HHS FY 2017 Budget in Brief - ACL
Administration 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 for Older Adults||2015||2016||2017||2017
|Home & Community-Based Supportive Services||348||348||358||+10|
|Native American Nutrition & Supportive Services||26||31||31||--|
|Preventive Health Services||20||20||20||--|
|Chronic Disease Self-Management (PPHF)||8||8||8||--|
|Falls Prevention (PPHF)||5||5||5||--|
|Aging Network Support Activities||10||10||10||--|
|Subtotal, Health and Independence||1,231||1,256||1,280||+24|
|Caregiver and Family Support Services||2015||2016||2017||2017
|Family Caregiver Support Services||146||151||151||--|
|Native American Caregiver Support Services||6||8||8||--|
|Alzheimer's Disease Demonstration Grants||4||5||5||--|
|Alzheimer's Disease Initiative – Specialized Supportive Services (PPHF)||11||11||11||--|
|Lifespan Respite Care||2||3||5||+2|
|Subtotal, Caregiver Services||168||177||178||+2|
|Protection of Vulnerable Older Adults||2015||2016||2017||2017
|Long-Term Care Ombudsman Program||16||16||16||--|
|Prevention of Elder Abuse & Neglect||5||5||5||--|
|Senior Medicare Patrol Program||9||--||--||--|
|Health Care Fraud and Abuse Control (HCFAC)||9||18||18||--|
|Elder Rights Support Activities||8||12||14||+2|
|Subtotal, Protection of Vulnerable Older Adults||46||50||52||+2|
|Disability Programs, Research and Services||2015||2016||2017||2017
+/ - 2016
|State Councils on Developmental Disabilities||72||73||73||--|
|Developmental Disabilities Protection and Advocacy||39||39||39||--|
|University Centers for Excellence in Developmental Disabilities||39||39||39||--|
|Projects of National Significance||9||10||10||--|
|Nat'l Institute on Disability, Indep. Living, & Rehab. Research /1||104||104||104||--|
|Independent Living /1||101||101||101||--|
|Traumatic Brain Injury /2||9||9||9||--|
|Limb Loss Resource Center||3||3||3||--|
|Paralysis Resource Center||7||8||8||--|
|Subtotal, Developmental Disabilities||381||385||385||--|
|Consumer Information, Access and Outreach||2015||2016||2017||2017
|Aging and Disability Resource Centers||6||6||8||+2|
|Voting Access for People With Disabilities||5||5||5||--|
|State Health Insurance and Assistance Programs||52||52||52||--|
|Alzheimer’s Disease Initiative – Communications (PPHF)||4||4||4||--|
|Assistive Technology /1||33||34||32||-2|
|Subtotal, Consumer Information, Access and Outreach||125||139||139||--|
|Other Programs, Total, and Less Funds From Other Sources||2015||2016||2017||2017
|Total, Program Level||1,990||2,048||2,076||+28|
|Less Funds from Other Sources||-61||-83||-83||--|
|Total, Budget Authority||1,928||1,965||1,993||+28|
1/ These programs were transferred to ACL from the Department of Education by the Workforce Innovation and Opportunity Act.FY 2015 program funding, administrative funding, and FTE for these programs are displayed comparably.
2/ Comparably adjusted to reflect the transfer of the Traumatic Brain Injury Program from HRSA to ACL in FY 2016.
The Administration for Community Living (ACL) is committed to the fundamental principle that people with disabilities and older adults should be able to live where they choose, live with the people they choose, and fully participate in their communities. ACL programs work to remove the barriers that can make it difficult for many older adults and people with disabilities to achieve this vision. The FY 2017 Budget requests $2 billion for ACL, an increase of $28 million over FY 2016. The Budget maintains critical programs that promote self‑determination, independence, productivity, and community integration for individuals with disabilities and prioritizes investments in elder justice activities, nutrition assistance, and long‑term services and supports that help seniors and individuals of all ages with disabilities to remain independent.
Helping Seniors Maintain Their Health and Independence
The Budget includes $1.3 billion in funding for essential preventive and supportive services. These resources assist older adults so they may remain in their homes and communities, leading healthy and independent lives. Within that total, the Budget requests $31 million to support the same services in Tribal communities. As the number of seniors who are at greatest risk of nursing home admission continues to rise, these services are vital to ensuring that seniors can remain in their homes and communities for as long as possible. The Budget requests $849 million for nutrition services, an increase of $14 million over FY 2016, to ensure that older adults have reliable access to nutritious meals. In FY 2017, this funding will enable ACL to support an estimated 205 million meals to over 2 million seniors nationwide. Meals are served in a variety of congreate settings and delivered to seniors’ homes, reaching some of the neediest members of the community. The Budget also proposes to support evidence based innovations that will help to modernize ACL’s meal programs while improving service quality and efficiency within this funding level.
The Budget also includes $358 million, an increase of $10 million over FY 2016, to fund in-home and community based services that enable seniors to live independently and avoid costly nursing home care. These services include transportation assistance, which will provide more than 22 million rides for critical daily activities, such as visiting the doctor, pharmacy, or grocery store. Nearly 50 percent of seniors benefitting from transportation assistance are mobility impaired, and nearly 77 percent have severe vision problems or other chronic conditions that could impair their ability to drive safely. Transportation services will provide these seniors with the access assistance and information they need to remain independent, as over half of the participants rely on them for the majority of their transportation needs and would otherwise be homebound.
The Budget also requests $20 million for Preventive Health Services to support evidence-based programs that help seniors adopt healthy behaviors, improve their health status, and reduce their use of costly hospital services and emergency room visits. The Budget also includes $8 million for Chronic Disease Self-Management Education and $5 million for Falls Prevention. Both programs promote evidence-based practices designed to empower seniors to improve the quality of their health, with the ultimate goal of preventing more costly medical interventions. The Budget also includes $10 million for Aging Network Support Activities to help seniors to access information about their care options and benefits, including $3 million to provide supportive services for elderly Holocaust survivors who suffer from complex physical and mental health needs.
Supporting Family Caregivers
The Budget includes $178 million to fund programs that support family and informal caregivers. Addressing the needs of unpaid caregivers is critical to helping the seniors and people with disabilities they care for to remain at home. These services allow caregivers to provide care longer than they otherwise could, which decreases the risk of institutionalization of the care recipient. With these investments, ACL supports many of the caregivers nationwide who provide an estimated $522 billion in care annually, a cost that might otherwise be billed to Medicare or Medicaid. The Budget will support approximately 900,000 caregivers who will be able to access counseling and training services to help them cope with the stresses of caregiving and respite care services to provide temporary relief from caregiving responsibilities.
Included within this request, ACL will invest $20 million to specifically address the needs of those caring for people with Alzheimer’s disease and related dementias. Most people living with Alzheimer’s disease are dependent upon family caregivers for years due to the slow loss of cognitive and functional independence. The complexity of care involved can cause significant caregiver distress, and result in earlier nursing home placement. The Budget addresses these challenges by providing competitive grants that will build on existing dementia capable service systems and expand access to evidence based interventions designed to assist people with Alzheimer’s disease and their caregivers.
The Budget also requests $5 million, an increase of $2 million over FY 2016, for the Lifespan Respite Care Program. Family caregiving is not just an aging issue; for persons with disabilities it can occur across the lifespan. The Lifespan Respite Care Program helps to ease the burdens of caregiving by providing grants to improve the quality of, and access to, respite care for family caregivers of children or adults of any age with special needs. Expanding this funding will provide more and better targeted services that will allow caregivers to continue to care for their loved ones longer, thereby allowing more care recipients to remain at home and independent for longer periods at a lower cost than if these individuals had to be institutionalized.
Preventing Elder Abuse, Neglect, and Exploitation
Highlighted in the 2015 White House Conference on Aging, elder abuse, neglect, and exploitation are significant and under recognized public health and human rights issues in the United States. Research has demonstrated that victims of elder abuse have dramatically higher (300 percent) morbidity and mortality rates than non-abused older adults. 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 Program will enable Adult Protective Services programs to test innovations and improvements in services, data collection, and reporting and will support the implementation of ACL’s National Adult Maltreatment Reporting System. With improved standards for conducting case investigations and collecting case-level data, states will be better equipped to respond in an effective and timely way to reports of elder abuse, neglect, and exploitation.
Protecting Vulnerable Older Americans
Protecting older adults from abuse, neglect, and exploitation remains one of ACL’s top priorities. The Budget requests $14 million for Elder Rights Support Activities, which includes an increase of $2 million to fund ACL’s Elder Justice/Adult Protective Services Program. This program continues to address the negative effects of abuse, neglect, and exploitation on the health and independence of seniors and other vulnerable adults by providing competitive grants to states to develop the technology infrastructure necessary to participate in the National Adult Maltreatment Reporting System. With the ability to participate in this system, states will be better equipped to prevent, identify, report, and respond to abuse of elderly adults.
In addition, the Budget requests $16 million to support long-term care ombudsmen in their role as advocates for residents of long term care facilities. Nearly 10,000 ombudsmen will continue to routinely monitor residential care facilities, resolve complaints on behalf of residents, and advocate for systemic improvement of long-term services and supports. The Budget also requests $5 million for the Prevention of Elder Abuse and Neglect Program and includes funding for the Senior Medicare Patrol Program, which will be financed from the Health Care Fraud and Abuse Control Account in the Centers for Medicare & Medicaid Services. These programs are critical tools that protect seniors from abuse and educate Medicare beneficiaries to prevent health care fraud.
Improving the Lives of Individuals with Disabilities
ACL is committed to helping people with disabilities live independently, be contributing members of society, and live free of abuse, neglect, and exploitation. Through a variety of ongoing partnerships with states and territories, information and referral services, and research efforts, ACL works to achieve this mission.
The Budget requests $73 million to fund State Councils on Developmental Disabilities. These councils engage in systems change and capacity building efforts that promote self-determination and inclusion for people with developmental disabilities. The Budget also requests $39 million for Developmental Disabilities Protection and Advocacy programs that provide legal‑based services to individuals with developmental disabilities who have been neglected, abused, or denied their rights. In addition, the Budget includes $39 million for University Centers for Excellence in Developmental Disabilities, a network of education and research centers that promotes knowledge and training in the disability field. The Budget requests $10 million for Projects of National Significance, which focus on identifying and addressing the most pressing issues that impact people with developmental disabilities and their families.
The Budget provides $101 million for the Independent Living Program, which includes Centers for Independent Living and State Independent Living grants. The Centers for Independent Living Program supports grants to community-based nonprofit agencies that provide information and referral, independent living skills training, peer counseling, and advocacy for individuals with significant disabilities. The Independent Living Services Program supports grants to states to coordinate state independent living services, conduct resource development, and train service providers on the independent living philosophy.
The Budget includes $9 million for the Traumatic Brain Injury Program, transferred to ACL from the Health Resources and Services Administration in FY 2016, which provides increased access to comprehensive, coordinated family and person-centered service systems for individuals who have sustained a traumatic brain injury through state-level infrastructure and service delivery systems. The Traumatic Brain Injury Program has two components: the aforementioned state program and a protection and advocacy services program for individuals with traumatic brain Injury. The Budget also requests $8 million for the Paralysis Resource Center and $3 million for the Limb Loss Resource Center to provide comprehensive information and referral services to improve the health and well‑being of individuals living with paralysis or limb loss.
The Budget provides $104 million for the National Institute on Disability, Independent Living, and Rehabilitation Research for research, knowledge translation, and capacity building to enable people with disabilities to make their own choices and to maximize their integration, employment, and independent living within the community. Among other activities, grantees conduct research to improve rehabilitation methodologies and service delivery systems and support pre-service and in-service training to help rehabilitation personnel provide more effective rehabilitation services for individuals with disabilities.
Ensuring Community Integration for People with Disabilities
The creation of the Administration on Disabilities brought together the Developmental Disabilities, Independent Living, and Traumatic Brain Injury programs along with the Paralysis Resource and Limb Loss Centers and Help America Vote Act programs in one entity. ACL has the unique ability to promote consistency and coordination in community living policy work across programs and better align critical community-based services and supports, medical supports, and clinical supports.
ACL provides a focal point for these efforts to develop policies, programs, and initiatives that support people with disabilities across the lifespan in living, working, and playing in their communities. ACL provides leadership in working with other federal agencies and non-governmental groups to assure that people with disabilities have access to home and community-based services and supports that can help individuals to fully participate in all aspects of community life.
Making Community-Based Service Delivery More Efficient
The Budget requests $8 million for Aging and Disability Resource Centers, an increase of $2 million over FY 2016, which serve as community-level entry points into long‑term services and supports for people of all ages who have chronic conditions and disabilities. These systems help states streamline access to community services and supports across multiple programs and divert individuals from more costly forms of care after a hospitalization, rehabilitation, or skilled nursing facility visits. This increased investment will help state grantees continue their development and operation of these systems based on the national standards established by ACL, the Centers for Medicare & Medicaid Services, and the Veterans Health Administration. The Budget also includes $32 million for the Assistive Technology Program, which provides states with financial assistance to increase the availability, access, provision, and training of assistive technology devices and services. Examples of such devices include computer or technology aids, modified driving controls, and durable medical equipment such as wheelchairs or walkers.
The Budget further requests $5 million to facilitate voting access for people with disabilities as well as $52 million to fund the State Health Insurance Assistance Program, which provides grants to states to support over 14,000 counselors in more than 1,300 community‑based organizations across the country. These counselors provide free, one-on-one counseling and assistance to help elderly and disabled Medicare and Medicaid beneficiaries, as well as those nearing Medicare eligibility, understand and make optimal use of their healthcare benefits and navigate the complexities of health and long‑term care systems.
The Budget includes $41 million for mission support and program administration including rent, staff, and support for ACL’s regional offices.