ACL funds programs that support American Indians, Alaska Natives and Native Americans in the areas of nutrition, supportive services for older adults, and caregiver services. The nutrition and supportive services grants include congregate and home-delivered meals, information and referral, transportation, personal care, chores, health promotion and disease prevention, and other supportive services. The caregiver services grants include assisting families in caring for older relatives with chronic illness or disability, and grandparents caring for grandchildren. There are other necessary services provided by ACL grants so the people we serve have meaningful support to help them live independently in their communities.
History of Title VI Programs
In 1978, the Older Americans Act was amended to include Title VI which established programs for the provision of nutrition and supportive services for Native Americans (American Indians, Alaska Natives and Native Hawaiians).
The program has since expanded to include caregiver support services. Eligible Tribal organizations receive grants in support of the delivery of home and community- based supportive services for their elders, including nutrition services and support for family and informal caregivers. The Authorizing Legislation comes from Sections 613, 623 and 631 of the Older Americans Act of 1965, as amended.
The Purpose of the Programs and How They Work
Services for Native Americans programs were first established in 1978 with the provision of nutrition and supportive services. In 2000, services expanded to include caregiver support services. Programs provide grants to eligible Tribal organizations to promote the delivery of home and community-based supportive services, including nutrition services and support for family and informal caregivers, to Native American, Alaskan Native, and Native Hawaiian elders. These programs, which help to reduce the need for costly institutional care and medical interventions, are responsive to the cultural diversity of Native American communities and represent an important part of the communities’ comprehensive services.
Criteria Used to Determine Eligibility for Grants
Formula grants for the Services for Native Americans programs are allocated to Tribal organizations based on their share of the American Indian, Alaskan Native, and Native Hawaiian population aged 60 and over in their services area. To be eligible for funding, Tribal organizations of federally-recognized Tribes must represent at least 50 Native American elders age 60 and over. There is no requirement for matching funds. Separate formula grant awards are made for nutrition and supportive services and caregiver support services.
Tribal Organizations Have Flexibility on Allocation of Resources
After meeting program requirements, Tribal organizations have flexibility to allocate resources among the various activities funded by each program. Tribes may also decide the age at which a member is considered an elder and thus be eligible for services. In FY 2011, grants for nutrition and supportive services were awarded to 254 Tribal organizations (representing more than 400 Tribes) and two organizations serving Native Hawaiian elders.
Nutrition and Supportive Services
Grants provide funding to Tribal organizations for a broad range of services to older Native Americans, including:
Congregate and home-delivered meals,
Information and referral,
Health promotion and disease prevention, and
Other supportive services.
Caregiver Support Services
Grants assist American Indian, Alaskan Native, and Native Hawaiian families caring for older relatives with chronic illness or disability, and grandparents caring for grandchildren. The program offers a variety of services that meet a range of caregivers’ needs, including information and outreach, access assistance, individual counseling, support groups and training, respite care, and other supplemental services.
Tribal organizations coordinate with other programs, including the Volunteers In Service To America (VISTA) program, to help support and create sustainable caregiver programs in Native American communities (many of which are geographically isolated). A core value of the Native American Caregiver Support Services, as expressed by Tribal leaders, is that the program should not replace the tradition of families caring for their elders. Rather, it provides support that strengthens the a family's caregiver role.
Data Show Extensive Services Provided to Native American Elders and Their Caregivers
FY 2013 output data give details on the units of service that have been provided through funding for this program:
Transportation Services provided approximately 657,287 rides to meal sites, medical appointments, pharmacies, grocery stores, and other critical daily activity locations.
Home-Delivered Nutrition Services provided more than 2.5 million meals to more than 22,000 home-bound Native American elders, as well as critical social contacts that help to reduce the risk of depression and isolation experienced by many home-bound elders.
Congregate Nutrition Services provided more than 2.3 million meals to nearly 52,000 Native American elders in community-based settings, which also provide opportunities for elders to socialize and participate in a variety of activities, including cultural and wellness programs.
Information, Referral, and Outreach Services provided approximately 700,000 hours of outreach and information on services and programs to Native American elders and their families, thus helping to empower them to make informed decisions about their care needs.
In-Home Services provided nearly 1.2 million units of service to assist Native American elders.
Caregiver Counseling and Support Group Services provided more than 29,000 units of counseling and support group services to caregivers caring for elders or grandparents caring for grandchildren.
Caregiver Respite Services provided close to 96,000 units of respite services to Native American caregivers caring for elders or grandparents caring for their grandchildren.
To obtain more information about the services provided to Native American elders and their caregivers, visit the AGing, Independence, and Disability (AGID) Program Data Portal, an online query system based on ACL-related data files and surveys as well as population characteristics from the Census Bureau for comparison purposes. The system allows users to produce customized tables in a step-by-step process and output the results in print or spreadsheet form. Information on Title VI Services by Tribal Organization is available through this data portal.
- Ongoing Evaluation Updates
In 2016 ACL/AoA contracted ICF International (ICF) to conduct a participatory evaluation of the Title VI Grant Program, which provides home and community-based supportive services for older American Indian, Alaskan Native, and Native Hawaiian populations. The evaluation seeks to answer the following questions:- How do tribes/organizations operate their Title VI Programs?
- What is the impact of Title VI programs on elders in the community? Are there differences nationally or by tribe/organization?
- Do Title VI programs that are sole-sourced funded have a different impact than programs that are funded through multiple sources?
The evaluation, still ongoing, has released its Evaluation of the ACL Title VI Programs: Year 1 Interim Report outlining the approach to and the design of the evaluation. In addition, the report provides information on the evaluation participants, timeline of the project, and initial findings.
In the second full year of the Title VI Evaluation, the ICF evaluation team focused on understanding the Title VI Programs from the perspective of program staff and elders. The evaluation uses mixed methods, including quantitative (primary and secondary) and qualitative (primary) data sources to understand the context and the impact of the Title VI Program through an implementation and outcomes study. The evaluation team analyzed multiple data sources to present a first look at the Title VI Programs. Emerging themes include elders’ met and unmet needs, social connectedness, and independence and quality of life. The evaluation found that Title VI Evaluation grantees were representative of the overall population of Title VI grantees across several components including elders’ health characteristics, health and nutrition status, and level of services they receive. Further, the evaluation uncovered how important the nutritional, social, and cultural aspects of the Title VI program are for Native elders. View the Evaluation of the ACL Title VI Programs: Year 2 Interim Report.
In the third year of the Title VI Evaluation, the evaluation team focused on understanding the Title VI Part C, Native American Caregiver Support Program, from the perspective of caregivers. Multiple data sources were analyzed, including interviews and focus groups with informal (unpaid) caregivers, in order to understand the implementation and impact of the Pact C Caregiver Support Program. The evaluation found that the Caregiver program is implemented in uneven ways across grantees, an issue that ACL began to address immediately. Emerging themes from this year’s findings were that caregiving is a rewarding but challenging experience, that caregivers do not always see themselves as caregivers, but that the services received through Title VI Part C provide important support to improve caregiver’s overall quality of life.
- Title VI Evaluation Year 3 Interim Report
- Title VI Evaluation Appendix A – Medicine Wheel
- Title VI Evaluation Appendix B – Methods
- Title VI Evaluation Appendix C – In Their Own Words: Caregiver Quotes
- Title VI Evaluation Appendix D – Focus Group Summary
- Funding History
Funding for the Services for Native Americans programs during the past four years is as follows:
Fiscal Year Part A/B Part C Total FY 2012 $27,601,000 $6,364,000 $33,965,000 FY 2013 $26,157,052 $6,031,076 $32,188,128 FY 2014 $26,158,000 $6,031,000 $32,189,000 FY 2015 $26,158,000 $6,031,000 $32,189,000 FY 2016 $31,158,000 $7,531,000 $38,689,000
- Resources and Useful Links
The AoA is currently funding three Resource Centers for Older Indians, Alaska Natives, and Native Hawaiians. These centers provide culturally competent health care, community-based long-term care, and related services. They serve as the focal points for developing and sharing technical information and expertise for Native American organizations, Native American communities, educational institutions, and professionals working with elders.
University of North Dakota. Since 1994 the AoA has funded the National Resource Center on Native American Aging, University of North Dakota. A culturally sensitive staff and national steering committee govern the resource center, which provides education, training, technical assistance, and research. It also assists in developing community-based solutions to improve the quality of life and the delivery of related support services to the Native elderly population. A major project of this Resource Center has been the development of an elderly needs assessment tool to assist Tribes in planning for elder care services.
University of Alaska-Anchorage. In 2003, AoA funded the National Resource Center on Native American Aging at the University of Alaska-Anchorage to: 1) empower Native communities to incorporate traditional and contemporary health practices that have the potential to effectively support and treat elders within community health care systems; 2) provide technical information to promote culturally sensitive and functionally appropriate services to maintain social well-being; and 3) provide an arena for discussions about the increasing problems of elder abuse to help Native communities in developing their own plans to reduce and control occurrences.
University of Hawaii. The National Resource Center for Native Hawaiian Elders was established in 2006 under a grant from AoA to the University of Hawaii School of Social Work. With the nation’s largest enrollment of Native Hawaiian students, the University of Hawaii has as its mission the development and transmission of knowledge for the betterment of all Native Hawaiians. The National Resource Center seeks to continue this commitment with a focus on improving the well-being of Native Hawaiian elders by forging stronger collaborative relationships among the University and Native Hawaiian and gerontology communities.
Other resources available to Title VI Programs include the Title VI Evaluation Tool (Excel) and Tool Guide (PDF) to help Title VI programs create and customize client feedback surveys for Part A/B and Part C services.
- Other Federal Programs
Indian Health Services Elder Care Initiative. The goal of the Elder Care Initiative is to promote the development of high-quality care for American Indian and Alaska Native elders by acting as a consultation and liaison resource for IHS, Tribal, and urban Indian health programs.
Centers for Medicare & Medicaid Services. Medicare, Medicaid, and the State Children's Health Insurance Program (SCHIP) play a critical role in determining the type and quality of healthcare received by American Indians/Alaska Natives (AI/AN). This site provides information on these programs and highlights aspects of specific interest to AI/AN.
Administration for Native Americans. The Administration for Native Americans (ANA) is a division of the Administration for Children and Families. The mission of ANA is to promote economic and social self-sufficiency for American Indians, Alaska Natives, Native Hawaiians, and other Native Pacific Islanders. ANA provides community-based project funding to improve the lives of native children and families thereby reducing long-term dependency on public assistance. Funding is provided to eligible Tribes and nonprofit Native American organizations through three competitive discretionary grant programs .