You asked what administrative structure other New England and Mid-Atlantic states use to address elderly programs and issues. Specifically, you want to know whether they have a separate, cabinet-level department or similar office on aging and what functions they perform or whether they place these functions in broader multi-purpose departments.

SUMMARY

Maryland, Massachusetts, New York, Pennsylvania, and Rhode Island have cabinet-level departments or similar agencies that administer federal Older Americans Act (OAA) programs. But Massachusetts’ Executive Office of Elder Affairs, which had been totally independent for many years and still remains a cabinet-level agency with its own secretary, is now under a broader umbrella agency, the Executive Office of Health and Human Services.

We determined where the bulk of the aging functions lie based on which agency receives OAA money. The OAA provides federal grant funds for various elderly services, such as homecare, elderly nutrition and meals on wheels, advocacy, protective services, information referral, long-term care ombudsman, health insurance counseling, and senior employment and volunteer programs. In some cases, the departments also administer non-OAA programs, most notably state-funded or Medicaid waiver home care, preadmission screening for long-term care, or prescription drug assistance.

Vermont has a recently reorganized Department of Disabilities, Aging, and Independent Living located in a broader umbrella Agency of Human Services. Maine, New Hampshire, and New Jersey administer OAA and certain other elderly programs through lower-level divisions of larger departments and vary considerably in how they organize them.

CABINET-LEVEL AGING AGENCIES

Maryland

Maryland’s Department of Aging, headed by a secretary of aging, was established in 1998. But it had already existed since 1975 as the Office on Aging, an independent cabinet-level executive branch agency, according to Mike LaChance, Aging Services Analyst in the department.

The department is the conduit for OAA funds and is designated the state’s unit on aging. It oversees the delivery of OAA programs, services, and benefits through the state’s network of 19 area agencies on aging, which are simultaneously county agencies on aging.

The department administers a number of home and community-based programs, including the Medicaid waiver home care program and a congregate housing services program. The Department of Health has delegated it authority to regulate small group homes for four to 16 seniors, and it also regulates continuing care retirement communities. It runs the Senior Information and Assistance Program, which provides a single point of entry for the elderly to various state services. It also has recently developed an Aging and Disabilities Resource Center, and has contained a health insurance counseling program for seniors since 1987.

A Commission on Aging advises the secretary of aging about the needs of the elderly in Maryland and the department’s work. In addition, an Innovations in Aging Services Advisory Council in the Aging Department advises the secretary on the annual Innovations in Aging Services Program Plan. The plan sets priorities for funding innovative aging services and training personnel who serve the elderly.

http: //www. mdarchives. state. md. us/msa/mdmanual/10da/html/dah. html

Massachusetts

Massachusetts’ Executive Office of Elder Affairs, established in 1973, is a cabinet-level agency headed by a secretary. Even though it was recently placed into the larger umbrella Executive Office of Health and Human Services, it remains a cabinet-level agency and keeps its secretary, who attends all cabinet meetings, according to Elana Margolis, Executive Office of Elder Affairs chief of staff.

The Executive Office of Elder Affairs is the state’s designated unit on aging and receives federal and state money for its programs. The programs include the usual OAA services. The Office coordinates local councils on aging. In addition, it (1) regulates and certifies assisted living facilities, (2) monitors and audits homecare corporations, (3) administers Medicaid long-term care for seniors, (4) works on policy issues for elderly housing, and (5) runs the state’s Prescription Advantage program for seniors and younger disabled people. For the latter program, the Office works with the University of Massachusetts Medical School, Commonwealth Medicine – Public Sector Partners, which provides enrollment and eligibility services, customer and call center services, premium billing, material development, production and mailings, plan design, and development of the information system and reports.

Elder Affairs Office services are administered through a statewide network of regional and local agencies. Twenty-seven nonprofit regional Aging Services Access Points (ASAPs) subcontract on the Office’s behalf with service providers for a broad spectrum of services; 23 area agencies on aging (AAAs), 20 of which are also ASAPs, provide OAA services. The Elder Affairs network also includes numerous volunteers and many other private and public organizations throughout the state, including 348 municipal councils on aging and 290 senior and drop-in centers, most of which are affiliated with councils on aging.

http: //www. sec. state. ma. us/cis/ciscig/o/o6o15. htm

http: //www. mass. gov/portal/site/massgovportal/menuitem. 7892fc7bf83731c14db4a11030468a0c/?pageID=eohhs2homepage&L=1&L0=Home&sid=Eeohhs2

New York

New York’s Office for the Aging was created by executive order in 1961. It was one of the first state units on aging under the OAA. It became an independent cabinet-level agency in 1965 and is the state's central agency for advocacy for the elderly and planning and coordinating both public and private programs and services for the aging at all levels. Its director reports directly to the governor.

The Office administers the usual services under the OAA. It also administers some state-funded programs such as Expanded In-Home Care for the Elderly (EISIP) and provides supplementary state funding to fill gaps in OAA funding, such as Community Services for the Elderly (other home care services are provided through Medicaid homecare waivers run by other departments), according to Tom Gallagher, director of public information.

Most Office for the Aging programs are administered by county offices for the aging (which are the designated area agencies on aging under the OAA). The office performs a number of outreach and public information activities concerning other agencies’ services that affect the elderly, such as elderly housing, long-term care, and prescription assistance, but it does not administer these programs. The Department of Health, for instance, runs a pharmaceutical assistance program and the Office for the Aging’s director is a member of that program’s board. The state and county offices for the aging engage in outreach to identify potential program participants.

The office engages in advocacy for the elderly; advises and assists the governor in developing elderly-related policies; creates the State Plan on Aging; works with other departments to coordinate state programs and services for the elderly; and fosters and supports studies, research, and education on the elderly. Recently, it has been made the lead agency for developing a single point of access system for long-term care. In 2004, the office was also involved in creating new legislation and regulations for assisted living facilities, which are regulated by the Department of Health.

Two advisory committees assist the office in advocacy and make recommendations for improving state elderly programs: (1) the Aging Services Advisory Committee, whose members are appointed by the Office’s director and (2) the Governor’s Advisory Committee on Aging, whose members are appointed by the governor.

http: //aging. state. ny. us/

Pennsylvania

Pennsylvania’s Department of Aging, established in 1978, is a cabinet level department headed by a secretary. The department advances the well-being of the state’s older citizens, promotes creation and growth of organizations designed to maximize their independence, and coordinates the administration of certain federal and state aging programs. It is designated as the state’s unit on aging and is responsible for developing the State Aging Plan. The department is supported by federal and state dollars, but most of its budget comes from the state lottery fund.

The department receives federal OAA funds, which it funnels to the state’s 52 area agencies on aging. It monitors these agencies and provides technical assistance to them, coordinates and conducts social research and special studies, and reviews other state agencies’ proposed regulations affecting the elderly. The department also has a state long-term care ombudsman.

Other Department of Aging responsibilities include (1) administering the state’s Pharmaceutical Assistance Contract for the Elderly (PACE), (2) administering the Long-term Care Assessment and Management Program, an interdepartmental effort that combines pre-admission assessment of nursing home applicants with a range of case-managed community-based care options to ensure that institutionalization occurs only when less restrictive options are inadequate, and (3) licensing adult day care centers and monitoring their quality.

The department’s Office of Community Services and Advocacy reports directly to the Secretary of Aging and is responsible for community long-term care support services and for advocating, protecting, and educating the population on services and options available to older Pennsylvanians, their families, and caregivers. The office’s work is carried out through the bureaus of Home and Community Based Services and Advocacy, Protection, and Education. The latter consists of the Ombudsman, Consumer Protection, and the Healthy Aging, Education, and Outreach divisions.  

The Consumer Protection Division is responsible for protecting elders against fraud, abuse, and neglect, and for managing the criminal history background check process.   The division directs the administration of the Older Adult Protective Services Program.  

In addition, a Council on Aging, composed of five regional councils on aging, assists the secretary in preparing the State Aging Plan. It also annually evaluates the quality of aging programs, holds public hearings on aging-related issues, and consults with the secretary on the department’s operation.

http: //www. aging. state. pa. us/

Rhode Island

Rhode Island’s Department of Elderly Affairs was established in 1977. The department is designated the state’s aging unit. It runs programs for elderly abuse and protective services, health promotion, home and community care, heating assistance, a housing rental security deposit program, housing and other information and referral, legal services, job training, pharmaceutical assistance, senior community service, and senior companions. The department also has a long-term care ombudsman. One of the department’s most significant programs is the Rhode Island Pharmaceutical Assistance to the Elderly (RIPAE), according to Kathleen McKeon, assistant director.

Rhode Island has no local area agencies on aging, and the department contracts directly with providers for the elderly nutrition, homecare, and other services supported by federal and state funds.

The department also helps communities solve problems relating to the elderly; acts as a clearinghouse for information, data, and materials relative to the elderly; carries out studies necessary for solving problems concerning the elderly; coordinates a variety of special supportive services including: heating assistance for the elderly; senior citizen transportation; nutrition and home-delivered meals; home & respite care for the frail elderly; protective services for the elderly, including abuse prevention and investigation; elderly emergency housing assistance; and senior employment opportunities.

In addition, the Rhode Island Advisory Commission on Aging advises the governor and the department director on issues of concern to seniors.

http: //www. dea. state. ri. us/

SUBCABINET-LEVEL AGING AGENCIES

Maine

Maine recently renamed its Bureau of Elderly and Adult Services, which is located in the Department of Human Services, as the Office of Elder Services (OES). The change (not yet entirely completed) refocuses the new office more on seniors by moving most of the services for younger adults with disabilities into other offices and better coordinating seniors’ services with mental health services for those who need them, according to Catherine Cobbs, OES acting director.

This reorganization is part of a larger move in which the departments of Human Services (DHS) and Behavioral and Developmental Service (BDS) merged into a new Department of Health and Human Services. The change was authorized by legislation in 2004 and mostly completed in 2005. This reorganization was intended to meet several goals, such as streamlining, coordinating, and integrating services; eliminating the “silo” approach (where people have to go to several different agencies to get their needs met); and using a more “holistic” approach for providing services.

Within the newly merged department, OES will continue to provide OAA services. It will also still manage programs providing seniors with home health and other supportive services, including homemaker services, congregate housing services (to be merged with homemaker services), Alzheimer’s respite, adult day care, Medicaid home and community waivers for the elderly, and the long-term care ombudsman program. For the Medicaid waivers, OES is the lead program agency and has programmatic responsibility for them, but the state’s Medicaid office writes policy (as directed by OES), handles claims, and reports on the waivers. OES also will continue to manage statewide nursing home preadmission assessments through a contract with a private company.

OES currently provides services for younger adults with disabilities and contains the federally funded Disability Determination Division, but many of these services will soon be moved elsewhere in the new department, according to Cobbs. OES will continue to investigate abuse of adults age 18 and over (including seniors), provide protective services, and run a conservator program. And it continues to be responsible for developing publicly assisted residential care facilities, assisted living facilities and adult family care homes. But its facility licensing functions will be moved elsewhere.

http: //www. maine. gov/dhhs/beas/

http: //www. maine. gov/dhhs/beas/services. htm

New Hampshire

New Hampshire’s Bureau of Elderly and Adult Services (BEAS) is located in a larger Department of Health and Human Services (DHHS). BEAS is the designated state unit on aging as well as the state’s only area agency on aging (there are no regional area agencies in New Hampshire).

BEAS provides a variety of social and long-term supports to adults age 60 and older and to younger adults who have a chronic illness or disability. These services include the usual OAA services, as well as assisted living, nursing home care, and advocacy for disabled adults. All services and supports are intended to assist people to live as independently as possible in safety and with dignity.

A significant component of the BEAS statewide delivery system is its community-based provider network; many of these providers are nonprofit agencies.   BEAS purchases long-term care support services at the local level. Its staff, located at twelve DHHS district offices coordinate services to seniors and adults with disabilities and chronic illnesses who meet certain eligibility criteria.   BEAS’ main office in Concord is responsible for administrative support and general program and financial planning.

A major partnership between BEAS and local communities is ServiceLink, a statewide network of community-based resources for seniors, adults with disabilities, and their families.   ServiceLink partners promote the independence and well-being of these people at thirteen primary locations and many satellites throughout New Hampshire.

The state also has a State Committee on Aging that advises and makes recommendations to the bureau and helps it develop the State Plan on Aging.

http: //www. dhhs. state. nh. us/DHHS/DHHS_SITE/default. htm

http: //www. dhhs. state. nh. us/DHHS/BEAS/default. htm

New Jersey

New Jersey’s Aging and Community Services Division is in the state’s Department of Health and Senior Services (DHSS). The division is the designated state unit on aging and receives and distributes the OAA funding, oversees the area agencies on aging, and runs the usual OAA programs.

The division also conducts preadmission screening for long-term care and administers Medicaid waiver home care programs. The separate Department of Human Services determines financial eligibility and makes the payments for these waiver programs. The division administers a nursing facility transition, state-funded home care, and assisted living programs; elderly congregate housing services; a statewide respite care program; an Alzheimer’s adult day care program; a public guardian program; and elderly protective services. It licenses adult day care centers. It also operates an Aging and Disability Resource Connection service (a single point of entry for both elderly and younger disabled people) and engages in community nutrition and wellness education.

A Commission on Aging, whose members are appointed by the governor, is also located in the division to advise it and to advocate for the elderly. The division also has historically contained the Office of the Ombudsman for the Institutionalized Elderly, but this is being moved to an independent Public Advocates’ Office.

The structural organization of elder services has had a long history in New Jersey, actually preceding the federal Older Americans Act. In 1957 an Office on Aging was created in the Governor’s Office. Then it became a division of the Department of Community Affairs. Then the division was moved to its current location at the Department of Health and Senior Services, according to Nancy Day, the division’s director. In its current location, the division is responsible to some extent for the Medicaid waiver and state-funded home care programs including preadmission screening, but the Department of Human Services, which is the single designated state Medicaid agency still does financial eligibility and payments.

Other DHSS divisions regulate long-term care, set rates for nursing facilities, and administer the state’s pharmaceutical assistance program for elderly and disabled people. A personal care assistant program is still in the Department of Human Services because less than 51% of the people in the program are elderly, according to Day.

http: //www. state. nj. us/health/

http: //www. state. nj. us/health/commiss/org. shtml

Vermont

Vermont currently has a Department of Disabilities, Aging, and Independent Living (DAIL) in a broader umbrella Agency of Human Services (AHS). As a result of a recent reorganization, DAIL now consists of the following major divisions: Disability and Aging Services, Vocational Rehabilitation, Blind and Visually Impaired, and Licensing and Protection. The reorganizations were intended to streamline services and provide better access to them.

DAIL resulted from the consolidation of the former Department of Aging and Disability Services, which was in AHS, and other agencies. The former department had administered programs and services for seniors and adults with physical disabilities, including the OAA; Medicaid waivers (aged and disabled and traumatic brain injury); vocational rehabilitation; services for the blind and visually impaired; and licensing and protection. The new DAIL includes all of these plus developmental services, medicaid high technology services, and children’s personal care.

Aging & Independent Living

http: //www. dad. state. vt. us/

http: //www. dad. state. vt. us/AboutUs. htm

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