The Older Americans Act (OAA) and its Various Titles
OAA Title III-B helps provide services like information and assistance, limited transportation to/from services, counseling, education, recreation, health screens, telephone reassurance, legal services, ombudsman, outreach, residential repair and renovation, and gap filling funds.
OAA Title III-E provides funding for Caregiver education and respite services. Respite services provide care for at home or in a assisted living setting for a short period time so family caregivers can have a break or respite. Also, Title III-D funds programs for health promotion. Title V of the OAA is the Senior Community Employment Services Program, which helps retrain older workers for different careers in order to either remain in or reenter the workforce.
How Older American Act funds flow from the federal government to help people throughout Illinois
OAA funding is passed through Illinois Department on Aging to the 13 Area Agencies on Aging across the state. The Area Agencies on Aging (AAAs) are responsible for assessing, understanding, and seeking to meet the service needs of their region. They are also responsible for creating the service structure within the various titles of OAA to support residents of their regions in the most meaningful ways with limited funding.
How Area Agencies on Aging Use Funds from the Older Americans Act to Support Older Persons
Generally, AAAs have contracts with various grantee organizations that perform direct services funded with OAA dollars. These direct service providers vary across the state and could be a non-profit, village, township, faith-based organization, or for-profit, other organization; If those organizations are receiving AAA/OAA grants, they must perform within the service standards generated by the AAA and IDoA. Many of the OAA services are carried out by organizations or local government departments that are identified as senior centers, senior services, aging services, older adult services, services for ages 55+, meals on wheels, faith-based organizations, or intergenerational community centers.
The Community Care Program
In 1979, Illinois created the Community Care Program (CCP) to help people remain in their homes and stay out of institutional care settings, such as nursing homes. Today CCP has five core services: Comprehensive case management (person-centered plan), homemaker services, adult day services, automated medication dispenser, and emergency home monitoring system. These services are available to individuals who meet the qualifications, individuals must: be age 60 or older; own less than $17,500 in assets; have an assessed need and at-risk for long term care placement; is a U.S. Citizen or eligible non-citizen; is a resident of Illinois; and is willing to apply for Medicaid.
While this is a Medicaid Waiver service, Illinois has allowed for persons with a higher asset level to be able to use this program. Most CCP participants who do fall within Medicaid guidelines are assigned, or choose, a Managed Care Organization (MCO) which provides case management and care coordination to meet the established care plan. This is a relatively new change from the past when all clients were assessed and managed through the local Care Coordination Unit (CCU). Person-centered service plans for CCP participants who do not have an MCO are managed and coordinated through the CCU. Additionally, CCUs assess and approve clients for home delivered meal services. Both CCUs and MCOs are contracted directly with the Illinois Department on Aging to provide these services in assigned areas.
Adult Protective Services
The Illinois Department on Aging (IDoA) contracts with providers across the state to deliver Adult Protective Services (APS). Providers of APS receive and investigate reports of abuse, and support victims of abuse who are age 60 and older or are persons aged 18-59 who are disabled. The AAAs provide oversight and monitoring of this program as well as the long-term care ombudsman program, which advocates for the rights of nursing home residents. Individuals or friends and family of persons living in long-term care facilities can contact the local ombudsman to advocate for improved quality of care and quality of life.
The Aging and Disability Resource Network
The AAAs also oversee the Aging and Disability Resource Network (ADRN), ADRN providers have a network of resources to refer individuals and families to when different situations and needs arise. Some regions of the state have a Coordinated Point of Entry (CPE), which can also provide a breadth of referrals and resources to meet a variety of needs for individuals and families. In regions that do not have an articulated CPE, the AAAs, the CCUs, and the Senior Centers generally have a referral network to help community members navigate local resources.
The Senior Health Insurance Program and Senior Health Assistance Program
Many of these organizations also have the Senior Health Insurance Program (SHIP) and/or the Senior Health Assistance Program (SHAP), that have trained volunteers and staff who can help navigate Medicare, Medicaid, Medicare Savings Programs, Extra Help, SNAP (Supplemental Nutrition Assistance Program), Benefits Access, and other resources to help individuals pay for and access healthcare and other services that help with disease prevention and offer financial support to seek such services.
Other Systems with Older Adult Services
While not under the umbrella of the Illinois Department on Aging, systems such as housing, transportation, healthcare, public health, veteran services, parks, libraries, schools, municipalities, and employers are all institutions within communities that are accessed by older persons and serve as supportive networks that promote good quality of life for people of all ages.
In Illinois, many communities have multiple tiers of housing and supportive living, that are a critical part of the systems that support aging in the community. Currently, 96% of older persons reside in the community and most live in independent housing, either owned or rented. There are a variety of affordable independent housing options provided through the Illinois Housing Development Authority (IHDA) which administers funding from the U.S. Department of Housing and Urban Development (HUD) and other housing sources for Illinois. IHDA also oversees the multiple housing authorities throughout the state.
Public housing where residents live in multi-unit buildings, and pay 30% of their income in rent through this means-tested program. There is also project based subsidized housing, which is owned by private property owners but operates like public housing. Another way to find affordable housing is through the Housing Choice Voucher program, also known as Section 8, in which residents find their own apartment and use the voucher to subsidize the rent. Tax-credit housing is another type of affordable housing that is also means-tested. Individuals living in these residences must qualify by being within the minimum and maximum income levels.
Housing Tax Exemptions and other help
People want to stay in their home, in fact 96% of older adults live at home, and 41% of Illinois homeowner occupied units are occupied by persons aged 60 and older. However, many on fixed incomes find the property taxes to be a burden to both continued ownership and ability to maintain or modify the home. To help with the financial cost of homeownership, older homeowners may want to apply for the Senior Homestead Tax Exemption. With qualifying incomes, another program to apply for is the Senior Citizens Assessment Freeze Homestead Exemption. Another tool to help pay property taxes is the Senior Citizens Real Estate Tax Deferral Program, in which taxes are deferred (up to a certain amount) and paid with interest upon the sale of the home. These programs are generally administered through local accessors’ offices. Shared housing is another way of reducing housing costs.
There is also LIHEAP (Low-income Home Energy Assistance Program) that helps people with low-income pay heating and cooling bills. For home repair, some areas have home repair and maintenance funding as well as home weatherization programs. Contact AAAs, CCUs, or the local health department for LIHEAP, home repair, home modification, and weatherization programs.
Sometimes, when more support is needed, some people move into assisted living residences. In Illinois, there are also Supportive Living Facilities (SLFs), that accept Medicaid to help pay for supportive housing expenses; otherwise, assisted living is paid out of pocket at the market rate or may be subsidized with long term care insurance. Memory care is often a feature of assisted living residences and sometimes is available within a stand-alone specialized assisted living residence.
As needs become too involved for the level of care available at an assisted living facility, then there are long-term care residences: nursing homes, that can provide a higher level of care. Nursing homes for long-term stay is not covered by Medicare, but some people may qualify for Medicaid to help with the cost in Medicaid-approved nursing homes. Married couples with one well spouse and one spouse in need of care, may consider Spousal impoverishment to qualify for Medicaid for the spouse needing care.
While transportation is a feature of the Older Americans Act, the funding allotment is not sufficient to support the transportation infrastructure needed to get all older persons who need these services where they want and need to go. There are additional transportation services through Human Services Transportation Providers (HSTP) who are generally community-based organizations who provide transportation services to medical appointments, service organizations, grocery stores and other stores, and work through state grants, local funding, and other community grants. There are also providers who transport individuals who receive Medicaid to medical appointments and to work, who may also be part of the HSTP network. Other transportation options are through local municipalities, like a City, Village, or Township in Illinois, this is mostly restricted to the large urban and suburban areas.
Healthcare is big part of keeping everyone healthy, including older persons. Paying for healthcare and fearing costs is among the biggest barriers to obtaining care, along with getting to the healthcare provider. Most people who are age 65 and older and retired, semi-retired, or are working for a smaller company are covered by Medicare or Medicare Advantage. Some older persons qualify for full Medicaid or Medicaid through spenddown to help with medical costs, and most of dual-eligible individuals are enrolled in a Medicare-Medicaid Alignment Initiative (MMAI).
Access to healthcare across the state varies. Urban areas have the largest amount of healthcare providers and specialized healthcare opportunities; however, there are significant inequities when comparing access to services both within and among urban, suburban, and rural neighborhoods and communities. Rural areas have the least access to primary care, urgent care, hospitals, and oral health care, due to limited supply of providers as well as transportation, which may not exist or may be very limited, to get people to health providers that may be a lengthy distance from home. There are several Federally Qualified Health Centers (FQHC) and Rural Health Centers throughout Illinois who serve underserved areas and provide a health safety net for people who are uninsured, but they are not available in every county. There are clinics that are emerging that serve mostly older persons with Medicare Advantage plans through a more wholistic lens; however, they are mostly in urban and suburban areas.
Home based primary care is another way primary health care can be delivered, particularly with Medicare Advantage Plans. There are a few providers in urban and suburban areas of the state that provide home based primary care or a hybrid of office and home services. Serious illness care, also known as palliative care and hospice care, is also mostly delivered where the person lives or is staying. People needing short-term rehabilitation (physical, occupational, and/or speech therapy) may also receive these services in the home if they meet the qualifications for Medicare or pay out of pocket.
Short-term rehabilitation in a Skilled Nursing Facility (SNF), may be covered by Medicare after a three-overnight hospital admission for up to 20 days, and then up to 100 days with a co-pay or coverage through a supplement plan (Medigap) or a Medicare Advantage plan. This all depends on Medicare approval and continued approval. Non-Medicare approved stays result in individuals paying out of pocket.
The Veterans Administration also provides health services to some Veterans. For Veterans who qualify, there are four regional Medical Centers in Illinois and some satellite clinics where qualifying Veterans can access health care services. There are a variety of other services available to Veterans, some are available to all Veterans, while others are reserved for Veterans who served in times of war or conflict. Home Aid and Attendance is one such program that helps pay for care for the qualifying Veteran or their widow. VA Healthcare can be used as credible coverage for prescription drug insurance for Medicare.
It should be noted that Medicare does not cover dental, vision, or hearing care, though Medicare Advantage plans may offer some coverage for these health items. And in many rural areas of Illinois, there is limited or no dental care due to limited or no providers, even if there is insurance coverage.
While IDoA oversees the ombudsman program to help nursing home residents advocate for their rights, the Illinois Department of Public Health (IDPH) is responsible for monitoring and licensing nursing home facilities. IDPH also provides guidance and oversight for the multiple county and city Health Departments across the state. IDPH monitors community health and the spread of disease as well as supports vaccinations of all kinds to keep communities healthy. Many local health departments provide an array of services including vaccines and mental health care as well as connections to other benefits and resources. Some local health departments also provide oral health care and others provide the Coordinated Point of Entry (CPE) for older adult services.
Park Districts, which many times have senior centers or are connected with the local community senior center, are an integral part of keeping communities healthy, active, and connected. Many Park Districts offer classes and activities specifically for the older person peer group. Many also help to foster intergenerational connections through a variety of community events. Also, park districts create and oversee green spaces, playground equipment, walking and biking paths, soccer and baseball fields, basketball, tennis, and pickleball courts, skating areas, swimming pools, and other recreational spaces that community members of all ages enjoy.
Many libraries across Illinois are connected with their local aging network and older community members. Many provide Memory Cafes, dementia toolkits, caregiver support groups, topical lectures and discussions, and access to current research. Libraries many times also provide a variety of local resources and referrals.
Through the CCP program and the OAA funds, there are many career paths and thousands of jobs in the aging network, homecare, care coordinators, APS investigators, social services, nutrition programs, transportation, senior centers, and more, all with opportunities to move from entry-level to supervisory and director positions. Looking outside of the scope of IDoA services, there are even more career paths for individuals specialized in serving the aging consumer base, from health care and housing to hospitality and travel––and so many more.
There are many benefits to hiring older workers, however, ageism is a continued narrative that impacts many persons from obtaining or retaining meaningful employment. As our workforce ages it is imperative that we abandon narratives that limit the potential workforce pool based on biased perceptions of abilities whether that is based on age, gender, race, disability, or some other bias.
Depending on the community, some services like care coordination, senior centers, information and assistance, transportation, nutrition programs, and more are provided through local municipalities like Villages, Townships, and Counties. Often, these municipalities are the direct service providers for the AAA funds that subsidize the costs of these services. Some further invest in community health with social and human services through local funding, some do this with a senior tax levy. Townships have the closest to a mandate to serve senior populations, while some do fulfill this service clause, others do not or do so limitedly, as it is not required. In some communities, Villages or the County provide and/or fund these services, and in other communities, there is no municipal support for services.