Screening and Priority-Setting to Determine Home- and Community-Based Aging Services for Older Floridians

Abstract

The National Aging Network serves millions of older Americans seeking home- and community-based services, but places others on waitlists due to limited resources. Little is known about how states determine service delivery and waitlists. We therefore conducted a process evaluation and analyzed data from one five-county Area Agency on Aging in Florida, where an algorithm calculates clients’ priority scores for service delivery. From 23,225 screenings over 5.5 years, clients with higher priority scores were older, married, living with caregivers, and had more health problems and needs for assistance. Approximately 51% received services (e.g., meals/nutrition, case management, caregiver support), 11% were eligible/being enrolled, and 38% remained on waitlists. Service status was complex due to multiple service enrollments and terminations, funding priorities, and transfers to third-party providers. More research is needed regarding how other states determine eligibility and deliver services, potentially informing national standards that promote optimal health in older Americans.

State Policies Concerning Disaster Preparedness for Home- and Community-Based Service Providers

“…These finding suggest that disaster preparedness could be developed in the future as a unique service for older adults trying to remain independent in their homes. The potential for this, however, is unclear, given the limited nature of OAA disaster preparedness requirements and the limits on funding (Thomas & Applebaum, 2015; Koumoutzis et al, 2020), evidenced by the large numbers of older adults on waiting lists for needed services (Schonfeld et al, 2021). However, it is important that more states emulate this approach of viewing disaster preparedness in the context of aging in place, particularly as efforts continue nationwide to meet older adults’ care needs through home- and community-based services as a way to reduce nursing home costs.…”

“…). OAA programs provide an important safety net for those who need assistance but do not qualify for Medicaid-funded services (Thomas & Applebaum, 2015), though many remain on waiting lists for services (Schonfeld et al, 2021).…”

“…An estimated 15 million older adults nationwide receive such care through federal Older Americans Act (OAA) and Medicaid programs that receive federal funds but are administered largely by the states, apart from Medicare (Gallo & Wilber, 2021;Ujvari et al, 2019;M.-O.Watts et al, 2020). OAA programs provide an important safety net for those who need assistance but do not qualify for Medicaid-funded services (Thomas & Applebaum, 2015), though many remain on waiting lists for services (Schonfeld et al, 2021).…”

Improving Older Adults’ Health by Reducing Administrative Burden

“…58 A study of a five-county Area Agency on Aging in Florida, focuses on coordinating access to long-term care, demonstrates these burdens. 59 Importantly, area agencies are funded by the Older Americans Act, with the purpose of helping older adults navigate the fragmented long-term care system. In this Florida agency, over five and a half years, ∼51% of clients received services, including meals, case management, and caregiver support; 11% were eligible or being enrolled; and 38% remained on waitlists.…”

Factors Associated With Contracting Between Area Agencies on Aging and Health Care Entities

“…Area Agencies on Aging (AAAs)—CBOs established by the Older Americans Act in 1973 that provide and coordinate social services for older adults and caregivers—have increased their partnerships and service contracts with health care organizations in recent years (Brewster et al, 2019, 2020; Valluru et al, 2019) in order to meet the needs of the rising population of older adults (Koumoutzis et al, 2021; Schonfeld et al, 2021). When contracting with health care entities, AAAs most commonly provide case management services or care transition planning, but they also contract to provide a range of other services including assessment for long-term services and supports (LTSS) eligibility, nutrition programs, personal care, transportation, adult day care, and more (Kunkel et al, 2018).…”