ASSIGNMENT DETAILS: POLICY ANALYSIS WORKSHEETS

POLICY ANALYSIS WORKSHEET

Name: _____Sarah J. Smith________ Date: _________3/10/15__________________

Policy Name/Definition:

The Older Americans Act of 1965 (Public Law 89-73)

The main objectives of the OAA is to improve the lives of older adults with regards to income, physical and mental health, housing, employment, and community service. The OAA Was the first legislation mandated to bring together fragmented public and private aging network delivery system to meet the basic needs of older adults. The OAA established the Administration on Aging and stipulates that state Agencies on Aging be established. It should be noted that the OAA was constructed to complement Medicare and Medicaid.

Section Discussion/ResearchSection #1Historical Background of the Policy:

What historical problems led to the creation of the policy?

The main problems facing older adults in the early

1960’s, when compiled, can be seen as four basic problems.

These problems are income insecurity, full access to quality

health and social services, decent and affordable housing,

and the opportunities to sustain full and productive living.

(The White House Conference on Aging, 1960).

In many states the standards of public assistance were set

below the minimum amount needed to adequately support

the older adults’ basic needs and restrictive residence, filial

responsibility, and citizenship requirements limited public

assistance (White House Conference on Aging, & United

States, 1961). These barriers prevented many needy older

adults from receiving adequate aid through the Old Age,

Survivor, and Disability Insurance under Social Security.

Before the Older American Act and Medicare, more than one

out of three Americans over 65 were living below the

poverty line (Tumulty, 2014).

In addition, there was a need for coordination of services,

planning and financing of programs and services for older

adults on the local, state and federal levels of the public,

private, and non-profit sectors. Federal oversight and

funding of the “aging network” was not sufficient and there

was need for a federal level leadership position (White

House Conference on Aging, & United States, 1961).

How the problem was previously handled?

Before 1935 not much thought was given to the economic

security of older adults as few people survived to old age

(Moody & Sasser, 2012). Traditional sources of economic

security consisted of assets, labor, family, and charity (Social

Security Administration, 2015). Extended family was most

often the source of economic security for the aged and many

states had filial responsibility laws (Moody & Sasser, 2012).

The Social Security Act created a social insurance

program for workers age 65 years or older funded through

contributory payments made to a joint fund during persons’

economically productive years (Social Security

Administration, 2015). The act also provided grants to states

for means-tested Old-Age-Assistance and was intended to be

a temporary “relief” program (Social Security

Administration, 2015). Dependent and Survivor benefits

were added in the 1939 Amendments.

The act was an attempt to protect against unforeseen

dangers of the modern life including old age, disability,

poverty, unemployment, and widowhood. Social Security

was of reasonable success as it lifted the poverty level of

older Americans from more than 50 percent during the Great

Depression to 32 percent in 1960 (Moody & Sasser, 2012).

Many older adults had few options if they needed medical

and personal care. In some communities, older adults were

boarded out to families that agreed to provide care in their

homes (Wacker & Roberto, 2014). Before 1965 and the

passage of Medicare, two federal grant programs assisted

states in the provision of health services for the aged that

could not afford their medical bills. The first program was

established in 1950 and provided federal matching funds to

states for payments to medical providers for individuals who

received means-tested public assistance (U.S. Department of

Health and Human Services, 2000). The second program

entitled Medical Assistance for the Aged, created by the

Kerr-Mills Act of 1960, provided federal funds for

individuals that did not qualify for OASDI, but were in need

of assistance with medical expenses (U.S. Department of

Health and Human Services, 2000).

The Housing Acts of 1956 and 1959 provided federal

assistance to older adults for the financing of home

purchases. Additionally, Federal assistance and loans were

authorized to corporate non-profit rental housing projects to

provide low-rent housing for the lower to middle income

older adults (New Aid Program for Housing of the Elderly,

1961).

After World War II, pensions as deferred compensation to

workers provided fringe benefits to retired older adults. In

1950, 25 percent of private sector workers were covered by

private pension plans (Moody & Sasser, 2012).

What is the historical background of the policy?

The Older Americans Act was passed as part of Lyndon

Johnson's Great Society reforms. What allowed for the

passage of these reforms and the OAA was the correct mix of

political energies coming together at the right time.

Organized political groups for the aged grew during the

late 1950s to mid-1960s. These included The National

Council of Senior Citizens (NCSC), The American

Association of Retired Persons (AARP), and The National

Retired Teachers’ Association (NRTA) (Binstock, 1978).

These organizations provided a powerful instrument for

developing a cohesive voting bloc and political leverage for

older adults. Older adults constituted as much as 16 percent

of the electoral vote during the mid-1960s (Binstock, 1978).

During this same timeframe, in 1959, The Standing

Subcommittee on Aging of the Senate Committee on Labor

and Social Welfare was established. This committee

morphed into The Senate Special Committee on Aging

(SSCA) in 1961. Both were established by Senator Pat

McNamara of Michigan and provided a plethora of

testimony, reports, and hearings of the problems older adults

faced by both experts and the public (Binstock, 1978). The

SSCA formed ties with the aging organizations, and although

the special committee had no legislative power, they were

able to assist these organizations in creating legislative

proposals (Binstock, 1978). In addition, the NCSC became

an organizing basis for “senior citizen” groups and lobbied

extensively for aging issues (Binstock, 1978).

Aging issues were rising on the political agenda in

Washington which generated a joint resolution of Congress

authorizing the first White House Conference on Aging in

Washing D.C. in January of 1961. This conference helped

build authority and provided a consensus of

recommendations for public policy of the aged at a national

level (White House Conference on Aging, & United States,

1961). In addition, the Democratic landslide in the 1964

election proved to be the most liberal House since 1938

(Congress is Nobodies [sic] Lap Dog, 1965) and has been

considered by many as the most productive legislative body

to date (Tumulty, 2014). The thriving American postwar

economy of the late 1940s and 1950s continued into the

1960s providing the necessary funds for new legislation

(Marx, 2011). These forces combined, thereby opening the

policy window wide which led to the passage of the OAA.

When did the policy originate? In 1958, Congressman John E. Fogarty introduced

legislation calling for a White House conference on aging.

Congress enacted the White House Conference on Aging Act

and the bill was signed by President Dwight D. Eisenhower

(Gelfand & Bechill, 1991). The White House conference

was held in 1961 and led to specific recommendations for

public policy that addressed the needs of older adults (White

House Conference on Aging, & United States, 1961). The

conference also called for a federal coordinating agency in

the field of aging and funding for a federal program

providing grants to states for community planning and

projects, research, and development. Many of these

recommendations can be seen in the objectives of both the

Older Americans Act and Medicare (Gelfand & Bechill,

1991).

The original act was eight pages in length and consisted

of six Titles. Title I listed 10 objectives that focused on the

concepts of the inherent dignity of older adults and the

responsibility of the governments of the United States to

assist older adults in securing equal opportunity in adequate

income, quality health and social services, suitable and safe

housing, employment, and the pursuit of meaningful

activities (Wikisource, 2013). Title II established the

Administration on Aging within the Department of Health,

Education, and Welfare under the direction of a

Commissioner on Aging to be appointed by the President

with consent from the Senate. It also mandated eight

functions of the AoA. Title III provided grants to states for

community planning and projects. Title IV authorized

research and development grants, and Title V authorized

training of persons working or preparing to work in the field

of aging. Title VI established an Advisory Committee on

Older Americans which consisted of the Commissioner on

Aging and 15 experts in special problems of the aging

(Wikisource, 2013).

How has the original policy changed over time?

Since the enactment of the Older Americans’ Act, congress

has reauthorized and amended the act numerous times.

Initial implementation stage: During its first years, The

Administration on Aging was preoccupied with figuring out

its role as the central figure in aging policy, and whether its

primary target group should encompass all older adults or

just the low-income older adult population (Gelfand &

Bechill, 1991). The 1969 amendments strengthened the Title

III grant program and authorized model projects to meet the

needs of older adults. The major change in the 1969

amendments was the establishment of the National Older

Volunteer Program (Gelfand& Bechill, 1991).

Rapid expansion stage: Between 1971 and 1978 the

OAA experienced significant expansion. President Nixon

increased the AoA funding from $20 million to $100 million

instead of supporting benefit increases and expansion of

Social Security and Medicare (Gelfand & Bechill, 1991). A

major amendment in 1972 created the Nutrition Program for

Older Americans as title VII (Wacker & Roberto, 2014).

The Nutrition program was the first national large-scale

program to come out of the OAA legislation (Gelfand &

Bechill, 1991).

The 1973 amendments established local Area Agencies

on Aging (AAAs) which filled an important gap in the aging

network. The AAAs were mandated to plan and coordinate

services, in an effort to develop comprehensive services in all

parts of a state, and to advocate on the behalf of older adults

within their jurisdiction (O’Shaughnessy & Napili, 2006).

Additionally, the establishment of employment programs for

unemployed low-income adults over 50 and funds for the

development of multipurpose senior centers were enacted

(Gelfand & Bechill, 1991).

The consolidation stage: In an effort to consolidate the

growth of programs and services and improve coordination

of these programs, the 1978 amendments embodied a major

structural change to the act. Separate grant programs for

social services, the nutrition program, and multipurpose

senior centers were consolidated into one program under title

III. State and local area agencies on aging were given

authority over these programs to provide a single point of

entry for services in their community (Gelfand & Bechill,

1991).

The targeting stage: The 1981 amendments emphasized

the transition of participants to private sector employment

under the community service employment programs. 1984

amendments targeted services to low-income minority older

adults and gave priority to the needs of those with

Alzheimer’s and their families (O’Shaughnessy & Napili,

2006). The 1987 amendments authorized six additional

appropriations for services: in-home services for the frail

elderly; long-term care ombudsman services; assistance for

special needs; health education and promotion services;

services to prevent abuse, neglect and exploitation of older

individuals; and outreach activities for persons who may be

eligible for needs-based benefits and liberalize the eligibility

of community service employment programs

(O’Shaughnessy & Napili, 2006). Additionally, a new Title

VI established grants to Indian tribal organizations for social

and nutritional services was enacted (O’Shaughnessy &

Napili, 2006).

Elder protection, aging in place, and caregiver support

stage: The 1992 amendments added a new Title VII,

Vulnerable Elder Rights Protection Activities, to the act.

Title VII incorporated appropriations for the long-term care

ombudsman program, program for the prevention of elder

abuse, neglect, and exploitation, elder rights and legal

assistance development program, and outreach, counseling,

and assistance for insurance and public benefit programs

(O’Shaughnessy & Napili, 2006).

The 2000 amendments authorized the National Family

Caregiver Support Program under Title III, and allowed

states to impose cost-sharing for certain Title III services

(O’Shaughnessy & Napili, 2006). The 2006 amendments

authorized competitive grants to states in order to detect and

prevent abuse, neglect and exploitation of older adults.

Additionally, these amendments targeted services to older

adults with limited English proficiencies. Funding for

demonstration projects to assist older adults to age in place

and for mental health services under Title IV. The 2006

amendments required the Secretary of Labor to conduct a

national competition for Title V funds every four years, and

the AoA was authorized to award funds for Aging and

Disability Resource Centers (ADRCs) to serve as

information clearinghouses on the full range of long-term

care options (O’Shaughnessy & Napili, 2006).

Stagnation stage: Federal funding has not grown in

response to either inflation or the increase of the older adult

population. Currently eligible individuals are experiencing

waiting periods for many OAA services in most states.

Reauthorization for the OAA expired in 2011. In October

2013 the Senate Health, Education, Labor and Pensions

Committee approved bipartisan legislation for the

reauthorization of the OAA for five years. However,

Congress has failed to reauthorize the act while Senators try

to agree on a formula for allocating OAA funds to states

(Government Relations and Policy, 2014).

What is the legislative history of the policy?

Two decades of political activity lead up to the creation

of the Older Americans Act (United States, 1990). In 1945

the Connecticut State Commission on the Care and

Treatment of the Chronically Ill, Aged, and Infirm was

established (United States, 1990). In the years following,

numerous states created Units on Aging which provided

states with the organizational faculty needed to implement

the coordination and cooperation component between the

Federal, State, and local level entities which serves as the

basis of the OAA (United States, 1990).

In response to the White House Conference on Aging

recommendations, Representative John Fogarty and Senator

Pat McNamara introduced legislation in 1962 to establish an

independent U.S. Committee on Aging to create authority

and cohesion across the many departments and agencies that

dealt with ageing issues, and to create a vehicle for grants for

social services, research, and training. This legislation was

not enacted (O’Shaughnessy & Napili, 2006).

In 1963 President Kennedy recommended a five-year

federal assistance program to state, local, and voluntary

organizations to plan and develop services for older adults.

These proposals were expanded upon, and recommended the

establishment of an Administration on Aging (Gelfand &

Bechill, 1991).

Legislation introduced in 1963 by Representative Fogarty

and Senator McNamara modified the 1962 proposal by

placing an Administration of Aging within the Department of

Health, Education, and Welfare and proposing that a

commissioner for Aging be appointed by the President with

the approval of the Senate enacted (O’Shaughnessy & Napili,

2006). However, this also was not enacted.

The Older Americans Act, as introduced in 1965 by

Representative Fogarty and Senator McNamara, closely

paralleled the 1963 proposal. This time however, the act

received wide bipartisan support and was signed into law by

President Johnson on July 14, 1965 enacted (O’Shaughnessy

& Napili, 2006).

Section #2:Problems that Necessitate the Policy:What is the nature of the problem?

Increased life expectancy and the older adult

population: Life expectancy dramatically increased in the

first half of the 20th century. In 1900 life expectancy was 47

years of age compared to 68 years of age in 1958 (Jurkowski,

2008). The increase in life expectancy, due to advancements

in technology, changes in quality of life and living

conditions, and advances in medicine (Jurkowski, 2008), led

to the increase of the older adult population. In the early

1900s, approximately five percent of the population was 65

plus. By 1953 the percentage had increased to almost 11

percent (C.O.S, B. B., 1953).

Changes in family structure, filial responsibility, and

urbanization: In the past it was not as difficult for families

to support the older generation. In part because of the

smaller percentage of the aged in earlier decades, but also

because families tended to live in rural districts which

provided less strenuous roles for the aged in a “homestead”

lifestyle. Between 1950 and 1960 approximately 50 percent

of people living in rural districts migrated to urban districts,

dropping from 71.2 percent to 37.5 percent (Jurkowski,

2008).

Additionally, This trend toward urbanization contributed

to the shift from extended family to the rise of the nuclear

family. Larger extended families and unmarried daughters

were more readily available to provide care for older adult

relatives (C.O.S, B. B., 1953). Additionally, a societal

change in filial responsibility emerged as parents of nuclear

families were more concerned with the welfare of their own

children and lacked the capacity to provide for both the

younger and older generation. The younger generation

would often leave parents behind to seek employment in

cities (Social Security Administration, 2014). These

demographic and societal changes helped create a greater

reliance on formal systems of elder care, such as community-

based services (Jurkowski, 2008).

Problem of the aging worker: In 1890 68 percent of

those aged 65 and older were in the labor force. By 1955 this

number had dropped to less than 40 percent (C.O.S, B. B.,

1953). This reduction in employment of the older adult

population, and the economic ramification for those that do

not have adequate retirement savings, has been referred to as

the problem of the “aging worker.” Advancements in

technology and white color jobs left many older adults’ job

skills obsolete (Moody & Sasser, 2012). Additionally, a

fixed retirement age, usually 65, was common practice in the

1950s and 1960s (C.O.S, B. B., 1953). Age discrimination in

hiring practices was also widespread. Stereotypes of the

negative effects of age on productivity, the inability to learn

new skills, and the perceived rise in pension payments left

many older workers displaced or unable to find adequate

employment (Moody & Sasser, 2012).

Societal ideological shift: The 1960s marked a period of

social advancement for women, minorities, and the elderly.

The ideology of liberal reform called for an activist national

state. It was increasingly seen as the role of government to

bring about social justice for those that had not been able to

fully participate in the market economy due to racism,

sexism, or ageism (Karger & Stoesz, 1994). This societal

shift from traditional, working-class values grounded in

economics was giving way to a new college educated,

suburban value system based on social and cultural issues of

the time (Milkis & Mileur, 2005). This heightened

awareness led to the fruition of the Great Society reforms,

the civil rights movement, and the sexual revolution for

women. Society had reached the point where they demanded

more protection from the government and a higher quality of

life (Milkis & Mileur, 2005).

How widespread is it? Older adult groups at high risk of poverty in the 1960s

included rural Americans, minorities, low-paid workers,

single women, and the oldest old. To illustrate, in 1966, the

percentage of rural Americans in poverty was 19 percent,

compared to 14 percent for urban Americans (Marx, 2011).

In that same year, the percent of nonwhite Americans in

poverty was 41 percent, in contrast to 12 percent of white

Americans (Marx, 2011).  In the early 1960s, the average

annual income of older couples were half of the annual

income of younger couples (James, G. E. O. R. G. E., 1964).

Additionally, because public assistance was largely

administered by the states, there was a wide variation in

eligibility requirements, what constituted need, and monies

paid out. In 1948 Oklahoma assisted 581 older adults per

1,000 and Colorado, Georgia, and Texas each assisted more

than 400 older adults per 1,000 (Social Security

Administration, 1948). Versus Delaware, the District of

Columbia, Maryland, New Jersey, New York, and Virginia

who each assisted less than 100 older adults per 1,000. The

average monthly assistance payment also varied by state

from a high of $84.72 in Colorado to a low of $15.87 in

Mississippi. The 10 highest paying states were Colorado,

California, Washington, Massachusetts, Wyoming, Arizona,

Nevada, New York, Utah, and Connecticut. The 10 lowest

paying states were Mississippi, Georgia, Kentucky, Virginia,

North Carolina, Alaska, Arkansas, W. Virginia, Tennessee,

and S. Carolina (Social Security Administration, 1948). It

can be inferred from these statistics that older adults living in

the rural south and parts of the mid-west received less public

assistance than those living in the western and northern

regions of the United States.

How many people are affected by it?

In the 1930s the Social Security Act excluded black and

other minority groups and most women from coverage

(Jurkowski, 2008). Women tend to live longer than men and

consequently more older women are widowed and live alone

than men (Jurkowski, 2008). In 1970, women living alone

between the ages of 65 and 74 was 31.7 percent compared to

19.1 percent of males in the same age group (Jurkowski,

2008). Social Security payments are based on amount of

time in workforce and the compensation amount. Most

women and many minorities who reached retirement age had

not participated in the paid work force and consequently they

rarely accumulated an adequate pension or substantial Social

Security payments (Jurkowski, 2008).

According to the 1964 census, of those 65 years of age

and over, 84 percent of white married couples, 75 percent of

white single men, and 66 percent of white single females

received retirement benefits in comparison to 61 percent of

single non-white males and 50 percent of single non-white

females (United States, 1965). Additionally, six percent of

married white couples, 16 percent of single white males, and

15 percent of single white females received public assistance

through individual states. In comparison, 30 percent of non-

white couples, 32 percent of single non-white males, and 48

percent of single non-while females received public

assistance (United States, 1965).

Who is affected and how? Social Security created an unequal system that linked

retirement benefits to employment in earlier life, but

excluded agricultural and service occupations which were

dominated by white women and minority men and women.

The women who did participate in paid labor commonly had

their time in employment interrupted by family obligations,

and their received benefits were primarily through

connection to a male breadwinner. Minority men were

disproportionately affected by under- and unemployment or

found themselves regulated to low paying jobs without

pensions or unemployment benefits. Widows and minorities

were generally left to rely on safety net state and local

stigmatized public assistance (Milkis & Mileur, 2005).

The oldest old were also disproportionately restricted

from receiving retirement benefits. In 1940 when Social

Security benefits started to be paid out, those who were

already in the second half of their economically productive

years provided substantially less contributory payments into

Social Security; therefore, they received a smaller amount in

retirement or none at all. In 1948 it was estimated by the

Social Security Administration Council that in 1960 10 to 13

percent of older males would not be eligible for Social

Security and that 83 to 87 percent of older women would not

have retirement benefits based on their own employment

(Social Security Administration, 1948). In addition,

pensions as added job compensation benefits were mainly

only received by white males. According to the 1960

census, 17 percent of married white couples received a

private pension compared to four percent of non-white

couples (United States, 1964).

Residential segregation and homeownership reflected the

economic divide between white and non-white individuals.

Federal agencies financed approximately half of all

residential homes in the 1950s and 1960s which assisted in

an increase of homeownership rates from 30 percent in 1930

to more than 60 percent by 1960 (Leadership Conference,

2015). However, discriminatory practices based on race was

commonly used as a determining factor for housing credit.

Consequently, whites received 98 percent of the loans

approved by the federal government between 1934 and 1968

(Leadership Conference, 2015). Additionally, many public

housing units built from the 1950s to the 1970s were

comprised of over populated "projects," often located in

depressed, racially segregated communities.

What are the causes of the problems?

Successful aging and equality in older age is not as easily

attainable for some as it is for others. An individual’s social

class influences the experience of old age due to the

accumulated advantage or disadvantage resulting from an

unequal share of wealth, status, and power over the life

course. Discrimination and inequality in education and

economic compensation, along with continuing and past

racism, sexism, and ageism in public assistance policies,

housing practices, and employment greatly impacted the

economic stability and wellbeing of some older adults. The

Greatest Generation cohort grew up at the turn of the

century. They were young adults during the prosperity of the

twenties and then experienced the Great Depression. Many

grew up in extreme poverty while others came from affluent

families. Those born before 1950 lived in a time before civil

rights and where racism and sexism were seen as normal part

of American society. For the first half of the 20th century,

women and minorities were treated as second rate citizens.

How a society treats its elderly says a lot about their

fundamental values. Ageism increased as our society placed

more value on youth. This trend began with the industrial

revolution, but was largely media influenced. Since the

1950s when TV began to be the primary source of

information and entertainment, the mass media has played a

significant role in shaping our societal identity formation and

modern consumer culture. Additionally, societal values of

work ethic, independence, and self-reliance are challenged

by the issues of older adults. Consequently this has

influenced the stigma attached to old age and has assisted in

denying full social acceptance and inclusion.

Section #3: Policy Description:

What resources or opportunities will this policy provide?

In response to widespread concern about a lack of

community social services for older persons, the Older

Americans Act of 1965 was enacted. The OAA was the first

program to focus on community-based services for older

adults and the first legislation to bring together a fragmented

service delivery system that today is called the aging network

(Wacker & Roberto, 2014). The OAA established authority

for formula grants to States for community planning,

coordination of programs, establishment or expansion of

multi-purpose senior centers, demonstration projects, and

training of personnel in the field of aging.

Throughout the years since 1965, the OAA has expanded

upon the objectives of the OAA, amended and added new

titles to the act, and expanded services and programs as

needs became evident through research and discussions.

Today, the scope of programs and projects offered under

the OAA encompass the vast needs of diverse populations of

older adults. These services include:

Services to facilitate access: Transportation, outreach,

information and referral, and case management.

Services provided in the community: Congregate meals,

multipurpose senior centers, legal assistance, adult day care,

protective services, legal aid, health screening, housing,

residential repairs, physical fitness and recreation,

employment services, crime prevention, volunteer services,

senior companion services, and health and nutrition

education.

Service provided in the home: Home health, homemaker,

home repairs, respite services, home delivered meals, and

supportive services for caregivers of those with Alzheimer’s.

Services to residents of care-providing facilities:

Casework, counseling, group work, grievance resolution, and

long-term care ombudsman programs.

In addition, hundreds of projects have been funded

through the act which have expanded the Nation’s

knowledge and understanding of the older adult population,

promoted innovative ideas and best practices, helped meet

the needs to train personnel, and increased the awareness of

citizens of all ages to assume personal responsibility for their

own health (Administration for Community Living, 2006).

Who will be covered by the policy and how?

The Older Americans Act empowers the federal

government to allocate funds to the states for community

based supportive services. These services are mandated to be

universal under the OAA which requires all services to be

available to all Americans aged 60 and over regardless of

income. However, the 2000 amendments allowed states to

impose cost-sharing for certain Title III services, such as

congregate meals. Individuals must be given the opportunity

to contribute to the cost of the service; however, persons are

eligible for services regardless of income or assets, and no

one can be denied services based on the inability or

disinclination to contribute (Wacker & Roberto, 2014).

The original Act did not explicitly state that services

should be targeted to those with the greatest need, but

language within the act placed emphasis on helping older

adults with the greatest need, mainly low-income individuals

of color (Wacker & Roberto, 2014).

Subsequent amendments placed emphases on providing

services for older adults with the greatest social and

economic needs. Today, targeting is directed towards those

who are frail, live in rural districts, are low-income, at risk

for institutionalization, those with Alzheimer’s, racial and

ethnic minorities, and/or those with limited English

proficiency (Wacker & Roberto, 2014).

The OAA set out specific objectives for maintaining the

dignity and welfare of older individuals and created the

Administration on Aging (AoA) which is the primary vehicle

for organizing, coordinating and providing community-based

services and opportunities for older adults. The AoA awards

funds for supportive home and community-based services to

the State Units on Aging, directs research and demonstration

programs, disseminates educational materials, and gathers

statistics in the field of aging. Each SUA makes sub-grants

or contracts to individual Area Agencies on Aging (AAAs)

for the purpose of development or enhancement of

coordinated and comprehensive community-based programs

to provide a continuum of services for older adults within

their designated areas. AAAs in turn make sub-grants or

contracts with services providers to preform and provide

specific functions and services (Administration on Aging,

2000).

How will the policy be implemented?

The passage of the OAA and subsequent amendments

created the aging network which today consists of formidable

structure made up of and links The Department of Health and

Human Services, The Administration for Community Living,

The Administration on Aging, 56 State Units on Aging, 629

Area Agencies on Aging, Title VI grants to 246 Indian tribes,

two Native Hawaiian organizations, and some 29,000

providers delivering services to older adults (Wacker &

Roberto, 2014).

The original legislation established authority for formula

grants to States for community planning and social services,

research and development projects, and personnel training in

the field of aging. States were required to establish a state

plan on aging to be approved by the Secretary of The

Department of Health, Education, and Welfare (HEW) for

the purposes of title III, and to establish or designate a single

State Agency on Aging to administer the plan and to be

primarily responsible for coordination of State programs and

activities to carry out the purposes of the OAA (Wikisource,

2013). Today the State Agencies are termed State Units on

Aging.

The Secretary of HEW was authorized under the OAA to

carry out the purposes of the OAA through grants for

research, development, and training projects to any public or

nonprofit private agencies, organizations, or institutions and

contracts with any such agencies, organizations, or

institutions (Wikisource, 2013).

Today, Formula grants are administered to State Units on

Aging (SUAs) under approved state plans on aging. Each

SUA makes sub-grants or contracts, under an approved area

plan on aging, to individual Area Agencies on Aging (AAAs)

for the purpose of development or enhancement of

coordinated and comprehensive community-based programs

to provide a continuum of services for older adults within

their designated areas. AAAs in turn make sub-grants or

contracts with services providers to preform and provide

specific functions and services (Administration on Aging,

2000)

What are the short term and long term goals of the policy?

The OAA created the “aging network” which was the

primary immediate short term goal of the OAA. This

network united with the fundamental long-term goal of

supporting the federal government in transforming the

fragmented public and private local, state, and federal

programs for older adults into a locally coordinated service

system (Wacker & Roberto, 2014).

The stated objectives of the act were to ensure equal

opportunity to the fair and free enjoyment of adequate

income in retirement; the best possible physical and mental

health services without regard to economic status; suitable

housing; restorative and long term care; opportunity for

employment; retirement in health, honor, and dignity; civic,

cultural, educational and recreational participation and

contribution; efficient community services; immediate

benefit from proven research knowledge; freedom,

independence, and the exercise of self-determination; and

protection against abuse neglect and exploitation

(Wikisource, 2013). These where the hoped for immediate

benefits of and goals of the OAA.

The overall purpose of the Act, as stated in its opening

statement, and its long term goals were to provide services,

opportunities, and protections for older adults to help them

maintain good health and independence in their homes and to

be able to continue to function as a meaningful part of their

community.

What is the funding mechanism for the policy?

Initially, the Act emphasized small grants to state

agencies on aging to fund community-based social services

programs. Since then, specific funding has been authorized

for state planning and coordinating undertakings (South

Dakota Department of Social Services, 2015).

Funding for the services required under the OAA are

appropriated by Congress yearly through tax revenues. These

funds are then distributed to states, territories, the District of

Columbia, Indian tribes and native Hawaiians by the AoA on

a formula basis which provides proportional funding levels

based on states’ over 60 population determined from census

data. For example, Because of its large elderly population

California receives almost 10 percent of OAA funding due to

its high population of older adults. Ten states receive 52

percent of the funding. Originally, the formula was based on

a state’s over 65 population (National Care Planning

Council, 2014).

States are required to provide a minimum 15 percent

match to the federal AoA grants. These matching funds vary

significantly from state to state and assist in providing

overall resources available to their states under the OAA

(Wacker & Roberto, 2014). SUAs keep 10 percent of their

federal appropriation for administration purposes (Wacker &

Roberto, 2014).

AAAs must also provide local matching in the form of

monetary funds or in-kind support, such as volunteer hours,

donated space, or equipment (Wacker & Roberto, 2014).

Title III, part C allows for a separate federal allocation to the

states for the operation of congregate and home-delivered

meals programs (Wacker & Roberto, 2014). For every dollar

provided by Congress local governments provide about two

dollars in direct money, in-kind services from volunteers,

community voluntary contributions and cost sharing funds.

(National Care Planning Council, 2014).

What agencies or organizations will be charged with overseeing, evaluation, and coordinating the policy?

The Secretary of Health, Education and Welfare (HEW):

The Secretary was designated to oversee the grant programs

under title III: Grants for Community Planning, Services, and

Training; Title IV: Research and Development Projects; and

Title V: Training Projects. Additionally, The Secretary was

designated to approve State plans on aging (Wikisource,

2013). The Department of Health, Education, and Welfare

was renamed the Department of Health and Human Services

(DHHS) in 1979, when its education functions were assigned

to the newly created United States Department of Education

under the Department of Education Organization Act (Laws,

2015).

Administration on Aging: Through the OAA, the

Administration on Aging (AoA) was established within the

Department of Health and Education, and Welfare under the

direction of a Commissioner on Aging to be appointed by the

President with consent from the Senate. The AoA is the

primary agency designated to carry out the provisions of the

OAA including serving as a clearinghouse of information,

administering the grants under the act to states, directing

research and demonstration programs, disseminating

educational materials, and gathering statistics in the field of

aging (Wikisource, 2013).

In 2012, three separate offices under DHSS, The

Administration on Aging, The Administration on

Developmental Disabilities, and The Office on Disability,

were reorganized under one office called The Administration

for Community Living (ACL). The units under the ACL are

now the AoA, Administration on Intellectual and

Developmental Disabilities, Center for Disability and Aging

Policy, and Center for Management and Budget. The

Commissioner on Aging was elevated to the rank of

Assistant Secretary on Aging who is also the ACL

administrator (Wacker & Roberto, 2014). Additionally, The

AoA was reorganized into five offices entitled the Office of

Supportive and Caregiver Services, Office of Nutrition and

Health Promotion Programs, Office of Elder Rights

Protection, Office of American Indian, Alaskan Native, and

Native Hawaiian Programs, and the Office of Long-Term

Care Ombudsman Programs. The reorganization has not

changed the AoA’s roles and functions as mandated under

the OAA (Wacker & Roberto, 2014).

Advisory Committee on Older Americans: Title VI of the

original legislation established an Advisory Committee on

Older Americans within HEW for the purpose of advising

the Secretary on matters and responsibilities under the Act.

The Council consisted of the Commissioner on Aging and 15

experts in special problems of the aging who were appointed

by the Secretary (Wikisource, 2013). Today the Assistant

Secretary, in carrying out the objectives and provisions of the

OAA, consults with and cooperates with the head of each

department or agency of the Federal Government that

administers programs or services substantially related to the

objectives of the OAA under Tittle II section 203 Federal

Agency Consultation (Administration on Aging, 2006).

State Units on Aging: Each state is required by the Older

Americans Act to have a State Unit on Aging (SUA). The

SUAs are designated by the governor and/or state legislatures

as the state-level focal point for all activities related to the

needs of and services for older adults. In addition, SAUs

administer programs under the OAA within their states,

develop state plans on aging, and are responsible for

providing leadership in identifying gaps and limitations in

the delivery of services and nurturing the expansion of

service programs for older persons (Detroit Area Agency on

Aging, 2015).

State Plans on Aging: Originally Each SUA was required to

submit a multi-year State Plan on aging to the secretary of

HEW to serve as a contract with the AoA in order to receive

funding under titles III and IV. Today the state plans are

based on Area Agency plans within each state and are

submitted for approval to the assistant secretary on aging

within DHHS. The plans include assurances and strategies to

be conducted by the SUAs to carry out all state activities in

accordance to the OAA. They address the service-delivery

system at the state level, create linkages at the state level, test

new models of services, promote training, coordinate and

pool resources, and conduct program evaluation (Detroit

Area Agency on Aging, 2015).

Area Agencies on Aging: 1973 amendments to the OAA

required states to divide their state into planning and service

areas, and to designate Area Agencies on Aging (AAA) to

develop and implement programs and services for older

adults at the local level (Missouri Department of Health and

Senior Services, 2015). Additionally, each AAA is required

to submit a four year area plan on aging for review and

approval. The plans state how the AAAs are going to

administer their plans, provide targeted services, and utilize

public hearings, customer surveys, advisory councils, and

other available information in decisions regarding programs

offered, evaluation, and targeting of services (Missouri

Department of Health and Senior Services, 2015).

Service Providers:

Under the Older Americans Act Title III strategy, service

providers contract with the SUAs and AAAs to provide

needed services including nutrition, adult day services,

employment, information, transportation, legal service, and

healthcare and prevention agencies. These service provider

agencies are an important component of the aging network.

(South Dakota Department of Social Services, 2015)

What are outcome measures of effectiveness for this policy?

The original act did little in the way of instructing

outcome measures of effectiveness of the OAA. the

Secretary of Health, Education, and Welfare was authorized

to provide consultative services and technical assistance to

public or nonprofit private agencies, organizations, and

institutions, to conduct research, and to circulate reports of

the projects funded under the OAA (Wikisource, 2013).

Today, under Title II section 206, the Secretary is

mandated to measure and evaluate the impact of all programs

authorized by this Act, their effectiveness in achieving stated

goals in general, and in relation to their cost, their impact on

related programs, their effectiveness in targeting for services

under this Act unserved older individuals with greatest

economic need and social need ,and their structure and

mechanisms for delivery of services including comparisons

with appropriate control groups. Evaluations shall be

conducted by persons not immediately involved in the

administration of the program or project evaluated.

Additionally, the Secretary is to obtain input from

organizations representing older adults’ needs and program

participants about the strengths and weaknesses of the

programs (Administration for Community Living, 2006).

Each fiscal year, the Assistant Secretary is required to

prepare and submit to the President and Congress a full and

complete report on the activities carried out under the OAA

including statistical data and analysis information regarding

the effectiveness of AAAs on targeting services to older

adults with the greatest economic and social need, and the

results of evaluative research and evaluation of program

impact and effectiveness (Administration for Community

Living, 2006).

In order to facilitate these mandates, each state is

required to submit to the commissioner of the Agency of

Aging objectively collected and statistically valid data with

evaluative conclusions concerning the unmet need for

supportive and nutrition services and multi-purpose senior

centers (Administration on Aging, 2000).

In 1992, the AoA was directed to refine the program

reporting procedures of SUAs. AoA developed the National

Aging Program Information System which is a computerized

reporting system to be used nationally for tracking the use of

aging services within the AAA network. The NAPIS

captures 15 standardized services in its reporting including

personal care, homemaker, chore, home-delivered meals,

adult day care services, case management, congregate meals,

nutrition counseling, assisted transportation, legal assistance,

nutrition education, outreach, and family caregiver support

programs (Administration for Community Living, 2013).

However, sparse comprehensive research exists that

supports either a positive or negative claim as to the

outcomes of the programs under the OAA (Wacker &

Roberto, 2014). In part this is due to the difficulty of

measuring such broad policy goals.

Section 4:Policy Analysis:

Do the goals of the policy contribute to greater social equality?

Discrimination and inequality in education and economic

compensation, along with continuing and past racism,

sexism, and ageism in public assistance policies, housing

practices, and employment were the primary underlying

inequalities that contributed to the leading problems for older

adults in 1965. Inequalities were being realized at an

accelerated pace in the 1960s. It was a time of civic unrest

and betterment. The OAA was a momentous piece of

legislature that addressed some of these inequalities.

Since the passage of the OAA, the knowledge and

understanding of the older adult population has expanded

tremendously. The older adult poverty rate has decreased

and there is a strong movement in culture change and holistic

living coming from our seniors and professionals. In 1959,

35 percent of older adults lived below the poverty line

compared to 9 percent in 2006 (Karger & Stoesz, 1994).

Of the 10 objectives of the OAA, five could be said to

directly address equality issues. They are: An adequate

income in retirement, the best possible physical and mental

health, suitable and affordable housing, opportunity for

employment free of age discrimination, and efficient and

available community services which provide social

assistance.

Some key services under the OAA that relate to social

equality are as follows:

Education: The 1987 amendments mandated that local

AAAs identify postsecondary schools in their areas that

offered tuition-free education to older adults and disperse this

information to local senior centers (Wacker & Roberto,

2014). AAAs also sponsor educational programs in health,

nutrition, prevention, legal concerns, and employment

(Wacker & Roberto, 2014).

Employment: In 1978, The Senior Community Service

Employment Program (SCSEP) became title V of the OAA

It is a community service and work-based job training

program for low-income, unemployed older adults.

Participants work an average of 20 hours a week, and are

paid the highest of federal, state or local minimum wage.

The goal is to place these older adults into unsubsidized

employment (Wacker & Roberto, 2014).

Health: In 1989, the AoA launched the Historically Black

Colleges and Universities Initiatives to address the health

needs of older African Americans. These initiatives resulted

in church-based health promotion programs and programs for

low-income inner-city and rural Georgia peer support

counselor programs (Wacker & Roberto, 2014).

Additionally, The Older Women’s Project created an

innovative health and wellness promotion program for older

minority and low-income women (Wacker & Roberto, 2014).

Legal Assistance: 1981 amendments required that AAAs put

forth an “adequate proportion” of title III-B funding toward

legal services for family issues, income benefits, age

discrimination, denied pension benefits, insurance fraud etc.

Elder Rights Protection Activities program under title VII is

designed to promote elder justice by means of preventing

elder abuse, neglect, and exploitation (Wacker &

Roberto,2014).

Transportation: Title III part B of the OAA authorizes

transportation services to be sub-contracted out to local

transportation providers to enable the access to supportive

and nutrition services (Wacker & Roberto, 2014).

Housing: Community development block grants and title III

monies from the OAA provide subsidized home repair

programs for emergency repairs for pluming, electricity, heat

and more (Wacker & Roberto, 2014).

Conversely, There is continued ageism in employment,

education, and popular society. There is continued racism,

sexism, and classism that is apparent in the statistics of the

older adult population and society at large. 26 percent of

older adults still live in the low-income bracket and poverty

rates differ by age, sex, and minority status as an outcome of

continued inequality. Women are almost twice as likely as

men to live in poverty and poverty rates among older Black,

Hispanic, and White adults are 23, 19, and 7 percent

respectively (Karger & Stoesz, 1994). The OAA does almost

nothing to alleviate the economic and social conditions that

facilitate inequalities in the older adult population in the first

place. Age segregated programs contribute to the

intergenerational tensions with regards to the nation’s

economic difficulties, and social class disparities are not

adequately addressed in the OAA (Wacker & Roberto,

2014).

Do the goals of the policy contribute to a better quality of life for the target population?

The intent of the OAA is to promote the dignity of older

adults by providing services and supports that enable them to

remain independent and engaged citizens within their

communities. The OAA requires that services be targeted to

those in greatest social and economic need in order to

address issues of food insecurity, health, social isolation, and

well-being.

Of the 10 objectives of the OAA, eight could be said to

directly address quality of life issues. They are: An adequate

income in retirement, the best possible physical and mental

health, restorative services, retirement in health, honor, and

dignity, pursuit of meaningful activity, immediate benefit

from proven research, efficient and available community

services which provide social assistance, and freedom,

independence, and autonomy in managing their own lives.

Some key services under the OAA that relate to quality of

life are as follows:

Nutrition: The 1972 amendments to the OAA added a major

service component, the National Nutrition program for Older

Americans as Title VII. Since then, the program has been

placed under Title III in the OAA (Wacker & Roberto,

2014). Adequate nutrition plays an invaluable role in

keeping adults healthy and independent as they age.  Proper

nutrition reduces the risk of chronic diseases and related

disabilities, maintains the immune system, and supports

better mental and physical health.  Malnutrition, including

being underweight or obese, is closely associated with

decreased functionality which hinders independent living.

Multi-purpose senior centers: The OAA played an

important part in the creation and support of multi-purpose

senior centers. These centers offer a wide range of leisure,

preventive health, civic, educational, cultural, fitness,

support, health screening, workshops, adult day care, meals,

and training services and activities that promote a higher

quality of life for older adults and their communities.

Health: In the past, health promotion programs largely

excluded older adults as they were not seen as benefiting

substantially from these programs. The 1992 amendment to

the OAA authorized the creation of Disease Prevention and

Health Services under Title III part F (Wacker & Roberto,

2014). Today, funding under the OAA provides health

promotion, educational health, evaluation screening,

prescription, and behavioral change support programs

(Wacker & Roberto, 2014).

Care management, Home care, and Respite care: The

OAA act identifies care management as a basic service

designed to avoid institutionalization. Care management

coordinates services that help frail elders remain in their

home while controlling the costs of such services (Wacker &

Roberto, 2014). Title III D of the OAA provides additional

financial support non-medical in home support services for

frail older adults like case management, lifeline systems, and

deep cleaning. Additionally, as part of the OAA 2000

amendments, the National Family Caregiver Support

Program was added under the OAA (Wacker & Roberto,

2014). The NFCSP is the largest support program under the

OAA since 1972. NFCSP funds are used for information and

referral services, individual counseling, support groups and

caregiver training, respite care, and supplemental services

(Wacker & Roberto, 2014).

The above services and programs are just some of the

many that support the objectives of the OAA and contributes

to a better quality of life for millions of older adults.

However, the OAA has struggled for the past 20 years from

chronic underfunding. Due to this limited funding, a

relatively small percentage of older adults receive title III

funded services (O’Shaughnessy & Erhardt, 2010). The

broad and extensive aspirations of the OAA in combination

with stagnant funding for an increased population of older

adults, leaves numerous individuals on extensive waiting lists

and underserved.

Will the goals adversely affect the quality of life of the target population?

The OAA targets vulnerable older adults who face

multiple barriers that can worsen economic insecurity, social

isolation, and various health problems. Unfortunately,

despite ample evidence that LGBT older adults are at a

heightened vulnerability and in need of unique aging

supports, LGBT older adults are invisible in this momentous

legislation (Sage, 2015).

LGBT older adults are more likely to live alone, lack

traditional caregiving supports, are at risk for isolation, face

health disparities, be victims of discrimination, suffer neglect

etc. These conditions accumulate into systematic disparities

for this population without reprieve from social policies, like

the OAA, while other targeted populations have their needs

addressed (Espinoza, 2012).

Older adults with mental disorders is another population

that has been largely overlooked. The OAA states as one of

its objectives that equal opportunity to enjoy “the best

possible physical and mental health services without regard

to economic status” should be provided to all older adults.

However, income security, physical health and nutrition has

taken precedence throughout the year with little attention

being paid to mental health issues of older adults.

Studies show that older adults are at greater risk of some

mental disorders than younger adults, and many of these

illnesses can be accurately diagnosed and treated.

Additionally, women are more likely than men to have

mental illness at 14 percent and 6.5 percent respectively

(Wacker & Roberto, 2014). Older adults from minority

groups use mental health services to a lesser extent, and rural

older adults are underserved by the mental health system.

The LGBT population is also at a greater risk due to chronic

social stigma and stressors (Wacker & Roberto, 2014).

These disparities are compounded by the fact that many

seniors are reluctant to seek treatment that could alleviate or

lessen symptoms and little has been done to promote help

seeking behavior, preventive care, or availability of mental

health services through the OAA (Wacker & Roberto, 2014).

These individuals have been essentially looked over.

Luckily for the first time in 2006, the AoA and the aging

network directed a substantial focus on the prevention and

treatment of mental disorders (Administration for

Community Living, 2015). The outcome to these new

mandates are yet to be recognized.

Are the goals of the policy consistent with the values of professional social work?

The Older Americans Act supports a variety of services

that enhance the health and well-being of older adults. These

services are essential to older adults’ independence and

dignity. Additionally, by law the OAA targets its services to

those in the greatest economic or social need, with particular

attention to those who are frail, live in rural districts, are low-

income, at risk for institutionalization, those with

Alzheimer’s, racial and ethnic minorities, and/or those with

limited English proficiency (Wacker & Roberto, 2014).

The 10 objectives, services provided under the OAA, and

targeting policies of the OAA are congruent with social work

values. Namely, Dignity and Worth of a Person: The OAA

supports the inherent dignity in all older adults; Service: The

OAA helps people to address social, environmental,

psychological, and biological problems; Social Justice: The

OAA pursues change and assistance for vulnerable older

adults and promotes decision making and input from the

older adult population.

The primary mission of social work is to enhance human

wellbeing and help meet basic human needs, with particular

attention to help the most vulnerable, oppressed, and

economically disadvantaged. The Older Americans Act

encompasses and supports this grand mission.

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