GAO: Up to 80% of Seniors in Need Lack Home Care

An overwhelming majority of seniors in need of home-based care services do not receive them, according to recently updated findings from the U.S. Government Accountability Office (GAO). 

In 2011, GAO analyzed data from 2008 and found that approximately 12 million out of 16 million older adults who likely needed home-based care did not receive it. The agency also found that about 9% of low-income older adults—an estimated 1.6 million—received meals like those provided by Title III programs under the Older Americans Act (OAA) of 1965. 

The OAA was enacted to help older adults remain in their homes and communities, by way of providing authorized programs and funding via OAA Title III grants that provide a range of assistance to seniors in need of home-based care, transportation services, as well as congregate and home-delivered meals. 


As Congress considers reauthorization of the OAA, GAO brought it upon itself to update the findings of the 2011 report in efforts to examine older Americans’ reported need for home- and community-based services, such as those funded by the OAA, as well as the potential unmet need for these services based on national survey data. 

In conducting its research, GAO analyzed the most recent data from two national surveys, the 2013 Current Population Survey (CPS) and the 2012 Health and Retirement Study. GAO’s analysis of CPS data focused on adults age-60 and older living in households with incomes below 185% of the poverty threshold. 

What the agency found was that many older Americans age-60 and older who are in need of essential home-based care, transportation or meal delivery services, either receive them on a limited basis or not at all. 


Per the 2013 data, an estimated 83% of low-income seniors who have difficulties with two or more daily activities do not receive meals, according to GAO’s updated findings.

While some figures are similar to those GAO found using 2008 data, the agency notes that more low-income seniors are food insecure than in 2008, meaning they report three or more conditions such as skipping meals because they don’t have enough money for food (19% in 2008 vs. 24% in 2013).

But in terms of home-based care, GAO estimates that 27% of people of people age-60 and older (about 16 million) likely need home-based care like the services provided by Title II programs. 

Furthermore, depending on the number and type of difficulty, between 67% and 78% of older adults who likely need home-based care receive limited or no help with their difficulties—either formally from sources such as Title III programs and Medicaid, or informally through family embers.

Among those who have difficulty with activities of daily living, such as housework or shopping, fewer than half of seniors receive home-based care, which GAO notes is more than in 2008 (an estimated 34% in 2008 vs. 44% in 2012).

GAO’s report echoes similar, recent reports that have indicated that huge proportions of in-need homebound Medicare beneficiaries do not receive medical or other services.

The findings are noteworthy especially when looking at current funding trends and how they will impact providing home- and community-based services to an increasingly growing aging population in the U.S. in the years to come.

Between 2009 through 2013, funding for Title III grants fell from $1.178 billion to $1.128 billion, according to GAO. In fiscal year 2014, approximately $1.156 billion was provided in grants to states for home- and community-based services under Title III of the OAA. 

As funding has declined over the years, the number of older adults living in the U.S. has risen, and continues to rise. Census data estimates there were approximately 62.9 million people over age-60 in the U.S. in 2013, compared to 55.5 million in 2009.

“As Congress considers reauthorization of the OAA, if current trends continue, the number of adults who need services like those provided by OAA Title III grants may continue to increase with the retirement of the baby boom generation,” writes Charles Jeszeck, GAO’s director of education, workforce and income security issues, in a letter preceding his agency’s report.

Written by Jason Oliva