Objective 3.3: Expand access to high-quality services and resources for older adults and people with disabilities, and their caregivers to support increased independence and quality of life

HHS is investing in several strategies to expand access to high-quality services and resources for older adults, people with disabilities, and their caregivers.  HHS enhances system capacity to develop processes, policies, and supports that are person centered and provide quality care for older adults and individuals with disabilities across settings, including home and community-based settings.  HHS ensures the availability and equitable access and delivery of evidence-based interventions that focus on research, prevention, treatment, and care toolder adults and individuals with disabilities.  HHS also supports development and implementation activities to better understand and address the needs of all caregivers across the age and disability spectrum.

Objectives represent the changes, outcomes and impact the HHS Strategic Plan is trying to achieve.  This objective is informed by data and evidence, including the information below.

• In 2017–2018, approximately 13.6 million children in the United States (18.5 percent) had a special health care need.  One in four households (24.8 percent) in the United States had one or more children and youth with special health care needs (CYSHCN).  (Source: Children and Youth with Special Health Care Needs)
• In 2019, 22.3 percent of the population age 65 to 74 assessed their health as fair or poor as compared to 29.3 percent of the population age 75 and over.  Consumers 65 and older averaged out-of-pocket healthcare expenditures of $6,833 in 2019, an increase of 41 percent since 2009 ($4,846).  Older Americans spent 13.6 percent of their total expenditures on health, as compared to 8.2 percent among all consumers.  (Source: 2020 Profile of Older Americans)
• In 2019, 19 percent of adults 65 and older reported they could not function at all or had a lot of difficulty with at least one of six functioning domains (seeing, hearing, mobility, communication, cognition, and self-care.  (Source: 2020 Profile of Older Americans)
• The number of caregivers in the United States for adults over the age of 50 increased from 34.2 million in 2015 to 41.8 million in 2020.  There is an increase in both health and functional needs of older adults since 2015.  Data shows that caregivers do not have access to the supports and services necessary to manage their caregiving responsibilities.  (Source: Caregiving in the U.S., 2020 Report)
• Fifty-seven percent of adults who reach age 65 are projected to experience serious long-term services and supports (LTSS) needs.  The risk of experiencing LTSS needs varies by lifetime earnings, with 65 percent of older adults in the bottom quintile of lifetime earnings projected to develop serious LTSS needs, compared with 57 percent of those in the second earnings quintile.  (Source: Economic Hardship and Medicaid Enrollment in Later Life: Assessing the Impact of Disability, Health, and Marital Status Shocks)

Contributing OpDivs and StaffDivs

ACF, ACL, AHRQ, ASPE, CDC, CMS, HRSA, IHS, NIH, OASH, and OGA work to achieve this objective.

HHS OpDivs and StaffDivs engage and work with a broad range of partners and stakeholders to implement the strategies and achieve this Objective.  They include: the American Academy of Pediatrics, Association of University Centers on Disabilities Public Health Practice, and United States Preventive Services Task Force (USPSTF).

Strategies

Enhance system capacity to address the health, health-related outcomes, and social determinants of health for older adults and individuals with disabilities of all ages by developing processes, policies, and supports that are person centered and provide quality care across settings, including home and community-based settings

• Deploy approaches to care, including primary care, that promote health and equitable, goal-directed care and self-determination for older adults, persons with disabilities, and caregivers.
• Enhance states’ ability to implement Medicaid Home and Community Based Services (HCBS) and incorporate standardized quality measures to assess and track the adequacy of the HCBS community integration on access, availability, quality, experience of care, health outcomes, and the workforce.
• Engage with individuals with lived experience and their families and caregivers to ensure processes, policies, and supports meet their needs.
• Support healthcare partners, states, tribes and tribal organizations, community, profit, and non-profit organizations to expand infrastructure and improve coordination and communication of resources and services such as in-home services, transportation, digital equipment, broadband access and healthcare to meet the day-to-day and long-term needs of older adults, persons with disabilities, and caregivers.
• Create pathways for older adults and persons with disabilities from vulnerable immigrant communities, such as refugees and asylees, to access relevant benefits and services, by strengthening the capacity of states, agencies, and providers to deliver culturally appropriate services and supply resources that address the needs of these immigrant populations.

Ensure availability and equitable access and delivery of evidence-based interventions that focus on research, prevention, services, and treatment of health and behavioral conditions that impact older adults and individuals with disabilities

• Establish supportive policies, strengthen communication and partnership initiatives for intervention dissemination and clinical treatment and care gaps, and build strategic alliances for improved disease management.
• Coordinate across federal agencies and collaborate with state, local, tribal, private, and non-profit partners to ensure availability and equitable distribution and access to evidence-based interventions that prevent the onset of symptoms, improve care management, and reduce health disparities for people diagnosed with multiple health conditions.
• Promote culturally and linguistically-tailored self-management programs and expand referral and delivery systems to improve health and behavioral health outcomes among older adults and individuals with disabilities.

Support the development and implementation activities to better understand and address the needs of all caregivers across the age and disability spectrum

• Develop and disseminate a National Family Caregiving Strategy as required by the Recognize, Assist, Include, Support and Engage (RAISE) Family Caregivers Act of 2017.
• Leverage technical assistance and resources to address the needs of older adult, kinship families, non-kinship, and minor caregivers at the federal, state, territorial, tribal and community levels.

Performance Goals

The HHS Annual Performance Plan provides information on the Department’s measures of progress towards achieving the goals and objectives described in the HHS Strategic Plan for FY 2022–2026.  Below are the related performance measures for this Objective.

• Reduce the percentage of caregivers participating in the National Family Caregiver Support Program who report difficulty in obtaining services
• Increase the percentage of individuals with developmental disabilities whose rights were enforced, retained, restored, or expanded
• Increase the age-adjusted percentage of adults (age 18+) diagnosed with arthritis who were counseled by a doctor or other health professional to be physically active or exercise to help arthritis or joint symptoms, in states funded by the CDC Arthritis Program
• Decrease the prevalence of hemophilia treatment inhibitors among Community Counts - Health Outcomes Monitoring System for People with Bleeding Disorders at HTCs
• Increase the percentage of older adults who receive appropriate clinical preventive services

Learn More About HHS Work in this Objective

• Advancing Systems of Services for Children and Youth with Special Health Needs: This program improves health and well-being for children and youth with special health care needs, and their families, by strengthening access to patient- and family-centered medical home, supporting the transition of youth into the adult health care system, and advancing the adoption of health care financing models that improve care and outcomes while achieving cost savings.
• Disability Employment Technical Assistance Center: The center is a comprehensive source for disability employment information, and resources, and helps identify and provide training on innovative, promising, and emerging practices.
• Early Hearing Detection and Intervention: This program aims to ensure that newborns, infants, and young children who are deaf or hard of hearing are identified and get the care they need when they need it.
• Evaluation of ACL Title VI Programs: Highlights significant improvements on reduced hospitalizations and falls, and increased socialization amongst older adults engaged in Title VI programs.
• Family-to-Family Health Information Centers: This program provides information, education, technical assistance, and peer support to families of children and youth with special health care needs, and to the professionals who serve them.
• Health Care Delivery Systems Innovations for Children with Medical Complexity: The purpose of this initiative is to improve the quality of life for children with medical complexity, the well-being of their families, and the cost-effectiveness of their care, through development of innovative care and payment models.
• Home- and Community-Based Services: Home- and Community-Based Services (HCBS) are types of person-centered care delivered in the home and community.  HCBS programs address the needs of people with functional limitations who need assistance with everyday activities, like getting dressed or bathing.  HCBS are often designed to enable people to stay in their homes, rather than moving to a facility for care.
• Healthy Aging Symposium: Focuses on providing actionable resources and information addressing social determinants of health to improve health equity and build long term recovery and resilience in the older adult population.
• Improve Access to Care and Economic Security for Medicare-Medicaid Dually Eligible Individuals: A CMS plan to improve enrollment and advance the Medicare Savings Program, promote Medicaid/Medicare integrated care, and support access to COVID-19 vaccinations.
• National Community of Practice for Supporting Families-Evaluation: Provided outcomes data and recommendations to improve supports to families and individuals with intellectual and developmental disabilities.
• National Institute on Disability, Independent Living, and Rehabilitation Research (NIDILRR) 2018–2023 Long-Range Plan: A five-year plan that supports the work in applied disability, independent living, and rehabilitation research.  The aim is to promote an agenda that emphasize consumer relevance and scientific integrity in developing national policy affecting people with disabilities.
• Preferred Communities: The Preferred Communities program supports refugee and ORR-eligible populations with challenging needs that require special attention, including those with serious medical conditions, women at risk, and elderly refugees.  The program provides critical interventions and services for refugees with special needs who have arrived within the past five years.  For these individuals, the Preferred Communities program offers intensive case management to overcome barriers as they acclimate to life in the United States and learn to manage the difficulties they face on their own.
• Preventive Services Self-Administered Questionnaire (MEPS Preventive Services Survey (PSAQ): Historically until 2018, MEPS-HC collected information about receipt of preventive care services through its core questionnaire for which one household respondent typically provides information for household members.  During Panel 18 Round 5 of the 2014 MEPS-HC, it fielded a paper-and-pencil questionnaire called the Preventive Care Self-Administered Questionnaire (PSAQ) in which each respondent provided information for himself or herself.  This pilot survey was designed to collect a variety of person-level preventive care data for a sample of adults age 35 and older.  In alternate years beginning 2018, these questions were incorporated into the standard MEPS Self-Administered Questionnaire (SAQ).
• Process Evaluation of the Long-Term Care Ombudsman Program (LTCOP): Examines the efficacy of LTCOP described in the Older Americans Act, the long-term impacts of the LTCOP’s for various stakeholders, what system advocacy among Ombudsman programs looks like, and effective or promising Ombudsman program practices.
• Recognize, Assist, Include, Support, and Engage (RAISE) Act Initial Report to Congress: A comprehensive review of family caregiving and associated recommendations to address the experiences and needs of caregivers.
• Spina Bifida Association's Clinical Care Network: Updated clinical care guidance for spina bifida covers 25 areas of physical health, mental health, and general well-being for people with spina bifida, from birth to adulthood.  These recommendations are based on recent scientific literature and clinical consensus or agreement of 80 clinicians from SBA’s Clinical Care Network who treat patients with spina bifida.  The Clinical Care Network receives funding from CDC’s National Center on Birth Defects and Developmental Disabilities.
• Stop Elderly Accidents, Deaths, and Injuries (STEADI) Initiative: The CDC's STEADI initiative supports healthcare partners to expand the infrastructure for fall prevention.