Other Federal Programs

The Veterans Health Administration (VA), which operates more than 160 hospitals, 43 domiciliary facilities, and more than 130 nursing homes, provides free health care to veterans with disabilities related to military service and, on a complicated priority basis, to those with other conditions. The VA also contracts to provide care in community hospitals and nursing homes. Several innovative geriatric programs, including geriatric assessment units; Geriatric Research, Education, and Clinical Centers; and hospital-based home health care programs, have been developed within the VA system.

The Older Americans Act (OAA), enacted in 1965, has evolved from a program of small grants and research projects into a network of 57 state, territorial, and Indian tribal units on aging; 670 area agencies on aging; and thousands of community agencies. The primary purpose of the OAA is to develop, coordinate, and deliver a comprehensive system of services for elderly people at the community level, including information and referral, outreach, transportation, senior centers, nutritional programs, advocacy, protective services, senior employment, ombudsman programs, and supportive services. The OAA also funds research and training. In FY 2004, the total projected appropriation for OAA programs was $1,114,131,000. This represents an increase from the FY 2003 actual figure of $1,099,877,794.

Although not usually considered a health program, Social Security provides basic pension payments that the elderly use for health care services. The elderly receive 2 types of payments: Old Age and Survivors Insurance, which is financed by Social Security trust funds and provides payments to retirees, surviving spouses, or qualified dependents, and Supplementary Security Income, which is financed from general revenues and provides a guaranteed minimum income to aged, blind, and disabled people.

Title XX of the Social Security Act authorizes reimbursements to states for social services, including various home health services and homemaker services (eg, meal preparation, laundry, light housekeeping, grocery shopping) for the frail elderly. These funds have shifted to the Social Services Block Grant program, which was designed to prevent or reduce inappropriate institutional care by providing for community-based care and other assistance that allows the elderly to maintain autonomy in the community. The program is defined, administered, and implemented by states; it does not support institutional care or any service covered by Medicare or Medicaid. The program covers health services only when they are an "integral but subordinate" component of an overall social service program.

This topic was last updated May 2005.