AoA at the Department of Health and Human Services provides grants to  the states through the SUAs. Agencies Report Increased Requests for Meals and Transportation and Varied Efforts to Reach Those Most in Need

Local agencies who responded to our survey identified home-delivered  meals and transportation as frequently requested services in fiscal year  2009. Thirteen of 67 agencies said they are  generally or very unable to serve all clients who request home-delivered  meals; 15 of the 63 agencies that provide transportation services said they  are generally or very unable to meet all transportation requests. State and local officials we spoke with also said requests for some OAA  services are increasing. A survey  conducted by the National Association of State Units on Aging to  determine the impact of the economic crisis on state-provided services  also found requests for the types of services provided by OAA increased,  particularly for home-delivered meals, transportation, and personal care. Given the number of agencies that cannot meet all requests for services  and the increasing demand for certain services, agencies must make  decisions about which applicants to serve. To reach and serve seniors with  the greatest economic or social need, local agencies responding to our  survey reported a range of strategies. Over 50 of 67 agencies said they  advertise, conduct outreach, and coordinate with other local organizations  to reach and provide services to seniors who are targeted by OAA: seniors  who are low-income, minority, or live in rural areas. Some officials we spoke to said there are additional seniors who need  services but do not contact OAA providers to request them. Preliminary responses to our  survey indicate agencies utilize the flexibility provided by the OAA to  transfer funds among Title III programs to meet requests from seniors for  services. Twenty-eight of 61 local agencies responding to our question  said they transferred funds among programs in fiscal year 2009, most often  removing funds from congregate meals, which are less requested, to home- delivered meals or other services. In addition to receiving federal funding, the programs created by Title III  of OAA receive funding from other sources as well. OAA funds  to states and local agencies increased in fiscal year 2009 by $97 million due  to Recovery Act funding explicitly for meal programs. Forty-four of 64 local  agencies said state funding – the second largest source of funding for these  programs nationally—decreased for fiscal year 2010. To replace lost state and local monies and maintain service levels to  seniors, just under half of those responding to our survey said they took  some steps to reduce administrative and operations costs and used  Recovery Act funds to fill budgeting gaps. In our preliminary survey  results, 27 of 65 agencies reported cutting administrative expenses, 22 of  54 reported cutting capital expenses, and 26 of 62 reported cutting  operating expenditures in fiscal year 2010. Additionally, 29 of 63 said they did not fill vacant positions. These  preliminary survey data are consistent with what we heard from state  officials on our site visits. Some state and local agencies we visited also told us they adapt to limited funding or increased requests for services by providing less service to all  rather than full service to only some. Seniors’ needs for the types of services provided through these programs  will only increase over time since demographic studies show a larger  proportion of Americans will be age 60 and older over the next few  decades. Programs that allow seniors to remain in their own homes and  communities afford seniors the independence and dignity they desire. As  current fiscal stress and looming deficits continue to constrain available  resources, it will be increasingly important for all elements of the home  and community-based service network to focus services on those in  greatest need. Appendix I: Objectives, Scope, and Methodology

To determine the Title III services requested most often, local agencies’  use of federal funds, and steps agencies take to deliver resources to those  most in need, we conducted a web-based random national sample survey  of 125 Area Agencies on Aging (AAA). The survey included questions  about: (1) utilization of OAA Title III services, (2) requests for OAA Title III  services, (3) approaches for measuring unmet need to target resources to  areas of greatest need, (4) use of OAA Title III funds, and (5) the economic  climate and use of American Recovery and Reinvestment Act (Recovery  Act) funds. The survey is on-going,  and the information included in this testimony presents preliminary  results, based on the 67 responses (54 percent) we received as of July 30,  2010. Some individual questions have lower response rates. These states were selected  due to varying sizes of the population age 60 and over and Title III  expenditures.
Why GAO Did This Study

Administered by the Administration on Aging (AoA) in the Department of Health and Human Services (HHS), Title III of the Older Americans Act (OAA) is intended to assist individuals age 60 and older by providing supportive services. Title III, Medicaid and Medicare, state, and other sources of funding provide for several types of services, including congregate and home-delivered meals, transportation, and support for caregivers. This testimony reports on ongoing GAO work in preparation for the reauthorization of the OAA and a full report to be issued by GAO in 2011. Based on preliminary findings, GAO describes (1) Title III services most requested by seniors and how state and local agencies reach those most in need, and (2) how agencies have coped with increasing requests in the current economic environment. To do this, GAO reviewed aging plans from the 50 states and District of Columbia; conducted site visits to 4 states; interviewed national, state, and local officials; and analyzed preliminary responses to a Web-based survey of 125 Local Area Agencies on Aging for fiscal year 2009. The survey data used in this document reflect a 54 percent response rate as of July 30, 2010. The survey is still in progress and our results are not generalizable at this time. GAO shared its findings with AoA and incorporated their comments as appropriate.

What GAO Found

Seniors frequently requested home-delivered meals and transportation services, and based on preliminary responses to GAO's survey and information from site visits, demand for some Title III services may be increasing. Some agencies said they were unable to meet all requests for services in fiscal year 2009. For example, 13 of 67 survey respondents said they were generally or very unable to serve all seniors who requested home-delivered meals, and 15 of 63 said they were generally or very unable to serve all who requested transportation assistance. Local officials cite seniors' desire to remain in their homes as they age, and the economic downturn as possible reasons for increased requests. Given this demand, providers must make decisions about which applicants will receive services. OAA requires providers to target those with the greatest economic and social need,--low-income, minority, lacking proficiency in English, and rural residents--and local officials said they advertise, conduct outreach, and coordinate with other local organizations to identify and serve these groups. Additionally, most local agencies reported screening potential clients to assess level of need, for example, to determine those most at risk of hospitalization due to poor nutrition. In addition to these known service needs, an unknown number of other seniors may need services but not know to contact OAA providers, some officials told GAO. Local agencies who responded to GAO's survey reported using the flexibility afforded by the OAA to transfer funds among Title III programs to meet increased requests for specific services. Twenty-eight of 61 local agencies said they transferred funds in fiscal year 2009, most often removing funds from congregate meals to home-delivered meals or other services. Although the American Recovery and Reinvestment Act (Recovery Act) provided an additional $97 million specifically for meal programs, Title III programs are heavily reliant on state funds, and 44 of 64 local agencies responding to our survey said their state funding was reduced for fiscal year 2010. To cope with funding reductions, some reported cutting services to seniors. Twenty-seven of 65 local agencies said they cut administrative expenses in fiscal year 2010; others relocated offices or left agency positions vacant. Some state and local officials said they provided less service to individuals so that more could get some amount of assistance. Some agencies said they used Recovery Act funds to replace lost state and local funding or created new programs, but the funding was restricted to meal services and was a relatively small percentage of total OAA allocations. The proportion of Americans age 60 and over will continue to grow over the coming decades, and demand for Title III services also will likely grow. Therefore it will be increasingly important for service providers to focus services on those most in need.