As people age, their ability to perform routine daily activities, such as eating, bathing, dressing, paying bills, and preparing meals declines (see fig. 1). About 70 percent of those aged 65 and older are likely to need long-term services and supports at some point in their lives, for an average of 3 Family or years. Twenty percent will need that care for at least 5 years.friends often informally assist frail older adults with these daily activities. However, when they have no one to help them informally, or need assistance that family and friends cannot provide, older adults rely on long-term services and supports (LTSS) from paid providers in both institutional and home and community-based settings. In either case, the cost of these services and supports can often be a considerable financial burden for older adults and families. For eligible low-income older adults, state Medicaid programs may cover the cost of institutional long-term services and supports and certain HCBS. According to the Census Bureau, the proportion of the U.S. population aged 65 and over is expected to increase from 13 percent in 2010 to more than 20 percent in 2050 and be more diverse. In 2050, about 22 percent of this group will be 85 and older compared to 14 percent in 2010. As the size of the older population grows, so will the number of older adults needing long-term services and supports, particularly for those 85 and older. 42 U.S.C. § 3012(b). established grants to states for the provision of services and supports. The framework of agencies, programs, and activities established by the act produced what is referred to today as the national aging services network. With support from AoA, within HHS’ Administration for Community Living (ACL), the 56 state units on aging, 618 area agencies on aging (AAA), and 264 Indian tribal and 2 Native Hawaiian organizations as components of the aging services network, are responsible for planning, developing, and coordinating home and community-based services and supports for older adults, nationwide. Community-based organizations (CBO) are public agencies or private nonprofit organizations that represent one or more communities or segments of communities and are engaged in meeting the human services needs of community residents. CBOs can include local or regional governmental or quasi-governmental organizations, as well as private nonprofit organizations. the receipt of, need for, and unmet need for services authorized under Title III of the act. State units on aging are to use their AAAs’ plans as a basis for an overall state plan that they submit to AoA. Five federal agencies across four departments have one or more programs that operate within a system of HCBS and related supports that older adults often require to live as independently as possible in their homes and communities (see table 1). The Older Americans Act is the cornerstone for federal leadership in the development of an HCBS system for older adults. The act authorizes funding to cover the cost of a range of services for older adults provided by local HCBS systems—sometimes referred to as core service delivery activities. HCBS funded under Title III of the act are available to anyone 60 or older, but are to be targeted to those with greatest economic or social need, particularly low-income and low-income minority older adults, and older adults living in rural areas, among others.authorizes funding a variety of aging services network support activities or technical assistance provided to state and local agencies by AoA (see table 2). Appendix II provides funding information for these programs for fiscal years 2010 through 2014. In addition to Older Americans Act funding for nutrition services, four programs within the Department of Agriculture target food assistance, at least in part, to low-income older adults (see table 4). These programs provide nutrition assistance in a variety of forms, ranging from commodities, to prepared meals, to vouchers or other targeted benefits used in commercial food retail locations. Two of these programs are exclusively for low-income older adults. The Commodity Supplemental Food Program provides food to participating states that, in turn, distribute it to older adults. The Senior Farmers’ Market Nutrition Program awards grants to states, territories and Indian tribes to provide coupons to low-income older adults to purchase fresh food at authorized farmers’ markets, roadside stands, and community- supported agricultural programs. Appendix II provides funding information for these two programs for fiscal years 2010 through 2014. 42 U.S.C. § 1766. Other USDA Programs That Provide Nutrition Assistance to Older Adults The Emergency Food Assistance Program (7 U.S.C. §§ 7501-7515) and the Food Distribution Program on Indian Reservations (7 U.S.C. § 2013(b)) also benefit older adults. The Emergency Food Assistance Program helps supplement the diets of low-income Americans, including older adults, by providing them with emergency food and nutrition assistance at no cost. It provides food and administrative funds to states to supplement the diets of these groups. The Food Distribution Program on Indian Reservations Program provides USDA foods to low-income households, including older adults, living on Indian reservations and to Native American families residing in designated areas near reservations and in the state of Oklahoma. According to USDA, fiscal year 2013 obligations for these programs were approximately $266 million and $100 million, respectively. Assistance provided to victims of Hurricane Sandy under the emergency food program in fiscal year 2013 is not included in this amount. of the Child and Adult Care Food Program offers federal funding, administered through state health or aging agencies, for meals at adult day care centers. These centers help elderly and disabled adults remain in their homes and communities and avoid premature institutionalization. According to USDA, this program plays a vital role in improving the quality of day care and making it more affordable for many low-income families. In fiscal year 2014, the program served over 71 million meals to older adults who received care in these centers. SNAP, the largest nationwide nutrition assistance program, enables low- income households to obtain a more nutritious diet by increasing their purchasing power. SNAP provides an electronic benefit transfer card to eligible low-income individuals and families, including older adults, that they can redeem for eligible food items at more than 261,150 stores across the nation authorized to accept SNAP benefits. USDA, close to nine percent of all SNAP participants in 2013 were age 60 or over. According to USDA, participation in SNAP does not interfere with older adults receiving meals free-of-charge at dining facilities that prepare and serve communal meals for older adults. Affordable housing is the nucleus of a system of HCBS and supports for older adults because, without access to affordable housing, care in nursing homes and similar facilities is the only option for low-income, frail older adults. The Department of Housing and Urban Development administers the Supportive Housing for the Elderly (Section 202) program, which plays a critical role in addressing the demand for affordable, supportive housing for older adults in this country. Currently, the program maintains the supply of multi-family housing stock for low- income older adults through renewal of existing rental assistance contracts that cover the difference between a property owner’s HUD- approved operating costs for a project and the tenants’ payments. In addition, Section 202 supports independent living by funding the salaries of nearly 1,300 service coordinators, nationwide, who help residents in Section 202-funded properties find the HCBS and supports they need to continue living in their own homes.program totaled $358 million in fiscal year 2014. Appendix II provides funding information for this program for fiscal years 2010 through 2014. Other HUD Programs That Serve Older Adults In addition to the Section 202 program, several other HUD programs serve older adults. For example, local public housing agencies can apply to HUD for approval to designate public housing developments or portions of developments, such as buildings or floors, for occupancy by only elderly families, only disabled families, or elderly and disabled families. HUD refers to this as “designated public housing”. 42 U.S.C. § 1437e. According to HUD, older adult tenants generally are well represented in HUD’s major rental assistance programs and as of December 2014, 42.5 percent of project- based Section 8 units and 31 percent of Public Housing units (42 U.S.C. § 1437b) were rented by older adult households, while 22 percent of Housing Choice Vouchers assisted older adult households. Section 8 units refer to low-income housing units under section 8 of the United States Housing Act of 1937 (Pub. L. No. 75-412, 50 Stat. 888 (as added by the Housing and Community Development Act of 1974, Pub. L. 93-383, 88 Stat. 633, 662-66, (codified as amended at 42 U.S.C. § 1437f)). Under the project-based Section 8 program, HUD contracts with property owners that receive rental subsidies for units rented to low-income tenants. The Federal Housing Administration (FHA), a component of HUD, also administers the Home Equity Conversion Mortgage program. 12 U.S.C. § 1715z-20. The program allows older adult homeowners access to FHA- insured reverse mortgages to convert the equity in their homes into monthly streams of income and/or lines of credit. According to HUD, in fiscal year 2013, FHA endorsed more than 60,000 of these loans nationwide. Up until fiscal year 2012, the Section 202 program also provided capital advances to private, nonprofit organizations (sponsors) to finance the construction, rehabilitation, or acquisition of new affordable rental housing units for very low-income older adults. According to HUD officials, appropriations for capital advances were discontinued beginning in fiscal year 2012 as a result of the Consolidated and Further Continuing Appropriations Act of 2012.