# Older Americans Act Reauthorization: Side-by-Side Comparison of Current Law, H.R. 5293, and S. 3570 > Briefs, arguments, decisions, and more. URL: https://www.frixlaw.com/law-library/documents/crs%3ARL33660 ## Record - **Collection:** Congressional research report - **Document type:** CRS Report - **Published:** August 24, 2006 - **Citation:** RL33660 ## Text Order Code RL33660 CRS Report for Congress Received through the CRS Web 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 Originally enacted in 1965, the act supports a wide range of social services and programs for older persons.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) CRS-11 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) CRS-12 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) CRS-14 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) CRS-15 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. CRS-16 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. CRS-17 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. CRS-18 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-inc [Text truncated at 120,000 characters. The full text is on the page linked above.] --- Source: Frix Law Library, https://www.frixlaw.com/law-library/documents/crs%3ARL33660. Public record. Not legal advice.