By Elizabeth Blair, National Association of Area Agencies on Aging
Area Agencies on Aging (AAAs) have nearly 50 years of experience developing, coordinating, and delivering services that address the health-related social needs of older adults in their communities. By providing nutrition, transportation, in-home services and a variety of other supports, AAAs help older adults — many of whom live with multiple chronic conditions and disabilities — remain in their homes and communities for as long as possible. Growing attention on the importance of social determinants of health has led to recognition of the vital role AAAs play in addressing health-related social needs in their communities, as well as opportunities for partnerships between health care entities, AAAs, and other aging and disability community-based organizations (CBOs).
Every two to three years, the AAA National Survey is conducted by the National Association of Area Agencies on Aging (n4a) in partnership with Scripps Gerontology Center at Miami University with funding from the Administration for Community Living. The survey tracks trends in programs, services, and funding affecting AAAs and the older adults they serve. Findings from the survey shed light on the wide range of needs that AAAs address in their communities, as well as the expertise their staff bring to meet those needs. AAAs provide an array of services that are critical to keeping older adults and people with disabilities living in their homes and communities and can be valuable partners to health care organizations in addressing the holistic needs of those populations.
Core and Supplemental AAA Services
On average, AAAs provide 27 services to address the needs of older adults in their communities. The Older Americans Act (OAA) requires all AAAs to provide a set of five types of core services, including home-delivered and congregate meals; evidence-based health promotion programs; caregiver supports such as support groups and respite care; elder rights services; and a range of supportive services, including information and referral and legal services. Table 1 shows the supplemental services AAAs most often provide, not including the core OAA services previously mentioned.
Table 1: Most Provided Supplemental Services
Many of the programs and services that AAAs provide have a direct impact on health outcomes. All AAAs provide meals, which improve the health outcomes of older adults. Eighty-six percent of AAAs provide case management, connecting older adults and their caregivers to essential services and supports that improve their quality of life and reduce the cost of care. A growing proportion of AAAs provide chore services, which entail heavier housework or yard work, increasing from 57 percent to 66 percent between 2016 and 2019. During that same timeframe, there were similar, smaller increases in the proportions of AAAs offering homemaker services, which provide light housework such as preparing meals (74 percent to 81 percent) and personal care services (74 percent to 79 percent). Health care entities have found many of these services valuable in improving outcomes for their patients and members. According to the 2020 Request for Information Survey from the Aging and Disability Business Institute, which supports aging and disability CBOs in effectively contracting with health care payers and providers, many of these services are being offered by health care entities through contracts with AAAs and other CBOs. The most common of these are case/care management or service coordination (42 percent), evidence-based health promotion programs (31 percent), transitions from hospital to home (30 percent), nutrition programs (30 percent) and home care (30 percent).
All AAAs provide evidence-based health promotion programs, which must be evaluated through rigorous research and proven to be effective in improving the health and well-being of older adults. This diverse group of programs helps prevent falls, manage chronic disease, increase physical activity, manage mental health, and support caregivers. Eighty-nine percent of responding AAAs provide at least one evidence-based fall prevention program to reduce the injuries, decreased mobility, and medical costs that result from falls. The most common of these — provided by 66 percent of AAAs — is the A Matter of Balance program, which aims to reduce fear of falling and increase physical activity among older adults. A Matter of Balance has been shown to reduce health care spending because it can lead to reductions in hospital admissions and skilled nursing facility use. Nearly half of AAAs provide the Chronic Disease Self-Management Program (CDSMP), which helps older adults manage chronic disease, and has resulted in improvements in self-reported health, reduced emergency department visits, and reduced health care spending.
The AAA workforce is highly professional, with focused expertise and clinical capability in providing the services described above to address health-related social needs. The most common AAA staff positions align with the most common services provided, with many AAAs having care managers/coordinators or evidence-based program coordinators to oversee the administration of programs such as CDSMP and A Matter of Balance, and nutritionist/dieticians to provide guidance for meals and other nutrition programs (see Table 2). The most common credentials among survey respondents are licensed social workers and certified case managers, which contribute expertise in connecting clients with and coordinating services (see Table 3). In addition, more than one-third have a registered or licensed practical/vocational nurse on staff, contributing valuable knowledge and experience in health care. In addition, a small percentage (three percent) have medical directors on staff.
Table 2: Most Common Staff Positions
AAAs have also developed their skills in business acumen and quality assurance to improve their operations and maintain regulatory compliance. Almost half (47 percent) have a quality assurance or compliance manager on staff and AAAs are increasingly seeking accreditation for their programs and organizations. More than 50 AAAs currently have National Committee for Quality Assurance Care Management-Long-Term Services and Supports Accreditation, indicating their commitment to high-quality services and continuous quality improvement. In addition, 16 percent employ staff to measure outcomes and assess program effectiveness.
Table 3: Most Common Qualifications, Education, or Certifications
Future Health Care Partnerships
AAAs have a long history of developing innovative services and supports to address the evolving needs of older adults in their communities. With the continued recognition that the AAA services address social determinants of health, there is growing interest in the development of AAA partnerships with the health care sector. AAAs report that, over the next five years, they will need to hire more positions that increase their business acumen and readiness for contracting with health care entities.
With their deep expertise in addressing the social and health-related needs that strongly contribute to overall health, AAAs are essential partners in achieving the Triple Aim of high-value health care: improving patient experience, improving the health of the population, and lowering health care costs.