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Missouri’s National Core Indicators for Aging and Disabilities©(NCI-AD) Report

The information within this report illustrates the impact of programs currently in place, as well as areas of need and opportunities for improvement and provides valuable insight to aging and disability advocates and public officials as they work in partnership to make future programmatic decisions.


As a result of the 1973 amendments to the federal Older Americans Act (OAA), states were required to divide their state into planning and service areas, and to designate Area Agencies on Aging (AAA) to develop and implement programs and services for older persons at the local level. Missouri has ten (10) AAAs, each responsible for providing services within specifically defined geographic boundaries. In order to receive funding from the Department of Health and Senior Services (DHSS), each AAA is required to submit an area plan for review and approval. They must address a wide variety of issues in their plans, including how the AAA will administer their programs for a two, three, or four-year period. Priority services are determined by utilizing public hearings, customer surveys, advisory councils, and other available information.


Each AAA is required to provide the following categories of service:

  • Legal Services
  • Nutrition--both congregate and home-delivered
  • In-Home Services--which might include homemaker, chore, personal care or respite
  • Disease Prevention/Health Promotion
  • Access--which includes transportation, information and assistance, advocacy, outreach, and case management at some AAAs

All AAAs also administer the following programs, although it is not required:

  • Ombudsman/Elder Rights
  • Tax Counseling

Each AAA may provide any combination of the following services, according to the identified needs within their service area:

  • Friendly Visiting
  • Housing Assistance
  • Gatekeeper
  • Health Education
  • Minor Home Repair
  • Letter Writing
  • Recreation

In addition, AAAs are allowed flexibility in the development of other programs required to meet needs identified within their service area.

NAPIS (National Aging Program Information System)

In 1992, the Administration on Aging (AoA) was directed to refine the program reporting procedures of State Units on Aging. As a result, AoA developed NAPIS, a computerized reporting system to be used nationally for tracking utilization of aging services within the AAA network.

Following are definitions for the fifteen standardized services captured within NAPIS reporting:

  1. Personal Care - Provision of personal assistance, standby assistance, supervision or cues for persons having difficulty with one or more ADLs, such as eating, dressing, bathing, toileting, and transferring in and out of bed.
  2. Homemaker - Provision of assistance to persons having difficulty with one or more IADLs, such as meal preparation, shopping, light housework, money management, or using the telephone.
  3. Chore - Provision of assistance to persons having difficulty with one or more IADLs, such as heavy housework, yard work, or sidewalk maintenance.
  4. Home Delivered Meals - Provision to an eligible client, or other eligible participant at the client's residence, a meal that complies with Dietary Guidelines for Americans, and provides at least one-third of the current daily Recommended Dietary Allowances.
  5. Adult Day Care Services- Provision of personal care for dependent adults in a supervised, protective, congregate setting during some portion of a 24-hour day. Services offered in conjunction may include social and recreational activities, training, counseling, meals, medication assistance, rehabilitation, and home health aide services.
  6. Case Management - Assistance in access or care coordination for persons with functional limitations in need of formal services. Activities may include assessing needs, developing care plans, authorizing and arranging services, coordinating provision of services among providers, follow-up and reassessment, as needed. (In some areas of the state, DHSS provides case management services for the AAAs through a cooperative agreement between the two agencies.)
  7. Congregate Meals - Provision to an eligible client, or other eligible participant, at a nutrition site, senior center, or some other congregate setting, a meal that complies with the Dietary Guidelines for Americans, and provides at least one-third of the current daily Recommended Dietary Allowances.
  8. Nutrition Counseling - Provision of individualized advice and guidance to persons who are at nutritional risk, due to health, medication, or other considerations, about options and methods to improve their nutritional status, performed by a health professional.
  9. Assisted Transportation - Provision of assistance, including escort, to a person who has difficulty using regular transportation.
  10. Transportation - Provision of a means to get from one place to another.
  11. Legal Assistance - Provision of legal advice, counseling, and representation by an attorney or other person acting under the supervision of an attorney.
  12. Nutrition Education - A program to promote better health by providing accurate information and instruction to participants in a group or individual setting, overseen by a dietitian or person with comparable expertise.
  13. Information and Assistance - Provision of current information on opportunities and services available within communities; assess problems and capacities of an individual; link the person to services available; and follow-up as needed.
  14. Outreach - Interventions initiated by an agency or organization for the purpose of identifying potential clients and encouraging their use of existing services and benefits.
  15. Family Caregiver Support Program - Establishes an infrastructure of program resources and assistance to family caregivers. States, AAAs, and local community agencies work together to provide support and services to family caregivers. You may be eligible for services if you are a family caregiver of older adults or an older adult caring for a related child under age 18.


Services are available under the OAA mandates to persons at least 60 years of age, in the greatest social and economic need, with special emphasis placed on low-income minority elderly.

Persons with disabilities aged 18-59 may receive assistance with transportation and nutrition services through Social Services Block Grant (SSBG) or other non-Title III funds.


As the designated State Unit on Aging, DHSS is required to allocate Title III funds to the ten AAA offices, using a federally approved intrastate funding formula based on mandated criteria and the best available information (e.g. Census data) about the demographics of persons age 60 and over within the state.

The AAAs also receive funding from General Revenue (GR), SSBG, and the Home-Delivered Meals Trust Fund, all of which are distributed according to the funding formula. Additional federal funding is received by the AAAs from USDA for the nutrition program.

Community funds, grants, and a considerable amount of program income from voluntary contributions are utilized to expand programs and/or the number of persons receiving services. Persons receiving services are invited to voluntarily and confidentially contribute toward the cost of the service.

Older Americans Act Program Administration

The Division of Senior and Disability Services, acting as the designated State Unit on Aging, has the responsibility of monitoring each AAA&'s compliance with OAA mandates, as well as providing technical assistance to enhance their program operations. These staff are a part of the central office administrative personnel and include the program administrator, program specialists, and support staff.


Throughout the state, local AAA and DHSS staff have begun to develop closer working relationships in an effort to enhance and improve the scope of services available to Missouri seniors. Included in DHSS's Case Management Manual is a map outlining the boundaries of each AAA's service area, along with their address and telephone information. Direct contact with local AAA staff will provide specific information about programs available in a particular county, as well as enhance the information-sharing necessary to further develop a coordinated network of aging services.