Community Support Expenditures in United States

United States

Most older adults value living in their own home safely and independently. Several federal and state programs offer older adults support in remaining independent at home, which ultimately saves money for both older adults and the federal programs that help fund nursing home care. 

Since the Older Americans Act (OAA) of 1965, the Administration on Aging has provided funding to states for community, social and nutritional services that assist adults age 60 and older and their caregivers. The funding is used by states for programs supporting transportation, personal care, adult day care, homemaker assistance, case management, home-delivered meals, congregate meals, physical fitness and nutrition education. 

These funds are targeted toward adults age 60 and older with an emphasis on those with greatest social and economic need, such as low-income older adults, racial and ethnic minorities, older adults living in rural communities and those at risk of institutional care. The Administration on Aging provided services to 1 in 7 older adults in 2018. 

While the community support measure in this report is limited to OAA dollars, other state and federal funding exists to support older adults. In fiscal year 2020, $124.6 billion, or 62.5%, of all Medicaid long-term services and support spending went toward home- and community-based services such as home health aides, adult day care, meal programs, in-home modifications and assistive equipment.

Of the 10.8 million individuals served by OAA support programs in 2018:

• 33.5% were living below the poverty line.
• 34.6% were living in a rural area.
• 32.2% self-identified as a racial or ethnic minority (Asian; Black or African American; Hispanic or Latino; Native Hawaiian or other Pacific Islander; American Indian; or Alaska Native). 

OAA programs also serve a disproportionate amount of older individuals who live alone, which is a risk factor for nursing home admission and social isolation.

Investment in social services for older adults may help them maintain function and independence. A 2013 study found that increases in home- and community-based services for older adults, such as home-delivered meals, congregate meals or community centers, were associated with a decrease in the proportion of low-care residents in nursing homes.

Further research published in 2017 found that Medicaid waivers for home- and community-based services lower the risk of long-term nursing home admissions, enabling older adults to engage in their communities and live in their own homes. 

Results from the 2022 National Survey of OAA Participants spoke to the effectiveness of community support services — 80% of congregate meals clients and 89% of home-delivered meals clients reported that these services helped them continue to live independently at home.

To learn about the programs and services funded in your community, visit the Administration on Aging’s Eldercare Locator.

Administration on Aging, and Administration for Community Living. “FY 2018 Older Americans Act Report to Congress.” U.S. Department of Health and Human Services, June 2021. https://acl.gov/sites/default/files/about-acl/2021-06/ACL_FY2018%20OAA%20Report%20to%20Congress.pdf.

Klinenberg, Eric. “Social Isolation, Loneliness, and Living Alone: Identifying the Risks for Public Health.” American Journal of Public Health 106, no. 5 (May 2016): 786–87. https://doi.org/10.2105/AJPH.2016.303166.

Murray, Caitlin, Michelle Eckstein, Debra Lipson, and Andrea Wysocki. “Medicaid Long Term Services and Supports Annual Expenditures Report: Federal Fiscal Year 2020.” Chicago, IL: Mathematica, June 9, 2023. https://www.medicaid.gov/sites/default/files/2023-10/ltssexpenditures2020.pdf.

Segelman, Micah, Orna Intrator, Yue Li, Dana Mukamel, Peter Veazie, and Helena Temkin-Greener. “HCBS Spending and Nursing Home Admissions for 1915(c) Waiver Enrollees.” Journal of Aging & Social Policy 29, no. 5 (October 20, 2017): 395–412. https://doi.org/10.1080/08959420.2017.1319714.

Thomas, Kali S., and Vincent Mor. “The Relationship between Older Americans Act Title III State Expenditures and Prevalence of Low-Care Nursing Home Residents.” Health Services Research 48, no. 3 (June 2013): 1215–26. https://doi.org/10.1111/1475-6773.12015.

Ujvari, Kathleen, Wendy Fox-Grage, and Ari Houser. “Spotlight: Older Americans Act.” AARP Public Policy Institute, February 2019. https://www.aarp.org/content/dam/aarp/ppi/2019/02/older-americans-act.pdf.