1995 State Program Report for Titles III an VII of the Older Americans Act

Contents

Introduction
Summary of New Reporting Requirements
Summary Highlights
Profile of Clients Served
Service Provision
Service Expenditures
Aging Network Staffing
Developmental Accomplishments

Introduction

Over thirty years ago the Older Americans Act (OAA) was passed. Since its initial passage, the OAA has been an important force for change for programs and services for older americans . The OAA fostered the creation of a national network of state and area agencies on aging and Indian Tribal Organizations. Through the development efforts of the Aging Network and OAA funding, an infrastructure of home and community based services has emerged in every state. While much has been accomplished, the job ahead is still very large. OAA funds are small compared to the need. Each OAA dollar must be well spent in order to address both current demand and, at the same time, prepare for emergent needs of the elderly in the 21st century.

This report summarizes programs and accomplishments reported by state units on aging which were supported by Titles III and VII of the OAA in Federal Fiscal Year 1995. The information provided in this report are the result of new reporting requirements introduced by the Administration on Aging (AoA) for Title III and VII in 1995. Implementation of the new Title III program reporting requirements is a multi-year process, with the 1995 performance report representing the first step toward reporting by the Aging Network which is more client centered.

To comply with the new reporting requirements, states are making major changes to long -standing reporting procedures. Every effort has been made by states and the AoA to review the new data submitted for FY1995 and ensure its accuracy. Once states submitted the data, AoA prepared summaries that were sent to states for review and concurrence. Still, AoA fully expects it will take two to three years before all the reporting procedures are in place to produce very accurate, comparable data.

This 1995 report is designed to provide summary highlights of Title III and VII program performance, including persons served, services provided, services expenditures, providers used, state and area agency staffing, developmental accomplishments and the use of senior centers. Both national and state specific summaries are included. This is the first time the annual State Program Performance Report (SPR) includes information on individual state activities and performance supported by Titles III and VII.

It should be noted that the AoA is required to produce a separate report to Congress on the Long Term Care Ombudsman Program supported by the OAA. This report provides only a brief synopsis of the Ombudsman Program accomplishments. See the separate Ombudsman Report for a more detailed report on accomplishments for this program.

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Summary of New Reporting Requirements

In 1995 AoA introduced a new set of reporting requirements for Titles III and VII, including special reporting for the Long-Term Care Ombudsman Program. The new Title III reporting requirements put more emphasis on accurate client counts and additional descriptive information on client characteristics. Key features of the new reporting requirements include:

• Consolidation and elimination of service reporting from 30 separate categories to 14;
• Addition of new service categories reflecting priorities of the Aging Network -- case management and adult day care/adult day health;
• A requirement for client registration for nine services in order to produce accurate, unduplicated client counts for the nine services (to be implemented in FY1997);
• Elimination of reporting on clients and service units by individual Title III Parts;
• Provision for optional reporting by states on Title III funded services not included by the AoA list of 14 services;

• Inclusion of the requirement for client registration for selected services; and,
  • Electronic transmittal of the data by states to AoA.

In 1995 several new data elements for Title III reporting were introduced. Additional data elements will be introduced in FY1997 tied to the requirement for client registration of selected services. New data elements introduced in 1995 include:

• Number of providers using Title III funds, by service;
• Number of minority providers, by service;
• Number of Area Agencies on Aging (AAAs) acting as direct service providers;
• Program income for each listed service;
• Total estimated persons served -- all services and all Title III parts;
• Summary descriptions of Aging Network developmental accomplishments;
• Staffing profiles for both state units on aging and area agencies on aging.

Given these new requirements, many states are upgrading their reporting systems at all levels. New procedures for client intake/registration are being implemented along with the capacity to maintain a master client registry that can be kept up-to-date as new clients are served, active clients drop out and current clients receive new or different services. AoA has encouraged the development of these new systems, recognizing each state has distinctive requirements and needs for information systems.

New service definitions and terms were introduced as part of the amended reporting requirements. Limited comparisons are possible of 1995 performance data with performance data submitted by states for prior years. AoA plans to use 1995 as a new base year against which future performance data will be compared.

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Summary Highlights

After thirty years, the Aging Network has put in place a program involving diverse services and the use of thousands of providers. All fifty-seven state level jurisdictions receive OAA funds awarded annually by the AoA in the form of a grant, based on the size of the elderly population in each state. With these funds, designated state units on aging, supported by area agencies on aging in all but eight states, develop and administer a diverse set of home and community-based services.

Even though funding has not kept up with demand, the Aging Network has still been able to implement and operate a far reaching, diverse program. Summary performance indicators for 1995 show the breadth of services and capacities now in place:

• Programs and services supported by the OAA served an estimated 7,453,575 persons age 60 and over;

• Twenty percent of the program participants were minority;

• Thirty-nine percent of the program participants had incomes at or below poverty;

• Twelve percent of the total count of program participants had incomes below poverty who were also minority participants;

• Of the total clients in poverty, thirty-two percent were minority participants; conversely, of those who were minority clients, 62% had incomes at or below the poverty level;

• Thirty-five percent of the program participants lived in rural areas;

• The OAA puts a high priority on the provision of nutrition services to the elderly. In 1995 a total of 123.4 million congregate meals were provided and 119 million home-delivered meals;
• Title III federal expenditures reported by states totaled $673 million; and,

• Title III federal funds comprised 39% of the total service expenditures reported by the Aging Network in 1995.

• A total of 6,397 senior centers were supported by Title III funds:

• A total of 564 long-term care ombudsman program entities were in place;

• A total of 1,182 staff in state units on aging were supported with Title III funds, 32% of total state unit on agency staffing.

• A total of 9,110 area agency on aging staff were supported by Title III funds, 48% of the total paid area agency on aging staff.

Three services account for the majority of OAA funding, congregate meals, home-delivered meals and transportation. In 1995 Title III federal expenditures for congregate meals reached $250 million and $134 million for home-delivered meals. Transportation is the third largest services in terms of Title III funding, $63 million. Together these three services account for 66% of the total Title III federal funding.

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Profile of Clients Served

In 1995, the Title III program provided services to an estimated 7,453,575 persons, approximately 16% of the population age 60 and over in the U.S. This estimate takes into account all services supported by Title III funds in the state. Five states (California, New York, New Jersey, Illinois and Michigan) account for 34% of the total persons served. These five states have 29% of the population aged 60 and over in the U.S. in 1995. The five states reporting the highest percent of the 60+ population served by OAA programs include Wyoming (64%), New Mexico (44%) Alaska (44%) North Dakota (43%) and Utah (39%). Twenty -three states report 20% or more of their population aged 60 and over were served through OAA supported programs.

Of the total participant population served, 1,497,916 persons were reported to be minority participants (20.1%). The distribution by race and ethnicity is estimated to be as follows:

Figure 1. Minority Participants

California, New York, New Jersey, Texas and Illinois account for 39% of the minority participants. All but three states had a percentage of minority clients served which was equal to or greater than the percentage of the total 60+ minority population in the state.

States reporting the highest percentage of minority participants include Hawaii (75%), Mississippi (47%), New Mexico (45%), and South Carolina (45%). Puerto Rico reports 100% of its participants are minority and the District of Columbia reports 82.1%. Approximately 55% of the total minority participants are African-American with 29% being Hispanic-origin.

An estimated 39% of the total participants have incomes at or below the federal poverty threshold. Among states, the poverty participant rate ranged from a low of 17.2% to a high of 86.9%. Of those below poverty, approximately 32% are minority participants. Low-income, minority participants comprise 12.5% of the total participant population. States with the highest percentage of poverty level participants included Mississippi (86.9%), Oklahoma (68.8%) and Texas (68.7%). The District of Columbia reports 88.5%. Mississippi has the highest percentage of participants who are both in poverty and minority (44.3%). Twelve states report that at least one-half of the participants have incomes at or below the poverty threshold.

When the profile of clients served is compared to the state 60+ population, based on poverty characteristics, every state is clearly targeting poverty clients. For the U.S., in 1989, the Census reports approximately 12% of the 60+ population with incomes at or below poverty. Each state reported a substantially higher percentage of poverty clients than the equivalent percentage of the 60+ population in the state whose incomes fell at or below the poverty threshold. The same is true for targeting of minority persons whose income is below poverty.

An estimated 2.6 million participants live in rural areas (35%). A total of 20 states have at least 50% or more of the total Title III participants who live in rural areas. States with the highest percentage of rural participants include Wyoming (100%), Mississippi (84.6%), Montana (80.9%), and Vermont (78.8%). States reporting the lowest percentage of rural residents include Tennessee (6.4%), Rhode Island (7.9%), Connecticut (7.1%), Massachusetts (11.1%) and California (11.9%).

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Service Provision

Beginning in 1995 the SPR service reporting was changed. As already noted, the list of services individually reported was reduced from thirty to fourteen. States have different service priorities for Title III funding so the mix of services and level of funding for services varies somewhat from one state to another. States could, at their option, provide information on other services supported by Title III and VII funding.

A. Scope of Services

Most states provide the majority of the listed services. To show the extent of service coverage, see Figure 3.

Figure 3. Scope of Services Supported by Older Americans Act

* Includes Puerto Rico and the District of Columbia

Five states indicate all fourteen services are provided in their state plus other services as well. Fifty-eight percent of the states fund at least 13 of the listed services and/or other services. No state reported providing less than eight of the listed services. Five states, Delaware, Indiana, Michigan, Oklahoma, and Oregon did not provide any "other" services with Title III funding support. Looking at service support from a different perspective, the number of states using Title III funds to support each listed service is shown in Figure 4.

Figure 4: State Support for Selected Services

As expected, all the states provide home-delivered and congregate meals. All of the states operate a long-term care ombudsman program supported by the OAA. In 1995, for the U.S., there were a total of 564 designated local ombudsman entities and a total of 1,546 paid staff (full time equivalents) as well a 6,428 certified volunteers.

B. Levels of Service Provision

Levels of service provision vary by state due to both funding levels and service priorities. The profile of service units is summarized in Figure 5.

Figure 5. Levels of Service Provision

Levels of service use by individual participants were examined for the nine registered services. Considerable variation exists from state to state. See Figure 6.

Figure 6. Units per Participant for FY1995

* Note: The District of Columbia estimates 213 units per person for home delivered meals and 286 units per person for homemaker. Puerto Rico reports 223 units per person for congregate meals.

States use Title III funds to provide services other than those individually reported to AoA. At the option of each state, information can be provided on these other services. The range of services optionally reported is extensive including such diverse services as benefits counseling, senior center activities, health promotion, home repair and modification, telephone reassurance, friendly visiting, adaptive/assistive technology, volunteer services coordination and more.

C. Service Providers

For the first time, the Title III State Program Report contains summary information on the number and type of service providers funded with Title III funds. Information was collected on the number of providers for each of the 14 listed services. See Figure 7. Providers of other services supported by Title III funding were not identified.

Figure 7. Service Providers for Selected OAA Supported Services

In 1995, AoA collected information on minority providers. It should be pointed out that Puerto Rico alone accounts for 94 minority providers in all but three services (case management, information and assistance and outreach) where Puerto Rico reports seven minority providers. The District of Columbia also has a high percentage of minority providers. In Figure 7 the count of minority providers is shown both with and without Puerto Rico and the District of Columbia.

As Figure 7 shows, the greatest number of providers are meals providers, closely followed by transportation providers. Some of the meal providers are likely to provide both home-delivered and congregate meals under Title III. Likewise, providers are likely to be funded to provide more than one home and community-based service.

Based on the reported data, the average level of service offered by a Title III supported provider is relatively small. Two indicators were developed to establish the level of service of Title III-funded providers: 1) average service units and average number of clients. See Figure 8.

Figure 8. Size of Provider Operations Supported in Whole or Part by Title III

* Data on persons served are not collected for these services.

In certain cases area agencies on aging choose to provide services directly rather than issue a contract with providers. The absence of a viable local provider is often the reason. In other cases, direct service provision helps the area agency on aging ensure a vital feature of home and community-based care is in place; for example, the presence of an independent, objective case management service. See Figure 9 for a profile of AAA direct services provision.

Almost one-third of the AAAs are involved in the direct provision of congregate meals (31%). Thirty percent of the AAAs are directly providing home-delivered meals. AAAs are also likely to provide access services directly. Of all the AAAs, 36% are providing some form of case management directly and 61% provided information and assistance services and 40% are involved in outreach activities.

Looking at AAAs as a percentage of total providers, AAAs represent almost a third of the case management providers (29%). By contrast, AAAs represent less than 5% of the providers of personal care, homemaker, adult day care, transportation and assisted transportation.

Figure 9. Area Agency on Aging Service Provision, By Service

D. Senior Centers and Focal Points

Title III funds are an important source of support for senior centers. Every year states report on the number of focal points designated in the state, the number of senior centers considered focal points and the number of senior centers supported by the Older Americans Act.

In 1995 for the U.S. a total of 11, 463 senior centers were identified by states. Of those 6,397 were supported by OAA funding (55.8%). States report a total of 8,341 designated focal points. Seventy-five percent of the focal points are senior centers. For the U.S. there were a reported 1.85 senior centers for every 10,000 persons age 60 and over in 1995. States with the highest percent of senior centers per 10,000 residents include Alabama (52 per 10,000 persons 60 and over), New York (27/10,000) and North Dakota (17/10,000).

Several states report that all of their senior centers receive some level of Title III support. They include Alaska, Alabama, Arizona, Arkansas, Maryland, Missouri, Pennsylvania, Utah, West Virginia and Wyoming. By contrast three states report none of the senior centers in the state received Title III funding -- Delaware, Idaho, and New Hampshire.

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Service Expenditures

A. OAA Appropriations for State and Community and Tribal Programs

In 1965, total OAA funding was small and little funding was available for services provision, approximately $5 million. However, in 1972 Congress enacted the Nutrition Program for the Elderly and made available in 1973 $167 million in grants for state and community programs. By 1973 there were 30 million persons age 60 and over in the U.S. For 1973, OAA service funding amounted to $5.44 per person age 60 and over. Since 1973 OAA funding for state and community programs has steadily increased. By 1995 OAA funding for state and community programs had increased four fold over the 1973 funding level. Despite these increases the effects of inflation and population growth diminished the actual impact of the increases in the annual OAA appropriation for state and community programs. See Figure 10 for an analysis of actual appropriations relative to the 1973 benchmark appropriation.

Figure 10. Analysis of OAA Appropriations for State and Community and Tribal Programs

Taking into account both annual inflation, as measured by the CPI, and net increases in the 60 and over population, the 1995 appropriation for state and community programs should have been $1.7 billion dollars to maintain parity with the 1973 funding level. Adjusting for inflation, per capita appropriations should have been $39 per person in 1995. Actual per capita funding was $19 per person. As a result actual appropriations have shrunk by just over 50% relative to the equivalent level in 1973. (NOTE: Figure 11 not shown in html version.)

B. Expenditures by Service

Total federal Title III expenditures for 1995 reported by states were $673 million. Typically Title III expenditures represent but a portion of the total expenditures for services supported through the OAA. State units on aging, area agencies on aging and service providers are able to leverage the federal Title III funding in the form of match resources, program income, and other state and federal funding sources. Total services expenditures for OAA supported services are estimated to be $1.714 billion for 1995. Title III federal expenditures in 1995 were 39% of the total service expenditures which were either contractually or administratively linked to Title III funding.

Beginning in 1995, AoA is examining service expenditures by service category. Fourteen listed services are divided into three categories (clusters) plus an "other category. Cluster 1 services include personal care, homemaker, chore, home-delivered meals, adult day care/health and case management. Cluster 2 services include congregate meals, nutrition counseling and assisted transportation. Cluster 3 services include information and assistance, transportation, legal assistance, nutrition education and outreach.

As can be seen in Figure 12 below, the 14 listed services account for the large majority of federal Title III expenditures (87.8%). The same 14 services account for 88.5% of total services expenditures reported by states.

Figure 12. Title III Expenditures by Service, U.S.

*See definitions in Appendix II of the full report for an explanation of total service expenditures.

Cluster one services account for approximately 30% of the Title III expenditures. Registered services (clusters 1 and 2 services) account for two thirds (67%) of Title III expenditures.

Data were collected on total services expenditures and the portion of total service funding provided through Title III. Figure 12 data show that Title III expenditures are approximately 40% of the total expenditures. Some services rely more heavily on Title III funding to cover the costs of services. Title III funding for nutrition education approaches 70% for the U.S. Approximately 56% of the nutrition counseling expenditures are attributable to Title III. By contrast Title III funding covers only 13% of the total services expenditures for personal care.

Figure 14. Distribution of Title III Funding by Service Category and Cluster

There are notable differences in the distribution of Title III funding by service cluster and individual service by state. Figure 14 shows the variation.

Delaware leads all states in funding for cluster 1 services (65%), while Kansas tops all states in funding for cluster 2 services (66%) and Maine leads in funding for cluster 3 services (45%). Besides Pennsylvania, three other states spend more than 20% of Title III funds for other services -- Vermont (34.86%), Arizona (34.6%) and New Jersey (20.72%).

Pennsylvania puts most of the "other" services expenditures toward senior centers reporting Title III expenditures of approximately $12 million. The Pennsylvania senior centers report serving approximately 194,000 persons and providing over 7.3 million client days of service. By contrast, Vermont lists 22 different "other" services that are supported by Title III funds ranging from assistive technology to utility assistance.

Various performance measures related to expenditures can be calculated based on the reported data. However, such measures should be used with caution. The data systems used to support Title III reporting are still under development and the data being reported are still subject to refinement. Furthermore, there are many factors which can contribute to the comparability of performance measures from one state to another such as different interpretation of service definitions, different cost determination methodologies and different cost factors which are specific to a state or region within the state. Figure 15, 16, 17 and 18 provide several basic performance measures.

Figure 15. Service Expenditure Measures, U.S.

* No data are collected on the unduplicated count of persons served for these services.

Unit costs in Figure 15 are shown for both Title III federal expenditures and total service expenditures. Unit costs are lower for Title III only because of the way the unit data are reported. States were asked to report total service units associated with total service expenditures, not just those attributable to the federal Title III resources used in the provision of the services. The unit costs, as calculated, reflect new service definitions and refined unit definitions introduced in 1995 by AoA and should be used with caution. Unit costs based on total service expenditures are the most useful performance measure for state comparison purposes. State and area agencies may only use small amounts of Title III funds to support a particular service. As a result, unit costs based on Title III expenditures reflect as much or more the funding strategies of the Aging Network as they do the relative efficiency of the service providers.

Figure 16. Unit Costs (Excluding Upper and Lower 5% of the Reported Unit Costs)

There is substantial variation in unit costs based on total service expenditures across states for individual services. The extent of variation depends on the service. Outliers exist; some of which may be reporting inconsistencies. To compensate for the outliers (both high and low) the unit costs were reviewed by computing both the standard deviation and the variance. The results of this analysis are summarized in Figure 16.

To address outliers, the data in Figure 16 for mean, median and standard deviation exclude the upper and lower 5% of the reported unit cost data, basically the two states with the most extreme values. The average unit cost includes all states. It should also be noted that average unit costs reported in Figure 14 were computed using the total service expenditures for the service for the U.S. and the total reported units for all states. The mean and median unit costs are based on the average unit costs computed for each state. Except for meal services, there remains considerable variation in reported total unit costs by service.

A similar profile was developed for another basic performance measure -- units per person served. The results are summarized below in Figure 17. The data in Figure 17 are organized and computed in the same way as the data in Figure 16. The variance is substantial for units per person.

Figure 17. Units Per Person Served (Excluded Upper and Lower 5%)

Another expenditure measure is the average level of funding for providers of individual services. See Figure 18.

Average Title III expenditures per provider are quite low except for home-delivered meals and congregate meals. Even the total service expenditures are relatively small for most services. While the average expenditures per provider are small, on a service specific basis, it is likely that many of the providers offer more than one service. Consequently the expenditures per provider, considering all services they provide, is likely to be higher.

Figure 18. Average Expenditures Per Provider, U.S.

Differences in average expenditures per provider are attributable to both available levels of funding and different approaches to use of providers. One area agency on aging may choose to bundle funding for a service or a group of contracts into a single contract. Another area agency on aging may find it necessary to award several contracts, in lesser amounts, to account for such issues as access issues and cultural diversity of the participants.

C. Generation of Program Income

OAA-supported programs have historically benefited from substantial generation of program income. Until 1995 program income has been reported in aggregate. For 1995 data on program income are identified by individual service. Both home-delivered meals and congregate meals stand out in terms of development of program income. For the balance of the services, program income is a small portion of the total revenues used to support services operations. In terms of program reporting, 1995 is the first year that states reported program income by specific service. In the past, program income has only been reported by Title III Part -- III B, C1, C2 etc. For this first year, no attempt has been made to reconcile the program income reported by states in their quarterly financial reports with the annual program report data reported here.

Based on fiscal (SF269) data, states generated approximately $200 million in program income from Title III related grant activities. The breakdown by Title III part, excluding Part F, was:

• Title III B. Supportive Services -- $30,898,999
• Title III C.1. Congregate Meals -- $98,503,924
• Title III C.2. Home-Delivered Meals -- $70,074,608
• Title III D. In-Home Services -- $7,427,249

Figure 19. Program Income by Type of Home/Community Service

For all but home-delivered meals and congregate meals, the level of program income generated relative to the Title III expenditures appears quite limited, 1-2% of Federal Title III funding.

D. Expenditures by Part

Individual Parts of Title III of the OAA have specific legislative mandates that identify the nature of services to be supported. Titles C1 and C2 are for nutrition related-services, Title III B for supportive services and centers, Title III D for in-home services and III F for preventive health services. In 1995, total U.S. Title III expenditures by part were reported to be:

• Title III B -- 37%
• Title III C1 -- 39%
• Title III C2 -- 20.1%
• Title III D -- 1.1%
• Title III F -- 2.0%

Another way to look at expenditures by part is to determine the distribution of expenditures for each Title III part by service; for example the percent of Title III B expenditures used for personal care. See Figure 20.

Figure 20. Distribution of Expenditures by Part for Each Service

Part III B and D funding predictably fund cluster 1 services other than home-delivered meals. Cluster 2 services are supported principally by Title III C 1 funds and Cluster 3 services are largely funded through Title III B funding.

As Figure 20 shows, the fourteen services account for 74% of the expenditures supported by Part III B versus 99% of III C1 funding, 99% of C2 funding, 79% of Part D funding and 17% of Part F funding. The greatest amount of Title III B is used for transportation and a range of "other" services. Case management and I&A comprise 20% of Title III B funding.

E. Transfers

Each state has a transfer authority which permits states to transfer funding between Title III, Parts B (supportive services), Subpart C-1 (congregate nutrition services) and Subpart C-2 (home-delivered nutrition services) with certain limitations specified in the law. For FY1995, no more than 30% may be transferred between Subparts C-1 and C-2 and no more than 25% may be transferred between Part B and Part C. A state may request a waiver from the AoA to increase the amounts transferred. In this report the focus is on transfers between Title III B (supportive services), Title III C1 (congregate meals) and Title C2 (home-delivered meals). See Figure 21.

Figure 21. 1995 Transfers between Title III Subparts, U.S. Summary

Source: AoA, Division of Grants Management, 1996.

As can be seen, Subpart transfers, in aggregate, are principally between Title III C1 and Title III C2. All but four states (including D.C. and Puerto Rico) transferred funds out of Title III C1. The highest transfer percentages were for the following states:

• To Title III B -- Minnesota (33% increase)
• Twenty-six states were able to double Title III C2 funding through transfers.

No state transferred funding to Title III C1.

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Aging Network Staffing

In each state there is a designated state unit on aging responsible for administering the Older Americans Act. The OAA funding pays for state unit on aging staffing to carry out administrative, development, advocacy and related activities. Area agencies on aging are funded to perform similar activities within planning and service areas of the state. Forty-four states, including Puerto Rico, have designated planning and service areas. In 1995 there were 655 area agencies on aging.

In many states, the state unit on aging and the area agencies on aging have assumed additional responsibilities for aging services programs. Over half the state units on aging have a role in administration of a Medicaid waiver program. Many state units administer state-funded programs that support the provision of home and community-based care services. As a result, the total staffing of state units on aging is frequently substantially more than the staff paid for with the OAA funding. Many area anagencies on aging have similar staffing arrangements.

In 1995 data were collected on the staffing profile of both state units on aging and area agencies on aging. In aggregate, state units on aging report a total of 3,676 staff. Of those, 32% are supported by Title III funds. Of the total staff, 17% are minority and 83% are paid professional staff. Few state units report the use of volunteers. The state staffing profile by functional responsibility is shown in Figure 22.

Figure 22. State Unit on Aging Staffing, All States

* Includes planning, development, administration, and other professional staff assigned to management and administrative responsibilities.

Approximately 31% of the SUA staff are reported to be providing access/care coordination or direct services. This is almost exactly the same percentage of area agency on aging staff who are reported to be providing access/care coordination services and/or direct services. It should be noted that Alaska accounts for 55% of the total state agencies on aging staff reported to be involved in direct service provision. Alaska is a single PSA state with no area agencies on aging. Arizona reports a high number of staff in direct services provision (134) as well. In Arizona, these staff are responsible for adult protective services.

Twenty-seven states report staff involved in direct services provision (e.g., transportation and meals.) Twenty-nine states report staff involved in the provision of access/care coordination functions.

Looking at paid staff, ten states report more than 100 full time equivalent staff -- Alaska, Arizona, California, Florida, Illinois, Missouri, New Hampshire, New York, Ohio, and Pennsylvania.

For comparison purposes, a similar staffing profile has been prepared in Figure 23 for area agencies on aging. There were 655 identified area agencies on aging in 1995.

Figure 23. Area Agency on Aging Staffing, All States

* Includes planning, development, administration, and other professional staff assigned to management and administrative responsibilities.

Area agencies on aging report a total of 38,958 staff. Of this total, 52% are volunteers. There were 18,821 paid area agency on aging staff. Of the total staff, 23% are paid by Title III and 15% are minority staff. Looking just at paid staff, 48% of the staff are supported by Title III funding.

At the AAA level, almost 30% of the staff are either providing access/care coordination services or other home and community services such as meals and transportation. Of the 11,341 staff involved in the provision of access/care coordination or direct services, a total of 3,219 are providing access services and 8,122 are providing direct services.

Of the total staff involved in access/care coordination and direct services delivery, Title III funds 44% of the staff -- less than what Title III pays for administrative/developmental staffing of area agencies on aging. Of the total staff, 3% are considered executive/management personnel. Taking out volunteers, executive/management personnel comprise 7% of the total staff.

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Developmental Accomplishments

State and area agency on aging staff are a primary source of development and advocacy on issues affecting the elderly in every state. States are required to report on three significant developmental accomplishments in each of two areas: 1) development of home and community-based programs and 2) development of systems of elder rights. Clearly, the Aging Network in each state is responsible for many different developmental initiatives each year. As such, the data on developmental accomplishments submitted by states is not a complete inventory of Aging Network accomplishments. The accomplishments which are reported are those considered as important achievements and provide a sense of the diversity and type of developmental accomplishments of the Aging Network in each state.

As an overview, examples of the developmental accomplishments are summarized below in each of the two major categories of development:

A. Home and Community-Based Programs

Development of enhanced home and community-based services is a continuing priority of the national Network on Aging. A diverse set of developmental activities was pursued with many successes and accomplishments. Seven different types of development activities were used to classify developmental accomplishments related to home and community-based care: they were:

1. Public Education/Awareness
2. Resource Development
3. Training/Education
4. Research and Development
5. Policy Development
6. Legislative Development
7. Other

Of those states reporting developmental accomplishments accompanied by codes for developmental type, almost half of the states reporting had accomplishments which were consider either public education or resource development in nature. About 30% of the states reporting indicated accomplishments which were training and education or research and development projects; Policy development was also an activity in which 30% of the states reported accomplishments. Few states singled out legislative accomplishments during 1995, although some states reported what were essentially legislative activities under the resource development category.

Examples of developmental accomplishments by category and type of assistance include the following:

Public Education/Awareness

• New Mexico initiated a three-part Alzheimer's Disease Program: respite, consultation, and information and referral through an 800 number.
• Puerto Rico developed a health promotion/disease prevention program including 8 radio programs, a teleconference, 2 health campaign promotions and a training session.

Resource Development

• South Carolina continued its senior center development initiative, adding $1 million in state funds to support the development of three new centers in 1995.
• Utah applied for and received Medicaid Waiver renewal, including provision for two new services - companion services and respite care outside the home.
• Iowa's successful advocacy with the General Assembly expanded the case management program by 35% allowing it to expand into additional counties.
• Nevada obtained increased funding from $72,000 to $320,000 for home and community -based services.

Training/Education

• Kansas convened a conference on managed long-term care.
• North Carolina co-sponsored a six-day workshop series entitled " Improving the Management and Supervision of In-Home Aide Services".
• Oklahoma trained and certified 600 OAA network staff in the implementation of the Uniform Comprehensive Assessment Tool as its single entry tool.

Research and Development

• Florida developed a screening and counseling program utilizing audiologists to conduct screening sessions in 14 counties, 269 seniors were screened, and 90 clients received volume control telephones from Florida Telecommunications Relay.
• North Carolina implemented a pilot project in two counties to establish a single point of entry for non-Medicaid eligible older adults who are at risk of out of home placement.
• Virginia began the development of the Virginia Aging Information System with three components - client assessment, service utilization and service spending.
• North Dakota developed a computerized Title III service assessment to assess quality in service delivery.
• South Dakota developed an Intervention Care Program designed to respond to families and individuals that need overnight care after a brief illness or hospitalization.

Policy Development

• Nevada implemented a Group Care Waiver Program, providing support services in group homes for older adults at risk of nursing home care.
• Arkansas developed regulations for assisted -living facilities.
• Kentucky developed and implemented an adult day care certification process.

Legislative Development

• Missouri developed the Elderly Health and Nutrition Act that is designed to stimulate collaboration among state and private agencies.
• Virginia conducted a study for the state legislature on the feasibility of developing a program using volunteers to assist older adults in time of crisis.

Other

• Ohio Department of Aging eliminated the Medicaid Waiver waiting list. ODA served 15,282 clients and ended the year with 10,000 active clients.

Figure 24. Developmental Accomplishments for Home and Community -Based Care, By Development Type

B. System of Elder Rights

The Older Americans Act encourages the development of improved systems of elder rights. States enhance elder rights through a number of services such as the long-term care ombudsman programs, legal assistance, benefits counseling and programs addressing abuse and neglect. Many states are active in the promotion of improved service delivery for elder rights. The accomplishments focus on activities undertaken to prevent abuse and neglect and to uphold/advocate for the rights of older adults.

States with accomplishments in elder rights are listed in Figure 25.

Figure 25. Developmental Accomplishments for A System of Elder Rights, By Development Type

Examples of state initiatives are reported by category.

Public Education/Awareness

• Connecticut's information and referral program implemented the BOSS System to screen and determine eligibility for elders seeking benefits information,
• Hawaii developed plans and activities with the Elder Rights Section of the Hawaii Bar Association.

Resource Development

• Washington DC Office on Aging supported the establishment of an imprest fund and legal consultation fund for abused adults served by Adult Protective Services, when no other resources are available.
• Pennsylvania expanded the Abuse Intervention Program with $686,000 of state lottery funds, a 10% increase.

Training/Education

• Illinois' Statewide Elder Abuse and Neglect Program utilized multi-disciplinary teams to provide support to the program's service delivery activities.
• Pennsylvania provided Protective Services Training for all staff involved in the provision of Adult Protective Services - 700 persons attended.
• Hawaii co-sponsored a training conference for nurses aides on elder abuse and neglect, over 200 persons attended.

Research and Development

• Alabama co-chaired with the Department of Human Resources the Governor's Special Commission on Elder Abuse and submitted policy recommendations to the Governor for his consideration.
• Colorado collected statistical and descriptive data to enhance the Elder Rights System.

Policy Development

• New Mexico expanded the Qualified Medicare Beneficiary outreach efforts statewide, using simplified enrollment forms and on-site enrollment, screened approximately 2,200 persons.
• New Jersey proposed regulations for Adult Protective Services.

Legislative Development

• Nevada advocated for revision of Elder Rights Statutes. The bill was drafted by the Division Chief of Elder Rights. Division Staff discussed elder abuse issues with a variety of professionals.
• District of Columbia Office on Aging Adult Prevention Committee revised the District's Guardianship legislation.

Other

• Arkansas took over direct administration of Adult Protective Services

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Hypertext conversion by Saadia Greenberg, last revised June 10, 199