DEPARTMENT

of HEALTH

and HUMAN

SERVICES

ADMINISTRATION 

ON AGING

FY 2010 Report to Congress
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i

FROM THE ADMINISTRATION ON AGING

I am pleased to present the Administration on Aging (AoA) FY 2010 Report to Congress. 

AoA and the national aging services network, comprised of 56 state and territorial units on aging 

(SUA), 629 area agencies on aging (AAA), 244 tribal organizations, two Native Hawaiian 

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

annually serve nearly 11 million seniors and their caregivers. AoA’s services complement 

medical and health care systems, help to prevent hospital readmissions, provide transportation to 

doctor appointments, and support some of life’s most basic functions, such as assistance to elders 

in preparing and delivering meals, or helping them with bathing. This assistance is 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 but are able to remain in their 

homes, in part, due to these community supports. 

The need for this support is growing rapidly. From 2010 to 2015, the population aged 60 and 

older will increase by 15 percent, from 57 million to 65.7 million. During this period, the 

number of seniors with severe disabilities who are at greatest risk of nursing home admission and 

Medicaid eligibility will increase by more than 13 percent. 

The following summary of the Older Americans Act (OAA) program data reveals that:

• OAA programs help older Americans with severe disabilities remain independent and in 

the community.

• OAA programs are efficient: Without controlling for inflation, OAA programs have 

increased efficiency by nearly 40 percent between FY 2002 and FY 2010, serving 8,459 

older Americans per million dollars of funding in FY 2010, compared to 6,103 

individuals per million dollars of funding in FY 2002. This increase in efficiency is 

understated since the purchasing power of a million dollars in 2010 is significantly less 

than in 2002 due to inflation.

• OAA programs build system capacity: For every one dollar of OAA funds expended for 

home and community-based services, nearly three dollars is leveraged from state, local or 

other sources.

The Older Americans Act is due for reauthorization in FY 2012. During FY 2010, AoA 

convened three national listening sessions, held one joint session with the Department of Labor, 

and sparked hundreds of national, state and local sessions convened by stakeholders and 

involving all states and area agencies. In addition, targeted outreach to national minority aging 

organizations representing diverse cultures and populations was conducted. As a result, the 

critical internal and external stakeholders representing thousands of older individuals and their 

caregivers were engaged in providing input and recommendations for the next reauthorization.

We look forward to working with Congress to strengthen and update these critical programs with 

an eye toward efficiency and effectiveness, and strengthening and building the capacity of the 

aging services network to deliver high-quality services that improve outcomes for seniors. 

Kathy Greenlee

Assistant Secretary for Aging
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Table of Contents

 Page Number

 

Introduction i

Executive Summary – Overview of Performance 1

Part I: Health and Independence 6

• Home and Community-Based Supportive Services 8

• Nutrition Services 10

• Recovery Act Funding of Nutrition Services for Seniors 12

• Preventive Health Services 13

• Chronic Disease Self-Management Programs 15

• Caregiver Services 17

• National Family Caregiver Support Program 18

• Lifespan Respite Care 19

• Alzheimer’s Disease Supportive Services Program 22

• National Data on Services Provided 24

Part II: Older American Indians, Alaska Natives & Native Hawaiians 26

Part III: Protection of Vulnerable Older Americans 29

• Prevention of Elder Abuse & Neglect 30

• Model Approaches to Statewide Legal Assistance Systems 31

• National Legal Assistance and Support Projects 34

• Pension Counseling and Information 35

• Senior Medicare Patrol Program 36

• Long-Term Care Ombudsman Program 39

Part IV: Supporting the National Aging Services Network 47

• Aging and Disability Resource Centers 47

• National Eldercare Locator 49

• Technical Assistance Centers 49

• Multigenerational Civic Engagement 50

• Meeting the Need for Trained Personnel in Aging 50

Part V: Program Innovations 54

• Community Innovations for Aging in Place 54

Appendix: Formula Grant Funding Allocation by 56

 State, Territory and Tribal Organization
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1

Executive Summary

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

Services (DHHS), plays a lead role in the mission of 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 of 56 

state and territorial units on aging (SUA), 629 area agencies on aging (AAA), 244 tribal

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

promote the development of comprehensive and coordinated home and community-based care 

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

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

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

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

that are available in the community and addresses issues related to caregivers. OAA services are 

less expensive than institutional care and performance data show that they are very effective. 

The most recent data available show that AoA and its national network rendered direct services 

to 10.8 million elderly individuals age 60 and over (nearly 20 percent of the country’s elderly 

population) and their caregivers, including nearly three million clients who received intensive inhome services.1

 Critical supports, such as respite care and a peer support network, were 

provided to nearly 700,000 caregivers.

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

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

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

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

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

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

Vision

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

vibrant aging services network at state, territory, local and tribal levels through the funding of 

lower-cost, non-medical services and supports that provide the means by which many seniors can 

remain out of institutions and live independently in their communities for as long as possible.

Mission

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

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

independence in their homes and communities. 

 1 Data from AoA’s FY 2010 State Program Report are preliminary and should not be taken as final.
2

Overview of Performance

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

accomplishing AoA’s mission.

Consistent with this Administration’s emphasis 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. To this end, AoA has:

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

aging network professionals and the public to develop benchmarks and examine trends 

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

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

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

decision makers. Results show:

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

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

homes.

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

that Title III serves older people who are less healthy and have more limitations 
3

than other older adults even after adjusting for demographic and socioeconomic 

differences between the groups.

• Tested through the Performance Outcomes Measurement Project (POMP) several 

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

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

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

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

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

• Employed more rigorous program evaluation methods such as longitudinal data 

collection and experimental design.

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

design that includes three major components and several subcomponents. The 

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

aging services 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 and 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.

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

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

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

measured over time.

o AoA is working with a research contractor to finalize the design and operational 

plan for an evaluation of Aging and Disability Resource Centers (ADRC). The 

evaluation is a quasi-experimental design that compares the experiences and 

outcomes associated with accessing long-term care services and supports through 

an ADRC to non-ADRC communities. AoA is working with the HHS Office on 

Disability and the Department of Education’s Rehabilitation Services 

Administration to better include the younger disabled population in the study who 

access services through Centers for Independent Living.

o During FY 2010, AoA, through an Interagency Agreement with the Agency for 

Healthcare Research and Quality (AHRQ), contracted with a research team to 

design a framework report for the evaluation of the Chronic Disease SelfManagement Program. This report indicated that the existing literature about the 

efficacy of CDSMP includes few subgroup analyses of the population AoA is 

mandated to serve, that is, people aged 60 or older, and that the studies that 

looked at the effects of CDSMP on older individuals either did not find positive 

effects or found only weak effects. A more recent study of CDSMP outcomes 

commissioned by the Centers for Disease Control and Prevention reveals that the 
4

CDSMP was as effective in studies where the majority of participants were aged 

65 years or older as it was with individuals in studies where the majority of 

participants were aged 65 years or younger.

2

o The final evaluation design report was received in May 2011 and recommended 

an experimental evaluation design in which individuals will be randomly assigned 

to receive the intervention or serve as a control group by delaying program 

participation for a minimum of six months. Multiple data collection points will 

enable AoA to measure program effects on its target service population over time. 

Next steps involve finalizing design details, developing an operational plan and 

gathering process data. 

 

o The final evaluation design report was received in May 2011 and recommended 

an experimental evaluation design in which individuals will be randomly assigned 

to receive the intervention or serve as a control group by delaying program 

participation for a minimum of six months. Multiple data collection points will 

enable AoA to measure program effects on its target service population over time. 

Next steps involve finalizing design details, developing an operational plan and 

gathering process data. 

Current Performance Information

An analysis of AoA’s performance trends shows that through FY 2010, most indicators have 

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

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

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

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

caregivers. Below are some examples of these observations:

• OAA programs help older Americans with severe disabilities remain independent and 

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

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

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

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

meals to 280,454 clients with three or more ADL impairments and by FY 2010 that number 

grew by 14 percent to 318,792 clients. Another approach to measuring AoA’s success is the 

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

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

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

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

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

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

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

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

institutional settings.

 2 Sorting through the Evidence for Arthritis Self-Management Program and the Chronic Disease Self-Management 

Program. Centers for Disease Control. May,2011.
5

• OAA programs are efficient: The national aging services network is providing high quality 

services to the neediest elders and doing so in a very prudent and cost-effective manner; as an 

example, AoA has significantly increased the number of clients served per million dollars of 

AoA funding. Without controlling for inflation, OAA programs have increased efficiency by 

nearly 40 percent between FY 2002 and FY 2010, serving 8,459 clients per million dollars of 

AoA funding in FY 2010, 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 2010 is significantly less than in 2002 due to inflation. 

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

“encourage and assist state agencies and area agencies on aging to concentrate resources in 

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

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

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

dollar of OAA funds expended for Home and Community-Based Services (Titles III-B, III-C 

and III-D), as well as in the expansion of projects such as the Aging and Disability Resource 

Center initiative, which has grown to 310 sites across 54 states and territories in FY 2010.

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

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

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

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

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

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

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

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

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

Disability Resource Centers. 
6

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

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

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

them to remain in the community.3

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

57 million to 65.7 million.4 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.5

 These programs help seniors in need maintain their health and 

independence.

In concert with other OAA programs, these services assist nearly 11 million elderly individuals 

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

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

home admission. These services help to keep these individuals from joining the 1.7 million 

seniors who live in nursing homes. These increases will also help the national aging services 

network improve its capacity to assist the rapidly growing senior population.

State and Territory Flexibility

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

Services and Nutrition Services, states and territories have the flexibility to allocate resources to 

best meet local needs through intra-state funding formulas which distribute funds to area 

agencies on aging (AAAs). These formulas vary by state and allow states to take into account 

their own local circumstances to best serve their population. States are required to submit their 

formulas to AoA for approval and must take into account the geographic distribution of older 

persons and the distribution of older persons in greatest social and economic need. AAAs 

administer these grants and provide grants or contracts to local service providers based on 

identified needs.

The OAA allows a state to transfer up to 40 percent of the funds between congregate and homedelivered meals for use as the state considers appropriate to meet the needs of the area served. 

 3 2009 National Survey of Older Americans Act Participants. http://www.data.aoa.gov, select AGID. 4 Data compiled by AoA from U.S. Census Bureau, “2008 National Population Projections, Projected Population by 

Single Year of Age, Sex, Race, and Hispanic Origin for the United States: July 1, 2000 to July 1, 2050” released 

August 2008, <http://www.census.gov/population/www/projections/downloadablefiles.html> Accessed August 

03, 2011.

5 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, 1992-2008.” Accessed August 02, 2011.
7

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

nutrition services, then the Assistant Secretary for Aging may grant a waiver that permits the 

state to transfer an additional 10 percent of the funds to meet those needs. The OAA provides 

further flexibility to states by allowing them to transfer up to 30 percent for any fiscal year 

between Supportive Services programs and Nutrition Services programs, for use as the state 

considers appropriate. These are options open only to states and territories. A state agency may 

not delegate to an area agency on aging or any other entity the authority to make such transfers.

In 2010, states transferred over $82 million from congregate nutrition to home and communitybased services and home-delivered meals, as illustrated in the following table. 

Table 1. FY 2010 Transfer of Federal funds within Title III of the OAA

Part B –

Home and CommunityBased Supportive Services

Part C1 –

Congregate Nutrition

Part C2 –

Home-Delivered Meals

Initial Allotment $366,038,034 $438,020,197 $216,311,617

Final Allotment after 

Transfers $415,543,507 $355,452,956 $249,373,385

Net Transfer +$49,505,473 ($82,567,241) +$33,061,768

Net Percent Change 13.52 (18.85) 15.28
Home and Community-Based Supportive Services

(Title III-B of OAA; FY 2010: $368,290,000)

The Home and Community-Based Supportive Services (HCBS) program, established in 1973, 

provides grants to states and territories based on their share of the population age 60 and over to 

fund a broad array of services that enable seniors to remain in their homes for as long as 

possible. AoA programs like the HCBS program serve seniors holistically; while each service is 

valuable in and of itself, it is often the combination of supports, when tailored to the needs of the 

individual, that ensures clients remain in their own homes and communities instead of entering 

nursing homes. 

The services provided to seniors through the HCBS program include transportation; case 

management; information and referral; in-home services such as personal care, chore, and 

homemaker assistance; and community services such as adult day care. In addition to these 

services, the HCBS program also funds multi-purpose senior centers which coordinate and 

integrate services for the elderly.

While age alone does not determine the need for these long-term care supports, statistics show 

that both disability rates and the use of long-term supports increase with advancing age. Among 

those aged 85 and older, 55 percent are unable to perform critical activities of daily living and 

require long-term support. Data also show that 90 percent of seniors have at least one chronic 

condition and over 70 percent have at least two6. Providing a variety of supportive services that 

meet the diverse needs of these older individuals is crucial to enabling them to remain healthy 

and independent in their homes and communities, avoiding unnecessary, expensive nursing 

home care. 

Data from AoA’s national surveys of elderly clients show that Home and Community-Based 

Supportive Services are providing seniors with the services and information they need to help 

them remain at home. For example, 48 percent of seniors using transportation services rely on 

them for the majority of their transportation needs and would otherwise be homebound, while 

80 percent of clients receiving case management reported that as a result of the services arranged 

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

 In addition, a study published 

in the Journal of Aging and Health shows that the “personal care services” provided by the 

HCBS program are the critical services that enable frail seniors to remain in their homes and out 

of nursing home care.8

 

Services provided by the HCBS program in FY 2010 include: 

 6

Anderson, Gerard, Chronic Care: Making the Case for Ongoing Care. Robert Wood Johnson Foundation. 2010 

Princeton, NJ. Available: http://www.rwjf.org/files/research/50968chronic.care.chartbook.pdf

7 2009 National Survey of Older Americans Act Participants. http://www.data.aoa.gov, select AGID.

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

• Adult Day Care/Day Health provided over ten 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 26 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 more than 35 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 more than 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 commitment to provide services to those in most need, nearly 

50 percent of riders on OAA-funded transportation 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:

• 68 percent of riders had a doctor tell them they had vision problems (including glaucoma, 

macular degeneration or cataracts); 

• 14 percent have had a stroke; and

• 7 percent have Alzheimer’s or dementia.

 

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

20 medications daily.9

 

 9 2009 National Survey of Older Americans Act Participants. http://www.data.aoa.gov, select AGID.
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. Nutrition Services include:

• Congregate Nutrition Services (Title III-C1; FY 2010: $440,718,000): 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 wellbeing.

• Home-Delivered Nutrition Services (Title III-C2; FY 2010: $217,644,000): 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. Home-delivered 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; FY 2010: $160,991,000): 

Provides additional funding to states, territories, and eligible tribal organizations that is 

used exclusively to provide meals. It 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. States and tribes elected to spend approximately $2.7 million on 

commodities in FY 2010. 

Formula grants for Congregate Nutrition Services and Home-Delivered Nutrition Services are 

allocated to states and territories based on their share of the population age 60 and over. 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. 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 40 percent of all persons age 85 and over are in need of assistance with instrumental 

activities of daily living (IADLs)10

 10 Hung et al.: Recent trends in chronic disease, impairment and disability among older adults in the United States. 

BMC Geriatrics 2011 11:47.

, including obtaining and preparing food; these nutrition 

programs help address their needs. Serving Elders at Risk, a national evaluation of AoA’s 
11

nutrition program clients, found that recipients are older, poorer, more likely to live alone, more 

likely to be minorities, are sicker, in poorer health, in poorer nutritional status, more functionally 

impaired, and at higher nutritional risk than those in the general population. Nutrition Services 

provide an important opportunity for social interaction that helps to improve the general health 

status of participants, particularly homebound elders. A comparison of the number of social 

contacts of congregate and home-delivered meal participants showed that nutrition program 

clients had significantly more social contacts than people who did not participate in the program. 

Data from AoA’s national surveys of elderly clients show that the Nutrition Services are 

effectively helping seniors to improve their nutritional intake and remain at home. For example, 

73 percent of congregate and 85 percent of home-delivered meal recipients say they eat healthier 

meals due to the programs, and 58 percent of congregate and 93 percent of home-delivered meal 

recipients say that the meals enabled them to continue living in their own homes.11 In addition, 

home-delivered meal and congregate meal participants had significantly better food energy 

intake, protein, vitamins A, B6 & D, Riboflavin, Calcium, Phosphorous, Potassium, Magnesium 

and Zinc intakes compared to matched non-participant group of senior citizens.12 Seniors with 

deficiencies of these nutrients can experience osteoporosis, night blindness, decreased resistance 

to infection, fatigue, vasodilatation, and other illnesses. 

AoA’s annual performance data further demonstrate that these programs are an efficient and 

effective means to help seniors remain healthy and independent in their homes and in the 

community. Ninety-one percent of home-delivered meal clients rate service as good to excellent 

(Outcome 2.9a). Also, the number of home-delivered meal recipients with severe disabilities 

(3+ ADL) totaled more than 342,000 in 2009. This level of disability is frequently associated 

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

home-delivered meal clients. The most recent data on how these nutrition programs are helping 

seniors remain healthy and independent in their homes include:

• Home-Delivered Nutrition Services provided more than 145 million meals to nearly

870,000 individuals in FY 2010.

• Congregate Nutrition Services provided over 96 million meals to more than 1.7 million 

seniors in a variety of community settings in FY 2010.

 11 2008 National Survey of Older Americans Act Participants. http://www.data.aoa.gov, select AGID. 12 Serving Elders at Risk – National Evaluation of the Elderly Nutrition Program, 1993-1995, pp.117-118
12

Recovery Act Funding of Nutrition Services for Older Americans

The American Recovery and Reinvestment Act of 2009 (ARRA) empowered the U.S. Department of 

Health and Human Services to help boost the nation’s economy, create or save jobs, maintain health 

care services, expand access to affordable health care, and protect and support those in greatest need.

AoA distributed $100 million in ARRA funding to the national aging services network to help older 

Americans hardest hit by the economic downturn receive the right foods to help keep them healthy 

and active, and to assist those who may be too impaired to prepare nutritious meals for themselves.

Without regular nutritious meals, the health of many older Americans declines; they become more 

susceptible to illness; their ability to manage their chronic diseases is reduced, and they may lose 

their ability to remain at home, independent in their community. The funds were expended in FY 

2009 and FY 2010.

Of the $100 million in ARRA funding, $65 million was distributed by formula to 56 states and 

territories for congregate nutrition services provided at senior centers and other community sites and 

$32 million was distributed by formula to states and territories for the preparation and delivery of 

meals to frail elders in their homes. A total of $3 million was provided to 254 tribal organizations

and two Native Hawaiian organizations. No ARRA funding was used to pay for AoA administrative 

costs associated with this activity. It is being used by the aging services network to augment existing 

resources, replace revenue lost from state, tribal, and local sources due to the economic downturn, 

and support the continued delivery of meals to vulnerable older Americans. As with funds provided 

through Title III OAA appropriations, states distributed funds to area agencies on aging or local 

providers, which coordinated the provision of meals to elderly individuals. 

Given the economic downturn, the National Association of States United for Aging and Disabilities

reported in FY 2009, that requests for community-based services for seniors increased, with about an 

80 percent increase in requests for home-delivered meals and a 50% increase for congregate meals. 

Within this context, some examples of how senior nutrition service providers used ARRA funding to 

meet this increased demand for meals to homebound seniors are summarized below:

• Seminole County, FL reported having a long waiting list for home-delivered meals to 

homebound seniors. ARRA funds were used to serve prepare and deliver two meals per day 

to frail elderly clients who otherwise would have gone without proper nutrition and be at 

greater risk of entering a nursing facility

• Meals on Wheels of Syracuse, New York used ARRA funds to avoid what would have been 

their first ever waiting list for seniors in need in the area.

• In another county in NY, ARRA funding enabled the senior nutrition program to provide 

meals to 334 homebound elderly individuals, 59 of whom are over the age of 90. 

Beginning in FY 2009, and continuing through the end of FY 2010, ARRA funding provided:

• 12,526,874 congregate meals to 729,690 individuals;

• 7,916,270 home-delivered meals to 33,791 individuals; and

• 408,436 home-delivered meals and 358,462 congregate meals to tribal and Native Hawaiian 

organizations.
13

Preventive Health Services

(Title III-D of OAA; FY 2010: $21,026,000)

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

based on their share of the population aged 60 and over, to support activities that educate older 

adults about the importance of healthy lifestyles and promote healthy behaviors that can help to 

prevent or delay chronic disease and disability, thereby reducing the need for more costly 

medical interventions. 

Due in large part to advances in public health and medical care, Americans are leading longer 

and more active lives. Average life expectancy has increased from less than 50 years at the turn 

of the 20th century to almost 78 years today. On average an American turning age 65 today can 

expect to live an additional 18.6 years. The population of older Americans is also growing, 

particularly the population age 85 and over, which is growing very rapidly, from 5.8 million in

2010 to 8.7 million by the year 2030. One consequence of this increased longevity is the higher 

incidence of chronic diseases such as obesity, arthritis, diabetes, osteoporosis, or depression as 

well as the greater probability of injury from a fall, which quickly limits physical activity. 

In recent years, states and territories have been statutorily required to use at least a portion of this 

funding for medication management, screening, and education activities, but otherwise have had 

flexibility to allocate resources among the preventive health activities of their choice to best meet 

local needs. Priority has been given to providing services to those elders living in medically 

underserved areas of the state or who have the greatest economic need. Services currently 

provided through the Preventive Health Service program include:

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

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

agencies on aging, senior centers, community parks and recreation programs, housing 

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

congregate meal sites, and the home-delivered meals program.

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

hypertension, diabetes, dental issues, high cholesterol, and hearing and vision loss.

• Evidence-based Prevention Programs, as described below.

Over the last few years, some states have begun to shift their funding to provide greater support 

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

Evidence-based programs are interventions that have been tested through randomized control 

trials and have been shown to be effective at helping participants adopt healthy behaviors, 

improve their health status, and reduce their use of hospital services and emergency room visits. 

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

prevention, and Chronic Disease Self-Management Programs, all of which have been 

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

interventions. AoA has encouraged states and the aging services network to adopt evidencebased prevention programs and more and more states are using these and other resources to do 

so. Some examples of evidence-based interventions are:
14

• Enhanced fitness and enhanced wellness programs: Enhanced fitness is a multicomponent group exercise program designed for community-based organizations and 

intended to promote physical activity among older adults. Strength training using soft 

wrist and ankle weights; cardiovascular workouts using dancing, aerobics, or walking; 

and balance and posture exercises are used to increase the physical health of older adults. 

In addition, exercise has been proven to improve depression, which studies have shown 

that nearly 20 percent of U.S. adults 65 years and older experience.13 Exercise may also 

act as a buffer against many illnesses impacted by stress. 

• Falls prevention: Falls prevention programs teach participants to improve strength, 

balance, and mobility; provide education on how to avoid falls and reduce fall risk 

factors; involve medication reviews and modifications; provide referrals for medical care 

management for selected fall risk factors; and provide home hazard assessments of ways 

to reduce environmental hazards. Recent studies have shown that in the United States 

more than one-third of adults age 65 and over fall each year. Of those who fall, 20 to 

30 percent will experience serious injuries, such as head trauma, broken bones, or hip 

fractures.14 These injuries may limit the ability of older adults to get around or live 

independently. Those who are not injured may develop a fear of falling, which may increase 

their actual risk of falling. Many people limit their activity after a fall, which may reduce 

strength, physical fitness, and mobility.15

• Medication management: Medication management programs focus on reviewing the 

multitude of medications that older adults are prescribed, focusing especially on high-risk 

medications. These programs have been shown to reduce unnecessary duplication of 

prescriptions and cardiovascular problems. They have also been shown to improve 

medication usage rates and decrease medication errors among older adults.

• Chronic disease self-management programs: Older Americans are disproportionately 

affected by a vast array of chronic conditions, including diabetes, obesity, heart disease, 

cancer, arthritis, and depression, that collectively account for seven out of every 

ten deaths and contribute to more than three-quarters of all Medicare expenditures.16 

 13 Administration on Aging. (2001). Older Adults and Mental Health: Issues and Opportunities. Washington, DC:

 U.S. Department of Health and Human Services. Also, “Mental Health: A Report to the Surgeon General,”

 http://www.surgeongeneral.gov/library/mentalhealth/chapter5/sec1.html.

14 Sterling DA, O'Connor JA, Bonadies J. Geriatric falls: injury severity is high and disproportionate to mechanism. 

 Journal of Trauma–Injury, Infection and Critical Care 2001; 50(1):116–9.

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

16 Deaths: Leading Causes for 2004. National Vital Statistics Report, V. 56, No. 5. Centers for Disease Control and 

Prevention. Available at http://www.cdc.gov/nchs/data/nvsr/nvsr56/nvsr56_05.pdf . Accessed December 30, 2009.

Follow the Money -- Controlling Expenditures by Improving Care for Patients Needing Costly Services. 

Bodenheimer, T., and Berry-Millett, R. New England Journal of Medicine. 15 October 2009.
15

Preventive Health Services have been carried out at multi-purpose senior centers, meal sites, and 

other community-based settings, as well as through individualized counseling and services for 

vulnerable elders. States reported 5.9 million seniors served in these health-related programs 

which received $16 million in additional funding from states and local entities. 

Chronic Disease Self-Management Programs

Funding for the Chronic Disease Self-Management Program (CDSMP) is awarded in the form of 

competitive grants to states. External experts review project proposals, and project awards are 

made for periods of one to three years. In FY 2010, AoA funded 47 state grants for CDSMPs, 

with an average award of $574,468, using funding provided under the Recovery Act. CDSMP is 

a low-cost, evidence-based disease prevention model that utilizes state-of-the-art techniques to 

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

reduce their need for more costly medical care. Older Americans are disproportionately affected 

by a vast array of chronic conditions (including diabetes, obesity, cancer, arthritis, and 

depression) that collectively account for seven out of every 10 deaths and more than threequarters of all health expenditures.17 Data show that as an individual’s number of chronic 

conditions increases, there is a corresponding escalation in adverse outcomes including 

mortality, poor functional status, unnecessary hospitalizations, adverse drug events, duplicative 

tests, and conflicting medical advice, all of which lead to higher health costs and greater outlays 

for programs like Medicare and Medicaid. CDSMP is helping to reduce these adverse outcomes 

by empowering individuals, particularly those who have two or more chronic health conditions, 

to address issues related to the management and treatment of chronic disease. 

CDSMP has been shown repeatedly through multiple studies (including randomized control 

experiments, with both English and Spanish speaking populations) to be effective at helping 

participants to adopt healthy behaviors, improve their health status and reduce their use of 

hospital stays and emergency room visits. The program has been shown to significantly improve 

participant health status, reduce the use of hospital care and physician services18 as well as 

reduce health care costs. 

CDSMP was developed by Stanford University and emphasizes a patient’s role in managing 

his/her illness. The program consists of a series of workshops that are conducted once a week 

for two and a half hours over six weeks in community settings such as churches, libraries, 

YW/MCAs, senior centers, public housing projects, community health centers and cooperative 

extension programs. People with different chronic health problems attend together, and the 

workshops are facilitated by two leaders who are trained and certified by Stanford University, 

one or both of whom are non-health professionals or lay people with chronic diseases 

themselves. Topics covered include: 1) techniques to deal with problems such as frustration, 

fatigue, pain and isolation; 2) appropriate exercise for maintaining and improving strength, 

flexibility, and endurance; 3) appropriate use of medications; 4) communicating effectively with 

health professionals; and 5) nutrition. 

 17 National Center for Chronic Disease Prevention and Promotion (NCCDPHP). Physical Activity and Good 

Nutrition: Essential Elements to Prevent Chronic Diseases and Obesity. Available at 

www.cdc.gov/nccdphp/aag/aag_dnpa.htm. Accessed September 14, 2004.

18 Sobel, DS, Lorig,KR, Hobbs,M. Chronic Disease Self-Management Program: From Development to 

Dissemination. Permanente Journal; Spring 2002.
16

Since 2003, AoA has supported the deployment of CDSMP through the aging services network, 

in partnership with AHRQ, CDC, CMS, HRSA and over 30 private foundations. In the 2006 

reauthorization of the OAA, Congress directed AoA to promote the nationwide implementation 

of evidence-based prevention programs through its network of community-based service 

provider organizations; and beginning in FY 2008, Congress appropriated funding specifically to 

support this initiative. AoA and its partners have invested over $50 million since 2003 in 

developing an infrastructure for delivering evidence-based programs at the community level. 

This infrastructure includes 1,200 community-based delivery sites, a national technical assistance 

center on evidence-based prevention programs for the elderly, a national CDSMP training and 

certification center at Stanford, local program training materials and guides, marketing materials, 

quality assurance mechanisms and fidelity protocols, and a variety of technologies, including an 

AHRQ sponsored Knowledge Transfer Program to support rapid diffusion. Over 12,000 

individuals have participated in the CDSMP programs offered through this infrastructure. 

Older Americans are disproportionately affected by a vast array of chronic diseases and 

conditions. Over 80 percent of adults 65 and over have at least one chronic condition, and 

roughly half suffer from two.19 Nearly half of older adults have hypertension and roughly one in 

five has heart disease, with a similar proportion having some type of cancer.20 The average 

75-year old has three chronic conditions and takes 4.5 medications.21 More than 65 percent of 

Americans aged 65 and over have some form of cardiovascular disease. One million adults age 

75+ have diabetes, a number that is expected to grow to 4 million by 2050 if nothing is done to 

change current growth rates.22 Minority elders – the fastest growing segment of the elderly 

population – are especially at risk of chronic illnesses and conditions. For example, among 

adults age 65+, 83 percent of Blacks had hypertension, compared to 69.97 percent of Whites;

23

and 27.8 percent of Hispanics have diabetes, compared to 17.5 percent of Whites.24

The Stanford University CDSMP represents the state-of-the-art in chronic disease selfmanagement and is ideally suited for delivery through AoA’s network of community based 

organizations, including senior centers, congregate meal programs, faith-based organizations and 

senior housing projects. Nationwide implementation will be accomplished at the community 

level by aging services provider organizations working in collaboration with public health 

agencies and health care providers. Participant referrals to the CDSMP program will come from 

both clinical and community-based organizations. Clinical referrals will come from community

health centers, physicians, hospitals, managed care organizations, and other health system 

components. Community referrals will come from a variety of sources, including the Aging and 

Disability Resources Centers that are currently funded by HHS (AoA and CMS). ADRCs serve 

as community-level “one stop shop” entry points into long-term care for people of all ages who 

have chronic conditions. 

 19 NCCDPHP. Healthy Aging: Preventing Disease and Improving Quality of Life Among Older Americans. 

Available at http://www.cdc.gov/nccdphp/aag/aag_aging.htm. Accessed September 14, 2004. 20 Centers for Disease Control and Prevention (CDC), National Center for Health Statistics, National Health 

Interview Survey, 2000-2001. 21 Alliance for Aging Research. Ten Reasons Why America Is Not Ready for the Coming Aging Boom. 2002. 22 NCCDPHP. Available at http://www.cdc.gov/nccdphp/bb_aging/index.htm. Accessed September 14, 2004. 23 National Health and Nutrition Examination Survey, NHANES 2005-2008. 24 National Health Interview Survey, NHIS 2010.
17

Caregiver Services

Families and other informal caregivers are the nation’s primary provider of long-term care. On a 

daily basis, these individuals assist relatives and other loved ones with tasks ranging from 

assisting with personal care and homemaking to more complex health-related interventions like 

medication administration and wound care. The availability of a skilled caregiver – whether an 

informal caregiver, a paraprofessional worker or an unrelated volunteer – all too often 

determines whether an individual remains independent or is admitted to a nursing home. 

Research has shown that caregiving exacts a heavy emotional, physical, and financial toll. As 

reported in AoA’s 2009 National Survey of Older Americans Act (OAA) Participants, 25 percent 

of caregivers are assisting two or more individuals. Sixty-five percent of Title III caregivers are 

60 or older, making them more vulnerable to a decline in their own health, and nearly one-third 

describe their own health as fair to poor.25 Caregivers also suffer from higher rates of depression 

than non-caregivers of the same age, and research indicates that caregivers suffer a mortality rate 

that is 63 percent higher than non-caregivers.26 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. 

Better support for caregivers is critical since often it is their availability – whether they are 

informal family caregivers, paraprofessionals or unrelated friends and neighbors who volunteer 

their time – that determines whether an older person can remain in his or her home. In 2004, 

approximately 43.5 million adult caregivers provided uncompensated care to those 50 years of 

age and older.27 The economic value of replacing unpaid caregiving in 2009 was estimated to be 

about $450 billion, an increase from $375 billion in 2007 (cost if that care had to be replaced 

with paid services).28 

Providing support that makes caregiving easier for family caregivers, such as information, 

counseling and training, respite care, or supplemental services, is critical to sustaining 

caregivers’ ability to continue in that role. Eighty-three percent of the caregivers served by AoA 

programs report that AoA services allow them to provide care longer than they otherwise 

could.29 

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

every day. By 2015, AoA projects that there will be 13.2 million non-institutionalized seniors 

age 65 and over with one or more ADL deficits, an increase of more than 2 million seniors or 

21 percent since 2010, needing caregiver assistance.30

 25 2009 National Survey of Older Americans Act Participants. 

 

http://www.data.aoa.gov, select AGID. 26 Schulz R, Beach SR. Caregiving as a risk factor for mortality. The Caregiver Health Effects study. JAMA 

December 15, 1999;282:2215-9. 27 National Alliance for Caregiving and AARP. Caregiving in the U.S.: A Focused Look at Those Caring for the 

50+. 2009. <http://www.caregiving.org/pdf/research/FINALRegularExSum50plus.pdf> 28 Feinberg L, Reinhard S.C., Houser A, Choula, R., Valuing the Invaluable: 2011 Update The Growing 

Contributions and Costs of Family Caregiving. (Washington, D.C.: AARP Public Policy Institute, July 1011).

Available from: http://assets.aarp.org/rgcenter/ppi/ltc/i51-caregiving.pdf . 29 2009 National Survey of Older Americans Act Participants. http://www.data.aoa.gov, select AGID. 30 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, 
18

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.

National Family Caregiver Support Program

(Title III-E of OAA; FY 2010: $154,197,000)

The National Family Caregiver Support 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 basic system components: information, access assistance, caregiver education, 

training and support groups, respite care, and supplemental services. These services work in 

conjunction with Health and Independence Services, such as transportation services, homemaker 

services, home-delivered meals, and adult day care, to provide a coordinated set of supports for 

seniors that caregivers can access on their behalf.

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

caregivers. In FY 2010, services provided include: 

• Access Assistance Services provided over one million contacts to caregivers assisting 

them in locating services from a variety of private and voluntary agencies.

• Counseling and Training Services provided nearly 125,000 caregivers with counseling, 

peer support groups, and training to help them better cope with the stresses of 

caregiving).

• Respite Care Services provided more than 64,000 caregivers with 6.8 million hours of

temporary relief – at home, or in an adult day care or nursing home setting – from their 

caregiving responsibilities.

Studies have shown that these types of supports can reduce caregiver depression, anxiety, and 

stress and enable them to provide care longer, thereby avoiding or delaying the need for costly 

institutional care for their loved ones. A study, Intervention to Delay Nursing Home Placement 

of Patients with Alzheimer’s Disease, indicates that counseling and support for caregivers of 

individuals with Alzheimer’s disease can permit the care recipient to stay at home, at 

significantly less cost, for an additional year before being admitted to a nursing home.

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

Medicare beneficiaries, ages 65+: US, 1992-2008.” www.cdc.gov/nchs/hdi.htm. Accessed 02 August 2011. 

 
19

Additionally, data from AoA’s national surveys of caregivers of elderly clients also shows that 

OAA services, including those provided through Family Caregiver Support Services, are 

effective in helping caregivers keep their loved ones at home. Approximately 83 percent of 

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

than otherwise would have been possible.31 Caregivers receiving services were also asked 

whether the care recipient would have been able to live in the same residence if the services had 

not been available. Nearly half the caregivers of nursing home eligible care recipients indicated 

that the care recipient would be unable to remain at home without the support services. Those 

respondents were then asked to identify where the care recipient would be living without 

services. A significant majority of those caregivers, 70 percent, indicated that the care recipient 

would most likely be living in a nursing home or assisted living. 

Lifespan Respite Care

(FY 2010: $2,500,000)

Established under Title XXIX of the Public Health Service Act, 42 U.S.C. 201, the 

Administration on Aging began implementation of the Lifespan Respite Care Program in 

FY 2009 and those activities continued into FY 2010. Throughout the program development 

process, AoA has carefully considered the requirements of the Lifespan Respite Care Act as well 

as Congressional intent as specified in the Committee Report accompanying the authorizing 

statute.

To help ensure that state agencies and Aging and Disability Resource Centers use the funds to 

serve all age and disability groups, AoA employed the following strategies in FY 2010:

First, applications from eligible state agencies are minimally required to:

1. Demonstrate the support and active involvement of a range of government and 

non-government, private, nonprofit and other organizations with a stake in serving 

all populations eligible to receive services under the Lifespan Respite Care Act; 

2. Demonstrate thorough understanding of the population to be served, including 

knowledge of the family caregiver population for whom lifespan respite program 

services are to be provided, or for whom respite care workers and volunteers will 

be recruited and trained;

3. Demonstrate a meaningful and active inclusion of the state’s Respite Coalition or 

organization to ensure statewide implementation of lifespan respite programs 

across all age and disability categories; and

4. Demonstrate the broadest possible collaboration with relevant respite stakeholders 

from across the age and disability spectrum. Further, applicants must develop

programs that immediately address the respite needs of caregivers assisting care 

recipients of all ages and special needs categories. No phase-in or preferences for 

age groups or disability categories are permitted. 

 31 2009 National Survey of Older Americans Act Participants. http://www.data.aoa.gov, select AGID.
20

Second, grantees are being monitored via semi-annual and annual reports as well as through 

ongoing communication with the AoA program officer to ensure the required elements outlined 

above are being fulfilled. Additionally, AoA facilitates regular email and telephone 

communications with the individual grantees and the group to share information and strategies 

related to program development and implementation.

Finally, AoA recognizes the necessity of providing technical assistance (TA) to the grantees as 

well as states yet to be funded under the Lifespan Respite Program. To that end, AoA has a 

Cooperative Agreement with the Family Caregiver Alliance in San Francisco with a sub-contract 

to the ARCH National Respite Network and Resource Center (ARCH) to design and disseminate 

training materials and TA on a range of issues associated with Lifespan Respite Care Program 

development and implementation.

During the first year of funded TA, ARCH assessed grantee training and TA needs, conducted

individual consultations via phone, email and in person with each of the grantees to identify 

specific training needs and to address specific program development issues. Additionally, 

ARCH has developed and archived webinars on Lifespan Respite programs, the importance of 

collaboration, and working with faith-based communities to develop respite programs. ARCH 

has developed and/or updated numerous fact sheets and publications on a range of issues of 

interest to grantees as they develop their programs. 

The Lifespan Respite Care program provides grants to eligible state organizations to improve the 

quality and access of respite care for family caregivers of children or adults of any age with 

special needs while promoting the statewide dissemination and coordination of community-based 

respite care services. Respite care services are highly valued by caregivers. In the most recent 

National Survey of Older Americans Act service recipients a random sample of 1,795 caregivers 

(which represented over 223,626 active caregivers) answered questions about the impact of the 

caregiver program. Eighty-four percent of caregivers received respite care within the past 

twelve months. The respite care service recipients reported that as a result of the services they 

received:

• 77 percent had less stress; 

• 81 percent said it was easier to care for their loved one; 

• 59 percent reported they now know more about caring for their loved one’s condition; 

• 77 percent reported that it was the most helpful service they received; 

• 95 percent reported the care recipient benefited from the service; and 

• 82 percent said that the services enabled them to care longer. 

The activities funded by the Lifespan Respite Care program help to address this growing need, 

providing respite care services for family caregivers, training and recruitment of respite care 

workers and volunteers, information and outreach, access assistance, and program development. 

The program also supports a grant to establish a National Lifespan Respite Resource Center to 

maintain a national database on lifespan respite care; provide training and technical assistance to 

state, community, and nonprofit respite care programs; and provide information, referral, and 

education programs to the public on lifespan respite care.
21

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

$200,000 for three-year project periods. 

According to a November 2009 study by the National Alliance for Caregiving, of six national 

policies or programs presented to caregivers as potential ways to help them, 26 percent of 

respondents ranked respite services as either their first or second most preferred option.32 By 

providing opportunities for family caregivers to receive the much needed short-term relief from 

caring for their loved ones, the Lifespan Respite Care program helps to sustain family caregiver 

health and well-being, reduces the likelihood of abuse and neglect, and allows care recipients to 

remain in their own homes for as long as possible. 

States providing Lifespan Respite Care will, at a minimum:

• Expand and enhance respite care services to family members;

• Improve the statewide dissemination and coordination of respite care; and

• Provide, supplement, or improve access and quality of respite care services to family 

caregivers, thereby reducing family caregiver strain.

 32 National Alliance for Caregiving and AARP. Caregiving in the U.S. Bethesda: National Alliance for Caregiving, 

and Washington, DC: AARP, 2009.
22

Alzheimer’s Disease Supportive Services Program

(FY 2010: $11,462,000)

Established under Section 398 of the Public Health Services Act, as amended, (42 U.S.C. 280c3), the Alzheimer’s Disease Supportive Services Program (ADSSP) funds competitive grants for 

states to expand the availability of diagnostic and support services that help persons with 

Alzheimer’s and dementia and the family members who care for them. A critical focus of these 

grants is to support the family caregivers who provide countless hours of unpaid care, thereby 

enabling their family members with Alzheimer’s and dementia to continue living in the 

community. In order to maintain the quality of life of the caregiver and their family members, 

the ADSSP provides respite care, personal care, counseling, and informational assistance, using 

proven and innovative direct care practices and enhances the responsiveness and readiness of the 

home and community-based care system by improving service coordination and educating 

service providers about proven dementia care strategies. 

ADSSP grants enable states to develop service and outreach programs that are specific to state 

needs and resources. The primary components of the ADSSP program include:

• Delivering supportive services including respite care, home health care, personal care, 

adult day care, and companion services to assist caregivers, families, and persons with 

Alzheimer’s disease.

• Translating and replicating evidence-based interventions for dementia caregivers at the 

community level.

• Incorporating evidence-based research in the formulation of innovative projects and 

advancing changes to a state’s overall system of home and community-based care.

• Providing individualized and public information, education, and referrals about 

diagnostic, treatment and related services; sources of assistance for services; and legal 

rights of people affected by Alzheimer’s disease.

• Linking public and non-profit agencies that develop and operate respite care and other 

community-based supports, educational, and diagnostic services within the state to people 

who need services.

In 2008, a programmatic review was performed to determine the future direction of the program 

and how to enhance the program’s operation and results. As a result of this review, AoA issued 

two grant funding opportunities in FY 2009 reflecting the new directions of the ADSSP that 

encourage states to 1) translate and replicate evidence-based interventions for people with 

dementia and their caregivers; and 2) develop or expand innovative service models for people 

with dementia and their caregivers, including a focus to expand services available to people in 

the early stages of dementia and to provide chronic care management. 

In FY 2010, 32 cooperative agreements were awarded to 22 states, the District of Columbia and 

Puerto Rico to deliver evidence-based and innovative care coordination for persons with 

Alzheimer’s disease and their families through the aging services network, community-based 
23

organizations, and partnerships with institutions of higher education. In particular, AoA awarded 

innovation grants for supportive services that enable individuals with Alzheimer’s disease to 

remain in the community longer, promote early intervention and chronic care management, and 

enhance the ability of state systems to provide effective and cost-efficient supportive services for 

persons with Alzheimer’s disease and their families. A key focus of the evaluation criteria for 

awarding Alzheimer’s disease supportive services grants is reaching underserved and culturallydiverse populations. 

In FY 2010, the ADSSP funded 32 cooperative agreements with an average award of $321,625 

and a range of grant awards from $163,393 to $500,000. Through these grant projects, seven 

states are in the process of translating four evidence-based interventions into practice and nine 

states are offering innovative programming for caregivers and their loved ones with dementia.

One example of these promising interventions is a spousal caregiver support program in New 

York City that, in a randomized-controlled trial, delayed institutionalization of persons with 

dementia by an average of 557 days.33 In 2009, the average nursing home cost was $219 daily 

($79,935 annually), which would mean an average savings of nearly $122,000 in institutional costs 

per person with dementia. 34 Minnesota is translating this intervention now; early results indicate 

that the project is achieving the outcomes that were found in the original study. Other FY 2010 

grant projects focus on innovations in areas of great need, such as programs to identify and 

provide appropriate services for persons in the earliest stages of Alzheimer’s disease. Overall, 

these demonstrations offer direct services and other supports to thousands of families, as well as 

support the continuous quality improvement and evaluation of these services. 

 33 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. 34 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
24

FY 2010 National Program Services Summary Report 35

FY 2010

Total Clients 10,797,126

Total Registered Clients 2,978,385

% Minority Clients 24.81%

% Rural Clients 36.73%

% Clients Below Poverty 30.07%

# Senior Centers 11,401 (6,399 receive OAA funding)

Service Persons 

Served

Units of 

Service36

Title III 

Expenditure

Total 

Expenditure

Personal Care 106,095 18,567,017 $16,094,289 $268,814,128

Homemaker 148,807 15,514,357 $28,878,723 $239,360,807

Chore 37,157 1,053,129 $5,974,725 $19,250,738

Home Delivered 868,076 145,454,444 $243,784,239 $776,792,256

Adult Day Care 20,724 10,269,894 $11,368,697 $86,194,921

Case Mgt. 464,491 4,123,835 $25,472,434 $276,843,452

Assisted Trans. 39,763 1,483,816 $4,452,178 $15,354,827

Congregate 1,733,176 96,426,593 $278,662,972 $639,881,574

Nutrition 

Counseling

25,739 48,422 $1,273,874 $2,711,607

Transportation 25,852,102 $69,133,540 $201,567,259

Legal Assistance 971,390 $26,179,732 $49,052,445

Nutr. Education 2,485,902 $5,198,889 $8,416,508

I&A 13,278,507 $56,766,621 $152,829,355

Outreach 3,238,615 $10,653,616 $25,021,294

Other $93,518,560 $694,773,360

 35 Data from AoA’s FY 2010 State Program Report are preliminary and should not be taken as final.

36 Service Units Definitions:

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
25

Caregivers Serving Elderly Individuals

Service Caregivers 

Served

Service 

Units37

Title III 

Expenditure

Total 

Expenditure

Counseling, Support Groups, Training 124,690 429,130 $17,460,661 $24,797,942

Respite 64,131 6,826,578 $53,964,324 $88,939,076

Supplemental Services 31,371 1,182,663 $12,384,496 $17,898,591

Access Assistance 498,065 1,096,845 $29,323,825 $47,291,668

Unduplicated Caregivers 

Provided Service or 

Access

681,626

 37 Title III-E service units definition:

Counseling = 1 session per participant

Respite Care = 1 hour

Supplemental services = variable

Access Assistance = 1 contact
26

Part II: Older American Indians, Alaska Natives and Native Hawaiians

(Title VI of OAA; FY 2010: $27,704,000)

Native American Nutrition and Supportive Services provides grants to eligible tribal 

organizations to promote the delivery of nutrition and home and community-based supportive 

services to Native American, Alaskan Native, and Native Hawaiian elders. According to the 

2009 American Community Survey, approximately 301,000 persons age 60 and over identified 

themselves as Native Americans or Alaskan Natives, and another 242,000 persons age 60 and 

over identified themselves as part Native Americans or Alaskan Natives. 

Native American Nutrition and Supportive Services grants fund a broad range of services to 

older Native Americans, including adult day care, transportation, congregate and home-delivered 

meals, information and referral, personal care, chore, and other supportive services. Currently, 

AoA’s congregate meal program reaches 32 percent of eligible Native American seniors in 

participating tribal organizations, home-delivered meals reach 14 percent of such persons, and 

supportive services reach 52 percent of such persons. These programs, which help to reduce the 

need for costly nursing home care and medical interventions, are responsive to the cultural 

diversity of Native American communities and represent an important part of each community’s 

comprehensive services. 

Services provided by this program in FY 2009, the most recent available data, include: 

• Transportation Services provided nearly one million rides to meal sites, medical 

appointments, pharmacies, grocery stores, and other critical daily activities.

• Home-Delivered Nutrition Services nearly 2.5 million meals to nearly 20,500 homebound 

Native American elders, as well as critical social contacts that help to reduce the risk of 

depression and isolation experienced by many home-bound elders.

• Congregate Nutrition Services provided 2.1 million meals to more than 45,900 Native 

American elders in community-based settings, as well as an opportunity for elders to 

socialize and participate in a variety of activities, including cultural and wellness 

programs.

• Information, Referral and Outreach Services provided nearly one million hours of 

outreach and information on services and programs to Native American elders and their 

families, thereby empowering them to make informed choices about their service and 

care needs.

The Native American Nutrition and Supportive Services program also provides training and 

technical assistance to Tribal organizations to support the development of comprehensive and 

coordinated systems of services to meet the needs of Native American elders. Training and 

technical assistance is provided through national meetings, site visits, e-newsletters, telephone 

and written consultation, and through the Native American Resource Centers, funded under 

Aging Network Support Activities.
27

Eligible tribal organizations receive nutrition and supportive services formula grants based on 

their share of the American Indian, Alaskan Native, and Native Hawaiian population age 60 and 

over. Tribal organizations must represent at least 50 Native American elders age 60 and over to 

receive funding. There is no requirement for matching funds. In addition, Tribes may decide the 

age at which a member is considered an elder and thus eligible for services. In FY 2010, grants 

were awarded to 246 Tribal organizations (representing 400 Tribes), including two 

organizations serving Native Hawaiian elders, with an average award of $109,499 and a range 

of grant awards from $76,160 to $1,505,000. 

Native American Caregiver Support Services

(FY 2010: $6,388,000)

Native American Caregiver Supportive Services provide grants to eligible tribal organizations to 

provide support for family and informal caregivers of Native American, Alaskan Native and 

Native Hawaiian elders. These programs, which help to reduce the need for costly nursing home 

care and medical interventions, are responsive to the cultural diversity of Native American 

communities and represent an important part of each community’s comprehensive services. 

Formula grants for the Native Americans Caregiver Supportive Services programs are allocated 

to eligible tribal organizations based on their share of the American Indian, Alaskan Native, and 

Native Hawaiian population aged 60 and over. Tribal organizations must represent at least 

50 Native American elders age 60 and over to receive funding. There is no requirement for 

matching funds. Tribes may also decide the age at which a member is considered an elder and 

thus eligible for services. In addition, there is no limit on the percentage of funds that can be used 

for services to grandparents caring for grandchildren. In FY 2010, grants for Caregiver Support 

Services were awarded to 204 tribal organizations, including one organization serving Native 

Hawaiian elders, with an average award of $31,240 and a range of grant awards from $14,410 to 

$58,837. 

Grants assist American Indian, Alaskan Native and Native Hawaiian families caring for older 

relatives with chronic illness or disability and grandparents caring for grandchildren. The 

program provides a variety of direct services that meet a range of caregiver needs, including 

information and outreach, access assistance, individual counseling, support groups and training, 

respite care, and other supplemental services. Tribal organizations coordinate with other 

programs, including the Volunteers In Service To America (VISTA) program, to help support 

and create sustainable caregiver programs in Native American communities (many of which are 

geographically isolated). A core value of the Native American Caregiver Support Services, as 

expressed by tribal leaders, is that the program should not replace the tradition of families caring 

for their elders. Rather, it provides support that strengthens the family caregiver role. 

In the 2000 Census, approximately 213,000 persons age 60 and over identified themselves as 

American Indians or Alaskan Natives, and another 182,000 persons age 60 and over identified 

themselves as part American Indians or Alaskan Natives. Caregiver support services will help

Native American elders, many of whom have limitations in activities of daily living that make it 

difficult to care for themselves, to remain at home, in the community, or on the reservation, 

which is what they prefer. Studies have shown that providing assistance to caregivers can help 

them cope with the emotional, physical and financial toll associated with caregiving, thereby 
28

enabling them to provide care for their loved ones longer and avoid or delay the need for costly 

nursing home care.
Part III: Protection of Vulnerable Adults

(Title VII of OAA; FY 2010: $39,200,000)

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

neglect, and exploitation continues to grow. While there is no single set of national elder abuse 

prevalence data, the number of reported cases of elder abuse, neglect, and exploitation are on the 

rise. A 2004 national survey of state Adult Protective Services (APS) programs conducted by 

AoA’s National Center on Elder Abuse showed a 16 percent increase in the number of elder 

abuse cases from an identical study conducted in 2000.38 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.39 Together, 

these data suggest that a minimum of 2.5 million elders are abused, neglected, and/or exploited 

annually.

The negative effects of abuse, neglect, and exploitation on the health and independence of 

seniors is extensive. Research has demonstrated that older victims of even modest forms of abuse 

have dramatically higher (300 percent) morbidity and mortality rates than non-abused older 

people. 40 Additional adverse health impacts include an increased likelihood of heart attacks, 

dementia, depression, chronic diseases and psychological distress. The result of these 

unnecessary health problems is a growing number of seniors who access the healthcare system 

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

forced to leave their homes and communities prematurely. 41 

Protection of Vulnerable Adults programs address this problem through a full array of services 

designed to prevent, detect, and respond to elder abuse, neglect, and exploitation. The focus of 

these programs and activities is to expand and improve the protection of individuals living in 

their communities and in long-term care settings; increase the information and technical 

assistance available to the public, states, and localities in preventing and addressing abuse; 

protect the rights of older adults and prevent their exploitation; reduce health-care fraud and 

abuse; and provide assistance to tribes in developing elder justice systems. This multifaceted 

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

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

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

disabilities.

 38 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

39 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 40 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. 41 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.
Prevention of Elder Abuse and Neglect

The Prevention of Elder Abuse and Neglect program provides state formula grants for training 

and education, promoting public awareness of elder abuse, and supports state and local elder 

abuse prevention coalitions and multi-disciplinary teams. These activities are important elements 

of AoA’s enhanced focus in FY 2012 on elder justice. The program coordinates activities with 

state and local adult protective services programs (over half of which are directly administered 

by state units on aging) and other professionals who work to address issues of elder abuse and 

elder justice. The importance of these services at the state and local level is demonstrated by the 

fact that states significantly leverage OAA funds to obtain other funding for these activities, 

including Social Services Block Grant and state general funds. In FY 2010, over $35 million of 

the Elder Abuse Prevention services expenditures came from non-OAA funds, a ratio of 

approximately $7 of non-OAA funds for every $1 investment of AoA funds.

Examples of state elder abuse prevention activities include:

• In Kentucky, the statewide network of Local Coordinating Councils on Elder Abuse has 

developed “Visor Cards” for law enforcement officers, which contain contact information 

and resource information to assist victims of elder abuse. Kentucky also produced 

“Fraud Fighter” forms that were distributed to thousands of seniors to help in the 

prevention of exploitation and scam artists. Other public awareness activities included 

renting billboards with elder abuse awareness messages and the state reporting number, 

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

and items to raise awareness in communities.

• Lifespan, out of Rochester, New York, used OAA funding to support training of 

non-traditional reporters, such as hairdressers, store clerks, and others who have frequent 

contact with the elderly, on what to look for and how to report suspected cases of elder 

abuse. Additionally, a series of television ads were developed and aired, which have 

resulted in an increased awareness of the problem of elder abuse.

• The Wisconsin Bureau of Aging and Disability Resources developed, in collaboration 

with the National Clearinghouse on Later Life, information designed to raise awareness 

of caregivers who have experienced abuse in the family, as well as of the risks and signs 

of abuse in later life, or “domestic violence grown old.” The information was distributed 

statewide and is available at http://dhfs.wisconsin.gov/aps/Publications/publications.htm.

The Prevention of Elder Abuse and Neglect program demonstrates AoA’s ongoing commitment 

to protecting the rights of vulnerable seniors and promoting their dignity and autonomy. 

Through education efforts, exposing problems that would otherwise be hidden from view, and 

providing a voice for those who cannot act for themselves, the program helps ensure that all 

older Americans are able to age with dignity in a safe environment. 
31

Model Approaches to Statewide Legal Assistance Systems

The Model Approaches to Statewide Legal Assistance Systems (Model Approaches) 

demonstration grants represent an innovative departure from AoA’s past approach to the funding 

of Senior Legal Helplines (SLH). The total budget for Model Approaches is $1,974,000. Thirtyone states have been awarded grants. 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 spectrum 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 

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 

2010, Model Approaches projects assisted 47,903 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. Some examples of the success of SLHs’ 

experience in assisting seniors include:

• An elderly man and his wife who were facing foreclosure contacted a Helpline for assistance. 

The couple had resided in their home for over 30 years and never had difficulty paying 

property taxes until they had to stop working due to declining health. A tax lien was placed 

on the property, and the couple faced automatic foreclosure because they were unable to pay 

the outstanding taxes. A Helpline attorney researched the tax abatement statute and 

discovered that the town had failed to comply with relevant law. Upon a review, the town 

granted a total abatement of the property taxes. As a result, the elderly man and his wife 

were able to remain in their home. 
32

• A Helpline assisted an elderly woman in her 90s who had significant medical expenses. It 

appeared that she could be eligible for more benefits than she was receiving. After involving 

the Medicare Part D Appeals Unit, it was discovered that she was receiving far fewer benefits 

than she was entitled to receive. With a helpline attorney’s assistance, the elderly client was 

able to recover more than $3,000 in a lump sum payment from the State and secured her 

ongoing benefits. The added benefits included nearly $100.00 a month in her Social Security 

check. In addition, she no longer has to pay a Medicare Part D premium and now pays 

nothing for her generic medications. 

In addition to providing assistance on priority legal issues, SLHs under Model Approaches have 

been very successful in reaching low income populations with 64 percent of older clients having 

incomes at or below 200 percent of the federal poverty guidelines. Also, minority clients 

receiving assistance through SLHs in the last reporting period constituted 33 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 legal service delivery system outcomes achieved in FY 2010 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.

A key example of legal service delivery systems enhancements resulting from Model 

Approaches projects emerged from the State of Florida, a 2007 grant recipient. Over the threeyear project period, the state of Florida integrated its SLH and Title III-B legal services with the 
33

pro bono legal services network and pro se resources; developed statewide standards that will 

ensure consistent levels of quality among and between legal service providers; and established a 

meaningful statewide reporting system to capture data needed to improve efficiency and 

maximize resources. 
34

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 is designed to 

empower professionals in aging and legal networks with the tools and resources necessary to 

provide older clients and consumers with high quality legal assistance in areas of critical 

importance to their independence, health, and financial security. 

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, AAA and ADRC personnel, senior legal

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

The NLRC 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. Examples of common legal issues on which the NLRC provides assistance 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 also provides technical assistance on the efficient, costeffective, and targeted provision of state-wide legal and elder rights advocacy services.

In FY 2010, 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 6,493 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 and outreach 

methodologies, SLH operations, statewide reporting systems, and legal service delivery 

standards.

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 2010, 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. 

In addition, the NLRC website continues to serve as a single entry point into a national legal 

assistance support system providing high quality resources and expertise on a broad range of 
35

legal and systems development issues: http://www.nlrc.gov The NLRC website received 

1,181,909 hits in the first 12 months of operation.

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 all older Americans have 

access to the help they need in order to access the employer-sponsored retirement benefits they

have 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 that would be otherwise unavailable, by assisting individuals 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 29 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 close to $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.

For example, during a six-month reporting period in FY 2010, a single regional counseling 

project recovered over $1,200,000 in benefits (lump-sum benefits totaling $210,738, and 

monthly benefits with an actuarial value of $992,273). One 78-year old woman with limited 

English proficiency, and an annual income of under $20,000, contacted the project when her 

claim for survivor’s benefits under her late husband’s pension plan was denied. The project was 

able to obtain evidence that the husband had not been properly credited for all of his time in 

union work and, as a result, his widow will receive an ongoing benefit of $160 per month for her 

lifetime, in addition to a retroactive payment of $15,000.
36

This case underscores the significance of the Pension Counseling & Information Program. 

While the client had a legitimate claim to this benefit, she required assistance with the claims 

appeal process. Due to the complexity of the matter and the small benefit amount at stake, it is 

extremely unlikely that she would have been able to pursue the case on her own, or find a private 

attorney to handle it. Without the project’s assistance, she may well have been deprived of the 

lifetime retirement benefit her late husband had earned. The additional $160 per month, though 

modest, will make a significant contribution to her financial security and independence.

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.

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 2010, the 

Center increased 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 Program

The Senior Medicare Patrol (SMP) program provides competitive grants to 54 States and 

Territories to support a national volunteer-based network for the purposes of preventing and 

identifying healthcare fraud and abuse. As a program of growing importance to the 

Department’s ongoing fraud prevention activities in conjunction with the Patient Protection and 

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

The SMP program serves a unique role in the Department’s fight to identify and prevent 

healthcare fraud in the Medicare and Medicaid programs. Projects use the skills of retired 

professionals as volunteers to conduct community outreach and education and provide toolkits 

that empower beneficiaries and their families to recognize and report suspected cases of 

Medicare and Medicaid fraud. Activities are carried out in partnership with the Centers for 

Medicare & Medicaid Services, the Office of Inspector General (OIG), healthcare providers, and 

other aging and elder rights professionals from around the country.

OIG collects performance data from the SMP projects semiannually. The most recent report, 

dated May 06, 2011, documented the following program outputs and outcomes for the calendar 

year 2010. Data show SMP projects:

• Maintained 4,964 active volunteers who worked 129,662 hours to educate beneficiaries 

about how to prevent Medicare and Medicaid fraud;

• Educated 298,097 beneficiaries in 8,300 group education sessions and held 

70,789 one-on-one counseling sessions; 

• Conducted 6,231 community outreach education events;
37

• Received 91,094 inquiries for information or assistance from beneficiaries and resolved 

87,951 inquiries; 

• Resolved or referred for further investigation 2,583 complaints of potential fraud, error, 

or abuse from beneficiaries, their families, or caregivers as a result of educational 

efforts; and 

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

• Educated 3,098,309 million beneficiaries in 82,968 group education sessions and held 

1,112,887 one-on-one counseling sessions; 

• Conducted 75,062 community outreach education events; and 

• Documented $105,975,979 million in savings, including Medicare and Medicaid funds 

recovered, beneficiary savings, and other savings as directly attributable to the project as 

a result of beneficiary complaints. This does not attempt to quantify the savings that may 

occur as a result of SMP program’s impact on fraud deterrence, which are believed to be 

substantial.

Healthcare Fraud and Abuse Control (HCFAC) Funds:

The Health Insurance Portability and Accountability Act of 1996 (HIPAA) created the Health 

Care Fraud and Abuse Control (HCFAC) Program to combat fraud and abuse in health care. 

Under HIPAA, recoveries from health care investigations are set aside in the Medicare Trust 

Fund and distributed at the joint discretion of the Secretary and Attorney General to finance antifraud activities. The SMP program historically has been supported by about $3.2 million in 

HCFAC funding for infrastructure, technical assistance, and other SMP program support and 

capacity-building activities designed to enhance program effectiveness. This includes support for 

project training and technical assistance provided by AoA’s National Consumer Technical 

Resource Center (Center). The Center’s website is maintained as a comprehensive “one stop” 

resource that contains information including current fraud alerts and consumer information, an 

SMP program locator, and the latest best practices information. 

In the past year, the critically important role of the SMP program was recognized by partners in 

Medicare fraud prevention in the private and public sectors. First, the Centers for Medicare & 

Medicaid Services (CMS) announced the award of $9 million in grants to help more than 50 

Senior Medicare Patrol (SMP) programs fight Medicare fraud. This action by CMS is in support 

of President Obama’s mandate to educate seniors and other Medicare beneficiaries about how to 

prevent fraud in Medicare.

More recently, in November 2010, AoA received a national level commendation for the SMP 

program. The National Health Care Anti-Fraud Association (NHCAA), considered the leading 

national organization focused exclusively on the fight against health care fraud, bestowed this 

honor upon AoA and the SMP program. The NHCAA’s members comprise more than 100 

private health insurers and those public sector law enforcement and regulatory agencies having 
38

jurisdiction over health care fraud committed against both private payers and public programs.

This award is given annually by the NHCAA to an organization or individuals “who have done 

the most in the past year to raise public awareness about the problem of health care fraud in our 

nation’s health care system.” This organization’s decision to award the Administration on 

Aging’s (AoA) Senior Medicare Patrol (SMP) program the NHCAA 2010 Excellence in Public 

Awareness Award is a major achievement, and a notable acknowledgement of the value of the 

SMP program.

The SMP program continues to demonstrate its expanded efforts to effectively reach 

beneficiaries with fraud prevention information. The number of SMP volunteers increased by 

12% between 2009 and 2010, from 4,444 to 4,964. In addition, the number of beneficiaries 

attending SMP-led group education sessions increased by 37% the past year, and the number of 

one-on-one counseling sessions increased from 33,855 to 70,789, or 109% between 2009 and 

2010. In addition, the SMP projects resolved 47% more inquiries from beneficiaries in 2010

than in 2009.

42 

Since the program’s inception, SMP projects have educated close to 3.1 million beneficiaries in 

group education sessions, provided over 1.1 million one-on-one counseling sessions, and 

received over 172,000 complex issues (complaints) from beneficiaries who have detected billing 

or other discrepancies based on that information. While SMPs make numerous referrals of 

potential fraud to CMS program integrity contractors, there is no mechanism for tracking the 

actions (investigation, prosecution, collection) required to realize actual savings to the 

government as a result of these referrals. Therefore, it is not possible to directly track the 

outcome of most of the cases reported and dollars recovered as a result of SMP program 

activities. Moreover, the impact of the SMP program’s primary activities - education of 

beneficiaries to prevent health care fraud - is difficult to measure and nearly impossible to 

quantify in dollars and cents. As the OIG indicated in the May 2011 report:

“We continue to emphasize that the number of beneficiaries who have learned 

from the Senior Medicare Patrol Projects to detect fraud, waste, and abuse and 

who subsequently call the OIG fraud hotline or other contacts cannot be 

tracked....In addition, the projects are unable to track substantial savings 

derived from a sentinel effect, whereby fraud and errors are reduced by

Medicare beneficiaries’ scrutiny of their bills.” 

Despite these evaluation challenges, the SMP program has documented nearly $106 million in 

savings to Medicare, Medicaid, program beneficiaries, and others since its inception in 1997, 

excluding any deterrent effect. During that same period, the program has recruited and trained 

24,431 volunteers who contributed a combined 673,466 hours of their time to preventing, 

detecting and reporting suspected incidents of fraud and educating and training community 

members about fraud prevention. 

 42 May 2011, Performance Data for the Senior Medicare Patrol Projects, OEI-02-11-00110. 

http://www.oig.hhs.gov/oei/reports/oei-02-11-00110.pdf
39

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 and other similar facilities (including assisted living). 

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.

This report provides data for FY 2010 from the Long-Term Care Ombudsman Program 

nationwide, based on state and local level activities. The data and other information presented 

and analyzed in this report are collected annually by AoA from State Long-Term Care 

Ombudsmen through the National Ombudsman Reporting System (NORS). 

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 completed resolution work on 211,937 complaints.

• Ombudsmen resolved or partially resolved 74 percent of these complaints to the 

satisfaction of the resident or complainant. 

• Of the 139,296 cases closed by ombudsmen,

43

 43 In FY 2010, ombudsmen opened 143,062 new cases (a case contains one or more complaints originating from 

the same person(s)), and completed resolution work on 139,296 closed cases, containing 211,937 complaints.

106,640 (77 percent) were associated with 

nursing facility settings. Of the remaining cases, 30,909 (22 percent) were related to 
40

board and care and other similar facilities (including assisted living); and 1,747 (one 

percent) were associated with non-facility settings or services to facility residents by an 

outside provider. 

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

residents themselves initiating 38 percent of cases in nursing facilities and 32 percent in 

board and care and other similar facilities (including assisted living). See Figures 1 and 2, 

below.

• Ombudsmen proactively identified issues in nearly 15 percent of cases in all settings. 
41

Ombudsman Program in Action:

Focusing Discharge Planning on the Needs of the Resident

A nursing home resident called the ombudsman to frantically report that she was going to 

be discharged that afternoon to a homeless shelter after 5 years of living in the facility. She 

wanted to live in another setting, but needed help finding housing and, because she no 

longer needed nursing home level of care, she did not qualify for Medicaid home and 

community based services. The resident had lost the appeal of her discharge notice and felt 

that the facility wanted to discharge her because they perceived her as a nuisance. Due to 

intervention by the ombudsman and Title III legal assistance provider, the facility delayed 

the move while the ombudsman helped the resident connect with more stable and 

appropriate housing options as well as access to needed medications and in-home services. 

After several weeks of planning, the resident was happy to move into her own apartment 

where she continues to live today.

• The five most frequent nursing facility complaints in 2010 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 medications – administration, organization; and 

o resident conflict, including roommate to roommate.

• 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
42

Ombudsman Program in Action:

Protecting Residents’ Rights

Staff of an assisted living community 

contacted the ombudsman because a 

resident felt her guardian was not acting 

in her best interests. The guardian 

refused to pay for needed dentures or 

hearing aid repairs, claiming a lack of 

funds. When the ombudsman 

investigated, she determined that the 

resident had significant assets and 

informed the resident of this fact. With 

this knowledge, the resident successfully 

convinced the guardian to purchase 

dentures and repair the hearing aid. 

Since that time, there have been 

significant improvements to the 

resident’s ability to participate in social 

activities and eat a normal diet. The state 

ombudsman has been providing training 

to both ombudsmen and public guardians 

statewide regarding the right of the 

resident -- even where a guardian is 

appointed -- to access an ombudsman.

• Ombudsman staff and volunteers provided 

a regular presence to facility residents, 

visiting residents of 74 percent of nursing 

facilities and 39 percent of board and care 

and similar homes (including assisted 

living) at least quarterly.

• Ombudsmen provided 278,104

consultations to individuals in 2010. 

Consultations most frequently addressed 

such topics as alternatives to institutional 

care, how to select and pay for a long-term 

care facility, residents’ rights, and federal 

and state rules and policies impacting 

residents.

• Ombudsmen provided 103,195

consultations to long-term care facility 

staff in FY 2010 on a wide range of issues, 

including residents’ rights, observations 

about care, working with resident 

behavioral issues, and transfer and 

discharge issues.

• In FY 2010, ombudsmen nationwide:

o provided information to resident 

councils (20,775 sessions) and 

family councils (3,531 sessions);

o trained long-term care facility staff

(5,662 sessions);

o educated the community (12,997 

sessions); and

o served as resident advocates and 

provided information to surveyors 

as part of long-term care facility surveys conducted by regulatory agencies

(participating in 23,585 surveys).

• 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. 
43

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 578 designated local entities across the 

nation.

In FY 2010, long-term care ombudsman services to residents were provided by 1,167 full-time 

equivalent staff and 8,813 volunteers, trained and certified to investigate and resolve complaints. 

An additional 2,550 volunteers also served residents or assisted in program operations in ways 

other than complaint resolution.

 Ombudsman Program in Action:

 Advocating for Quality Care

A nursing home resident’s family reported to an ombudsman the circumstances

surrounding the death of the resident’s roommate. When the roommate’s call bell 

went unanswered and he could wait no longer, he tried to make it to the restroom on

his own. On the way, he fell, sustaining serious injury and the following day passed

away. The family reported on-going issues with insufficient staff and slow responses 

to call lights. The ombudsman involved the regulatory agency which found violations

in facility practice related to falls. Since then, the ombudsman program has been 

providing training for facility staff; increasing ombudsman presence in the facility to

more closely monitor conditions related to staffing, falls, and responses to call lights;

and working in collaboration with the regulatory agency to address the quality of care

in this facility.

Program Funding

• Total FY 2010 funding from all sources for the Ombudsman Program nationwide was 

$87,671,325, an overall increase of $2,738,004 (approximately 3 percent) from the 

FY 2009 level. 

• The federal government is the primary entity funding the Ombudsman Program, 

providing 58 percent of total funding in FY 2010. States provided 34 percent of funds, 

and other non-federal sources funded the remaining 8 percent. Figure 3 shows the 

percentage of total program funding by source.
44

Where Long-Term Care Facility Residents Live

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” array. 

• In the five years between 2006 and 2010, the number of board and care and similar 

facilities (including assisted living) increased by 12 percent to 52,681, while the number 

of nursing facilities slightly decreased by 1 percent from 16,750 in 2006 to 16,639 in 

2010. 
45

National Long-Term Care Ombudsman Resource Center Activities:

In order to effectively advocate 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 2010, 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 2010, 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;

• Resident transitions from nursing homes to other settings, including through 

implementation of federal initiatives such as:

o MDS 3.0, Section Q – a new version of the Minimum Data Set (MDS) 

resident assessment tool used by Medicare and/or Medicaid-certified 

nursing facilities and implemented in FY 2010 by the Centers for 

Medicare and Medicaid Services (CMS). Section Q of the MDS instructs 

nursing facilities to ask all residents if they would like information 

regarding returning to the community and to link residents to local contact 

agencies for further information; and 

o Money Follows the Person – a demonstration project to assist individuals 

receiving Medicaid to move out of nursing homes and into other settings 

to receive long-term services and supports.

• Culture Change and Person-Centered Care; and

• Advocacy in Assisted Living.

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.

Program Results and Challenges

Ombudsmen solve problems at the facility level -- 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, the work of ombudsmen 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 information --

Ombudsman programs served as a credible source of information for residents (including 

through resident councils), their families (including through 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.
46

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

other sources for ombudsman programs. Almost 42 percent of program funds came from nonfederal sources during FY 2010. 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 and other similar facilities (including assisted 

living).
47

Part IV: Supporting the National Aging Services Network

(FY 2010: $8,198,000)

Aging Network Support Activities provides competitive grants and contracts to support eleven 

ongoing activities which help seniors and their families obtain information about their care options 

and benefits, and which assist states, tribes, and community providers of aging services carry out 

their mission to help older people remain independent and live in their own homes and communities. 

These activities provide critical and ongoing support for the national aging services network and help 

support the activities of AoA’s core service delivery programs. 

Consumer Information, Access, and Outreach

Older Americans and Americans with disabilities today face a vast array of choices when trying 

to determine the right services and supports to assist them to remain active and independent in 

their communities. As the number of opportunities available to assist them grows, so too does the 

complexity of navigating these programs and choosing among them so as to determine which 

best suit the needs of individuals. 

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 by streamlining access to public services, diverting individuals from more costly services 

and supports, and helping to overcome duplication and fragmentation in the long-term care 

system.

ADRCs are a key component in transforming states’ long-term supports and services programs. 

Since 2003, AoA and CMS have provided grants to states to develop a foundational 

infrastructure for delivering person-centered systems of information, counseling, and access that 

make it easier for individuals to learn about and access their health and long-term services and 

support options. ADRCs grew out of best practice innovations known as “No Wrong Door”44

and “Single Points of Entry” Programs, where people of all ages or disability may turn for 

objective information on their long-term services and support options.

ADRCs provide services including:

• targeted discharge planning, care transition and diversion support that integrates the 

medical and social service systems on behalf of older adults and individuals with 

disabilities to help them remain in their own homes and communities after a hospital, 

rehabilitation or skilled nursing facility visit; 

 44 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).
48

• “one-on-one” counseling and advice to help consumers and their caregivers fully 

understand the options available to them, including private pay individuals;

• outreach and assistance to Medicare beneficiaries on their Medicare benefits including 

prevention and low-income subsidies;

• streamlined access to all publicly supported long-term care services and support 

programs; and

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

the AoA and the Department of Veterans Affairs (VA) Veteran Directed Home and 

Community-Based Services Program partnership.

AoA and the Centers for Medicare & Medicaid Services (CMS) have invested over $100 million 

in the ADRC program since 2003. As a result of these investments: 

• More than 300 ADRC sites have been established across 50 states, 3 territories, and 

Washington, DC, often by expanding existing infrastructure in the aging services 

network such as AAAs, etc. Together these ADRC sites can reach roughly 51 percent 

of the U.S. population.

• Thirteen states and territories are achieving statewide coverage and an additional 

13 states are achieving 50 percent or more statewide coverage. 

• Twenty-five states have developed statewide web-based directories available to 

consumers and service providers which improve the quality and consistency of the 

aging services network information and assistance provided across the state. 

• Standards have been established to provide guidance to states on the desired end 

result of how an ADRC should perform. For example, the standards require that each 

ADRC has a plan for reducing the average time from initial contact to determination 

of their eligibility for public services.

Evaluation

With ADRCs in place for nearly a decade, AoA is partnering with the Agency for Healthcare 

Research and Quality and the Assistant Secretary for Planning and Evaluation to rigorously evaluate 

the effectiveness of ADRCs. In FY 2009, AoA initiated a design contract for the evaluation. In 

FY 2010, AoA began a roughly $2.1 million evaluation based on recommendations from the design 

contract. The results of this evaluation will influence future performance measures and indicators. 
49

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 Resource Centers on Native American Elders

The National Resource Centers on Native American Elders (Resource Centers) enhance 

knowledge about older Native Americans and thereby increase and improve the delivery of 

services to them. Each Resource Center addresses at least two areas of primary concern which 

are specified in the OAA. These include health issues, long-term care (including in-home care), 

elder abuse, mental health, and other problems and issues facing native communities. The 

Resource Centers are administered under cooperative agreements by three institutions of higher 

education. The Resource Centers partner with Native American organizations and communities, 

educational institutions including tribal colleges and universities, and professionals and 

paraprofessionals in the field.

National Minority Aging Organizations Technical Assistance Centers

The National Minority Aging Organizations (NMAO) Technical Assistance Centers Program 

works to address health disparities among racial and ethnic minority older individuals. These 

Centers design and disseminate front line health promotion and disease prevention information 

that is culturally and linguistically appropriate for older individuals of African American, 

Hispanic, Asian American and Pacific Islander descent, and American Indian and Alaska Native 

elders. Each NMAO project pilots a practical, nontraditional, community-based intervention for 

reaching older individuals who experience barriers to accessing home and community-based 

services. Strategies are focusing on barriers due to language and low literacy as well as those 

directly related to cultural diversity. Strategies developed under this program incorporate the 

latest technology and facilitate the generation and dissemination of knowledge in forms that can 

assist racial and ethnic minority older individuals to practice positive health behaviors and 

strengthen their capacity to maintain active, independent life styles.

National Technical Assistance Resource Center for LGBT Elders

Older lesbian, gay, bisexual and transgender (LGBT) adults face a number of unique challenges 

as they strive to maintain their independence. To begin to address the special needs of LGBT 

elders, in FY 2010 AoA funded the National Technical Assistance Resource Center for LGBT 

Elders. The Resource Center strives to meet three primary objectives: educate mainstream aging 

services organizations about the existence and special needs of LGBT elders; sensitize LGBT 

organizations about the existence and special needs of older adults; and educate LGBT 

individuals about the importance of planning ahead for future long-term care needs. The 
50

national resource center began services in September 2010 with the launching of a website 

including training curricula and social networking tools. 

Multigenerational Civic Engagement

The Multi-Generational Civic Engagement (MGCE) initiative enhances discovery, 

documentation and support for existing, exceptional locally-developed program models and 

volunteer engagement strategies. These projects engage older adults in civic engagement 

projects aimed at increasing services to frail elders, families of children with special needs, and 

grandparents raising grandchildren. These model programs are also supported by 

the Corporation for National and Community Service.

AoA continues to support a grant to the National Council on the Aging to identify and provide 

technical assistance and other support to local programs that can become national multigenerational and civic engagement models for utilizing older volunteers in meaningful direct 

services. This grant, extended through 2011, focuses on three target populations: 1) older 

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

caregivers of frail elderly. 

Next steps include synthesis and dissemination of best practices and setting the stage for 

widespread replication of the most promising models, using strategies and on-line tools grounded 

in diffusion of innovations theory and practice. This will be most helpful to the aging services 

network, which is heavily dependent on volunteers in providing its services. 

In 2010, AoA announced a grant competition to fund a National Aging Civic Engagement 

Technical Center (the Center). The National Association of Area Agencies on Aging was 

awarded the grant. The Center will help AoA and the national aging services network use 

volunteers, especially baby boomers, more effectively; develop AoA’s and the aging network’s 

leadership in civic engagement; and expand the aging network’s existing use of volunteers. The 

Center, working together with the AARP Foundation, the National Association of State Units on 

Aging and Disabilities and Senior Service America Incorporated, will 1) conduct a systematic 

inquiry on civic engagement; 2) recommend an Action Plan in civic engagement for AoA and 

the aging network; 3) develop a national communication and outreach strategy; 4) provide 

training and technical assistance; 5) identify effective practices, develop and promote models; 

and 6) create a continuous quality improvement strategy. Outcomes include measurable change 

in the network’s ability to meet needs and preferences of volunteers. Products include Action 

Plans, volunteer management toolkits, model practice fact sheets, conferences, website widgets, 

and a final report. 

In addition to the above, AoA continues its relationship and coordination with the Corporation 

for National and Community Service. We expect to work closely with the Corporation as we 

expand our civic engagement efforts.

Meeting the Need for Trained Personnel in Aging

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 and 

over living in the United States. This shift in our nation’s demography has profound implications 
51

for the assistance the aging network provides people who need long-term services and support. 

In addition, the Affordable Care Act provides new and important opportunities for the aging 

network to assist older adults to age in place and remain in the community. 

The aging network, including state and area agencies on aging, plays an important role in

planning, developing and managing home and community-based service systems. To assist them 

in these efforts AoA, through the funding of technical assistance resource centers, offers a 

variety of training and technical assistance opportunities to build the capacity of the aging 

network to play a lead role in the provision of long-term supports and services for older adults 

and non-elderly persons with disabilities. 

• Aging Network Business Practice, Planning and Program Development 

Funding to the National Association of Area Agencies on Aging (n4a) provides support 

to area agencies on aging and Title VI tribal organizations in the areas of business and 

strategic planning, leadership development, single point of entry systems, personcentered approaches, consumer-directed services and using evidence-based approaches. 

Each year the this grant holds an Aging Business Academy attended by representatives 

from approximately 25 area agencies on aging (AAAs) to assist them in such areas as 

business and strategic planning. In addition they present at a number of conference every 

year in an effort to develop interest among AAAs for increasing their skills in business 

and strategic planning. The grantee has also developed a website called the Resource 

Exchange for Aging Data and Innovation or (READI) Center which averages about 2000 

hits per year and offers a variety of tools to assist AAAs in learning new approaches. In 

addition to working with area agencies on aging, this project also assists Older Americans 

Act Tribal Organizations through conference presentations and training. The grantee also 

develops reports and briefs on a number of topics to assist the national aging services 

network. Examples include: Area Agencies on Aging: Advancing Access for Home and 

Community-Based Services (2009); Area Agencies on Aging: Advancing Health and 

Long-Term Services and Supports (2010); Building Capacity Through Our Workforce 

(2010); Elder Abuse and Legal Assistance (2009); and an Online Board and Advisory 

Council Manual (2011). 

• Technical Assistance Support Center (TASC) Planning Zone

AoA funded the National Association of States United for Aging and Disability 

(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. 

The TASC Planning Zone provides step by step guidance on the development of a plan, 

including a plan template, most recent AoA plan guidance or program instructions, and 

guidance on how to submit a state plan renewal or amendment. In terms of educating the 

Aging Network about such resources, NASUAD regularly holds conference calls among 

states as well one-on-one calls or meetings with new directors on the TASC Planning 

Zone, its resources and how to use the planning tools. NASUAD delivers presentations 

on the TASC Planning Zone and its utility at an array of conferences including, but not 

limited to AoA Regional Office meetings, NASUAD membership meetings, the National 

HCBS Conference, the National Association of Area Agencies on Aging (n4a) 

membership meetings, ADRC Grantee meetings, and the American Society on Aging 
52

(ASA). NASUAD provides onsite state presentations on the TASC Planning Zone and 

its resources for state aging networks. NASUAD, in collaboration with AoA, also 

delivers targeted technical assistance to SUAs with State Plan Renewals due as well as to 

states that are developing off cycle amendments to their state plans. Additionally, 

NASUAD worked closely with n4a to add AAA specific information to better tailor the 

site to AAA needs. NASUAD continually updates the website both based on AoA 

requests as well as NASUAD additions which are vetted through AoA before posting or 

promulgation. Over the past two years, NASUAD has developed and posted a robust 

repository of Affordable Care Act (ACA) information and held technical assistance calls 

with states on how such opportunities could be integrated into state aging plans. 

NASUAD, in collaboration with AoA, maintains an array of links to AoA-analyzed 

Census data as well as links directly to appropriate Census databases. The TASC 

Planning Zone also includes a GIS mapping tool with state by state analyses. These 

analyses aid states and AAAs in plan development and maintenance. NASUAD also 

provides state-by-state training on how to use the mapping tool, TASC planning Zone 

data, as well as orientation to the Census data housed at or linked to via the TASC 

Planning Zone. Working closely with AoA Central and Regional Offices, NASUAD 

posts all state plans at the TASC Planning Zone and, with AoA guidance, highlights plans 

considered to be best practices. Conference calls on best practices are held regularly as 

well as incorporated into presentations delivered at an array of meetings including n4a 

and other Aging Network events.

• National Center on Benefits Outreach and Enrollment 

AoA funded the National Council on Aging (NCOA) to implement the National Center 

for Benefits Outreach and Enrollment (NCBOE) to increase the use of person-centered 

approaches to state and federal public benefits outreach and enrollment to maximize the 

economic security of seniors and younger adults with disabilities. The NCBOE does this 

through a number of programs. The NCBOE has funded 20 Benefits Enrollment Centers 

(BECs) across the country since 2009 and to date they have provided one-on-one 

counseling to 406,632 individuals and filed 214,660 applications for benefits worth up to 

$1.1 billion in support. The NCBOE also serves as a technical assistance resource center 

for the 51 state Medicare Improvements for Patients and Providers Act (MIPPA) 

grantees. Since 2009, MIPPA grantees have filed 453,529 applications for LIS and MSP 

worth $1.2 billion in Medicare savings for beneficiaries. The NCBOE also provides 

multi-faceted technical assistance to their grantees and the broader Aging Network. This 

includes: ongoing grantee support for both MIPPA and BEC grantees including one-onone conversations to provide customized guidance, monthly group calls with BECs, and a 

separate listservs for MIPPA and BEC grantees which allows them to interact in real 

time. The NCBOE also offers the broader aging network a monthly webinar series on a 

variety of topics with a focus on expanding the knowledge base and skill sets of aging 

and disabilities community professionals. They present at a variety of conferences and 

meetings each year reaching between 500 and 1000 practitioners annually. Publications 

of the NCBOE include quarterly issue briefs, a case study series examining successful 

strategies in benefits access, promising practices and others. Finally the Center offers 

one-on-one assistance to any aging or benefits professional with questions related to 

benefits outreach and enrollment. More information can be found at 
53

http://www.centerforbenefits.org. Online tools include BenefitsCheckup 

(http://www.benefitscheckup.org), My Medicare Matters 

(http://www.mymedicarematters.org), a data mapping tool for professionals and clients to 

help them better understand benefits programs 

(http://www.benefitscheckup.org/datamap), and Beneifts Alert, an e-newsletter published 

twice a month, goes to over 4,600 benefits counselors. 

• 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. 

• National Resource Center for Participant Directed Services

This center is dedicated to providing information, education and technical assistance to 

the aging network on the development and maintenance of consumer direction in longterm supports and services systems. 

In 2010, AoA funded a new grant, “Strengthening the Aging Network” to increase the capacity 

of state units on aging (SUA) across the country to play strong leadership roles in the 

development and implementation of modernized systems of long-term services and supports. 

NASUAD was awarded this grant and is working with AoA to design and implement an 

intensive training for SUA directors and their senior staff. This effort will also assist AoA in 

gathering information about current performance standards used by states to measure the impact 

of their long-term services and supports systems as well as to assess SUA progress in key areas 

of systems change to give us a better sense of future training needs of personnel in the field of 

aging. 

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. 
Part V: Program Innovations

(Title IV of OAA: FY 2010: $27,873,000)

Program Innovations grants provide a source of funding to use as a catalyst for tapping new 

approaches, translating cutting-edge research and evaluation results into practice, and 

demonstrating techniques and best practices that can be replicated across the states and 

communities in the network to strengthen core OAA programs. It also provides funds to address 

key AoA priorities to help seniors stay healthy, active, independent, and living in their own 

homes and communities.

Generally, these innovations are modeled after best practices developed within the aging services 

network that need further support, modeling, and evaluation before widespread replication and 

adoption. This effort, for instance, provided the seed money for developing Aging and Disability 

Resource Centers and Evidence-Based Disease Prevention projects that are now successfully 

implemented across the nation.

Program Innovation grants also provide a vehicle for the exploration of emerging opportunities 

or risks facing seniors and caregivers where the aging services network has limited expertise. In 

these cases, universities, consumer-focused organizations, and other entities may be brought 

collaboratively into the aging network as technical assistance partners to assist with these 

emerging challenges. 

Community Innovations for Aging in Place

The Community Innovations for Aging in Place Initiative (CIAIP), authorized by Congress in the 

Older Americans Act (OAA) reauthorization of 2006 and first funded in FY 2009, is intended to 

assist communities in their efforts to enable older adults to sustain their independence and age in 

place in their homes and communities. Congress directed the Assistant Secretary for Aging to 

award three-year grants, on a competitive basis, to community-based non-profit organizations to 

develop and carry out model aging in place projects targeted to individuals who reside in 

Naturally Occurring Retirement Communities (NORCs). Congress further directed that 

innovative approaches under the CIAIP initiative should be based on needs assessments of 

community strengths and gaps as well as the needs of older individuals in the community. 

In FY 2009, the Assistant Secretary for Aging funded fourteen organizations representing 

diverse communities from across the country. In addition, a grant was awarded to provide 

training and technical assistance to the CIAIP grantees. CIAIP grantees are currently in the 

second year of funding. 

During the first year of the CIAIP program, grantees focused on “start up” activities including 

hiring or training staff, refining their goals and objectives, surveying older adults in their 

communities, engaging in other assessment and research activities, finalizing partnerships, and 

developing evaluation plans. Most of the grantees are still in the early stages of project 

implementation. Six of the grantees, however, have made rapid progress. These grantees are 

implementing programs that build on previous work and already had a structure and staff in 

place when their CIAIP proposals were funded.
55

Grantees that have the most promise for successful and sustainable projects appear to have a 

combination of several of the following attributes:

• Strong leadership

• A good reputation in the community

• High aptitude for partnering and discerning who should be “at the table”

• Pre-existing relationships with a wide array of stakeholders, including those outside the 

aging network

• Organizational coherence and effectiveness

• Experienced staff 

• Strong support from the grantees’ parent agency

• Leadership and staff have a common vision and they can describe it succinctly 

• Oversight and/or supporting roles for senior-leaders in the community being served

• Flexibility to change as opportunities or barriers arise 

While each of the 14 CIAIP grantees is developing an aging in place initiative that is tailored to 

its own community, common themes, strategies, and benefits are emerging across CIAIP grantee 

programs:

• Building capacity. The CIAIP program is providing both an impetus and a framework 

for strengthening a community’s ability to provide the services and supports necessary 

for supporting aging in place as well as assisting communities in developing partnerships 

to leverage existing community resources and to decrease service redundancy where it 

exists. Many grantees are also looking at how they can enhance community 

infrastructure to enhance aging in place. 

• Forging new partnerships. CIAIP grantees are reaching beyond the aging network and 

involving other sectors to support older adults’ aging in place. This strategy underscores 

the message that aging is a community-wide issue and provides an opportunity for these 

disparate sectors to work together to create a common community agenda. Examples 

include partnerships with the local disability network, affordable housing, faith-based 

organizations, tribal organizations, community planning departments, transportation 

networks, health care providers, public and affordable housing providers and others. 

• Tapping social capital. Grantees are mobilizing the skills of older adults and the 

willingness of volunteers of all ages to contribute their time to improve and strengthen 

their communities. 

• Providing leadership. Participation in the CIAIP program is allowing area agencies on 

aging and others within the aging network to assume new leadership roles.

• Developing a community of practice. Cross-fertilization of experiences and ideas 

among the CIAIP grantees, facilitated by the technical assistance provider, is leading to 

joint problem-solving and new approaches to common issues. Grantees are learning 

about best and evidence-based practices, sharing information about new resources 

including funding opportunities, and learning how to use technical assistance to support 

them in such areas as business plan development. 

The CIAIP program is providing AoA with important data about what it takes to support older 

adults in their homes in innovative ways.
56

Appendix

Formula Grant Funding

Allocation by 

State, Territory and 

Tribal Organization

U.S. Administration on Aging 

Department of Health and Human Services
57

State

Title IIIB:

Supportive 

Services

Title III-C1

Congregate 

Meals

Title III-C2

Home 

Meals

Title III-D

Preventive 

Services

Title III-E

NFCSP Total Title III

Alabama $5,655,995 $6,769,708 $3,405,044 $333,168 $2,394,015 $18,557,930 

Alaska $1,830,190 $2,190,101 $1,081,558 $105,130 $766,267 $5,973,246 

Arizona $7,536,954 $9,021,043 $4,537,425 $405,273 $3,287,930 $24,788,625 

Arkansas $3,575,124 $4,279,096 $2,152,310 $211,585 $1,523,673 $11,741,788 

California $36,448,142 $43,625,084 $21,942,649 $2,132,032 $15,564,926 $119,712,833 

Colorado $4,762,294 $5,700,029 $2,867,014 $256,172 $1,863,239 $15,448,748 

Connecticut $4,414,911 $5,278,429 $2,542,112 $261,174 $1,828,019 $14,324,645 

Delaware $1,830,190 $2,190,101 $1,081,558 $105,130 $766,267 $5,973,246 

DC $1,830,190 $2,190,101 $1,081,558 $105,130 $766,267 $5,973,246 

Florida $26,729,390 $31,992,629 $16,091,728 $1,557,571 $12,466,239 $88,837,557 

Georgia $9,120,376 $10,916,254 $5,490,683 $487,659 $3,507,709 $29,522,681 

Hawaii $1,830,190 $2,190,101 $1,081,558 $105,130 $766,267 $5,973,246 

Idaho $1,830,190 $2,190,101 $1,081,558 $105,130 $766,267 $5,973,246 

Illinois $14,559,760 $17,408,492 $8,336,107 $841,161 $5,948,072 $47,093,592 

Indiana $7,178,800 $8,592,366 $4,321,809 $427,123 $3,054,571 $23,574,669 

Iowa $4,271,107 $5,117,349 $2,283,552 $232,252 $1,740,403 $13,644,663 

Kansas $3,441,149 $4,118,756 $1,920,469 $191,697 $1,418,364 $11,090,435 

Kentucky $5,039,351 $6,031,641 $3,033,809 $292,333 $2,082,732 $16,479,866 

Louisiana $4,819,982 $5,769,076 $2,901,744 $295,701 $2,008,607 $15,795,110 

Maine $1,830,190 $2,190,101 $1,081,558 $105,333 $766,267 $5,973,449 

Maryland $6,134,814 $7,342,810 $3,693,304 $361,152 $2,501,853 $20,033,933 

Massachusetts $8,228,803 $9,849,264 $4,624,607 $465,465 $3,353,928 $26,522,067 

Michigan $11,593,775 $13,876,686 $6,979,729 $693,994 $4,878,303 $38,022,487 

Minnesota $5,741,350 $6,871,870 $3,456,429 $339,094 $2,461,149 $18,869,892 

Mississippi $3,284,196 $3,930,881 $1,977,164 $196,251 $1,388,506 $10,776,998 

Missouri $7,135,518 $8,526,779 $4,253,437 $423,251 $3,035,089 $23,374,074 

Montana $1,830,190 $2,190,101 $1,081,558 $105,130 $766,267 $5,973,246 

Nebraska $2,300,448 $2,758,123 $1,246,551 $124,900 $939,403 $7,369,425

Nevada $2,749,585 $3,291,001 $1,655,315 $151,762 $1,048,359 $8,896,022 

New Hampshire $1,830,190 $2,190,101 $1,081,558 $105,130 $766,267 $5,973,246 

New Jersey $10,287,611 $12,276,488 $6,096,854 $620,946 $4,365,417 $33,647,316 

New Mexico $2,249,693 $2,692,676 $1,354,369 $127,394 $959,260 $7,383,392 

New York $24,341,729 $29,168,186 $13,782,442 $1,376,603 $9,906,970 $78,575,930 

North Carolina $10,329,835 $12,363,865 $6,218,806 $577,661 $4,188,342 $33,678,509 

North Dakota $1,830,190 $2,190,101 $1,081,558 $105,130 $766,267 $5,973,246 

Ohio $13,849,980 $16,509,438 $8,269,111 $835,879 $5,957,778 $45,422,186 

Oklahoma $4,311,211 $5,160,125 $2,595,452 $257,429 $1,841,367 $14,165,584 

Oregon $4,555,027 $5,451,950 $2,742,235 $254,913 $1,881,639 $14,885,764 

Pennsylvania $17,922,902 $21,429,838 $9,870,666 $1,018,552 $7,449,148 $57,691,106 

Rhode Island $1,830,190 $2,190,101 $1,081,558 $105,130 $766,267 $5,973,246 

South Carolina $5,403,971 $6,468,058 $3,253,319 $295,433 $2,180,698 $17,601,479 

South Dakota $1,830,190 $2,190,101 $1,081,558 $105,130 $766,267 $5,973,246 

Tennessee $7,355,714 $8,804,116 $4,428,315 $416,815 $3,005,220 $24,010,180 

Texas $22,369,742 $26,774,531 $13,467,117 $1,253,246 $9,149,374 $73,014,010 

Utah $2,184,965 $2,615,203 $1,315,401 $115,100 $911,931 $7,142,600 

Vermont $1,830,190 $2,190,101 $1,081,558 $105,130 $766,267 $5,973,246 

Virginia $8,507,855 $10,183,122 $5,121,931 $484,930 $3,437,386 $27,735,224 
58

State

Title III-B

Supportive 

Services

Title III-C1

Congregate 

Meals

Title III-C2

Home-Deliv. 

Meals

Title III-D

Preventive 

Services

Title III-E

NFCSP Total Title III

Washington $7,172,705 $8,585,070 $4,318,139 $397,692 $2,894,555 $23,368,161 

West Virginia $2,780,196 $3,329,269 $1,505,721 $153,137 $1,073,857 $8,842,180 

Wisconsin $6,566,139 $7,859,067 $3,952,972 $391,448 $2,861,507 $21,631,133 

Wyoming $1,830,190 $2,190,101 $1,081,558 $105,130 $766,267 $5,973,246 

American Samoa $473,451 $599,039 $137,820 $13,141 $95,783 $1,319,234 

Guam $915,095 $1,095,050 $540,779 $52,565 $383,133 $2,986,622 

Northern Mariana 

Islands $228,774 $273,763 $135,195 $13,141 $95,783 $746,656 

Puerto Rico $4,802,050 $5,747,614 $2,890,949 $269,747 $1,974,516 $15,684,876 

Virgin Islands $915,095 $1,095,050 $540,779 $52,565 $383,133 $2,986,622 

TOTAL $366,038,034 $438,020,197 $216,311,617 $21,026,000 $153,253,357 $1,194,649,205 
59

State

Title VII

Ombudsman

Title VII

Elder Abuse Total Title VII

Alabama $264,292 $78,707 $342,999 

Alaska $83,947 $25,224 $109,171 

Arizona $352,186 $104,883 $457,069 

Arkansas $167,058 $49,751 $216,809 

California $1,703,142 $507,205 $2,210,347 

Colorado $222,532 $66,271 $288,803 

Connecticut $197,313 $59,907 $257,220 

Delaware $83,947 $25,224 $109,171 

District of Columbia $83,947 $25,224 $109,171 

Florida $1,249,006 $371,960 $1,620,966 

Georgia $426,175 $126,917 $553,092 

Hawaii $83,947 $25,224 $109,171 

Idaho $83,947 $25,224 $109,171 

Illinois $647,031 $197,384 $844,415 

Indiana $335,450 $99,899 $435,349 

Iowa $177,244 $55,927 $233,171 

Kansas $149,063 $45,843 $194,906 

Kentucky $235,478 $70,126 $305,604 

Louisiana $225,227 $68,518 $293,745 

Maine $83,947 $25,224 $109,171 

Maryland $286,666 $85,371 $372,037 

Massachusetts $358,952 $109,606 $468,558 

Michigan $541,752 $161,337 $703,089 

Minnesota $268,281 $79,895 $348,176 

Mississippi $153,463 $45,702 $199,165 

Missouri $330,143 $98,318 $428,461 

Montana $83,947 $25,224 $109,171 

Nebraska $96,755 $29,770 $126,525 

Nevada $128,482 $38,263 $166,745 

New Hampshire $83,947 $25,224 $109,171 

New Jersey $473,225 $143,950 $617,175 

New Mexico $105,123 $31,306 $136,429 

New York $1,069,764 $318,581 $1,388,345 

North Carolina $482,691 $143,748 $626,439 

North Dakota $83,947 $25,224 $109,171 

Ohio $641,831 $197,185 $839,016 

Oklahoma $201,454 $60,208 $261,662 

Oregon $212,847 $63,387 $276,234 

Pennsylvania $766,140 $242,944 $1,009,084 

Rhode Island $83,947 $25,224 $109,171 

South Carolina $252,516 $75,200 $327,716 

South Dakota $83,947 $25,224 $109,171 

Tennessee $343,717 $102,361 $446,078 Texas $1,045,289 $311,293 $1,356,582 

Utah $102,099 $30,406 $132,505 

Vermont $83,947 $25,224 $109,171 

Virginia $397,554 $118,394 $515,948 

Washington $335,165 $99,814 $434,979 
60

State

Title VII

Ombudsman

Title VII

Elder Abuse Total Title VII

West Virginia $116,871 $36,736 $153,607 

Wisconsin $306,821 $91,373 $398,194 

Wyoming $83,947 $25,224 $109,171 

American Samoa $10,493 $3,153 $13,646 

Guam $41,974 $12,612 $54,586 

Northern Mariana 

Islands $10,493 $3,153 $13,646 

Puerto Rico $224,389 $66,824 $291,213 

Virgin Islands $41,974 $12,612 $54,586 

TOTAL $16,789,432 $5,044,712 $21,834,144 
61

State/Territory

Nutrition 

Services 

Incentive 

Program

Alabama $2,724,877 

Alaska $320,721 

Arizona $2,266,704 

Arkansas $2,638,692 

California $12,346,182 

Colorado $1,379,870 

Connecticut $1,441,385 

Delaware $493,229 

District of Columbia $639,886 

Florida $6,978,546 

Georgia $2,725,424 

Hawaii $487,594 

Idaho $624,476 

Illinois $7,030,610 

Indiana $1,856,248 

Iowa $1,684,532 

Kansas $1,954,524 

Kentucky $1,809,827 

Louisiana $3,213,739 

Maine $524,039 

Maryland $1,843,421 

Massachusetts $4,345,685 

Michigan $7,439,014 

Minnesota $1,984,038 

Mississippi $2,113,771 

Missouri $4,199,819 

Montana $871,753 

Nebraska $1,351,963 

Nevada $869,620 

New Hampshire $1,114,365 

New Jersey $3,946,325 

New Mexico $2,054,916 

New York $16,923,613 

North Carolina $3,322,232 

North Dakota $809,231 

Ohio $5,716,593 

Oklahoma $2,556,199 

Oregon $1,765,224

Pennsylvania $5,980,007 

Rhode Island $501,008 

South Carolina $1,612,591 

South Dakota $986,347 

Tennessee $1,695,578 

Texas $12,180,903 

Utah $1,426,187 

Vermont $730,946 
62

State/Territory

Nutrition 

Services 

Incentive 

Program

Virginia $2,299,971 

Washington $1,913,507 

West Virginia $1,724,020 

Wisconsin $2,709,222 

Wyoming $760,086 

Guam $358,586 

Northern Mariana Islands $61,433 

Puerto Rico $2,775,055 

Virgin Islands $173,105 

TOTAL $154,257,439 
63

State

Tribe 

No. Grantee Name

TITLE VI

A/B

TITLE VI

C NSIP

AK 1 Aleutian/Pribilof Islands Association $98,120 $28,830 $24,949 

AK 2 Association of Village Council Pres. $87,390 $2,465 

AK 3 Bristol Bay Native Association $141,660 $50,460 $6,034 

AK 4 Central Council, Tlingit & Haida Indian Tribes of AK $141,660 $50,460 $1,988 

AK 6 Copper River Native Association $86,410 $21,620 $2,181 

AK 7 Hoonah Indian Association $76,160 $14,410 $1,441 

AK 8 Kodiak Area Native Association (Northern Section) $76,160 $14,410 $2,076 

AK 9 Kodiak Area Native Association (Southern Section) $76,160 $14,410 $2,714 

AK 10 Metlakatla Indian Community $86,410 $21,620 $3,685 

AK 11 Native Village of Barrow $98,120 $28,830 $9,522 

AK 12 Tanana Chiefs Conference for Kuskokwim subregion $76,160 $14,410 $1,979 

AK 13 Tanana Chiefs Conference for Lower Yukon Subregion $76,160 $14,410 $4,093 

AK 14 Tanana Chiefs Conference for Yukon Flats Subregion $76,160 $14,410 $2,174 

AK 15 Tanana Chiefs Conference for Yukon Koyukuk Subregion $86,410 $21,620 $1,898 

AK 16 Tanana Chiefs Conference for Yukon Tanana Subregion $76,160 $14,410 $162 

AK 17 Fairbanks Native Association, Inc. $141,660 $50,460 

AK 19 Maniilag Association $122,290 $43,260 $12,947 

AK 20 Native Villiage of Unalakleet $76,160 $5,883 

AK 21 Chugachmiut $86,410 $21,620 $4,261 

AK 22 Artic Slope Native Association, Limited $86,410 $21,620 $6,850 

AK 23 Denakkanaaga, Inc. $86,410 $21,620 

AK 24 Klawock, I.R.A. $76,160 $14,410 $973 

AK 25 Kootznoowoo Inc. $76,160 $14,410 $1,761 

AK 26 Gwichyaa Gwich'in Tribal Government $76,160 $14,410 $5,136 

AK 27 Native Village of Point Hope $76,160 $14,410 $2,119 

AK 28 Seldovia Village Tribe $76,160 $1,264 

AK 30 Sitka Tribes of Alaska $98,120 $28,830 $1,580 

AK 31 Yakutat Native Association $76,160 $14,410 $1,841 

AK 32 Ketchikan Indian Corporation $98,120 $28,830 $1,944 

AK 33 Kuskokwim Native Association $86,410 $21,620 $2,751 

AK 35 Southcentral Foundation $186,000 $57,680 $8,352 

AK 36 Kenaitze Indian Tribe, IRA $98,120 $28,830 $4,051 

AK 37 Wrangell Cooperative Association $76,160 $14,410 $1,346 

AK 38 Native Village of Savoonga $76,160 $7,928 

AK 39 Native Village of Gambell $76,160 $14,410 $5,778 

AK 40 Native Village of Eyak $76,160 $14,410 $622 

AK 41 ORGANIZED VILLAGE OF KAKE $76,160 $14,410 $1,609 

AK 42 Chickaloon Village $86,410 

AK Total $3,449,580 $778,370 $146,357 

AL 1 Poarch Creek Indians $110,570 $36,040 $15,235 

AL Total $110,570 $36,040 $15,235 

AZ 2 Colorado River Indian Tribes $110,570 $36,040 $4,562 

AZ 3 Gila River Indian Community $141,660 $50,460 $26,997 

AZ 4 Hopi Tribal Council $141,660 $50,460 $6,925 

AZ 5 Hualapai Tribal Council $86,410 $21,620 $5,405 

AZ 6 Navajo Nation $141,660 $50,460 $59,111 

AZ 7 The Pascua Yaqui Tribe $141,660 $50,460 $35,420 
64

State

Tribe 

No. Grantee Name

TITLE VI

A/B

TITLE VI

C NSIP

AZ 9 Salt River Pima-Maricopa Community $122,290 $43,260 $15,291 

AZ 10 San Carlos Apache Tribe $141,660 $50,460 $5,256 

AZ 11 Tohono o'Odham Nation $141,660 $50,460 $9,414 

AZ 12 White Mountain Apache Tribe $141,660 $50,460 $15,316 

AZ 13 Ak-Chin Indian Community $76,160 $14,410 $1,826 

AZ 14 Yavapai-Apache Tribe $86,410 $7,263 

AZ 15 Havasupai Tribal Council $76,160 $14,410 $7,989 

AZ 16 Inter-Tribal Council of Arizona $76,160 $14,410 $1,105 

AZ 17 Cocopah Indian Tribe $76,160 $10,984 

AZ 18 Quechan Indian Tribe $86,410 $21,620 $10,126 

AZ Total $1,788,350 $518,990 $222,990 

CA 1 Bishop Indian Tribal Council $86,410 $21,620 $21,249 

CA 2 Blue Lake Rancheria $86,410 $21,620 $18,453 

CA 6 Karuk Tribe of California $98,120 $28,830 $3,208 

CA 7 Pit River Health Services $76,160 $2,882 

CA 8 Picayune Rancheria $76,160 $4,426 

CA 9 Riverside-San Bernardino Co. Indian Health-for Morongo $86,410 $21,620 $8,596 

CA 10

Riverside-San Bernardino Co. Indian Health-for 

Pechanga $76,160 $14,410 $3,875 

CA 11 Riverside-San Bernardino Co. Indian Health-for Soboba $76,160 $14,410 $6,868 

CA 12 Sonoma County Indian Health Project $76,160 $6,165 

CA 13 Southern Indian Health Council-Area I $76,160 $14,410 $2,258 

CA 14 Southern Indian Health Council-Area II $76,160 $14,410 $7,918 

CA 15 Toiyabe Indian Health Project - Northern $76,160 $14,410 $6,460 

CA 16 Tule River Indian Health Center $86,410 $21,620 $12,230 

CA 17 United Indian Health Services (for Resighini) $86,410 $21,620 $7,407 

CA 18 United Indian Health Services (for Smith River, etc.) $86,410 $21,620 $8,583 

CA 19 California Indian Manpower Consortium $76,160 $14,410 $10,937 

CA 20 Indian Senior Center, Inc. $86,410 $21,620 $8,223 

CA 21 Sonoma County Ind. Health Pro., Manchester $76,160 $5,765 

CA 23

CA Indian Manpower Consort-LaJolla & Susanville 

Ranche $76,160 $14,410 $7,286 

CA 24 California Indian Manpower Consortium - Ysabel, Pasual $86,410 $21,620 $8,665 

CA 25 Pala Band of Mission Indians $76,160 $14,092 

CA 26 Redding Rancheria Indian Health Services $141,660 $50,460 $5,646 

CA 28 Toiyabe Indian Health Project - Southern $76,160 $14,410 $6,886 

CA 29 Hoopa Valley Tribe $76,160 $7,686 

CA 30 Round Valley Indian Tribes $76,160 $4,005 

CA 31 Fort Mojave Indian Tribe $76,160 $14,410 $5,229 

CA 32 Santa Ynez Band of Mission Indians $76,160 $1,909 

CA Total $2,225,780 $381,940 $206,907 

CO 1 Southern Ute Indian Tribe $86,410 $21,620 $4,340 

CO 2 Ute Mountain Ute Tribe of Indians $86,410 $10,852 

CO Total $172,820 $21,620 $15,192 

HI 1 Alu Like, Inc. $1,505,000 $57,680 $44,997 

HI 2 Hana Community Health Center $86,410 $6,060 

HI Total $1,591,410 $57,680 $51,057 

ID 1 Coeur d'Alene Tribe $86,410 $21,620 $15,109 

ID 2 Nez Perce Tribe of Idaho $110,570 $36,040 $4,371 
65

State

Tribe 

No. Grantee Name

TITLE VI

A/B

TITLE VI

C NSIP

ID 3 Shoshone-Bannock Tribes $98,120 $28,830 $23,592 

ID Total $295,100 $86,490 $43,072 

KS 1 Kickapoo Nation in Kansas $76,160 $14,410 $7,015 

KS 2 Prairie Band of Potawatomi Indians $110,570 $36,040 $18,705 

KS 3 Iowa Tribe of Kansas and Nebraska $76,160 $14,410 $6,696 

KS Total $262,890 $64,860 $32,416 

LA 1 Institute for Indian Development, Inc. $86,410 $6,819 

LA Total $86,410 $6,819 

ME 1 Passamaquoddy Tribe $98,120 $28,830 $18,730 

ME 2 Penobscot Indian Nation $86,410 $4,296 

ME Total $184,530 $28,830 $23,026 

MI 1 Grand Traverse Band of Ottawa & Chippewa Indians $86,410 $21,620 $6,882 

MI 2 Inter-Tribal Council of Michigan, Inc. $76,160 $14,410 $11,590

MI 3 Keweenaw Bay Indian Community $86,410 $21,620 $11,930 

MI 4 Sault Ste. Marie Tribe of Chippewa Indians $141,660 $24,370 

MI 5 Little Traverse Bay Bands of Odawa Indians $86,410 $5,111 

MI 7 Bay Mills Indian Community $76,160 $14,410 $4,410 

MI 8 Pokagon Band of Potawatomi Indians $86,410 $2,849 

MI 9 Little River Band of Ottawa Indians $98,120 

MI 10 Nottawaseppi Huron Band of Potawatomi Tribe $76,160 $14,410 $2,890 

MI Total $813,900 $86,470 $70,032 

MN 1 Bois Forte Reservation Business Committee $86,410 $21,620 $8,785 

MN 2 Fond du Lac Reservation Business Committee $122,290 $43,260 $40,314 

MN 3 Leech Lake Reservation Business Committee $141,660 $50,460 $15,357 

MN 5 Mille Lacs Band of Chippewa Indians $98,120 $28,830 $34,099 

MN 6 Minnesota Chippewa Resource Development $86,410 $21,620 $9,750 

MN 7 Red Lake Band of Chippewa Indians $122,290 $44,320 

MN 8 White Earth Reservation Tribal Council $86,410 $5,829 

MN 9 Grand Portage Reservation Business Committee $76,160 $3,843 

MN Total $819,750 $165,790 $162,297 

MO 99 Eastern Shawnee Tribe of Oklahoma $76,160 $14,410 $18,611 

MO Total $76,160 $14,410 $18,611 

MS 1 Mississippi Band of Choctaw Indians $141,660 $50,460 $17,294 

MS Total $141,660 $50,460 $17,294 

MT 1 Assiniboine and Sioux Tribes $122,290 $43,260 $25,994 

MT 2 Blackfeet Tribe $141,660 $50,460 $27,593 

MT 3 Chippewa-Cree Tribe $98,120 $28,830 $41,051 

MT 4 Confederated Salish and Kootenai Tribes $141,660 $50,460 $2,245 

MT 5 Fort Belknap Community Council $110,570 $36,040 $14,808 

MT 6 Northern Cheyenne Tribe $86,410 $21,620 $15,564 

MT 7 Crow Tribal Elders Program $141,660 $50,460 $43,009 

MT Total $842,370 $281,130 $170,264 

NC 1 Eastern Band of Cherokee Indians $186,000 $57,680 $28,944 

NC Total $186,000 $57,680 $28,944 

ND 1 Spirit Lake Nation $86,410 $21,620 $19,490 

ND 2 Standing Rock Sioux Tribe $122,290 $43,260 $50,541 

ND 3 Three Affiliated Tribes $141,660 $50,460 $12,378 

ND 4 Trenton Indian Service Area $110,570 $36,040 $3,609 

ND 5 Turtle Mountain Band of Chippewa Tribe $141,660 $50,460 $19,823 
66

State

Tribe 

No. Grantee Name

TITLE VI

A/B

TITLE VI

C NSIP

ND Total $602,590 $201,840 $105,841 

NE 1 Omaha Tribe of Nebraska $86,410 $21,620 $8,746 

NE 2 Santee Sioux Tribe of Nebraska $76,160 $3,231 

NE 3 Winnebago Tribe of Nebraska $86,410 $21,620 $17,389 

NE Total $248,980 $43,240 $29,366 

NM 1 Eight Northern Indian Pueblos Council (Picuris, etc.) $141,660 $50,460 $10,683 

NM 2 Eight N. Indian Pueblos Council(San Ildefonso, etc.) $86,410 $21,620 $6,902 

NM 3 Five Sandoval Indian Pueblos, Inc. $98,120 $11,974 

NM 4 Jicarilla Apache Tribe $110,570 $36,040 $15,079 

NM 5 Laguna Rainbow Corporation $141,660 $50,460 $17,271 

NM 6 Mescalero Apache Tribe $98,120 $9,921 

NM 7 Pueblo de Cochiti $86,410 $21,620 $8,172 

NM 8 Pueblo of Acoma $141,660 $50,460 $9,136 

NM 9 Pueblo of Isleta $141,660 $50,460 $22,125 

NM 10 Pueblo of Jemez $110,570 $36,040 $5,854 

NM 11 Pueblo of San Felipe $110,570 $36,040 $9,314 

NM 12 Pueblo of Taos $110,570 $36,040 $9,349 

NM 13 Pueblo of Zuni $141,660 $50,460 $25,348 

NM 14 Ohkay Owingeh $122,290 $43,260 $12,650 

NM 15 Santa Clara Pueblo $98,120 $28,830 $10,199 

NM 16 Santo Domingo Pueblo Tribe $98,120 $9,590 

NM 17 Pueblo of Tesuque $76,160 $14,410 $3,434 

NM Total $1,914,330 $526,200 $197,001 

NV 1 Fallon Paiute-Shoshone Tribes $86,410 $21,620 $18,913 

NV 2 Inter-Tribal Council of Nevada, Inc. (McDermitt, etc.) $86,410 $21,620 $7,230 

NV 3 Inter-Tribal Council of Nevada, Inc. (Duckwater, etc.) $76,160 $14,410 $5,067 

NV 4 Inter-Tribal Council of Nevada, Inc. (Ely, etc.) $76,160 $14,410 $4,714 

NV 5 Shoshone-Paiute Tribes $98,120 $28,830 $9,235 

NV 6 Walker River Paiute Tribe $86,410 $9,851 

NV 7 Washoe Tribe of Nevada and California $98,120 $28,830 $23,403 

NV 8 Yerington - Paiute Tribe $76,160 $3,736 

NV 9 Pyramid Lake Paiute Tribe $98,120 $28,830 $4,580 

NV 10 Elko Band Council $76,160 $14,410 $6,448 

NV 11 Reno-Sparks Indian Colony $76,160 $14,410 $10,482 

NV Total $934,390 $187,370 $103,659 

NY 1 St. Regis Mohawk Tribe Office for Aging $141,660 $50,460 $12,561 

NY 2 Seneca Nation of Indians $122,290 $43,260 $18,793 

NY 3 Oneida Indian Nation $76,160 $14,410 $1,849 

NY Total $340,110 $108,130 $33,203 

OK 1 Apache Tribe of Oklahoma $141,660 $50,460 $13,009 

OK 2 Caddo Tribe of Oklahoma $141,660 $50,460 $3,401 

OK 3 Cherokee Nation of Oklahoma $187,076 $58,837 $45,260 

OK 4 Cheyenne-Arapaho Tribes of Oklahoma $141,660 $50,460 $16,152 

OK 5 Chickasaw Nation $186,000 $57,680 $87,198 

OK 6 Choctaw Nation of Oklahoma $186,000 $57,680 $31,555 

OK 7 Citizen Band Potawatomi of Oklahoma $186,000 $57,680 $11,093 

OK 8 Comanche Indian Tribe $141,660 $50,460 $14,413 

OK 9 Delaware Tribe of Western Oklahoma $78,960 $14,410 $4,934 

OK 10 Iowa Tribe of Oklahoma $141,660 $50,460 $9,169 
67

State

Tribe 

No. Grantee Name

TITLE VI

A/B

TITLE VI

C NSIP

OK 11 Kaw Tribe of Oklahoma $141,660 $4,304 

OK 12 Kickapoo Tribe of Oklahoma $100,000 $21,620 $14,940 

OK 13 Kiowa Tribe of Oklahoma $141,660 $50,460 $5,871 

OK 14 Miami Tribe of Oklahoma $186,000 $57,680 $22,651 

OK 15 Muscogee (Creek) Nation $186,000 $57,680 $146,757 

OK 16 Osage Nation of Oklahoma $186,000 $57,680 $15,362 

OK 17 Otoe-Missouria Tribe $98,120 $28,830 $5,735 

OK 18 Ottawa Tribe of Oklahoma $141,660 $50,460 $17,260 

OK 19 Pawnee Tribe of Oklahoma $141,660 $50,460 $9,011 

OK 20 Peoria Tribe of Oklahoma $141,660 $15,303 

OK 21 Ponca Tribe of Oklahoma $86,410 $21,620 $7,683 

OK 22 Quapaw Tribe of Oklahoma $98,120 $28,830 $13,209 

OK 23 Sac and Fox Tribe of Indians of Oklahoma $141,660 $50,460 $13,093 

OK 24 Seminole Nation of Oklahoma $122,290 $43,260 $12,655 

OK 25 Seneca-Cayuga Tribe of Oklahoma $86,410 $21,620 $8,463 

OK 26 Wichita and Affiliated Tribes $141,660 $50,460 $6,676 

OK 27 Wyandotte Tribe of Oklahoma $141,660 $50,460 $12,795 

OK 28 Absentee Shawnee Tribe $186,000 $57,680 $34,028 

OK 29 Fort Sill Apache Tribe $98,120 $28,830 $4,440 

OK 31 United Keetowah Band of Cherokee Indians in Oklahoma $141,660 $50,460 $12,988 

OK Total $4,240,746 $1,277,137 $619,408 

OR 1 Confederated Tribes of Siletz Indians of Oregon $98,120 $28,830 $2,573 

OR 2 Confederated Tribes of the Umatilla Indian Reservation $122,290 $43,260 $7,341 

OR 3 Confederated Tribes of Warm Springs $110,570 $36,040 $7,153 

OR 4 Confederated Tribes of Grand Ronde $76,160 $14,410 $8,931 

OR 5 Klamath Tribe $141,660 $50,460 $2,817 

OR 6 Confed. Tribes of Coos, Lower Umpqua & Siuslaw Indian $76,160 $14,410 $8,061 

OR Total $624,960 $187,410 $36,876 

RI 1 Narragansett Indian Tribe $98,120 $2,711 

RI Total $98,120 $2,711 

SC 1 Catawba Indian Nation Eldercare Program $86,410 $21,620 $7,970 

SC Total $86,410 $21,620 $7,970 

SD 1 Cheyenne River Sioux Tribe $141,660 $50,460 $10,937 

SD 2 Crow Creek Sioux Tribe $86,410 $15,182 

SD 3 Lower Brule Sioux Tribe $76,160 $14,410 $10,598 

SD 4 Oglala Sioux Tribe $186,000 $57,680 $158,183 

SD 5 Rosebud Sioux Tribe $186,000 $57,680 $68,792 

SD 6 Sisseton-Wahpeton Sioux Tribe $141,660 $31,166 

SD 7 Yankton Sioux Tribe $86,410 $39,206 

SD Total $904,300 $180,230 $334,064 

TX 1 Alabama-Coushatta Tribe $86,410 $21,620 $10,220 

TX 2 Kickapoo Traditional Tribe of Texas $76,160 $6,060 

TX Total $162,570 $21,620 $16,280 

UT 1 Uintah and Ouray Business Committee $86,410 $21,620 $7,314 

UT Total $86,410 $21,620 $7,314 

WA 1 Colville Confederated Tribes $141,660 $50,460 $17,218 

WA 2 Lower Elwha Klallam Tribe $86,410 $21,620 $3,210 

WA 3 Lummi Indian Business Council $110,570 $36,040 $17,025 

WA 4 Makah Indian Tribal Council $86,410 $21,620 $6,278 
68

State

Tribe 

No. Grantee Name

TITLE VI

A/B

TITLE VI

C NSIP

WA 5 Muckleshoot Indian Tribe $141,660 $50,460 $31,578 

WA 8 Nooksack Indian Tribe $86,410 $21,620 $3,878 

WA 9 Puyallup Tribe of Indians $141,660 $50,460 $6,489 

WA 10 Quinault Indian Nation $122,290 $43,260 $13,450 

WA 11 S. Puget Intertribal Plng. Ag.- Nisqually $122,290 $43,260 $2,568 

WA 12 S. Puget Intertribal Plng. Ag.- Squaxin Island $86,410 $4,398 

WA 13 Swinomish Indian Tribal Community $76,160 $14,410 $4,032 

WA 14 Spokane Tribe of Indians $86,410 $21,620 $10,251 

WA 15 Yakama Indian Nation $76,160 $14,410 $2,289 

WA 16 Tulalip Tribes $122,290 $43,260 $9,030 

WA 17 Jamestown S'Klallam Tribal Center $86,410 $21,620 $1,426 

WA 19 Quileute Tribal Council $76,160 $14,410 $5,909 

WA 20 S. Puget Intertribal Plng. Ag.- Shoalwater Bay $98,120 $28,830 $5,849 

WA 21 Stillaguamish Tribe of Indians $86,410 $21,620 $1,616 

WA 22 Upper Skagit Indian Tribe $76,160 $14,410 $2,525 

WA 24 The Suquamish Indian Tribe $98,120 $28,830 $6,272 

WA 25 Port Gamble S'Klallam Tribe $86,410 $21,620 $2,208 

WA 26 Samish Indian Nation $86,410 $21,620 $2,656 

WA 27 Cowlitz Indian Tribe $98,120 $28,830 $3,396

WA 28 SKOKOMISH INDIAN TRIBE $98,120 $28,830 $2,371 

WA 29 Confederated Tribes of the Chehalis Reservation $98,120 $28,830 $2,155 

WA Total $2,475,350 $691,950 $168,077 

WI 1 Bad River Band of Lake Superior Chippewa $86,410 $21,620 $10,958 

WI 2 Forest County Potawatomi Community $76,160 $14,410 $6,619 

WI 3 Lac Courte Oreilles Band of Lake Superior Chippewa $98,120 $28,830 $9,524 

WI 4

Lac du Flambeau Band of Lake Superior Chippewa 

Indians $86,410 $21,620 $14,518 

WI 5 Menominee Indian Tribe of Wisconsin $122,290 $43,260 $21,150 

WI 6 Oneida Tribe of Indians of Wisconsin $122,290 $43,260 $17,020 

WI 7 Red Cliff Band of Lake Superior Chippewa $86,410 $21,620 $12,713 

WI 8 St. Croix Chippewa Indians of Wisconsin $86,410 $21,620 $2,886 

WI 9 Stockbridge-Munsee Community $86,410 $21,620 $5,333 

WI 10 Ho-Chunk Nation $110,570 $36,040 $9,477 

WI Total $961,480 $273,900 $110,198 

WY 1 Northern Arapaho Business Council $98,120 $10,678 

WY 2 Shoshone Tribal Business Council $110,570 $12,865 

WY Total $208,690 $23,543 

Total $26,936,716 $6,373,027 $3,026,024