Title III State and Community Programs

Under Title III, State and Community Programs, 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 F of Title III. As advocates, state and area agencies on aging also use OAA funds 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, chore maintenance and supportive services for families of older individuals who are victims of Alzheimer's disease.

3. Community Services - adult day care and legal assistance.

Supportive services are designed to maximize the informal support provided by caregivers and to enhance the capacity of older persons to remain self-sufficient.

Title III-C Congregate and Home-Delivered Meals

Nutrition services are provided under Title III-C of the Older Americans Act. 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, state and local financial 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 IIID 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 IIID program help stimulate innovation by providing money to test new approaches and Disease Prevention and Health Promotion activities.  These programs help to attract individuals through innovative fitness programs, health technology, and healthy aging screenings.  The Administration on Aging (AoA) uses a graduated or tiered set of criteria for defining evidence-based interventions implemented through the OAA. Health promotion programs can fall within any of the three following tiers. Based on the history of the program and the degree of change needed to transition to the optimal-level of evidence-based implementation, each program will need to be assessed based on the following criteria. The goal is for all Title IIID activities to move toward the highest-level criteria.

Highest-level Criteria

• Undergone Experimental or Quasi-Experimental Design; and
• Level at which full translation has occurred in a community site; and
• Level at which dissemination products have been developed and are available to the public.

Intermediate Criteria

• Published in a peer-review journal; and
• Proven effective with older adult population, using some form of a control condition (e.g. pre-post study, case control design, etc.); and
• Some basis in translation for implementation by community level organization.

Minimal Criteria

• Demonstrated through evaluation to be effective for improving the health and wellbeing or reducing disease, disability and/or injury among older adults; and
• Ready for translation, implementation and/or broad dissemination by community-based organizations using appropriately credentialed practitioners.

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.

Families are the major provider of long-term care, but research has shown that caregiving exacts a heavy emotional, physical and financial toll. Many caregivers who work and provide care experience conflicts between these responsibilities. Twenty two percent of caregivers are assisting two individuals, while eight percent are caring for three or more. Almost half of all caregivers are over age 50, making them more vulnerable to a decline in their own health, and one-third describe their own health as fair to poor.

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:

• information to caregivers about available services,
• assistance to caregivers in gaining access to the services,
• individual counseling, organization of support groups, and caregiver training,
• respite care, and
• supplemental services, on a limited basis.

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. As of the 2006 Reauthorization of the Older Americans Act, the following specific populations of family caregivers are eligible to receive services:

• Adult family members or other informal caregivers age 18 and older providing care to individuals 60 years of age and older;
• Adult family members or other informal caregivers age 18 and older providing care to individuals of any age with Alzheimer's disease and related disorders;
• Grandparents and other relatives (not parents) 55 years of age and older providing care to children under the age of 18; and
• Grandparents and other relatives (not parents) 55 years of age and older providing care to adults age 18-59 with disabilities.

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. Fortunately, a number of national organizations and programs exist to help inform and support program development and innovation. Please see resources and links below for additional information regarding research, technical assistance and support for program development.