GAO believes that this responds to its recommendation and, if successfully implemented, title III-B funds will be used more efficiently. However, GAO believes that HHS has not adequately addressed some of the other recommendations. (See app. VIII.) These recommendations and GAO's comments are discussed in detail at the end of chapters 2 and 3. (See pp. 25 and 40.) GAO also provided copies of its draft report to the six State agencies included in its review. Each State was asked to review the report and comment on it. Two States--Florida and California--provided written comments. (See apps. IX and X.) Like HHS, both State agencies basically agreed with GAO's evaluation of management weaknesses. Both also specifically noted the need for national service definitions and standards to evaluate the title III social services program. The State comments have also been addressed at the conclusions of chapters 2 and 3. AOA and State agencies have not provided specific instructions to area agencies on how best to use title III-B funds to Inadequate instructions for compensating GAO reports issued on matters relating to admin- istration of social services (title III-B) CHAPTER 1 INTRODUCTION The Chairman, Subcommittee on Aging, Senate Committee on Human Resources, in a March 7, 1979, letter, requested that we examine how well State and area agencies on aging are bringing together the many Federal programs serving the elderly. The Chairman also requested recommendations for improving performance, should problems or limits to the aging network's effectiveness be found. In subsequent discussions with the Chairman's office, we agreed to issue two reports. This report addresses the administration of contracts and subgrants, awarded by the area agencies under title III-B of the Older Americans Act, to provide social services for the elderly. A second report, to be issued later, will examine the progress and problems experienced by State and area agencies in bringing together other programs to establish a comprehensive, coordinated service system for the elderly. HOW SOCIAL SERVICES ARE PROVIDED In response to concerns over the service needs of older persons, the Congress enacted the Older Americans Act of 1965 (42 U.S.C. 3001 et seq.). The act, designed expressly to address the social services needs of the Nation's elderly population, set forth 10 broad objectives. It also called for the creation of the Administration on Aging (AOA) to serve as both the national focal point for the elderly and the administrator of programs authorized by the act. Since initial passage, the act has been amended on several occasions, most recently in 1978. Appropriations for the act have increased from $217.8 million in 1974, when the area agencies were established, to $673 million in 1981. Appendix I presents an analysis of funding for recent fiscal years. Through the act and its amendments, the Congress established a series of State and sub-State units charged with planning, coordinating, and implementing a comprehensive system of social services for the elderly. These units are the backbone of the so-called "aging network," which consists of AOA, located in the Department of Health and Human Services (HHS); 57 State agencies on aging serving the 50 States, the District of Columbia, and 6 territorial units; and approximately 665 local area agencies on aging. Under the act's social services program, referred to as title III-B, these agencies plan, coordinate, and fund a broad array of social services that further three goals of title III. These goals are (1) to secure and maintain maximum independence and dignity in a home environment for older persons capable of self-care, (2) to remove individual and social barriers to economic and personal independence for older persons, and (3) to provide a continuum of care for the vulnerable elderly. Typical social services authorized for funding by the program include transportation and escort services, in-home health and homemaker services, home repair and handyman services, legal and other counseling services, and information and referral services. Title III-B social services are available to older individuals, with preference to those with the greatest economic or social needs. To support the title III-B program, the Federal Government provides funds on a formula grant basis to each State, upon AOA's approval of a plan prepared by each State. These plans must assure compliance with the objectives of the Older Americans Act and assurance that funds provided under the act will be properly handled. Similarly, area agencies receive funding on a formula basis upon the State agency's approval of the area's plan. With minor exceptions, a State's total title III-B allocation is based on the ratio of its elderly population age 60 or over to the Nation's elderly population age 60 or over. Since area agencies are responsible for obtaining services for the elderly through subgrants and contracts with service providers, funds are allocated specifically for the title III-B services program and are passed from the State agency directly to the area agency. 1/ State agencies also receive a separate allocation for administering all programs and activities included in the State plan. This, of course, includes more than the title III-B program. State agencies, for example, also have administrative responsibilities for nutrition programs authorized under title III-C. Likewise, AOA administrative funds are used for all programs mandated by the Older Americans Act--including title III-B. As shown in the following table, funding in all three areas has increased over the past 5 years. 1/In 13 of the less populated States and territories, the State agency functions as the single area agency. Only about 5 percent of total title III-B allotments went to these States and territories in fiscal year 1980. |