The updated regulations reinforce and clarify policies and expectations, promote appropriate stewardship of OAA resources and incorporate lessons learned during the COVID-19 pandemic. For example, the final rule: • Clarifies requirements for state and area plans on aging and details requirements for coordination among tribal, state and local programs; • Improves consistency of definitions and operations between state and tribal OAA programs; • Clarifies and strengthens provisions for meeting OAA requirements for prioritizing people with the greatest social and economic needs; • Specifies the broad range of people who can receive services, how funds can be used, fiscal requirements and other requirements that apply across programs; • Clarifies required state and local agency policies and procedures—for example, the final rule establishes expectations regarding conflicts of interest; • Requires state agencies to establish flexible and streamlined processes for area agencies to receive approval for contracts and commercial relationships; • Includes guidance for the National Family Caregiver Support Program and the Native American Caregiver Support Program, which were authorized since the last update; • Addresses emergency preparedness and response, incorporating lessons from the COVID-19 pandemic; • Establishes expectations for legal assistance and activities to prevent elder abuse; • Clarifies the role of the aging network in defending against the imposition of guardianship and in promoting alternatives; and • Updates definitions, modernizes requirements and clarifies flexibilities within the OAA nutrition programs. For example, the rule allows for the continuation of innovations developed during the COVID-19 pandemic, such as providing carryout meals through the congregate meals program, in certain circumstances. “Our world has changed dramatically in the 36 years that have passed since the last substantial update to the regulations for most of ACL’s OAA programs in 1988,” ACL said in its announcement of the final rule. “The population of older adults has nearly doubled, and older adults are living longer than ever before.” The announcement notes that the expectations for aging are different from those of earlier generations. “Increased understanding of the impact of the social determinants of health is reshaping healthcare, as nonmedical services that help people avoid hospitalization and institutional care—like those provided through OAA programs—are increasingly being incorporated into healthcare service delivery models,” according to ACL in a statement. First passed in 1965 and last reauthorized on March 25, 2020, OAA authorizes a wide range of programs and services, most of which focus on helping older adults age in place. These services include homedelivered and congregate meals, support for family caregivers, preventive health services, personal and home care services, transportation, legal assistance, elder abuse prevention and so much more. In addition, OAA provides ombudsman services for people who live in long-term care facilities. These services are provided by local Area Agencies on Aging that contract with nearby service providers. In fiscal year 2020, the most recent year for which participation data are available, about 10.1 million older people were served by OAA programs, including 225.8 million home-delivered meals, 25.4 million congregate meals and 8.9 million rides to medical appointments, grocery stores and other activities. Darryl Hicks is NRMLA’s vice president of communications. “The overwhelming majority of Americans want to live in their own homes as they age, and almost 95 percent of them do.” —Alison Barkoff, who is performing the duties of the ACL administrator and assistant Secretary for Aging REVERSE MORTGAGE /MAY-JUNE 2024 31
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