Older Americans Act

Within the rubric of supporting independent living for older people, the OAA has long had a multiple mission. Most clearly, the state and area agencies were to plan for the elderly's service needs and to contract with private agencies that would then provide those concrete services. But this entire aging network was also charged with serving as an advocate for older people and as a coordinator of services that were provided by large agencies—such as mental health departments—that were outside of this network itself. Indeed, the very establishment of a "network" was seen by some as detracting from this larger infusion function that the OAA's designers had very much in mind (Hudson, 1986).

During the act's early years, there was concern that these different mandates would weaken the overall impact of the OAA and those working under it. However, more recent events, largely outside of the control of any of these individuals, have lessened that concern. First, the network has become sufficiently large in the context of other human services agencies that it could both provide and advocate in ways that made the functions synergistic rather than separate. Second, the growing frailty of the older population brought the OAA, and agencies operating under it, increasingly into the world of long-term health care. In this arena, aging network agencies found themselves involved with the much larger Medicaid health care program. While Medicaid serves low income people of all ages, roughly one-third of Medicaid expenditures are directed toward frail elders, living either in nursing homes or in the community. The nature of the OAA and Medicaid interface varies greatly around the United States, but in some states the Medicaid money dedicated to these older individuals has completely or partially come under the aegis of the state unit on aging. In recent years, many states have also appropriated additional money directed toward care of community-based elders, with these monies usually administered by aging network agencies. And, attesting in particular to the issue of disability, today roughly half of the traditional state units on aging also have administrative responsibility for disabled adults who are under the age of sixty (Justice).