s current and future older adults and their caregivers. Below is a summary of five of these 

initiatives and the activities they are undertaking. 

• Aging Network Business Practice, Planning and Program Development

The National Association on Area Agencies on Aging (n4a), in partnership with the 

Scripps Gerontology Center, conducted a survey of area agencies on aging. Through this 

activity, a number of training and technical assistance needs of AAAs were identified in 

order to modernize their systems to meet the needs of the growing number of older adults 

and their caregivers. To begin to provide this support, n4a and Scripps conducted a series 

of intensive Business Training Institutes introducing concepts for business and strategic 

planning, leadership development and focusing on key topic areas in the provision of 

home and community-based services, including single point of entry, person-centered 

approaches, participant-directed services and using evidence-based approaches. 

• Technical Assistance Support Center (TASC) Planning Zone

For the aging network to succeed in developing comprehensive and coordinated systems 

of long-term supports for aging baby boomers, persons with disabilities and their 

families, effective comprehensive planning skills are critical. AoA funded NASUAD to 

develop a web-based planning tool to serve as a one-stop source for state and area 

agencies on aging to support the development of comprehensive plans on aging. 

Resources available include information useful for developing a mission and vision for 

aging services, information on federal priorities and strategic direction, potential 

challenges, demographic and programmatic data, and resources on quality improvement. 

• National Center on Benefits Outreach and Enrollment 

With public benefits programs undersubscribed, a person-centered, community-wide 

approach to benefits outreach and enrollment can effectively find and enroll individuals 

into need-based programs. Since 2008, AoA has funded the National Center for Benefits 

Outreach and Enrollment to serve as a much-needed “hub” to inform, centralize and 

coordinate national, state and local efforts to enroll low-income seniors and younger 

adults with disabilities into benefits in a person-centered, cost-efficient manner. The 

overall goal of the center is to increase the coordination of benefits and participation of 

seniors and younger adults with disabilities in state and federal benefits programs.

• Center for Healthy Aging

The Center for Healthy Aging encourages and assists community-based organizations 

serving older adults to develop and implement evidence-based programs on health 

promotion, disease prevention and chronic disease self-management. The Center serves 
51

as a resource center for aging service providers nationwide to implement healthy aging 

programs. Resources provided include manuals, toolkits, research, examples of model 

health programs, and links to websites on related health topics. The Center also serves as 

the technical assistance resource center for the AoA’s Evidence-Based Disease and 

Disability Prevention grant program. 

Each of these AoA-funded training and technical assistance initiatives report regularly to AoA 

on their progress in working with AoA grantees, and the broader aging network, and collaborate 

with AoA and others in the design and implementation of their technical assistance and training 

activities. Collectively, these training and technical assistance efforts have reached aging 

network professionals in all states and territories including agency leaders, boards, advisory 

councils and front line staff at the state and community levels. Key outcomes include: 

• four Aging Network Business Institutes have been held involving staff and board 

members from over 100 AAAs and tribal organizations; 

• all training content for the business institutes has been based on a series of surveys to 

AAAs and tribal organizations, all with response rates over 80 percent; 

• approximately 200 aging network professionals attend monthly calls hosted by NASUAD

on issues of importance to strategic planners;

• each month over 500 aging network professionals attend webinars on person centered 

benefits outreach and enrollment and over 2,500 receive new regular e-mail updates 

including issue briefs, best practice reports and information on new tools and resources.

Preparing for and Responding to Disasters

Approximately five percent of Americans over the age of 65 live in nursing homes. The rest live 

in the community, with about 30 percent living alone. Over 50 percent of these individuals have 

two or more chronic conditions which limit their mobility; many use various assistive devices. 

Two million are homebound.

Older persons and persons with disabilities are especially at risk in times of disaster. Family and 

community-based support systems are often disrupted or cease to function. If evacuation occurs, 

moving to a local shelter increases vulnerability. 

Post-Hurricane Katrina reports indicate that 1,330 persons died as a result of the storm and its 

aftermath. Approximately 70 percent of these deaths were persons over the age of 60. A 

January 2009 report in the American Journal of Managed Care noted that New Orleans seniors

affected by Hurricane Katrina had an illness rate four times greater than other U.S. residents and 

had a 21 percent increase in emergency rooms visits the post-hurricane year. 

AoA’s disaster assistance funding for federally declared disasters is statutorily set-aside out of 

Title III State and Community-Based Services funding. The total available is specified in section 

310 of the OAA as an amount from Title III equal to two percent of the appropriation for Title 

IV Program Innovations. This funding helps states address unexpected disasters affecting the 

national aging services network. In 2009, there were 59 federally declared disasters. 
52

Most of this funding is used to reimburse states and tribal organizations for the additional cost of 

assistance and services needed to respond to nationally declared disasters such as floods, fires, 

hurricanes, tornados, and other natural events. Funds enable states to fill gaps and provide 

services not readily available, such as: essential community supportive services; ongoing 

information and assistance; case management; replacement of shelf-stable meals and 

transportation; home repair; chore services and the continued clean up of debris from disasters so 

that individuals can return home. 

Additionally, AoA works in partnership with the national aging services network to support 

training and emergency planning efforts, working with federal, state and local partners to 

increase preparedness and establish more responsive plans for assisting frail elderly individuals 

and their families before, during and after a disaster. 

Examples of some of the planning activities conducted during FY 2009 included:

• AoA conducted five regional training sessions on emergency preparedness and disaster 

response. Participants included the directors and emergency managers from 33 agencies 

on aging. The sessions covered a wide range of emergency planning activities, focusing 

particular attention on natural disasters such as hurricanes, tornadoes, earthquakes and 

fires that more frequently occur in each of the various regions.

• Materials were prepared for inclusion in DHHS and FEMA emergency planning reports, 

playbooks and staff manuals related to the special needs of elderly individuals during 

disasters and strategies for strengthening health and human service response systems. 

• AoA assisted in the review and implementation of a nationwide case management 

contract designed to focus assistance to persons with disabilities and special needs.

• AoA prepared a detailed Emergency Checklist for state and area agencies on aging. This 

checklist, which was used as a technical assistance document, was designed to strengthen 

state and area agency involvement in state and local preparedness efforts and improve 

planning for disaster response. Later in the year, the National Association of Area 

Agencies on Aging used this information as a guide for a nationwide survey of the 629

area agencies on aging, which had nearly an 80 percent response rate. Information from 

this survey is being incorporated into plans at the federal, state and local levels to 

improve emergency preparedness and response activities.

The aging network has access to up-to-date information about millions of frail elderly

individuals living in the community who are served by OAA programs and are impaired due to 

two or more chronic health conditions. During emergencies, AoA works with the HHS 

Secretary’s Operations Center and other federal, state and local partners to share information 

between the aging network and emergency response partners at all level to help coordinate

assistance to older persons and persons with disabilities. If there is advance warning of a 

possible emergency, the aging network contacts vulnerable and homebound seniors to assess 

their situations and try to provide assistance that may be needed – both before and after the 

event. In situations where individuals may need to “shelter in place,” the aging network 

distributes shelf stable meals in advance of the emergency. Long-term care ombudsmen staff 

and volunteers contact nursing home and assisted living facilities to determine the status of 

emergency plans should evacuation be necessary, and follow up after the event to check on the 

safety and well-being of residents. 
53

Part VI: Program Innovations

Program Innovations is intended to provide a source of funding for AoA to use as a catalyst for

tapping existing aging services network practices that represent 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 

and Disability Prevention projects that are now being successfully implemented in locations 

across the nation.

When resources are available to AoA, Program Innovation grants are awarded 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. 

Community Innovations for Aging in Place

The Community Innovations for Aging in Place Initiative (CIAIP) was authorized by Congress 

in the Older Americans Act (OAA) reauthorization of 2006 to assist communities in their efforts 

to enable older adults to sustain their independence and age in place in their homes and 

communities. Toward this end, Congress directed the assistant secretary for aging to make threeyear grants, on a competitive basis, to community-based non-profit organizations to develop and 

carry out model aging in place projects. The Act specifies that the projects should be designed to 

promote aging in place for older individuals, including individuals who reside in Naturally 

Occurring Retirement Communities (NORCs) in order to sustain their independence. Congress 

further directed that innovative approaches under the CIAIP initiative should be based on needs 

assessments that identify community strengths and gaps in supporting aging in place as well as 

the unique needs of older individuals in the community. Funding was first authorized for the 

CIAIP initiative in FY 2009. 

AoA published a funding opportunity announcement in May, 2009 soliciting proposals for 

awards of $250,000 to $500,000 for Community Innovations for Aging in Place. Applicants for 

funding under the CIAIP initiative were instructed to assess their communities to identify any 

barriers to independence and aging in place, and then, in collaboration with other community 

organizations, identify innovative strategies for providing and linking older individuals to 

programs and services that provide comprehensive and coordinated health and social services to 

older individuals and support aging in place. As identified in the OAA, health and social 
54

services considered critical to aging in place include care management including health care 

management, evidence-based disease prevention and health promotion services, education, 

socialization, recreation and civic engagement opportunities. The solicitation identified 

collaboration as an important component of community-based innovative strategies to assist frail 

older adults to age in place. Successful projects were identified as those able to establish 

meaningful partnerships with local entities including ADRCs, AAAs, local providers of health 

and social services, housing entities, and others in order to develop and implement innovative 

aging in place intervention. 

In response to the funding opportunity announcement, over 200 applications were received. 

Nineteen independent review panels were established, each consisting of three professionals with 

expertise in a variety of areas in the field of aging and home and community-based services. 

Based on the results of the independent review, late in FY 2009, the Administration on Aging 

funded fourteen (14) organizations representing diverse communities from across the country. In 

addition, a grant was awarded to the Visiting Nurse Service of New York City to provide 

training and technical assistance to the CIAIP grantees. 

Funded late in FY 2009, CIAIP grantees did not begin their work until early in FY 2010. This 

report summarizes the diverse proposals of the 14 community grants. AoA’s FY 2010 report 

will begin to report on lessons learned as identified at the end of year one of the three year

projects. 

Atlanta Regional Commission Area Agency on Aging – Atlanta, GA

The purpose of the Atlanta project, Building Lifelong Communities in South Cobb County, is 

to build capacity at the local community level for establishing a lifelong livable community 

where individuals of all ages can benefit throughout their lifetimes from comprehensive 

planning, design, programming and community involvement. 

Boston Medical Center – Boston, MA

The Boston Medical Center’s Elders Living at Home Program (ELAHP) will provide 

comprehensive services allowing low-income formerly homeless older adults who are at risk 

of recurring homelessness to remain in public housing, with maximum independence, 

improved health and healthcare, and meaningful activities and relationships. The approach is 

to provide comprehensive, individualized, ongoing case management targeted to the specific 

needs of formerly homeless older adults.

Catholic Charities – Stockton, CA

Catholic Charities - Diocese of Stockton proposed the Older Adult Outreach and Engagement 

Project in collaboration with Tuolumne and Calaveras County’s social service agencies, the Area 

Agency on Aging, and community organizations supporting the needs of older adults. The 

project proposes to provide a comprehensive, community-coordinated case management 

system that is responsive to the diverse needs of older adults residing in a rural area, enabling 

more elderly residents to safely age in place, continue to live independently in their 

community while retaining the dignity and respect they have earned. 

Catholic Charities – Kansas City, MO

Catholic Charities of Kansas City-St. Joseph proposes implementing Caring Communities 

Resource Centers in collaboration with senior centers and diverse community partners with 
55

health and aging expertise. The approach takes health care assistance, social workers, chronic 

disease education and related health activities into senior neighborhood settings with an 

overall goal of enhancing the older adults’ ability to live independently and to increase 

healthy behaviors through localized access to a continuum of health and social services 

focused on seniors and their caregivers. 

City of Montpelier – Montpelier, VT

The City of Montpelier will lead a collaborative grassroots effort building on the

community's awareness of Time Banking to create the REACH (Rural Elder Assistance for 

Care & Health) Care Bank: a network of people and organizations coordinating multiple 

avenues of support. REACH Care Bank is a new social enterprise that will foster health, 

wellness, and resiliency for elders and caregivers who need expanded services to build 

livable communities for elders of all income levels and facilitate aging-in-place by engaging 

the community at large in the exchange of services and time. The project will work to 

integrate informal and formal services into a single comprehensive services systems 

supporting aging in place. 

Coordinating Center for Home and Community Care – Millersville, MD

The Coordinating Center proposes an aging in place project in collaboration with the Howard 

County Department of Aging (ADRC). The approach integrates innovative case management 

expertise with existing community-based services to sustain independence of older 

individuals. Actualizing aging in place principles, the project goal is to target older adults at 

risk of institutionalization and spend down to Medicaid and provide comprehensive 

assessment, case management and tailored services to assist them in their efforts to age in 

their own homes and avoid costly re-hospitalizations and inappropriate facility placement.

Easter Seals – Manchester, NH

Easter Seals New Hampshire proposes the Seniors Count Coordination Initiative in 

collaboration with the Catholic Medical Center, Elliot Senior Health Center, DartmouthHitchcock, the Bureau of Elderly & Adult Services, Manchester Department of Public 

Health, and the Aging and Disability Resource Center. The overall goal is to create and 

implement a replicable person-centered model that enhances coordination between medical 

services, community living/social services, and caregiver support for frail seniors in the 

Manchester service area.

Family Eldercare – Austin, TX

Family Eldercare proposes a Community Innovations for Aging in Place project in 

collaboration with the area agency on aging and five other agencies. The program will be 

provided in subsidized housing with high concentrations of low-income older adults in three 

Central Texas communities. The approach is to deliver services through a Service 

Coordinator at each site, provide case management to persons at risk of premature 

institutionalization and provide activities, including evidenced based practices, that impact 

aging in place. 

Jewish Family Services – Albuquerque, NM

Jewish Family Service proposes a Community Innovations for Aging in Place project in 

collaboration with the NM Aging & Long Term Services Department, the local area agencies 

on aging, NM Department of Health, Fort Sumner Community Development Corporation, 
56

and other local providers. The goal of the project is to implement a culturally diverse, 

innovative, and cost-effective aging in place program for the delivery and coordination of 

community-based health and social services that support seniors and their caregivers at four 

sites: Native American; rural; urban; and suburban. The intervention at each site will be 

based on an assessment of the community’s provider agencies as well as of a sampling of 

residents. 

LA Gay and Lesbian Community Center – Los Angeles, CA

The L.A. Gay & Lesbian Center seeks funding for an aging in place initiative based on a 

unique intervention to provide lesbian, gay, bisexual and transgender (LGBT) seniors with 

targeted support services including services that will bring individuals together as a 

“community”. The project will also develop and provide LGBT cultural competency training 

for mainstream aging service providers that assist area seniors as they age in place. The 

overarching goal of the project is to ensure that LGBT older adults in Los Angeles feel 

treated with dignity and respect as they access a comprehensive and coordinated continuum 

of aging-in-place support services. 

Mount Sanford Tribal Consortium – Gakona, AK

In collaboration with the Alaska Native Tribal Health Consortium, the University of Alaska, 

Alaska Senior and Disability Services and regional service providers this project proposes the 

development of an aging in place program in two small frontier native Alaskan villages that 

will serve as a model for developing similar programs in other villages in Alaska. The goal of 

this project is to design and implement a cost effective, model that enables native elders 

living in an isolated frontier area to remain in their homes and villages for as long as possible 

by maximizing limited formal services and available informal supports. 

Neighborhood Centers – Houston, TX

Neighborhood Centers, guided by the Aging Agenda for Houston and Harris County, will 

implement Houston Aging in Place Innovations with the Houston Health Department and 

Area Agency on Aging, the Care for Elders partnership, the YWCA, Interfaith Ministries of 

Greater Houston and Gateway to Care. The project will develop a new role for senior centers 

in serving naturally occurring retirement communities with a menu of evidence-based health 

promotion programs, case management teams that include certified community health 

workers and elder care field specialists, and neighborhood Elder-Care Action Teams. The 

project will target minority older adults in three neighborhoods to assist them to optimizing their 

ability to age in place.

NYC Department for the Aging – New York, NY

The New York City (NYC) Department for the Aging proposes to broaden the scope of 

existing naturally occurring retirement communities (NORC) in NYC to improve the health 

and mental health of residents and guide systems change for aging in place models. The 

NORC Health Plus program is designed to encourage a stronger community role for NORC 

programs, increase resident participation in the governance and development of NORC 

supportive services programs, and introduce evidence-based disease prevention interventions 

into NORC programming. 
57

Supportive Older Women’s Network – Philadelphia, PA

The Supportive Older Women’s Network proposes Growing Healthy Lives Together, a 

comprehensive healthy living program for older adults, predominately women, who are aging 

in place in their homes. The project is targeted to serve a West Philadelphia neighborhood 

that has a very high percentage of minority low-income older adults living alone with 

multiple chronic health conditions. The project is based on a prevention model that is 

inclusive, open to all older residents in the targeted community. The Healthy Lives project 

provides an integrated approach to wellness, coupling physical and emotional health, is nonstigmatizing and provides on-going support to sustain healthy lifestyle changes. 
58

Appendix

Formula Grant Funding

Allocation by 

State, Territory and 

Tribal Organization

U.S. Administration on Aging 

Department of Health and Human Services
59

Title III - Grants for State and Community Programs on Aging

FY 2009 Final Allocation

9/3/2009

State

Supportive 

Services

Congregate 

Meals

Home 

Meals

Preventive 

Services NFCSP Total Title III

Alabama $5,511,235 $6,625,002 $3,357,241 $333,168 $2,388,721 $18,215,367 

Alaska $1,795,942 $2,158,368 $1,065,886 $105,130 $766,492 $5,891,818 

Arizona $7,186,334 $8,638,621 $4,377,649 $405,273 $3,197,875 $23,805,752 

Arkansas $3,510,940 $4,215,426 $2,125,590 $211,585 $1,521,777 $11,585,318 

California $35,454,106 $42,619,031 $21,597,330 $2,132,032 $15,485,835 $117,288,334 

Colorado $4,564,582 $5,487,038 $2,780,574 $256,172 $1,847,782 $14,936,148 

Connecticut $4,416,847 $5,306,740 $2,544,147 $261,174 $1,867,650 $14,396,558 

Delaware $1,795,942 $2,158,368 $1,065,886 $105,130 $766,492 $5,891,818 

District of Columbia $1,795,942 $2,158,368 $1,065,886 $105,130 $766,492 $5,891,818 

Florida $26,072,475 $31,341,465 $15,882,387 $1,557,571 $12,409,192 $87,263,090 

Georgia $8,752,179 $10,520,908 $5,331,504 $487,659 $3,474,146 $28,566,396 

Hawaii $1,795,942 $2,158,368 $1,065,886 $105,130 $766,492 $5,891,818 

Idaho $1,795,942 $2,158,368 $1,065,886 $105,130 $766,492 $5,891,818 

Illinois $14,566,145 $17,501,863 $8,286,262 $841,161 $6,001,247 $47,196,678 

Indiana $7,018,309 $8,436,640 $4,275,294 $427,123 $3,066,134 $23,223,500 

Iowa $4,272,980 $5,144,796 $2,272,276 $232,252 $1,760,734 $13,683,038 

Kansas $3,442,659 $4,140,847 $1,901,319 $191,697 $1,430,357 $11,106,879 

Kentucky $4,892,022 $5,880,652 $2,980,039 $292,333 $2,070,600 $16,115,646 

Louisiana $4,809,520 $5,716,325 $2,824,249 $295,701 $1,987,302 $15,633,097 

Maine $1,795,942 $2,158,368 $1,065,886 $105,333 $766,492 $5,892,021 

Maryland $5,978,676 $7,186,907 $3,641,988 $361,152 $2,508,352 $19,677,075 

Massachusetts $8,232,411 $9,902,090 $4,603,113 $465,465 $3,412,029 $26,615,108 

Michigan $11,376,983 $13,676,158 $6,930,437 $693,994 $4,936,669 $37,614,241 

Minnesota $5,609,504 $6,743,129 $3,417,102 $339,094 $2,478,709 $18,587,538 

Mississippi $3,282,007 $3,939,582 $1,957,399 $196,251 $1,390,319 $10,765,558 

Missouri $7,138,648 $8,572,513 $4,213,292 $423,251 $3,053,274 $23,400,978 

Montana $1,795,942 $2,158,368 $1,065,886 $105,130 $766,492 $5,891,818 

Nebraska $2,301,456 $2,772,917 $1,235,779 $124,900 $945,715 $7,380,767 

Nevada $2,657,189 $3,194,181 $1,618,661 $151,762 $1,035,492 $8,657,285 

New Hampshire $1,795,942 $2,158,368 $1,065,886 $105,130 $766,492 $5,891,818 

New Jersey $10,292,122 $12,342,333 $6,090,428 $620,946 $4,425,545 $33,771,374 

New Mexico $2,169,925 $2,608,445 $1,321,837 $127,394 $942,470 $7,170,071 

New York $24,352,403 $29,324,630 $13,605,956 $1,376,603 $9,932,045 $78,591,637 

North Carolina $9,988,771 $12,007,403 $6,084,790 $577,661 $4,171,739 $32,830,364 

North Dakota $1,795,942 $2,158,368 $1,065,886 $105,130 $766,492 $5,891,818 

Ohio $13,856,054 $16,597,987 $8,207,423 $835,879 $6,013,361 $45,510,704 

Oklahoma $4,290,438 $5,144,022 $2,572,440 $257,429 $1,846,777 $14,111,106 

Oregon $4,399,453 $5,288,538 $2,679,984 $254,913 $1,879,727 $14,502,615 

Pennsylvania $17,930,762 $21,544,777 $9,858,253 $1,018,552 $7,582,087 $57,934,431 

Rhode Island $1,795,942 $2,158,368 $1,065,886 $105,130 $766,492 $5,891,818 

South Carolina $5,183,532 $6,231,073 $3,157,616 $295,433 $2,153,600 $17,021,254 

South Dakota $1,795,942 $2,158,368 $1,065,886 $105,130 $766,492 $5,891,818 

Tennessee $7,115,319 $8,553,255 $4,334,389 $416,815 $2,980,312 $23,400,090 

Texas $21,600,611 $25,965,881 $13,158,293 $1,253,246 $9,079,495 $71,057,526 

Utah $2,077,089 $2,496,848 $1,265,286 $115,100 $889,240 $6,843,563 
60

State

Supportive 

Services

Congregate 

Meals

Home 

Meals

Preventive 

Services NFCSP Total Title III

Vermont $1,795,942 $2,158,368 $1,065,886 $105,130 $766,492 $5,891,818 

Virginia $8,246,003 $9,912,439 $5,023,160 $484,930 $3,417,589 $27,084,121 

Washington $6,927,144 $8,327,051 $4,219,760 $397,692 $2,883,863 $22,755,510 

West Virginia $2,781,416 $3,347,126 $1,494,599 $153,137 $1,082,333 $8,858,611 

Wisconsin $6,429,923 $7,729,347 $3,916,871 $391,448 $2,887,829 $21,355,418 

Wyoming $1,795,942 $2,158,368 $1,065,886 $105,130 $766,492 $5,891,818 

American Samoa $473,659 $602,252 $138,905 $13,141 $95,811 $1,323,768 

Guam $897,971 $1,079,184 $532,943 $52,565 $383,246 $2,945,909 

Northern Mariana 

Islands $224,493 $269,796 $133,236 $13,141 $95,811 $736,477 

Puerto Rico $4,658,903 $5,600,421 $2,838,031 $269,747 $1,937,877 $15,304,979 

Virgin Islands $897,971 $1,079,184 $532,943 $52,565 $383,246 $2,945,909 

TOTAL $359,188,415 $431,673,607 $213,177,293 $21,026,000 $153,298,310 $1,178,363,625 
61

Title VII - Allotments for Vulnerable Elder Rights Protection Activities

FY 2009 Final Allocation

State Ombudsman Elder Abuse Total Title VII

Alabama $256,575 $78,989 $335,564 

Alaska $81,457 $25,225 $106,682 

Arizona $334,558 $102,997 $437,555 

Arkansas $162,447 $50,011 $212,458 

California $1,650,561 $508,140 $2,158,701 

Colorado $212,503 $65,421 $277,924 

Connecticut $194,435 $59,907 $254,342 

Delaware $81,457 $25,225 $106,682 

District of Columbia $81,457 $25,225 $106,682 

Florida $1,213,801 $373,679 $1,587,480 

Georgia $407,457 $125,439 $532,896 

Hawaii $81,457 $25,225 $106,682 

Idaho $81,457 $25,225 $106,682 

Illinois $633,272 $197,384 $830,656 

Indiana $326,737 $100,589 $427,326 

Iowa $173,657 $55,927 $229,584 

Kansas $145,307 $45,843 $191,150 

Kentucky $227,748 $70,114 $297,862 

Louisiana $215,841 $68,518 $284,359 

Maine $81,457 $25,225 $106,682 

Maryland $278,337 $85,688 $364,025 

Massachusetts $351,790 $109,606 $461,396 

Michigan $529,654 $163,059 $692,713 

Minnesota $261,150 $80,397 $341,547 

Mississippi $149,593 $46,053 $195,646 

Missouri $321,998 $99,130 $421,128 

Montana $81,457 $25,225 $106,682 

Nebraska $94,444 $29,770 $124,214 

Nevada $123,705 $38,084 $161,789 

New Hampshire $81,457 $25,225 $106,682 

New Jersey $465,457 $143,950 $609,407 

New Mexico $101,021 $31,100 $132,121 

New York $1,039,826 $320,120 $1,359,946 

North Carolina $465,026 $143,162 $608,188 

North Dakota $81,457 $25,225 $106,682 

Ohio $627,247 $197,185 $824,432 

Oklahoma $196,597 $60,524 $257,121 

Oregon $204,816 $63,054 $267,870 

Pennsylvania $753,411 $242,944 $996,355 

Rhode Island $81,457 $25,225 $106,682 

South Carolina $241,319 $74,292 $315,611 

South Dakota $81,457 $25,225 $106,682 

Tennessee $331,253 $101,979 $433,232 

Texas $1,005,614 $309,587 $1,315,201 

Utah $96,699 $29,769 $126,468
62

State Ombudsman Elder Abuse Total Title VII

Vermont $81,457 $25,225 $106,682 

Virginia $383,892 $118,184 $502,076 

Washington $322,492 $99,282 $421,774 

West Virginia $114,224 $36,736 $150,960 

Wisconsin $299,344 $92,156 $391,500 

Wyoming $81,457 $25,225 $106,682 

American Samoa $10,182 $3,153 $13,335 

Guam $40,729 $12,612 $53,341 

Northern Mariana 

Islands $10,182 $3,153 $13,335 

Puerto Rico $216,895 $66,773 $283,668 

Virgin Islands $40,729 $12,612 $53,341 

TOTAL $16,291,466 $5,044,997 $21,336,463 
63

Grants to Tribal Organizations

FY 2009 Final Allocation

State

Tribe 

No. Grantee Name TITLE6 A/B TITLE6 C

AK 01 Aleutian/Pribilof Islands Association $96,180 $28,730

AK 02 Association of Village Council Pres. $87,390

AK 03 Bristol Bay Native Association $138,850 $50,290

AK 04

Central Council, Tlingit & Haida Indian Tribes 

of AK $138,850 $50,290

AK 06 Copper River Native Association $84,700 $21,550

AK 07 Hoonah Indian Association $74,650 $14,360

AK 08

Kodiak Area Native Association (Northern 

Section) $74,650 $14,360

AK 09

Kodiak Area Native Association (Southern 

Section) $74,650 $14,360

AK 10 Metlakatla Indian Community $84,700 $21,550

AK 11 Native Village of Barrow $96,180 $28,730

AK 12

Tanana Chiefs Conference for Kuskokwim 

subregion $74,650 $14,360

AK 13

Tanana Chiefs Conference for Lower Yukon 

Subregion $74,650 $14,360

AK 14

Tanana Chiefs Conference for Yukon Flats 

Subregion $74,650 $14,360

AK 15

Tanana Chiefs Conference for Yukon Koyukuk 

Subregion $84,700 $21,550

AK 16

Tanana Chiefs Conference for Yukon Tanana 

Subregion $74,650 $14,360

AK 17 Fairbanks Native Association, Inc. $138,850 $50,290

AK 19 Maniilag Association $119,880 $43,110

AK 20 Native Villiage of Unalakleet $74,650

AK 21 Chugachmiut $84,700 $21,550

AK 22 Artic Slope Native Association, Limited $84,700 $21,550

AK 23 Denakkanaaga, Inc. $84,700 $21,550

AK 24 Klawock, I.R.A. $74,650 $14,360

AK 25 Kootznoowoo Inc. $74,650 $14,360

AK 26 Gwichyaa Gwich'in Tribal Government $74,650 $14,360

AK 27 Native Village of Point Hope $74,650 $14,360

AK 28 Seldovia Village Tribe $74,650

AK 30 Sitka Tribes of Alaska $96,180 $28,730

AK 31 Yakutat Native Association $74,650 $14,360

AK 32 Ketchikan Indian Corporation $96,180 $28,730

AK 33 Kuskokwim Native Association $84,700 $21,550

AK 35 Southcentral Foundation $182,320 $57,480

AK 36 Kenaitze Indian Tribe, IRA $96,180 $28,730

AK 37 Wrangell Cooperative Association $74,650 $14,360

AK 38 Native Village of Savoonga $74,650

AK 39 Native Village of Gambell $74,650 $14,360

AK 40 Native Village of Eyak $74,650 $14,360

AK 41 ORGANIZED VILLAGE OF KAKE $74,650 $14,360

AK 42 Chickaloon Village $84,700

AK Total Total $3,382,990 $775,720

AL 01 Poarch Creek Indians $108,380 $35,920

AL Total Total $108,380 $35,920

AZ 02 Colorado River Indian Tribes $108,380 $35,920
64

State

Tribe 

No. Grantee Name TITLE6 A/B TITLE6 C

AZ 03 Gila River Indian Community $138,850 $50,290

AZ 04 Hopi Tribal Council $138,850 $50,290

AZ 05 Hualapai Tribal Council $84,700 $21,550

AZ 06 Navajo Nation $138,850 $50,290

AZ 07 The Pascua Yaqui Tribe $138,850 $50,290

AZ 09 Salt River Pima-Maricopa Community $119,880 $43,110

AZ 10 San Carlos Apache Tribe $138,850 $50,290

AZ 11 Tohono o'Odham Nation $138,850 $50,290

AZ 12 White Mountain Apache Tribe $138,850 $50,290

AZ 13 Ak-Chin Indian Community $74,650 $14,360

AZ 14 Yavapai-Apache Tribe $84,700

AZ 15 Havasupai Tribal Council $74,650 $14,360

AZ 16 Inter-Tribal Council of Arizona $74,650 $14,360

AZ 17 Cocopah Indian Tribe $74,650

AZ 18 Quechan Indian Tribe $84,700 $21,550

AZ Total Total $1,752,910 $517,240

CA 01 Bishop Indian Tribal Council $84,700 $21,550

CA 02 Blue Lake Rancheria $84,700 $21,550

CA 06 Karuk Tribe of California $96,180 $28,730

CA 07 Pit River Health Services $74,650

CA 08 Picayune Rancheria $74,650

CA 09

Riverside-San Bernardino Co. Indian Health-for 

Morongo $84,700 $21,550

CA 10

Riverside-San Bernardino Co. Indian Health-for 

Pechanga $74,650 $14,360

CA 11

Riverside-San Bernardino Co. Indian Health-for 

Soboba $74,650 $14,360

CA 12 Sonoma County Indian Health Project $74,650

CA 13 Southern Indian Health Council-Area I $74,650 $14,360

CA 14 Southern Indian Health Council-Area II $74,650 $14,360

CA 15 Toiyabe Indian Health Project - Northern $74,650 $14,360

CA 16 Tule River Indian Health Center $84,700 $21,550

CA 17 United Indian Health Services (for Resighini) $84,700 $21,550

CA 18

United Indian Health Services (for Smith River, 

etc.) $84,700 $21,550

CA 19 California Indian Manpower Consortium $74,650 $14,360

CA 20 Indian Senior Center, Inc. $84,700 $21,550

CA 21 Sonoma County Ind. Health Pro., Manchester $74,650

CA 23

CA Indian Manpower Consort-LaJolla & 

Susanville Ranche $74,650 $14,360

CA 24

California Indian Manpower Consortium -

Ysabel, Pasual $84,700 $21,550

CA 25 Pala Band of Mission Indians $74,650

CA 26 Redding Rancheria Indian Health Services $138,850 $50,290

CA 28 Toiyabe Indian Health Project - Southern $74,650 $14,360

CA 29 Hoopa Valley Tribe $74,650

CA 30 Round Valley Indian Tribes $74,650

CA 31 Fort Mojave Indian Tribe $74,650 $14,360

CA 32 Santa Ynez Band of Mission Indians $74,650

CA Total Total $2,181,680 $380,660

CO 01 Southern Ute Indian Tribe $84,700 $21,550

CO 02 Ute Mountain Ute Tribe of Indians $84,700

CO Total Total $169,400 $21,550

HI 01 Alu Like, Inc. $1,505,000 $57,480
65

State

Tribe 

No. Grantee Name TITLE6 A/B TITLE6 C

HI 02 Hana Community Health Center $84,700

HI Total Total $1,589,700 $57,480

ID 01 Coeur d'Alene Tribe $84,700 $21,550

ID 02 Nez Perce Tribe of Idaho $108,380 $35,920

ID 03 Shoshone-Bannock Tribes $96,180 $28,730

ID Total Total $289,260 $86,200

KS 01 Kickapoo Nation in Kansas $74,650 $14,360

KS 02 Prairie Band of Potawatomi Indians $108,380 $35,920

KS 03 Iowa Tribe of Kansas and Nebraska $74,650 $14,360

KS Total Total $257,680 $64,640

LA 01 Institute for Indian Development, Inc. $84,700

LA Total Total $84,700

ME 01 Passamaquoddy Tribe $96,180 $28,730

ME 02 Penobscot Indian Nation $84,700

ME Total Total $180,880 $28,730

MI 01

Grand Traverse Band of Ottawa & Chippewa 

Indians $84,700 $21,550

MI 02 Inter-Tribal Council of Michigan, Inc. $74,650 $14,360

MI 03 Keweenaw Bay Indian Community $84,700 $21,550

MI 04 Sault Ste. Marie Tribe of Chippewa Indians $138,850

MI 05 Little Traverse Bay Bands of Odawa Indians $84,700

MI 07 Bay Mills Indian Community $74,650 $14,360

MI 08 Pokagon Band of Potawatomi Indians $84,700

MI 09 Little River Band of Ottawa Indians $96,180

MI 10 Nottawaseppi Huron Band of Potawatomi Tribe $74,650 $14,360

MI Total Total $797,780 $86,180

MN 01 Bois Forte Reservation Business Committee $84,700 $21,550

MN 02 Fond du Lac Reservation Business Committee $119,880 $43,110

MN 03 Leech Lake Reservation Business Committee $138,850 $50,290

MN 05 Mille Lacs Band of Chippewa Indians $96,180 $28,730

MN 06 Minnesota Chippewa Resource Development $84,700 $21,550

MN 07 Red Lake Band of Chippewa Indians $119,880

MN 08 White Earth Reservation Tribal Council $84,700

MN 09

Grand Portage Reservation Business 

Committee $74,650

MN Total Total $803,540 $165,230

MO 99 Eastern Shawnee Tribe of Oklahoma $74,650 $14,360

MO Total Total $74,650 $14,360

MS 01 Mississippi Band of Choctaw Indians $138,850 $50,290

MS Total Total $138,850 $50,290

MT 01 Assiniboine and Sioux Tribes $119,880 $43,110

MT 02 Blackfeet Tribe $138,850 $50,290

MT 03 Chippewa-Cree Tribe $96,180 $28,730

MT 04 Confederated Salish and Kootenai Tribes $138,850 $50,290

MT 05 Fort Belknap Community Council $108,380 $35,920

MT 06 Northern Cheyenne Tribe $84,700 $21,550

MT 07 Crow Tribal Elders Program $138,850 $50,290

MT Total Total $825,690 $280,180

NC 01 Eastern Band of Cherokee Indians $182,320 $57,480

NC Total Total $182,320 $57,480

ND 01 Spirit Lake Nation $84,700 $21,550

ND 02 Standing Rock Sioux Tribe $119,880 $43,110

ND 03 Three Affiliated Tribes$138,850 $50,290

ND 04 Trenton Indian Service Area $108,380 $35,920
66

State

Tribe 

No. Grantee Name TITLE6 A/B TITLE6 C

ND 05 Turtle Mountain Band of Chippewa Tribe $138,850 $50,290

ND Total Total $590,660 $201,160

NE 01 Omaha Tribe of Nebraska $84,700 $21,550

NE 02 Santee Sioux Tribe of Nebraska $74,650

NE 03 Winnebago Tribe of Nebraska $84,700 $21,550

NE Total Total $244,050 $43,100

NM 01

Eight Northern Indian Pueblos Counc. (Picuris, 

etc.) $138,850 $50,290

NM 02

Eight N. Indian Pueblos Council (San 

Ildefonso, etc.) $84,700 $21,550

NM 03 Five Sandoval Indian Pueblos, Inc. $96,180

NM 04 Jicarilla Apache Tribe $108,380 $35,920

NM 05 Laguna Rainbow Corporation $138,850 $50,290

NM 06 Mescalero Apache Tribe $96,180

NM 07 Pueblo de Cochiti $84,700 $21,550

NM 08 Pueblo of Acoma $138,850 $50,290

NM 09 Pueblo of Isleta $138,850 $50,290

NM 10 Pueblo of Jemez $108,380 $35,920

NM 11 Pueblo of San Felipe $108,380 $35,920

NM 12 Pueblo of Taos $108,380 $35,920

NM 13 Pueblo of Zuni $138,850 $50,290

NM 14 Ohkay Owingeh $119,880 $43,110

NM 15 Santa Clara Pueblo $96,180 $28,730

NM 16 Santo Domingo Pueblo Tribe $96,180

NM 17 Pueblo of Tesuque $74,650 $14,360

NM Total Total $1,876,420 $524,430

NV 01 Fallon Paiute-Shoshone Tribes $84,700 $21,550

NV 02

Inter-Tribal Council of Nevada, Inc. (McDermitt, 

etc.) $84,700 $21,550

NV 03

Inter-Tribal Council of Nevada, Inc. 

(Duckwater, etc.) $74,650 $14,360

NV 04 Inter-Tribal Council of Nevada, Inc. (Ely, etc.) $74,650 $14,360

NV 05 Shoshone-Paiute Tribes $96,180 $28,730

NV 06 Walker River Paiute Tribe $84,700

NV 07 Washoe Tribe of Nevada and California $96,180 $28,730

NV 08 Yerington - Paiute Tribe $74,650

NV 09 Pyramid Lake Paiute Tribe $96,180 $28,730

NV 10 Elko Band Council $74,650 $14,360

NV 11 Reno-Sparks Indian Colony $74,650 $14,360

NV Total Total $915,890 $186,730

NY 01 St. Regis Mohawk Tribe Office for Aging $138,850 $50,290

NY 02 Seneca Nation of Indians $119,880 $43,110

NY 03 Oneida Indian Nation $74,650 $14,360

NY Total Total $333,380 $107,760

OK 01 Apache Tribe of Oklahoma $138,850 $50,290

OK 02 Caddo Tribe of Oklahoma $138,850 $50,290

OK 03 Cherokee Nation of Oklahoma $184,421 $58,667

OK 04 Cheyenne-Arapaho Tribes of Oklahoma $138,850 $50,290

OK 05 Chickasaw Nation $182,320 $57,480

OK 06 Choctaw Nation of Oklahoma $182,320 $57,480

OK 07 Citizen Band Potawatomi of Oklahoma $182,320 $57,480

OK 08 Comanche Indian Tribe $138,850 $50,290

OK 09 Delaware Tribe of Western Oklahoma $78,960 $14,360

OK 10 Iowa Tribe of Oklahoma $138,850 $50,290
67

State

Tribe 

No. Grantee Name TITLE6 A/B TITLE6 C

OK 11 Kaw Tribe of Oklahoma $138,850

OK 12 Kickapoo Tribe of Oklahoma $100,000 $21,550

OK 13 Kiowa Tribe of Oklahoma $138,850 $50,290

OK 14 Miami Tribe of Oklahoma $182,320 $57,480

OK 15 Muscogee (Creek) Nation $182,320 $57,480

OK 16 Osage Nation of Oklahoma $182,320 $57,480

OK 17 Otoe-Missouria Tribe $96,180 $28,730

OK 18 Ottawa Tribe of Oklahoma $138,850 $50,290

OK 19 Pawnee Tribe of Oklahoma $138,850 $50,290

OK 20 Peoria Tribe of Oklahoma $138,850

OK 21 Ponca Tribe of Oklahoma $84,700 $21,550

OK 22 Quapaw Tribe of Oklahoma $96,180 $28,730

OK 23 Sac and Fox Tribe of Indians of Oklahoma $138,850 $50,290

OK 24 Seminole Nation of Oklahoma $119,880 $43,110

OK 25 Seneca-Cayuga Tribe of Oklahoma $84,700 $21,550

OK 26 Wichita and Affiliated Tribes $138,850 $50,290

OK 27 Wyandotte Tribe of Oklahoma $138,850 $50,290

OK 28 Absentee Shawnee Tribe $182,320 $57,480

OK 29 Fort Sill Apache Tribe $96,180 $28,730

OK 31

United Keetowah Band of Cherokee Indians in 

Oklahoma $138,850 $50,290

OK Total Total $4,161,341 $1,272,817

OR 01

Confederated Tribes of Siletz Indians of 

Oregon $96,180 $28,730

OR 02

Confederated Tribes of the Umatilla Indian 

Reservation $119,880 $43,110

OR 03 Confederated Tribes of Warm Springs $108,380 $35,920

OR 04 Confederated Tribes of Grand Ronde $74,650 $14,360

OR 05 Klamath Tribe $138,850 $50,290

OR 06

Confed. Tribes of Coos, Lower Umpqua & 

Siuslaw Indian $74,650 $14,360

OR Total Total $612,590 $186,770

RI 01 Narragansett Indian Tribe $96,180

RI Total Total $96,180

SC 01 Catawba Indian Nation Eldercare Program $84,700 $21,550

SC Total Total $84,700 $21,550

SD 01 Cheyenne River Sioux Tribe $138,850 $50,290

SD 02 Crow Creek Sioux Tribe $84,700

SD 03 Lower Brule Sioux Tribe $74,650 $14,360

SD 04 Oglala Sioux Tribe $182,320 $57,480

SD 05 Rosebud Sioux Tribe $182,320 $57,480

SD 06 Sisseton-Wahpeton Sioux Tribe $138,850

SD 07 Yankton Sioux Tribe $84,700

SD Total Total $886,390 $179,610

TX 01 Alabama-Coushatta Tribe $84,700 $21,550

TX 02 Kickapoo Traditional Tribe of Texas $74,650

TX Total Total $159,350 $21,550

UT 01 Uintah and Ouray Business Committee $84,700 $21,550

UT Total Total $84,700 $21,550

WA 01 Colville Confederated Tribes $138,850 $50,290

WA 02 Lower Elwha Klallam Tribe $84,700 $21,550

WA 03 Lummi Indian Business Council $108,380 $35,920

WA 04 Makah Indian Tribal Council $84,700 $21,550

WA 05 Muckleshoot Indian Tribe $138,850 $50,290
68

State

Tribe 

No. Grantee Name TITLE6 A/B TITLE6 C

WA 08 Nooksack Indian Tribe $84,700 $21,550

WA 09 Puyallup Tribe of Indians $138,850 $50,290

WA 10 Quinault Indian Nation $119,880 $43,110

WA 11 S. Puget Intertribal Plng. Ag.- Nisqually $119,880 $43,110

WA 12 S. Puget Intertribal Plng. Ag.- Squaxin Island $84,700 ($21,360)

WA 13 Swinomish Indian Tribal Community $74,650 $14,360

WA 14 Spokane Tribe of Indians $84,700 $21,550

WA 15 Yakama Indian Nation $74,650 $14,360

WA 16 Tulalip Tribes $119,880 $43,110

WA 17 Jamestown S'Klallam Tribal Center $84,700 $21,550

WA 19 Quileute Tribal Council $74,650 $14,360

WA 20 S. Puget Intertribal Plng. Ag.- Shoalwater Bay $96,180 $28,730

WA 21 Stillaguamish Tribe of Indians $84,700 $21,550

WA 22 Upper Skagit Indian Tribe $74,650 $14,360

WA 24 The Suquamish Indian Tribe $96,180 $28,730

WA 25 Port Gamble S'Klallam Tribe $84,700 $21,550

WA 26 Samish Indian Nation $84,700 $21,550

WA 27 Cowlitz Indian Tribe $96,180 $28,730

WA 28 SKOKOMISH INDIAN TRIBE $96,180 $28,730

WA 29

Confederated Tribes of the Chehalis 

Reservation $96,180 $28,730

WA Total Total $2,426,370 $668,250

WI 01 Bad River Band of Lake Superior Chippewa $84,700 $21,550

WI 02 Forest County Potawatomi Community $74,650 $14,360

WI 03

Lac Courte Oreilles Band of Lake Superior 

Chippewa $96,180 $28,730

WI 04

Lac du Flambeau Band of Lake Superior 

Chippewa Indians $84,700 $21,550

WI 05 Menominee Indian Tribe of Wisconsin $119,880 $43,110

WI 06 Oneida Tribe of Indians of Wisconsin $119,880 $43,110

WI 07 Red Cliff Band of Lake Superior Chippewa $84,700 $21,550

WI 08 St. Croix Chippewa Indians of Wisconsin $84,700 $21,550

WI 09 Stockbridge-Munsee Community $84,700 $21,550

WI 10 Ho-Chunk Nation $108,380 $35,920

WI Total Total $942,470 $272,980

WY 01 Northern Arapaho Business Council $96,180

WY 02 Shoshone Tribal Business Council $108,380

WY Total Total $204,560

Total Total Total $26,439,461 $6,330,117