Resource Guide for Counties
In summer of 2023, the National Association of Counties (NACo) partnered with the National Academy of State Health Policy to survey county leaders on the delivery of aging services and supports available to the caregivers of older adults. NACo surveyed the following networks to inform this guide: Human Services and Education Policy Steering Committee, Health Policy Steering Committee, Healthy Counties Advisory Board and more. This action guide highlights those survey findings, the challenges and opportunities for counties and key strategies and recommendations for raising public awareness and improving service delivery for aging adults and their caregivers.
The County Role in Aging Service Delivery and Caregiver Supports
County governments play a crucial role in providing vital services throughout a person’s life, from birth through their golden years. As the nation’s population rapidly ages, counties are confronted with increasing demand for comprehensive care systems serving older residents, alongside supporting caregivers. In this resource, NACo explores several approaches for counties to consider in improving aging services and supports to family caregivers and recognizes the varying roles that county leaders play in their administration.
Counties are safety net providers and therefore, have a deep understanding of the needs and challenges faced by aging populations, allowing them to effectively tailor services to meet those needs.
Counties are also providing support to all types of caregivers and are enacting comprehensive approaches to foster safe environments and utilize local resources to enhance caregiver assistance.
Counties are engaged in intergovernmental partnerships with state and federal agencies to provide these critical services. At the federal level, the U.S. Department of Health and Human Services’ Administration on Aging (AOA) funds programs to help older adults age in place with their chosen companion and increase engagement in community-based services that support health and wellbeing. AOA invests in research and innovation that benefits many older Americans and the local communities that serve them.
Nearly a quarter of the U.S. population will be over 65 by 2060. (Source: AARP)
Source: NACo’s County Explorer Tool
Additionally, the Older Americans Act supports programs for seniors to live independently in their communities, offering services like transportation, nutrition, caregiver support, recreation, in-home assistance and disease prevention. It also funds aging-related training, research and services for Native American elders. Through Older Americans Act, states receive Title III grants based on their senior population, which are then passed to local Area Agencies on Aging (AAAs). Counties play a vital role in program implementation, with many AAAs operating within county governments and using local funding for other aging services.
Counties, within their role and authority, deliver a wide range of aging services and caregiver supports through various county-based agencies, departments and programs. Some common agencies include health and human services departments, adult protective services and local AAAs. Other programs include, but are not limited to, aging disability and resource centers, local health departments and emergency services.
Types of Aging Services and Programs That Counties Administer
- In-Home Assistance
- Caregiver Support
- Case Management
- Nutrition & Meal Provision
- Transportation
- Health Education and Disease Prevention
- Respite Services
- Counseling
- Financial Assistance
- Long-Term Care
Meeting the needs of older adults through aging services often requires partnering with community-based organizations (CBOs). Partnerships with CBOs promote comprehensive and coordinated responses to the diverse range of needs and challenges faced by older adults. They can promote equity, build capacity and support in communities and enable counties to increase access to aging services for at-risk and under-resourced populations. They also emphasize the importance of using community outreach and building community trust.
Many counties are leveraging CBOs to integrate wraparound services in central hubs through a ‘no wrong door’ approach, recruiting bilingual social workers and caregivers, simplifying paperwork procedures, designating outreach and service coordinators, offering materials in various languages and placing significant emphasis on community education. Using a ‘no wrong door’ approach can help older adults and their caregivers navigate the complex array of services available to them that tend to operate in siloes and lack coordination.
Examples of Aging Services Delivered by County-Based CBOs
Meals on Wheels: A program that delivers nutritious meals to homebound older adults to alleviate hunger and isolation. Bath Aide: Home health aides help with bathing, dressing and various self-care necessities, aiming to enhance the quality of life of older adults. Adult Day Programs/Services: Facilities that offer structured programs and services during daytime hours for older adults who require assistance and supervision. They provide social activities, meals, health care services and caregiver breaks. Fall Prevention Services: Evidence-based programs proven to help older adults reduce risk of falling. | Legal Aid: Access to legal support for senior citizens, encompassing counseling, advisory and representation services. Health Insurance Counseling and Advocacy Program (HICAP): A program that provides assistance, information and advocacy related to health insurance and Medicare for older adults and individuals with disabilities. Home Modification Service: A program that supports older adults with financial assistance in making cost-effective changes that boost safety, reduce fall risks and improve accessibility in their homes. |
Counties Determine Eligibility for Aging and Caregivers Services
The eligibility criteria for aging services differ across counties, influenced by each locality’s distinct priorities and regulatory obligations. Common factors in determining eligibility include age, race, social needs such as language barriers or isolation and geography, as well as socio-economic, disability and caregiver status.
Survey respondents noted the use of the following common definitions to determine eligibility for aging services:
- Individuals 60 years or older
- Individuals of the greatest social or economic need (e.g., adults with disabilities, language barriers, or experiencing isolation due to race, ethnicity, culture or geography)
- Individuals who are caregivers
Counties Fund Aging Services and Caregiver Supports
Counties utilize a variety of funding streams to provide aging and caregiver services, including federal, state, local, private and other sources. Often, these services are administered with the support of health plan contractsand human service levy funds.
Funding plays a pivotal role in ensuring the accessibility and sustainability of aging services for older adults.
The County Role in Supporting Caregivers
Caregivers can be part of the aging services continuum of care in local communities. Counties offer a range of assistance to family caregivers to improve their wellbeing while simultaneously serving aging adults. Caregiver assistance includes education, counseling and peer support, respite care, health promotion and fitness programs, emergency shelter and caregiver assessments.
Informal caregivers are individuals who provide unpaid assistance (such as spouses, partners, family members, friends or neighbors) to help people with their daily activities or medical conditions.
Formal caregivers provide paid care in the home or care facility (e.g., daycare, residential facility, long-term care facility).
Challenges and Opportunities
County governments encounter a variety of barriers when providing aging services and support for caregivers in their communities. These challenges underscore the importance of comprehensively addressing workforce shortages across departments and amongst caregivers, securing sufficient funding and enhancing infrastructure to better deliver services to aging individuals and caregivers.
We asked county leaders to share what barriers they face and opportunities for improvement:
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County Spotlights
Counties are using innovative approaches for funding and administering aging and caregiver services. Here are a few examples of local initiatives across various communities.
Promoting Equity and Accessibility of Services
Montgomery County, Ohio
In Montgomery County, aging services are delivered and prioritized by zip code, ensuring there is equity and improved accessibility to county-based services. The Department of Jobs and Family Services conducts site visits and semi-annual reviews with community-based service providers to ensure that demographic factors such as income, age, zip codes and high-risk factors are considered in eligibility policies and determinations and service provision. County workers use this information to assess how older adults are being served, whether contracted services are making an impact and to determine how to address service gaps.
Community Outreach
Alachua County, Florida
In Alachua County, a Community Stabilization program under the Office of Community Support Services is making steps to rebuild trust and rapport with older adults being served in the community. Under this program are the Community Self-Sufficiency Program (CSSP) and the Community Sustainability Program (CSP). CSSP helps residents with referrals and service connection, as well as applications to food stamps or other assistance programs. CSP helps residents gain independence and sustain it, assisting with medical respite care and other supports. This approach helps promote quality aging service delivery and increased communication with the residents.
Cross-Collaborations and Partnerships
Douglas County, Nebraska
In Douglas County, the Choosing Healthy Appetizing Meal Plan Solutions for Seniors (CHAMPSS) program represents an innovative senior care approach by operating in spaces commonly visited by people of all ages. This program provides seniors aged 60 and above with the freedom to choose from a variety of entrees and enjoy meals at their convenience, offered daily at six CHAMPSS locations in the county. The CHAMPSS program is supported by nearby grocery stores and restaurants, which facilitates the distribution of meals and provides a convenient grab-and-go choice.
Innovative Caregiver Supports
Mecklenburg County, North Carolina
In Mecklenburg County, Project: C.A.R.E. (“Caregiver Alternatives to Running on Empty”) offers aid to Alzheimer’s and dementia caregivers by assigning a family consultant to address caregiving concerns, linking caregivers with local resources and potentially securing funding for short-term relief or respite care. This initiative aims to alleviate unpaid caregiver stress and fatigue, enabling individuals with Alzheimer’s and dementia to continue residing at home for an extended period.
Recommendations for County Leaders
- Strengthen Cross-Sector Partnerships and Interagency Collaboration: County leaders from across the country emphasized the significance of cross-sector partnerships and interagency collaboration. They also encourage other counties to identify existing federal, state and local assets that county leaders can leverage to expand services within their aging offices and community-based organizations and to design systems that improve service delivery and coordination.
- Engage in Federal, State, and Local Advocacy: To improve intergovernmental partnerships and efforts, county leaders expressed the need for more policies at all levels of government – local, state and federal – that raise public awareness and secure sustained and enhanced funding to address the needs of older adults and their caregivers. County leaders can advocate to reduce restrictions and limitations on their ability to flexibly braid federal funding streams (e.g., Medicaid and Older Americans Act) to improve the coordination of services, help older adults remain in their community and enhance funding for family caregivers.
- Prioritize Community Engagement, Input and Needs: County leaders also recommend developing a process for community engagement and using approaches for gathering and integrating community input to strengthen service delivery systems that meet the unique needs of aging residents and their caregivers.
Strategies Supporting Family Caregivers
NACo examined how county leaders are leveraging local actions included in the 2022 National Strategy to Support Family Caregivers: Actions for States, Communities, and Others. Here are goals that county leaders said are most relevant to their efforts and strategies for improving caregiver supports:
Goal 1: Actions to increase awareness of and outreach to family caregivers
Vision for Goal 1: To optimize the wellbeing of family caregivers by strengthening their recognition among society and improving the dissemination of resources to reach the appropriate audience.
- Use messaging tools designed for county elected officials to highlight the value that family caregivers of older adults and what county agencies can do within their authority to increase services for them.
- Disseminate information through local distribution channels (e.g., social media, local news outlets, community advocates and faith leaders, materials created by schools and business, etc.) and leverage county agencies to reach family caregivers in a range of culturally and ethnically diverse communities.
Goal 2: Actions to advance partnerships and engagement with family caregivers
Vision for Goal 2: To recognize, engage and support family caregivers as key partners in the provision of health care and long-term services and supports.
- Streamline service delivery systems and processes to expand family caregiver access, improve efficiencies across programs and assist with the navigation of complex, often fragmented systems of providers and services.
- Encourage community-providers to use caregiver assessments to identify needs and link caregivers to available services.
Goal 3: Actions to strengthen services and supports for family caregivers
Vision for Goal 3: To expand access to programs, services, supports and products to family caregivers.
- Develop and adopt approaches for policy, funding and systems change to coordinate and expand services for family caregivers.
- Increase awareness among county government staff about the breadth of caregiving and implement policies and approaches that expand service access.
- Maximize inclusion in supportive programs by producing guidance on language use and communication for county agencies (e.g., aging, health, behavioral health, human services public safety, emergency management and human resources departments) to improve service delivery for family caregivers and clearly define “family caregivers” and “family” in the widest possible terms to enhance eligibility for services.
This action guide was made possible by a grant from The John A. Hartford Foundation to the National Academy for State Health Policy in collaboration with the U.S. Administration for Community Living.
Learn More
To learn more about the National Strategy to Support Family Caregivers and find more resources, visit the the National Academy for State Health Policy’s RAISE Act Family Caregiver Resource and Dissemination Center.
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