Shawnie Rechtenbaugh, Department Secretary

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long term services and supports

Older Americans Act

In response to the growing number of older people and their diverse needs, the Older Americans Act (OAA) of 1965 as amended calls for a range of programs offering services and opportunities for older Americans, especially those at risk of losing their independence.

The Older Americans Act focuses on improving the lives of older people in areas of income, housing, health, employment, retirement and community services.

Older Americans Act History

The Older Americans Act (OAA) was passed in the same year as Medicare and established the primary vehicle for organizing and delivering community-based services through a coordinated system at the state level. Initially, the Act emphasized small grants to state agencies on aging to fund social services programs. Soon after, specific funding was authorized for state planning and coordinating activities.

Through amendments in 1972, a major service component -- the national nutrition program for the elderly -- was added. Beginning in the late 1970s, several trends occurred which shifted the focus of Older American Act activities. Funds became more limited, forcing programs to deal differently with the fact that the aged population is diverse with different levels of need. Particular populations were identified as vulnerable, including frail elders, older women, minorities, rural elders and the growing number of oldest of the old individuals.

As the proportion of older frail elderly has increased, the emphasis has shifted from community-based social services for a broad population (such as senior centers, volunteer programs and recreational activities) to more health-related, long-term care services for the frail elderly who are at risk for institutionalization. Developing a community-based long-term care structure -- a new concept in the 1980s for most communities -- meant significant state and local planning and increased involvement of private and for-profit providers.

Aging Network

Administration on Aging

Through the Older Americans Act, the Administration on Aging (AoA) was established. AoA is a center under the Administration for Community Living (ACL) agency, which is within the Department of Health and Human Services (HHS). ACL is the federal agency responsible for increasing access to community supports, while focusing attention and resources on the unique needs of older Americans and people with disabilities, across the lifespan.

AoA is the federal focal point and advocate agency for older persons. In this role, AoA works to heighten awareness among other federal agencies, organizations, groups and the public about the valuable contributions older Americans made to the nation and alerts them to the needs of vulnerable, older people.

AoA works closely with its nationwide network of regional offices and state and area agencies on aging to plan, coordinate and develop community-level systems of services. AoA administers key programs at the federal level mandated under various titles of the Older Americans Act.

State Unit on Aging

Each state is required by the Older Americans Act to have a state unit on aging. South Dakota's State Unit on Aging is the South Dakota Department of Human Services' Division of Long Term Services and Supports.

The responsibilities of the Division of Long Term Services and Supports include:

In addition to its Title III mandate, the Division of Long Term Services and Supports administers the:

Advisory Council on Aging

Title III of the Older Americans Act requires the Division of Long Term Services and Supports to take into account views of recipients on the state level to advise and help in:

The Advisory Council on Aging members are appointed by the Governor. Eleven members, including minority representation, serve on this council and are geographically distributed across the state. Consideration is given to requirements of the state and federal programs to which the council relates. A majority of the membership of the council consists of actual or potential consumers of services under the Older Americans Act.

Long Term Services and Supports Local Offices

Service Providers

Under the Older Americans Act Title III strategy, service providers include those within the existing service delivery system. Service providers contracted with the State Unit on Aging to provide needed services include the nutrition providers, adult day services providers, transportation providers and legal services agencies. These provider agencies and their respective services are an important component of the aging network.

Title III - State and Community Programs

Title III State and Community Programs fall under the umbrella of the Administration for Community Living (ACL) the Administration on Aging (AoA). The Administration on Aging (AoA) works closely with its nationwide network on aging composed of regional offices, state units on aging and area agencies on aging to plan, coordinate and develop community-level systems of services meeting the unique needs of older persons and their caregivers.

Title III supports services designed to assist older persons at risk of losing their independence and active older persons. Through Title III, AoA advocates for the needs of the elderly in program planning and policy development provides technical assistance, issues best practices guidelines and initiates policy relative to funding the 57 state units on aging and territories to provide services to older Americans.

AoA awards funds for Title III to the 57 state agencies on aging which are located in every state and territory. Program funding is allocated to each state based on the number of older persons in the state, to plan, develop and coordinate systems of supportive in-home and community-based services.

In general, funds provided to state units on aging are used to administer and provide for supportive and nutrition services authorized under Parts B, C, D, and E of Title III. As advocates, state and area agencies on aging also use Older American Act (OAA) funding to leverage state and local resources to expand and improve services. These services make a vital difference in the lives of older persons who are trying to remain self-sufficient and to live in their homes and communities.

All individuals age 60 and over are eligible for services, although the Act directs priority to serving those with the greatest economic and social need, with particular attention to low-income minority older persons. There are no mandatory fees for services. Older persons, however, are encouraged to make contributions to help defray the costs of services. Under current law, these contributions are used to expand services. In addition, volunteer support is an integral component of the service system.

Title III-B Supportive Services

This funding is used to provide home and community based care. Most supportive services fall under three broad categories:

  1. Access Services - transportation, outreach, information and assistance and case management.
  2. In-Home Services - homemaker services and supportive services for families of older individuals who are victims of Alzheimer's disease.
  3. Community Services - adult day care and legal assistance.

Title III-C Congregate and Home-Delivered Meals

Nutrition services are provided under Title III-C of the Older Americans Act (OAA). The title contains two parts, congregate nutrition services (C-1) and home-delivered nutrition services (C-2). The services provided under these two parts are similar, but are targeted to different populations of older people.

Although meals are the primary service provided in the group meals program, ancillary services include nutrition screening, education, counseling and outreach. Congregate meals must comply with the dietary guidelines for Americans and provide at least 33 percent of the recommended dietary allowances (RDA) in each meal served. Service providers are encouraged to expand meal service to more than one meal per day and more than five days a week to those persons with increased needs. Whenever possible and appropriate, meals must meet the special health, religious and ethnic requirements of participants.

There is substantial private sector and state and local financial support as well as volunteer support for the meals program. While older participants are not charged a fee, they are encouraged to contribute through volunteering and financial donations to help defray the cost of services.

Title III-D Disease Prevention and Health Promotion Services Program

Title III-D of the OAA was established in 1987 and provides grants to States and Territories based on their share of the population aged 60 and over for education and implementation activities that support healthy lifestyles and promote healthy behaviors. Evidence-based health promotion programs reduce the need for more costly medical interventions. Priority is given to serving elders living in medically underserved areas of the State or who are of greatest economic need. Title III-D program help stimulate innovation by providing money to test new approaches and Disease Prevention and Health Promotion activities.

Title III-E National Family Caregiver Support Program

The National Family Caregiver Support Program (NFCSP), established in 2000, provides grants to States and Territories, based on their share of the population aged 70 and over, to fund a range of supports that assist family and informal caregivers to care for their loved ones at home for as long as possible.

The National Family Caregiver Support Program offers a range of services to support family caregivers. Under this program, States shall provide five types of services:

These services work in conjunction with other State and Community-Based Services to provide a coordinated set of supports. Studies have shown that these services can reduce caregiver depression, anxiety, and stress and enable them to provide care longer, thereby avoiding or delaying the need for costly institutional care.

While the Aging Network has always been involved with meeting the needs of both care recipients and family caregivers, by creating the National Family Caregiver Support Program, Congress explicitly recognized the important role that family caregivers occupy in our nation's long-term services and supports system.

Each family caregiver presents his or her own unique needs and preferences for the types of programs and services they wish to receive at any given point in time. Further, the programs and services that are available vary from state to state and community to community.