More Specific Guidance and Closer Monitoring Needed To Get More From Funds Spent on Social Services for the Elderly

HRD-82-14: Published: Nov 12, 1981. Publicly Released: Nov 12, 1981.

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GAO examined the administration of social services subgrants and contracts awarded under the Older Americans Act to determine how well the State and area agencies on aging are coordinating and managing numerous Federal programs which could be used to serve the elderly. Under the Act's social services program, these agencies provide to the elderly a broad array of social services, such as transportation, homemaker services, and information/referral services. The area agencies are responsible for obtaining these services, usually through subgrants and contracts with service providers. Federal funds for the program are distributed to each State on a formula grant basis upon the Administration on Aging's (AOA) approval of the State's or area's plan.

GAO believes that better monitoring and management controls are needed at both the State and area agency levels to assure that subgrants and contracts to service providers are being managed efficiently. In a review of 6 State agencies on aging and 11 area agencies, GAO found that only 1 of the area agencies had emphasized the use of the funds to attract needed outside resources in accordance with congressional expectations. Other management weaknesses attributable to a lack of specific instructions were found. A general area agency practice of compensating service providers based on costs claimed, regardless of the services provided, often resulted in compensation for the total agreement before all the service objectives had been accomplished. Area agencies did not spend significant portions of their funds during the year for which the funds had been allocated. GAO believes that the lack of specific instructions limits the effectiveness of evaluations of area operations and the provision of appropriate technical assistance. GAO found a lack of monitoring and enforcement at area agencies in all six States reviewed. GAO also found a lack of compliance with regulations on: (1) the prohibition against denying services based on a person's income or charging the elderly for services; and (2) the requirement to spend 50 percent of each area agency's allocation on national priority services. GAO also believes that improvements are needed in AOA and State agency accountability, perhaps through performance reports.

Recommendations for Executive Action

  1. Status: Closed - Implemented

    Comments: Please call 202/512-6100 for information.

    Recommendation: The Secretary of the Department of Health and Human Services should direct the Commissioner of AOA to develop more specific instructions for State agencies' use in assisting area agencies on using title III-B subgrants and contracts as catalysts to attract needed outside resources.

    Agency Affected: Department of Health and Human Services

  2. Status: Closed - Implemented

    Comments: Please call 202/512-6100 for information.

    Recommendation: The Secretary of the Department of Health and Human Services should direct the Commissioner of AOA to develop more specific instructions for State agencies' use in assisting area agencies on using title III-B subgrants and contracts as catalysts to attract needed outside resources.

    Agency Affected: Department of Health and Human Services: Administration on Aging

  3. Status: Closed - Implemented

    Comments: Please call 202/512-6100 for information.

    Recommendation: The Secretary of the Department of Health and Human Services should direct the Commissioner of AOA to develop more specific instructions for State agencies' use in assisting area agencies in providing performance-based payment provisions, to the extent possible, in subgrants and contracts with service providers.

    Agency Affected: Department of Health and Human Services

  4. Status: Closed - Implemented

    Comments: Please call 202/512-6100 for information.

    Recommendation: The Secretary of the Department of Health and Human Services should direct the Commissioner of AOA to develop more specific instructions for State agencies' use in assisting area agencies in providing performance-based payment provisions, to the extent possible, in subgrants and contracts with service providers.

    Agency Affected: Department of Health and Human Services: Administration on Aging

  5. Status: Closed - Implemented

    Comments: Please call 202/512-6100 for information.

    Recommendation: The Secretary of the Department of Health and Human Services should direct the Commissioner of AOA to develop more specific instructions for State agencies' use in assisting area agencies on expending title III-B funds for needed services in a timely manner.

    Agency Affected: Department of Health and Human Services

  6. Status: Closed - Implemented

    Comments: Please call 202/512-6100 for information.

    Recommendation: The Secretary of the Department of Health and Human Services should direct the Commissioner of AOA to develop more specific instructions for State agencies' use in assisting area agencies on expending title III-B funds for needed services in a timely manner.

    Agency Affected: Department of Health and Human Services: Administration on Aging

  7. Status: Closed - Implemented

    Comments: Please call 202/512-6100 for information.

    Recommendation: The Secretary of the Department of Health and Human Services should direct the Commissioner of AOA to work with State agencies to develop a set of instructions that could be used by all the area agencies.

    Agency Affected: Department of Health and Human Services: Administration on Aging

  8. Status: Closed - Implemented

    Comments: Please call 202/512-6100 for information.

    Recommendation: AOA and State agencies should develop instructions which will help determine why an area agency has not spent its available title III-B funds.

    Agency Affected: Department of Health and Human Services: Administration on Aging

  9. Status: Closed - Implemented

    Comments: Please call 202/512-6100 for information.

    Recommendation: AOA and State agencies should develop instructions which will help set a maximum amount or percent of an area agency's allocation that can be carried forward from one program year to the next.

    Agency Affected: Department of Health and Human Services: Administration on Aging

  10. Status: Closed - Implemented

    Comments: Please call 202/512-6100 for information.

    Recommendation: The Secretary of the Department of Health and Human Services should direct the Commissioner of AOA to require State agencies to effectively monitor area agencies to help insure that program instructions are followed.

    Agency Affected: Department of Health and Human Services

  11. Status: Closed - Implemented

    Comments: Please call 202/512-6100 for information.

    Recommendation: The Secretary of the Department of Health and Human Services should direct the Commissioner of AOA to require State agencies to effectively monitor area agencies to help insure that program instructions are followed.

    Agency Affected: Department of Health and Human Services: Administration on Aging

  12. Status: Closed - Implemented

    Comments: Please call 202/512-6100 for information.

    Recommendation: The Secretary of the Department of Health and Human Services should direct the Commissioner of AOA to have State agencies develop performance accountability systems for title III-B expenditures.

    Agency Affected: Department of Health and Human Services

  13. Status: Closed - Implemented

    Comments: Please call 202/512-6100 for information.

    Recommendation: The Secretary of the Department of Health and Human Services should direct the Commissioner of AOA to have State agencies develop performance accountability systems for title III-B expenditures.

    Agency Affected: Department of Health and Human Services: Administration on Aging

  14. Status: Closed - Implemented

    Comments: Please call 202/512-6100 for information.

    Recommendation: The Secretary of the Department of Health and Human Services should direct the Commissioner of AOA to require State agencies to use area plans as intended for setting goals and monitoring results.

    Agency Affected: Department of Health and Human Services: Administration on Aging

  15. Status: Closed - Implemented

    Comments: Please call 202/512-6100 for information.

    Recommendation: The Secretary of the Department of Health and Human Services should direct the Commissioner of AOA to require State agencies to enforce area agencies' use of statewide standards in setting service objectives, defining provider requirements in subgrants and contracts, and reporting the results of subgrants and contract expenditures.

    Agency Affected: Department of Health and Human Services: Administration on Aging

  16. Status: Closed - Implemented

    Comments: Please call 202/512-6100 for information.

    Recommendation: The Secretary of the Department of Health and Human Services should direct the Commissioner of AOA to revise its performance reporting system to include data on the levels of commonly provided services to elderly persons.

    Agency Affected: Department of Health and Human Services

  17. Status: Closed - Implemented

    Comments: GAO has no information on the actions taken in response to this recommendation.

    Recommendation: The Secretary of the Department of Health and Human Services should direct the Commissioner of AOA to revise its performance reporting system to include data on the levels of commonly provided services to elderly persons.

    Agency Affected: Department of Health and Human Services: Administration on Aging

  18. Status: Closed - Implemented

    Comments: GAO has no information on the actions taken in response to this recommendation.

    Recommendation: The Secretary of the Department of Health and Human Services should direct the Commissioner of AOA to direct State agencies to verify performance data as part of their required onsite assessments of area agencies to assure that accurate data are being reported under the revised system.

    Agency Affected: Department of Health and Human Services: Administration on Aging

 

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