Blog May 31, 2019

Spotlight: Amy Gotwals of n4a on the Older Americans Act

Amy Gotwals

Chief, Public Policy and External Affairs

National Association of Area Agencies on Aging (n4a)


Can you tell us about n4a?

We’re the national association for the 620+ Area Agencies on Aging, as well as a voice in the nation’s capital for the more than 250 Title VI Native American aging programs. Whether it is helping Washington set priorities, building the capacity of our members, raising the visibility of AAAs and Title VI programs nationwide, offering training and educational events, or working to drive excellence in the fields of I&R/A, transportation, business acumen, healthy aging, older adult engagement, livable and dementia-friendly communities, n4a is dedicated to supporting the success of its members. (See our annual report for specifics.)

What services are provided through the Older Americans Act?

The Older Americans Act provides a wide range of supportive services to help people age at home and in the community. Responding to the needs of older adults, the OAA funds transportation, in-home assistance, meals, legal services, case management, falls prevention, home modification, information and referral services, caregiver respite and counseling, healthy aging and social engagement programs, long-term care ombudsmen and other elder abuse prevention activities, workforce training for low-income older workers, and whatever else that community needs. The only eligibility for most programs is to be age 60 or older, although services are targeted at those most in need of support.

What other services are provided through the Aging Network?

The Aging Network is the network of federal (Administration on Aging at the Administration for Community Living), state (state units on aging) and local (Area Agencies on Aging plus providers) entities that plan, develop and provide home and community-based and other aging services across the country.

While the OAA is foundational and an important source of funding, the Aging Network also plays a role in the provision of Medicaid home and community-based services and in state-funded aging programs that fill gaps left by federal programs—all focused on addressing the social determinants of health and helping older adults live with dignity and independence in their homes and communities for as long as possible.

Area Agencies on Aging also offer Medicare education and assistance with enrolling in Medicare programs for individuals who have low income, and roughly two-thirds of State Health Insurance Assistance Programs are run through the Aging Network, offering counseling on the best Medicare plan for the beneficiary. The Aging Network also helps build age-friendly, dementia-friendly communities by engaging a wide range of stakeholders to help respond to the aging of our nation.

There’s more to say if I was to truly cover all that the Aging Network does, but I will stop here! For those whose interest I have piqued, check out our survey report on what AAAs do.

How is the health workforce that cares for older adults connected to the aging network and programs like Older Americans Act?

The direct care and health care workforces are essential to advancing healthy aging and maintaining the independence of older adults and supporting their family caregivers. As America’s aging population booms, we must have well-trained and supported workforces that understand the aging process and population.

While some Area Agencies on Aging employ nurses, most of the AAA workforce are social workers who address the social determinants of health, coordinate care for clients, deploy community programs, and so much more.

But the Aging Network also works with direct care workers who provide care to older adult clients through OAA, Medicaid and private pay programs. Our members are increasingly telling us that workforce shortages and challenges are having a negative effect on their ability to provide the best in-home care to their clients.

Please share examples of aging programs that coordinate with health care systems\hospitals etc. to provide integrated care.

The last five years have seen a transformation in the way the Aging Network works with health systems, plans and providers. Examples from early innovators include:

  1. Contracting with hospitals to provide care transitions to people headed home, so that they avoid preventable readmissions to the hospital;
  2. Contracting with health plans or systems to provide case management, in-home and/or non-medical supportive services to high-need patients;
  3. Providing evidence-based health and wellness programs to prevent falls or self-manage chronic diseases to health plans; and
  4. Coordinating the social needs of high-risk patients for primary care practices, health plans and other value-based health providers/systems.

n4a’s Aging and Disability Business Institute provides a vast array of case studies, technical assistance and other resources to help aging and disability community-based organizations prepare to contract with health care entities.

How can we help make sure OAA services are available to the growing number of older adults in the US?

In this year’s reauthorization of the Older Americans Act, Congress needs to double over five years the funding that is authorized, so that the Aging Network can better meet the current unmet need and reach more older adults and caregivers who need support. Then Congress needs to actually provide that increased OAA funding through the annual appropriations cycle! With a rapidly rising aging population, we must invest in the most cost-effective ways to support older adults’ independence.