The Older Americans Act (OAA) was passed in the same year as Medicare and established the primary vehicle for organizing and delivering community-based services through a coordinated system at the state level. Initially, the Act emphasized small grants to state agencies on aging to fund social services programs. Soon after, specific funding was authorized for state planning and coordinating activities.
Through amendments in 1972, a major service component -- the national nutrition program for the elderly -- was added. Beginning in the late 1970s, several trends occurred which shifted the focus of OAA activities. Funds became more limited, forcing programs to deal differently with the fact that the aged population is diverse with different levels of need. Particular populations were identified as vulnerable, including frail elders, older women, minorities, rural elders and the growing number of oldest old individuals.
As the proportion of older frail elderly has increased, the emphasis has shifted from community-based social services for a broad population (such as senior centers, volunteer programs and recreational activities) to more health-related, long-term care services for the frail elderly who are at risk for institutionalization. Developing a community-based long-term care structure -- a new concept in the 1980s for most communities -- meant significant state and local planning and increased involvement of private and for-profit providers.