The purpose of Title III of the OAA is to help seniors maintain independence in their homes and communities by providing appropriate support services and promoting a continuum of care for the vulnerable elderly. The OAA laid the foundation for the current aging services network. This network is comprised of 56 state units on aging (SUA), 629 area agencies on aging (AAA), 244 tribal and Native American organizations, and 2 organizations serving Native Hawaiians, as well as nearly 20,000 local service provider organizations. These organizations are responsible for the planning, development, and coordination of a wide array of home and community-based services within each state under Title III of the OAA. This testimony focuses on three categories of services— those provided under parts B, C, and E of Title III of the OAA. Part B covers, among other things, supportive services and senior centers, including transportation, help with homemaker tasks and personal care, and adult day care. Part C covers nutrition services, including home- delivered and congregate meals. Part E authorizes the National Family Caregiver Support Program, which provides counseling, support groups, and relief from caregiver duties (respite services) for caregivers. (See table 1.) AoA at the Department of Health and Human Services provides grants to the states through the SUAs. Grant amounts are based on funding formulas weighted to reflect a state’s age 60 and over population, which is generally the group eligible for services. For example, in fiscal year 2009, the state of Florida received about $87 million in Title III dollars compared to the state of Montana, which received $6 million, because more seniors reside in Florida. SUAs then typically allocate funds to Area Agencies on Aging (AAA) to directly provide services or to contract with local service providers. In a few states, the SUA directly allocates funds to local providers or provides services. (See fig. 1.) A significant amount of program funding is also provided to state and local agencies by other sources, such as federal Medicare and Medicaid, states, private donations, and voluntary contributions from seniors for services they receive. According to a 2009 study published by the National Association of Area Agencies on Aging and Scripps Gerontology Center of Miami University, 99 percent of AAAs secure funds from additional sources, and the average AAA utilized funding from six sources to provide services in their communities. The amount secured by AAAs varies. OAA services are available to all people age 60 and older who need assistance. The law did not, however, establish an open-ended entitlement available to all seniors, nor was it intended to meet all of seniors’ needs. OAA requires providers to target, or place a priority on reaching, seniors with the greatest economic and social need, and defines them as individuals who have an income at or below the poverty level, or who are culturally, socially, or geographically isolated, face language barriers, or have physical and mental disabilities. Targeting these seniors who are most in need may include a local agency locating a congregate meal site in a low-income neighborhood or working collaboratively with organizations that represent minority seniors. In addition, some services are targeted to vulnerable groups by definition. Examples of these include the long-term care ombudsman program, family care-giver support services, and assisted transportation to those with limited mobility. OAA gives state and local agencies flexibility in determining which populations to target. The recent health care reform legislation—the Patient Protection and Affordable Care Act—contains new provisions for senior health care, including one removing barriers to home- and community-based services under Medicaid. While these changes may shift the provision of some services for seniors from OAA to Medicaid, the extent of this shift is unknown; nevertheless, seniors will likely continue to look to OAA-funded providers for a range of assistance. Local agencies who responded to our survey identified home-delivered meals and transportation as frequently requested services in fiscal year 2009. These agencies also said they receive many requests for information and assistance services—help locating resources and programs—and for respite for caregivers. In preliminary responses to our survey, 49 of those 61 local agencies said more seniors requested home-delivered meals than congregate meals. Forty-four of our 67 survey respondents thus far cited transportation and 43 cited information and assistance as the support services requested most frequently. One local official we spoke with in Wisconsin highlighted the importance of transportation services for his rural clients, while an agency official in Massachusetts said OAA transportation services can be important in urban settings because seniors often prefer them to mass transit options. In addition, 36 of the 63 local agencies who have responded to our survey and track such requests said respite services were most frequently requested by caregivers in fiscal year 2009. Respite care provides temporary caregiving for seniors so that a family member can take a break or engage in other activities. Some agencies responding to our survey said they are currently unable to meet all requests for services. Thirteen of 67 agencies said they are generally or very unable to serve all clients who request home-delivered meals; 15 of the 63 agencies that provide transportation services said they are generally or very unable to meet all transportation requests. Of the 64 agencies that provide respite care, 17 said they were generally or very unable to meet all requests. State and local officials we spoke with also said requests for some OAA services are increasing. Specifically, officials at several local agencies we visited described increased requests for home-delivered meals, transportation, or home-based services. Officials attributed these increases to several factors. First, some agency officials said there are increasing numbers of Americans who are age 60 and older and eligible for services. According to U.S. Census data, more than 9 million more Americans were 60 years and older in 2009 than in 2000, and the Census Bureau projects that population group will continue to grow. Secondly, some agency officials told us requests for OAA services such as home- delivered meals and home-based care are increasing as more seniors stay in their homes longer rather than move to assisted living facilities or nursing homes. For example, state officials in Wisconsin said their client population is increasingly older and those who remain in their homes less likely to go out, leading many to request home-delivered meals. Lastly, most agencies who responded to our survey said requests for services have increased since the economic downturn began. Forty-eight of 61 said they have received increased requests for home-delivered meals, 44 of 62 for support services such as transportation, and 40 of 61 agencies for caregiver services since the downturn began. Twenty-five of 60 agencies said they had increased requests for congregate meals, even as long-term trends show a decline in use of this service. A survey conducted by the National Association of State Units on Aging to determine the impact of the economic crisis on state-provided services also found requests for the types of services provided by OAA increased, particularly for home-delivered meals, transportation, and personal care. Some researchers have concluded that older Americans have been hard hit by the economic recession for reasons such as depreciating home values and retirement accounts. These increasing economic challenges may lead to increased need for services like those provided by OAA programs. Given the number of agencies that cannot meet all requests for services and the increasing demand for certain services, agencies must make decisions about which applicants to serve. To reach and serve seniors with the greatest economic or social need, local agencies responding to our survey reported a range of strategies. Over 50 of 67 agencies said they advertise, conduct outreach, and coordinate with other local organizations to reach and provide services to seniors who are targeted by OAA: seniors who are low-income, minority, or live in rural areas. At least 47 of 67 said they use these approaches to reach seniors who speak limited English, another group targeted by OAA. Additionally, most local agencies reported screening potential clients to assess, whether seniors requesting home- delivered meals or respite care had physical limitations that made these types of services particularly beneficial. For example, at one local agency where demand often exceeds supply, an official said preference may be given to those most at risk for hospitalization due to diagnosed malnutrition or chronic diseases managed through nutrition, such as diabetes. Most local agencies did not screen for congregate meals or transportation services. Some officials we spoke to said there are additional seniors who need services but do not contact OAA providers to request them. For example, one local official in Illinois said needs assessments and anecdotal information indicate a much greater need for services than requests to the agency indicate. Similarly, researchers from one organization we spoke with surmised that if more seniors knew about the types of services available through Title III, the requests for such services would be greater. Local agencies have adopted a number of coping mechanisms to address seniors’ requests and decreased funding. Preliminary responses to our survey indicate agencies utilize the flexibility provided by the OAA to transfer funds among Title III programs to meet requests from seniors for services. Twenty-eight of 61 local agencies responding to our question said they transferred funds among programs in fiscal year 2009, most often removing funds from congregate meals, which are less requested, to home- delivered meals or other services. On a national level, nearly 20 percent of OAA funding for congregate meals in fiscal year 2008 was transferred out of the program by states and split almost evenly between home-delivered meals and support services, AoA data show. (See fig. 2.) As a result, support services and home-delivered meal programs experienced an 11 percent and 20 percent net increase, respectively, in Title III funds. On the state level, 34 states transferred funds from congregate meals to home- delivered meals in fiscal year 2008, according to AoA data. The ability to transfer funds offers states flexibility, yet some officials have questioned the need for meal funding to arrive in two streams.