Strengthening Innovations in Aging Services Through the Next Reauthorization of the Older Americans Act

Abstract

The Older Americans Act (OAA) was enacted in 1965 and is the primary vehicle for federal funding of home-and community-based services to America's aging population. The OAA's wide range of services and programs, which empower seniors to remain independent and healthy, include home-delivered and congregate nutrition, transportation , support for family caregivers, health promotion and disease prevention, benefits access, community service employment for low-income older workers, senior center services, and elder rights protections. Unlike Medicare and Medicaid, two entitlement programs also enacted in 1965, OAA programs are on the dis-cretionary side of the federal budget, making them subject to annual appropriations and periodic reauthorizations. Reauthorization provides an opportunity to update and modernize the OAA to better serve the rapidly growing number of older Americans and to strengthen the ability of the Aging Services Network to address the pressing challenges that threaten the independence, health, and economic security of seniors in need. There is a growing recognition of the importance of social and behavioral determinants of health (SBDOH) as key drivers of health, well-being, and costs for individuals of all ages. Social determinants of health are the conditions in which people are born, grow, live, work, and age (Artiga & Hinton, 2018). They include factors like socioeconomic status, education, neighborhood and physical environment, employment, and social support networks, as well as access to health care. Behavioral determinants of health relate to the choices people make in their lives that impact their health status. They are the actions or patterns of an individual or group that impact health, such as smoking, sexual activity, participation in physical activity, and eating practices (Short & Mollborn, 2015). As detailed in Figure 1, it is evident that the social and behavioral determinants that contribute to health and well-being for older adults describe work that community-based aging organizations have been doing from their inception. There is rapidly growing recognition and interest in the health sector about exploring opportunities to better understand and invest in those services and supports related to the social and behavioral determinants of health that have proven results. For example, Health and Human Services Secretary Alex Azar stated in November 2018 that SBDOH was "the root cause of so much of our health spending" and that "we could spend less money on health care-and, most important, help Americans live healthier lives-if we did a better job of aligning federal health investments with our investments in non-health care needs" (Azar, 2018). One study (Bradley et al., 2016) found that states with a higher ratio of social-to-health spending had significantly better health outcomes one and two years later on key measures, compared to states with lower ratios. The report concluded: "[O]ur findings suggest broadening the debate beyond health care spending to include investments in social services and public health" (Bradley et al., 2016).