Congressional Research Service Report: 'Older Americans Act: 2020 Reauthorization'
Summary:
First enacted in 1965, the Older Americans Act (OAA) was created in response to concern by policymakers about a lack of community social services for older individuals. Since then, the OAA has been reauthorized and amended numerous times. Before 2020, the last OAA reauthorization occurred in 2016, when the Older Americans Act Reauthorization Act of 2016 (P.L. 114-144) was enacted, which extended the act's authorizations of appropriations through FY2019 (authorizations of appropriations for most OAA programs had expired after
The OAA supports a wide range of social services and programs for individuals aged 60 years or older. These programs and services include supportive services and funding for senior centers, congregate nutrition services (i.e., meals served at group sites such as senior centers, community centers, schools, churches, and senior housing complexes), home-delivered nutrition services (sometimes informally referred to as "meals on wheels"), family caregiver support, community service employment, the Long-Term Care Ombudsman Program, and services to prevent the abuse, neglect, and exploitation of older persons. Except for the programs and activities authorized under Title V, Community Service Employment for Older Americans (CSEOA), all other programs and activities are administered by the
In the 116th
* specific disease prevention and health promotion activities, such as fall-related injuries and social isolation;
* modifications to nutrition services programs to call attention to malnutrition;
* changes to the National Family Caregiver Support Program to include caregiver assessments;
* best practices and technical assistance;
* changes to the Title III statutory funding formula for certain programs; and
* dedicated funding for a supportive services program for
This report provides an analysis of P.L. 116-131, the Supporting Older Americans Act of 2020, and discusses key reauthorization amendments. It also presents a brief summary of the act's historical development and a section-by-section summary of the provisions contained in P.L. 116-131. Appendix A provides additional information about deadlines and effective dates for implementing provisions under P.L. 116-131; and Appendix B lists the authorizations of appropriations under the act.
Introduction
Originally enacted in 1965, the Older Americans Act (OAA) supports a wide range of social services and programs for individuals aged 60 years or older./1
These programs and services include home-delivered nutrition services, congregate nutrition services,/2 supportive services such as transportation and home care services, family caregiver support, community service employment, the Long-Term Care Ombudsman Program, and services to prevent the abuse, neglect, and exploitation of older persons. Except for programs and activities authorized under Title V, Community Service Employment for Older Americans (CSEOA), all programs and activities are administered by the
The OAA has been reauthorized and amended numerous times. Most recently, on
Prior to the FY2020 reauthorization, the last OAA reauthorization occurred in 2016, when the Older Americans Act Reauthorization Act of 2016 (P.L. 114-144) was enacted.
P.L. 114-144 extended the OAA's authorizations of appropriations through FY2019 (authorizations of appropriations for most OAA programs had expired after
OAA-authorized activities continued to receive annual discretionary appropriations for FY2020. This report provides a legislative timeline for reauthorization, as well as an analysis of key reauthorization issues. This is followed by a brief summary of the OAA's historical development.
Next, it provides a section-by-section summary of P.L. 116-131, the Supporting Older Americans Act of 2020. Appendix A provides additional information about deadlines, reporting requirements, expiring provisions, and other effective dates for implementing provisions under P.L. 116-131. Appendix B lists the authorizations of appropriations under the act./4
As used in this report, the term Secretary refers to the Secretary of
Older Americans Act: Reauthorization Timeline and
This section provides the legislative timeline for OAA reauthorization in the 116th
Reauthorization Timeline
In the 116th
On
On
Rather than amend the
Key OAA reauthorization issues for policymakers and stakeholders included amending the act to address a range of health promotion and disease prevention activities, such as chronic disease self-management and falls prevention, as well as addressing the negative effects of social isolation among older individuals. Policymakers focused on other reauthorization issues as well, including changes to nutrition services programs and to programs that provide support to family caregivers. In addition, policymakers continued to seek alternative ways to distribute Title III funding through the statutory funding formula for certain programs and established a new program authority for supportive services to
Health Promotion and Disease Prevention
The OAA seeks to promote the health and wellness of older individuals by supporting healthy lifestyles and behaviors. In addition, the OAA includes a number of grant authorities and other activities that address disease management and preventive services to assist older individuals in maintaining their quality of life and potentially avoiding more costly medical interventions. For example, evidence-based chronic disease self-management programs provide older individuals with education and tools to help them manage chronic conditions such as arthritis, asthma, depression, diabetes, lung disease, heart disease, stroke, and osteoporosis, among others./7
P.L. 116-131 makes several changes to the OAA to further promote healthy lifestyles and behaviors among older individuals and to promote evidence-based disease prevention activities.
For example, the law amends the definition of disease prevention and health promotion services to include screening for immunization status, suicide risk, fall-related traumatic brain injury and other fall-related injuries, and social isolation. The amended definition of disease prevention and health promotion services includes infectious disease and vaccine-preventable disease, prevention of sexually transmitted diseases, and chronic pain management as evidence-based health promotion programs. P.L. 116-131 further defines new terms such as "person-centered, traumainformed" and "traumatic brain injury." Under the OAA Title III Supportive Services and Senior Centers Program, P.L. 116-131 authorizes states to provide screening for negative health effects associated with social isolation and traumatic brain injury, and to provide services that promote or support social connectedness and reduce social isolation. And, under OAA Title IV for training, research, and demonstration projects in the field of aging, the law includes evidence-based falls prevention, chronic disease self-management programs, addressing social isolation, and public awareness of traumatic brain injury among the list of authorized grant activities. P.L. 116-131 further amends OAA Title IV to add language authorizing the establishment and operation of a national resource center focusing on older individuals experiencing trauma. In addition, the law requires separate studies on the negative health effects of social isolation and on federal programs that support falls prevention, home assessments, and home modifications.
Nutrition Services
The Nutrition Services Program, authorized under OAA Title III, provides grants to states and
P.L. 116-131 makes several changes to the OAA to clarify standards and make further improvements to the nutrition programs. It amends OAA Title II to specify that the officer or employee responsible for federal administration of the Nutrition Services Program be a registered dietician or registered dietician nutritionist. Under OAA Title III, the law includes reducing malnutrition as a purpose of the Nutrition Services Program and similarly includes screening for malnutrition in the definition of disease prevention and health promotion services. P.L. 116-131 specifies that meals adjusted to meet special dietary needs should include those adjusted for cultural considerations and preferences and medically tailored meals.
With respect to the states' authority to transfer funds between nutrition programs under OAA Title III, P.L. 116-131 further requires states to ensure that transfers are done in a manner that reduces administrative barriers and directs limited resources to the greatest nutrition service needs at the community level. The law also directs the Assistant Secretary to perform a study to assess how to measure and evaluate the discrepancy between available services and the demand for such services in the Nutrition Services Program.
Family Caregiving
OAA Title III authorizes the National Family Caregiver Support Program (NFCSP), a formula grant program available to states and
Caregiving issues were of particular interest to policymakers in this OAA reauthorization. P.L. 116-131 amends the NFCSP to include caregiver assessments as a defined process of gathering information to identify the specific needs and barriers to caregiving, as well as identifying existing supports to appropriately target program services. Such assessments may be used to inform the resources and services provided to caregivers. P.L. 116-131 requires the Assistant Secretary to provide technical assistance on the use of caregiver assessments and to include caregiver assessments in certain reporting requirements. It also requires the Assistant Secretary to issue a report to
The reauthorization also includes provisions to address specific populations of caregivers and makes amendments to other caregiving statutes that broadly address caregiving issues.
Specifically, it amends OAA Title III to address younger onset Alzheimer's disease by specifying that caregivers can care for individuals of any age with Alzheimer's disease. It also removes NFCSP's funding cap for support services to older relative caregivers of children and young adults with severe disabilities. P.L. 116-131 extends the sunset date for the advisory council established under the Supporting Grandparents Raising Grandchildren Act (P.L. 115-196) by one year, until
Statutory Funding Formula
Similar to past OAA reauthorizations, changes to the OAA Title III funding formula were of interest to policymakers.
To address this issue, P.L. 116-131 eliminates the hold harmless provision for two programs--(1) Home-Delivered Nutrition Services and (2) Disease Prevention and Health Promotion Services-- beginning in FY2020. It also changes the funding formula calculation for two programs--(1) Supportive Services and Senior Centers and (2) Congregate Nutrition Services--over a 10-year period from FY2020 to FY2029. For these two programs, the law establishes one methodology that goes into effect when the amount of funding available under the program for grants to states and territories in a given year is less than or equal to the amount available for FY2019. It establishes an alternate grant allocation methodology that takes effect when the amount of funding available for grants to states and territories in a given year exceeds the amount available for FY2019. For FY2030, it eliminates the hold harmless provision for Supportive Services and Senior Centers and Congregate Meals, effective
Older Americans Act:
First enacted in 1965, the Older Americans Act (OAA) was created in response to concern by policymakers about a lack of community social services for older individuals. The original legislation established authority for grants to states for community planning and social services, research and development projects, and personnel training in the field of aging. The law also established the
Although older individuals may receive services under many other federal programs, today the OAA is considered the major vehicle for the organization and delivery of social and nutrition services to this population. The act authorizes a wide array of service programs through a nationwide network of State Units on Aging (SUAs), Area Agencies on Aging (AAAs), and tribal organizations, as well as thousands of aging and social service providers in local communities.
For example, Title III programs provide grants to SUAs, who in turn fund local AAAs to act as advocates on behalf of and to coordinate home-delivered meals, homemaker and chore services, and disease prevention and health promotion programs for older persons, among other activities.
The act also supports the sole federal job program targeting low-income older workers and funds training, research, and demonstration activities in the field of aging.
Prior to the enactment of the OAA in 1965, older persons were eligible for limited social services through some federal programs. However, with the recognition that older individuals were becoming a larger proportion of the population and that their needs were not being formally addressed through existing federal programs, many groups began advocating on their behalf.
Their actions led
Further interest in the field of aging led
In response to the
The OAA as introduced in 1965 paralleled the 1963 proposal. Sponsors emphasized how it would provide resources necessary for public and private social service providers to meet the social service needs of the elderly. The act received bipartisan support and was signed into law by President
Major Amendments to the Older Americans Act
Since the original legislation was enacted in 1965, the OAA has been amended numerous times. The following section provides a summary of major amendments to the OAA over the past six decades.
1960s
The first amendments to the act in 1967 (P.L. 90-42) extended authorization for the state grant program and for research, demonstration, and training programs created in 1965. In 1969, authority was added under P.L. 91-69 for a program of area-wide model projects to test new and varied approaches to meet the social service needs of the elderly. The 1969 amendments also authorized the foster grandparent and retired senior volunteer programs to provide part-time volunteer opportunities for the elderly. (Authority for volunteer programs under the OAA was repealed by P.L. 91-69. These programs were subsequently authorized under the Domestic Volunteer Service Act of 1973, P.L. 93-113.)
1970s
Major amendments to the act occurred in 1972 with the creation of the national nutrition program for the elderly (P.L. 92-258). The 1973 amendments (P.L. 93-29) represented a major shift in federal law, with the establishment of sub-state Area Agencies on Aging (AAAs). For the first time, the act authorized the creation of local agencies whose purpose is to plan and coordinate services for older persons and to act as advocates for programs on their behalf. These amendments also created legislative authority for the community service employment program for older Americans that had previously operated as a demonstration initiative under the Economic Opportunity Act. In 1974,
The 1978 amendments (P.L. 95-478) made major structural changes to the act by consolidating previously separate grant programs for social services, nutrition services, and multipurpose senior center facilities into one program under the administration of SUAs and AAAs. The intent of these amendments was to improve coordination among the various service programs under the act. Among other changes were requirements for establishing state long-term care ombudsman programs and a new Title VI that authorized grants to Indian tribal organizations for social and nutrition services to older
1980s
The 1981 amendments (P.L. 97-115) made modifications to give SUAs and AAAs more flexibility in the administration of their service programs. These amendments also emphasized the transition of participants to private sector employment under the community service employment program. In 1984,
The 1987 amendments (P.L. 100-175) expanded certain service components of SUAs and AAAs to address the special needs of certain populations.
1990s
The 1992 amendments (P.L. 102-375) restructured some of the act's programs. A new Title VII, Vulnerable Elder Rights Protection Activities, was created to consolidate and expand certain programs that focus on protection of the rights of older persons. Title VII incorporated separate authorizations of appropriations for the long-term care ombudsman program; the 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. In addition, provisions were included to strengthen requirements related to targeting of Title III services on special population groups. Other amendments authorized programs for assistance to caregivers of the frail elderly, clarified the role of Title III agencies in working with the for-profit sector, and required improvements in AOA data collection.
In 1993, the OAA was amended (P.L. 103-171) to establish an Assistant Secretary for Aging (formerly the Commissioner on Aging) within HHS, to extend the time frame for convening the
2000s
The 2000 amendments (P.L. 106-501) were enacted after six years of congressional debate on reauthorization. P.L. 106-501 extended the act's authorizations of appropriations for programs through FY2005. These amendments authorized the National Family Caregiver Support Program under Title III; required the Secretary of Labor to establish performance measures for the senior community service employment program; allowed states to impose cost-sharing for certain Title III services older persons receive while retaining authority for voluntary contributions by older persons toward the costs of services; and consolidated a number of previously separately authorized programs. In addition, the amendments required the President to convene a
In 2003, the OAA was amended (P.L. 108-7) to revise provisions for the Nutrition Services Incentive Program, whereby access to commodities within
The 2006 amendments (P.L. 109-365) extended the act's authorizations of appropriations for programs and activities through FY2011. Among other things, P.L. 109-365 authorized the Assistant Secretary for Aging to designate an individual within AOA to be responsible for prevention of elder abuse, neglect, and exploitation and to coordinate federal elder justice activities. It revised the formula for the allocation of certain Title III funds and revised the Title V community service employment program to place more emphasis on training of older individuals, while maintaining emphasis on placing them in community service activities. The law also required the Secretary of Labor to conduct a national competition for Title V funds every four years. In addition, the 2006 amendments required states to conduct increased planning efforts related to the growing number of older people in coming decades, and focused attention on the needs of older people with limited English proficiency and those at risk of institutional placement. The law added authority for the Assistant Secretary for Aging to conduct several new demonstration programs under Title IV. Among these were demonstration projects for model projects to assist older people to age in place, including supportive services programs in Naturally Occurring Retirement Communities (NORCs).
2010s
The 2016 amendments (P.L. 114-144) were enacted after six years of congressional debate, which was framed in the context of constraints on discretionary appropriations due to a restrictive budgetary climate. As a result, policymakers and stakeholders had little interest in seeking new or significant program expansions or activities under a reauthorization. Similar to past OAA reauthorizations, P.L. 114-144 revised the formula for the allocation of certain Title III funds. The law also revised the statutory language for most OAA discretionary authorizations of appropriations to identify discrete amounts of funding rather than authorizations of "such sums as may be necessary" for a given fiscal year. In doing so, the law extended the act's authorizations of appropriations for a three-year period through FY2019. Among other things, the law provided additional flexibility to states, AAAs, and social services providers in addressing the modernization of senior centers, falls prevention, and behavioral health screening, and it codified existing practices, such as requiring "evidence-based" disease prevention and health promotion services. Furthermore, the law aligned related programs, such as the workforce programs under Title V and those under the Workforce Innovation and Opportunity Act (WIOA, P.L. 113-128), while establishing new Title V performance measures and providing states with the option to establish a combined state plan for Title V under WIOA. The law also repealed certain sections under Title IV that, at the time, did not receive funding. Other provisions clarified policy for the Long-Term Care Ombudsman Program and addressed coordination among Aging and
* * *
Footnotes:
1 OAA defines older individual as an individual who is 60 years of age or older (42 U.S.C. 3002(40)). However, under OAA Title V, Community Service Employment for Older Americans, participants aged 55 or older are eligible for program participation (42 U.S.C. 3056(a)(1), 42 U.S.C. 3056p(a)(3)(A)).
2 Congregate nutrition services are meals served at group sites such as senior centers, community centers, schools, churches, and senior housing complexes.
3 For a compilation of the Older Americans Act of 1965, as amended through P.L. 116-131, see https://acl.gov/sites/ default/files/about-acl/2020-04/Older%20Americans%20Act%20Of%201965%20as%20amended%20by%20Public%20Law%20116131%20on%203-25-2020.pdf.
4 Prior to enactment of P.L. 116-131, FY2020 discretionary appropriations for OAA programs, projects, and activities under ACL's Aging and Disability Services Programs budget authority and the
5
6 H.Rept. 116-258.
7 Administration for Community Living, "Health, Wellness, and Nutrition," https://acl.gov/programs/health-wellness.
8
9
10 Public Papers of the Presidents of
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View the text of the full report at https://crsreports.congress.gov/product/pdf/R/R46439
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