Services for Older Adults
The 2000 U.S. Census identified almost 46 million persons age 60 years and older, which accounts for more than 16 percent of the total population. This segment of the population is expected to double to 90 million by the year 2030.[2] The demand for services for older adults is likely to increase as well. The SSBG is a critical source of Federal funds for services to older adults.
The SSBG provides funds to States, in proportion to their population, to assist with the provision of social services. States have substantial discretion in the use of SSBG funds and may determine what services are provided and who is eligible to receive them. In addition, a State may transfer up to 10 percent of its annual Temporary Assistance for Needy Families (TANF) Block Grant allocation into its SSBG program.
States report on SSBG expenditures and recipients annually in a postexpenditure report. The term SSBG expenditures refers to the expenditures of the SSBG allocation combined with funds transferred from TANF into SSBG. States also report the age of adult recipients in two categories -- age 59 years and younger or age 60 years and older.
A review of 2004 data revealed that more than one-third of SSBG expenditures for each of eight service categories were directed toward individuals age 60 years and older. The eight categories are congregate meals, adult foster care, adult day care, home-based services, home-delivered meals, recreation services, transportation services, and other services.[3] In addition, a high percentage of adult recipients age 60 years and older received education and training services, information and referral, and adult protective services supported with SSBG expenditures.
Nutrition Programs
A number of nutrition programs are available to adults age 60 years and older, including congregate and home-delivered meals. Congregate meals are served to individuals in group settings with the intention of providing nutrition as well as to prevent institutionalization and social isolation. Congregate meal services may include nutritional education and counseling and transportation to and from the site.
Home-delivered meals are provided to individuals within their residences along with nutritional information, referrals to services, and social engagement. Such nutrition programs not only provide meals, but also reduce social isolation and connect clients with other community-based services. Nationally, 3.1 million older Americans participate in meal programs each year.[4], [5] Twenty States spent $23 million for nutrition programs for adults age 60 years and older during 2004.
Adult Foster Care
Adult foster care includes services aimed at assessing the needs of vulnerable adults and arranging for substitute care that meet those needs. Activities conducted as part of these services may include case planning and management, counseling services, and the recruitment and licensing of adult foster care placements. Adult foster care is provided in a variety of settings -- family homes, boarding homes, and homes for the aged. Adult foster care is intended for adults with mental, sensory, and physical impairments, and typically serves as an alternative to other more restrictive types of residential care.[6] During 2004, nine States spent approximately $8 million on adult foster care for adults age 60 years and older.
Health-related Services
Health-related services may be provided in or out of the home to meet a family's or individual's health needs. The activities associated with these services include assessing an individual's health needs, developing treatment plans, referring to or providing health services, and following up on services. During 2004, 11 States spent approximately $3 million on health-related services for adults age 60 years and older.
Adult Day Care
Adult day care services are intended for adults who require care or supervision for some portion of the day. The services provided in adult day care centers typically include medical, health, and personal care services, social and recreation services, meals, transportation, and caregiver support. The Robert Wood Johnson National Study of Adult Day Services found that the average age of adults served in adult day care is 72 years. Most of these individuals have dementia or are older than 60 years and require supervision or are socially isolated. Further, this study concluded that adult day care is a cost-effective way to help older adults maintain their independence and remain living in their communities.[7] During 2004, 19 States spent almost $8 million on adult day care for adults age 60 years and older.
Highlights
Highlights of SSBG's role in the funding of services for older adults are listed below.
- More than 1 million adults age 60 years and older in 37 States received services that were funded in whole or in part with SSBG expenditures during 2004.
- During 2004, States spent approximately $238 million on services for adults age 60 years and older. This amount was 12 percent of SSBG expenditures.
- Of the States with the largest SSBG expenditures for older adults, five States spent more than $20 million of SSBG expenditures for older adults.
Table 1 displays the expenditure data and recipient data, by service, for adults age 60 years and older. Table 2 displays the expenditure and recipient data, by State, for adults age 60 years and older. These tables only include the 36 States that reported age breakdowns for recipients.
| Table 1. Services for Older Adults by Service Category (N=37 States) | ||||||
|---|---|---|---|---|---|---|
| Service Category | SSBG Expenditures | Estimated SSBG Expenditures for Adults Age 60 Years & Older | Percent of SSBG Expenditures for Adults Age 60 Years & Older | Adults | Adults Age 60 Years & Older | Percent of Adults Age 60 Years & Older |
| Adoption Services | $20,731,848 | $35,955 | 0% | 11,803 | 629 | 5% |
| Case Management | $116,679,146 | $17,219,920 | 15% | 709,935 | 87,658 | 12% |
| Congregate Meals | $6,791,694 | $6,728,476 | 99% | 96,284 | 91,504 | 95% |
| Counseling Services | $23,174,185 | $2,044,036 | 9% | 71,434 | 16,569 | 23% |
| Day Care--Adults | $12,107,598 | $7,977,945 | 66% | 50,221 | 17,268 | 34% |
| Day Care--Children | $246,002,857 | $201 | 0% | 10,233 | 7 | 0% |
| Education and Training Services | $8,266,995 | $655,888 | 8% | 143,862 | 47,701 | 33% |
| Employment Services | $40,040,615 | $14,331,570 | 36% | 31,779 | 6,985 | 22% |
| Family Planning Services | $39,589,957 | $151,923 | 0% | 495,106 | 2,070 | 0% |
| Foster Care Services--Adults | $13,166,352 | $8,014,658 | 61% | 18,985 | 12,503 | 66% |
| Foster Care Services--Children | $222,642,031 | $31,668 | 0% | 1,394 | 108 | 8% |
| Health-Related Services | $10,969,688 | $2,826,010 | 26% | 212,345 | 36,198 | 17% |
| Home-Based Services | $192,713,639 | $64,992,597 | 34% | 252,694 | 101,561 | 40% |
| Home-Delivered Meals | $20,316,492 | $16,016,535 | 79% | 78,618 | 69,890 | 89% |
| Housing Services | $10,672,031 | $1,028,373 | 10% | 97,675 | 4,444 | 5% |
| Independent/Transitional Living | $7,658,479 | $379,812 | 5% | 42,346 | 2,334 | 6% |
| Information and Referral | $17,256,278 | $2,693,135 | 16% | 649,574 | 217,498 | 33% |
| Legal Services | $16,729,542 | $1,348,761 | 8% | 52,439 | 10,328 | 20% |
| Pregnancy and Parenting | $6,981,427 | $15,765 | 0% | 4,854 | 26 | 1% |
| Prevention and Intervention | $135,915,800 | $2,577,291 | 2% | 242,705 | 15,854 | 7% |
| Protective Services--Adults | $121,865,015 | $56,724,200 | 47% | 451,036 | 142,247 | 32% |
| Protective Services--Children | $153,612,684 | $2,921 | 0% | 298,382 | 51 | 0% |
| Recreation Services | $1,037,199 | $556,139 | 54% | 29,280 | 24,583 | 84% |
| Residential Treatment | $37,577,064 | $376,435 | 1% | 19,482 | 670 | 3% |
| Special Services--Disabled | $323,329,875 | $9,464,208 | 3% | 937,943 | 37,511 | 4% |
| Special Services--Youth at Risk | $12,095,458 | $1,768 | 0% | 3,502 | 12 | 0% |
| Substance Abuse Services | $7,575,957 | $76,508 | 1% | 184,859 | 3,950 | 2% |
| Transportation | $14,907,468 | $5,302,242 | 36% | 164,429 | 105,517 | 64% |
| Other Services | $87,039,749 | $16,141,050 | 19% | 270,334 | 113,611 | 42% |
| TOTAL | $1,927,447,123 | $237,715,989 | 12% | 5,633,533 | 1,169,287 | 21% |
| Table 2. Services for Older Adults by State | ||||||
|---|---|---|---|---|---|---|
| State | SSBG Expenditures | SSBG Expenditures for Adults Age 60 Years & Older | Percent SSBG Expenditures | Adults | Adults Age 60 Years & Older | Percent of Adults Age 60 Years & Older |
| Arizona | $49,324,159 | $6,841,406 | 14% | 168,449 | 94,882 | 56% |
| Arkansas | $12,323,440 | $2,423,792 | 20% | 37,882 | 12,634 | 33% |
| California | $305,398,248 | $25,989,820 | 9% | 646,185 | 35,808 | 6% |
| Colorado | $43,323,783 | $1,336,671 | 3% | 2,783 | 1,809 | 65% |
| Connecticut | $45,186,051 | $5,997,999 | 13% | 74,945 | 10,418 | 14% |
| Delaware | $7,336,272 | $501,767 | 7% | 1,462 | 802 | 55% |
| District of Columbia | $6,648,127 | $2,136,876 | 32% | 16,334 | 3,950 | 24% |
| Florida | $158,751,820 | $5,859,171 | 4% | 146,421 | 35,598 | 24% |
| Georgia | $46,662,992 | $1,625,023 | 3% | 48,065 | 1,088 | 2% |
| Idaho | $9,089,327 | $22,501 | 0% | 1,696 | 18 | 1% |
| Illinois | $112,750,233 | $1,798,941 | 2% | 656,556 | 40,700 | 6% |
| Indiana | $35,926,084 | $20,498,618 | 57% | 67,333 | 24,917 | 37% |
| Kansas | $20,253,434 | $1,238,517 | 6% | 24,483 | 5,693 | 23% |
| Kentucky | $25,651,499 | $295,334 | 1% | 82,130 | 9,851 | 12% |
| Maine | $12,135,287 | $1,018,724 | 8% | 9,244 | 1,591 | 17% |
| Maryland | $54,907,117 | $9,582,804 | 17% | 55,700 | 11,550 | 21% |
| Michigan | $52,634,344 | $1,526,487 | 3% | 71,627 | 11,685 | 16% |
| Minnesota | $33,933,470 | $1,921,520 | 6% | 201,086 | 21,628 | 11% |
| Mississippi | $23,195,566 | $5,013,419 | 22% | 40,536 | 36,349 | 90% |
| Montana | $4,297,870 | $462,316 | 11% | 5,877 | 3,076 | 52% |
| Nebraska | $9,086,558 | $1,851,332 | 20% | 25,081 | 11,303 | 45% |
| Nevada | $12,593,196 | $1,930,663 | 15% | 94,932 | 20,993 | 22% |
| New Jersey | $52,336,405 | $10,182,001 | 19% | 763,069 | 418,787 | 55% |
| New York | $217,215,693 | $26,160,842 | 12% | 63,474 | 7,656 | 12% |
| North Carolina | $52,337,162 | $13,335,543 | 25% | 328,936 | 71,821 | 22% |
| Ohio | $118,273,275 | $27,141,044 | 23% | 291,545 | 46,130 | 16% |
| Oklahoma | $35,618,390 | $10,264,097 | 29% | 42,821 | 37,780 | 88% |
| Pennsylvania | $101,308,659 | $56,318 | 0% | 198,510 | 283 | 0% |
| Rhode Island | $6,530,534 | $552,248 | 8% | 209,753 | 2,008 | 1% |
| South Carolina | $28,546,537 | $4,350,662 | 15% | 12,754 | 6,659 | 52% |
| South Dakota | $6,262,903 | $1,655,710 | 26% | 6,683 | 5,372 | 80% |
| Tennessee | $14,433,265 | $3,851,708 | 27% | 12,778 | 9,475 | 74% |
| Texas | $139,660,301 | $22,082,286 | 16% | 869,320 | 30,423 | 3% |
| Utah | $11,996,276 | $1,095,436 | 9% | 135,859 | 41,688 | 31% |
| Vermont | $3,372,845 | $736,296 | 22% | 27,379 | 1,672 | 6% |
| West Virginia | $16,877,688 | $836,565 | 5% | 31,562 | 4,250 | 13% |
| Wisconsin | $41,268,313 | $15,541,532 | 38% | 160,283 | 88,940 | 55% |
| TOTAL | $1,927,447,123 | $237,715,989 | 12% | 5,633,533 | 1,169,287 | 21% |
[1] U.S. Department of Health and Human Services, Administration for Children and Families, Office of Community Services. Social Services Block Grant Program Annual Report 2004 available at: http://www.acf.hhs.gov/programs/ocs/ssbg/index.html.
[2] Projections of the Total Resident Population by 5-year Age Groups, and Sex with Special Age Categories: Middle Series, 2025 to 2045: Census 2000, obtained from the U.S. Census Bureau at: http://www.census.gov/population/projections/nation/summary/np-t3-f.pdf (accessed on 3/2/06).
[3] The analyses in this focus report include only the 37 States that reported age of recipients.
[4] U.S. Administration on Aging, The Elderly Nutrition Program, available http://www.aoa.gov/press/fact/alpha/fact_elderly_nutrition.asp.
[5] National Association of Area Agencies on Aging, Home and Community-Based Services for Older Adults: Nutrition and Wellness, available http://www.n4a.org/
[6] Hill, B. K., K. C. Lakin, A. R. Novak and C. C. White. 1987. Foster Care for Children and Adults with Handicaps: Child Welfare and Adult Social Services. Available: http://aspe.hhs.gov/daltcp/reports/fosteres.htm.
[7] The Robert Wood Johnson Foundation, National Study of Adult Day Services 2001–2003, available at: http://www.rwjf.org/news/special/adultdayServicesSummary.jhtml?liquid&pf.