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Justice in Aging is releasing a series of two issue briefs to ensure advocates are aware of the services available to American Indian and Alaska Native older adults and the unique challenges they may face. This second issue brief in the series discusses the benefits available to tribal elders through the Older Americans Act (OAA), the coordination opportunities of OAA-funded services between states and tribes, and the barriers and cultural factors that advocates should be aware of when supporting tribal elders in accessing these services.
Introduction
There are over 300,000 American Indian and Alaska Native older adults ages 65 and older in the United States. Tribal elders live in all areas of the country—on tribal lands, urban areas, and rural communities—with the highest rates concentrated in Alaska, Arizona, California, Oklahoma, and New Mexico.[1] Tribal elders are generally revered as knowledge-keepers in their communities, but their communities are extremely diverse in their culture, history, language, and traditions.
As a result of historical and ongoing harms, tribal elders face significant inequities in terms of access to and outcomes in health care, housing, nutrition, transportation, and other services necessary to aging with dignity. The Older Americans Act (OAA) is one federal vehicle that aims to address the unmet needs of tribal elders and fosters their ability to live independently in their communities. Aging service providers and advocates can better support tribal elders in their communities by understanding the landscape of services available under the Older Americans Act and facilitating connections with older adult-focused tribal organizations.
The Older Americans Act
The Older Americans Act (OAA) is a major vehicle for addressing the needs of older adults across the United States. The OAA not only establishes the Administration on Aging—the central entity for issues involving older adults within federal government—but it also gave it authority to create grants for states and tribes for social services, planning, and research aimed at improving the lives of older adults.[2] Through a network of Area Agencies on Aging, state agencies on aging, and tribal and Native Hawaiian organizations, millions of older adults are able to receive free services like congregate meals and meal delivery, senior centers, Long-Term Care Ombudsman, legal assistance, and in-home support and caregiver support.[3]
The OAA and its accompanying regulations ensure that such services are targeted to older adults with the greatest economic and social needs.[4] While OAA-funded services are available to everyone 60 and older, regardless of income, states must target services to older adults living below the federal poverty line, those with disabilities, language barriers, tribal membership, LGBTQ+ or HIV status, or those who are isolated due to race or ethnicity.[5]
Title VI
Title VI of the OAA specifically provides authorization for nutrition, supportive, and caregiver support services grants for older Native Americans. There are 290 grants awarded to organizations representing over 400 American Indian, Alaska Native, and Native Hawaiian communities.[6] As of 2021, more than 237,000 tribal elders were served by Title VI programs.[7] Importantly, Title VI programs primarily serve tribal elders in rural, remote, or frontier areas, where distance and transportation barriers otherwise hinder elders’ ability to access critical services.[8]
This important feature of the OAA—added by Congress in 1975 after a successful push by tribal activists—allows tribes and tribal organizations to better serve the unique needs of their community. For example, tribes have greater flexibility in the age requirements for OAA service eligibility—allowing tribal elders of any age to access Title VI services.[9] This distinction allows Title VI programs to serve elders who show signs of aging early in life as a result of significant health inequities among AIAN populations. Because Title VI programs are often administered by tribal organizations and nonprofits, tribal elders benefit from culturally competent and relevant services and the opportunity to connect with their broader AIAN community.
Some of the services offered by Title VI programs include home delivered and congregate meals, and food pantries; cultural events; transportation; and medical services, such as vaccinations, blood sugar checks, diabetes management, assistance devices, and mental health services.[10] Such services—some of which are funded with a combination of Title VI and other funding sources—are key to bridging the many inequities tribal elders experience. For example, approximately one quarter of all AIAN people experience food insecurity, and this inequity is even greater for those in rural communities and was exacerbated during the Covid-19 pandemic.[11] Title VI programs are using their meal programs to do more than just nourish tribal elders, but also to uplift traditional Native foods, providing a place for elders to share their family recipes, and inviting elders to participate in community gardens.[12] These meal programs—much like Title VI social and cultural programs—uplift indigenous traditions and support the survival of AIAN people and cultures, which face cultural, historical, and linguistic extinction due to a history of oppression.[13]
Advocates and Title VI Programs
Title VI programs across the country are making significant impacts in their communities. However, they still face barriers in terms of staffing shortages (particularly, in terms of recruiting culturally responsive staff), technical assistance and training needs, and significant budget shortages.[14] Older adult advocates, such as legal aid programs and Area Agencies on Aging, can support tribal elders in their service area by learning about local Title VI programs and their offerings in order to build partnerships, make referrals, and support policy development. Below are a few tips for engaging with Title VI programs:
- Understanding tribal culture, including legal relationships and cultural practices. Tribal sovereignty refers to tribes’ right to self-govern. When local, state, and federal government entities interact with federally recognized tribes, it is a government-to-government relationship. Older adult advocates should aim to learn more about the tribal government structures that support tribal elders in their service area.[15] Moreover, advocates and service providers can demonstrate their commitment by learning about the history of Native communities nationally and that of the local tribes in or near their service area. Finally, non-tribal entities can take on the responsibility of internally improving their cultural competency through regular trainings on Native values, cultural norms, and practices.[16]
- Building trusting relationships. Advocates and service providers can demonstrate that they are committed to long-term partnerships by being consistently engaged, such as by regularly attending public meetings and events. When engaging on policy development, whether developing a multisector plan on aging or conducting outreach to local tribal elders, advocates should approach tribes with the intent to listen and take feedback from those lived experiences.[17] Many tribes value personal—and in-person—connections in addition to professional ones, and some may be located in remote areas. By taking on the responsibility of travel and coordinating ongoing opportunities to connect, service providers can demonstrate their commitment to building trusting relationships with local tribes.
- Putting policy into practice. The OAA requires targeting services to older adults with the greatest social needs, and localities can further their impact by considering the unique needs of tribal elders in their planning, outreach, and service delivery. Moreover, the OAA requires coordination between Title VI and Title III entities on services and emergency planning.[18] Title III programs can initiate communication with Title VI Directors and actively include them in meetings, events, and advisory committees.
Title III
Title III of the Older Americans Act authorizes grants to states, tribes, and territories to coordinate and provide services for older adults ages 60 and older.[19] Entities that receive Title III-funding include State Units on Aging, Area Agencies on Aging (AAAs), and tribal organizations. Over 10 million older adults are served through Title III programming, which includes senior centers and adult daycares, transportation services, homemakers and personal care givers, nutrition services, case management, and legal assistance.[20]
Importantly, tribes are able to access both Title III and Title VI funding to fulfill the needs of elders. The OAA requires Title III and Title VI programs to coordinate their services, a feature that is further emphasized in the latest regulations.[21] Some outcomes of collaboration include coordinating needs assessments for AAAs and Title VI service recipients, AAAs providing trainings or contractor support to Title VI programs, AAAs and Title VIs planning joint events, and Title VI programs receiving Title III funding.[22] Given the limited scope and availability of Title VI funds, coordination between these OAA authorities allows tribes to use Title III funds to fill gaps where there are unmet needs for tribal elders.[23]
Spotlight: Minnesota
The Minnesota Board on Aging honors the government-to-government approach in coordinating with tribal governments on policy development, service delivery, and ensuring that Area Plans on Aging address the OAA’s coordination requirements. Some successes from this intentional coordination include one AAA aiding the Prairie Island Indian Community in applying for Title VI funding and launching a state-wide caregiver platform that highlights Indigenous Caregiving.[24]
Resources
Endnotes
See Nat’l Council on Aging, American Indians and Alaska Natives: Key Demographics and Characteristics (Jan. 10, 2023). ↑
See Administration for Community Living, Older Americans Act (Oct. 21, 2023). ↑
See National Council on Aging, Older Americans Act (last visited Dec. 4, 2024); Congressional Research Service, Older Americans Act: Overview and Funding (May 6, 2024). ↑
42 U.S.C. § 3002(23), (24) (2024). ↑
See SAGE, Making your State Plan on Aging LGBTQ+ and HIV+ Inclusive: New Older Americans Act and ACL Guidelines (2024). ↑
See Congressional Research Service, Older Americans Act: Overview and Funding (May 6, 2024). ↑
See Cynthia Lacounte, Generations, Title VI of the Older Americans Act: Past, Present, and Future (Feb. 23, 2022). ↑
Administration for Community Living, Overview of Older Americans Act Title III, VI, and VII Programs: 2020 Summary of Highlights and Accomplishments VI-17 (2020). ↑
See Cynthia Lacounte, Generations, Title VI of the Older Americans Act: Past, Present, and Future (Feb. 23, 2022). ↑
See U.S. Aging, 2024 Chartbook: Supporting Native Elders in Their Communities: Title VI Native American Aging Programs and Services 2 (2024) (noting that not all such services are exclusively funded by Title VI money). ↑
See Administration for Native Americans, Ending Hunger and Improving Physical Wellness in Native Communities (Dec. 1, 2023); Sara U. Maillacheruvu, Centers on Budget & Policy Priorities, The Historical Determinants of Food Insecurity in Native Communities (Oct. 4, 2022).↑
See U.S. Aging, 2024 Chartbook: Supporting Native Elders in Their Communities: Title VI Native American Aging Programs and Services 7-9 (2024) ↑
See Cynthia Lacounte, Generations, Title VI of the Older Americans Act: Past, Present, and Future (Feb. 23, 2022) (noting that tribal elders who access Title VI programs are 20% more likely to participate in regularly occurring traditional practices); U.S. Aging, 2024 Chartbook: Supporting Native Elders in Their Communities: Title VI Native American Aging Programs and Services 16 (2024) (listing pow-wows and sharing traditions with younger generations as examples of Title VI social programming). ↑
See U.S. Aging, 2024 Chartbook: Supporting Native Elders in Their Communities: Title VI Native American Aging Programs and Services 27-28 (2024). ↑
See Administration for Community Living, Quick Guide to Title III-Title VI Nutrition Collaboration (last visited Dec. 4, 2024). ↑
See Administration for Community Living, Title VI and Title III Grantees Collaboration Study Final Report 13 (Sep. 28, 2020). ↑
See Administration for Community Living, Title VI and Title III Grantees Collaboration Study Final Report 12 (Sep. 28, 2020). ↑
42 C.F.R. § 1321.52 (2024); 42 C.F.R. § 1322.37 (2024). ↑
42 U.S.C. § 3001 et seq. (2024). ↑
See Administration for Community Living, Overview of Older Americans Act Title III Programs; 2018 Summary of Highlights and Accomplishments 4, 18 (2018). ↑
89 Fed. Reg. 11566, 11635-36 (Feb.14, 2024). ↑
See U.S. Aging, 2024 Chartbook: Supporting Native Elders in Their Communities: Title VI Native American Aging Programs and Services 30-31 (2024). ↑
Some of the reported unmet needs of Title VI recipients include: in-home and personal care aide services, home modifications and home repairs, and support for grandparents raising grandchildren. U.S. Aging, 2024 Chartbook: Supporting Native Elders in Their Communities: Title VI Native American Aging Programs and Services 18 (2024). ↑
See Minnesota Board on Aging, Minnesota State Plan on Aging FFY 2024-2027 17 (Oct. 1, 2023). ↑