The Older Americans Act (OAA), passed in 1965 as part of President Johnson’s “Great Society” programs, works to support the ability of older Americans to live at home and is the genesis of the aging network. The aging network — comprised of federal, state and local entities — is the organizational infrastructure created to develop, plan and deliver home and community-based services to older adults and their caregivers.
The aging-network infrastructure started with the original OAA and included the Administration on Aging (AoA). The network has expanded to include a national network of 56 state agencies on aging, 629 area agencies on aging (AAAs), about 20,000 service providers funded through the OAA and almost 250 Title VI Native American aging programs. The OAA and AoA are now considered part of Administration for Community Living (ACL).
The strength of the OAA has grown since it first passed in 1965. Since the OAA requires reauthorization every few years, the legislative process offers opportunities to make changes to adapt and address current needs. For example, Area Agencies on Aging (AAA) were added to the Act in 1973, creating agencies within local communities throughout the country to help vulnerable older adults live with dignity and mandating that AAAs ensure local needs are addressed. The OAA was most recently reauthorized in 2016, which renewed the act for three years.
While some services vary across the country, all AAAs offer five core services under the OAA including supportive services such as in-home services and transportation; elder rights, including abuse prevention and the Long-Term Care Ombudsman Program (LTCOP); nutritional programs such as congregate and home-delivered meals; support for caregivers; and health and wellness evidence-based programs such as fall prevention and chronic-disease self-management programs.
The OAA also includes job training and employment services, research and demonstration activities in the field of aging. The act requires that the aging network prioritize services and supports for marginalized populations, including older adults with the “greatest economic and social need.” Unfortunately, LGBT elders are not specifically identified in the act but, in 2012, AoA issued guidance stating that this group could include LGBT older people. Since then, SAGE and others have been advocating to require the aging network to assess whether it is meeting the needs of LGBT older adults.
One of the most unique aspects of the act is the requirement for advocacy on behalf of older Americans. Not only does the act authorize some advocacy programs such as legal assistance and the LTCOP, but it also requires that many members of the aging network advocate on behalf of older adults. For example, the Assistant Secretary for Aging and ACL must advocate for older Americans within federal government and any related federal policy initiative. State units on aging (SUA), which in Pennsylvania is the Department of Aging, must advocate for older adults within state government and promote state policies to improve the lives of older adults. Even local AAAs are to advocate on behalf of elders on policies that may impact older members within local communities.
Although the OAA has a strong advocacy focus, older Americans — and especially LGBT elders — face many unresolved problems and issues impacting their ability to live with dignity and independence. As LGBT people age, they face many challenges such as discrimination in housing and health care, and are at higher risk for social isolation, poorer health status and poverty.
The Trump administration has proposed an 18-percent budget cut, or about $15 billion, from the Department of Health and Human Services (HHS), which oversees OAA programs. Compounding potential future cuts is that funding for the OAA has been basically flat for decades, despite the growing aging population. While the aging network has done a commendable job with limited funds and increasing need, any cuts would be devastating to the ability of the aging network to meet the needs of older adults.
There surely is no shortage of critical issues demanding advocates’ attention to help to preserve key OAA services so access and quality are not diminished. In addition to ensuring that any new policy best meets the needs of elders, including members of the LGBT community, the next OAA reauthorization needs to recognize LGBT elders as a population of “greatest social need” so they have the supports and services needed to age with dignity. Hopefully, advocates are up to the challenge and will continue to fight on behalf of vulnerable older adults. They are counting on us!
Kathy Cubit is the advocacy manager at the Center for Advocacy for the Rights and Interests of the Elderly (CARIE), and has been an advocate at CARIE for the past 30 years. For more information about CARIE, visit www.carie.org.