PCA’s summary of comments to Administration for Community Living regarding proposed changes to the Older Americans Act
On August 14th, 2023, Philadelphia Corporation for Aging submitted comments on the Administration for Community Living (ACL) notice of proposed rulemaking to modernize the implementing regulations of the Older Americans Act of 1965, 45 CFR Parts 1321, 1322, 1323, and 1324, RIN 0985–AA17. PCA commends ACL and its staff for their hard work and thoughtfulness in proposing changes. In this context our comments only focus on selected areas of major concern based on our perspective and experience in an older, truly diverse major city with the highest rate of older adults in poverty.
While PCA recognizes and supports our state association, P4A, and USAging’s important comments and suggested modifications we also provided comments on this necessary update to regulations implementing the Older Americans Act (OAA) advocates on behalf of the more than 308,800 older Philadelphians. Older Philadelphians are diverse with 44% identifying as white; 56.4% identifying as minority and 16% identifying as foreign born. Nearly 20% of Philadelphia’s total population is over 60 and 28% of them are 75 or older. Additionally, 30% of older Philadelphians with 30% live below 150% of the federal poverty level and nearly 20% below 100% of the federal poverty level.
Some of the important issues highlighted in PCA’s comments are:
The definition of “Greatest Economic Need” – Although we generally support flexibility for state agencies and AAAs, as drafted PCA believes this definition gives too much latitude to the states to determine greatest economic need beyond income level.
The definition of “Greatest Social Need” – As drafted this definition is not explicit enough with respect to reflecting socials needs due to racial or ethnic status. Given the enormous body of research on the linkage of racial and ethnic status to disparities in health and social wellbeing, there should be an explicit separate requirement that racial or ethnic status be a factor in this definition.
Rural Minimum Expenditure – Unfortunately, minimum expenditure levels in practice get turned into a cap on expenditures. As opposed to minimum expenditures, we would recommend a more robust mandate on states to demonstrate how the proposed intrastate funding formula meets the needs of older adults in greatest economic and social need.
Contracting and Commercial Relationships – AAAs should be able to negotiate and finalize contracts and enter commercial relationships without state agencies emmeshed in the local negotiations or final product.
Content of state plans – In preparing a state plan, states should be required to provide an assessment of key strategic challenges facing the aging network and an action plan for maintaining and enhancing aging network services. There should be an affirmation obligation on states in the planning process to focus on ensuring there is a sustainable aging network.
Intrastate Funding Formula – PCA requests greater transparency by specifically requiring public disclosure of the actual data used in the intrastate funding formula (IFF), including a clear articulation of any modifications or adjustments to the data so AAAs and other interested parties can model and replicate the formula outcomes. PCA urges ACL to require states to at least provide an opportunity to comment and evaluate the appropriateness of the intrastate funding formula criteria, methodology and data as part of each state plan cycle. The outcome of this process would be either to affirm the continuing appropriateness of the formula or to suggest modifications to the formula. In addition to adjustments for the proportions of persons in greatest economic and social need, we suggest a general provision that the IFF, should include adjustments to reflect intrastate differences in the cost of delivering services, including labor costs, transportation costs and staff safety and security costs.
Conflicts of Interest – PCA has longstanding policies and procedures designed to prevent and address conflicts of interest. While we support the intent of regulations, PCA is concerned that inappropriate application of conflict-of-interest standards could negatively impact AAAs’ ability to develop and provide services designed to support older adults with the greatest economic and social needs. Through strict adherence to OAA mandates, AAAs, like state and federal agencies charged with similar responsibilities, are capable of remaining excellent stewards of the public funding allocated, advocating for the rights and benefits of older adults, and providing person-centered services and supports on the long-term care continuum of care.
Nutrition – PCA supports ACL’s effort to provide more flexibility to states and AAAs in meeting the nutrition and social needs of older adults in the local communities. Regarding Grab-n-Go Meals, PCA recommends that the ceiling be raised from 20% to 50% as the appropriate limit as a proportion of all congregate dollars. PCA also urges that ACL modify the regulations to provide flexibility to AAAs to implement grab-n-go meals in their service area even if their state has not implemented a statewide policy. This would allow AAAs to respond to the needs of their local communities as appropriate. The AAAs should still be required to complete all reporting as designated by the state.
Emergency and Disaster Requirements – PCA supports appropriate disaster preparedness efforts at all levels of government and in every community. Further it is important that these efforts be designed to enhance resiliency and be built into everyday operations. However, PCA urges ACL not to permit states to divert scarce Title III funds that are critically needed to meet the growing needs of older adults. Financing both natural and manmade disasters is a national policy challenge, but the solution is not to take funds from programs designed to address the everyday “emergencies” of older adults in greatest economic and social need.