A Brief History of I&R and the National I&R Support Center
The primary focus of I&R historically and today is to link people with needed services. In 1973, amendments to the Older Americans Act (OAA) required State and Area Agencies on Aging to develop and maintain I&R services within "reasonably convenient access to all older Americans." It was that same year that the United Way published the first formal standards for I&R systems and services. The Administration on Aging (AoA) was the only federal agency with a clear mandate for I&R services, and throughout the 1970s and 1980s, AoA took a leadership role in developing guidelines and technical assistance documents for aging agencies.
In 1983, the Alliance of Information and Referral Systems (AIRS), in collaboration with United Way, updated the original standards and published a study that indicated that approximately 80% of all I&R services in this country were designed specifically for older persons. In 1988, the National Association of State Units on Aging (NASUA) completed a feasibility study and made recommendations to AoA for the establishment of a national toll-free access system. The system proposed was aimed at assisting caregivers (particularly long distanced caregivers) to link to the most appropriate information sources in the community where their older relatives resided. To assess the consistency and quality of the I&R service at the point of referral of such a national access service, NASUA conducted a series of statewide focus groups.
Based on these studies, the Administration on Aging in 1990 launched its two-pronged National I&R Initiative—the Eldercare Locator, to provide consumer access to information resources nationwide, and the National Aging I&R/A Support Center. The primary focus of the Support Center was to enhance the quality of state and local I&R services. To initiate action, the Center’s strategy was to encourage and facilitate the development by states of 3-5 year quality improvement plans for their I&R systems. To assist the states in achieving consistency in the quality of I&R program operations, the Center developed the OAA I&R Standards. While based on the standards developed by AIRS, the OAA Standards helped define the important differences between aging I&R and other information and referral services. Published in 1993, they also established the National Aging I&R Support Center's leadership role in the aging I&R network. To assist aging network I&R/A programs in achieving the OAA Standards, the Support Center also produced Standards Assessment and Implementation Guide, Aging I&R/A Inclusion/Exclusion Policy Development Guide for Aging Information & Referral/Assistance, and other training guides.
Although the provision of aging I&R/A continues to be specialized, these many advances required increased consistency in design and operation to maximize coordination and interface. It became increasingly important for I&R specialists who come from diverse disciplines to function from the same frame of reference. This was the basis of the decision to return to using the AIRS Standards as the professional foundation of I&R/A services, instead of revising the OAA I&R Standards. Throughout the 1990s, the Center provided extensive training and technical assistance across the country to assist state aging I&R systems to achieve the goals outlined in the Standards.
In response to a growing number of I&R specialists assisting older adults and their caregivers within the aging network, in 2001, the I&R Support Center was instrumental in helping AIRS launch the Aging Specialty for I&R Certification (CIRS-A). The Center supported this certification by developing CIRS-A training curriculum, providing training to specialists, and launching a train-the-trainer initiative, as well as partnering with AIRS to improve and update exam and training materials.
A major development experienced by the I&R/A network over the last decade is the network-wide movement toward integration of aging and disability service delivery systems. This move toward integration is a result of several factors: State and federal programs focused on expanding home and community based services, decreased state and federal budgets, and combined federal funding streams. Important indicators of this change include two key developments: the implementation of Aging and Disability Resource Centers (ADRCs) starting in 2003, and the creation of the U.S. Department of Health and Human Services, Administration for Community Living (ACL) in 2012. ACL is the umbrella organization for AoA, the Office on Disability (OD) and the Administration on Developmental Disabilities (ADD), and is charged with developing policies and improving community supports for older adults and people with disabilities.
ADRCs were created as a collaboration between AoA and Centers for Medicare and Medicaid Services to support state efforts to streamline access to long- term services and support (LTSS) for all people. ADRCs work in close partnership with aging and disability human service organizations and are a key component to long-term care systems reform. Depending on the state and organization, I&R/A specialists often work with or for ADRCs in conjunction with both Area Agencies on Aging and Centers for Independent Living. Rarely stand-alone agencies, ADRCs are intended to operate as comprehensive, collaborative “No Wrong Door” programs where people of all ages, incomes, and abilities can access information and counseling on the full range of long-term services and supports available to them.
In 2012, the National I&R/A Support Center surveyed organizations nationwide that play a key service provision role within the I&R/A network. The survey was designed to capture the expanding scope and increasing crossover between aging and disability services that is currently taking place within the I&R/A Network, as well as the degree to which I&R/A agencies are providing and coordinating services and supports to the populations they serve. Four overall themes emerged from the survey:
- Theme 1. Aging and disability networks continue to integrate
- Theme 2. The use of technology in I&R/A service delivery is slow to develop
- Theme 3. The Role of I&R/A organizations is expanding.
- Theme 4. There are opportunities for improved coordination and quality service delivery.
The results of the survey were documented in a publication entitled Aging and Disability Information and Referral/Assistance Networks: Challenges and Opportunities.
To keep pace with these changes, the Support Center again partnered with AIRS as well as n4a to expand the AIRS certification program to reflect the trend towards specialists serving both older adults and persons with disabilities. As a result, AIRS, in partnership with NASUAD and n4a, worked with subject matter experts to evolve its credential from a CIRS—Aging (CIRS-A) to a CIRS—Aging/Disabilities (CIRS-A/D), a transition widely supported by CIRS-A certificate holders. In March 2015, AIRS launched the CIRS-A/D credential to replace the CIRS-A. AIRS partnered with NASUAD to develop an approach to allow existing CIRS-A holders to grandfather to the CIRS-A/D. NASUAD developed a training course called “Disability for I&R Specialists” that is available on its online learning site, NASUADiQ. Successful completion of this course allowed CIRS-A holders to use the CIRS-A/D designation and recertify as CIRS-A/D holders. The CIRS-A/D represents an important development in the professional certification of I&R/A specialists.