Social Services

Today professional services are offered under a variety of auspices and for a variety of purposes. Funding sources and eligibility requirements, even within a single organization, can vary tremendously. For example, an agency might provide assistance with several different funding streams, such as the Older Americans Act, the Social Services Block Grant, the Community Development Block Grant, Medicaid, and Medicare. Each of these streams might impose different eligibility requirements and require different program procedures.

The information and outreach program provided through an Area Agency on Aging (AAA) is an excellent starting point in the search for supportive services for an older adult. Under the OAA, all AAAs must provide information and outreach. Every jurisdiction in the United States provides this means of accessing needed services. Area Agencies on Aging may be housed in different types of organizations, such as local or county government, state government, or even nonprofit organizations. AAAs usually contract for services, hiring private or other governmental organizations to deliver assistance to older adults. If no other organization is available, an agency might provide the service directly. AAAs can be located by calling the national hotline (1800-677-1166) or through the Web site maintained by the U.S. Administration on Aging (www.aoa.dhhs.gov). Eligibility for assistance is based on age. Anyone over sixty years old may access services through the AAA. Some services are restricted to individuals with limited financial resources (Gelfand).

Several of the AAA services are ‘‘mandated,’’ in that the agencies are required to spend an adequate proportion of their yearly allocation for them. These include access services, which help people reach the services they need; in-home services; and community services.

Access services include outreach or information and referral programs, as well as transportation programs. The information and referral phone number for the AAA is usually listed in the government section of the phone book. By calling this number, an individual can receive information about both public and private services available in his or her community. Most AAAs provide transportation only for specific purposes, usually medical need. This might involve doctors’ appointments or visiting a family member in a nursing home. Some also provide transportation to senior citizen centers and other services such as grocery runs and trips to entertainment.

In-home services consist of homemaker services, home health aides, visiting or telephone reassurance, and chore services. Homemaker services help with light housekeeping tasks, such as vacuuming, dusting, and dishwashing. Home health aides provide personal care and limited health-related care. An aide may help with bathing or dressing, or might check blood pressure. Aides do not perform health-related tasks, such as changing a catheter. Many AAAs provide telephone and personal contacts for elderly persons by using volunteers. These individuals contact older homebound people periodically to see how they are doing and identify pressing needs. In-home services are typically restricted to individuals with limited financial resources, though some agencies offer the services to those with higher incomes using a sliding scale fee system. Chore services help with home maintenance, performing tasks such as clearing rain gutters, minor home repairs, and shoveling snow. Usually eligibility for in-home services is restricted to the financially needy.

Community services include the long-term care ombudsman program, and legal services. Each state employs a professional long-term care ombudsman. Many states also train volunteer ombudsmen. These individuals are charged with advocating on behalf of residents of long-term care facilities. They receive and investigate complaints, and maintain a record of facility compliance. These records, often called ‘‘report cards,’’ are usually available for public inspection. Legal services are usually available to people with limited incomes. Through legal services programs lawyers assist with wills and guardianships, but usually not with civil suits or criminal matters.

AAAs may also provide other services, including nutrition programs, socialization programs, protective programs, employment programs, and case management.

Nutrition programs may provide congregate meals in senior centers, and/or home-delivered meals known as Meals on Wheels. Congregate meals usually consist of a lunch, followed by a brief program of education or entertainment. These meals are available to anyone over the age of sixty. Sometimes a small donation is requested. The meals usually provide a menu that is familiar to the majority community, which may not be attractive to cultural and ethnic minorities. Home-delivered meals usually have more restrictive eligibility requirements. In most areas a physician must certify that a person is unable to prepare meals. Generally demand for home-delivered meals exceeds supply. Sometimes a nominal donation is requested. The people who deliver meals can be wonderful resources for older adults. Usually the same driver delivers the meals each day, so he or she can check on a person and secure attention for medical emergencies.

Socialization programs include the Senior Companion program, senior center activities, Foster Grandparents, and Retired Senior Volunteer Program (RSVP). The Senior Companion program provides employment for low-income seniors and help for the homebound elderly. Companions are trained and receive a small stipend for their services. They visit frail, community-living elderly people, providing company for them and respite for their caregivers. Senior centers provide a wide range of activities, including arts and crafts, discussion of current events, dancing, health promotion, and other social activities. These are available for anyone over the age of sixty. They typically reflect the cultural and social interests of the majority population in a community, so members of cultural and ethnic minorities are often under-represented in senior centers. The Foster Grandparent program was established to provide meaningful activities for elderly individuals and assistance to children. Foster grandparents work with children in a variety of settings, including schools, nurseries, Head Start programs, hospitals, and treatment centers. The RSVP program offers additional opportunities for meaningful activities. These volunteers provide services in diverse settings such as hospitals and libraries. The program offers recognition and covers volunteers’ expenses.

Protective services investigate reports of elder abuse and neglect and intervene on behalf of the victim. In most states professionals are required by law to report cases of suspected elder abuse, neglect, or exploitation to the protective services agency. Intervention may take the form of family counseling or guardianship proceedings. In some cases the AAA may become a guardian.

Employment services provide training and subsidies for older adults who are seeking employment. Most of these programs are federally funded, and some also have job-development components, with staff who work with corporations and organizations to identify jobs for seniors. The Senior Community Service Employment Program (SCSEP) provides part-time employment to low-income individuals age fifty-five and over. Typically the SCSEP program offers both training and employment in nonprofit and government agencies. Age discrimination in employment is a continuing concern. Individuals who suspect that they have been victims of age discrimination should seek assistance through their AAAs.

Caregiver services were introduced as part of the National Family Caregiver Support Program established under the 2000 amendments to the Older Americans Act. Under the auspices of the U.S. Administration on Aging, this program offers funding for a wide range of services that support family members who provide care to frail elderly people.

In addition to services available through the Area Agencies on Aging, mental health services and housing assistance often prove valuable to older adults.

Housing assistance. Federal housing assistance dates to the New Deal, when public housing was developed for low-income working families. Through incremental changes, the structure of the federal program of low-income housing has evolved. The elderly have been the greatest beneficiaries of that evolution, making up a significant proportion of those served by low-income housing facilities and rent subsidies.

Three major housing programs provide assistance to low-income elderly people; Section 202 of the Housing Act of 1959; Section 8 of the Housing and Community Development Act of 1974, and public housing. Section 202 provides low-interest construction loans to nonprofit sponsors (such as churches and civic organizations) for up to forty years. Once constructed, the Section 202 development is operated by the nonprofit sponsor, with federal oversight. Section 8 offers rent subsidies for low-income families. While some senior households do receive rent subsidies through this program, the vast majority of those in need do not, because need for housing assistance greatly exceeds the supply of rent vouchers. Public housing was developed as part of the New Deal, to house working families with children. Since then the eligible population has changed considerably. The elderly and people with disabilities are frequent residents of public housing, often sharing the same facility.

Housing developments exclusively for the elderly offer a modicum of safety, and a convenient site for the delivery of other kinds of social services. Many communities offer health promotion and other services on site at senior housing facilities.

Mental health services. Mental health services often include counseling and support groups to assist people coping with age-related changes. Growing numbers of older adults have participated in the ‘‘self-help’’ movement by joining support groups. These groups, designed for everyone from the physically ill, to the bereaved, to people suffering from addictions, often provide a sense of comradery and a source of information and advice. Support groups may be operated by a wide range of organizations or agencies, from churches to senior centers. Some are led by a professional, and others by a volunteer.

Older men are usually more reluctant than older women to participate in support groups. Participating in a support group does not match popular notions of masculinity. So, while older women may be comfortable admitting weakness and sharing emotions, older men may resist these activities and deprive themselves of the benefits of a support group. Recruiting and management strategies that are sensitive to the needs and relationship styles of older men can enhance the effectiveness of a support group for this vulnerable population (Kosberg and Kaye).