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HHS FY2015 Budget in Brief

Administration for Community LivingAdministration for Community Living (ACL)

The Administration for Community Living works to maximize the independence, well-being, and health of older adults, people with disabilities across the lifespan, and their families and caregivers.

ACL Budget Overview

(Dollars in millions)

Health and Independence Services

2013

2014

2015

2015
+/
2014

Home & Community-Based Supportive Services 

348

348

348

--

Nutrition Services 

768

815

815

--

Native American Nutrition & Supportive Services 

26

26

26

--

Preventive Health Services 

20

20

20

--

Chronic Disease Self-Management (PPHF)

7

8

8

--

Falls Prevention [PPHF]

--

5

5

--

Senior Community Service Employment Program 

425

434

380

-54

Aging Network Support Activities 

7

7

7

--

Subtotal, Health and Independence

1,601

1,663

1,609

-54


 

Caregiver Services

2013

2014

2015

2015
+/
2014

Family Caregiver Support Services 

146

146

146

--

Native American Caregiver Support Services /1

6

6

6

--

Alzheimer's Disease Demonstration Grants 

4

4

4

--

Alzheimer's Disease Initiative – Services (PPHF)

--

11

11

--

Lifespan Respite Care /1

2

2

2

--

Subtotal, Caregiver Services

158

168

168

--


 

Protection of Vulnerable Older Adults

2013

2014

2015

2015
+/
2014

Elder Justice Initiative / Adult Protective Services 

2

--

25

+25

Long Term Care Ombudsman Program 

16

16

16

--

Prevention of Elder Abuse & Neglect 

5

5

5

--

Senior Medicare Patrol Program 

9

9

9

--

Elder Rights Support Activities 

4

4

4

--

Subtotal, Protection of Vulnerable Older Adults

35

33

58

+25


 

Developmental Disabilities Programs

2013

2014

2015

2015
+/
2014

State Councils on Developmental Disabilities 

71

71

71

--

Protection and Advocacy 

39

39

39

--

Projects of National Significance 

9

9

9

--

Univ. Centers for Excellence in Developmental Disabilities

37

37

37

--

Youth Transitions Initiative 

--

--

5

+5

Subtotal, Developmental Disabilities

155

155

160

+5


 

Consumer Information, Access and Outreach

2013

2014

2015

2015
+/
2014

Voting Access for People With Disabilities (HAVA) 

5

5

5

--

Aging and Disability Resource Centers

16

15

20

+5

National Clearinghouse for Long-Term Care Information 

--

--

1

+1

State Health Insurance and Assistance Programs 

46

52

52

--

Alzheimer’s Disease Initiative – Outreach (PPHF)

--

4

4

--

Paralysis Resource Center /1

7

7

7

--

MIPPA Extensions 

24

13

--

-13

Subtotal, Consumer Information, Access and Outreach 

97

96

89

-7


 

Other Programs, Total, and Less Funds From Other Sources

2013

2014

2015

2015
+/
2014

White House Conference on Aging

--

--

3

+3

Holocaust Survivor Assistance Fund

--

--

5

+5

Program Administration

28

30

30

--

Total, Program Level 

2,074

2,146

2,123

-23

Less Funds from Other Sources

-43

-49

-61

-12

Total, Budget Authority 

2,031

2,097

2,062

-34


 

Full Time Equivalents 

2013: 162

2014: 171

2015: 178

2015 +/- 2014: +7

1/These programs are funded with PHS Evaluation Funds in FY 2015.

 

ACL Programs and Services

The FY 2015 Budget requests $2.1 billion for the Administration for Community Living (ACL). ACL works on behalf of both older adults and individuals with disabilities to ensure that they are able to live at home with the supports they need while also participating fully in their communities. In FY 2015, the Budget prioritizes efforts to address elder abuse, assist transitioning youth with intellectual and developmental disabilities, support caregivers, help older adults and people with disabilities access services and supports, and improve the coordination of programs across federal government that serve these populations. The Budget also includes $3 million for the decennial White House Conference on Aging to bring together stakeholders and consumers from across the country to discuss the range of aging issues they face, as well as $5 million for a new Holocaust Survivor Assistance Fund that will provide support to the approximately 130,000 elderly Holocaust survivors living in the United States, individuals who are disproportionately poorer and who suffer worse health outcomes than the elderly in general.

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NEW INITIATIVE -- Elder Justice: Addressing Elder Abuse, Neglect, and Exploitation.

A 2004 national survey showed a 16 percent increase in the number of elder abuse cases from an identical study conducted in 2000. Research has demonstrated that older victims of even modest forms of abuse have dramatically higher (300 percent) morbidity and mortality rates than non-abused older people. Additional adverse health impacts include an increased likelihood of heart attacks, dementia, depression, chronic diseases, and psychological distress.

The request for ACL's Elder Justice initiative is a critical first step toward fulfilling the mandate of the Elder Justice Act and implementing the recommendations of the Elder Justice Coordinating Council. The Council first met in 2012 and is led by the HHS Secretary. Council members include the U.S. Attorney General, as well as representatives from a number of federal partner agencies, including the Social Security Administration, the Securities and Exchange Commission, and the Treasury Department. ACL’s Elder Justice initiative is based off of a set of nine proposals presented to the Council in May of 2013 that call for increased federal involvement with regard to addressing elder abuse, neglect, and exploitation.

Keeping Seniors Healthy and Independent

The Budget requests a total of $1.2 billion for services that help older adults to remain independent and in the community, including $32 million to support these services in Tribal communities. Within this total, the budget requests $815 million for nutrition services to ensure that millions of older Americans remain healthy and independent by providing reliable access to nutritious food. The meals programs supported by ACL are designed to reach seniors both in their homes and in the community. ACL’s meal programs reach some of the frailest, yet nevertheless independent, members of the community by delivering meals right to their homes. For seniors who are able to access community settings like senior centers, ACL supports meals in congregate settings where they get access to a nutritious meal, as well as to vital social contact. The Budget will support ACL’s partnership with state and local agencies to provide 208 million congregate and home-delivered meals for over 2 million older individuals nationwide.

The Budget also includes $348 million to fund in‑home and community‑based services to help older Americans live independently and with dignity. These services include assistance with transportation; case management; information and referral; help with personal care, including eating, dressing, and bathing; and adult day care and physical fitness programs. The Budget, in combination with state and local funding, will support over 26 million hours of assistance to seniors unable to perform daily activities; more than 21 million rides for critical activities such as visiting the doctor, pharmacy, or grocery stores; and 8 million hours of adult day care. These services provide direct assistance to older individuals and also assist the caregiving friends and family members of these seniors by providing them with relief and flexibility to attend to other demands in their lives while also maintaining support for their friends or loved ones.

As noted, the Budget also includes $5 million for a new Holocaust Survivor Assistance Fund which will provide federal resources through a competitive grant-making process to support nonprofit service providers that work with the Holocaust survivor community. The fund will incorporate matching requirements for grantees in order to also attract private, philanthropic investment, multiplying the impact of this funding.

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Protecting Older Americans and People with Disabilities

Combating the rising scourge of adult abuse, neglect, and exploitation in America remains one of ACL’s top priorities. The Budget requests $25 million for a new Elder Justice initiative to address the negative effects of abuse, neglect, and exploitation on the health and independence of seniors while making key investments in Adult Protective Services, research, and evaluation activities.

With this funding, ACL will initiate the development of a national Adult Protective Services data system, including grants to states to test and develop infrastructure, and provide funding for key research, which is essential to the development of evidence‑based interventions to prevent, identify and report, and respond to elder abuse. As the lead agency in addressing adult abuse, ACL will become the federal home for Adult Protective Services and will develop national standards to assist all states in improving the quality and consistency of their Adult Protective Services programs.

This investment in Adult Protective Services builds on ACL’s existing consumer rights programs, which help protect seniors and people with disabilities in a number of ways. The Budget requests $16 million for the Long-Term Care Ombudsman Program, which provides support for ombudsmen who advocate on behalf of residents of long‑term care facilities to ensure the protection of their rights and welfare and funds Protection and Advocacy systems, discussed below, that protect the rights of people with disabilities. The Budget also requests $18 million for other programs that address elder abuse prevention, provide legal assistance to seniors, and help educate consumers to prevent Medicare fraud.

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Providing Support for Caregivers

The Budget request includes $173 million to fund programs designed to support family and informal caregivers by providing these caregivers with a number of forms of assistance, including counseling, training, information, and respite support, among other services. Assisting these hardworking and unpaid caregivers ultimately helps the seniors and people with disabilities they care for to live at home and to enjoy greater independence. When institutional care is avoided, this can translate into lower overall costs. Through these investments, ACL supports some of the many caregivers nationwide who provide $450 billion in care annually. The Budget will support an estimated 790,000 caregivers who will be able to participate in counseling, peer support groups, and training to help them manage the physical, emotional, mental, and financial stresses associated with caregiving for a family member or friend.

Included within this request, ACL will invest $19 million to specifically address the needs of those caring for persons with Alzheimer’s disease. The nature of Alzheimer’s disease – a slow loss of cognitive and functional/physical independence – means that most people with Alzheimer’s disease are cared for in the community for years. People with Down syndrome are at greater risk of developing Alzheimer’s, as well as older adults. The Budget supports a three pronged approach for addressing the challenges posed by the effects of Alzheimer’s disease, including competitive grants to states that expand the availability of evidence‑based interventions designed to assist persons with dementia and their caregivers; grants to strengthen the dementia capabilities of states, tribes, and localities, enabling these entities to enact permanent systems change; and outreach to inform those who care for individuals with Alzheimer’s disease about resources available to help them.

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Helping Individuals with Disabilities Participate in Their Communities and Achieve Their Goals

ACL is dedicated to ensuring that individuals with disabilities, as well as their families, have the opportunity to fully participate and contribute to all aspects of community life. ACL works toward accomplishing this goal through a variety of ongoing partnerships with states and territories, including State Councils on Developmental Disabilities, Developmental Disabilities Protection and Advocacy programs, and University Centers for Excellence in Developmental Disabilities.

In addition, the Budget proposes $5 million in FY 2015 for a new Youth Transitions initiative as part of a larger HHS effort young Americans in the midst of difficult transitions and provide them with the tools and supports they need to enter adulthood.

At ACL, funding for this initiative will help youth with intellectual or developmental disabilities to transition from adolescence and the supportive environment of school into an adulthood that includes post‑secondary education and work opportunities, reducing their likelihood of becoming solely dependent on Social Security, Medicaid, or other similar benefits. This initiative will provide grants to replicate and evaluate the outcomes of programs that have shown promising employment results for youth with intellectual and developmental disabilities when Medicaid‑funded long‑term services and supports, vocational rehabilitation, Social Security, and education systems collaborate. For example, in Washington, King County changed its approach to transitioning students with intellectual and developmental disabilities from school to employment by adopting a statewide “Employment First” policy coupled with supportive services. In just 5 years, the percentage of King County youth with disabilities that were employed rose from 6 percent to 56 percent.

NEW INITIATIVE -- Transitioning Youth to Adulthood

Current support systems for youth with disabilities transitioning to adulthood and coordination efforts across federal agencies to assist these youth are insufficient. A 2012 GAO report strongly recommended development of an interagency approach across HHS, the Social Security Administration, and the Departments of Education and Labor to work toward improving common outcomes for transitioning youth with disabilities and their families related to health, education, employment, support services and community living.

The FY 2015 Budget includes a multi-pronged HHS effort aimed at transitioning youth, comprised of a new $5 million investment in ACL to assist youth with intellectual and developmental disabilities, funding for the Administration for Children and Families’ Psychosocial Interventions for Children in the Child Welfare System effort, and the Substance Abuse and Mental Health Services Administration’s Healthy Transitions program, an activity within the Now is the Time initiative. Together, these activities target populations of young Americans in the midst of difficult transitions and provide them with the tools and supports to enter adulthood.

The Budget requests $71 million to fund State Councils on Developmental Disabilities. These councils, which operate in each state and territory, promote systems change efforts aimed at helping individuals with developmental disabilities live with self‑determination, integration, and inclusion in their communities. The Budget also requests $44 million to continue funding for the Protection and Advocacy programs that assist states and territories to establish and maintain Protection and Advocacy systems. These systems protect the legal and human rights of all people with developmental disabilities by using their authority to investigate incidents of abuse and neglect against individuals with developmental disabilities, and to pursue administrative, legal, or other appropriate means when necessary. This includes $5 million to ensure that individuals with disabilities are able to fully participate in every step of the voting process. These protection and advocacy programs educate individuals on topics such as voter registration and their legal voting rights, provide them with voter registration opportunities, and help them access the polls on election day.

The Budget request also includes $37 million for University Centers for Excellence in Developmental Disabilities. These centers inform and advise federal, state, and community policymakers of the opportunities that exist for individuals with developmental disabilities to exercise self‑determination, be independent, productive, and integrated and included in all facets of community life. In addition, the Budget requests $9 million for Projects of National Significance, which focus on identifying and addressing the most pressing issues that impact people with disabilities and their families. Included in the amount for Projects of National Significance is $1 million to continue efforts to identify and test coordinated transportation systems through the Transportation Research and Demonstration Program. Together, these efforts will allow ACL to enhance the independence, productivity, inclusion, and integration of people with developmental disabilities.

The Budget further requests $7 million in funding for the Paralysis Resource Center, which assists individuals living with spinal cord injury, mobility impairment, or paralysis through referral services and other resources focused on health promotion and community living after paralysis.

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Promoting Efficiency in Community ­Based Service Delivery

The Budget requests $52 million to fund the State Health Insurance Assistance Program, which supports 12,000 counselors in more than 1,300 community‑based organizations. These individuals and organizations provide Medicare beneficiaries who have a disability and/or who are elderly, as well as those nearing Medicare eligibility, with one‑on‑one outreach and counseling on the health insurance options available to them. This program helps beneficiaries navigate the many complexities of health and long‑term care systems. Administration of this program transferred to ACL in FY 2014 from the Centers for Medicare & Medicaid Services (CMS).

The Budget also includes funding for the Senior Community Service Employment Program, proposing to move its administration to ACL from the Department of Labor at a funding level of $380 million, $54 million below the FY 2014 funding level. The program provides unemployed older adults with opportunities for community service training and employment in non‑profit organizations and government agencies such as schools, libraries, and senior citizens programs. Participants are low‑income older individuals with low or limited job prospects who can ultimately benefit from the social and supportive services provided by ACL’s aging network. Under ACL’s administration, this program will be better aligned with other ACL programs that serve program participants, such as nutrition services and home and community‑based services.

Supporting Evidence‑Based Initiatives and Increased Access to Services

ACL identifies, evaluates, and replicates the best models and practices nationwide across the aging and disability services networks to ensure their continued vitality and success, with a focus on funding lower‑cost, non-medical services and supports. The Budget requests $20 million each year for the next 5 years in new mandatory funding for Aging and Disability Resource Centers. These centers are “no wrong door” entry points at the community level where individuals of all ages can turn for objective information and one‑on one counseling on their long‑term services and support options, including help, as needed, in accessing public programs. ACL, CMS, and the Department of Veteran’s Affairs are now working with eight Aging and Disability Resource Center states to develop national standards for a high‑performing, No Wrong Door system that serves all populations and all payers.

The Budget includes $8 million for Chronic Disease Self‑Management Education programs. These programs help participants take charge in better managing their own chronic diseases by teaching them how to manage their illnesses, adopt healthy behaviors, and improve their health status, with the ultimate goal of reducing hospital stays and emergency room visits.

The Budget also includes $5 million for falls prevention, which was first funded in FY 2014. Falls are the leading cause of both fatal and nonfatal injuries for those 65 and over, and falls can result in significant loss of independence for older Americans and often trigger the onset of a series of growing medical needs. ACL’s falls prevention program aims to help participants achieve improved strength, balance, and mobility and also provide education on how to avoid falls.

Federal Administration

The Budget includes $30 million in funding for program management and support activities, the same as FY 2014. This funding supports rent, staff, and other administrative costs, and is also used to support staff in ACL’s regional office.

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