Inside The Senior Alliance: The Older Americans Act with Amy Gotwals (Ep 1.30)
In this episode, Jason Maciejewski, CEO of The Senior Alliance, talks to Amy Gotwals, Chief, Public Policy and External Affairs of U.S. Aging. Jason and Amy discuss the entirety of the Older Americans Act, why the Federal Government decided to create it, and how each section of the Act, or Titles, regulates how the Federal, State, and local governments and agencies operate and get funded. You can also learn about the upcoming reauthorization of the Act, and how to get involved in advocating for seniors in your own community. Excellent information!
Produced by The Senior Alliance and Blazing Kiss Media
Jason Maciejewski (00:00):
Welcome to Inside The Senior Alliance, a podcast exploring resources and issues in the field of aging. I’m Jason Maciejewski, CEO at the Senior Alliance, the Area Agency on Aging serving Western and Southern Wayne County. Joining me today is Amy Gotwals, Chief, Public Policy and External Affairs of USAging. She’s earned a bachelor’s degree from Mount Holyoke College and a Master’s of Legislative Affairs from George Washington University. Amy, welcome to the podcast.
Amy Gotwals (00:23):
Thanks Jason. A pleasure to be here.
Jason Maciejewski (00:25):
USAging is a national association for the area agencies on aging. Amy, could you tell us about USAging’s role in the Aging network and the work it does with AAAs?
Amy Gotwals (00:35):
Yes, happy to. Thanks for the question. So we are the National Association representing and also supporting the network of AAAs around the country and we’re also advocates for the Title VI of the very older Americans Act. We’re going to talk about today, the Title VI Native American Aging Programs. And so we feel we will have accomplished our mission when we’ve given the fullest of support to the success of our members. And we do it in a couple ways. We try to advance public policy, spark innovation, strengthen the capacity of our members to do the amazing work they do, raising their visibility at a national level and working to drive excellence in the broader fields of aging and home and community-based services. That’s who we are and what we do and how we work to support our members.
Jason Maciejewski (01:20):
The Older Americans Act is the foundational document for area agencies on aging. It was signed by President Lyndon Johnson on July 14th, 1965 and its goal was to support older adults to live independently at home and in the community. Could you tell us how the Older Americans Act itself is organized and what governmental structures it creates?
Amy Gotwals (01:39):
Well, I’ll start with the structure, actually, I’m going to flip your question a little bit. So what folks need to know is that this is a very significant historical piece of legislation and statute and now that it’s in law and it created, a government agency to oversee this work that’s the Administration on Aging, which today is part of a larger agency that pairs some other services in the disability space. Since we share the goal of community living. It is also designated in every state there be a leader on this set of programs that are created by the Older Americans Act. So those are called state units on aging. Now that doesn’t sound like a very exciting name to call yourself. So most states have names that reflect what government agencies sound like New York Office for the Aging or, Governor’s Office of Elderly Affairs and the like.
Amy Gotwals (02:30):
So there’s a state leadership role there as well in administering the Older Americans Act, federal programs across that state in a consistent and equitable way and with proper oversight. And then the part I’m most excited about is what happens at that local level, which is those area agencies on aging as well as the tens of thousands of service providers who AAAs works with to deliver the services. So there’s really three tiers if you keep AAAs and and providers still in again at that more local level. And that is the delivery system through which these programs operate. And very important that all of those layers are involved. We all have different roles and different responsibilities, but together it really makes it work. As far as the titles of the Act, Title I sets out wonderful, beautiful. It’s a beautiful piece of legislation to read and I’m not just being wonky.
Amy Gotwals (03:22):
It really sets an aspirational view of what Congress originally envisioned in how this statute would support older adults to age well at home and in the community, even if they used different terms that long ago. Title II creates all those authorities for that federal level government. We talked about stration on aging and what are the responsibilities of that Senate confirmed leader at the head of that agency. And then Title III is where the bulk of the actual programs and services are. Many key programs under Title III are what we actually see happening then at that local level, the delivery of different options in the community, different supports to help people age well and at home. Title VII, which I already mentioned added not too long after AAAs were added to the act to address additional concerns happening in Indian country and among Native Americans and Native Hawaiians.
Amy Gotwals (04:14):
And then Title VII funds elder justice activities such as the Long-term Care Ombudsman program, which is an interesting program and that really the one part of the act where the funding and the programming that flows from it are focused on people living inside institutions such as nursing homes or in many cases now also assisted living. So that’s the one piece that’s not solely home and community-based services focused and that’s under Title VII of the Older Americans Act, along with some other ways to prevent elder abuse and Title VII. So Title IV used to be a wonderful research and demonstration title and while there’s a lot of authority in there, Congress unfortunately stopped giving it enough funding years ago, although we’re working to get back some of that research and demonstration funding into the act in the coming year.
Jason Maciejewski (05:02):
Great. Thanks for taking us through the structure of aging services and the different titles in the Older Americans Act and perhaps the most well-known Older Americans Act program is again under Title III to be specific to home delivered meals and congregate meals programs. But not everybody needs nutritional supports and a lot of people might need meals and a host of other services, but how do the Older Americans Act programs come together to combat poverty, poor health and the ability to remain at home for older adults?
Amy Gotwals (05:33):
That’s really the sort of magic of the Older Americans Act and of course it’s a lot of hard work and a lot of ingenuity. Not really magic, but I really love the act for this. Those titles and distinct programs, they go from good ideas to real services and it starts with leveraging of federal funding. That’s the core of the foundation of how these programs and services come to be. And a lot of people do not know that they see some of these programs in action in their community and assume it is either all local nonprofits think it’s all charitable donations that are funding these agencies. And I think we can do a side note here, better job of educating people that it were not for that starter federal funding. You wouldn’t have the robust services that do exist in communities under Older Americans Act, but then state funding is leveraged as well.
Amy Gotwals (06:21):
The states kick in money to support and again, help make this initial investment flourish and supporting people. And then there’s also another layer of local governments often contribute as well. And of course not forgetting that private funding does help support these programs in many ways. So that first step is more money. There is not enough given by the feds every year to have that be where we stop. We have to create a not where the buck stops, but we have to keep creating more bucks through leveraging. And that’s something that obviously those state units on aging do but also AAAs have that as a key part of their role. And then taking those additional sources of funding and creating options for people. You’ve got all kinds of rules that come with government funding, but for the consumer, the AAAs are trying to create a person-centered experience.
Amy Gotwals (07:11):
Not everybody needs all the same services and those who need a bunch of services to be able to stay well and age at home and in the community, they might need totally different set of lists. And so that created and that person-centered experience by meeting people where they are using the sources of funding in the most flexible way possible. And the most flexible source of funding in the act that I want to give a shout out to is Title III. Supportive Services is the, you know, legislative name. But this is where some of the most needed services like in-home services, transportation as well as legal services, the way that the AAAs set up information and referral and assistance programs to help people connect to resources in the community, the case management for people who aren’t gonna be managed exactly their services on their own and need that additional coordination from a trusted aging professional.
Amy Gotwals (08:04):
All of that and about nearly another dozen and a half more services are allowable uses under Title IIIB in the act. And AAAs really use that not only to create those specific services and make them available in the community, but to have enough flexibility so that they can create additional things that their client needs, what we might call wraparound services. So as you said, meals are the most well known part of the act, but if you only had that, the ACT itself wouldn’t be successful in creating options for people. You want to have all of the kind of options that they need, which often involve a whole host of other services. Your most immediate need may be meals if you are at risk of malnutrition or you are hungry. But in the end of the, eventually, maybe by the end of the week, we also want people to have those other services as well.
Amy Gotwals (08:53):
Rides to important appointments. The doctor help with bathing, dressing all the other supports that are provided through these. And so the goal is that all of that comes together, but on a person-centered level to help someone give them just what it is they need to be able to remain at home to maintain their health and prove it if possible. And as you mentioned in your question, all of this helps support the income security of older adults. While the ACT doesn’t set an income limit at all to access these services, Congress has also charged the aging network with making sure you are prioritizing those of low income. And so a lot of people helped through the ACT are a very low income. And so by providing these assistance, whether through that meal that help in the home, that ride to the doctor, or to other places in the community, we are supporting the financial health as well as people and helping keep people from spending their later years struggling in poverty.
Jason Maciejewski (09:53):
The ACT really is a mesh of so many different programs and services that can have a really important impact for so many people. I want to, my shot at Policy wonkiness here and reference section 306A6 of the Older Americans Act, which outlines area plans, but specifically charges the state units on aging. And the area agencies is on aging to advocate and specifically the ACT calls for AAAs to serve as the advocate and focal point for older individuals within the community by monitoring, evaluating and commenting upon all policies, programs, hearings, levies, and community actions, which will affect older adults. So how do you bring that advocacy charge to life at US Aging and how do you work with the vast network of AAAs to make that happen?
Amy Gotwals (10:42):
Yeah, thanks. That is such a cool part of the Older Americans Act. And I want to say for those who haven’t spent a lot of their time yet on earth, knowing what federal legislation and federal statute usually looks like, I want to tell you this is not a common occurrence in federal authorizing statute to see such a bold advocacy charge to federal grantees. This is unique, this is a really important role under the act for area agencies on aging. And one we like to remind them of all the time since so much of our priority of acting on their behalf in DC is around advocacy. And in fact, advocacy is one of the primary reasons we exist as an association. And part of why we originally founded to bring a United Voice of leaders at the area agency on aging level to DC and then later the Title VI Native American Aging Programs came to us and said, can you help us advocate for our programs?
Amy Gotwals (11:31):
And we were happy to join hands and help take up their charge as well. And it’s really why we’re located in Washington DC. Even in this virtual world, being close to the federal action has a tremendous advantage and so on AAAs behalf, our job is to form relationships with key policy makers and their staff and Congress and also key people in the administration. But we’re not just lobbying for AAAs solely, right? We’re not taking that role away from them. I look at my job and the work that our policy team does as a translator. We translate in both directions. So we translate for our members of what is going on at the federal panel, how that will impact not only their agencies and their programs, but most importantly the people they’re serving caregivers, people with disabilities, older adults. I put that in a weird order, but <laugh>, those are the three key constituencies that we are monitoring federal policy on.
Amy Gotwals (12:25):
So we want our members to have the right information at the right time to take their own action. We also want to strengthen their own relationships with their congressional delegation. So getting them this information is not just as an fyi, it should be empowering and supporting because at the end of the day, while we play a key role in passing on all this information to Congress, it’s really important that all members of Congress and key people in the administration of course have a very clear sense from those folks on the ground how their actions in Congress, the administration affect the professionals who are supporting older adults and caregivers and people with disabilities. But then part of our role is to take what you all teach us and tell us your challenges as well as the challenges of those you serve. And then we translate that world of AAAs and those you serve back to Congress in the administration because we speak their lingo and we translate that sort of aging network, speak to them so that they understand how they can be helpful.
Amy Gotwals (13:26):
Sometimes we have to chide them if they’re being hurtful of that as being work that’s happening under Older Americans Act, but also under a lot of other federal programs. So we don’t take all the lobbying and advocacy out of our members’ hands, we do our own that should supplement what they’re doing. And then of course the key to this is that everybody’s doing their part. You know, there are lots of different members and a lot of different places on the political spectrum, on the spectrum of what’s their interest in policy issues. But when all of our members are singing off of roughly the same song sheet with lots of good detail about the specific programs they’re operating and why that member should realize the value of it and support it through policy, that’s part of our, we see that as our work to help coordinate that to, to create those, those advocacy moments to make sure our members are prepared for them and to support them in that advocacy that they do.
Amy Gotwals (14:22):
We focus solely on the federal level and love hearing about all the great statewide advocacy work our AAAs do. But as you pointed out in the act it really starts out at that local advocacy. And I like to try to convince any reluctant new AAA leaders or staff, like this is all part of it. You have to of course focus on who you’re serving in your particular planning and service area, but there is also now an advocacy charge to make sure that federal policy doesn’t get in the way and it at best supports that work you’re already doing. So it’s just like a continuum and going in directions. We’re all connected in that advocacy charge. We just played different rules.
Jason Maciejewski (15:03):
We’ve certainly taken that advocacy charge and emphasized it to our board of directors and our advisory council and are really using it as a, you know, the thing we point to to get people engaged in advocacy on our side. Really key piece. So thanks for taking us through that part of it. The Older Americans Act itself is authorizing legislation. And could you explain the relationship of the annual federal budget process to the actual delivery of Older Americans Act programs and services?
Amy Gotwals (15:32):
So when we say a program is authorized, it means it has that statute that was created by legislation. It’s in law that Congress has approved the use of future federal dollars to do X, Y, and Z. And then here’s the long list of how you should do X, Y, and Z. And it can either be very light, very light touch on the X, Y, and Zs, and it can be a very long list and a very prescribed program or other ways of making policy that just says it can be done and it can be done with in this way. It doesn’t automatically give it money. Authorizers and there’s a whole committee set up to oversee this once it is a statute, they’re still responsible for keeping an eye on how that program is going. The authorizers can make recommendations on how much money they think that program should get every year, but they don’t actually decide.
Amy Gotwals (16:23):
That is a whole other set of committees in Congress, particularly one massive committee with 12 subcommittees under it called the Appropriations Committee. And that is the actual doling out of discretionary funding. I say discretionary because that is different than the automatic funding that flows to programs such as Medicare, Medicaid, Social Security, which some folks call entitlements. But let’s focus on its funding. And the funding is mandatory. Congress sets those programs up, sets the X, Y, and Z, and then has money tied to it that will grow as the need grows. They can still change that law, but they don’t change those programs as much. They mostly set it on more of an automatic spending process. The rest of the federal, that’s about two thirds of federal spending, is already on that track of if there’s more older people, we’re going to spend more on Medicare and we don’t have to pass a budget every year to do that.
Amy Gotwals (17:16):
They can go in and change it, but they don’t often. The rest of it is appropriations. After you account for like nine, 10%, which is interest payments on our national debt, then the rest of the budget is about 32% in any given year is the actual stuff we talk about when people say the federal budget, the stuff that Congress will argue over and if they can’t pass it in time becomes a shutdown. That’s appropriations, that’s discretionary funding. And they decide that every single year. So one of the subcommittees of these big committees, there’s one in Senate and one in the House obviously, thankfully these subcommittees line up so <laugh> there’s not any confusion about jurisdiction. And both chambers decide what that spending should be every single year right down to deciding this is how much goes into those III-B supportive services. This is how much we’re going to spend on adult protective services or funding for other programs.
Amy Gotwals (18:11):
This is exactly how much we’re going to spend for meals in congregate settings. And they decide that every year. So it’s really two different tracks and you talk to the authorizers every few years, whenever that piece of statute is up again to be reauthorized, re-looked at by Congress. And you talk to appropriators pretty much year round because you’re feels like anyway now, but they don’t usually get their bills done on time. We are talking with them and lobbying for more money all the time, all year long for those annual spending bills, which actually is where the rubber meets the road and the funding flows from the feds to the states and down to the AAAs and ultimately providers to create that magic of the Older Americans Act.
Jason Maciejewski (18:51):
So the authorization of the Older Americans Act is actually time limited. It expires periodically and the next time it expires is 2024. And so what do you think the road to reauthorization of the Older Americans Act looks like and what type of process do you see occurring?
Amy Gotwals (19:07):
I wanna say one thing. Technically there’s an expiration date on the Older Americans Act, but thankfully, as long as Congress continues to give money in those annual appropriations bills, it doesn’t stop happening. So that word can strike fear in the heart of advocates, and I want to make sure we’re being clear. It certainly, if it weren’t reauthorized for years and years and years, some members of Congress could come along and say, well, look, we haven’t paid it any attention. Do we still wanna have this? And they could suggest cuts to funding. But for the most part, if Congress misses its own self-imposed reauthorization deadline, not much happens as long as the appropriators keep giving the program the money they need every year to actually do the for mentioned X, Y, and Z and try to meet the mission of the act. So yes, as you said, we passed the last reauthorization.
Amy Gotwals (19:56):
We <laugh> please advocates helped push Congress through passing a reauthorization and it was signed by the then president in March of 2020. Promptly everybody, you know, turned and pivoted to Covid. And so we haven’t talked about the changes that were made there very often, and now it feels like we’re already up for another reauthorization. So typically at the start of this reauthorization, the committees that have jurisdiction over this, those authorizing committees, the committee staff start educating the staff representing the members who serve on that committee. It’s their first chance to engage. They bring in speakers from the government, from government supporting agencies like, the GAO, and they educate them about here’s what’s action law, here’s what it means, here’s what it looks like on the ground. And you know, we are also knocking on their doors, having meetings so that we can give them additional information that is of course, based on the experiences of our members.
Amy Gotwals (20:51):
Eventually once they feel their committee’s kind of ready to start considering this, then they start to talk about other processes that they can use, such as do we want to have a hearing? Do we want to have a hearing out in the field? Do we want to just have a listening session and invite a lot of people to come and give their opinions, but not as formal as a hearing. So there’s a lot of steps they can take before they actually sit down and start drafting a bill that would amend the original OAA. They never start from scratch, thank goodness. But you really are looking at where do we need to make improvements? What new idea do we want to try, et cetera, et cetera. Thankfully the Older Americans Act has always been a bipartisan endeavor. And so we often what you’ll see is while the committees are working through that process, you’ll see them set up a very fair bipartisan process.
Amy Gotwals (21:39):
So it’s Republican and Democratic staff all working together. They might have different opinions, but they’re coming together on a regular basis to air those opinions, to negotiate what might be feasible to both sides or acceptable to both sides. Our job is to tell them if that’s feasible, we give them lots of feedback as they’re throwing out these ideas over these many months. And that is really how you ultimately end up with a bill that everybody can sign off on. It can take less than a year if everybody’s motivated and the changes aren’t earth shattering. And it’s also taken as long as five or six years if you hit controversy, if one chamber is out of sync with the other, like the center really wants to move, but the house has got other things it’s working on and it hasn’t been a priority. So there’s a lot of rolling of the dice on how this goes, but historically I’ve been involved in several reauthorizations and heard stories of previous ones. Usually they’re very responsibly handled by Congress. The last time we did this, it was a Republican senate, but a Democratic house. And now that’s flipped. But I think even in this partisan environment and the fact that 2024 is a presidential election year, I still think the OA reauthorization will still be a, a healthy bipartisan process. I just can’t give any sense of when it’ll all be done and when we’ll be fully reauthorized. It may not be by that expiration date of September 30, 2024.
Jason Maciejewski (23:02):
Well, we thank you for your leadership and the team at USAging as we go into this process for reauthorization for the Older Americans Act. Is there anything else that you would like to share about the act and its impact?
Amy Gotwals (23:14):
I think I’ve already touched on this, but this is a really dynamic piece of legislation that I think most of the time, I’m sure our members could all find exceptions to this, as could others, but most of the time this allows the right balance of federal guidance. So you have consistency state leadership because they have a key role to play and also local innovation. It’s like everyone gets a specific role to play. You get that central fidelity across the country, but it flourishes because when that service is ultimately delivered, it’s delivered in a way that reflects the communities being served. And I really love the Older Americans Act not only for that, that healthy infrastructure where there is that dynamism and you have to collaborate to make this really work well. But I also love that the Older Americans Act meets older adults and caregivers where they are.
Amy Gotwals (24:05):
These are just options for people to help support aging well at home. They’re not prescribed, they’re not one size fits all. They really reinforce the dignity of those served by these programs and they remind us also, and this is a little bit semantics, but I think it’s important semantics in word choice. They remind us that remaining independent pretty much every human wants to do isn’t really all or nothing. You know, you can receive a service or get help with some meals or bathing or transportation or legal services and still be considered living independently in your own home or the setting of your choice. And I think that’s the right approach. I think it does it in cost effective, smart ways. I think ultimately these program, even though these are different sides of the ledgers, we say, and we can’t always have the data that we would like to have to prove this in large measure, but these programs are helping reduce Medicaid expenditures. They’re helping people stay healthier, which saves Medicare money. They’re helping people maintain their own resources as we talked about the financial support by the provision of the help people need. So they’re not only helping these individuals, but they’re helping all of us as taxpayers because they’re delivering services that prevent much greater expenditures by both, again, the individuals served and the taxpayer. And so they’re smart on top of all the beauty of them. They’re also really smart financially and as far as creating the types of services people prefer.
Jason Maciejewski (25:33):
Amy, thank you so much for joining us today to talk about the Older Americans Act.
Amy Gotwals (25:35):
My pleasure. Anytime.
Jason Maciejewski (25:38):
If you have any questions about services or programs The Senior Alliance offers, you can call us at 1-800-815-1112 or email us at firstname.lastname@example.org. Information about our agency or the programs and services we offer found on our website at www.thesenioralliance.org. On Facebook, we can be located by searching for the Senior Alliance. And finally, our Twitter handle is @AAA1C. I’m Jason Maciejewski. Thank you for listening to this episode of Inside the Senior Alliance.
Speaker 3 (26:06):
Inside the Senior Alliance is a production of The Senior Alliance and Blazing Kiss Media.