State Units on Aging (SUAs) are agencies of state and territorial governments designated by governors and state legislatures to administer, manage, design and advocate for benefits, programs and services for the elderly and their families and, in many states, for adults with physical disabilities. The term "state unit on aging" is a general term: the specific title and organization of the governmental unit will vary from state to state and may be called a Department, Office, Bureau, Commission, Council or Board for the elderly, seniors, aging, older adults and/or adults with physical disabilities. Regardless of the exact title, these state government agencies all share a common agenda of providing the opportunities and supports for older persons to live independent, meaningful, productive, dignified lives and maintain close family and community ties.
Since 1965 all State Units on Aging have administered the Older Americans Act (OAA) in their respective states, and today it remains the cornerstone upon which all efforts are based. Through a state network of area agencies on aging and service providers, a range of services is provided to older persons including home-care, congregate and home delivered meals, transportation, information and assistance and advocacy on behalf of individual older citizens.
Empowering older persons and their families to make informed decisions and choices, through the provision of accessible and credible information is central to the mission of all SUAs, and a key component of all the programs and services they provide or oversee. In every state there is a comprehensive information, counseling, education and assistance system through which consumers are linked to the resources and services they need to remain independent in their homes and communities.
SUAs also have significant policy, planning and advocacy roles in leveraging other federal, state and local public and private funds to support programs on aging. Today, in addition to the OAA, in all state, SUAs administer state funded home and community based programs for older persons, the Medicaid Home and Community Based Services Waiver programs for the elderly (in 28 states), and/or programs for younger adults with physical disabilities (in 21 states). The goal of these programs is the development of a comprehensive service system that enables individuals to remain independent in their homes and communities and avoid unnecessary institutionalization. Nationally, about a third of the funding provided by the SUAs for home and community services is derived from the federal OAA with the remainder from state and other federal sources.
In addition to a primary focus in each state on home and community based services, all SUAs have the mission to assure that individual older persons have their civil rights, autonomy and dignity protected, their claims to entitlements honored, and their contracts and covenants for care and benefits fulfilled. States address that mission through the administration of a number of elder rights programs:
Long Term Care Ombudsman Program investigates and resolves complaints (over 200,000 annually nationwide) concerning the health, safety, welfare and rights of residents of long term care facilities; empowers residents and their families to engage in self-advocacy; educates residents and their families about rights and benefits; provides information and consultation for individuals—most often in selecting and paying for a nursing home or alternatives to nursing home placement; and advocates for statewide long term care system reform.
Legal Services Program offers advice, counsel and legal intervention to older persons on issues such as public benefits, health care, pensions financial exploitation, consumer problems, advanced directives and guardianship. These services are primarily provided by local legal service providers in the community funded by area agencies on aging. At the state level, SUAs have Legal Service Developers on staff to provide leadership in securing, maintaining, supporting and coordinating the provision of legal assistance. Many states also operate statewide legal hotlines.
Adult Protective Service/Elder Abuse Program through which states have organized a range of services to assist, or act on behalf of, vulnerable adults. These services are intended to help those who are unable to protect their own interests, health or safety; designed to prevent and remedy abuse, neglect or exploitation; and targeted to adults who because of mental or physical disabilities are unable to provide for their own needs and who have no family or friends willing or able to provide essential services.
State Health Insurance Program intervenes and advocates for older consumers regarding Medicare, Medicaid, Medicare supplemental and long term care insurance and other health insurance issues. Funded by the federal Health Care Financing Administration, this program is administered by the SUAs in 36 states and by State Insurance Commissions in the other states through a network of highly trained volunteers at the community level. The program helps consumers understand their options under Medicare+Choice, secures answers about claims and billing issues, works to resolve disputes between health care providers and insurers, serves as an advocate in appeals of coverage denials by Medicare, Medicaid or private insurers and assists beneficiaries file grievances and complaints with appropriate oversight agencies.
A growing number of states (18 as of September 2000) have established programs to provide pharmaceutical coverage or assistance, primarily to low-income older persons and/or persons with disabilities who do not qualify for Medicaid. Most of these programs use state funds to subsidize a portion of the cost of prescription drugs, usually for a defined population that meets enrollment criteria. In most of these states, the SUA has responsibility of administering these programs.
SUAs play a critical role in all states in working with governors, state legislatures, other state agencies, local governments, provider organizations, older consumers and their advocates in promoting changes in state aging policies and programs in a wide range of areas including: home and community based long term services, institutional care, housing, prescription drug coverage, transportation, workforce development, taxes, elder rights including elder abuse and guardianship issues, etc.
Lastly, all SUAs play significant roles in ensuring that all older persons have the opportunity to continue productive lives in their communities through the administration of a variety of programs, such as employment and training/workforce development, health promotion and disease prevention, volunteer and intergenerational.
A central goal of all SUA's is to empower older people to make informed decisions about their own lives and to enable them to influence policymaking and program implementation at the state and local levels. In addition, most SUAs have state advisory committees comprised of older persons and other advocates to provide ongoing guidance. About a third of the states convene Silver Haired Legislatures to develop policy recommendations to state legislatures and governors.