GAO report discusses “What Seniors Want”

Summary:  Administeredby the Administration on Aging (AoA) in the Department of Health andHuman Services (HHS), Title III of the Older Americans Act (OAA) isintended to assist individuals age 60 and older by providing supportiveservices. Title III, Medicaid and Medicare, state, and other sources offunding provide for several types of services, including congregate andhome-delivered meals, transportation, and support for caregivers. Thistestimony reports on ongoing GAO work in preparation for thereauthorization of the OAA and a full report to be issued by GAO in2011. Based on preliminary findings, GAO describes (1) Title IIIservices most requested by seniors and how state and local agenciesreach those most in need, and (2) how agencies have coped withincreasing requests in the current economic environment. To do this,GAO reviewed aging plans from the 50 states and District of Columbia;conducted site visits to 4 states; interviewed national, state, andlocal officials; and analyzed preliminary responses to a Web-basedsurvey of 125 Local Area Agencies on Aging for fiscal year 2009. Thesurvey data used in this document reflect a 54 percent response rate asof July 30, 2010. The survey is still in progress and our results arenot generalizable at this time. GAO shared its findings with AoA andincorporated their comments as appropriate.

Seniors frequentlyrequested home-delivered meals and transportation services, and basedon preliminary responses to GAO’s survey and information from sitevisits, demand for some Title III services may be increasing. Someagencies said they were unable to meet all requests for services infiscal year 2009. For example, 13 of 67 survey respondents said theywere generally or very unable to serve all seniors who requestedhome-delivered meals, and 15 of 63 said they were generally or veryunable to serve all who requested transportation assistance. Localofficials cite seniors’ desire to remain in their homes as they age,and the economic downturn as possible reasons for increased requests.Given this demand, providers must make decisions about which applicantswill receive services. OAA requires providers to target those with thegreatest economic and social need,–low-income, minority, lackingproficiency in English, and rural residents–and local officials saidthey advertise, conduct outreach, and coordinate with other localorganizations to identify and serve these groups. Additionally, mostlocal agencies reported screening potential clients to assess level ofneed, for example, to determine those most at risk of hospitalizationdue to poor nutrition. In addition to these known service needs, anunknown number of other seniors may need services but not know tocontact OAA providers, some officials told GAO. Local agencies whoresponded to GAO’s survey reported using the flexibility afforded bythe OAA to transfer funds among Title III programs to meet increasedrequests for specific services.

Twenty-eight of 61 local agencies saidthey transferred funds in fiscal year 2009, most often removing fundsfrom congregate meals to home-delivered meals or other services.Although the American Recovery and Reinvestment Act (Recovery Act)provided an additional $97 million specifically for meal programs,Title III programs are heavily reliant on state funds, and 44 of 64local agencies responding to our survey said their state funding wasreduced for fiscal year 2010. To cope with funding reductions, somereported cutting services to seniors. Twenty-seven of 65 local agenciessaid they cut administrative expenses in fiscal year 2010; othersrelocated offices or left agency positions vacant. Some state and localofficials said they provided less service to individuals so that morecould get some amount of assistance. Some agencies said they usedRecovery Act funds to replace lost state and local funding or creatednew programs, but the funding was restricted to meal services and was arelatively small percentage of total OAA allocations. The proportion ofAmericans age 60 and over will continue to grow over the comingdecades, and demand for Title III services also will likely grow.Therefore it will be increasingly important for service providers tofocus services on those most in need.

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