Older Americans Act Reauthorization: Side-by-Side Comparison of Current Law, H.R. 5293, and S. 3570
Congressional research reportAug 24, 2006
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Older Americans Act Reauthorization:
Side-by-Side Comparison of Current Law,
H.R. 5293, and S. 3570
August 24, 2006
Carol O’Shaughnessy
Specialist in Social Legislation
Domestic Social Policy Division
Kirsten Jennie Black
Analyst in Gerontology
Domestic Social Policy Division
Sarah C. Kaufman
Research Associate
Domestic Social Policy Division
Congressional Research Service ˜ The Library of Congress
Older Americans Act Reauthorization: Side-by-Side
Comparison of Current Law, H.R. 5293, and S. 3570
Summary
Authorization of appropriations for the Older Americans Act expired at the end
of FY2005, though appropriations legislation has continued funding of the act’s
programs. Legislation to reauthorize the act is being considered by the 109th
Congress. H.R. 5293, the Senior Independence Act of 2006, was passed by the
House on June 21, 2006; S. 3570, the Older Americans Act Amendments of 2006,
was ordered reported by the Senate Committee on Health, Education, Labor, and
Pensions on June 28, 2006. A compromise version of the House and Senate bills
may be taken up before the end of the 109th Congress.
The Older Americans Act (OAA) is the major vehicle for the delivery of social
and nutrition services for older persons. Originally enacted in 1965, the act supports
a wide range of social services and programs for older persons. These include
supportive services, congregate and home-delivered nutrition services, community
service employment, the long-term care ombudsman program, and services to prevent
the abuse, neglect, and exploitation of older persons. The act also supports grants
to Native Americans and research, training, and demonstration activities.
H.R. 5293 and S. 3570 would authorize all titles of the act through FY2011. A
number of provisions contained in both bills would require state and area agencies
on aging to focus attention on planning comprehensive and coordinated systems of
home and community-based services to assist older persons with long-term care
needs to remain in their own homes, rather than entering institutions; require states
to conduct increased planning efforts related to the growing number of older people
in coming decades; and would focus attention on the needs of older people with
limited English proficiency and those at risk of institutional placement. In addition,
both bills would allow family caregiver services authorized under Title III to assist
older people caring for their adult children with disabilities.
Both H.R. 5293 and S. 3570 make changes to the Title V community service
employment program, but take different approaches. The House bill proposals are
wider in scope than those in the Senate committee’s bill, and many of its proposed
changes emanate from the view that the program should place more emphasis on
training of participants for unsubsidized employment than what exists under the
current program.
S. 3570 would authorize new elder justice grant programs and a national study
on the incidence of elder abuse, neglect, and exploitation. It would also require the
Administration on Aging (AoA) to set up a method to collect national uniform data
on elder abuse, neglect, and exploitation.
This report highlights major selected provisions of the bills and provides a
section-by-section comparison of most provisions of H.R. 5293 and S. 3570. A
shortened version of this report will be issued when final legislation is approved.
Contents
Introduction . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1
Highlights of Selected Provisions of H.R. 5293 and S. 3570 . . . . . . . . . . . . . . . . 2
Home and Community-Based Long-Term Care Services . . . . . . . . . . . . . . . 2
Role of AoA . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2
Role of State and Area Agencies on Aging . . . . . . . . . . . . . . . . . . . . . . 2
Aging and Disability Resource Centers (ADRCs) . . . . . . . . . . . . . . . . . 3
State and Area Agency on Aging Planning
for the Baby Boom Population . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3
Nutrition Services . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 4
National Academy of Sciences Study of Nutrition . . . . . . . . . . . . . . . . 4
Other Nutrition Program Proposals . . . . . . . . . . . . . . . . . . . . . . . . . . . . 4
National Family Caregiver Support Program . . . . . . . . . . . . . . . . . . . . . . . . 5
Senior Community Service Employment Program
for Older Americans . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 5
Limit on Time of Participant Enrollment . . . . . . . . . . . . . . . . . . . . . . . 6
Eligibility . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 7
Elder Justice . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 7
AoA Responsibility for Elder Justice Issues . . . . . . . . . . . . . . . . . . . . . 8
National Incidence Study and Data Collection Efforts . . . . . . . . . . . . . 8
Grants to States and Tribal Organizations
for Elder Justice Programs . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 8
Research and Demonstration Initiatives . . . . . . . . . . . . . . . . . . . . . . . . . . . . 8
Model Projects for Aging in Place . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 8
Demonstration Efforts to Address Mental Illness
in Older People . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 9
TITLE I, DECLARATION OF OBJECTIVES; DEFINITIONS . . . . . . . . . . . . . 10
DEFINITIONS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 10
Assistive device, assistive technology,
and assistive technology service . . . . . . . . . . . . . . . . . . . . . . . . . 10
Health promotion program/evidence-based health promotion . . . . . . 10
Information and assistance . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 10
Aging and Disability Resource Center (ADRC) . . . . . . . . . . . . . . . . 11
At risk of institutional placement . . . . . . . . . . . . . . . . . . . . . . . . . . . . 11
Long-term care facility . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 11
Elder justice . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 12
Exploitation . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 12
Neglect . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 12
Self-neglect . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 13
Hispanic serving institution . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 13
Long-term care . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 13
Multivitamin-mineral supplement . . . . . . . . . . . . . . . . . . . . . . . . . . . 14
Self-directed care . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 14
State system for long-term care . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 15
TITLE II, ADMINISTRATION ON AGING (AoA) . . . . . . . . . . . . . . . . . . . . . . 15
FUNCTIONS OF THE ASSISTANT SECRETARY ON AGING . . . . . . . 15
Elder abuse prevention services . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 15
Mental health services . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 17
Assistive technology . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 17
Coordination with Centers for Medicare
and Medicaid Services (CMS) regarding new benefits . . . . . . . . 18
Technical assistance regarding benefits outreach
and establishment of a National Center on Senior Benefits . . . . . 18
Data collection on home and community-based care . . . . . . . . . . . . . 19
Evidence-based disease prevention and health promotion . . . . . . . . . 19
AoA role in long-term care . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 20
Involvement of older individuals
in voluntary community activities . . . . . . . . . . . . . . . . . . . . . . . . 23
AoA collaboration with other federal agencies:
reference to impact on persons
with limited English proficiency . . . . . . . . . . . . . . . . . . . . . . . . . 24
Assistive Technology Act . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 24
Coordinating committee on aging . . . . . . . . . . . . . . . . . . . . . . . . . . . . 24
Functions of nutrition program officer . . . . . . . . . . . . . . . . . . . . . . . . 29
Expertise of the nutrition officer . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 30
Set aside of funds for evaluation projects . . . . . . . . . . . . . . . . . . . . . . 30
Reports on the activities under the act . . . . . . . . . . . . . . . . . . . . . . . . 30
Contracting and grant authority; commercial and
private pay relationships; appropriate use of act funds . . . . . . . . 30
Nutrition education . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 32
Pension counseling and information programs . . . . . . . . . . . . . . . . . . 32
Authorization of appropriations for Title II activities . . . . . . . . . . . . . 33
TITLE III, GRANTS FOR STATE AND
COMMUNITY PROGRAMS ON AGING . . . . . . . . . . . . . . . . . . . . . . . . 33
Purpose of Title III: coordination with volunteer services . . . . . . . . . . . . . 33
Authorization of appropriations: supportive, nutrition,
and disease prevention and health promotion services . . . . . . . . 33
Authorization of appropriations: National Family
Caregiver Support Program . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 33
Area agency administrative funds to be use
for needs assessment of growing elder population . . . . . . . . . . . 34
State plans on aging: focus on older individuals
with limited English proficiency . . . . . . . . . . . . . . . . . . . . . . . . . 34
State long-term care systems . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 34
Puerto Rico, single planning and service area . . . . . . . . . . . . . . . . . . . 35
AREA PLANS ON AGING . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 35
Area plans on aging: focus on older individuals
with limited English proficiency . . . . . . . . . . . . . . . . . . . . . . . . . 35
Area plans on aging: focus on persons at risk
of institutional placement . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 36
Area plans on aging: mental health services . . . . . . . . . . . . . . . . . . . . 36
Area plans on aging: information and assistance . . . . . . . . . . . . . . . . 36
Area plans on aging: specific objectives for serving
older individuals . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 37
Area plans on aging: provider agreement regarding serving
older individuals . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 37
Area plans on aging: outreach efforts . . . . . . . . . . . . . . . . . . . . . . . . . 37
Area plans on aging: use of trained volunteers . . . . . . . . . . . . . . . . . . 38
Area plans on aging: advisory council membership . . . . . . . . . . . . . . 38
Area plans on aging: increasing public awareness
of mental health . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 38
Area plans on aging: comprehensive coordinated system
for home and community-based long-term care . . . . . . . . . . . . . 38
Area plans on aging: area agency costs to carry out
commercial relationships . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 39
Area plans on aging: priority for use of funds
for specified older individuals; maintaining
public purpose mission and disclosure of information
on contractual relationships . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 40
Area plans on aging: self-directed care . . . . . . . . . . . . . . . . . . . . . . . . 40
Area plans on aging: emergency preparedness . . . . . . . . . . . . . . . . . . 40
Area plans on aging: area agency planning
for demographic changes in the older population
in planning and service areas . . . . . . . . . . . . . . . . . . . . . . . . . . . . 40
STATE PLANS ON AGING . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 42
State plans on aging: focus on older individuals
with limited English proficiency . . . . . . . . . . . . . . . . . . . . . . . . . 42
State plans on aging: identifying service needs
of low-income minority older individuals
with limited English proficiency . . . . . . . . . . . . . . . . . . . . . . . . . 42
State plans on aging: outreach to individuals
with limited English proficiency . . . . . . . . . . . . . . . . . . . . . . . . . 42
State plans on aging: self-directed care . . . . . . . . . . . . . . . . . . . . . . . . 42
State plans on aging: planning for demographic changes
in the older population in the state . . . . . . . . . . . . . . . . . . . . . . . 43
State plans on aging: emergency preparedness . . . . . . . . . . . . . . . . . . 43
State plans on aging: Aging and Disability Resource Centers
(ADRCs) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 44
State plans on aging: non-federal share
for Title III services . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 45
NUTRITION SERVICES INCENTIVE PROGRAM . . . . . . . . . . . . . . . . . 45
Disbursement . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 45
Bonus of commodities . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 45
High protein foods; terms and conditions . . . . . . . . . . . . . . . . . . . . . . 45
Cash used to buy commodities . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 45
Authorization of appropriations for nutrition service
incentive program . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 46
Distribution of information regarding
federal commodity processing programs . . . . . . . . . . . . . . . . . . . 46
VOLUNTARY CONTRIBUTIONS FOR TITLE III SERVICES . . . . . . . . 46
Solicitation of voluntary contributions . . . . . . . . . . . . . . . . . . . . . . . . 46
Voluntary contributions are to supplement not supplant
Title III funds . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 47
Mandatory cost-sharing: participation of older individuals
with limited English proficiency . . . . . . . . . . . . . . . . . . . . . . . . . 47
AoA study of cost-sharing . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 47
ALLOWABLE TITLE III SUPPORTIVE SERVICES . . . . . . . . . . . . . . . . 47
NUTRITION SERVICES . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 48
Nutrition services: purpose of nutrition services . . . . . . . . . . . . . . . . 48
Nutrition services: nutrition education . . . . . . . . . . . . . . . . . . . . . . . . 48
Nutrition services: multivitamin-mineral supplements . . . . . . . . . . . . 49
Nutrition services: home-delivered nutrition services . . . . . . . . . . . 49
Consultation with nutrition experts . . . . . . . . . . . . . . . . . . . . . . . . . . . 49
State responsibility to obtain expertise of a dietician . . . . . . . . . . . . . 49
Dietary Guidelines for Americans . . . . . . . . . . . . . . . . . . . . . . . . . . . 49
Intergenerational meals . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 50
Nutrition screening, education and assessment . . . . . . . . . . . . . . . . . . 50
Influenza and other vaccinations . . . . . . . . . . . . . . . . . . . . . . . . . . . . 50
Evaluation of the Nutrition Program . . . . . . . . . . . . . . . . . . . . . . . . . . 50
Improving indoor air quality in building
where seniors congregate . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 51
CAREGIVER SUPPORT PROGRAM . . . . . . . . . . . . . . . . . . . . . . . . . . . . 51
Definitions . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 51
Support services for caregivers . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 52
Priority to caregivers providing care to older individuals . . . . . . . . . . 52
Coordination with volunteer services . . . . . . . . . . . . . . . . . . . . . . . . . 52
Reports on caregiver program . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 53
Limitation on federal and non-federal funds
for relative caregiver services . . . . . . . . . . . . . . . . . . . . . . . . . . . 53
Programs of national significance . . . . . . . . . . . . . . . . . . . . . . . . . . . . 53
Allotment of funds to states . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 54
TITLE IV, RESEARCH, TRAINING, AND
DEMONSTRATION PROJECTS AND PROGRAMS . . . . . . . . . . . . . . . 54
Grant programs . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 54
Authorization of appropriations for grant programs . . . . . . . . . . . . . . 55
Career preparation for the field of aging . . . . . . . . . . . . . . . . . . . . . . . 56
Health care service demonstration projects in rural areas . . . . . . . . . . 56
Graduate programs with capability in mental health . . . . . . . . . . . . . . 56
Technical assistance and innovation to improve
transportation for older individuals . . . . . . . . . . . . . . . . . . . . . . . 57
Economically sustainable transportation . . . . . . . . . . . . . . . . . . . . . . . 58
Community planning for the aging population . . . . . . . . . . . . . . . . . . 58
DEMONSTRATION PROJECTS
FOR MULTIGENERATIONAL ACTIVITIES . . . . . . . . . . . . . . . . . 58
Demonstration projects for multigenerational activities:
grants and contracts . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 58
Demonstration projects for multigenerational activities:
use of funds . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 59
Demonstration projects for multigenerational activities:
preference . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 59
Demonstration projects for multigenerational activities:
application . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 60
Demonstration projects for multigenerational activities:
eligible organizations . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 60
Demonstration projects for multigenerational activities:
local evaluation and report . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 60
Demonstration projects for multigenerational activities:
report to Congress . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 60
DEFINITIONS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 61
Civic engagement activity . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 61
Multigenerational activity . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 61
Multigenerational coordinator . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 62
Native American programs . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 62
MULTIDISCIPLINARY CENTERS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 62
Multidisciplinary centers: grant programs . . . . . . . . . . . . . . . . . . . . . . 62
MULTIDISCIPLINARY HEALTH SERVICES
IN COMMUNITIES . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 64
Multidisciplinary health services in communities:
grant programs . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 64
COMMUNITY INNOVATIONS FOR AGING IN PLACE . . . . . . . . . . . . 66
Community Innovations for Aging in Place: authorization . . . . . . . . . 66
Community Innovations for Aging in Place: definitions . . . . . . . . . . 66
Community Innovations for Aging in Place: grants . . . . . . . . . . . . . . 67
Community Innovations for Aging in Place: eligibility
and application requirements . . . . . . . . . . . . . . . . . . . . . . . . . . . . 67
Community Innovations for Aging in Place: use of funds . . . . . . . . . . 68
Community Innovations for Aging in Place: required services . . . . . . 69
Community Innovations for Aging in Place: service areas . . . . . . . . . 69
Community Innovations for Aging in Place: supplement
and not supplant federal, state, or other funds . . . . . . . . . . . . . . 69
Community Innovations for Aging in Place: technical assistance . . . 70
Community Innovations for Aging in Place:
eligibility requirements for grants to provide
technical assistance . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 70
Community Innovations for Aging in Place: report to Congress . . . . . 70
CHOICES FOR INDEPENDENCE
DEMONSTRATION PROJECTS . . . . . . . . . . . . . . . . . . . . . . . . . . . . 71
Choices for Independence: authorization . . . . . . . . . . . . . . . . . . . . . . . 71
Choices for Independence: definitions . . . . . . . . . . . . . . . . . . . . . . . . . 71
Choices for Independence: grants to states . . . . . . . . . . . . . . . . . . . . . 72
Choices for Independence: eligibility . . . . . . . . . . . . . . . . . . . . . . . . . 72
Choices for Independence: use of funds . . . . . . . . . . . . . . . . . . . . . . . 72
Choices for Independence: public education . . . . . . . . . . . . . . . . . . . . 73
Choices for Independence: ADRCs . . . . . . . . . . . . . . . . . . . . . . . . . . . 73
Choices for Independence: Healthy Lifestyle Choices . . . . . . . . . . . . 74
Choices for Independence: Community Living Incentives (CLI) . . . . 75
Choices for Independence: technical assistance . . . . . . . . . . . . . . . . . 77
Choices for Independence: evaluation . . . . . . . . . . . . . . . . . . . . . . . . 77
Choices for Independence: responsibilities
of the Assistant Secretary . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 78
TITLE V, COMMUNITY SERVICE EMPLOYMENT
FOR OLDER AMERICANS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 78
Title V, Community Service Employment
for Older Americans . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 78
Program authorized: purposes . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 78
Agreements/grants to public and private non-profit
organizations/state agencies/tribal organizations . . . . . . . . . . . . 79
PROGRAM REQUIREMENTS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 79
Provision of employment for eligible individuals . . . . . . . . . . . . . . . . 79
50% of hours worked to be in community service
employment-based training . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 79
Employment in communities where eligible individuals
reside; no less than 50% of hours worked to be
in community service employment-based training . . . . . . . . . . 80
Employment for individuals, including Indians
residing on Indian reservations . . . . . . . . . . . . . . . . . . . . . . . . . . 80
Prohibition of participation by eligible individuals
exceeding a specified period . . . . . . . . . . . . . . . . . . . . . . . . . . . . 80
Employment in public and private non-profit
organizations/for-profit organizations . . . . . . . . . . . . . . . . . . . . . 81
Result in unsubsidized employment . . . . . . . . . . . . . . . . . . . . . . . . . . 81
Contribution to the community . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 81
Provision of employment for eligible individuals . . . . . . . . . . . . . . . . 82
Increase in employment opportunities . . . . . . . . . . . . . . . . . . . . . . . . 82
Prohibition of Title V enrollees performing work
of a person who is on layoff . . . . . . . . . . . . . . . . . . . . . . . . . . . . 82
Coordination with the Workforce Investment system . . . . . . . . . . . . 82
Training and payment of trainees’ expenses . . . . . . . . . . . . . . . . . . . . 82
Safe and healthy conditions . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 83
Wages of enrollees . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 83
Projects to be established with advice of experienced persons . . . . . . 83
Payment for transportation costs/supportive services . . . . . . . . . . . . . 83
Special needs individuals . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 83
Activities with WIA . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 84
Sufficient administrative funds for entities . . . . . . . . . . . . . . . . . . . . 84
Innovative work modes and job opportunities . . . . . . . . . . . . . . . . . . 84
Reciprocity of assessments of individuals
under Title V and WIA . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 84
Non-federal share . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 84
Definition of administrative costs . . . . . . . . . . . . . . . . . . . . . . . . . . . . 85
Wages . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 86
Programmatic costs: fringe benefits . . . . . . . . . . . . . . . . . . . . . . . . . . 86
Programmatic costs: training . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 86
Programmatic costs: supportive services . . . . . . . . . . . . . . . . . . . . . . . 86
Limit on fund for wages and benefits of enrollees . . . . . . . . . . . . . . . 86
Consultation with area agencies on aging . . . . . . . . . . . . . . . . . . . . . . 87
Demonstration projects . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 87
Evaluation of Title V activities . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 88
Sense of the Senate . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 88
STATE PLAN . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 88
State Plan: submission, timing and comments . . . . . . . . . . . . . . . . . . . 88
State Plan: comments by Governor/state chief executive officer . . . . 90
State Plan: avoidance of participant disruption . . . . . . . . . . . . . . . . . . 90
State Plan: collaboration by grantees that serve older Indians . . . . . . . 90
State Plan: distribution of assistance . . . . . . . . . . . . . . . . . . . . . . . . . . 90
COMPETITION FOR AWARD OF GRANTS . . . . . . . . . . . . . . . . . . . . . . 92
Period of grant awards . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 92
Prohibition on competition until implementation
of indicators, or January 1, 2010 . . . . . . . . . . . . . . . . . . . . . . . . . 92
Eligibility criteria for awards . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 93
PERFORMANCE MEASURES . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 94
Performance measures: establishment . . . . . . . . . . . . . . . . . . . . . . . . . 94
Performance measures: annual requirement . . . . . . . . . . . . . . . . . . . . 94
Performance measures: agreement on expected levels . . . . . . . . . . . . 94
Performance measures: composition . . . . . . . . . . . . . . . . . . . . . . . . . 95
Performance measures: indicators . . . . . . . . . . . . . . . . . . . . . . . . . . . . 95
Performance measures: additional indicators . . . . . . . . . . . . . . . . . . . 95
Performance measures: issuance of rules on indicators . . . . . . . . . . . . 96
Performance measures: adjustments . . . . . . . . . . . . . . . . . . . . . . . . . . 96
Performance measures:
annual publication of grantee performance . . . . . . . . . . . . . . . . . 96
Performance measures:
placement into unsubsidized employment . . . . . . . . . . . . . . . . . . 96
Performance measures: retention in employment . . . . . . . . . . . . . . . . 97
Performance measures:
exemption when a grantee extends time for participation . . . . . . 98
CORRECTIVE ACTION AND TECHNICAL ASSISTANCE
BASED ON PERFORMANCE, AND REQUIREMENTS
FOR COMPETITION BASED ON PERFORMANCE . . . . . . . . . . . 98
National organizations: technical assistance
and corrective action based on performance . . . . . . . . . . . . . . . . 98
National organizations: second year of failure in meeting
performance standards — reduction of 25% of funds . . . . . . . . . 99
National organizations: third year of failure in meeting
performance standards — withdrawal of all funds . . . . . . . . . . . 99
National organizations: additional competition requirements
where national organizations have performance levels
20% or more below the national performance standards . . . . . . . 99
Performance measures: request by the Governor . . . . . . . . . . . . . . . . 100
States: technical assistance and corrective action
based on performance . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 100
States: second year of failure — reduction of 25% of funds . . . . . 101
States: third year of failure — withdrawal of all funds . . . . . . . . . . 101
Grantees serving individuals with barriers to employment . . . . . . . . 101
Prohibition on promulgation of rules negatively affecting
minority serving grantees . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 102
Authorization of Appropriations . . . . . . . . . . . . . . . . . . . . . . . . . . . . 102
Unexpended funds . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 103
DEFINITIONS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 103
Community service/community service
employment-based training . . . . . . . . . . . . . . . . . . . . . . . . . . . . 103
Eligible individuals . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 103
Individuals to have priority for work opportunities . . . . . . . . . . . . . . 103
Exclusion of individuals who have participated
in Title V projects for a specified period . . . . . . . . . . . . . . . . . 104
Income . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 104
Program . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 104
Supportive services . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 105
Unemployed individual . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 105
TITLE VI, GRANTS FOR NATIVE AMERICANS . . . . . . . . . . . . . . . . . . . . 105
Distribution of funds among tribal organizations . . . . . . . . . . . . . . . 105
Native Americans caregiver support program . . . . . . . . . . . . . . . . . . 106
TITLE VII, ALLOTMENTS FOR VULNERABLE ELDER RIGHTS
PROTECTION ACTIVITIES . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 106
Vulnerable elder rights protection activities:
ombudsman program . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 106
Native American organization provisions . . . . . . . . . . . . . . . . . . . . . 106
Elder abuse, neglect, and exploitation prevention . . . . . . . . . . . . . . . 106
ELDER JUSTICE PROGRAMS: PURPOSES . . . . . . . . . . . . . . . . . . . . . 107
DEFINITIONS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 108
Caregiver . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 108
Direct care . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 108
Elder . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 108
Elder justice . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 108
Eligible entity . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 109
Fiduciary . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 109
Grant . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 109
Law enforcement . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 109
Long-term care . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 110
Loss of capacity . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 110
Long-term care facility . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 110
Nursing facility . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 110
State legal assistance developer . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 110
State long-term care ombudsman . . . . . . . . . . . . . . . . . . . . . . . . . . . . 111
STATE AND TRIBAL GRANTS TO STRENGTHEN
LONG-TERM CARE AND PROVIDE ASSISTANCE
FOR ELDER JUSTICE PROGRAMS . . . . . . . . . . . . . . . . . . . . . . . 111
State and tribal grants: authorization . . . . . . . . . . . . . . . . . . . . . . . . . 111
State and tribal grants: application for eligibility . . . . . . . . . . . . . . . . 111
State and tribal grants: use of funds . . . . . . . . . . . . . . . . . . . . . . . . . . 111
State and tribal grants: administrative expenses . . . . . . . . . . . . . . . . 115
State and tribal grants: supplement not supplant . . . . . . . . . . . . . . . . 115
State and tribal grants: maintenance of effort . . . . . . . . . . . . . . . . . . 115
State and tribal grants: accountability measures . . . . . . . . . . . . . . . . 116
State and tribal grants: evaluating programs . . . . . . . . . . . . . . . . . . . 116
State and tribal grants: compliance with applicable laws . . . . . . . . . 116
State and tribal grants: eligible partnerships . . . . . . . . . . . . . . . . . . . 116
State and tribal grants: authorization of appropriations . . . . . . . . . . . 117
COLLECTION OF UNIFORM NATIONAL DATA
ON ELDER ABUSE, NEGLECT, AND EXPLOITATION . . . . . . . 117
Collection of uniform national data: authorization . . . . . . . . . . . . . . 117
Collection of uniform national data: purpose . . . . . . . . . . . . . . . . . . 117
Collection of uniform national data: phase I — development
of methods of collection and reporting . . . . . . . . . . . . . . . . . . . 117
Collection of uniform national data: phase I — forms
and protection of privacy . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 118
Collection of uniform national data: phase II — pilot test . . . . . . . . 119
Collection of uniform national data: phase II — adjustments
to form and methods . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 119
Collection of uniform national data: phase III — distribution
of national data reporting forms . . . . . . . . . . . . . . . . . . . . . . . . . 119
Collection of uniform national data: phase III — data collection
grants, authorization . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 119
Collection of uniform national data: phase III — data collection
grants, application . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 120
Collection of uniform national data: phase III — data collection
grants, requirements . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 120
Collection of uniform national data: phase III — data collection
grants, funding . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 120
Collection of uniform national data: phase III — required
information . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 121
Collection of uniform national data: report . . . . . . . . . . . . . . . . . . . . 121
Collection of uniform national data: authorization
of appropriations . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 121
Rule of construction . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 121
List of Tables
Table 1. Side-by-Side Comparison of Current Law,
H.R. 5293, and S. 3570 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 10
Older Americans Act Reauthorization:
Side-by-Side Comparison of Current Law,
H.R. 5293, and S. 3570
Introduction
Authorization of appropriations for the Older Americans Act of 1965 expired
at the end of FY2005. The 109th Congress is considering legislation to reauthorize
the act. H.R. 5293, the Senior Independence Act of 2006, was reported by the House
Education and Workforce Committee on June 8, 2006,1 and was passed by the House
on June 21, 2006. S. 3570, the Older Americans Act Amendments of 2006, was
ordered reported by the Senate Committee on Health, Education, Labor and Pensions
on June 28, 2006. A compromise version of the House and Senate bills may be taken
up before the end of the 109th Congress.
The Older Americans Act (OAA) is the major vehicle for the delivery of a wide
range of supportive services, as well as nutrition services and community service
employment opportunities for older people. Title II of the act authorizes activities
of the Administration on Aging (AoA). The Title III nutrition program is the major
single service funded by the act, and provides meals to older people in congregate
settings and in their homes. Title III supportive services include information and
assistance about accessing services, a range of home and community-based long-term
care, transportation, and family caregiver support services, among many others. Title
IV supports a wide range of research, training, and demonstration activities in the
field of aging. The Title V community service employment program supports
subsidized jobs for low-income people aged 55 and over. Title VI funds supportive
and nutrition services for Native American older people, and Title VII supports the
long-term care ombudsman program and services to prevent the abuse, neglect, and
exploitation of older persons. For a description of Older Americans Act programs
and funding, see CRS Report RL31336, The Older Americans Act: Programs and
Funding, by Carol O’Shaughnessy.
This report highlights selected provisions of H.R. 5293 and S. 3570, and
provides a section-by-section comparison of current law with the bills.
1
Senior Independence Act of 2006, Comm. on Education and the Workforce, House of
Representatives, H.Rept. 109-493, June 8, 2006. 109th Cong., 2nd sess.
CRS-2
Highlights of Selected Provisions
of H.R. 5293 and S. 3570
Home and Community-Based Long-Term Care Services
Title III supports a wide range of home and community-based long-term care
services, including personal care, homemaker and chore services, home-delivered
nutrition services, and assisted transportation. Beyond these Title III-funded
services, many state and area agencies administer home and community-based longterm care services not funded by Title III. These include those funded by the
Medicaid Section 1915(c) home and community-based services waiver program and
by the Social Services Block Grant program (Title XX of the Social Security Act).
Some state and area agencies on aging are responsible for administering and
managing case management and assessment of the long-term care needs of older
persons and have made great strides in expanding and coordinating a variety of
services to help older persons remain at home and avoid entry into institutions. In
recent years, AoA has supported a wide range of projects that focus on home and
community-based long-term care, including Aging and Disability Resource Centers
(ADRCs).
Program planning and service delivery initiatives by states, as well as research
and demonstration initiatives by AoA and the Centers for Medicare and Medicaid
Services (CMS), have focused on what many believe to be an institutional bias in
federal program support for long-term care. (The primary federal program that
finances long-term care services is Medicaid, and most of its long-term care spending
for the elderly is for nursing home care.)
In the Older Americans Act reauthorization legislation, both the Senate
Committee and House bills define the roles of AoA and state and area agencies on
aging with respect to home and community-based services for older people.
Role of AoA . The bills would require the Assistant Secretary on Aging within
the Department of Health and Human Services (HHS) to promote the development
and implementation of comprehensive, coordinated systems at federal, state, and
local levels for providing long-term care in home and community-based settings, in
a manner responsive to the needs and preferences of older individuals and their
family caregivers. In doing so, the Assistant Secretary would be required to, among
other things, conduct research and demonstration projects to identify innovative,
cost-effective strategies for modifying state systems of long-term care; and target
services to individuals at risk for institutional placement in order to permit them to
remain in home and community-based care settings.
Role of State and Area Agencies on Aging. Likewise, the bills would
require that state and area agencies on aging develop and implement a
comprehensive, coordinated system, at their respective levels, to develop home and
community-based services. They would accomplish this by, among other things,
collaborating, coordinating and consulting with other agencies responsible for
formulating, implementing and administering long-term care programs; and making
recommendations regarding strategies to modify the state’s long-term care system in
CRS-3
order to respond to the needs and preferences of older individuals and family
caregivers.
Aging and Disability Resource Centers (ADRCs). In recent years, AoA
has used its Title IV research and demonstration authority to award funds for ADRCs
in 43 states. The ADRC grant program is a cooperative effort between AoA and
CMS and was developed to assist states in their efforts to create a single, coordinated
system of information and access for all persons seeking long term support to assist
them in accessing services, enhance individuals’ choice of services, and support
informed decision-making. Both H.R. 5293 and S. 3570 would provide authority
in the Older Americans Act for the Assistant Secretary to continue this initiative. In
the bills, ADRCs are defined as entities that provide comprehensive information on
available public and private long-term care programs, options, and resources and
provide personal counseling to assist individuals to develop and implement a plan to
meet long-term care needs. ADRCs are to serve as a convenient point of entry for
people needing such assistance for these programs.
State and Area Agency on Aging Planning
for the Baby Boom Population
The increasing numbers of people turning age 65 in the coming decades will
place increasing burdens on aging service providers supported by the Older
Americans Act (the first wave of the baby boom population are turning age 60 in
2006). Groups representing these providers, such as the National Association of
State Units on Aging, and the National Association of Area Agencies on Aging, have
proposed new Older Americans Act initiatives to assist state and area agencies in
their planning efforts to prepare for the growing elderly population across the nation.
While state and area agencies are already responsible for assessing the needs of the
current older population in their states and areas, the baby boom population is
expected to increase the need for resources as well as planning efforts.
Both H.R. 5293 and S. 3570 would require each state agency on aging, at the
election of the state, to include in state plans on aging an assessment of how prepared
the state is for changes in the elderly population over a 10-year period. The
assessment may also include:
!
!
!
an analysis of how demographic changes may affect older
individuals, including those with low-income, greatest economic
need, minority older individuals, those residing in rural areas, and
those with limited English proficiency;
an analysis of how the programs, policies, and services provided by
states and area agencies can be improved, and how resource levels
can be adjusted to meet the needs of the changing population of
older individuals in the state; and
an analysis of how the change in the number of persons age 85 years
and older is expected to affect the need for supportive services.
Both bills would also authorize area agencies on aging to conduct similar
activities and to make recommendations to governmental officials on actions to build
CRS-4
their capacity to respond to the needs of the growing aging population, including
health and human services, land use, housing, transportation, public safety, workforce
and economic development, among others. In addition, S. 3570 would allow an
additional 1% of a state’s allotment for Title III funds to be used for area plan
administration to carry out these activities. This could only occur when
appropriations for Title III supportive, nutrition and disease prevention and health
promotion services exceed 110% of the FY2006 amount.
Nutrition Services
The Title III nutrition program is the largest single program under the Older
Americans Act. Funded at $715.1 million in FY2006, it represents 58% of Title III
funds, and 40% of the act’s total funding. Data for FY2004 (latest available) show
that of the 249 million meals served, 57% were provided to frail older persons (and
their caregivers) at home, and 43% were provided in congregate settings, such as
senior centers and schools.2
The program serves a particularly vulnerable older population. AoA data show
that about 62% of congregate nutrition participants, and 73% of home-delivered
nutrition participants, are age 75 or older. About 52% of congregate nutrition
participants, and 61% of home-delivered participants, live alone. About 56% of
congregate nutrition participants, and 66% of home-delivered participants, report that
the meals they receive through the program provided one-half or more of their daily
food intake.3
National Academy of Sciences Study of Nutrition. Both H.R. 5293 and
S. 3570 would require the Assistant Secretary to use funds set aside for evaluation
to conduct an evidence-based evaluation of the nutrition program. The evaluation
would be conducted by the Food and Nutrition Board of the Institute of Medicine
(IOM) and is to include:
!
!
!
an evaluation of the effect of nutrition projects on the health and
nutrition status of participants, prevention of hunger and food
insecurity, and ability of participants to remain living independently;
a cost-benefit analysis of nutrition projects, including their potential
to affect costs of Medicaid; and
recommendations on how nutrition projects may be modified to
improve outcomes, and nutritional quality of meals.
Other Nutrition Program Proposals. H.R. 5293 and S. 3570 would add
several new services designed to enhance the scope of the services currently
available. The bills would add assessment and counseling as services that may be
available to participants. In addition, H.R. 5293 would allow nutrition projects to
2
U.S. Department of Health and Human Services, Fiscal Year 2007: Administration on
Aging: Justification of Estimates for Appropriations Committees, pp. 28-29.
3
Administration on Aging. Highlights from the Pilot Study: Second National Survey of
Older Americans Act Title III Service Recipients. [http://www.aoa.gov/about/results/
Final-Highlights-2nd-natioinal-survey.pdf], accessed Sept. 1, 2006.
CRS-5
provide participants with a multivitamin supplement along with the meal. S. 3570
does not include this provision.
National Family Caregiver Support Program
The National Family Caregiver Support Program, added to Title III by the 2000
amendments to the act, authorizes a number of services to assist caregivers of frail
older persons, including information and assistance to caregivers about available
services; individual counseling; organization of support groups and caregiver
training; respite services to provide families temporary relief from caregiving
responsibilities; and supplemental services (such as adult day care or home care
services, for example), on a limited basis, that complement care provided by family
and other informal caregivers.
Under current law, priority is to be given to older persons and their families who
have the greatest social and economic need, with particular attention to low income
individuals, and to older persons who provide care and support to persons with
mental retardation and developmental disabilities. Under current AoA guidance,
parents of children with disabilities may receive caregiver services if their children
are age 18 or younger. If the child is age 19-59, including, for example, adult
children with developmental disabilities who still need parental care, their parents are
not eligible for the act’s caregiver services. Both bills would clarify that services
may be provided to parents of a child with disabilities regardless of age of the child
(S. 3570 specifically refers to an adult child with a developmental or related
disability, while H.R. 5293 does not limit the disability type).
Under current law, grandparents or other older individuals who are relative
caregivers for children under the age of 18 may receive caregiver support services if
they are age 60 and older. Both H.R. 5293 and S. 3570 would decrease the age of
eligibility for grandparents/relative caregivers to age 55.
Senior Community Service Employment Program
for Older Americans
The community service employment program for older Americans (also known
as the Senior Community Service Employment Program, or SCSEP) has as its
purpose the promotion of useful part-time opportunities in community service
activities for unemployed low-income persons who are 55 years or older and who
have poor employment prospects. The program not only provides opportunities for
part-time employment and income for older persons, but also contributes to the
general welfare of communities by providing a source of labor for various
community service activities. Enrollees work part-time in a variety of community
service activities. The program provides for 61,050 jobs, serving about 92,300
people in FY2006.
Both H.R. 5293 and S. 3570 make changes to the Title V program, but take
different approaches. The House bill proposals are wider in scope than those in the
Senate Committee bill, and many of its proposed changes emanate from the view that
the program should place more emphasis on training of participants for unsubsidized
CRS-6
employment than what exists under the current program. (H.R. 5293 would change
the name of the program to Older American Community Service Employment-Based
Training Act.) While H.R. 5293 would retain the community service nature of the
jobs in which enrollees are placed, it would place more emphasis on training as part
of the program and would allow enrollees to be placed in private, for-profit
employment while serving as Title V enrollees.
Under the current program, participants primarily receive on-the-job training
after they have been placed in a community service position, rather than formal
training before placement. H.R. 5293 would decrease the amount of program funds
that could be spent on wages and fringe benefits in order to allow for an increased
amount to be used for training. Under current law, national and state grantees are to
spend 75% of their grants for wages and fringe benefits for enrollees. The remainder
is to be used for administration (between 13.5% and 15%), and other enrollee costs,
such as supportive services and training (between 10% and 12.5%). H.R. 5293
would decrease the amount to be spent on wages and fringe benefits to 65%. The
House Committee report indicates that this change would allow grantees to spend
more of their funds on classroom training and on-the-job training.4
H.R. 5293 would also allow enrollees to be placed in private, for-profit
organizations while receiving a Title V wage. The Senate bill does not make this
change and would add a provision to underline the community service employment
aspect of the program. It states that it is the sense of the Senate that the older
American community service employment program was created with the intent of
placing older individuals in community service positions to provide job training
placements; and placing older individuals in community service positions strengthens
the ability of individuals to become self-sufficient, provides much-needed volunteer
support to organizations which benefit significantly from increased civic engagement,
and strengthens the communities that are served by such organizations.
Limit on Time of Participant Enrollment. Under the current program,
there is no time limit on how long an enrollee may spend as a Title V participant. The
average length of time participants spend in the program is about 27 months. H.R.
5293 would limit participation by eligible individuals to 24 months (in the
aggregate). Individual participants could stay in the program for up to four years.
S. 3570 would allow an eligible individual to participate for up to 36 months in
the aggregate (and grantees may ask for a waiver of this limit under certain
circumstances). Under the bill, a grantee may extend the period of participation for
up to 20% of the project participants. In selecting participants for the extended
period, the grantee is to give priority to certain groups, including participants age 65
and older, those who are frail older individuals, and individuals who have more than
one barrier to employment, such as a disability, residence in an area of high
employment, or failure to find employment after using services under Title I of the
Workforce Investment Act (WIA), among other things.
4
Senior Independence Act of 2006, Comm. on Education and the Workforce, House of
Representatives, H.Rept. 109-493, June 8, 2006, 109th Cong., 2nd sess., p. 58
CRS-7
Eligibility. The bills make a number of changes to individual eligibility. When
determining an individual’s eligibility, H.R. 5293 and S. 3570 would exclude as
income unemployment compensation, Supplemental Security Income (SSI) benefits,
and 25% of benefits received under Title II of the Social Security Act. In addition,
S. 3570 would also exclude payments made to or on behalf of veterans or former
members of the Armed Forces under laws administered by the Secretary of Veterans
Affairs.
Elder Justice
Title VII authorizes Vulnerable Elder Rights Protection Activities. Two of the
four programs authorized have received funding — the long-term care ombudsman
program (whose purpose is to investigate and resolve complaints of residents of
nursing facilities, board and care facilities, and other adult care homes) and the elder
abuse, neglect and exploitation prevention program.5 Relatively limited resources
have been given to domestic elder abuse issues under Title VII. Most Title VII
funding is directed at the older people residing in institutions through the long-term
care ombudsman program. Of $20.2 million appropriated for FY2006 for Title VII
programs, almost three-quarters was for ombudsman activities.
As older individuals continue to live longer lives, increasing the likelihood of
age-related disability, those who rely on family, friends, or professionals for care
could become vulnerable to abuse, neglect, and exploitation. Given these
demographic trends, it is anticipated that cases of elder abuse, neglect, and
exploitation will increase. It has been difficult to estimate the number of older
people living in institutions and in the community who may be subject to elder abuse,
neglect and exploitation. Efforts to collect data on elder abuse, neglect, and
exploitation at the national level pose several problems, including variation in state
statutory definitions of elder abuse making it difficult to identify actions that
constitute abuse and neglect, and lack of a uniform reporting system across states.
Recognizing the need for a coordinated federal effort with a multidisciplinary
approach that combines law enforcement, public health, and social services to
combat abuse, neglect, and exploitation of the elderly, legislation has been
considered in recent Congresses. Senator John Breaux first introduced the Elder
Justice Act of 2002 (S. 2933) in the 107th Congress. A similar measure (S. 333) was
introduced in the 108th Congress; the bill was approved by the Senate Finance
Committee but never taken up on the Senate floor. On November 15, 2005, Senator
Hatch introduced S. 2010, the Elder Justice Act; the bill was ordered reported by the
Senate Finance Committee on August 3, 2006.
In addition to these efforts, Congress has included provisions related to elder
justice activities in legislation to reauthorize the Older Americans Act. Both H.R.
5293 and S. 3570 focus on efforts to increase attention to elder justice issues, but take
different approaches. In both bills, elder justice is defined as efforts to prevent,
5
Two other programs are authorized, but not funded — legal assistance development and
the Native American elder rights program.
CRS-8
detect, treat, intervene in, and respond to elder abuse, neglect, and exploitation and
to protect elders with diminished capacity while maximizing their autonomy.
AoA Responsibility for Elder Justice Issues. The House bill would
authorize the Assistant Secretary to designate within the AoA responsibility for elder
abuse prevention and services while the Senate Committee bill would authorize the
Secretary of HHS to establish within the AoA an Office of Elder Abuse Prevention
and Services.
National Incidence Study and Data Collection Efforts. S. 3570 would
authorize the Assistant Secretary to carry out a study to determine the national
incidence and prevalence of elder abuse, neglect, and exploitation in all settings. In
addition, the bill would add a provision for the collection of uniform national data on
elder abuse, neglect, and exploitation. The purpose of this provision of the bill is to
improve, streamline, and promote uniform collection, maintenance, and
dissemination of national data relating to the various types of elder abuse, neglect,
and exploitation.
Grants to States and Tribal Organizations for Elder Justice
Programs. S. 3570 would authorize funds for grants to states and Indian tribes to
strengthen long-term care and provide assistance for elder justice programs. Among
other things, state and tribal grants would be used for the following activities:
!
!
!
prevention, detection, assessment, and treatment of, intervention in,
investigation of, and response to elder abuse, neglect, and
exploitation;
examination of various types of elder shelters (referred to as “safe
havens”), and to test various safe haven models; and
support for multidisciplinary elder justice activities.
Research and Demonstration Initiatives
S. 3570 would add authority for the Assistant Secretary on Aging to conduct
several new demonstration programs under Title IV. Among these are demonstration
projects for model projects to assist older people to age in place, including in
Naturally Occurring Retirement Communities (NORCs); and for mental health
services for older people. H.R. 5293, as passed by the House, makes no changes to
the Title IV research, training, and demonstration program.
New research and demonstration programs contained in S. 3570 include the
following.
Model Projects for Aging in Place. Many communities around the country
are experimenting with ways to assist older people who have “aged in place,” that is
who have resided in their own homes independently for many years, and now may
need a variety of supportive services to assist them to continue to do so. In recent
years, House and Senate appropriation legislation has included earmarks for a
number of projects to provide support for organizations that assist these “Naturally
Occurring Retirement Communities” (NORCs). For example, for FY2007, the
House and Senate Appropriations Committees have earmarked funds for,
CRS-9
respectively, 15 and 5 NORC projects as part of the AoA Title IV research and
demonstration program.6
Under current Older Americans Act statute, there is no explicit authority to
carry out NORC projects. S. 3570 would require that the Assistant Secretary award
Title IV funds to carry out model aging in place projects, including NORCs. The aim
of these projects would be to help sustain the independence of older individuals in
communities where the individuals have established personal, family, and
professional supportive networks. The bill defines Naturally Occurring Retirement
Community as a residential building, a housing complex, an area (including a rural
area) of single family residences, or a neighborhood composed of age-integrated
housing where 40% of the heads of household are older individuals; or a critical mass
of older individuals that exists, based on local factors which, taken in total, allow an
organization to achieve efficiencies in the provision of health and social services to
older individuals living in the community; and that is not an institutional care or
assisted living setting.
Entities that would receive funds under this demonstration would be required
to provide comprehensive and coordinated health and social services, including the
following services: case management, case assistance, and social work services;
health care management and health care assistance; education, socialization, and
recreational activities; volunteer opportunities for project participants; and
coordinating the services provided under Title III for eligible older individuals served
by the project.
Demonstration Efforts to Address Mental Illness in Older People.
S. 3570 would add a new provision requiring the Assistant Secretary to make
competitive grants to states to develop systems for the delivery of mental health
screening and treatment services for older individuals who lack access to such
services and programs. The purpose of the grants would be to
!
!
!
6
increase public awareness regarding the benefits of prevention and
treatment of mental disorders in older individuals;
reduce the stigma associated with mental disorders in older
individuals and other barriers to the diagnosis and treatment of the
disorders; and
reduce age-related prejudice and discrimination regarding mental
disorders in older individuals.
House Committee on Appropriations, Departments of Labor, Health and Human Services,
and Education, and Related Agencies, H.Rept. 109-515, 109th Cong., 2nd sess., p. 161ff;
Senate Committee on Appropriations, Departments of Labor, Health and Human Services,
and Education and Related Agencies, S.Rept. 109-287, 109th Cong., 2nd sess., p. 212.
CRS-10
Table 1. Side-by-Side Comparison of Current Law, H.R. 5293, and S. 3570
PROVISION
CURRENT LAW
H.R. 5293, the Senior Independence
Act of 2006, as passed by the House,
June 21, 2006 (RFS)
S. 3570, Older Americans Act
Amendments of 2006, as ordered
reported by the Senate HELP Committee,
June 28, 2006 (IS)
TITLE I, DECLARATION OF OBJECTIVES; DEFINITIONS
DEFINITIONS
Assistive device, assistive
technology, and assistive
technology service
No provision.
Defines assistive device, assistive technology,
and assistive technology service to have the
same meaning as section 3 of the Assistive
Technology Act of 1998 (29 U.S.C. 3002).
(p. 3)
No provision.
Health promotion
program/evidence-based
health promotion
Defines health promotion programs as
programs that include, but are not limited
to, programs relating to prevention and
reduction of effects of chronic disabling
conditions (including osteoporosis and
cardiovascular disease), alcohol and
substance abuse reduction, smoking
cessation, weight loss and control, and
stress management. These programs are
part of the broader definitions of disease
prevention and health promotion services.
Changes the term to evidence-based health
promotion programs which include programs
related to the prevention and mitigation of the
effects of chronic disease (including
osteoporosis, hypertension, obesity, diabetes,
and cardiovascular disease), alcohol and
substance abuse reduction, smoking cessation,
weight loss and control, stress management,
falls prevention, physical activity, and
improved nutrition through the consumption of
a healthful diet and multivitamin-mineral
supplementation. (p. 3)
Same as H.R. 5293, but would eliminate
reference to improving nutrition through the
consumption of a healthful diet and
multivitamin-mineral supplementation. (p. 2)
Information and assistance
Defines information and assistance as
services that, among other things, serve the
entire community of older individuals,
particularly, older individuals at greatest
social need and with greatest economic
need.
Adds reference to older individuals at risk for
institutional placement. (p. 3)
Same as H.R. 5293. (p. 2)
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PROVISION
Aging and Disability
Resource Center (ADRC)
CURRENT LAW
No provision.
H.R. 5293, the Senior Independence
Act of 2006, as passed by the House,
June 21, 2006 (RFS)
S. 3570, Older Americans Act
Amendments of 2006, as ordered
reported by the Senate HELP Committee,
June 28, 2006 (IS)
Defines ADRCs as a program established by a
state, as part of the state’s system of long-term
care, to provide a coordinated system for —
Similar to H.R. 5293, except defines ADRCs
as center (rather than program). (p. 4)
• comprehensive information on available
public and private long-term care programs,
options, and resources; (p. 5)
Same as H.R. 5293. (p. 4)
• personal counseling to assist individuals in
assessing their existing or anticipated longterm care needs, and developing and
implementing a plan for long-term care
designed to meet their specific needs and
circumstances; and (p. 5)
Same as H.R. 5293. (p. 4)
• consumer access to the range of publiclysupported long-term care programs for which
they may be eligible, by serving as a
convenient point of entry for such programs.
(p. 5)
Similar to H.R. 5293, except refers to
consumers (rather than they). (p. 4)
At risk of institutional
placement
No provision.
Defines at risk for institutional placement as an
older individual who is unable to perform at
least two activities of daily living without
substantial human assistance (including verbal
reminding, physical cuing, or supervision) and
is determined by the state to be in need of
placement in a long-term care facility. (p. 6)
Same as H.R. 5293, except refers to
substantial assistance (rather than substantial
human assistance) and does not require, but
includes an older individual who is
determined by state to be in need of
placement in a long-term care facility. (p. 4)
Long-term care facility
Defines long-term care facility as —
• any skilled nursing facility, as defined in
section 1819(a) of the Social Security
Act;
• any nursing facility, as defined in section
1919(a) of the Social Security Act;
No change in current law.
Adds reference to an assisted living facility.
(p. 3)
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PROVISION
CURRENT LAW
H.R. 5293, the Senior Independence
Act of 2006, as passed by the House,
June 21, 2006 (RFS)
S. 3570, Older Americans Act
Amendments of 2006, as ordered
reported by the Senate HELP Committee,
June 28, 2006 (IS)
• for the purposes of sections 307(a)(12)
and 712, a board and care facility; and
any other adult care home similar to a
facility or institution.
Elder justice
No provision.
Defines elder justice as efforts to prevent,
detect, treat, intervene in, and respond to elder
abuse, neglect, and exploitation and to protect
elders with diminished capacity while
maximizing their autonomy. (p. 6)
No provision in Title II of the act. Elder
justice is defined in Title VII, as efforts to
prevent, detect, treat, intervene in, and
respond to elder abuse, neglect, and
exploitation and to protect elders with
diminished capacity while maximizing their
autonomy; and from an individual
perspective, the recognition of an elder’s
rights, including the right to be free of abuse,
neglect, and exploitation. (p. 114)
Exploitation
Defines exploitation as the illegal or
improper act or process of an individual,
including a caregiver, using the resources
of an older individual for monetary or
personal benefit, profit, or gain.
Defines exploitation as the fraudulent or
otherwise illegal, unauthorized, or improper act
or process of an individual who uses the
resources of an older individual for monetary or
personal benefit, profit, or gain, or that results
in depriving an older individual of rightful
access to, or use of, benefits, resources,
belongings, or assets. (p. 4)
Similar to H.R. 5293, except that reference to
individual includes a caregiver or fiduciary.
(p. 2)
Neglect
Defines neglect as —
• the failure to provide for oneself the
goods or services that are necessary to
avoid physical harm, mental anguish, or
mental illness; or
• the failure of a caregiver to provide the
goods or services.
Defines neglect as the failure of a caregiver or
fiduciary to provide goods or services that are
necessary to maintain the health or safety of an
elder; or self-neglect. (p. 4)
Similar to H.R. 5293, except refers to an
older individual (rather than elder). (p. 3)
CRS-13
PROVISION
CURRENT LAW
H.R. 5293, the Senior Independence
Act of 2006, as passed by the House,
June 21, 2006 (RFS)
S. 3570, Older Americans Act
Amendments of 2006, as ordered
reported by the Senate HELP Committee,
June 28, 2006 (IS)
Same as H.R. 5293. (p. 3)
Self-neglect
No provision.
Defines self-neglect as an adult’s inability, due
to physical or mental impairment or diminished
capacity, to perform essential self-care tasks
including obtaining essential food, clothing,
shelter, and medical care; obtaining goods and
services necessary to maintain physical health,
mental health, or general safety; or managing
one’s own financial affairs. (p. 9)
Hispanic serving institution
No provision.
Defines Hispanic serving institution to have the Same as H.R. 5293. (p. 5)
same meaning as in section 502 of the Higher
Education Act of 1965 (20 U.S.C. 1101a).
(p. 6)
Long-term care
No provision.
Defines long-term care as any services, care, or
items (including assistive devices), including
disease prevention and health promotion
services, in-home services, and case
management services —
Same as H.R. 5293, except that the term
long-term care does not include disease
prevention and health promotion services, inhome services, and case management
services. (p. 5)
• intended to assist individuals in coping with,
and to the extent practicable compensate for,
functional impairments in carrying out
activities of daily living; (p. 7)
Same as H.R. 5293. (p. 5)
• furnished at home, in a community care
setting (including a small community care
setting as defined in subsection (g)(1), and a
large community care setting as defined in
subsection (h)(1), of section 1929 of the
Social Security Act (42 U.S.C. 1396t)), or in
a long-term care facility; and (p. 7)
Same as H.R. 5293. (p. 5)
• not furnished to prevent, diagnose, treat, or
cure, a medical disease or condition. (p. 7)
Same as H.R. 5293, except does not include
the term prevent. (p. 5)
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PROVISION
CURRENT LAW
H.R. 5293, the Senior Independence
Act of 2006, as passed by the House,
June 21, 2006 (RFS)
S. 3570, Older Americans Act
Amendments of 2006, as ordered
reported by the Senate HELP Committee,
June 28, 2006 (IS)
Multivitamin-mineral
supplement
No provision.
Defines multivitamin-mineral supplement as a
dietary supplement that provides at least twothirds of the essential vitamins and minerals at
100 percent of the daily value levels as
determined by the Food and Drug
Administration. (p. 7)
No provision.
Self-directed care
No provision.
Defines self-directed care as an approach to
providing services (including programs,
benefits, supports, and technology) under this
act intended to assist an older individual with
activities of daily living, in which —
Same as H.R. 5293 with slightly different
wording. (p. 5)
• services (including the amount, duration,
scope, provider, and location of services) are
planned, budgeted, and purchased under the
direction and control of such individual;
(p. 8)
• Same as H.R. 5293. (p. 6)
• the individual is provided with information
and assistance as necessary and appropriate to
enable informed decisions about his or her
care options; (p. 8)
• Similar to H.R. 5293, except refers to an
individual’s service options (rather than
care options). (p. 6)
• the individual’s needs, capabilities, and
preferences for services and the individual’s
ability to direct and control his or her receipt
of services, are assessed by the area agency
on aging (or other agency designated by the
area agency on aging); (p. 8)
Similar to H.R. 5293, except that services are
assessed by the area agency on aging
involved or the local provider agency (rather
than an agency designated by the area
agency on aging). (p. 6)
• based on the assessment, the area agency on
aging (or other agency designated by the area
agency on aging) together with the
individual’s family, caregiver, or legal
representative develops a plan of services that
specifies which services the individual will be
responsible for directing; a determination of
the role of family members (and others whose
participation is sought by the individual) in
Similar to H.R. 5293, except that upon
request the area agency on aging assists the
individual and the individual’s family,
caregiver, or legal representative in
developing the plan, role of family, and
budget. (p. 6)
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PROVISION
CURRENT LAW
H.R. 5293, the Senior Independence
Act of 2006, as passed by the House,
June 21, 2006 (RFS)
S. 3570, Older Americans Act
Amendments of 2006, as ordered
reported by the Senate HELP Committee,
June 28, 2006 (IS)
providing services under such plan; and a
budget for services; (p. 9)
State system for long-term
care
No provision.
• the area agency on aging or state agency
provides for oversight of such individual’s
self-directed receipt of services, including
steps to ensure the quality of services
provided and the appropriate use of funds
under this act. (p. 9)
Same as H.R. 5293, but refers to the area
agency on aging or state agency involved.
(p. 7)
Defines state system for long-term care as the
federal, state, and local programs and activities
administered by a state that provide, support, or
facilitate access to long-term care to individuals
in such state. (p. 10)
Same as H.R. 5293. (p. 7)
The bill would authorize the Assistant Secretary
to designate within the AoA responsibility for
elder abuse prevention and services. (p. 10)
The bill would authorize the Secretary of
Health and Human Services (HHS) to
establish or designate within the AoA an
Office of Elder Abuse Prevention and
Services. (p. 7)
The bill would require the Assistant Secretary,
acting through the person designated with
responsibility for elder abuse prevention and
services, to develop objectives, priorities,
policy and a long-term plan for —
Same as H.R. 5293. (p. 8)
• carrying out elder justice programs and
activities relating to elder abuse prevention,
detection, treatment, intervention, and
response; training of individuals in these
matters; and improvement of the elder justice
system in the U.S.; (p. 10)
Same as H.R. 5293. (p. 8)
TITLE II, ADMINISTRATION ON AGING (AoA)
FUNCTIONS OF THE ASSISTANT SECRETARY ON AGING
Elder abuse prevention
services
No provision.
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PROVISION
CURRENT LAW
H.R. 5293, the Senior Independence
Act of 2006, as passed by the House,
June 21, 2006 (RFS)
S. 3570, Older Americans Act
Amendments of 2006, as ordered
reported by the Senate HELP Committee,
June 28, 2006 (IS)
• collecting and disseminating data relating to
the abuse, neglect, and exploitation of older
individuals; (p. 11)
Same as H.R. 5293, would add that collecting
and disseminating data will be conducted
annually and authorizes the Secretary to
include vulnerable adults (in addition to
older adults). (p. 8)
No provision.
Would also authorize the inclusion of data
under section 753 (as added by the bill) after
consultation with the Attorney General and in
collaboration with experts from the
Department of Justice. (p. 8)
• disseminating information concerning best
practices regarding, and providing training
on, carrying out activities related to abuse,
neglect, and exploitation of older individuals;
(p. 11)
• Same as H.R. 5293, but would authorize
the Secretary to include vulnerable adults
(in addition to older individuals). (p. 9)
• conducting research related to abuse, neglect,
and exploitation of older individuals; (p. 11)
• Same as H.R. 5293, would require the
Assistant Secretary to conduct research in
conjunction with the necessary experts and
authorizes the Secretary to include
vulnerable adults (in addition to older
individuals). (p. 9)
• providing technical assistance to states and
other eligible entities under Title VII; (p. 11)
• Similar to H.R. 5293 with different
wording and refers to subtitle B of Title VII
as added by the bill. (p. 9)
• assisting states and other eligible entities
under Title VII to develop strategic plans to
better coordinate elder justice activities,
research, and training; and (p. 11)
No provision.
• promoting collaborative efforts and
diminishing duplicative efforts in the
development and carrying out of elder justice
programs at the federal, state, and local
levels. (p. 11)
No provision.
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PROVISION
National study on incidence
and prevalence of elder
abuse, neglect, and
exploitation
CURRENT LAW
No provision.
H.R. 5293, the Senior Independence
Act of 2006, as passed by the House,
June 21, 2006 (RFS)
S. 3570, Older Americans Act
Amendments of 2006, as ordered
reported by the Senate HELP Committee,
June 28, 2006 (IS)
No provision.
Would authorize the Assistant Secretary to:
• carry out a study to determine the national
incidence and prevalence of elder abuse,
neglect, and exploitation in all settings; and
• implement the overall policy and a strategy
to carry out the plan described above; and
provide advice to the Secretary on elder
justice issues and administer such programs
relating to elder abuse, neglect, and
exploitation as the Secretary determines to
be appropriate.
The Secretary, acting through the Assistant
Secretary, may issue such regulations as may
be necessary to carry out this subsection and
subtitle B of Title VII as added by the bill.
(p. 9)
Mental health services
No provision.
The bill would authorize the Assistant Secretary No provision.
to designate an officer or employee who shall
be responsible for the administration of mental
health services authorized under the act.
The Assistant Secretary, acting through the
officer or employee, would be required to
develop objectives, priorities, and a long-term
plan for supporting state and local efforts
involving education, prevention, and detection,
and treatment of mental disorders, including
age-related dementia, depression, and
Alzheimer’s disease and related neurological
disorders. (p. 12)
Assistive technology
Section 202(a)(5) requires the AoA to
develop plans, conduct and arrange for
research in the field of aging, and assist in
the establishment and implementation of
programs designed to meet the needs of
older individuals for supportive services
The bill would add assistive technologies to the
list of programs. (p. 12)
No provision.
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PROVISION
CURRENT LAW
H.R. 5293, the Senior Independence
Act of 2006, as passed by the House,
June 21, 2006 (RFS)
S. 3570, Older Americans Act
Amendments of 2006, as ordered
reported by the Senate HELP Committee,
June 28, 2006 (IS)
(including nutrition), hospitalization,
education and training services (including
preretirement training, and continuing
education); low-cost transportation and
housing; and health (including mental
health) services.
Coordination with Centers
for Medicare and Medicaid
Services (CMS) regarding
new benefits
No provision.
The bill would require the Assistant Secretary
to consult and coordinate activities with the
CMS and other federal entities to implement
and build awareness of programs providing
benefits affecting older individuals. (p. 12)
Same as H.R. 5293, but does not include
requirement to coordinate with other federal
entities. (p. 10)
Technical assistance
regarding benefits outreach
and establishment of a
National Center on Senior
Benefits
Section 202(a)(20) requires the AoA to
encourage and provide technical assistance
to states and area agencies on aging, to
carry out outreach to inform older
individuals with greatest economic need
who may be eligible to receive, but are not
receiving, benefits under the Supplemental
Security Income (SSI), Medicaid, and food
stamps programs.
The bill would add reference to service
providers to carry out outreach activities. It
would require outreach regarding any other
applicable federal programs, or any other
service (including technology and internetbased decision support tools) to assist
consumers to learn about, to receive benefits
under, and to participate in programs for which
they may be eligible. (p. 13)
No provision.
The bill would require AoA to provide
technical assistance and support for benefits
enrollment assistance and outreach to support
efforts to inform and enroll low-income older
individuals who may be eligible to participate,
but who are not participating, in federal and
state programs for which they are eligible, and
may in cooperation with federal partners, make
grants or contracts to establish a National
Center on Senior Benefits Outreach and
Enrollment, which is required to —
Similar to H.R. 5293, with different wording.
Also refers to greatest economic need. (p. 11)
• maintain and update web-based decision
supports and enrollment tools and integrated,
person-centered systems designed to inform
older individuals about the full range of
Similar to H.R. 5293, with slightly different
wording. Also refers to benefits under
federal and state programs. (p. 11)
CRS-19
PROVISION
CURRENT LAW
H.R. 5293, the Senior Independence
Act of 2006, as passed by the House,
June 21, 2006 (RFS)
S. 3570, Older Americans Act
Amendments of 2006, as ordered
reported by the Senate HELP Committee,
June 28, 2006 (IS)
benefits for which they may be eligible;
(p. 14)
• utilize cost-effective strategies to find and
enroll those with greatest economic need;
(p. 14)
Same as H.R. 5293, with slightly different
wording. (p. 11)
• create and support efforts for ADRCs, and
other public and private state and communitybased organizations and coalitions, including
faith-based organizations, to serve as
enrollment benefit centers; (p. 14)
Same as H.R. 5293, with slightly different
wording. (p. 11)
• develop and maintain an information
clearinghouse on best practices and costeffective methods for identifying and
enrolling limited income older Americans in
benefits for which they are eligible; and
(p. 14)
Similar to H.R. 5293, with slightly different
wording. Also refers to individual with
greatest economic need, instead of limited
income (in the act greatest economic need
refers to income below the federal poverty
level). (p. 12)
• provide, in collaboration with federal partners
administering programs, training and
technical assistance on effective outreach
screening, enrollment and follow-up
strategies. (p. 14)
Same as H.R. 5293, slightly different
wording. Also refers to follow-up strategies
for federal and state programs. (p. 12)
Data collection on home and
community-based care
Section 202(a)(26)(D) requires AoA to
design and implement data collection
procedures, including procedures for
collecting information on gaps in services
needed by older individuals.
The bill would eliminate reference to gaps in
services needed, and change reference to
services needed by older individuals (including
services that would permit such individuals to
receive long-term care in home and
community-based settings). (p. 15)
Similar to H.R. 5293. (p. 12)
Evidence-based disease
prevention and health
promotion
No provision.
The bill would add a new provision requiring
AoA to make available to states, area agencies,
and service providers, information and
technical assistance to support the provision of
evidence-based disease prevention and health
promotion services. (p. 15)
Same as H.R. 5293, but would make
information available to states only. (p. 13)
CRS-20
PROVISION
AoA role in long-term care
CURRENT LAW
Section 202(b) requires AoA to strengthen
its involvement in the development of
policy alternatives in long-term care and to
give the development of community
alternatives priority attention. In doing so,
the Assistant Secretary is required to —
• develop planning linkages with
utilization and quality control peer
review organizations under Title XI of
the Social Security Act, the Substance
Abuse and Mental Health Services
Administration (SAMHSA), and the
Administration on Developmental
Disabilities (ADD);
• participate in all departmental and
interdepartmental activities related to
institutional and noninstitutional longterm health care services development;
• review and comment on all departmental
regulations and policies on community
health and social service development for
older individuals; and
• participate in all departmental and
interdepartmental activities to provide a
leadership role for AoA, and for state
and area agencies on aging in the
development and implementation of
national community-based long-term
care programs for older individuals.
H.R. 5293, the Senior Independence
Act of 2006, as passed by the House,
June 21, 2006 (RFS)
S. 3570, Older Americans Act
Amendments of 2006, as ordered
reported by the Senate HELP Committee,
June 28, 2006 (IS)
The bill would rewrite requirements for AoA’s
role in long-term care. It would require the
Assistant Secretary to promote the development
and implementation of comprehensive,
coordinated systems at federal, state, and local
levels for providing long-term care in home and
community-based settings, in a manner
responsive to the needs and preferences of
older individuals and their family caregivers. In
doing so, the Assistant Secretary would be
required to —
• collaborate, coordinate, and consult with
other federal agencies and departments
responsible for formulating and implementing
programs, benefits, and services related to
providing long-term care, and authorize the
Assistant Secretary to make grants, contracts,
and cooperative agreements with funds
received from other federal entities;
• conduct research and demonstration projects
to identify innovative, cost-effective
strategies for modifying state systems of
long-term care to respond to the needs and
preferences of older individuals and family
caregivers; and target services to individuals
at risk for institutional placement, to permit
them to remain in home and communitybased care settings; and
• establish criteria and promote the
implementation (through area agencies on
aging, service providers, and such other
entities as the Assistant Secretary determines
to be appropriate) of evidence-based
programs to assist older individuals and their
family caregivers in learning about and
making behavioral changes intended to
reduce the risk of injury, disease, and
disability among older individuals. (p. 16)
Same as H.R. 5293. (p. 13)
CRS-21
PROVISION
H.R. 5293, the Senior Independence
Act of 2006, as passed by the House,
June 21, 2006 (RFS)
S. 3570, Older Americans Act
Amendments of 2006, as ordered
reported by the Senate HELP Committee,
June 28, 2006 (IS)
Facilitate, in coordination with CMS, the Cash
and Counseling National Program office, and
other federal entities as appropriate, the
provision of long-term care in home and
community-based settings, including self-care
models that —
Similar to H.R. 5293; excludes reference to
the Cash and Counseling National Program
office and other federal entities as
appropriate, but would facilitate with CMS.
(p. 14)
Assessment of needs
• provide for the assessment of the needs and
preferences of an individual at risk for
institutional placement to help them avoid
unnecessary nursing home placement and
depletion of income and assets to qualify for
Medicaid eligibility; (p. 17)
Same as H.R. 5293, except refers to
institutional placement (rather than nursing
home placement), and has slightly different
wording. (p. 14)
Option of individual to direct
and control supportive
services
• respond to the needs and preferences of the
individual and provide him/her (or
representative, as appropriate) the option to
direct and control the receipt of support
services provided; and (p. 17)
Similar to H.R. 5293 with different wording.
Includes a definition of representative. (p.
15)
Individual plan for long-term
care
• assist an older individual (or a representative,
as appropriate) develop a plan for long-term
support, including the selecting, budgeting,
and purchasing of home and communitybased long-term care and supportive services;
(For purposes of this paragraph, the term
‘representative’ means a person appointed by
the eligible individual, or legally acting on the
individual’s behalf to represent or advise the
individual in financial or service coordination
matters). (p. 17)
Same H.R. 5293, slightly different wording.
(p. 15)
Require the AoA to play a lead role with
respect to issues concerning home and
community-based long-term care, including —
• directing (as the Secretary or the President
determines to be appropriate) or otherwise
participating in departmental and
interdepartmental activities concerning long-
Same as H.R. 5293. (p. 15)
Home and community-based
long-term care, and models for
care
AoA to play lead role in longterm care
CURRENT LAW
No provision.
No provision.
CRS-22
PROVISION
CURRENT LAW
H.R. 5293, the Senior Independence
Act of 2006, as passed by the House,
June 21, 2006 (RFS)
S. 3570, Older Americans Act
Amendments of 2006, as ordered
reported by the Senate HELP Committee,
June 28, 2006 (IS)
term care;
• reviewing and commenting on departmental
rules, regulations, and policies related to
providing long-term care; and
• making recommendations to the Secretary
with respect to home and community-based
long-term care, including recommendations
based on findings made through research and
demonstration projects to modify state longterm care systems. (p.18)
Advance planning for longterm care
No provision.
Promote, in coordination with other appropriate
federal agencies, enhanced public awareness
for the importance of planning in advance for
long-term care and the availability of
information and resources to assist in such
planning. (p. 19)
Same as H.R. 5293. (p. 16)
Aging and Disability
Resource Centers (ADRCs)
No provision.
Implement in all states ADRCs —
• to serve as visible and trusted sources of
information on the full range of long-term
care options that are available in the
community, including both institutional and
home and community-based care;
• to provide personalized and consumer
friendly assistance to empower people to
make informed decisions about their care
options;
• to provide coordinated and streamlined access
to all publicly supported long-term care
options so that consumers can obtain the care
they need through a single intake, assessment
and eligibility determination process;
• to help people to plan ahead for their future
long-term care needs; and
• to assist, in coordination with the state Health
Insurance Assistance Program, Medicare
beneficiaries in understanding and accessing
the Prescription Drug Coverage and
No provision. (See section on ADRCs in
Title III under State plans.)
CRS-23
PROVISION
CURRENT LAW
H.R. 5293, the Senior Independence
Act of 2006, as passed by the House,
June 21, 2006 (RFS)
S. 3570, Older Americans Act
Amendments of 2006, as ordered
reported by the Senate HELP Committee,
June 28, 2006 (IS)
preventative health benefits available under
the Medicare Modernization Act. (p. 19)
National technical assistance
programs for home and
community-based services
No provision.
The bill would establish, either directly or
through grants or contracts, national technical
assistance programs to assist state agencies,
area agencies on aging, and community-based
service providers funded under this act in
implementing home and community-based
long-term care systems, including evidencebased health promotion and disease prevention
programs. (p. 20)
Similar to H.R. 5293, refers to a national
technical assistance program (rather than
programs) and the term evidence-based does
not include health promotion and disease
prevention programs. (p. 16)
Performance standards for
long-term care
No provision.
D e v e l o p , i n c o l l a b o r atio n with t h e
Administrator of CMS, performance standards
and measures for use by states to determine the
extent to which their systems of long-term care
fulfill the objectives described in this
subsection. (p. 20)
Same as H.R. 5293. (p. 17)
Other long-term care
activities
No provision.
Conduct such other activities as the Assistant
Secretary determines to be appropriate. (p. 21)
Same as H.R. 5293. (p. 17)
Involvement of older
individuals in voluntary
community activities
No provision.
The bill would require the Assistant Secretary,
in consultation with the Corporation for
National and Community Service to —
Similar to H.R. 5293 with slightly different
wording. (p. 17)
• encourage and permit voluntary groups active
in supportive services and civic engagement,
including youth organizations active at the
secondary or postsecondary levels, to
participate and be involved individually or
through representative groups, in such
programs or activities to the maximum extent
feasible; (p. 21)
Similar to H.R. 5293, but references national
service programs. (p. 17)
• develop a comprehensive strategy for
utilizing older individuals to address critical
local needs of national concern, including the
engagement of older individuals in the
Similar to H.R. 5293, but does not reference
engagement of older individuals in the
activities of public and nonprofit
organizations, such as community-based and
CRS-24
PROVISION
CURRENT LAW
H.R. 5293, the Senior Independence
Act of 2006, as passed by the House,
June 21, 2006 (RFS)
activities of public and nonprofit
organizations such as community-based and
faith-based organizations; and (p. 21)
S. 3570, Older Americans Act
Amendments of 2006, as ordered
reported by the Senate HELP Committee,
June 28, 2006 (IS)
faith-based organizations. (p. 17)
• encourage other community capacity building
initiatives involving older individuals, with
particular attention to initiatives that
demonstrate the effectiveness and cost
savings in meeting critical needs. (p. 21)
Similar to H.R. 5293, but does not reference
with particular attention to initiatives that
demonstrate the effectiveness and cost
savings in meeting critical needs. (p. 18)
AoA collaboration with other
federal agencies: reference to
impact on persons with
limited English proficiency
Section 203(a) requires the heads of
federal departments, agencies, or
instrumentalities administering programs
and services related to the Older
Americans Act to develop a written
analysis of their impact on older
individuals (with particular attention to
low-income minority older individuals and
older individuals residing in rural areas)
and Title V eligible individuals.
The bill would add reference to older
individuals with limited English proficiency. (p.
22)
Same as H.R. 5293. (p.18)
Assistive Technology Act
Section 203(a) requires the AoA to
coordinate, advise and consult with heads
of numerous federal agencies and
programs.
The bill would add reference to sections 4 and
5 of the Assistive Technology Act of 1998 (29
U.S.C. 3003-3004). (p. 22)
Same as H.R. 5293. (p. 18)
Coordinating committee on
aging
No provision.
No provision.
The bill would require the Secretary of HHS
to establish an interagency coordinating
committee (Committee) focusing on the
coordination of agencies with respect to
aging issues, particularly related to
demographic changes and housing needs
among older individuals. This would be
established in collaboration with the
Secretary of Labor, the Secretary of Housing
and Urban Development (HUD), the
Attorney General, the Secretary of
CRS-25
PROVISION
CURRENT LAW
H.R. 5293, the Senior Independence
Act of 2006, as passed by the House,
June 21, 2006 (RFS)
S. 3570, Older Americans Act
Amendments of 2006, as ordered
reported by the Senate HELP Committee,
June 28, 2006 (IS)
Transportation, the Secretary of the Treasury,
the Secretary of Agriculture, the
Commissioner of Social Security, the
Surgeon General, the Administrator of CMS,
the Director of the Centers for Disease
Control and Prevention, the Director of the
National Institutes of Health, the Assistant
Secretary for Children and Families, the
Administrator of the National Highway
Traffic Safety Administration, and such other
federal officials as the Secretary of HHS
determines to be appropriate. (p. 18)
The bill would require the Secretary of HHS
to serve as the first chairperson of the
Committee, for an initial period of two years.
After the initial period, the bill would require
the Secretary of HUD and the Secretary of
HHS to alternate as chairpersons, each
serving as chairperson for a period of two
years. (p. 19)
The Committee is required to:
1) review all federal programs and services
that assist older individuals in finding and
affording housing, health care, and other
services, including those federal programs
and services that assist older individuals in
accessing health care, transportation,
supportive services, and assistance with daily
activities, at the place or close to the place
where the older individuals live;
2) monitor, evaluate, and recommend
improvements in programs and services
administered, funded, or financed by federal,
state, and local activities to assist older
CRS-26
PROVISION
CURRENT LAW
H.R. 5293, the Senior Independence
Act of 2006, as passed by the House,
June 21, 2006 (RFS)
S. 3570, Older Americans Act
Amendments of 2006, as ordered
reported by the Senate HELP Committee,
June 28, 2006 (IS)
individuals in meeting their housing, health
care, and other service needs and make any
recommendations about how the agencies can
better carry out and provide the programs and
services to house and serve older individuals;
recommend ways to —
• facilitate aging in place, by identifying and
making available the programs and services
necessary to enable older individuals to
remain in their homes as they age;
• reduce duplication by federal agencies of
programs and services to assist in meeting
older individuals’ housing, health care, and
other service needs;
• ensure collaboration among and within
agencies in providing and making available
programs and services so that older
individuals are able to easily access needed
programs and services;
• work with states to better provide housing,
health care, and other services to older
individuals by holding individual meetings
with state representatives, providing
ongoing technical assistance to states about
better meeting the needs of older
individuals; and working with states to
designate state liaisons for the Committee;
• identify model programs and services to
assist older individuals in meeting their
housing, health care, and other service
needs, including programs linking housing,
health care, and other services, financing
products offered by government, quasigovernment, and private sector entities, and
innovations in technology applications that
give older individuals access to information
CRS-27
PROVISION
CURRENT LAW
H.R. 5293, the Senior Independence
Act of 2006, as passed by the House,
June 21, 2006 (RFS)
S. 3570, Older Americans Act
Amendments of 2006, as ordered
reported by the Senate HELP Committee,
June 28, 2006 (IS)
on available services or that help in
providing services to older individuals;
• collect and disseminate information about
older individuals and the programs and
services available to them to ensure that
they can access comprehensive
information; and
• work with the Federal Interagency Forum
on Age-Related Statistics, the Bureau of the
Census, and member agencies to collect
and maintain data relating to the housing,
health care, and other service needs of older
individuals so that all such data can be
accessed in one place on a designated
website; and to identify and address unmet
data needs. (p. 20)
3) Make recommendations to guide policy
and program development across federal
agencies with respect to demographic
changes among older individuals; and (p. 22)
4) Actively seek input from and consult with
all appropriate and interested parties,
including public health interest and research
groups and foundations about these activities.
(p. 23)
Each year, the Committee is required to
prepare and submit to the President, the
Committee on Financial Services of the
House of Representatives, the Committee on
Education and the Workforce of the House of
Representatives, the Committee on Banking,
Housing and Urban Affairs of the Senate, the
Committee on Health, Education, Labor, and
Pensions of the Senate, and the Special
CRS-28
PROVISION
CURRENT LAW
H.R. 5293, the Senior Independence
Act of 2006, as passed by the House,
June 21, 2006 (RFS)
S. 3570, Older Americans Act
Amendments of 2006, as ordered
reported by the Senate HELP Committee,
June 28, 2006 (IS)
Committee on Aging of the Senate, a report
that —
• describes
the
activities
and
accomplishments of the Committee in
working with federal, state, and local
governments, and private organizations, in
coordinating programs and services to meet
the requirements of the Committee; (p. 23)
• assesses the level of federal assistance
required to meet the needs described for the
Committee; (p. 23)
• incorporates an analysis from the head of
each agency that is a member of the
Committee that describes the barriers and
impediments, including barriers and
impediments in statutory and regulatory
law, to the access and use by older
individuals of programs and services
administered by such agency; and (p. 23)
• makes recommendations for appropriate
legislative and administrative actions to
meet the needs described for the Committee
and/or coordinating programs and services
designed to meet those needs. (p. 24)
The Secretary of HHS is required to appoint
an executive director of the Committee, after
consultation with the Secretary of HUD. On
the request of the Committee, any federal
government employee may be detailed to the
Committee without reimbursement, and such
detail shall be without interruption or loss of
civil service status or privilege. (p. 24)
CRS-29
PROVISION
Functions of nutrition
program officer
CURRENT LAW
H.R. 5293, the Senior Independence
Act of 2006, as passed by the House,
June 21, 2006 (RFS)
S. 3570, Older Americans Act
Amendments of 2006, as ordered
reported by the Senate HELP Committee,
June 28, 2006 (IS)
Section 205 requires the AoA nutrition
project officer to carry out a number of
functions. These include:
• designing, implementing, and evaluating
nutrition programs;
The bill would change the reference to
designing, implementing, and evaluating
evidence-based programs to support improved
nutrition and regular physical activity for older
individuals. (p. 23)
Same as H.R. 5293. (p. 25)
• disseminating information to nutrition
service providers about nutrition
advancements.
The bill would require the officer to conduct
outreach and disseminate evidence-based
information to nutrition service providers about
the benefits of healthful diets and regular
physical activity, including information about
the most current Dietary Guidelines for
Americans published under section 301 of the
National Nutrition Monitoring and Related
Research Act of 1990 (7 U.S.C. 5341), the
Food Guide Pyramid published jointly by the
Secretary of HHS and the Secretary of
Agriculture, and advances in nutrition science.
(p. 23)
Same as H.R. 5293. (p. 25)
No provision.
The bill would require the officer to:
• disseminate guidance that describes strategies
for improving the nutritional quality of meals
provided under Title III, particularly
strategies for increasing the consumption of
whole grains, low-fat dairy products, fruits
and vegetables; (p. 24)
Same as H.R. 5293, but does not include
reference to strategies for increasing the
consumption of whole grains, low-fat dairy
products, fruits, and vegetables. (p. 26)
No provision.
• develop and disseminate guidelines for
conducting nutrient analyses of meals,
including guidelines for averaging key
nutrients over an appropriate period of time;
and (p. 24)
No provision.
No provision.
• provide technical assistance to the AoA
regional offices. (p. 24)
Same as H.R. 5293. (p. 26)
CRS-30
PROVISION
CURRENT LAW
H.R. 5293, the Senior Independence
Act of 2006, as passed by the House,
June 21, 2006 (RFS)
S. 3570, Older Americans Act
Amendments of 2006, as ordered
reported by the Senate HELP Committee,
June 28, 2006 (IS)
Expertise of the nutrition
officer
Section 205(a)(2)(C) requires that the
nutrition officer have expertise in nutrition
and dietary services and planning.
The bill would require the officer to have
expertise in nutrition, energy balance, and meal
planning. (p. 24)
Similar to H.R. 5293, but does not include
expertise in energy balance. (p. 26)
Set aside of funds for
evaluation projects
Section 206 authorizes the Secretary to use
such funds as may be necessary, but not to
exceed $3 million (of which $1.5 million
shall be available from Title III funds
appropriated and $1.5 million shall be
available from Title IV funds), to conduct
evaluations under this section.
The bill would authorize the Secretary to use up
to ½ of 1 percent of Title III funds for
evaluation. (For FY2006, for example, this
would amount to $6 million rather than $3
million in current law). (p. 25)
Same as H.R. 5293. (p. 26)
Reports on the activities
under the act
Section 207(b)(2) requires the Assistant
Secretary to submit a report on activities
under the act to —
• the Special Committee on Aging of the
Senate;
• the Committee on Education and Labor
of the House of Representatives; and
• the Committee on Labor and Human
Resources of the Senate.
The bill would change the provision to require
the report be submitted to —
• the Special Committee on Aging of the
Senate;
• the Committee on Education and the
Workforce of the House of Representatives;
and
• the Committee on Health, Education, Labor,
and Pensions of the Senate. (p. 25)
Same as H.R. 5293. (p. 27)
Contracting and grant
authority; commercial and
private pay relationships;
appropriate use of act funds
Section 212 requires that none of the
provisions are to be construed to prevent a
recipient of a grant or a contract from
entering into an agreement, subject to the
approval of the state agency (or in the case
of a grantee under Title VI, subject to the
recommendation of the Director of the
Office for American Indian, Alaskan
Native, and Native Hawaiian Aging, and
the approval of the Assistant Secretary),
with a profitmaking organization to carry
out the provisions of this act and of the
appropriate state plan.
The bill would amend the provision to read as
follows: Section 212. Contracting and Grant
Authority; Private Pay Relationships;
Appropriate Use of Funds.
(a) In General. — Subject to subsection (b), this
act shall not be construed to prevent a recipient
of a grant or a contract from entering into an
agreement —
• with a profitmaking organization;
• under which funds provided under such grant
or contract are used to pay part or all of a cost
(including an administrative cost) incurred by
such recipient to carry out a contract or
commercial relationship for the benefit of
older individuals or their family caregivers,
Similar to H.R. 5293, but specifies that
individuals who seek services may
voluntarily pay at their own private expense.
(p. 28)
CRS-31
PROVISION
CURRENT LAW
H.R. 5293, the Senior Independence
Act of 2006, as passed by the House,
June 21, 2006 (RFS)
whether such relationship is carried out to
implement a provision of this act or to
conduct activities inherently associated with
implementing such provision; or
• under which any individual, regardless of age
or income (including the family caregiver of
such individual), who seeks to receive one or
more services pays, at their own private
expense, to receive such services based on the
fair market value of such services. (p. 26)
(b) Ensuring Appropriate Use of Funds. — An
agreement described under subsection (a) may
not —
• be made without the prior approval of the
state agency (or, in the case of a grantee
under Title VI, without the prior
recommendation of the Director of the Office
for American Indian, Alaska Native, and
Native Hawaiian Aging and the prior
approval of the Assistant Secretary);
• directly or indirectly provide for, or have the
effect of, paying, reimbursing, or otherwise
compensating an entity under such agreement
in an amount that exceeds the fair market
value of the goods or services furnished by
such entity under such agreement;
• result in the displacement of services
otherwise available to an older individual
with the greatest social need, an older
individual with greatest economic need, or an
older individual who is at risk for institutional
placement; or
• in any other way compromise, undermine, or
be inconsistent with the objective of serving
the needs of older individuals, as determined
by the Assistant Secretary. (p. 27)
S. 3570, Older Americans Act
Amendments of 2006, as ordered
reported by the Senate HELP Committee,
June 28, 2006 (IS)
CRS-32
PROVISION
CURRENT LAW
H.R. 5293, the Senior Independence
Act of 2006, as passed by the House,
June 21, 2006 (RFS)
S. 3570, Older Americans Act
Amendments of 2006, as ordered
reported by the Senate HELP Committee,
June 28, 2006 (IS)
Nutrition education
Section 214 authorizes the Assistant
Secretary and the Secretary of Agriculture
to provide technical assistance and
appropriate material to agencies carrying
out nutrition education programs in
accordance with section 339(2)(J).
The bill would authorize the Assistant
Secretary, in consultation with the Secretary of
Agriculture, to conduct outreach and provide
technical assistance to agencies and
organizations that serve older individuals to
assist them in carrying out integrated health
promotion and disease prevention programs
that are designed for older individuals and that
include nutrition education, physical activity,
and other activities to modify behavior and to
improve health literacy (including information
on optimal nutrition intake) through education
and counseling in accordance with section
339(2)(J). (p. 27)
Same as H.R. 5293, but adds reference to
providing information on optimal nutrition
intake. (p. 29)
Pension counseling and
information programs
Section 215 authorizes the Assistant
Secretary to include, as part of the
application, a plan to provide information,
counseling, referral and assistance
regarding pension and other retirement
benefits, with particular emphasis on
outreach to women, minorities, older
individuals residing in rural areas and lowincome retirees.
The bill would add reference to older
individuals with limited English proficiency. (p.
28)
Same as H.R. 5293. (p. 30)
Section 215 requires the Assistant
Secretary to consider, among the criteria in
awarding pension counseling programs
grants, the applicant’s ability to perform
effective outreach to affected populations,
particularly populations that are identified
in need of special outreach.
The bill would add reference to populations
with limited English proficiency. (p. 28)
Same as H.R. 5293. (p. 30)
No provision.
No provision.
The bill would add reference to individuals
with limited English proficiency to the
content of the pension assistance national
telephone hotline. (p. 30)
CRS-33
PROVISION
Authorization of
appropriations for Title II
activities
CURRENT LAW
Section 216 authorizes the appropriation of
such sums as may be necessary for AoA
administration, salaries and expenses, the
National Elder Locator Service, and
Pension Counseling and Information
Programs for FY2001-FY2005.
H.R. 5293, the Senior Independence
Act of 2006, as passed by the House,
June 21, 2006 (RFS)
S. 3570, Older Americans Act
Amendments of 2006, as ordered
reported by the Senate HELP Committee,
June 28, 2006 (IS)
The bill would authorize such sums as may be
necessary for FY2006-FY2011. (p. 29)
Same as H.R. 5293. (p. 30)
TITLE III, GRANTS FOR STATE AND COMMUNITY PROGRAMS ON AGING
Purpose of Title III:
coordination with volunteer
services
Section 301 of the act states that the
purpose of Title III is to encourage and
assist state and area agencies on aging to
develop greater capacity and foster the
development and implementation of
comprehensive and coordinated systems to
serve older individuals by entering into
cooperative arrangements with a number
of entities, including other state agencies,
Indian tribes, tribal organizations, and
providers, among others.
The bill would add to the entities, organizations
with experience in providing senior volunteer
services, such as federal volunteer programs
administered by the Corporation for National
and Community Services designed to provide
training, placement and stipends for volunteers
in community service settings. (p. 29)
Same as H.R. 5293. (p. 31)
Authorization of
appropriations: supportive,
nutrition, and disease
prevention and health
promotion services
The law authorizes such sums as may be
necessary for each of FY2001-FY2005.
The bill would authorize such sums as may be
necessary for each of FY2007-FY2011. (p. 30)
Same as H.R. 5293. (p. 32)
Authorization of
appropriations: National
Family Caregiver Support
Program
The law authorizes $125 million for
FY2001, if the aggregate amount
appropriated for supportive services,
congregate nutrition services, homedelivered nutrition services, and disease
prevention and health promotion exceeds
the FY2000 amount. It also authorizes
such sums as may be necessary for
FY2002-FY2005.
The bill would authorize such sums as may be
necessary for each of FY2007-FY2011.
(p. 30)
The bill would authorize $170 million in
FY2008; $180 million in FY2009; $190
million in FY2010; and $200 million in
FY2011. (p. 32)
CRS-34
PROVISION
CURRENT LAW
H.R. 5293, the Senior Independence
Act of 2006, as passed by the House,
June 21, 2006 (RFS)
S. 3570, Older Americans Act
Amendments of 2006, as ordered
reported by the Senate HELP Committee,
June 28, 2006 (IS)
The law requires that of funds authorized
for the national caregiver program, 4% be
reserved for national innovative
approaches to caregiving, and 1% be
reserved for activities of national
significance to promote quality and
improvement in caregiver support.
No provision.
No provision.
Area agency administrative
funds to be use for needs
assessment of growing elder
population
No provision.
No provision.
The bill would allow an additional 1% of the
state’s allotment to be used for area plan
administration to carry out activities related
to assessment of the needs of the growing
elderly population (added by the bill). This
could occur only when appropriations for
Title III supportive, nutrition, and disease
prevention and health promotion services
exceed 110% of the FY2006 appropriations
level. (p. 33)
State plans on aging: focus on
older individuals with limited
English proficiency
Section 305(a) of the law requires state
agencies to divide the state into planning
and service areas that consider among
other things, the distribution of older
people, with particular attention to low
income minority individuals and older
individuals residing in rural areas and that
preference in providing services will be
given to these groups.
The bill would add reference to older
individuals with limited English proficiency.
(p. 31)
Same as H.R. 5293. (p. 33-34)
State long-term care systems
No provision.
The bill would require that the state agency on
aging promote the development and
implementation of a comprehensive,
coordinated system in the state for providing
long-term care in home and community-based
settings, in a manner that is responsive to the
needs and preferences of older individuals and
their families by:
Similar to H.R. 5293, but with slightly
different wording in some places. (p. 34)
CRS-35
PROVISION
CURRENT LAW
H.R. 5293, the Senior Independence
Act of 2006, as passed by the House,
June 21, 2006 (RFS)
• collaborating, coordinating, and consulting
with other agencies responsible for
formulating, implementing, and administering
programs, benefits, and services regarding
long-term care;
• participating in state government activities
regarding long-term care;
• conducting analysis and making
recommendations with respect to strategies
for modifying the state’s long-term care
system in order to respond to the needs and
preferences of individuals and family
caregivers; facilitate provision of home and
community-based care; target services to
those at risk of institutional placement; and
implement evidence-based programs to assist
older individuals and their family caregivers
in learning about and making behavioral
changes to reduce the risk of injury, disease,
and disability; and
• providing for distribution of information on
the need to plan in advance for long-term care
and on the range of available public and
private long-term care programs, options, and
resources. (pp. 31-33)
Puerto Rico, single planning
and service area
S. 3570, Older Americans Act
Amendments of 2006, as ordered
reported by the Senate HELP Committee,
June 28, 2006 (IS)
Refers to targeting services to older
individuals at risk of institutional placement.
No reference to evidence-based programs.
No provision.
No provision.
The bill would allow the Commonwealth of
Puerto Rico to designate a single planning
and service area, with the approval of the
Assistant Secretary. (p. 36)
Section 306(a)(1) requires area plans on
aging to develop a comprehensive and
coordinated system for supportive,
nutrition, and multi-purpose senior centers
The bill would add reference to older
individuals with limited English proficiency.
(p. 33)
Same as H.R. 5293. (p. 37)
AREA PLANS ON AGING
Area plans on aging: focus on
older individuals with limited
English proficiency
CRS-36
PROVISION
CURRENT LAW
H.R. 5293, the Senior Independence
Act of 2006, as passed by the House,
June 21, 2006 (RFS)
S. 3570, Older Americans Act
Amendments of 2006, as ordered
reported by the Senate HELP Committee,
June 28, 2006 (IS)
taking into consideration the number of
older individuals with low income, the
number of older individuals with greatest
economic need, and the number with
greatest social need (with particular
attention to low-income minority people
and older individuals residing in rural
areas).
Area plans on aging: focus on
persons at risk of institutional
placement
Section 306(a)(1) requires area plans on
aging to develop a comprehensive and
coordinated system for supportive,
nutrition, and multi-purpose senior centers
taking into consideration the number of
older individuals with low-income, the
number of older individuals with greatest
economic need, and the number with
greatest social need (with particular
attention to low income minority people
and older individuals residing in rural
areas).
The bill would add reference to the number of
older individuals at risk for institutional
placement residing in the area. (p. 34)
Same as H.R. 5293. (p. 37)
Area plans on aging: mental
health services
No provision.
No provision.
The bill would require area agencies to
provide assurances that an adequate
proportion of Title III funds be spent on
services associated with access services,
including health services (including mental
health). (p. 37)
Area plans on aging:
information and assistance
No provision.
No provision.
The bill would include as information and
assistance, services on the availability of
supportive services under part B of the act,
and how to receive benefits under and
participate in publicly supported programs
for which the consumer may be eligible.
(p. 38)
CRS-37
PROVISION
CURRENT LAW
H.R. 5293, the Senior Independence
Act of 2006, as passed by the House,
June 21, 2006 (RFS)
S. 3570, Older Americans Act
Amendments of 2006, as ordered
reported by the Senate HELP Committee,
June 28, 2006 (IS)
Area plans on aging: specific
objectives for serving older
individuals
Section 306(a)(4) requires area plans on
aging to assure that they will set specific
objectives for providing services to older
individuals with greatest economic and
social need, and include specific objectives
for providing services to low-income
minority individuals and older individuals
residing in rural areas.
The bill would require area plans to set
objectives, consistent with state policy, for
providing services to not only those with the
greatest economic and social need, but also to
individuals at risk of institutional placement,
and include objectives and proposed methods to
serve these individuals. (p. 34)
Similar to H.R. 5293, but wording is
different. (p. 38)
Area plans on aging:
provider agreement
regarding serving older
individuals
Section 306(a)(4)(A)(ii) requires area
agencies on aging to include in provider
agreements they make with service
providers, a requirement that providers
specify how they intend to serve the needs
of low-income minority individuals
(among other groups).
The bill would add reference to older
individuals with limited English proficiency.
(p. 35)
Similar to H.R. 5293. (p. 38)
Area plans on aging:
outreach efforts
Section 306(a)(4)(B) requires that the area
agency on aging will use outreach efforts
that will identify eligible individuals for
assistance, with special emphasis on those
residing in rural areas, those with greatest
economic and social need, those with
severe disabilities, those with limited
English-speaking ability, and those with
Alzheimer’s disease or related neurological
and organic brain dysfunction.
The bill would also require outreach to older
individuals at risk for institutional placement.
(p. 35)
Similar to H.R. 5293, but also changes
reference to individuals with limited English
proficiency, instead of limited Englishspeaking ability. (p. 39)
Section 306(a)(5) requires area agencies to
assure that they will coordinate planning,
identification, need assessment, and
service provision with particular attention
to individuals with severe disability, and
with agencies that develop or provide
services to individuals with disabilities.
The bill would require area agencies to give
particular attention to individuals at risk for
institutional placement. (p. 36)
Similar to H.R. 5293. (p. 39)
CRS-38
PROVISION
CURRENT LAW
H.R. 5293, the Senior Independence
Act of 2006, as passed by the House,
June 21, 2006 (RFS)
S. 3570, Older Americans Act
Amendments of 2006, as ordered
reported by the Senate HELP Committee,
June 28, 2006 (IS)
Area plans on aging: use of
trained volunteers
No provision.
The bill would require area agencies to make
use of trained volunteers in providing direct
services to elderly and disabled individuals
needing care, and, if possible, work in
coordination with volunteer programs
(including programs administered by the
Corporation for National Service) designed to
povide training, placement and stipends for
volunteers in community service settings.
(p. 36)
Similar to H.R. 5293. (p. 40)
Area plans on aging:
advisory council membership
Section 306(a)(6) requires area agencies on
aging to establish an advisory council and
specified council membership.
The bill would add to the membership, family
caregivers of older individuals, service
providers, and the business community. (p. 36)
Similar to H.R. 5293. (p. 40)
Area plans on aging:
increasing public awareness
of mental health
Section 306(a) requires area agencies to
coordinate mental health services
provided with funds expended by area
agencies with mental health services
provided by community health centers and
by other public agencies and nonprofit
private organizations.
The bill would require area agencies on aging,
in coordination with the state agency on aging
and the state agency responsible for mental
health services, to increase public awareness of
mental health disorders, to remove barriers to
diagnosis and treatment, and to coordinate
mental health services (including mental health
screenings) with funds expended by the area
agency with mental health services provided by
community health centers and other agencies.
(p. 37)
The bill would add reference to mental health
screening. It does not include the provision
regarding public awareness of mental health
disorders or removing barriers to diagnosis
and treatment. (p. 41)
Area plans on aging:
comprehensive coordinated
system for home and
community-based long-term
care
Section 306(a)(7) requires that area
agencies on aging facilitate the
coordination of community-based longterm care services to enable older
individuals to remain in their own homes.
Area agencies are to accomplish this by:
• developing case management services as
a component of long-term care;
• involving long-term care providers in the
coordination of these services; and
The bill would rewrite the section as follows.
The bill would require that area agencies
facilitate the areawide development and
implementation of a comprehensive,
coordinated system for providing long-term
care in home and community-based settings, in
a manner that is responsive to the needs and
preferences of older individuals and their
families by:
• collaborating, coordinating, and consulting
Similar to H.R. 5293, but with slightly
different wording in some places. (pp. 41-43)
CRS-39
PROVISION
Area plans on aging: area
agency costs to carry out
commercial relationships
CURRENT LAW
H.R. 5293, the Senior Independence
Act of 2006, as passed by the House,
June 21, 2006 (RFS)
S. 3570, Older Americans Act
Amendments of 2006, as ordered
reported by the Senate HELP Committee,
June 28, 2006 (IS)
• increasing community awareness of and
involvement in addressing the needs of
residents of long-term care facilities.
with other local public and private agencies
responsible for formulating, implementing
and administering programs, benefits, and
services regarding long-term care;
• conducting analysis and making
recommendations and implementing
programs related to strategies for modifying
the state’s long-term care system in order to
respond to the needs and preferences of older
individuals and family caregivers; facilitate
provision of home and community-based
care; target services to older individuals at
risk of institutional placement;
• implementing evidence-based programs to
assist older individuals and their family
caregivers in learning about and making
behavioral changes to reduce the risk of
injury, disease, and disability; and
• providing for distribution of information on
the need to plan in advance for long-term care
and on the range of available public and
private long-term care programs, options, and
resources. (pp. 37-39)
Section 306(a)(14) and (15)(second
paragraph (15)) prohibits area agencies
from paying any costs incurred as a result
of a contract or commercial relationship
unrelated to the act. (These paragraphs are
duplicative.)
Deletes these provisions (duplication in current
law.) (p. 39) For related content, see the
provisions that immediately follow (in the next
row) relating to maintaining public purpose
mission of Title III.
Retains paragraph (14), but eliminates second
paragraph (15). (p. 43) For related content,
see the provisions that immediately follow
(in the next row) relating to maintaining
public purpose mission of Title III.
Section 306(a)(15) (first paragraph (15))
and (16) also prohibits area agencies from
giving preference to particular individuals
as a result of a contract or commercial
relationship unrelated to the act. (These
paragraphs are duplicative.)
Deletes first paragraph (15) but retains
paragraph (16), essentially retaining current
law. (p. 39)
Same as H.R. 5293. (p. 43)
CRS-40
PROVISION
Area plans on aging: priority
for use of funds for specified
older individuals;
maintaining public purpose
mission and disclosure of
information on contractual
relationships
CURRENT LAW
No provision.
.
H.R. 5293, the Senior Independence
Act of 2006, as passed by the House,
June 21, 2006 (RFS)
S. 3570, Older Americans Act
Amendments of 2006, as ordered
reported by the Senate HELP Committee,
June 28, 2006 (IS)
The bill would require that area agencies assure
that Title III funds will be used in a manner that
gives priority in furnishing benefits and
services to older individuals with greatest
economic need, older individuals with great
social need and older individuals at risk for
institutional placement. (p. 39)
Similar to H.R. 5293, but adds reference to
older individuals with limited English
proficiency and those living in rural areas. (p.
43)
The area agency would also be required to
assure that funds will be used in a manner that
is consistent with Section 306(a)(13) (regarding
maintaining the integrity and public purpose of
services provided and service providers, in all
contractual and commercial relationships,
among other things) and Section 212(b) of the
act (as amended by the bill). (p. 40 )
Same as H.R. 5293.
Area plans on aging: selfdirected care
No provision.
The bill would require that area plans on aging
provide for, to the maximum extent feasible,
furnishing of services under the act consistent
with self-directed care. (p. 40)
Similar to H.R. 5293 (does not include to the
maximum extent feasible). (p. 43)
Area plans on aging:
emergency preparedness
No provision.
No provision.
The bill would require area plans to include
information detailing how the area agency
will coordinate activities and develop longrange emergency plans with local and state
emergency response agencies, relief
organizations, local and state governments,
and any other institutions that have
responsibility for disaster relief service
delivery. (p. 43)
Area plans on aging: area
agency planning for
demographic changes in the
older population in planning
and service areas
No provision.
The bill would authorize area agencies on aging
to include in their area plans, an assessment of
how prepared the planning and service area is
for any anticipated change in the number of
older individuals during the 10-year period
Same as H.R. 5293, with slightly different
wording in some places. (p. 44)
CRS-41
PROVISION
CURRENT LAW
H.R. 5293, the Senior Independence
Act of 2006, as passed by the House,
June 21, 2006 (RFS)
S. 3570, Older Americans Act
Amendments of 2006, as ordered
reported by the Senate HELP Committee,
June 28, 2006 (IS)
following the fiscal year for which the plan is
submitted.
The assessment may include:
• the projected change in the number of older
individuals in the planning and service area;
• an analysis of how this change may affect
older individuals, including those with low
income, greatest economic need, minority
older individuals, those residing in rural
areas, and those with limited English
proficiency;
• an analysis of how the programs, policies,
and services provided in the planning and
service area can be improved, and how
resource levels can be adjusted to meet the
needs of the changing population of older
individuals in the areas, and an analysis of
how the change in the number of persons age
85 and older is expected to affect the need for
supportive services. (p. 40)
The bill would authorize area agencies on
aging, in cooperation with governmental
officials, state agencies, tribal organizations, or
local entities, to make recommendations to
government officials in the planning and
service area and the state, on actions to build
the capacity to meet the needs of older
individuals for:
• health and human services;
• land use;
• housing;
• transportation;
• public safety;
• workforce and economic development;
The bill would also add reference to
emergency preparedness. (p. 45)
CRS-42
PROVISION
CURRENT LAW
H.R. 5293, the Senior Independence
Act of 2006, as passed by the House,
June 21, 2006 (RFS)
S. 3570, Older Americans Act
Amendments of 2006, as ordered
reported by the Senate HELP Committee,
June 28, 2006 (IS)
• recreation;
• education;
• civic engagement; and
• any other services determined by the area
agency. (p. 41)
STATE PLANS ON AGING
State plans on aging: focus on
older individuals with limited
English proficiency
Section 307(a) requires the state plan to
conduct periodic evaluations on state
activities and projects, including
evaluations of the effectiveness of services
provided to individuals with greatest
economic or social need, or disabilities
with particular attention to low-income
minority individuals and older individuals
residing in rural areas.
The bill would add reference to older
individuals with limited English proficiency.
(p. 42)
Same as H.R. 5293. (p. 46)
State plans on aging:
identifying service needs of
low-income minority older
individuals with limited
English proficiency
Section 307(a)(15) requires the state plan
to identify the number of low-income
minority older individuals in the state and
describe the methods used to satisfy their
service needs.
The bill would add reference to the number of
low-income older individuals with limited
English proficiency. (p. 42)
Similar to H.R. 5293. (p. 47)
State plans on aging:
outreach to individuals with
limited English proficiency
Section 307(a)(16) requires the state
agency to conduct outreach to older
individuals with greatest economic or
social need (with particular attention to
low-income minority individuals and older
individuals residing in rural areas).
The bill would add reference to low-income
older individuals with limited English
proficiency. (p. 43)
Same as H.R. 5293. (p. 46)
State plans on aging: selfdirected care
No provision.
The bill would require that state plans on aging
provide assurances that area agencies will, to
the maximum extent feasible, furnish services
under the act consistent with self-directed care.
(p. 43)
Same as H.R. 5293. (p. 47)
CRS-43
PROVISION
CURRENT LAW
H.R. 5293, the Senior Independence
Act of 2006, as passed by the House,
June 21, 2006 (RFS)
S. 3570, Older Americans Act
Amendments of 2006, as ordered
reported by the Senate HELP Committee,
June 28, 2006 (IS)
State plans on aging:
planning for demographic
changes in the older
population in the state
No provision.
The bill requires state agencies on aging, at the
election of the state, to include an assessment of
how prepared the state is, under its statewide
service delivery model, for a change in the
number of older individuals during the 10-year
period following the fiscal year for which the
plan is submitted. The assessment may include:
• the projected change in the number of older
individuals in the state;
• an analysis of how this change may affect
older individuals, including those with lowincome, greatest economic need, minority
older individuals, those residing in rural
areas, and those with limited English
proficiency;
• an analysis of how the programs, policies,
and services provided by the state can be
improved, including coordinating with area
agencies on aging, and how resource levels
can be adjusted to meet the needs of the
changing population of older individuals in
the state; and
• an analysis of how the change in the number
of persons age 85 years and older is expected
to affect the need for supportive services.
(p. 43)
Same as H.R. 5293. (p. 47)
State plans on aging:
emergency preparedness
No provision.
No provision.
The bill requires state plans to include
information detailing how the state will
coordinate activities, and develop long-range
emergency preparedness plans, with area
agencies on aging, local emergency response
agencies, relief organizations, local
governments, and any other institutions that
have responsibility for disaster relief service
delivery. The plan is to include information
describing the involvement of the head of the
CRS-44
PROVISION
CURRENT LAW
H.R. 5293, the Senior Independence
Act of 2006, as passed by the House,
June 21, 2006 (RFS)
S. 3570, Older Americans Act
Amendments of 2006, as ordered
reported by the Senate HELP Committee,
June 28, 2006 (IS)
state agency in the development, revision,
and implementation of emergency
preparedness plans, including the State
Public Health Emergency Preparedness and
Response Plan. (p. 48)
State plans on aging: Aging
and Disability Resource
Centers (ADRCs)
No provision.
No provision in Title III (see ADRCs in title II
above.)
The bill requires the state to implement an
ADRC which is to:
• serve as a visible and trusted source of
information on the full range of options for
long-term care, including institutional and
home and community-based care, that are
available in the state;
• provide personalized and consumerfriendly assistance to empower individuals
to make informed decisions about their
long-term care options;
• provide coordinated and streamlined access
to all publicly funded long-term care
options so that consumers can obtain the
care they need through a single intake,
assessment and eligibility determination
process;
• help individuals plan ahead for their longterm care needs; and
• assist Medicare beneficiaries and
prospective beneficiaries in understanding
and accessing prescription drug and
preventive health benefits under provisions
of, and amendments made by, the Medicare
Prescription Drug, Improvement, and
Modernization Act of 2003, in coordination
with the entity carrying out the health
insurance information, counseling and
assistance program (under Section 4360 of
the Omnibus Reconciliation Act of 1990) in
the state. (pp. 49-50)
CRS-45
PROVISION
State plans on aging: nonfederal share for Title III
services
CURRENT LAW
Section 309(b)(2) requires that funds
required to meet the non-federal share, in
amounts that exceed the non-federal share
prior to FY1981, are to be from state
sources. (Prior to 1981, the required nonfederal share was 10%; in 1981, the nonfederal share was increased to 15%).
H.R. 5293, the Senior Independence
Act of 2006, as passed by the House,
June 21, 2006 (RFS)
S. 3570, Older Americans Act
Amendments of 2006, as ordered
reported by the Senate HELP Committee,
June 28, 2006 (IS)
The bill deletes the reference to the non-federal
share prior to 1981. The bill would clarify that
funds required to meet the non-federal share for
Title III funds be from state sources. (p. 44)
Same as H.R. 5293. (p. 50)
NUTRITION SERVICES INCENTIVE PROGRAM
Disbursement
Section 311 of the act requires the
Secretary of Agriculture to provide cash or
commodities or a combination of cash and
commodities to state agencies on aging.
The bill would clarify that each state agency
promptly and equitably disburse amounts
received under Section 311 to recipients of
grants and contracts. (p. 45)
Same as H.R. 5293 (p. 51)
Bonus of commodities
Section 311 requires that agricultural
commodities available under section 32 of
the act of August 24, 1935, section 416 of
the Agricultural Act of 1949, and under
section 709 of the Food and Agricultural
Act of 1965 are to be donated or used by
recipients of Title III nutrition funds.
The bill would also require that additional
bonus commodities are to be donated or used
by recipients of Title III nutrition funds. (p. 45)
Same as H.R. 5293. (p. 51)
High protein foods; terms
and conditions
No provision.
The bill would require the Secretary of
Agriculture to give special emphasis to high
protein foods. The Secretary of Agriculture, in
consultation with the Assistant Secretary, is
authorized to prescribe the terms and conditions
related to donated commodities. (p. 45)
No provision.
Cash used to buy
commodities
Section 311(d) requires that when a state
elects to receive cash payments under
Section 311, the Secretary of Agriculture is
to make them to the state in an amount
equivalent in value to the donated foods
which the state otherwise would have
received in commodities.
The bill would revise the provision to require
that Section 311 funds may be used only to
purchase U.S. agricultural commodities and
other foods. (p. 45)
No provision.
CRS-46
PROVISION
CURRENT LAW
H.R. 5293, the Senior Independence
Act of 2006, as passed by the House,
June 21, 2006 (RFS)
S. 3570, Older Americans Act
Amendments of 2006, as ordered
reported by the Senate HELP Committee,
June 28, 2006 (IS)
No provision.
Part or all of Section 311 funds may be used to
pay school food authorities to obtain U.S.
commodities for nutrition projects, when state
grantees and contractors, and Title VI grantees,
have an agreement with the school food
authority that the payments:
• cover the cost of the commodities and
• cover related expenses, including the cost of
transporting, distributing, processing, storing,
and handling the commodities. (p. 46)
No provision.
Authorization of
appropriations for nutrition
service incentive program
Section 311(e) authorizes such sums as
may be necessary for FY2001-FY2005.
The bill would authorize such sums as may be
necessary for FY2007-FY2011. (p. 46)
Same as H.R. 5293. (p. 51)
Distribution of information
regarding federal commodity
processing programs
Section 312(f) would require that the
Secretary of HHS and the Secretary of
Agriculture distribute to state and area
agencies on aging and nutrition service
providers information on:
• any federal commodity processing
program; and
• procedures to be followed to participate
in the program.
The bill would require the Assistant Secretary
on Aging and the Secretary of Agriculture to
distribute information on:
• school food authorities within geographic
area service by the state agency; and
• the donated foods available to state and area
agencies and nutrition service providers.
(p. 46)
No provision.
The bill would add to current law a provision
that voluntary contributions shall be
encouraged for individuals whose self-declared
income is at or above 125% of the poverty line,
and may be requested at contribution levels
based on the actual cost of services if the
method of solicitation is noncoercive. (p. 47)
The bill would add to current law a provision
that voluntary contributions shall be
encouraged for individuals whose selfdeclared income is at or above 200% of the
poverty line, at contribution levels based on
the actual cost of services. (p. 52)
VOLUNTARY CONTRIBUTIONS FOR TITLE III SERVICES
Solicitation of voluntary
contributions
Section 315(b) of the act provides that
voluntary contributions from older
individuals shall be allowed and may be
solicited for all Title III services provided
that the method of soliciting contributions
is noncoercive.
CRS-47
PROVISION
CURRENT LAW
H.R. 5293, the Senior Independence
Act of 2006, as passed by the House,
June 21, 2006 (RFS)
S. 3570, Older Americans Act
Amendments of 2006, as ordered
reported by the Senate HELP Committee,
June 28, 2006 (IS)
Voluntary contributions are
to supplement not supplant
Title III funds
No provision.
The bill would clarify that funds received
through voluntary contributions are to
supplement, not supplant, funds received under
Title III. (p. 47)
Same as H.R. 5293. (p. 52)
Mandatory cost-sharing:
participation of older
individuals with limited
English proficiency
Section 315(c) requires state and area
agencies to develop plans designed to
ensure that cost-sharing procedures will
not decrease participation in Title III
services by low income older individuals
(with particular attention to low income
minority individuals and older individuals
residing in rural areas).
The bill would add reference to older
individuals with limited English proficiency.
(p. 48)
Same as H.R. 5293. (p. 52)
AoA study of cost-sharing
Section 315(d) requires the Assistant
Secretary to conduct a study of costsharing to determine its impact on
participation rates with particular attention
to low-income and minority older
individuals and older individuals residing
in rural areas.
The bill would add reference to older
individuals with limited English proficiency.
(p. 48)
Same as H.R. 5293. (p. 52)
ALLOWABLE TITLE III
SUPPORTIVE SERVICES
Section 321(a) requires the Assistant
Secretary to carry out a program for
making grants to states under state plans
approved under section 307 for supportive
services listed in 321(a)(1) through
321(a)(23).
The bill would change the references for the
following supportive services under Section
321(a) to read:
• services designed to provide health screening
(including mental health screening);
• services (including assistive technology
devices and assistive technology services)
designed to meet the unique needs of older
individuals who are disabled, and older
individuals who provide uncompensated care
to their adult children with disabilities; and
• effective referral to existing health (including
mental health), employment, housing, legal,
consumer, transportation, and other services
(related to Senior Opportunities and Services
Similar to H.R. 5293, but does not include
change to the SOS program. (p. 53)
CRS-48
PROVISION
CURRENT LAW
H.R. 5293, the Senior Independence
Act of 2006, as passed by the House,
June 21, 2006 (RFS)
S. 3570, Older Americans Act
Amendments of 2006, as ordered
reported by the Senate HELP Committee,
June 28, 2006 (IS)
(SOS)). (p. 48)
The bill would add the following as new
allowable services:
• services designed to support states, area
agencies on aging, and local service providers
carry out and coordinate, with respect to
mental health services, activities including
outreach, education, screening, and referral
for treatment of older individuals; and
• activities to promote and disseminate
information about life-long learning programs
It also makes other technical and coordination
changes. (p. 49)
NUTRITION SERVICES
Nutrition services: purpose of
nutrition services
Nutrition services: nutrition
education
No provision.
Section 331 allows nutrition projects to
provide nutrition education services and
other appropriate nutrition services.
The bill would add a new purpose to Title III,
Nutrition Services, as follows:
The bill would add a new purpose to Title III,
Nutrition Services, as follows:
It is the purpose of this part to promote
socialization and the health and well-being of
older individuals by assisting such individuals
to gain access to disease prevention and health
promotion services (including information,
nutrition services, and programs of physical
activity) to delay the onset of health conditions
resulting from poor nutritional health or
sedentary behavior. (p. 50)
It is the purpose of this part to promote
socialization and the health and well-being of
older individuals by assisting such
individuals to gain access to nutrition
services to delay the onset of adverse health
conditions. (p. 54)
The bill would specify that nutrition projects
are to provide nutrition education, nutrition
counseling, and other nutrition services, as
appropriate based on the needs of meal
participants. (p. 51)
Same as H.R. 5293. (p. 54)
CRS-49
PROVISION
CURRENT LAW
H.R. 5293, the Senior Independence
Act of 2006, as passed by the House,
June 21, 2006 (RFS)
S. 3570, Older Americans Act
Amendments of 2006, as ordered
reported by the Senate HELP Committee,
June 28, 2006 (IS)
Nutrition services:
multivitamin-mineral
supplements
No provision.
The bill would allow nutrition projects to
provide a multivitamin-mineral supplement,
along with a meal, to participants. (p. 51)
No provision.
Nutrition services: homedelivered nutrition services
Section 336 requires the Assistant
Secretary to establish the home-delivered
nutrition program which is to provide at
least one home-delivered hot, cold, frozen,
dried, canned or supplemental foods (with
a satisfactory storage life) meal per day.
The bill would add reference to fresh food. It
would also delete the reference to (with a
satisfactory storage life). (p. 51)
Same as H.R. 5293. (p. 55)
Consultation with nutrition
experts
Section 337 requires the Assistant
Secretary to consult with representatives
from various named organizations to
develop minimum criteria of efficiency
and quality for home-delivered meals
services, including the American Dietetic
Association, among others.
The bill would eliminate reference to particular
organizations and instead would specify that
the Assistant Secretary is to consult with
experts in the field of nutrition science,
dietetics, meal planning and food service
management, and aging. (p. 52)
Same as H.R. 5293. (p. 55)
It also requires that the criteria take into
account the ability of established home
delivered meals programs to continue these
services without major alteration in the
services.
The bill would delete this requirement.
No change in current law.
State responsibility to obtain
expertise of a dietician
Section 339 requires a state to solicit the
advise of a dietician or an individual with
comparable expertise in the planning of
nutritional services.
The bill would require the state to solicit the
advise of a dietician or other individual with
equivalent education and training in nutrition
science, or another individual with comparable
expertise. (p. 52)
Similar to H.R. 5293, but does not refer to
equivalent education and training. (p. 56)
Dietary Guidelines for
Americans
Section 339 requires that meals comply
with the Dietary Guidelines for Americans.
The bill would specify that the Guidelines be
the most recent. (p. 53)
Same as H.R. 5293. (p. 53)
It also refers to the daily recommended
dietary allowances.
The bill would change the reference to dietary
reference intakes. (p. 53)
No change in current law.
CRS-50
PROVISION
CURRENT LAW
H.R. 5293, the Senior Independence
Act of 2006, as passed by the House,
June 21, 2006 (RFS)
S. 3570, Older Americans Act
Amendments of 2006, as ordered
reported by the Senate HELP Committee,
June 28, 2006 (IS)
Intergenerational meals
Nutrition projects are to encourage
arrangements with schools and other
facilities to promote intergenerational
meals programs.
The bill would clarify that these arrangements
are to be done jointly with schools and other
facilities and are to be shared intergenerational
meals programs. (p. 53)
Refers to joint programs but no reference to
shared intergenerational programs. (p. 56)
Nutrition screening,
education and assessment
Section 339(2)(J) requires that nutrition
projects provide for nutrition screening,
and, where appropriate, nutrition education
and counseling.
The bill would also
assessment. (p. 54)
Same as H.R. 5293. (p. 57)
Influenza and other
vaccinations
No provision.
The bill would encourage professionals who
distribute home-delivered meals to provide
information to homebound seniors on how to
get an influenza vaccination in their local areas.
(p. 54)
Similar to H.R. 5293, but would add
reference to information about pneumonia
and shingles vaccinations. (p. 57)
Evaluation of the Nutrition
Program
No provision.
The bill would require the Assistant Secretary
to use funds set aside for evaluation to conduct
an evidence-based evaluation of the nutrition
program. This would be under a contract with
the Food and Nutrition Board of the Institute of
Medicine.
Similar to H.R. 5293, with some slightly
different wording. (p. 57)
require
nutrition
The study would include:
• an evaluation of the effect of nutrition
projects on the health and nutrition status of
participants, prevention of hunger and food
insecurity, and ability of participants to
remain living independently;
• a cost-benefit analysis of nutrition projects,
including their potential to affect costs of
Medicaid; and
• recommendations on how nutrition projects
may be modified to improve outcomes, and
for improving nutritional quality of meals and
other potential strategies to improve the
nutritional status of participants, including
Does not refer
supplementation.
to
vitamin-mineral
CRS-51
PROVISION
CURRENT LAW
H.R. 5293, the Senior Independence
Act of 2006, as passed by the House,
June 21, 2006 (RFS)
S. 3570, Older Americans Act
Amendments of 2006, as ordered
reported by the Senate HELP Committee,
June 28, 2006 (IS)
vitamin-mineral supplementation.
Improving indoor air quality
in building where seniors
congregate
No provision.
The Institute of Medicine would be required to
establish a panel of experts within 90 days of
the bill’s enactment. The panel would be
required to submit the report to the Assistant
Secretary within 24 months of enactment. In
addition, the Assistant Secretary would be
required to submit a report on the findings to
the House Committee on Education and the
Workforce of the House and the Senate
Committee on Health, Education, Labor and
Pensions of the Senate. (pp. 54-56)
Same as H.R. 5293 (p. 59)
The bill would require the Assistant Secretary
to work in consultation with qualified experts to
provide information on methods of improving
indoor air quality in buildings where seniors
congregate. (p. 56)
Same as H.R. 5293. (p. 60)
CAREGIVER SUPPORT PROGRAM
Definitions
Child
Defines child as an individual who is 18
years or younger.
The bill would define child as an individual
who is 18 or younger or an individual with a
disability. (p. 56)
The definition of child would be amended to
include an adult child with mental retardation
or a related developmental disability. (p. 60)
Family caregiver
Defines family caregiver as an adult family
member, or another individual who is an
informal provider of in-home and
community care to an older individual.
The bill would add to the definition, caregiver
of an individual with Alzheimer’s disease or a
related disorder with neurological and organic
brain dysfunction. (p. 56)
The bill would add to the definition,
caregiver of an individual with Alzheimer’s
disease, or a related disorder with
neurological and organic brain dysfunction,
who is 50 years of age or older. (p. 60)
Grandparent or older
individual who is a relative
caregiver
Defines grandparent or older individual
who is a relative caregiver
as a
grandparent who is 60 and older (among
other things).
The bill would change the age to 55 years and
older. (p. 56)
Same as H.R. 5293 regarding age of
grandparents.
It also amends the definition to specify that a
CRS-52
PROVISION
CURRENT LAW
H.R. 5293, the Senior Independence
Act of 2006, as passed by the House,
June 21, 2006 (RFS)
S. 3570, Older Americans Act
Amendments of 2006, as ordered
reported by the Senate HELP Committee,
June 28, 2006 (IS)
child of a grandparent or step-grandparent
caregiver includes an adult child with mental
retardation or a related developmental
disability. It also includes a child who is
adopted. (p. 61)
Developmental disability
No provision.
No provision.
The bill adds a definition of developmental
disability and refers to the definition in
Section 102 of the Developmental
Disabilities Assistance and Bill of Rights Act
of 2000. (p. 61)
Support services for
caregivers
Section 373 includes as one of the support
services for caregivers, individual
counseling, organization of support
services groups, and caregiver training to
caregivers to assist them in making
decisions and solving problems relating to
their caregiving roles.
The bill would add reference to assisting
caregivers with health, nutrition, and financial
literacy issues. (p. 57)
Same as H.R. 5293. (p. 61)
Priority to caregivers
providing care to older
individuals
Section 373 stipulates that in providing
services, priority is to be given to services
to older individuals with the greatest social
and economic need and those providing
c a r e t o p e r s o n s wi t h m e n t a l
retardation/development disabilities.
No change in current law.
The bill adds a new provision stipulating that
in providing services for family caregivers,
the state is required to give priority for
services to family caregivers who provide
care to older individuals. (p. 62)
Coordination with volunteer
services
Section 373(d) requires area agencies on
aging to coordinate the caregiver support
program with other community agencies
and voluntary organizations.
The bill would require area agencies to
encourage the use of trained volunteers to
expand available caregiver support services,
and to coordinate, if possible, with volunteer
programs (including programs administered by
the Corporation for National Service) to
provide training, placement, and stipends for
volunteers in community service settings.
(p. 57)
Same as H.R. 5293. (p. 62)
CRS-53
PROVISION
CURRENT LAW
H.R. 5293, the Senior Independence
Act of 2006, as passed by the House,
June 21, 2006 (RFS)
S. 3570, Older Americans Act
Amendments of 2006, as ordered
reported by the Senate HELP Committee,
June 28, 2006 (IS)
Reports on caregiver
program
The state is required to submit reports to
the Assistant Secretary, as required by the
Assistant Secretary.
The bill would add a requirement that the
reports must describe any mechanism used in
the state to provide family caregivers of an
older individual and relative caregivers of a
child or an adult child with a disability,
information about and access to various
services so that caregivers can better carry out
their care responsibilities. (p. 57)
Similar to H.R. 5293, but with slightly
different wording. (p. 62)
Limitation on federal and
non-federal funds for relative
caregiver services
Section 374(g) stipulates that a state may
not use more than 10% of federal and nonfederal funds to support services to
grandparents and older individuals who are
relative caregivers.
The bill would clarify that the limitation applies
to relative caregivers of children age 18 or
younger. (p. 58)
No change in current law.
Programs of national
significance
Section 376
requires the Assistant
Secretary to carry out activities of national
significance to promote quality and
continuous improvement in support
provided to family and other informal
caregivers. This provision was sunsetted
in FY2003.
The bill would repeal this section.
The bill would allow the Assistant Secretary
to support:
• multigenerational programs, including
supports for grandparents and other older
relatives raising children (such as kinship
navigator programs) and those that sustain
and replicate innovative multigenerational
family support programs that involve senior
volunteers;
• programs providing support and
information to families who have a child
with a disability or chronic illness and to
other families in need of such family
support programs;
• programs addressing the unique issues
faced by rural caregivers;
• programs focusing on the needs of older
persons with Alzheimer’s disease and
related dementia and their caregivers;
• programs supporting caregivers in the role
they play in health promotion and disease
prevention. (pp. 63-64)
CRS-54
PROVISION
CURRENT
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