Older Americans Act: Updated Information on Unmet Need for Services

What GAO Found

Per 2013 data, many older adults with low incomes who likely need meals services do not receive them. An estimated 90 percent of low-income older adults (those age 60 and older with incomes below 185 percent of the poverty threshold) do not receive meals services like those funded by Older Americans Act (OAA) Title III programs, according to GAO's analysis of 2013 Current Population Survey (CPS) data. About 83 percent do not receive meals among low-income adults who are food insecure, meaning they report three or more conditions such as skipping meals because they did not have enough money for food. Similarly, an estimated 83 percent of low-income older adults who have difficulties with two or more daily activities do not receive meals. While some of these figures are similar to those GAO found using 2008 data, more low-income older adults are food insecure than in 2008 (about 19 percent in 2008 compared to 24 percent in 2013), though a substantially larger percentage of this population are receiving meals services (11 percent in 2008 compared to 17 percent in 2013).

An estimated 27 percent (about 16 million) of people age 60 and older likely need home-based care like the services provided by Title III programs because they report difficulties with one or more daily activities, according to GAO's analysis of 2012 Health and Retirement Study (HRS) data. Depending on the number and type of difficulty, between approximately 67 and 78 percent of older adults who likely need home-based care receive limited or no help with their difficulties. However, some aspects of home-based care have improved since 2008. For example, among those who reported three or more difficulties with basic activities such as bathing or walking, more older adults received professional help in 2012 with these difficulties (about 19 percent in 2008 compared to 30 percent in 2012).

GAO estimates that about one in five people age 65 and older potentially need transportation services. Specifically, about 20 percent of people age 65 and older are potentially at-risk for needing transportation services, such as those provided by Title III programs, according to GAO's analysis of 2012 HRS data. This is similar to the percentage GAO reported in a prior report using 2008 data. Then as now, the extent of unmet transportation need is unknown among the population that may need it. In 2011, GAO recommended that the Secretary of Health and Human Services partner with others to develop uniform data collection procedures for obtaining information on older adults with unmet needs. The agency said it would explore options to implement this recommendation, though it has not fully implemented the recommendation to date.

Why GAO Did This Study

The OAA of 1965 was enacted, among other things, to help older adults remain in their homes and communities. Programs authorized and funded by OAA Title III grants provide a broad range of assistance to older adults in need of such services, including congregate and home-delivered meals, home-based care, and transportation services. In 2011, GAO analyzed 2008 data and found that approximately nine percent of low-income older adults (an estimated 1.6 million out of 17.6 million) received meals like those provided by Title III programs, and that approximately 12 million of 16 million older adults who had difficulties with daily activities received limited home-based care. While funding provided to states for Title III programs has decreased since 2009, the number of older adults has increased from 55.5 million to 62.9 million in 2013. As Congress considers reauthorization of the OAA, if current trends continue, the number of adults who need services like those provided by OAA Title III grants may increase.

To update the findings of GAO's 2011 report, GAO examined what is known about older Americans' reported need for home and community-based services like those funded by the OAA and the potential unmet need for these services, based on national survey data. GAO's methodology is consistent with the methodology it used for its 2011 report. Specifically, to estimate likely need and receipt of meals services like those funded by Title III programs, GAO analyzed the most recent data from the CPS Food Security Supplement (2013). GAO estimated likely need for meals services by examining the percentages of low-income older adults (those age 60 and older with incomes below 185 percent of the poverty threshold) who were food insecure, using the U.S. Department of Agriculture's measure of food insecurity, or had one or more types of functional impairments that may make it difficult to obtain or prepare meals. To estimate likely need and receipt of home-based care, GAO analyzed the most recent data from HRS (2012) on whether respondents of all incomes age 60 and older reported having difficulty with one or more daily activities and whether they received help. Finally, to estimate potential need for transportation services, GAO analyzed HRS data on driving capabilities and car access for respondents of all incomes age 65 and older.

For information, contact Charles A. Jeszeck at (202) 512-7215 or jeszeckc@gao.gov.