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This year marks the 35th anniversary of the Older Americans Act (OAA). In signing this important piece of legislation, President Lyndon Johnson described it as "seed corn" which would provide an "intelligent and constructive program of both services and opportunities for older citizens in every State and community." Because of the OAA and the work of the dedicated and talented national aging network, made up of state and area agencies on aging, Indian Tribal organizations, service providers, and volunteers, millions of older Americans are able to continue to contribute to their families, communities, and country.
Title I of the OAA sets out 10 broad national objectives to be achieved on behalf of older persons. These are:
This year also marks the 20th anniversary of the OAA grant program for Indian Tribal Organizations. Prior to 1978, the OAA allowed Indian Tribes to bypass the traditional state funding mechanism and apply directly to the Commissioner on Aging for funds necessary to establish a service program for older Indians. In order to award such grants, the Commissioner first had to determine that older Indians would be better served by direct grants to a Tribe, and then the Tribe would receive funds from the state's allotment. Because that authority had never been exercised and to improve services for older Indians, Congress created a new title with separate funding for services to older Indians.
In the 1978 amendments Congress recognized the special sovereign status of Tribal governments and created Title VI, Grants for Indian Tribal Organizations. The purpose of Title VI was to promote the delivery of supportive and nutrition services to American Indians and Alaska Natives that are comparable to services offered to other older persons under the Title III program.
In establishing this new title, Congress identified findings with respect to the needs of older Indians. The law stated the following: older Indians are a rapidly increasing population; suffer from high unemployment; have a poverty rate estimated at 61 percent; have a life expectancy between 3 and 4 years less than the general population; lack sufficient nursing homes and other health and long-term care facilities; lack sufficient Indian area agencies on aging; frequently live in substandard and overcrowded housing and receive less than adequate health care.
Although Title VI became a part of the OAA in 1978, funds were not available until 1980. In 1980, an appropriation of $6 million provided funding for the first 85 Title VI grants. These grantees represented nearly 20,000 elders. By 2000, the program funding had increased to $18,470,000 for 227 grants, and the number of elders represented by these grantees had increased to 134,333 (figure 1)
Nutrition services have always been a major component of the Tribal Title VI programs. Most program sites provide hot meals in a congregate setting 4-5 times a week. For elders unable to leave their homes, a hot meal is delivered 5 times a week. Most programs provide modified meals for diabetics and others who are on low fat, low cholesterol, and low sodium diets. A few programs provide special nutrition services such as meals for homeless elderly, an evening meal option for home-delivered meals participants, and week-end home-delivered meals. Additionally, the congregate meal programs are important sources for social interactions by providing opportunities for elders to meet with friends and participate in recreation and other activities. In addition to providing meals and nutrition education and counseling, Title VI programs are important sources for supportive services. Transportation to meal sites, doctors appointments, and grocery shopping is a vital supportive service component of many Title VI programs.
Other supportive services provided to elders and their families include outreach, information and referral, homemaker and chore services, friendly visiting, and family support. Between 1980 and 2000, nearly 31 million meals and 32 million supportive services, such as transportation, homemaker, and family support services, have been provided to American Indian, Alaska Native and Native Hawaiian elders (figure 2).
The Comprehensive Older Americans Act Amendments of 1978 (P.L. 95-478) made substantial changes in the OAA. Several titles of the Act were consolidated under a new Title III - Grants to States, and a new title, Title VI - Grants for Indian Tribes, was added. Title VI authorized the Commissioner on Aging to implement a new program of direct grants to eligible Indian Tribal Organizations for services to elders, age 60 and over. There were four services required under these grants - nutrition, legal, information and referral, and ombudsman services. Additional services designed to meet the unique social and nutritional needs of older Indians within the service area could be provided. In order to be eligible for a grant, a Tribal Organization had to represent at least 75 elders, age 60 and over .
In the spring of 1980 AoA provided
cluster training sessions throughout the
country to assist Tribes with completing
their applications. In September of 1980,
85 grants were funded for a two year
project period (Appendix
A). One grantee
dropped out of the program during the
first year and another one dropped out at
the end of the second year. During the
1980-1982 project period, over 1,750,000
meals were provided to nearly 30,000
elders. Transportation was a large part of
the program with over 500,000 units of
transportation provided.
| Figure 2: Title VI Services, 1980 to 1999 |
|
When the first two year grant period was assessed, Tribes requested that the requirement for legal services be discontinued since there appeared to be adequate legal services available to elders through Tribal attorneys and other sources. They were also concerned that a number of older persons under the age of 60 were in need of nutrition and supportive services.
In the 1981 amendments, Congress recognized that the life span of Indians was considerably shorter than that of other older persons and gave Tribes the authority to determine the age at which their elders would be able to participate in the program. Tribal Organizations were given more flexibility to design their programs to better meet local needs by eliminating some requirements, such as the requirement to provide legal services and long-term care ombudsman services. In 1982, AoA provided two year continuation grants to the original 83 grantees. During these two years, 1982-1984, over two million meals were provided to nearly 35,000 elders.
The 1984 amendments to the OAA decreased the number of elders a Tribal Organization had to represent in order to be eligible for a grant to 60. This number was reduced to 50 in the 1987 amendments.
In 1985 and 1986 the Title VI program was opened for new applicants. With both a change in the age requirement and lower number of elders to be represented, more Tribes became eligible for Title VI grants. Thus, 125 grants were awarded in 1985 and 133 grants were awarded in 1986.
The 1987 amendments made significant changes in American Indian provisions of the OAA. The amendments established an Office for American Indian, Alaskan Native and Native Hawaiian Programs (OAIANNHP) to be headed by an Associate Commissioner on American Indian, Alaskan Native and Native Hawaiian Aging. The role identified for the Associate Commissioner included serving as the effective and visible advocate in behalf of older Native Americans within the Department of Health and Human Services (DHHS) and with other departments and agencies of the Federal Government regarding all Federal policies affecting older Native Americans, coordinating activities between other Federal departments and agencies to assure a continuum of improved services, administering and evaluating grants to Indian Tribes, public agencies and nonprofit private organizations serving Native Hawaiians, recommending policies and priorities in the development and operation of programs and activities conducted under the OAA relating to older Native Americans, collecting and disseminating information related to problems experienced by elders, developing research plans and conducting and arranging for research in the field of Native American aging, and providing technical assistance and training programs to Title VI grantees. Additionally, an interagency task force related to older Indians to be chaired by the Associate Commissioner, was established.
In the Older Americans Act Amendments of 1987, the name of Title VI was changed to Grants for Native Americans, and part B - Native Hawaiian Programs - was added. The first grant was awarded under Title VI-Part B in 1989. Additionally, a Title VII-Part B, Native American Elder Rights Program was included in the amendments. Title VII, Part B has yet to be funded.
A change to enhance program coordination between Title VI grantees and Title III state and local programs was made in 1987. The amendments eliminated a prior law provision that had prohibited individuals or Tribal Organizations from receiving services or funds under Title VI from also benefiting from the Title III program. A provision was included in both Title VI and Title III to require coordination between the two programs. Congress indicated that this change corrected an "unintended effect of existing law which can result in making ineligible for Title III services older Indians who could be served by a Title VI grant but are not, or in making the older Indians who receive only one type of service under Title VI ineligible for any other services under Title III." They further indicated that this change was intended to assist Tribal Organizations and area agencies to broaden the scope of cooperative efforts.
In 1988 Dr. J.T. Garrett was detailed from the Indian Health Service (IHS) to assist in establishing the OAIANNHP and arranging for evaluating outreach to Native Americans as required in the OAA amendments. In the fall of 1988, Dr. Garrett returned to the IHS and Dr. Yvonne Jackson was detailed to AoA from IHS to continue establishing the OAIANNHP. During this time the outreach study was conducted and the Interagency Task Force on Older Indians was established.
In 1989 the first grant was awarded to a Native Hawaiian organization. The Title VI program was opened for new applications each year between 1989 and 1992. The program increased to 182 grantees in 1989, 194 grantees in 1990, 212 grantees in 1991, and 217 grantees in 1992. This resulted in over two and a half times the number of elders eligible to receive services -- from 40,886 in 1987 to 107,193 in 1992. During this same time period, funding increased from $7.5 million in 1987 to $15.086 million in 1992. Unfortunately, this increase was not enough to keep pace with the increasing numbers of elders to be served and inflation.
In March 1991, Dr. Yvonne Jackson was selected as the Associate Commissioner for American Indian, Alaskan Native and Native Hawaiian Programs. The following year, the OAA reauthorization called for establishing resource centers for Native American Aging, providing training and technical assistance to grantees, and convening a national meeting for Title VI directors. Cooperative agreements were awarded to the University of Colorado and the University of North Dakota to establish these Resource Centers. Three Feathers Inc., was awarded a cooperative agreement for training and technical assistance and convening the national meeting.
In 1992 the Commissioner on Aging invited Title VI program directors to a roundtable meeting to discuss issues of concern in the program. Three additional roundtables were held during 1993-1995 to discuss issues concerning home and community based long-term care in Indian communities.
The 1992 amendments to the OAA required a study of the nutrition programs. The National Evaluation of the Elderly Nutrition Program (ENP), 1993-1995, conducted by Mathematica Policy Research, Inc. found the following:
The 1992 amendments also called for a White House Conference on Aging. These Conferences have been held about every 10 years since 1961 and are designed to develop recommendations for additional research and action in the field of aging. The delegates to the 1995 White House Conference on Aging adopted a number of resolutions aimed on assuring that all people have access to a continuum of quality health care, in which all people are economically secure, and in which all people live in a healthy social environment that includes adequate housing and nutrition, and where they are not isolated by discrimination. As with previous White House Conferences on Aging, a number of implementation strategies for the resolutions focused on Tribal issues, including the call to continue a Federal set aside and increase funding for Tribal governments within the OAA and to maintain Title VI as a separate title in the OAA.
In 1995-1996 the OAIANNHP, the Native Elder Health Care Resource Center at the University of Colorado, and the National Resource Center on Native American Aging at the University of North Dakota surveyed key tribal program administrators from 108 tribes concerning the availability and funding of home and community-based long-term care (HCBLTC) programs and resources in Indian country and the barriers to establishing such programs and services. Key findings from this study included:
AoA is coordinating efforts with other Federal departments and agencies to address these issues. In addition, AoA has submitted a legislative proposal that will fund a new National Family Caregiver Support Program with authority specific to American Indian, Alaska Native, and Native Hawaiian populations.
A Presidential Executive Order, issued in 1993, called for all Federal departments and agencies to engage in consultation with Tribal leaders. During 1995-1999 AoA participated in DHHS wide consultation meetings. In August 2000 AoA will hold the first AoA/Tribal Listening Session to obtain input from Tribal leaders and program staff concerning issues facing American Indian elders today.
According to Program Performance Reports (PPR) completed by the Title VI grantees, these programs continue to ensure that essential services are provided to American Indian, Alaska Native, and Native Hawaiian elders. In 1999 nearly 1.3 million congregate meals and 1.7 million home-delivered meals were provided. The PPR data for 1980 to 1999 is provided in Appendix B. August 2000.
Appendix A: Original Title VI Grants, 1980
REGION I:
Passamaquoddy Tribe
REGION II:
Tonawanda Band of Seneca Indians
REGION IV:
Mississippi Band Choctaw Indians
Eastern Band Cherokee Indians
REGION V:
Keweenaw Bay Indian Community
Inter-Tribal Council of Michigan
Sault Ste. Marie Chippewa
Fond Du Lac Band of Chippewa
Red Lake Band of Chippewa
Mille Lacs Band of Chippewa
Stockbridge-Munsee Community
Red Cliff Band of Chippewa
Wisconsin Winnebago Tribe
Lac Courte Oreilles Band of Chippewa
Menominee Indian Tribe
Bad River Band of Chippewa
St. Croix Chippewa Tribal Council
REGION VI:
Santo Domingo Pueblo
Pueblo of Taos
Six Sandoval Pueblos
Eight Northern Pueblos
Santa Clara Pueblo
San Juan Pueblo
Pueblo of Isleta
Pueblo of Zuni
Jicarilla Apache Tribe
Pueblo of Laguna
Mescalero Apache Tribe
Pueblo of Acoma
Kiowa Tribe
Kickapoo Tribe
Pawnee Tribe
Otoe-Missouria Tribe
Quapaw Tribe
Miami Tribe
Creek Nation
Chickasaw Nation
Seneca-Cayuga Tribe
Seminole Nation
Osage Tribe
Citizen Band Potawtomi Indian Tribe
Choctaw Nation
Cherokee Nation
REGION VII:
United Tribes of Kansas & SE Nebraska
Prairie Band of Potawatomi Indians
Kickapoo Tribe
NE Inter-Tribal-Santee Sioux
NE Inter-Tribal-Omaha
REGION VIII:
Southern Ute Indian Tribe
Ute Mountain Tribe
Confederated. Salish & Kootenai Tribes
Northern Cheyenne Tribe
Blackfeet Tribe
Chippewa-Cree Tribes
Assiniboine and Sioux
Standing Rock Sioux
Yankton Sioux Tribe
Cheyenne River Sioux
Oglala Sioux Tribe
Ute Indian Tribe
REGION IX:
Navajo Nation
Salt River Pima-Maricopa Indian Community
White Mountain Apache Tribe
Papago Tribe
Pascua Yaqui Tribe
Hopi Tribe
San Carlos Apache Tribe
Hupa Health Association
Inter-Tribal Council of Nevada
Washoe Tribe
REGION X:
Ketchikan
Kodiak Area Native Association
Shoshone-Bannock Tribes
Nez Perce Tribe
Confederated Tribes of the Umatilla Reservation
South Puget Intertribal
Yakima Indian Nation
Lower Elwha Tribe
Quinault Indian Tribe
Muckleshoot Indian Tribe
Puyallup Tribe
Lummi Tribe
Confederated Tribes of the Colville Reservation
E Washington Indian Consortium
NW Washington Service Unit
For further information about the Tiltle VI program, contact: Dr.
Yvonne Jackson, yvonne.jackson@aoa.hhs.gov
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