Academic journal article Generations

The Administration for Community Living: Programs and Initiatives Providing Family Caregiver Support

Academic journal article Generations

The Administration for Community Living: Programs and Initiatives Providing Family Caregiver Support

Article excerpt

For many older people, the ability to remain living at home in the community is often contingent upon consistent support provided by a family caregiver. No matter the cause or causes behind the need for increased support, family caregivers often go to great lengths to ensure their loved ones are able to remain at home for as long as possible, often to the detriment of their own physical, financial, and emotional wellbeing. While the construct of family caregiving is as old as humanity, only in more recent history has a concerted and coordinated effort been made to provide comprehensive, personcentered, and evidence-based services and supports for family caregivers.

For more than two decades, the U.S. Administration on Aging (AOA), a program division within the Administration for Community Living (ACL), has been at the forefront of efforts to support family caregivers through its funding of a range of support programs, each of which is designed to address the many daily challenges caregivers face. Over the years, family caregiver support programs administered by the ACL have enabled states and communities to deliver a range of community-based family caregiver supports that are an integral part of our longterm services and supports (LTSS) system.

The National Family Caregiver Support Program

The centerpiece of ACL's family caregiver support efforts is the National Family Caregiver Support Program (NFCSP). Established in the 2000 reauthorization of the Older Americans Act as Titles III-E and VI-C (federally recognized tribes), the NFCSP was the first federal program to specifically address the needs of family caregivers of older individuals and grandparents (and other relatives) raising grandchildren.

Funding for the NFCSP flows from the ACL to the fifty-six state and territorial units on aging via a formula based on the number of individuals ages 70 and older living in each state. Most states, in turn, develop an intrastate funding formula to disseminate funds to local area agencies on aging. Federal funding levels for the NFCSP have ranged from its initial 2001 appropriation of $120 million to a high of $156 million in 2007 but, since 2013, have been stable at $146 million. States are required to match federal spending with a 25 percent contribution coming from nonfederal sources.

The NFCSP requires states and tribes to develop comprehensive programs that address the multi-faceted needs of family caregivers via five required services: information about available services and supports; assistance with accessing services; counseling, training, and support groups to help family caregivers better manage caregiving tasks; respite to provide temporary relief from caregiving duties; and, supplemental services, on a limited basis, to address caregiver-specific needs. Beyond ensuring the availability of each service, states have considerable flexibility in program design and implementation. Program design is guided by local and state planning processes that draw upon a broad range of input from consumers and stakeholders who inform the planning efforts to help ensure the program is responsive to consumer needs and preferences. As a result, distinct state-by-state differences in program development and implementation exist.

Early in the program's development, many states found it necessary to build or improve the service infrastructure to support family caregivers. For example, as the new program got underway and a new population of service recipients was identified, to successfully administer the program, many states had to develop new policies, enhance or expand statewide information databases, identify new service providers, and develop or increase communication links between area agencies on aging and state units on aging. As service delivery infrastructures matured, states worked to integrate the NFCSP with state LTSS systems so those who needed it could access the program, and services were able to meet often rapidly changing support needs. …

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