Several Federal Departments Fund HCBS and Related Supports for Older Adults

Five federal agencies across four departments have one or more  programs that operate within a system of HCBS and related supports that  older adults often require to live as independently as possible in their  homes and communities (see table 1). In Selected Localities, Area Agencies on Aging and Community-Based Organizations Planned and Delivered Services to Older Adults, Using a Mix of Funding Sources

		Community-Based Organizations Collaborated to Plan and Deliver HCBS Funded Through a Mix of Federal, State, and Local Programs

In San Francisco, California; Montgomery County, Maryland; and the  Atlanta, Georgia region, similar steps were taken to plan HCBS and  related supports for the growing population of older adults in their  communities. Each  locality’s system of HCBS and related supports for older adults provided  information and referral, nutrition and in-home services, as well as  affordable housing and transportation services. There were some  differences, however, in how these services and supports were funded  and delivered in each locality. The San Francisco village, one of  two we spoke with, also provided companionship visits and assistance  with errands. In Montgomery County, for example, the Senior Care  program provided in-home services funded by the state. CBO officials also reported waiting lists for affordable senior housing. Further, HHS budget  documents note that states, tribes, and localities that depend on federal  funds for these services have limited options to offset losses of federal  funding. AoA Has Reported Collaboration on Certain Projects

The Older Americans Act directs AoA to facilitate, in coordination with  CMS and other federal agencies as appropriate, the provision of services  and supports in the home and community. Collaboration to develop mutually  reinforcing or joint strategies could help ensure that federal resources for  HCBS and supports are used efficiently and effectively. Each of the five agencies that fund home and  community-based services and supports for older adults, however, for the  most part does so independently. While AoA is well-positioned to lead  federal agencies in planning a cross-agency federal strategy for the  provision of home and community-based services and supports for older  adults, an AoA representative indicated that the many competing priorities  it has for its limited resources prevent it from doing so. Recommendation for Executive Action

The Secretary of the Department of Health and Human Services should  facilitate development of a cross-agency federal strategy to help ensure  that federal resources from ACL, CMS, USDA, HUD, and DOT are  effectively and efficiently used to support a comprehensive system of  HCBS and related supports for older adults. We continue to encourage HHS to  engage all five agencies—the Administration on Aging and Centers for  Medicare and Medicaid Services in HHS, HUD, DOT and USDA--in  development of a cross agency federal strategy for administering home  and community-based services for older adults.
Why GAO Did This Study

Research has shown that many older adults want to age in their homes and communities, and their ability to do so often depends on the availability of home and community-based services and other supports. GAO was asked to review the availability of such services.
This report addresses (1) federal programs that fund these services and supports for older adults, (2) how these services and supports are planned and delivered in selected localities, and (3) agencies' efforts to promote a coordinated federal system of these services and supports. GAO reviewed federal program documents and interviewed federal officials. It also visited programs in the Atlanta, Georgia region, Montgomery County, Maryland, and San Francisco California, chosen based on efforts made to enhance their system of HCBS and supports, recommendations from federal agencies and experts, varied governmental jurisdiction, and geographic dispersion.

What GAO Found

Five federal agencies within four departments fund home and community-based services and supports that older adults often require to continue living independently in their own homes and communities. The Administration on Aging (AoA) and Centers for Medicare & Medicaid Services (CMS) in the Department of Health and Human Services (HHS), and the Departments of Housing and Urban Development (HUD), Transportation (DOT), and Agriculture (USDA) provide funds, often through state agencies, to local governments and community-based organizations.
The Older Americans Act of 1965 (the Act) requires AoA to promote and support a comprehensive system of services.
In the three localities GAO visited, local area agencies on aging, assisted by other community-based organizations, took the lead in planning and delivering services and supports for older adults, paid for with a mix of federal, state, and local funding. An Atlanta organization employed home-care aides for older adults and delivered meals. Senior housing developments across the three localities connected more frail residents to in-home services. In San Francisco and Montgomery County, grassroots organizations known as villages provided help with errands. Officials in two localities reported that flat funding of certain state funds, combined with the growing number of older adults, has resulted in waiting lists for affordable housing and in-home services.
The Act requires AoA to facilitate collaboration among federal agencies; however, the five agencies that fund these services and supports for older adults do so, for the most part, independently. GAO's work on interagency collaboration has found that collaboration is important for federal efforts that involve more than one agency. HHS, through AoA, has indicated that competing priorities for its limited resources prevent it from leading development of a cross-agency federal strategy. However, developing such a strategy could help ensure that the five agencies' resources for HCBS and supports are used efficiently and effectively.

What GAO Recommends

GAO recommends that HHS facilitate development of a cross agency federal strategy to ensure efficient and effective use of federal resources for HCBS. HHS concurred and HUD, DOT, and USDA did not comment.