Older Americans Act

Important as it has been in making social services available to older people, the OAA was a relatively minor item among the legislation that was enacted by the federal government during the mid-1960s. The major aging-related policy event of the time was the enactment of Medicare, the federal health insurance program for the elderly. Yet, had it not been for the struggle surrounding Medicare, the OAA probably would never have been passed. That is because many different individuals and organizations mobilized on behalf of Medicare, but not all of them were doctors, hospitals or other providers concerned only with access to health care. Many older people and their advocates wanted the federal government to recognize the presence and needs of older Americans in a broader and more symbolic way than Medicare alone could do. Many professionals, providers of non-health-related services, also wanted federal financial support for their services (Binstock).

As a result of these twin pressures, the OAA was passed as a piece of legislation that served both to give symbolic recognition to the presence of older Americans in national life and to provide to them community-based services beyond those associated with health care alone. Title I of the OAA was very clear on both of these points, declaring that "the older people of our Nation are entitled to secure full and free enjoyment of the following objectives" and going on to list ten broad areas in which the federal government should act on their behalf.

While these objectives extended to income maintenance, employment, and housing, among others, the remainder of the OAA itself concentrated principally on the organization and provision of social services to be provided to older people living in their homes in their communities. Title II established the Administration on Aging within the federal Department of Health, Education, and Welfare (which became the Department of Health and Human Services in 1977). The Title III community grant program was by far the most important of the original titles in the act. It provided federal matching funds to the states to establish State Units on Aging, which would serve as focal points for state-level activities directed toward older people. Title IV authorized a research, demonstration, and training grants program, and the original Title V established an advisory committee on aging within the Department of Health, Education, and Welfare.

Despite its broad mandate, early funding under the OAA was very small by the standards of the federal government, only $7.5 million in 1966 and $10.3 million in 1967. These dollars were barely sufficient to help the new state agencies get off the ground and to fund a few service efforts, mainly in senior centers. Indeed, there was talk in 1970 of eliminating the program because so little was being done (Sheppard).

However, events in 1971 led to a massive and unexpected increase in the size and scope of the OAA program. The precipitating event was a speech that President Richard Nixon gave to the White House Conference on Aging held that year (Pratt). The president was opposing a 20 percent increase in Social Security benefits being proposed by the Democrats, and in order to please his audience of 4,500 older Americans, he focused his attention on the small but appealingly named Older Americans Act. The president called for a five-fold increase in appropriations to the level of $100 million and the creation of new sub-state area agencies on aging that would plan aging services in over six hundred planning and service areas. Thus, even though the president continued to oppose the much more expensive increase in Social Security benefits, the audience gave him a standing ovation for these remarks, Table 1 Federal Expenditures Under the OAA SOURCE: Author and the Older Americans Act—almost over night—became one of the nation's largest social services programs.

OAA programs continued to grow rapidly throughout the 1970s. The area agencies on aging were established, and they succeeded in pressing both federal and state governments for more OAA money. In 1972 a new nutrition program was added to the OAA, one that today rivals the social services under Title III in size and importance. The best indicator of the OAA's growth, however, is the enormous increase in appropriations, increasing from $7.5 million in 1966 to over $900 million in 1980 (see Table 1).

The major spending increases came in the social services and nutrition programs and also in a new community services employment program for low income older people. By the end of the decade, there was in place what one analyst referred to as "the aging network" (Estes), consisting of the federal, state, and area agencies, and the literally thousands of direct service organizations that these governmental bodies contracted with for actual services provision.

This expansion of programs and spending under the OAA during the 1970s is important for several reasons. First, services were made available to many more older people than would have been possible with more modest growth. Second, the new aging network became a political force, being able to both lobby for increases in OAA expenditures and around issues of broader concern to older Americans. Third, the growth and the leveling off that came in the 1980s was indicative of broader changes in aging politics that were emerging by the late 1970s. And fourth, the aging network had sufficiently institutionalized itself by the dawn of the more conservative 1980s and the presidency of Ronald Reagan so that it was able to maintain itself quite successfully while programs elsewhere were being dramatically downsized (Hudson, 1994).

Since the early 1980s, the OAA has been largely in a consolidation mode. Some modifications and additions have occurred, but its size and mission have remained relatively unchanged. Thus, on the matter of funding, appropriations reached $953.7 million by 1983, but seventeen years later had only risen another $350 million to $1.3 billion. These increases average out to roughly $20 million a year in comparison to the 1970s, where the average annual increases approximated $90 million per year. Other significant legislative changes over this latter time period include new authorizations for in-home services for frail elders, long-term care ombudsman program, health education and illness prevention programs, prevention of elder abuse and neglect, and a heightened emphasis on the needs of older people with greatest economic and social needs (U.S. Administration on Aging, 1999). More recently, new attention has been devoted to intergenerational concerns and the needs of those providing care to the frail elderly. Organizationally, the biggest change was the elevation of the Commissioner on Aging— head of the Administration on Aging—to the rank of Assistant Secretary for Aging within the Department of Health and Human Services.

After considerable modification over the years, the titles authorized under the OAA most recently are as follows: Title I: Objectives; Title II: Administration; Title III: Supportive Services, Meals, In-Home Services Preventive Health Services; Title IV: State and Local Innovations and Projects of National Significance; Title V: Senior Community Service Employment Program (administered by the Department of Labor); Title VI: Grants to Indian Tribes; Title VII: Vulnerable Older Americans/Senior Rights.