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PART IV. ACTIVE GRANTS UNDER TITLE IV OF
OLDER AMERICANS ACT

In order to further enhance and strengthen the capacity building and program effectiveness of the Long-Term Care Ombudsman Program, the Administration on Aging has provided discretionary funding for research and demonstration activities. These efforts will help to stimulate and expand community-based systems of services to improve the quality of life for the elderly throughout this Nation. These research and demonstration strategies will increase the ability of the State Agencies on Aging to shape long-term care policy through the State Long-Term Care Ombudsman Program, and to facilitate the exchange of information between researchers, and professional groups associated with the long-term care issue of our Nation's older persons.

The following awards have been provided by the Administration on Aging to address concrete issues surrounding long-term care and institutional care of the elderly in this country.

NATIONAL AGING RESOURCE CENTER ON THE LONG-TERM CARE
OMBUDSMAN PROGRAM

The National Association of State Units on Aging has been awarded $500,000 to manage a National Aging Resource Center on the Long-Term Care Ombudsman Program. This resource center will be supported through September 30, 1991. The Center is established in collaboration with the National Citizens Coalition for Nursing Home Reform to expand the capacity of the nation's State Agencies on Aging in the design, development and administration of a statewide long-term care ombudsman program. The Center objectives are to: 1) assist States in developing and managing effective Statewide programs; 2) conduct activities which enhance the ability of State Agencies to impact on State policy for institutional based long-term care; 3) facilitate effective communication and enhance understanding between the State long-term care ombudsman program and the public, professional groups and the research community; and 4) examine the effectiveness of the ombudsman program in establishing and managing various ombudsman program components. To meet these objectives the Center conducts training, provides technical assistance, disseminates information, conducts surveys and initiates nationally oriented short term activities.

Other long-term care discretionary projects focused on institutional long-term care are:

Demonstration

The South Central Michigan Commission on Aging was awarded $70,880 in Fiscal Year 1987 to research and demonstrate institutional long-term care issues pertinent to the Long-Term Care Ombudsman Program. The project developed and mobilized a range of community-linked activities and services that improved the quality of life for older people residing in nursing homes. The project established a community-linked enrichment program in five nursing homes. This project was supported from September 30, 1987 through January 31, 1989.

Research

The Florida Department of Health and Rehabilitative Services was awarded $126,496 in Fiscal Year 1987 to conduct a study, "Tracer Approach for Measuring Quality of Care in Adult Congregate Living Facilities." The Tracer method evaluates a care delivery system by focusing on a set of "tracer conditions." The Tracer approach was developed by the Brookdale Institute and was examined for applicability to other settings, such as Florida. The Brookdale Institute was a subcontractor and simplified the original version.

The project was supported from September 1, 1987 through April 30, 1989. The study concluded that the psycho-social tracers would be more appropriate than medical tracers and would be particularly useful with a consultive model for licensure inspection. Additional research is needed in this area as well as proposed ways to make the "Tracer" approach a valid way of assessing quality of care. The Final Report will contain a separate report on the Brookdale Institute's work to simplify the Tracer method. The Brookdale Institute is currently searching for additional funds to develop a handbook to enable other regulatory systems, researchers, etc., to adopt the methodology for meeting their own quality assurance needs. Dissemination activities to publicize the findings are underway.

The Administration on Aging (AOA) has reviewed its policy goals and will enhance its commitment to develop and implement new strategies to target more effectively resources and programs on the needs of the most vulnerable older persons, with special emphasis on low-income minority elderly. We are confident that all segments of the national network of services for the elderly share our conviction that substantial improvement on this mandate can and must be achieved as a priority. Although this memorandum emphasizes a particular issue related to this goal (intra-state funding formulas), we anticipate a continuing dialogue and partnership with you on other aspects of services targeting.

BACKGROUND

Since the passage of the Older Americans Act (OAA) in 1965, all persons age sixty or over have been eligible to receive services under the Act, without any restrictions based on income or other personal characteristics. Despite this all inclusive eligibility, the Act requires that special consideration be given to targeting those older individuals who are in greatest economic or social need, with particular attention to low income minority older persons. The terms "greatest economic need" and "greatest social need" are defined in section 302 of the Act

(20) The term "greatest economic need" means the need resulting from an income level at or below the poverty levels established by the Office of Management and Budget. (21) The term "greatest social need" means the need caused by noneconomic factors which include physical and mental disabilities, language barriers, and cultural, social, or geographical isolation including that caused by racial or ethnic status which restricts an individual's ability to perform normal daily tasks or which threatens such individual's capacity to live independently.

The 1987 Amendments to the Older Americans Act added the
requirement that services be developed and provided with,
"particular attention to low-income minority older
individuals." This language was added in several places,
including sections 305(a)(1)(E), 305(a)(2)(E) and (F),
306(a)(1), 306(a)(5), 307(a)(8), 307(a)(23) and 307(a)(24).
The Act is also amended to require that all service provider
contracts include details on the presence and needs of the
priority target population and how those needs will be met.
There is sustained Congressional interest in full and timely
implementation of these provisions of the Older Americans
Act. The General Accounting Office is conducting surveys to
support Congressional oversight of this aspect of the Act.

The Administration on Aging and State and Area Agencies on Aging
have encouraged and supported strategies and initiatives to raise
the level of participation of the priority groups of elderly
people required in the Older Americans Act. The Administration on
Aging recently convened a Commissioner's Roundtable that included
the Executive Directors of the National Association of State Units
on Aging and the National Association of Area Agencies on Aging.
National minority aging organizations were also invited including;
the National Indian Council on Aging, the National Caucus and
Center on Black Aged, Asociacion Nacional Pro Persones Mayores,
the Pacific/Asian Resource Center on Aging, and AOA's National
Resource Center on Minority Aging. The meeting also included a
State Agency on Aging Director, an Area Agency on Aging Director
and a service provider agency representative. We generally agree
that, despite many sincere and significant efforts, the level of
services to the low-income minority, nationwide, should be
significantly improved.

DISCUSSION

States and Area Agencies on Aging are employing many strategies and methods to improve the participation level of low-income minority elderly in Older Americans Act Programs. These approaches include: hiring more minority staff; training of staff to improve sensitivity to and effectiveness with the minority

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elderly; placing the service delivery sites in locations where they are more accessible to the target population; encouraging contracts and grants with minority firms and organizations for the provision of services; carefully monitoring the content and execution of area and service plans to assure a substantial effort and achievement in this area; revising the intra-state funding formula and a number of other useful approaches (See Information Memorandum 89-11 for further examples and descriptions]. Each of these methods is worthy of lengthy discussion and should be evaluated and implemented, as applicable. State and Area Agencies on Aging should meet to review their current efforts on this issue and cooperatively develop action plans to achieve the goals

established.

At this time, we wish to point out the potential usefulness of the intra-state funding formula as a means of increasing the funds available for services to low-income minority elderly. Although the Act requires that each State review its intra-state funding formula when it submits a new State Plan, current circumstances may warrant a change in your intra-state funding formula. The intra-state funding formula required by section 305 (a)(2)(C) of the Act and section 1321.37 of the Title III regulations provides a basic means by which the State Agency on Aging can assure that funds received under the Act are directed in an appropriate manner to those planning and service areas of the State in which older persons in the greatest economic or social need reside. Section 1321.37(a) sets forth the basic requirements which the State Agency must follow in developing its intra-state funding formula as follows:

The

The State agency, after consultation with all area agencies in
the State, shall develop and use an intra-state funding
formula for the allocation of funds to area agencies under
this part. The State agency shall publish the formula for
review and comment by older persons, other appropriate
agencies and organizations and the general public.
formula shall reflect the proportion among the planning and
service areas of persons age 60 and over in greatest economic
or social need with particular attention to low-income
minority individuals. The State agency shall review and
update its formula as often as a new State plan is submitted
for approval.

Recently the intra-state funding formula has become the focus of extensive discussion within the network and, in some instances, has become the basis for legal action brought against States by parties that challenged whether a particular formula was consistent with the intent and letter of the Older Americans Act. In the Florida case, Meek v. Martinez, guidelines for the State's intra-state formula emerged which include:

(a) that the requirements of the Act establish mandatory
obligations;