STATE PLAN ON AGING

2020-2024

Keystone for Empowered Aging

PENNSYLVANIA DEPARTMENT OF AGING

Pennsylvania Department of Aging
State Plan on Aging
2020 - 2024

Governor Tom Wolf
Secretary Robert Torres

COMMONWEALTH OF PENNSYLVANIA 
OFFICE OF THE GOVERNOR 
COMMONWEALTH OF PENNSYLVANIA 
OFFICE OF THE GOVERNOR 

 
 

ear Fellow Pennsylvanians: 
ear Fellow Pennsylvanians: 

 
One of our highest priorities in public service is to help the most vulnerable populations 
 
among  us,  especially  older  adults.  In  support  of  our  growing  and  diversifying  older  adult 
One of our highest priorities in public service is to help the most vulnerable populations 
population,  the  commonwealth  receives  federal  funding  under  the  Older  Americans  Act  and  is 
among  us,  especially  older  adults.  In  support  of  our  growing  and  diversifying  older  adult 
obligated  to  develop  a State Plan  on  Aging  every  four  years.  This  strategic  plan,  developed  by 
population,  the  commonwealth  receives  federal  funding  under  the  Older  Americans  Act  and  is 
the Pennsylvania Department of Aging, will serve as a blueprint to help build capacity for a more 
obligated  to  develop  a State Plan  on  Aging  every  four  years.  This  strategic  plan,  developed  by 
age-friendly Pennsylvania. As we continue to improve access to and the quality of services, we 
the Pennsylvania Department of Aging, will serve as a blueprint to help build capacity for a more 
must  do  so  in  a  manner  that  honors  all  older  residents  and  is  responsive  to  racial,  ethnic  and 
age-friendly Pennsylvania. As we continue to improve access to and the quality of services, we 
cultural differences while promoting purpose, well-being and a sense of community.  
must  do  so  in  a  manner  that  honors  all  older  residents  and  is  responsive  to  racial,  ethnic  and 
 
cultural differences while promoting purpose, well-being and a sense of community.  
This  plan  was  informed  by  and  developed  with  input  from  many  partners  and 
 
stakeholders that play an important role in serving Pennsylvania’s older adults.  Throughout the 
This  plan  was  informed  by  and  developed  with  input  from  many  partners  and 
next  four  years,  the  Department  of  Aging  will  implement  dozens  of  action  steps  with  the 
stakeholders that play an important role in serving Pennsylvania’s older adults.  Throughout the 
assistance  of  the  statewide  network  of  Area  Agencies  on  Aging,  the  Pennsylvania  Council  on 
next  four  years,  the  Department  of  Aging  will  implement  dozens  of  action  steps  with  the 
Aging  and  other  stakeholders  to  further  the  goals  of  the  plan.  To  maintain  a  commitment  to 
assistance  of  the  statewide  network  of  Area  Agencies  on  Aging,  the  Pennsylvania  Council  on 
transparency  and  accountability,  the  plan  provides  measures  and  timelines  that  will  be 
Aging  and  other  stakeholders  to  further  the  goals  of  the  plan.  To  maintain  a  commitment  to 
periodically monitored, and progress shared throughout the duration of this plan.  
transparency  and  accountability,  the  plan  provides  measures  and  timelines  that  will  be 
 
periodically monitored, and progress shared throughout the duration of this plan.  
This  plan  is  designed  to  meet  the  needs  of  older  adults  over  the  next  four  years  and 
 
beyond  while  ensuring  that  the  Department  of  Aging  and  its  many  partners  and  stakeholders 
This  plan  is  designed  to  meet  the  needs  of  older  adults  over  the  next  four  years  and 
work  together  to  build  an  age-friendly  commonwealth  that  will  serve  as  a  keystone  to 
beyond  while  ensuring  that  the  Department  of  Aging  and  its  many  partners  and  stakeholders 
empowered aging.     
work  together  to  build  an  age-friendly  commonwealth  that  will  serve  as  a  keystone  to 
empowered aging.     

Sincerely, 
Sincerely, 

TOM WOLF  
Governor 
TOM WOLF  
Governor 

       

       

 

 

 

 

  D

  D

 
 

   

   

       

       

 
 

   

   

225 Main Capitol Building | Harrisburg, PA 17120 | 717.787.2500 | Fax 717.772.8284 | www.pa.gov 

225 Main Capitol Building | Harrisburg, PA 17120 | 717.787.2500 | Fax 717.772.8284 | www.pa.gov 

COMMONWEALTH  OF PENNSYLVANIA
DEPARTMENT OF AGING

COMMONWEALTH  OF PENNSYLVANIA
DEPARTMENT OF AGING

Dear Fellow Pennsylvanians:

As Secretary of the Pennsylvania Department of Aging, it has truly been an honor to 
Dear Fellow Pennsylvanians:
work with so many of our staff, partners and stakeholders on the development of this new 
State Plan on Aging.  This plan is effective on October 1, 2020 and will be executed through 
As Secretary of the Pennsylvania Department of Aging, it has truly been an honor to 
2024 to help meet the demand for services from our growing and diversifying older adult 
work with so many of our staff, partners and stakeholders on the development of this new 
population.    
State Plan on Aging.  This plan is effective on October 1, 2020 and will be executed through 
2024 to help meet the demand for services from our growing and diversifying older adult 
Designated by the federal government as the State Unit on Aging, the Department of 
population.    
Aging is bound by the Older Americans Act to focus programs and develop targeted outreach 
to support older adults with the greatest economic and social need.  This means focusing on 
Designated by the federal government as the State Unit on Aging, the Department of 
older adults living at or below the poverty level or being impacted by non-economic factors 
Aging is bound by the Older Americans Act to focus programs and develop targeted outreach 
such as physical and mental disabilities, language barriers, cultural, social or geographical 
to support older adults with the greatest economic and social need.  This means focusing on 
isolation, including isolation caused by racial or ethnic status.
older adults living at or below the poverty level or being impacted by non-economic factors 
such as physical and mental disabilities, language barriers, cultural, social or geographical 
The Department of Aging has worked diligently on developing this new State Plan 
isolation, including isolation caused by racial or ethnic status.
that will direct the commonwealth’s efforts in support of older Pennsylvanians through 2024. 
It is a plan that was informed by a statewide survey that yielded 5,600 responses from adults 
The Department of Aging has worked diligently on developing this new State Plan 
all  over  the  commonwealth including  family  caregivers,  veterans,  people  living  with  a 
that will direct the commonwealth’s efforts in support of older Pennsylvanians through 2024. 
disability,  direct  care  workers,  volunteers  who  work  with  older  adults,  members  of  the 
It is a plan that was informed by a statewide survey that yielded 5,600 responses from adults 
LGBTQ  community  and  grandparents  raising  grandchildren.  It  was  also  presented  to the 
all  over  the  commonwealth including  family  caregivers,  veterans,  people  living  with  a 
Pennsylvania  Council  on  Aging  and  its  corresponding  Regional  Councils,  and  at  several 
disability,  direct  care  workers,  volunteers  who  work  with  older  adults,  members  of  the 
virtual  community  forums where  nearly  500  individuals  participated and  gave  testimony,
LGBTQ  community  and  grandparents  raising  grandchildren.  It  was  also  presented  to the 
raised questions or shared comments.
Pennsylvania  Council  on  Aging  and  its  corresponding  Regional  Councils,  and  at  several 
virtual  community  forums where  nearly  500  individuals  participated and  gave  testimony,
I thank all of you who took the time to review the plan, provide input and pledge your 
raised questions or shared comments.
support to help us meet our goals.  No one organization can achieve these goals on their own. 
It will take a collaborative well aligned effort to ensure that Pennsylvania can lead the way 
I thank all of you who took the time to review the plan, provide input and pledge your 
and be a model to this nation on how to serve older adults.  The Department of Aging looks 
support to help us meet our goals.  No one organization can achieve these goals on their own. 
forward to working with you on this journey.  
It will take a collaborative well aligned effort to ensure that Pennsylvania can lead the way 
and be a model to this nation on how to serve older adults.  The Department of Aging looks 
forward to working with you on this journey.  

Sincerely,

Sincerely,
Robert Torres 
Secretary

Robert Torres 
Secretary

SECRETARY OF AGING
555 Walnut Street, 5th Floor I Harrisburg, PA. 17101 1 717.783.1550 I aging.pa.gov

SECRETARY OF AGING
555 Walnut Street, 5th Floor I Harrisburg, PA. 17101 1 717.783.1550 I aging.pa.gov

Governor’s Authorization and Verification of Intent 

The Pennsylvania Department of Aging (PDA), serving as the State Unit on Aging, 
hereby submits the Pennsylvania State Plan on Aging for the period October 1, 2020 
through September 30, 2024 and certifies that the development of the state plan is and 
its administration by PDA shall be in compliance with the required assurances and 
provisions of the Older Americans Act. 

This State Plan will serve as a blueprint over the next four years to build capacity, 
promote innovation, implement best practices, improve data management and 
reporting, support healthy living and active engagement, embrace diversity, honor 
individual choice, advocate and protect against elder abuse and strengthen 
accountability.  

PDA will work to enhance the development of comprehensive and coordinated systems 
for the delivery of supportive services, such as aligning health and social services, 
promoting multipurpose senior centers and expanding nutrition services. PDA is 
committed to serving as the commonwealth’s visible and effective advocate for older 
individuals, at-risk older adults, and people with disabilities including their families and 
caregivers. 

_________________________________ 

Robert Torres, Secretary     
Pennsylvania Department of Aging 

 September 10, 2020 
 _____________________________ 

 Date 

I hereby authorize the Pennsylvania Department of Aging, as the designated State Unit 
on Aging for Pennsylvania, to submit the 2020 – 2024 State Plan on Aging to the United 
States Administration for Community Living (ACL) for their approval.  Upon approval of 
the State Plan by ACL, I further direct the Department of Aging to execute the strategies 
outlined in the plan to achieve the stated goals and objectives.  

  September 10, 2020 

____________________________________ 

 ______________________________ 

Tom Wolf, Governor     
Commonwealth of Pennsylvania 

 Date 

Table of Contents 

Mission, Vision, Values  

State Plan Narrative  

Executive Summary 

Context 

 

 

 

 

 

 

 

 

 

 

 
 

 

 

 

 

 

 
 

 

 

 

 

 

 

 

 

 

 
 

 

 

 
 

 

 

PA Department of Aging Background  

State Unit on Aging Operations Overview 

Pennsylvania’s Older Adult Population 

Programs & Funding 

 

 

Core Programs  

Grant Funding 

Councils and Workgroups  

Collaborative Engagement with other  
Commissions & Councils

Other Department of Aging Initiatives  

Emerging Issues and Trends 

State Plan on Aging Development 

Strategic Planning 

Needs Assessment 

Statewide Feedback & Virtual 
Community Conversation

Public Comment & Recommendations  

Quality Assurance 

Goals, Objectives, Strategies, Actions, Outcomes 

Contact Information for PDA, AAAs, ADRCs & P4A 

1

2 

2

4

4

4

5

7

8

9

10

11 

12

12

20

20 

20

21 

22

22

25

44

Mission, Vision, Values

MISSION

VISION

The mission of the Pennsylvania Department of Aging is to promote independence, purpose and 
well-being in the lives of older adults through advocacy, service and protection. 

Our vision is a Pennsylvania where older adults are embraced and empowered to live and 
age with dignity and respect.

CORE VALUES

With older adults at the center of everything we do, we are guided by these core values:

Diversity and inclusion strengthen us.

Innovation drives us.

We are passionate about the customer experience.

We lead strategically to meet future needs.

We listen and effectively communicate with consumers and partners.

We act with integrity.

We value our workforce.

Partnership and collaboration enhance our capacity.

We hold ourselves and partners accountable for results.

We manage resources entrusted to us responsibly.

1  |  2020-2024 Pennsylvania State Plan on Aging

Executive Summary 

The mission of the Pennsylvania Department of Aging (PDA) is to promote independence, purpose and 
well-being in the lives of older adults through advocacy, service and protection. This mission drove the 
development of our federally required four-year state plan on aging. The plan keeps the present and 
future needs of Pennsylvania’s growing and diversifying population of older adults and their caregivers 
at the forefront. The department seeks to both honor and recognize the lives of more than 3 million 
adults over 60 years old who call Pennsylvania home by completing the goals, objectives and strategies 
outlined in this plan.

The development of the plan was accomplished with input, cooperation and support from the public, 
stakeholders and other state agencies who support our mission. Among our primary collaborators were 
the Pennsylvania Council on Aging (PCoA), the Pennsylvania Association of Area Agencies on Aging 
(P4A), and our statewide network of 52 Area Agencies on Aging (AAAs), all of whom support the needs 
of older adults within their respective communities.

We have many unique opportunities to be innovative in our approach to programming, advocacy and 
service for older adults in Pennsylvania, not only during this four-year plan, but well beyond. From 
changing the narrative around what it means to grow older to leveraging the experience and wisdom of 
our diverse and talented older adult population in order to combat ageism. We look to our many part-
nerships to help enliven the spirit of community for Pennsylvanians of all ages and to support our vision 
of a commonwealth where older adults are embraced and empowered to live and age with dignity and 
respect.

Over the next four years, PDA will strategically focus its efforts on the following five overarching goals 
in order to position Pennsylvania to meet the needs of and enhance services for older adults:

Goal One: Strengthen aging network’s capacity, promote innovation and best practices, and build effi-
ciencies to respond to the growing and diversifying aging population.

Goal Two: Improve services for older adults and the ability to advocate for them by using evidence-in-
formed planning, committing to data integrity and being accountable for results.

Goal Three: Establish and enhance efforts to support healthy living, active engagement and a sense of 
community for all older Pennsylvanians.

Goal Four: Emphasize a citizen-first culture that provides outreach, embraces diversity, and honors 
individual choice.

Goal Five: Advocate for the rights of older adults and ensure their safety and dignity by raising aware-
ness of and responding effectively to incidences of abuse, injury, exploitation, violence and neglect.

Currently, one in four Pennsylvanians is over 60 years old. This older adult population is expected to 
reach 4 million, nearly one-third of the total population, by 2030 and remain at that level through 2040. 
While a smaller part of the total population, those 85 years and older, represents a subgroup that is ex-
pected to continue growing steadily to nearly 610,000 in 2040. Among the special concerns of a rising 
85-and-older population is the greater prevalence of comorbidities and higher rate of disability, which 
will increase the demand for home and community-based services.

In addition to the growth of Pennsylvania’s older adult population, it is also becoming more diverse. 
Currently, diverse racial and ethnic groups make up only 12% of the 65-and-older population in PA; 
however, those numbers are expected to grow to 22% by 2050. Hispanics, currently a little over 2% of 
this population, are projected to experience the highest increase in older adults and reach 7% by 2050. 
These projections highlight the importance of continuing to focus on person-centered, culturally com-
petent services and outreach to diverse communities in order to be responsive to the needs of every-
one seeking services.

2020-2024 Pennsylvania State Plan on Aging  |  2

The increasing diversity in our population further extends to the LGBTQ community. The unique needs 
of LGBTQ older adults must be thoughtfully considered in our planning. Although data is still largely 
unavailable, we recognize our responsibility to be responsive to the needs of this growing sector of the 
aging community. We can be responsive by ensuring welcoming spaces, culturally-affirming services, 
and taking the steps necessary to allow these and all older individuals to age with the dignity and re-
spect that every person deserves.

To address the needs of Pennsylvania’s growing and diversifying older adult population, PDA needs to 
remain agile in its ability to respond to emerging trends and to stand ready to advocate for our most 
vulnerable residents. Supporting measures that allow for increased access to telehealth, telemedicine 
and socialization via technology are examples of ways we can help to improve access to health care and 
social services and to reduce social isolation, which are issues addressed by older adults who answered 
the State Plan on Aging 2020–2024 Community and Stakeholder Survey.

Social isolation of older adults is a significant concern because of the negative effect it can have 
on overall health and emotional well-being.  Establishing innovative ways to reduce social isolation 
through new or existing technologies and strategic partnerships is important to impact the very real 
innate human need of simply connecting with others. 

The State Plan on Aging 2020–2024 Community and Stakeholder Survey further validated this point 
when we asked participants to rate 14 factors in terms of importance to age-friendly communities.  
Rating fourth behind predictably high scoring areas like affordable housing, access to in-home services 
and affordable prescriptions was “opportunities to make meaningful connections with others,” reinforc-
ing the need for continued work in this area.

Older adults who are socially isolated are also more susceptible to abuse, neglect, violence, and finan-
cial exploitation and scams perpetrated by people who are either known or unknown to them. Older 
adult protective services, which are overseen by PDA and carried out by AAAs in local communities, are 
the most urgent and critical services we provide. Reports of need for protective services have increased 
97% in the past five years. This rise in reports is due in part to the growing population, but also commu-
nity awareness efforts and targeted training and collaboration with other state agencies and partners. 
The trend of increasing reports of need is expected to continue and serves to highlight the need for the 
department to stay vigilant in the important role we serve in developing policy, providing oversight and 
promoting advocacy of this critical program serving the most vulnerable older Pennsylvanians.

Protective services and other programs administered by PDA, through the AAAs, are financed largely 
by the state lottery and federal funds. Pennsylvania has the distinct advantage of being the only state 
where all proceeds of the state lottery are for programs that benefit older residents. This significant 
infusion of funds each year helps to support major programs like prescription assistance, reduced-fare 
and free transit services, property tax and rent rebate programs, and home and community-based 
services. The state lottery system is critically important in helping to serve and meet the needs of older 
Pennsylvanians.  

Commonwealth residents have resources available to assist them as they age whether they are older 
adults, caregivers of older adults, grandparents raising grandchildren, persons living with a disability, or 
older veterans. This State Plan on Aging provides a comprehensive roadmap to improve access to and 
the quality of services for older adults. PDA is committed to working tirelessly to implement this plan to 
improve quality of life and well-being for all older adults.

3  |  2020-2024 Pennsylvania State Plan on Aging

Introduction & Context

PDA was created by Pennsylvania’s Act 70 of 1978, which established “a cabinet-level State agency 
whose jurisdiction, powers, and duties specifically concern and are directed to advancing the well- 
being of Pennsylvania’s older citizens.” It further established that PDA would “serve as an advocate for 
the aging at all levels of government.” 

As the State Unit on Aging (SUA) for Pennsylvania, PDA provides the strategic vision and leadership 
to develop and administer programs and services to meet the many unique needs of older adults and 
their caregivers through a network of 52 local AAAs. In addition to administering state and federal 
funding to the AAAs and ensuring adherence to contract requirements, PDA also provides policy guid-
ance, programmatic structure, data collection systems management, technical assistance, quality assur-
ance and training.

PDA, as the SUA, is federally required by the Older Americans Act (OAA) of 1965, as amended, to sub-
mit a state plan on aging to the Administration for Community Living (ACL) at the U.S. Department of 
Health and Human Services (HHS) at least once every four years. Local AAAs are similarly required to 
develop area plans for their local planning and service area which align with the state plan both in tim-
ing and, while keeping local needs in mind, content. Area plans undergo a similar development process 
to the state plan and are submitted to PDA for review and approval.

As part of the state plan development process, PDA must ensure the steps taken to create the state plan 
and the execution of the plan over the next four years adhere to assurances required by ACL. For the 
development of the state plan, this includes things like conducting a needs assessment, ensuring we 
seek public input on our plan, developing plan goals that align with the four focus areas identified by 
ACL and allowing for public feedback on the state plan draft. For the execution of the plan, it includes a 
promise that the department will adhere to its programmatic obligations under the OAA and be ac-
countable to our plan by having measurable outcomes and transparently reporting results.

This plan is the product of a development process that began as an internal strategic planning meeting 
amongst the leadership team at PDA in mid-2019 and grew through the input of our staff, valued stake-
holders and the public to be a robust, living, 2020-2024 strategy for the department.

State Unit on Aging Operations Overview

In conjunction with administering the OAA and ACL discretionary grants, PDA coordinates a compre-
hensive array of services that benefit older Pennsylvanians, their families, their caregivers, and the aging 
network. These services are made available primarily through the network of 52 local AAAs across the 
commonwealth. With guidance from the department, AAAs are responsible for planning, developing, 
and implementing a system of services for persons age 60 and over in their respective PSAs. 

In addition to the AAAs, the aging network includes senior community centers, adult daily living cen-
ters, Aging and Disability Resources Centers (ADRCs), direct care workers and other providers. These 
partners are crucial to the delivery of services and the well-being of older Pennsylvanians. 

By recognizing the importance of our internal and external partnerships and leveraging resources 
through discretionary grants and other funding sources, we are continually striving to expand our  
capacity to serve older adults in new and innovative ways. 

2020-2024 Pennsylvania State Plan on Aging  |  4

3.4M+
Adults 60 Years Old and 
Older in Pennsylvania

234K
Direct Care  
Workers

300+
Long-Term Care  
Advocate Ombudsman

52
Area Agencies  
on Aging

2K
Aging and Disability  
Resources Center  
Partner Organizations

513
Senior  
Community Centers

247
Adult Daily  
Living Centers

Population

Pennsylvania’s rapidly growing older adult population is also growing enriched with diversity, making 
the commonwealth a desirable place to live and age. Currently, one in four Pennsylvanians is over 60 
years old, but in the next 10 years, the population shift is expected to be such that nearly one-third of 
our population will be over 60 years old.

While the 60-and-older population swells to nearly 4 million people and is estimated to hold rather 
steady for a number of years after 2030, there is expected to be a marked, steady increase in the 85 
years old and older age group. In fact, it is expected the number of the oldest older adults (85+) in 2040 
will be double the number there were in 2010. Projected increases in the oldest older adult (85+) are 
important to consider in our plans because they are more likely to be living with multiple health condi-
tions or disabilities. They are also more likely to live alone and be at risk for social isolation.

5  |  2020-2024 Pennsylvania State Plan on Aging

The growing older adult population is also becoming more diverse. This changing demographic is 
adding the experience and wisdom of older adults of different races, ethnicities, cultures, backgrounds, 
sexual orientations and gender identities. At the PDA, our first core value is “diversity and inclusion 
strengthen us,” so meeting the needs of our diversifying older adult population is an exciting challenge 
and opportunity. It will require us to continue to develop services that reach, speak and are responsive 
to every older Pennsylvanian who needs them.

 88% 

7% 

2% 

3%

 86% 

8% 

3% 

3%

 78% 

9% 

7% 

6%

PDA recognizes another layer of diversity includes the varying level of ability of each individual. Older 
adults live with disabilities at a much higher rate than adults 18-59, often with co-occurring conditions. 
Living with disabilities can make it difficult to access needed services and participate in opportunities 
like volunteerism, senior centers and other activities. 

2020-2024 Pennsylvania State Plan on Aging  |  6

47.5%

23.8%

21.4%

8.6%

8.5%

3.6%

12.2%

4.8%

11.7%

3.8%

30.2%

14.3%

Programs & Funding

Older adults in Pennsylvania have access to a variety of aging programs and services funded by state 
and federal resources. A distinct advantage for older adults in the commonwealth is that our program-
ming receives a significant amount of funding through the state lottery.

The Pennsylvania Lottery is the only state lottery that designates all of its proceeds to programs that 
benefit older residents. Thanks to loyal PA Lottery players, the PA Lottery has been able to contrib-
ute more than $30 billion to programs for older adults since the lottery began in 1972. In 2019, the 
Pennsylvania Lottery generated more than $1 billion in PA Lottery benefits for those programs, many 
of which would not exist without this funding. These include property tax and rent rebates, free and 
reduced-fare transit services, low-cost prescription drug programs, and an array of home and commu-
nity-based services.

Specific to PDA’s programs and services, which do not include PA Department of Human Services 
Medicaid-funded home and community-based services for older adults and nursing facility care, our 
funding is as follows: For fiscal year 2020-21, the lottery generated $463,795,000 toward services and 
supports for older Pennsylvanians. This represents 81% of the total budget for PDA-administered pro-
grams and services. PDA’s budget also included $104,717,000 in federal funding and $796,000 in other 
augmentations.

PDA allocates state and federal funding to PSAs across the commonwealth through allocations to AAAs 
calculated by an Intrastate Funding Formula approved by ACL. The weighted formula takes into consid-
eration the population of older adults who are of greatest economic and social need. In particular, the 
formula considers the following factors: Low-income persons 60 years and older (at or below 100% of 
poverty), rural population 60 years and older, minority persons 60 years old and older, persons 75 years 
old and older, and persons 60 years old and older. The term “block grant” refers to state funds and not 
federal funds throughout this document.

7  |  2020-2024 Pennsylvania State Plan on Aging

Core Programs

Adult Daily Living 
Centers

Available through our OPTIONS program, Adult Daily 
Living Centers can provide supervision and support for 
older adults one or more days a week

APPRISE Free and objective one-on-one Medicare counseling 

Caregiver Support 
Program

from trained APPRISE volunteers
Program of supports and services designed to ease  
caregiver stress

Education Programs Medication management, nutrition classes, health 

screenings, and more

Health & Wellness Evidence-based exercise, chronic disease management, 
falls prevention and other classes
Nutrition Services Provide direct meal service and nutrition counseling at 
no charge to eligible individuals
Provides legal assistance, advocacy and counseling for 
qualifying older adults on a variety of issues

Older Pennsylvanians 
Legal Assistance  
Program
Office of the  
Long-Term Care  
Ombudsman
Ombudsman: PA 
Empowered Expert 
Residents (PEERs)
OPTIONS – Help at 
Home

PA Link to Aging & 
Disability Resources

PACE & PACENET 
Prescription  
Assistance
PA Patient  
Assistance Program 
Clearinghouse 
(Sponsored by PACE)

Advocacy and complaint resolution for individuals living 
in long term care facilities such as nursing or personal 
care homes and assisted living facilities
In-facility long-term care advocate residents, available to 
assist other residents in understanding their rights

Cost-shared in-home services which could include care 
management, personal care, home modifications, home 
health care, adult day care, home-delivered meals,  
transportation and other services
Person-centered information and assistance for  
accessing long-term services and supports for adults 18 
years and older. PA Link: 1(800)753-8827
Income-based eligibility low-cost prescription  
medications for qualified residents age 65 and older. 
PACE/PACENET: 1(800)225-7223
Adults 18 and older can call the Clearinghouse for  
assistance with a variety of medical, food, housing,  
employment, and other programs. Statewide  
Clearinghouse: 1(800)955-0989

Protective Services Protection for adults 60 years old and older from  

physical, emotional and financial abuse, exploitation, 
neglect and abandonment. Statewide hotline:  
1(800)490-8505

Senior Centers Offer socialization, activities and free, nutritious meals in 

a congregate setting

Senior Employment Federally funded program providing job training and 

employment for low-income adults 55 and older

Transportation Free and discounted rides to assist older adults getting 

to medical appointments, senior centers and other  
essential destinations
The Department has many volunteer opportunities for 
older adults and others. Express your interest here.

Volunteer  
Opportunities

2020-2024 Pennsylvania State Plan on Aging  |  8

Grant Funding

In addition to state and federal funding, PDA seeks ACL and other discretionary grants in order to 
develop innovative programs that allow us to expand our capacity, strengthen the aging network, and 
better serve Pennsylvania’s older adults and those living with a disability.

The following are current grant initiatives at PDA:

Aging and Disability Resources Center Grant

The ADRC, also known as PA Link, was awarded a $3 million grant in April 2020 from HHS-ACL to sup-
port capacity and resource allocation for the PA Link at the state and local level in its efforts to prevent, 
prepare for and respond to COVID-19. All activities within the scope of the grant will be completed 
within the performance period, which ends in September 2021.

Funded activities include:

•	

Implementing e-services for PA Link staff and consumers to assist and overcome challenges 
related to accessing PA Link programs

•	 Supporting those most at risk in seeking transitional support from hospital-to-home and nurs-

ing home-to-home by using aging network supports

•	 Collaborating with local grocery stores, restaurants, mobile food ordering and delivery services 

to provide groceries to consumers in need

•	 Assisting older adults, people with disabilities, caregivers and clinicians to understand how to 
use telehealth technologies to provide and receive needed services and to reduce social isola-
tion

•	 Providing personal protective equipment (PPE) for PA Link partners to ensure in-home supports 

can be maintained

•	

Increasing public awareness of the PA Link helpline

•	 Providing consumers with the ability to request periodic check-in calls by trained staff and 

increase awareness of consumers to low-cost programs that connect individuals through broad-
band and telecommunication equipment

•	 Assisting the PA Link network partners to respond to requests from consumers in need of  

resource information and assistance

Protective Services Office Grant

The Protective Services Office was awarded a $1.568 million grant in September 2018 from ACL to col-
laborate with Pennsylvania Department of Health’s Community Health Nurses to enhance services for 
older adults at risk of or found to be neglecting their own care needs and provide a multi-faceted ap-
proach to reducing identified risks. All activities within the scope of the grant will be completed within 
the performance period, which ends in August 2021.

Funded activities include:

•	 Providing person-centered one-on-one health education from a community health nurse to 

older adults at risk of, or who are currently neglecting their own care needs 

9  |  2020-2024 Pennsylvania State Plan on Aging

•	 Educating older adults and the general public about elder abuse and reporting and available 

community programs designed to assist them in maintaining their health and wellness

Protective Services Office Grant

The Protective Services Office was awarded a $600,000 grant in September 2019 as a subgrantee from 
the PA Commission on Crime and Delinquency (PCCD) Office for Victims of Crime to enhance the deliv-
ery of protective services for older adults through technology. All activities within the scope of the grant 
will be completed within the performance period, which ends in August 2021.

Funded activities include:

•	 Development and implementation of an online protective services report of need to increase 

access for the public to report elder abuse electronically

•	 Development of an electronic data dashboard designed to assist investigative staff to most 

efficiently manage the needs of victims in accordance with Pennsylvania’s Older Adult Protective 
Services Act (OAPSA)

•	 Enhancement of the functionality of the statewide Elder Abuse Reporting Hotline (1-800-490-

8505)

Councils and Workgroups

The department has several councils that we consider to be key partners in advancing efforts on legisla-
tion, policy discussions, advocacy and more. They advise the department on current trends within older 
adult serving systems of care and provide recommendations on emerging issues.

Pennsylvania Council on Aging

The Pennsylvania Council on Aging (PCoA) was created in 1977 by Pennsylvania Statutes Title 71 State 
Government § 581-4 (Administrative Code § 2204-A). The 21 members who make up the council (the 
majority of whom are required to be age 60 or older) are nominated by the governor and subject to 
Senate confirmation. Five members of the council serve as chairs of five separate regional councils.  
Council members represent all older Pennsylvanians and serve as advocates for older adults and advise 
the governor and the department on planning, coordination, and delivery of services to older adults. 

Pennsylvania Long-Term Care Council

The Pennsylvania Long-Term Care Council (LTCC) was established by Act 64 of 2015, replacing the In-
tra-Governmental Council on Long-Term Care in order to reflect today’s broader long-term care con-
tinuum. Chaired by the Secretary of Aging, the council is comprised of 35 members appointed by the 
governor, in consultation with the Secretary of Aging, including long-term care consumers, advocates, 
caregivers, providers, and policymakers. The LTCC consults with various departments and agencies 
to make recommendations on regulations, licensure, financing, or any other responsibilities of those 
departments or agencies relating to long-term care. The council’s scope includes all areas of long-term 
care, including, but not limited to, institutional care and home and community-based services. 

Cultural Diversity Advisory Council 

The Cultural Diversity Advisory Council advises PDA on developing and sustaining a network of pro-
viders and services that are culturally sensitive, responsive, and inclusive to the diverse needs of Penn-
sylvania’s older adults. The council is comprised of AAA representatives and stakeholders from diverse 
backgrounds and perspectives. 

2020-2024 Pennsylvania State Plan on Aging  |  10

Alzheimer’s Disease and Related Disorders (ADRD) Task Force

The ADRD Task Force was established in 2018. It was created to take a lead role in implementing the 
goals and recommendations of the Pennsylvania State Plan for ADRD. The objectives of the Task Force 
include:

•	 Working with local organizations, entities, advocates, and other stakeholders to identify and 
share best practices that support the goals and overall success of the ADRD State Plan at the 
local level

•	 Developing and facilitating the actions needed to carry out the recommendations and goals of 

the ADRD State Plan

•	 Encouraging research and reviewing any other issues that are relevant to ADRD
•	 Assisting in planning the annual ADRD Forum
•	 Leading efforts to review and revise the ADRD State Plan, as necessary

Task force members represent a diverse group of individuals and organizations from across the com-
monwealth. Its members include individuals and families living with ADRD, representatives from the 
Alzheimer’s Association, consumer advocacy groups, long-term care organizations, and other profes-
sionals. The ADRD Task Force is comprised of a chair and 15 members and meets at least quarterly.

Collaborative Engagement with other Commissions & Councils

Governor’s Commissions 

As part of the Administration’s promise of a commonwealth committed to providing equality and 
opportunity for all its citizens, there are several commissions that advocate for and advise the Admin-
istration on the unique needs of diverse communities. Pennsylvania currently has five commissions: 
Commission on African American Affairs, Commission on Asian Pacific American Affairs, Commission 
on Latino Affairs, Commission on LGBTQ Affairs (established by Governor Tom Wolf and the first in the 
nation), and Commission for Women. Members of the commissions are appointed by the governor and 
have representation across the state. 

PDA has developed well-established relationships with several commissions and consider them a valued 
resource in helping the department reach out and build trust within their communities.  Commissions 
are a resource to PDA to ensure our outreach connects us with OAA targeted groups. A powerful exam-
ple of these partnerships is the relationship built with the PA Commission on LGBTQ Affairs. This com-
mission has an aging workgroup that includes a participating representative from PDA. This relationship 
has allowed for many collaborations, as well as sharing of information including the submission of 
formal recommendations to PDA to help inform this plan.

PA Supreme Court Advisory Council on Elder Justice in the Courts

The Advisory Council on Elder Justice in the Courts was established in 2015 to advise the Office of Elder 
Justice in the Courts regarding the implementation of the Elder Law Task Force’s Report and Recom-
mendations regarding best practices, judicial rules, and legislation to benefit elder citizens of the com-
monwealth. The mission of the Advisory Council on Elder Justice in the Courts is to identify and address 
elder justice issues affecting the commonwealth’s elders. As part of their roles at PDA, both the Secre-
tary of Aging and Chief Counsel are among the 24 members of this Council, which strategizes around 
elder justice matters such as guardianship, grandfamilies rights, protective services and others at their 
quarterly meetings.

11  |  2020-2024 Pennsylvania State Plan on Aging

Other Department of Aging Initiatives

University of Pennsylvania Behavioral Health Lab Partnership

To comprehensively serve beneficiaries of the Department’s Pharmaceutical Assistance Contract for the 
Elderly (PACE), the program partners with the University of Pennsylvania to provide evidence-based, 
algorithm-driven services through the university’s Behavioral Health Lab (BHL) program.

The Behavioral Health Lab program seeks to address depression, anxiety, and dementia, which are prev-
alent later in life and lead to significant morbidity and disability, thereby contributing to increased use 
of medical services, nursing home utilization, and mortality.

The BHL program has three arms:

•	 Supporting Seniors Receiving Treatment and Intervention (SUSTAIN) – outreaches to cardholders 

•	 Caregiver Resources, Education, and Support (CREST) – addresses the needs of caregivers of 

with depression or anxiety problems

cardholders with dementing illnesses

•	 High Dose Opioid Program (HDO) – provides cardholders with an innovative approach to man-

aging chronic pain and addressing the unmet psychosocial needs that contribute to the cycle of 
chronic pain

Emerging Issues and Trends

COVID-19 and the Future of Service Delivery 

The emergence of the COVID-19 pandemic, during the development of this four-year state plan, and 
its impact on older adults, has elevated the importance of the key services provided by SUAs and the 
AAAs. The delivery of nutrition services, in-home services and support, protective services and check-
in services for older adults who faced adverse impacts from being socially isolated, were particularly 
critical during this emergency.  

The overwhelming concern about social isolation of seniors during this pandemic has raised the level of 
awareness of the problem and interest, from both the public and private sectors, in helping to address 
it. This experience has also created opportunities to adapt and innovate how we deliver services to and 
support our seniors. Leveraging new partnerships and technology solutions will be key strategies for 
this plan to better support and empower older adults in ways we may not have imagined before this 
pandemic.  

Addressing Racial Discrimination & Inequities 

As Pennsylvania’s older adult population continues to grow and become more diverse, it is important 
for PDA and AAAs to consider the implications that racial discrimination and systemic inequities have 
on individuals as they age. This includes issues, like health disparities, that were magnified during the 
COVID-19 pandemic. PDA and the AAAs are working during this plan to train on issues like unconscious 
bias, diversity and inclusion, cultural competence and trauma in order to more effectively outreach and 
be responsive to the needs of diverse older adults. 

As the state unit on aging, we are bound by the OAA to ensure that preference will be given to provid-
ing services to older adults with greatest economic need and greatest social need. Greatest economic 
need means the need resulting from an income level at or below the poverty line. Greatest social need 
means the need caused by non-economic factors, which include: Physical and mental disabilities; lan-
guage barriers and cultural, social or geographical isolation, including isolation caused by racial or eth-
nic status. We are further called specifically to undertake program development, advocacy and outreach 
efforts focused on the needs of low-income minority individuals.

2020-2024 Pennsylvania State Plan on Aging  |  12

Alzheimer’s Disease and Related Disorders 

Currently there are an estimated 280,000 people aged 65 and older in Pennsylvania who are living with 
Alzheimer’s Disease. By 2025, that number is expected to increase by 14.3% to 320,000. Alzheimer’s 
Disease and related dementias touch nearly every family in some way. For caregivers, the burden can 
be extreme. In Pennsylvania, 677,000 family caregivers provide 771 million hours of unpaid care valued 
at $10.1 billion. At PDA, we not only focus on services for older adults who need help or assistance to 
remain in their homes, we also support these caregivers. The help and support of unpaid friend and 
relative caregivers for loved ones living with Alzheimer’s and other dementias is indispensable. 

PDA consistently partners with the two Pennsylvania chapters of the Alzheimer’s Association on pro-
grams, services and outreach for the benefit of people living with Alzheimer’s Disease and all dementias 
and their caregivers throughout the commonwealth. During the state plan period, we will engage the 
Delaware Valley and Greater Pennsylvania Chapters in several collaborative efforts:

•	 Community outreach to increase community and volunteer engagement and develop new com-

munity partnerships, with a focus on underserved and diverse communities

•	 Building public and private partnerships with health systems, public health centers and clini-

cians to change the way we diagnose, treat and support the aging population, especially around 
dementia and cognitive decline

•	 Engaging in evidence-based, person-centered best practices to deliver quality care and support 

in long-term care and community-based settings

•	 Marketing to increase public awareness and messaging about dementia and the importance of 

access to care, early detection, diagnosis, and risk reduction

Dementia Friendly PA

Dementia friendly communities promote communities working together to allow people living with 
dementia to remain in the community to engage with family and others in their day-to-day life. The 
Dementia Friends PA movement has trained over 4,200 people as dementia friends in the two short 
years since the program started. The department has partnered with Dementia Friends PA to train all 
our staff, the ADRD Task Force and AAA directors with plans to spread this movement to every county in 
the commonwealth. 

LGBTQ Age-Friendly PA

In October 2018, PDA held the inaugural LGBTQ Aging Summit with the theme, “Connecting Communi-
ties & Inspiring Change.” The objective of this historic summit, attended by over 300 LGBTQ community 
leaders and advocates, AAA staff, providers, and other stakeholders, was to raise awareness and mo-
bilize collaborative efforts to support LGBTQ older adults. Since the summit, the department and the 
Pennsylvania Commission on LGBTQ Affairs have partnered to continue working on the issues raised at 
the summit and make further progress. The commission has also created an aging workgroup to help 
focus the work to remove obstacles and ensure equality and inclusive programming for LGBTQ older 
adults. The department has a participating member in the workgroup.

One of the key action items from the 2018 LGBTQ Aging Summit was the need for our aging network to 
have the cultural competency to make our entire organization welcoming, friendly and a safe space for 
LGBTQ older adults. PDA partnered with SAGECare, a training arm of the national advocacy organization 
SAGE to provide comprehensive cultural competency training for leadership and staff of PDA, P4A lead-
ership and staff, and AAAs. PDA has received platinum-level SAGECare credentials, and once trainings 
are completed throughout the network, Pennsylvania will be the first state nationally to achieve this 
level of training with its state unit and AAAs. We plan to continue to roll out this training to more of our 
OAA programs during this state plan period.

13  |  2020-2024 Pennsylvania State Plan on Aging

Further action items from the summit include the need to collect sexual orientation and gender iden-
tity (SOGI) data on our consumers. In order to most effectively serve all older adults, we believe data 
collection that supports comprehensive care planning is critical, so the department has action steps to 
implement the collection of SOGI data. Data nationally on this topic is limited; however the American 
Community Survey completed a one-year estimate of same-gender households for select U.S. cities in 
2017. Results of this survey indicated that Philadelphia households included 1% same-gender couples. 
Collection of SOGI data will allow PDA to improve care plans for individuals and contribute to more 
effective program development for LGBTQ older adults.

Integration of Healthcare & Social Services

Pennsylvania currently has four AAAs that have been members of a health information exchange (HIE), 
receiving valuable benefits such as quicker access to medical information on consumers, future ap-
pointments, notification of emergency room visits and hospital admissions, allowing the AAAs to more 
effectively manage their resources and better support their consumers. As a result, PDA has promoted 
and facilitated the participation of all AAAs in health information exchanges to take advantage of and 
leverage the integration of healthcare and social services data. This will provide a holistic picture of an 
individual’s health and social support status enabling healthcare providers, AAAs and other social ser-
vices organizations to better support older adults.

Affordable/Available Housing

In Pennsylvania, nearly one-third of all households have at least one person over 65 living in them. In 
fact, there are more than 630,000 individual householders over 65 in Pennsylvania who live alone. PDA 
recognizes that access to safe, affordable, inclusive and accessible housing is a key factor to being able 
to age in place. 

The PDA State Plan Community and Stakeholder Survey revealed just how important this is to Pennsyl-
vanians when respondents were asked to rate the importance of affordable/available housing to ensur-
ing age-friendly communities for older adults over the next five years:

 

46% 

33% 

16% 

3% 

2%

2020-2024 Pennsylvania State Plan on Aging  |  14

PDA’s Division of Housing and Community Services is addressing the need for affordable housing by 
collaborating with local, state, and federal agencies to develop and implement innovative housing pilot 
projects to expand housing options for older adults throughout the commonwealth. The pilots have 
created affordable and accessible housing options that can be replicated in communities statewide and 
have proven to be successful options for older adults to remain in their homes and communities. Ongo-
ing initiatives include:

•	 Shared Housing and Resource Exchange (SHARE) is an ongoing shared housing pilot program 

funded by a Money Follows the Person (MFP) grant from the Centers for Medicare and Medicaid 
Services (CMS). This pilot has been successfully implemented in Pike, Wayne and Monroe coun-
ties, with expansion plans in several other counties throughout the state plan period.

•	 Elder Cottage Housing Opportunity (ECHO) cottages in Clearfield County have successfully 

placed two units housing two older adults, and in July 2020 through a partnership with PDA, 
P4A was awarded a $400K PHARE Grant (Pennsylvania Housing Affordability and Rehabilitation 
Enhancement Fund) which is expanding the ECHO cottage program to several other counties.

Direct Care Worker Shortage 

Pennsylvania’s more than 234,000 direct care workers are critically important to the long-term services 
and supports system (LTSS), helping older adults remain connected to their communities and live their 
best lives possible as they age. Our state faces a growing crisis, however, due to a shortage of these 
crucial paid caregivers. In April 2019, PDA’s LTCC released its Blueprint for Strengthening Pennsylvania’s 
Direct Care Workforce. The report cites low wages, high turnover and lack of a clear career path as just 
a few of the reasons for the shortage. As the older adult population in the commonwealth continues 
to grow, especially in the oldest age category of those over 85, there will be an even higher demand 
for direct care workers. This need was further supported in our State Plan Community & Stakeholder 
Survey, in which over 80% of respondents over 65 years old categorized the need for access to in-home 
care and services as either “absolutely critical” or “very important” to age-friendly communities.

The volatility experienced by this workforce due to low wages, minimum training and high emotional 
and physical demands threatens both access to and the quality of services and supports on which many 
older Pennsylvanians depend. This further jeopardizes continuity of care – a proven factor in improved 
health outcomes. The recommendations contained in the LTCC’s blueprint provide strategies needed to 
empower this workforce and LTSS providers in order to meet the increasing need. PDA is committed to 
pursuing initiatives that remove barriers to entering and remaining in this noble profession.

Hunger and Food Insecurity

According to the America’s Health Rankings 2020 report, food insecurity among older adults is  
expected to increase through 2050 as the baby boomers continue to age. Older adults may report  
missing meals due to a variety of factors including functional limitations affecting their ability to  
prepare them, lack of social support, lack of transportation, and having to choose between food and 
other necessities because they can’t afford both. Food insecurity can have a negative impact on  
overall health for older adults, including increased incidence of heart attack, congestive heart failure, 
high blood pressure, depression, exacerbation of chronic conditions and others. 

15  |  2020-2024 Pennsylvania State Plan on Aging

The America’s Health Rankings 2020 report also found that 14.7% of Pennsylvania adults age 60 and 
older faced the threat of hunger in the preceding 12 months. Although the Supplemental Nutrition 
Assistance Program (SNAP) reaches qualifying older adults in poverty in our commonwealth, there are 
opportunities to be creative in how we execute nutrition services provided through the OAA that might 
allow us to better reach and serve individuals at greater risk for food insecurity, including older adults 
who are black/African American, are Latino, live with a disability, live alone, live in poverty, or live in a 
food desert.

Financial Exploitation 

Financial exploitation is a rapidly growing form of elder abuse which has catastrophic impacts on both 
the individual and the economy. As a result of Governor Tom Wolf’s Executive Order on the Protection 
of Vulnerable Populations, PDA was directed to conduct a study, in 2020, of the current impact of finan-
cial exploitation on older Pennsylvanians and the commonwealth. The study found that over 80% of 
victims lived in urban communities, over 60% were female, and nearly two-thirds were either widowed 
or single. The study further found that the average age of a victim was 79 years old.

As a result of the study, the department is implementing several recommendations over the course 
of the state plan. These recommendations include updating the statutory and regulatory language of 
Pennsylvania’s Older Adults Protective Services Act; creating an intra-agency financial exploitation team 
to explore opportunities across state government to address regulatory barriers to reporting financial 
abuse; creating a task force comprised of state agencies and stakeholders; and enhancing communi-
cations to increase prevention education and outreach strategies to those most vulnerable to being 
financially exploited.

Opioid Crisis

PDA is an active member of Pennsylvania’s OPIOID Command Center and works to ensure older adults 
have access to the treatment they need. While older adults are not often directly impacted by opioid 
addiction, the department plays a role in educating them on safe storage, use and proper disposal of 
unused medications.  

PDA’s Pharmaceutical Assistance Contract for the Elderly (PACE) Program has opioid case management 
built into each enrollee’s file. The program holds and edits opioid claims if they seem inappropriate and 
offers real-time assistance to pharmacies to ensure proper dispensing. 

PACE also utilizes academic detailing through a partnership with Harvard University to provide physi-
cian-to-physician education on the latest and best practices on prescribing opioids to older adults. Ses-
sions include information on treating chronic pain with non-opioid and non-pharmacological therapies, 
when possible.  

Grandfamilies

According to the U.S. Census Bureau 2018 American Community Survey 5-Year Profile, more than 
235,000 grandparents lived with their grandchildren under 18 years old in Pennsylvania, and of that, 
over 84,000 were responsible for the basic needs of their grandchildren. Grandparents and other older 
relative caregivers of children face emotional, financial, and legal challenges as they raise children a sec-
ond time, often unexpectedly. The need to provide effective and comprehensive support to these care-
givers, particularly grandparents raising grandchildren, is vital to ensuring they have access to resources 
that will strengthen their caregiving relationship.    

2020-2024 Pennsylvania State Plan on Aging  |  16

The department has been actively advocating for the needs of grandfamilies through collaborations 
with other state agencies, stakeholder groups, advocacy organizations, the legal community including 
the Pennsylvania Supreme Court Advisory Council on Elder Justice, SeniorLAW Center and legislators. 
PDA’s Caregiver Support Program (CSP) provides resources and assistance to caregivers, including 
grandfamilies, with the purpose of alleviating stress and enhancing the caregiving relationship. Grand-
families can benefit from reimbursements for care-related and respite expenses through this program. 
However, there is more work to be done for all of Pennsylvania’s grandfamilies.

The PA Joint State Government Commission Report, Grandfamilies in Pennsylvania: “The Second Time 
Around”, recommends the Caregiver Support Program be expanded to serve grandparents under the 
age of 55. While the PDA CSP will continue to serve individuals 55 and older, we hope to expand the 
program by removing the statutory CSP monthly care plan cost cap and allowing it to be set by the de-
partment; removing the $300 aggregate average requirement for all CSP cases; removing the assistive 
devices limit and $2,000 CSP home modification lifetime limit and allowing it to be set by the depart-
ment.

Social Isolation 

Social circles change as we age, and while there are many definitions of social isolation, it is, in essence, 
a lack of meaningful social connections. For older adults, the type and number of connections shift 
with changing social roles, increasing the risk of isolation. Social isolation can have a negative impact 
on physical health, mental well-being and is associated with a lower use of healthcare and an increased 
risk of mortality. Strong social support and connection, however, have positive effects on health and 
well-being.

The U.S. Census American Community Survey uses six measures as risk factors for social isolation, which 
includes the status of an individual on each of the following: Poverty; living alone; divorced, separated 
or widowed; never married; disability; and independent living difficulty. According to the 2018 5-Year 
American Community Survey, Pennsylvania ranks higher in terms of the number of adults 65 and older 
having these risk factors on four of six factors.

Source: U.S. Census Bureau, American Community Survey, 2014-2018

35.3%

38.7%

13.9%

10.9%

5.4%

8.8%

34.1%

38.9%

14.2%

12.6%

6.6%

8.1%

17  |  2020-2024 Pennsylvania State Plan on Aging

Social isolation has long been a concern of the department. Efforts to study social isolation, develop 
tools to address isolation and mitigate risk are being driven by the Social Isolation Task Force of the 
PCoA. However, the COVID-19 pandemic magnified the focus on social isolation and the issue gained 
the department’s full attention when older adults who attended senior centers daily suddenly needed 
to stay home for their safety.  

As the council’s work continues, so do innovative projects and partnerships at the department aimed at 
addressing this problem. For example, our Office of the Long-Term Care Ombudsman partnered with 
AARP Pennsylvania to provide phones and tablets to nursing facilities to increase the opportunity to al-
low residents to interact virtually with their loved ones. In addition, the department is developing part-
nerships within the state university system to match older adults at risk of social isolation with students 
who need service learning encounters as part of their degree program.

Technology

Access to technology is something many of us may take for granted. Yet there are nearly 1 million 
Pennsylvanians, including older adults, without broadband internet access. As the COVID-19 pandem-
ic demonstrated, many aging adults could benefit from technology to remain at home and virtually 
connect with loved ones, obtain food and medications, participate in telehealth/telemedicine and even 
socialization. 

The push for high-speed internet everywhere in Pennsylvania has been a part of Governor Wolf’s Re-
store Pennsylvania initiative that addresses the commonwealth’s vital infrastructure needs. In August 
2019, PDA participated in a listening session held by the governor’s office on the initiative, which could 
make a difference for aging adults with telemedicine, home monitoring, fall prevention, and staying 
connected to prevent social isolation. 

The PCoA has voiced its unanimous support of the governor’s Restore PA initiative. Older adults make 
up the fastest-growing age group to use technology, and when they are given the opportunity to learn 
about technology and how to use it, their communication with family and friends increases. In April 
2020, the PCoA released the findings of its statewide survey on how older adults managed during the 
COVID-19 pandemic and the results revealed an eagerness to learn about and use technology. Further, 
the State Plan Community and Stakeholder Survey uncovered a strong desire for accessible and avail-
able technology.  

Mental Health

A lack of connection with loved ones and friends can put older Pennsylvanians at risk of social isolation, 
which could lead to depression, loneliness, lack of self-care and more. Many aging and disability com-
munities lack a system of support to treat mental health, while many facilities specializing in mental 
health services do not have appropriate accommodations to properly serve older adults and people 
living with disabilities. 

Suggestions to help combat mental health among older Pennsylvanians include: Provide specialized 
training for mental health providers, reevaluate billing codes that may hinder proper care and treat-
ment, improve accessibility to services, place social workers specialized in geriatrics in senior centers, 
encourage hospitals and medical practices to seek accreditation through the Age-Friendly Health Sys-
tems initiative, and develop destigmatizing public service announcement campaigns involving different 
cultures and age groups. 

According to a 2017 study from the University of Southern California, approximately 1 million adult 
Pennsylvanians struggled with serious psychological distress at least once in 2015. Of those adults, 
more than 27% had an unmet need for mental health care. That population includes 42% who did not 
receive mental health care because they could not afford it.

In early 2020, PDA hosted two roundtable discussions that focused on reducing stigma and under-
standing mental health issues and service needs. The discussions were in coordination with the gover-
nor’s Reach Out PA: Your Mental Health Matters initiative, which is aimed at expanding resources and 
the state’s comprehensive support of mental health and related health care priorities in Pennsylvania.

2020-2024 Pennsylvania State Plan on Aging  |  18

Trauma-Informed Pennsylvania Plan 

On July 27, 2020, the Wolf Administration released its “Trauma-Informed PA” plan to guide the com-
monwealth and service providers on what it means to be trauma-informed and healing-centered in 
Pennsylvania. The implications of trauma and stress on individuals as they age is a particular concern 
for PDA. Throughout the state plan period, PDA will be promoting and facilitating training within the 
department and to aging network partners to help recognize and be more responsive to older adults 
impacted by trauma.  

The Trauma Informed Plan focuses on six key areas:

1.  Ensuring that state culture is trauma-informed through universal training
2.  Ensuring state agencies’ policies and practices are trauma-informed and more focused on pre-

vention and healing

3.  Mandating that all licensed and funded entities become trauma-informed
4.  Building and supporting grass roots/community-based efforts to become trauma-informed in 

every part of the commonwealth

5.  Recognizing and healing from traumas of major crisis like COVID-19
6.  Preventing and healing racial, communal and historical traumas, whether they be individual or 

systemic

Suicide 

Suicide is a public health concern that affects all communities and in PA, is on the rise in older adults.  
For men, older adult suicide rates are considerably higher than that of younger adults. Suicide is also 
higher in white older adults than in people of color. In the LGBTQ community, lifelong experiences of 
discrimination and homophobia now coupled with ageism can cause feelings of grief that are difficult 
to overcome; and with the information available anecdotally, the number of suicides in LGBTQ older 
adults is also on the rise.

According to the Centers for Disease Control and Prevention, one out of four older adults who attempts 
suicide dies. While the exact reasons for that figure remain unknown, researchers suggest aging adults 
are frailer and therefore more vulnerable to self-inflicted injury. They can also be more isolated, which 
makes rescues more difficult, and they perhaps even plan their attempts more carefully. Men who are 65 
and older face the highest risk of suicide, while adults 85 and older, regardless of gender, are the sec-
ond most likely age group to die from suicide. 

In late 2019, PDA participated in several listening sessions held across the commonwealth by the Penn-
sylvania Suicide Prevention Task Force. These sessions provided opportunities for attendees to share 
their stories of how suicide and mental health impacted their lives and communities, to offer education-
al information and to share recommendations for the task force to consider in developing a statewide 
suicide prevention plan. 

Access to social connections, trauma informed interventions and mental healthcare continue to be im-
portant to ensuring Pennsylvania is equipped to serve an aging and diversifying commonwealth.

Older Adult Released Prisoner Reentrants 

Over the past decade, the Pennsylvania Department of Corrections has paroled or released an average 
of 20,000 “reentrants,” annually, some of whom are 60 years of age or older. The recidivism rate for 
these individuals exceeds 70%. Many of those who recidivate are unable to sustain themselves in their 
community because they do not have adequate health care, paid employment, affordable transporta-
tion, or housing.

PDA’s PACE Program “Clearinghouse,” established in 1999, has a legislative authorization to assist per-
sons 19 years of age and older in these circumstances. Working closely with the Department of Cor-
rections, since January 2015 the Clearinghouse has provided critical resources to many reentrants that 
have sustained them in their communities. This program has completed 25,000 phone calls with reen-
trants, assisted 15,000 individuals, and achieved a recidivism rate of under 3%. 

19  |  2020-2024 Pennsylvania State Plan on Aging

State Plan on Aging Development

Strategic Planning and Initial Steps

State plan development began in mid-2019 when senior department leadership gathered for a strategic 
planning meeting to reassess the department’s mission and to create a vision and core values statement 
that aligned with our direction.  During this effort, we added the opening statement to our core values, 
“With older adults at the center of everything we do, we are guided by these core values.”  These watch-
words consistently kept the development of this plan focused on older adults as our most important 
consideration.

Upon release of ACL’s state plan guidance in October 2019, we began to consider how programs and 
initiatives we had in place and those we were considering over the next several years aligned with ACL’s 
four focus areas. This led to a natural emergence of the five overarching goals being pursued through 
2024.

Concurrent to the development of our goals, we also began to share information with our key stake-
holders including the PCoA, who are key partners in ensuring our plan meets the needs of older adults 
in every community throughout the commonwealth. We also began communicating with our network 
of AAAs about our intended development process, as well as the type and scope of guidance they could 
expect from the department for their four-year area plans.

It was very important to our leadership team that this process remain transparent, so wherever possible, 
we shared information with stakeholders. The ACL guidance was shared with the PCoA, AAAs, PA LTCC 
and others, for example. As each step of our internal process was completed, information was shared, 
and feedback welcomed.

In late 2019, the entire PDA team gathered for an all-staff meeting, part of which was dedicated to 
reviewing the 2016-2020 State Plan on Aging and initiating objective and strategy development for 
this plan. It was important to assess ourselves on progress made on that plan, as well as the mechanics 
of it, to determine how this plan could be developed to allow us to clearly demonstrate our results to 
stakeholders, older adults and their caregivers, our network, legislators and the public. We also want to 
ensure that we could adequately hold ourselves accountable to the actions set forth in this plan.

Needs Assessment

In June 2020, the department conducted a needs assessment by using a survey available online or by 
phone. The PA State Plan on Aging 2020-2024 Community and Stakeholder Survey was available on the 
PDA website, through a direct hyperlink, or could be completed by phone, and was available in English 
and Spanish. 

We relied on and appreciated the support of the PCoA, AARP Pennsylvania, the Pennsylvania Com-
mission on LGBTQ Affairs and the Pennsylvania Commission on Latino Affairs as well as many other 
commissions and stakeholders, to assist in getting the survey press release distributed to encourage 
participation. We also reached out directly to many community organizations to ask for participation 
and shared several different versions of culturally affirming marketing materials with a direct link to the 
survey.

In the survey, we sought to gauge public awareness of aging services and how to access them, includ-
ing protective services. We also asked respondents to rate factors important to age-friendly commu-
nities over the next five years, including what was most important. Finally, we asked respondents to 
consider the next 10 years and beyond and freely share thoughts on what would be needed to maintain 
age-friendly communities in the future.

The survey was open for nearly three weeks and we were pleased to receive 5,599 responses covering 
all 67 counties in the commonwealth. The survey was open to all adults 18 years and older; however 
nearly 4,200 or 75% of respondents were 60 years old and older. The response by race and ethnicity 
closely mirrored that of the current older adult population in the state: American Indian or Alaska Na-
tive .6%, Asian .9%, Black or African American 6.6%, Hispanic or Latino 2.7%, Native Hawaiian or other 
Pacific Islander .05%, Other 1.9%, White 89%.

2020-2024 Pennsylvania State Plan on Aging  |  20

We also heard from several stakeholder groups whose unique needs assisted in informing this plan. 
From caregivers to veterans, people living with disabilities, grandparents raising grandchildren, LGBTQ 
older adults and more; we heard from Pennsylvanians who shared their opinions, concerns and hopes 
for how they will age in our state. Feedback from some of these groups was used throughout the plan 
to further support our actions over this planning period.

Key takeaways from the survey included our need to ensure older adults throughout Pennsylvania are 
better aware of the services available and how to access them, including protective services. 

Respondents told us that over the next five years (2020-2025) and beyond, the following six factors are 
absolutely critical to age-friendly communities:

•	 Affordable prescription medications (67.9%)
•	 Access to in-home care & services (51%)
•	 Available/affordable housing options (45.6%)
•	 Available/affordable transportation (43%)
•	 Dementia-capable/ dementia-friendly communities (40.5%)
•	 Access to mental health services (40.2%)

We also asked survey participants to choose the one factor they believe to be the most critical to 
age-friendly communities, and access to in-home care and services came in at the top, followed closely 
by accessible/affordable housing and affordable prescription medications. Interestingly, the next clos-
est factor considered to be most important after these three was the opportunity to make meaningful 
connections with others.

Finally, the survey asked respondents to share what innovations they felt Pennsylvania needed to meet 
the needs of our growing and diversifying 60+ population in the next 10-20 years. Overwhelmingly, 
Pennsylvanians told us about the need to advance technologies that could help older residents. Broad-
band access in every community in the commonwealth could allow for virtual senior centers, telehealth, 
telemedicine and mental healthcare, remote home monitoring and other services not available in many 
areas, especially rural communities and for those living in poverty. We also heard about the need for 
innovations such as drone and robotic technologies, driverless vehicles and more innovations in hous-
ing for older adults.

The survey validated the department’s work and assisted in ensuring our strategies addressed concerns 
of older adults and their caregivers. Some actions were developed in direct response to what we heard 
on the survey.  In addition, it gave us an opportunity to hear what we need to consider in our strategies 
beyond the current planning period.

Statewide Feedback & Virtual Community Conversation

In July 2020, the department held two Statewide Virtual Community Conversations to formally pres-
ent the State Plan draft and to hear from stakeholders, advocates, older adults and caregivers. Online 
meetings, which could be joined by tablet, computer or telephone, were held in lieu of in-person public 
hearings due to the social-distancing requirements of the COVID-19 pandemic and for the safety of all 
those who might want to attend. Community conversation testimony, as well as participant feedback 
submitted during the conversation, was used to ensure plan goals, objectives, strategies and actions 
met with the needs of older adults and make adjustments where we felt as though we could better 
align with what we were hearing from stakeholders.

The first Community Conversation was held specifically for members of the five regional councils of the 
PCoA as a follow-up to a formal presentation of the plan given to the statewide council a month earlier. 
Prior to the pandemic, our in-person conversations would have been held in the regions represented by 
these dedicated council members, and they were instrumental in the planning of these events before 
the department elected the virtual format ultimately used. Nearly half of the 60 members of the five 
regional councils participated in the conversation. The department welcomed comments and recom-
mendations for the plan shared by the PCoA following their review of the draft.

21  |  2020-2024 Pennsylvania State Plan on Aging

The second Community Conversation was statewide, open to the public, and was well attended with 
over 200 people from across the commonwealth participating virtually either online or by phone. Par-
ticipants were required to register in advance and could request time to present public testimony.  In all, 
eight stakeholders, advocates and community members presented testimony on a variety of topics. All 
the valuable testimony was considered in furthering the development of a responsive state plan. Partic-
ipants in the Community Conversation were also given the opportunity to submit questions about the 
plan, which were answered during the event.

LGBTQ Aging in PA Statewide Virtual Town Hall Meeting

In addition to the two virtual Community Conversations, the department hosted a statewide LGBTQ 
Aging in PA Virtual Town Hall with the Secretary of Aging. This was a follow up to the work done by the 
department on LGBTQ aging issues since it hosted a LGBTQ Aging Summit in 2018. Over 250 people 
from the LGBTQ community, allies, service providers, AAAs, stakeholders, advocates and others joined in 
the dialogue. Twelve stakeholders and advocates from the LGBTQ community, and allies shared testimo-
ny on issues important to LGBTQ older adults, several of which impacted the state plan.

Draft Posted for Public Comment

During July 2020, the draft State Plan on Aging was posted to the department’s website where stake-
holders and the public were able to view specific goals, objectives and strategies of the plan as well as 
the action steps and measures the department would be using to ensure our accountability to the plan. 
Those who desired could also offer feedback on the plan through a link to an open text survey which 
was available throughout the two-week public comment period. We received several feedback sub-
missions, many of them affirming the actions set forth in the draft. Other feedback included wonderful 
suggestions that helped us be more thorough in our explanations and develop a plan that more fully 
meets the needs of older adults in the commonwealth.

Stakeholder Recommendations

In addition to the above discussed methods for gathering state plan input, the department also en-
couraged advocates, stakeholders and even other state agencies to share recommendations to help 
inform the vision and direction of the plan. The aging workgroup of the Commission on LGBTQ Affairs 
conducted its own statewide survey on issues of importance to LGBTQ older adults and based on those 
findings, submitted formal recommendations to the Secretary of Aging. We also received recommenda-
tions from the Department of Military and Veterans Affairs (DMVA), with whom the department already 
meets regularly to ensure we meet the needs of older and disabled veterans. We found these recom-
mendations and others received to be indispensable when creating a plan that spoke to the needs of 
specific stakeholder groups.

State Plan Quality Assurance

PDA is committed to ensuring continuous quality improvement of all aging programs, as well as con-
tinued progress on the action steps and timelines set forth in this plan. PDA regularly completes quality 
assurance monitoring on programs and services delivered by AAAs. These monitoring efforts are fol-
lowed up by remediations, technical assistance and corrective action plans that assist the AAA in ensur-
ing compliance with policy and regulations. AAAs are similarly required to complete quality assurance 
monitoring on vendors with whom they contract to provide services. Further, PDA is rigorously working 
with AAAs to ensure data integrity by working through data irregularities with exception reporting. 
Benchmark and other reports assist the department in determining if a AAA is in need of programmatic 
guidance. It also assists in crafting more specific program directives and technical assistance documents 
to ensure better accountability, which we also require of ourselves and AAAs in the four-year plan.

One of the department’s core values is that we hold ourselves and partners accountable for results, 
and for a strategic plan that stretches over four years, this value couldn’t be more critical. Every quarter 
throughout the plan period, the department leadership reviews a reporting dashboard of the actions 
laid out in the plan to ensure adherence to targeted benchmarks, monitor progress made and adjust, if 
necessary. If more frequent monitoring is necessary, PDA leadership will consider what adjustments are 
needed to maintain meaningful progress while keeping the end goal a priority.  

2020-2024 Pennsylvania State Plan on Aging  |  22

We ensure transparency of our progress by posting results of specific goals to a simple dashboard when 
milestones are reached, allowing stakeholders and the public to see progress made on the plan. In ad-
dition, the department makes routine periodic updates on plan progress to the PCoA. Throughout the 
state plan period, the department makes data-informed decisions to ensure the actions remain viable 
and on course to meet target outcomes.

Specific to AAAs, the department also has a critical role in monitoring and follow-up of area plans. Each 
AAA has outcomes and performance measures detailed in their Area Plan and is required to report to 
PDA on progress achieved in reaching their goals, objectives and strategies throughout the four-year 
plan period.

PDA Goals, Objectives & Strategies

PDA wants to ensure steady progress toward the five main goals introduced in the executive summary 
of this plan. The PDA management team developed goals, objectives and strategies for the plan, keep-
ing in mind the need to continually improve and innovate, expand our capacity, serve a diverse com-
monwealth and ensure consistent program compliance. 

Elements in support of the objectives and strategies are woven throughout the plan; however, the heart 
of the work to reach the goals comes in the action steps outlined in the plan. While the goals demon-
strate our alignment to the ACL focus areas and our own mission and vision, the actions are a subset of 
each objective and strategy.

The following pages contain details of the goals, objectives and strategies for the 2020-2024 planning 
period. Keeping older adults at the center of everything we do, our efforts focus on furthering all as-
pects of this plan, with adjustments as needed, to improve lives.

23  |  2020-2024 Pennsylvania State Plan on Aging

ACL Older Americans Act Core Programs Focus Area

Goal One: Strengthen aging network’s capacity, promote innovation and best practices, and build efficiencies 
to respond to the growing and diversifying aging population.

Objectives:

collaborations.

•  Leverage technology to improve quality and efficiency of aging services network.

•  Increase the department’s capacity to serve older adults through strategic and meaningful partnerships and 

•  Ensure OAA programs are reaching diverse, LEP and socially isolated older adults, including LGBT older 

adults & those living with a disability.

supportive programs and services.

•  Help older adults achieve better quality of life by ensuring those who seek assistance are connected to  

•  Support families and friends who are caregivers to enable them to thrive in their caregiving roles.

Goal Two: Improve services for older adults and the ability to advocate for them by using evidence-informed 
planning, committing to data integrity and being accountable for results.

Objectives:

Objectives:

•  Ensure excellence in service delivery through use of data and analytics to assess the outcomes, quality and 

value of services provided to older adults.

•  Ensure that data capture is efficient, compliant, and provides meaningful information and knowledge.

ACL Discretionary Grants & Other Funding Sources Focus Area

Goal Three: Establish and enhance efforts to support healthy living, active engagement and a sense of  
community for all older Pennsylvanians.

•  Ensure a network of age and dementia-friendly providers and communities throughout Pennsylvania.

•  Advance efforts to reduce stigma associated with mental health disorders and connect older adults with 

mental healthcare resources.

•  Expand the availability and use of programs that reduce social isolation.

•  Promote engagement in healthy aging, nutrition, education and prevention programs.

ACL Participant-Directed/Person-Centered Planning Focus Area

Goal Four: Emphasize a citizen-first culture that provides outreach, embraces diversity, and honors individual 
choice.

Objectives:

a variety of sources.

•  Ensure aging services information and resources are accessible, inclusive, consistent and available through 

•  Build a workforce that prioritizes and is responsive to the needs of older Pennsylvanians by listening, being 

inclusive, having empathy and respecting individual choice.

ACL Elder Justice Focus Area

Goal Five: Advocate for the rights of older adults and ensure their safety and dignity by raising awareness of 
and responding effectively to incidences of abuse, injury, exploitation, violence and neglect.

Objectives:

•  Increase effectiveness in responding to elder abuse and protecting older adults through expanded  

outreach, enhanced training, innovative practices and strategic collaborations.

•  Increase capacity and expertise in the ability to investigate and resolve allegations of financial exploitation.

•  Equip older adults, their loved ones, advocates and stakeholders with information needed to identify and/
or prevent abuse, neglect and exploitation, and support them in their ability to exercise their full rights.

2020-2024 Pennsylvania State Plan on Aging  |  24

Pennsylvania State Plan on Aging 2020 – 2024  
Goals, Objectives, Strategies, Actions, Measures 

ACL Older Americans Act Core Programs Focus Area 

Goal One: Strengthen aging network’s capacity, promote innovation, and best practices, and build 
efficiencies to respond to the growing and diversifying aging population. 

Objective #1:  Leverage technology to improve quality and efficiency of aging services network. 

     Strategies:   

1. Enhance user and consumer experience by creating efficiencies through technology. 

Actions 

Goals/Measures 

Target Dates 

Develop E-grants technology to allow grant 
applications to be submitted and processed 
electronically expediting financial support for senior 
community centers for capital improvements and 
program enhancements that benefit seniors.  

Implement new  
E-grant system and 
report on 
enhancements to grant 
process. 

1st QTR 2021   
Progress 
monitored 
quarterly on 
enhancements 

Enroll PDA & AAAs with one of Pennsylvania’s health 
information exchanges to leverage health and social 
services data in serving seniors and improve financial 
and resource management throughout aging network.  

PDA and 40% of AAAs 
enrolled year one, 
remaining AAAs 
enrolled year two 

Complete by 
end of FFY 21-
22 

Develop, using discretionary grant funding, and launch 
public-facing report of need (RON)  
self-reporting tool, on PDA website to improve access 
and increase reporting of elder abuse. 

Expand PACE iDashboard capacity to interface with 
AAA network to improve timeliness, follow-up and 
accountability on Protective Service’s case 
management for older Pennsylvanians. 

Develop and launch interactive dashboards to 
effectively present ombudsman and Pennsylvania 
Empowered Expert Residents (PEER) program data.   

Implementation 
date: TBD 

Implementation 
date: TBD 

Implementation 
date: TBD 

Implement public-
facing RON self-
reporting tool and use 
first year statistics as 
baseline to set future 
goals for years 2-4 

Implement protective 
services dashboard 
interface  

Data collection will be 
more efficient and 
accurate as data will be 
provided in single 
report rather than 
compiling 53 reports.  
PEER data will be 
accurately captured to 
reflect program impact 
on LTC facility 
residents’ quality of 
care and quality of life. 

25  |  2020-2024 Pennsylvania State Plan on Aging

Update department website to improve readability and 
user experience for all, including differently abled 
people and improve access to information about aging 
services.  

Implement web-based 
improvement quality  
initiatives that enhance 
user experience 

Spring 2021 and 
ongoing 

2. Explore and develop avenues to use virtual programming to serve more people, including 

those who are isolated. 

Actions 

Goals/Measures 

Target Dates 

Pilot and implement technology recommendations of 
the PA Council on Aging presented as part of their 
research on social isolation. 

PCoA will pilot 
technology assistance 
with its members. 

October 2020 

Create safe and effective telehealth and virtual 
communication systems for consumers of long-term 
care and assure technology is a resource for long-term 
care residents of all ages and all abilities. 

October 2020 
and ongoing 

Establish a workgroup 
of residents in LTC 
facilities, Tech Owl, the 
Office of the LTC 
Ombudsman, Local 
Ombudsmen Entities, 
the Department of 
Health, the 
Department of Human 
Services, along with 
other private and 
public partners (to be 
determined) to create 
a technology lending 
library, adaptive 
devices and technical 
assistance to be 
provided/available for 
all LTC ombudsmen to 
effectively and 
consistently schedule 
virtual visits with 100% 
of LTC facility 
residents. Increase 
technology utilization 
in 25% increments 
each fiscal year.   

 

 

2020-2024 Pennsylvania State Plan on Aging  |  26

Objective #2:  Increase the Department’s capacity to serve older adults through strategic and 
meaningful partnerships and collaborations. 

1. Expand partnerships and enhance existing collaborations to grow the aging network’s 

     Strategies: 

capacity to deliver services. 

Actions 

Local SHIPs will continue to collaborate with businesses 
on Medicare education for those turning 65 or nearing 
retirement. 

Goals/Measures 

Target Dates 

July 2020 – June 
2022 

Add 20 additional 
businesses statewide 
each year. Develop a 
virtual presentation to 
support this effort. 

Work with formal partners and the Alzheimer’s Disease 
and Related Disorders (ADRD) Task Force to advance 
the goals and objectives of the PA ADRD State Plan.  

Implement 2 strategies 
in the ADRD State Plan 
per year. 

Develop programming with state university system to 
conduct research, expand capacity to deliver services 
and promote careers in aging. 

Collaborate with local, state, and federal agencies to 
leverage housing resources for older adults.  

Number of partnership 
and summary of 
success compared to 
agreed to objectives 
for each partnership. 

Identify 2 new 
collaborative housing 
partnerships or 
resources per year. 

PA Link will continue to collaborate with home and 
community-based services resource partners and build 
upon the PA Link network. 

Increase the PA Link 
statewide resource 
network by 20 partners 
per year. 

 

 

Measured 
annually and 
progress 
monitored 
quarterly 
through 2024 

August 2020 
and ongoing  

Measured 
annually and 
progress 
monitored 
quarterly 
through 2024 

Measured 
quarterly 
through 2024 

27  |  2020-2024 Pennsylvania State Plan on Aging

2. Build and strengthen partnerships with organizations representing diverse or isolated older 
adults (culture/race/ethnicity/LGBTQ/disability/rural) to conduct more effective outreach in 
these communities. 

Actions 

Goals/Measures 

Target Dates 

Local SHIPs will continue to build and/or strengthen 
partnerships with government agencies and local 
community partnerships to help educate Medicare 
beneficiaries. 

Add 5 additional 
government/communit
y partnerships 
statewide each year. 

July 2020 – June 
2024 

Local SHIPs will continue to develop and/or build 
partnerships with various organizations/foundations to 
disseminate Extra Help and MSP outreach materials.  

PA Link will continue to provide education and training 
for partners and organizations on topics related to 
home and community based services. 

Add 5 additional 
government/commun-
ity partnerships 
statewide each year. 

July 2020 – June 
2024 

Facilitate PA Link 
Monthly Webinars to 
statewide partners - 12 
each year 

Measured 
quarterly 
through 2024 

Objective #3:  Ensure OAA programs are reaching diverse, LEP and socially isolated older adults, 
including LGBTQ older adults & those living with a disability. 

     Strategies: 

1.
Actions 

Improve marketing and outreach materials directed at underserved communities.  

Goals/Measures 

Target Dates 

Collaborate with the Office for the Deaf and Hard of 
Hearing to deploy Deaf and/or Deaf/Blind optimally 
appropriate web-based PACE materials.   

Measure website visits 
and satisfaction rates. 

Disseminate culturally & linguistically appropriate PACE 
materials and deliver through trusted community 
organizations. 

Update resident rights information and make available 
in targeted languages, MP3 audio, and large font 
editions. 

Measured 
quarterly 
through 2024 

Measured 
quarterly 
through 2024 

Measured 
quarterly 
through 2024 

Measure effectiveness 
and rate of enrollment 
in underserved 
communities. 

Increase awareness of 
LTC facility Resident 
Rights information to a 
broader audience by 
providing a variety of 
methods in which to 
obtain the information 
and 
coordinating/branding 
with the Office of 
Advocacy and Reform. 

2020-2024 Pennsylvania State Plan on Aging  |  28

Engage in volunteer recruitment from culturally diverse 
and LGBTQ communities. 

Measured 
annually 
through 2024 

Increase in the 
numbers of the 
culturally diverse and 
LGBTQ volunteers by 
50%. Ombudsman staff 
will create a focus 
group with SAGE, RSVP 
and other LGBTQ 
stakeholders along 
with various local 
ombudsmen to create 
targeted volunteer 
recruitment platforms.   

Measure number of 
communication 
channels utilized, 
number and 
demographics of 
consumers reached 
and effectiveness of 
effort. 

Measure number of 
communities and 
citizens reached, 
number and 
demographics 
consumers and 
effectiveness of effort. 

Measure number of 
communication efforts 
targeted at older 
adults in diverse 
communities. 

October 2020 
and ongoing 

October 2020 
and ongoing 

October 2020 
and ongoing 

Continue to update and expand communication reach 
and offerings through various channels to help 
establish PDA and the aging network as an inclusive, 
empowering resource for a diverse audience of older 
adults and caregivers.  

Expand distribution of PDA communications into 
underserved communities by partnering for 
distribution and making materials available in Spanish 
and other languages.  

Diversify older adult resources and topics available 
through PDA’s communications channels and 
publications, including the Benefits and Rights booklet, 
Inside Aging, and social media. 

 

 

29  |  2020-2024 Pennsylvania State Plan on Aging

2. Drive program engagement efforts to include diverse, LEP, socially isolated and LGBTQ older 

adults, veterans & older adults living with a disability.   

Actions 

Conduct PACE services enrollment outreach projects 
with trusted community organizations, counties, HIEs, 
health systems and community and advocacy 
organizations such as PASSI, LGBTQ organizations in 
Pittsburgh and Philadelphia, PA Assn. of Community 
Health Centers and the Consumer Health Coalition.  

Ensure senior staff attendance at events supporting 
older adults held in diverse communities. 

Engage in systems training and advocacy to promote 
person-centered models of long-term care. 

Goals/Measures 

Target Dates 

Enrollment in PACE 
and other benefits in 
diverse communities. 

Measured 
quarterly 
through 2024 

October 2020 
and ongoing 

Measured 
quarterly 
through 2024 

Measure number of 
events and 
participation rate. 

State Office staff will 
research and provide 
training on newest 
person-centered care 
approaches/best 
practices to local 
ombudsman entities to 
engage in and improve 
systems advocacy with 
nursing facility staff 
when facilities are 
developing care plans 
for residents they 
serve.  

Designate LGBTQ older adults as a population of 
“greatest social need” and ensure they are 
appropriately supported with OAA programs.  

Issue policy statement, 
related communication 

December 31, 
2020 

Objective #4:  Help older adults achieve better quality of life by ensuring those who seek 
assistance are connected to supportive programs and services. 

     Strategies: 

1. Raise public awareness about all programs and services available through area agencies on 

aging and advocacy organizations. 

Actions 

Goals/Measures 

Target Dates 

Coordinate with the PA Libraries Association through 
their PA Forward Initiative to outreach PACE to libraries 
via social media.   

Measured 
quarterly 
through 2024 

Measure number of 
times PACE 
information is pushed 
out to social media via 
PA Forward and 
resulting enrollments 

2020-2024 Pennsylvania State Plan on Aging  |  30

State Ombudsman 
staff will expand on 
current social media 
platforms that are in 
existence such as the 
Virtual Family Council 
and the Volunteer 
Facebook page. 

Measure number of 
joint communications 
and effectiveness of 
communications. 

Annual distribution 

Annually 

Develop joint communications and education efforts 
with advocates, courts, partners and stakeholders on 
services for older adults. 

Spring 2021 and 
ongoing 

Fall 2021 

Produce and launch 
campaign 

pring 2022 

        S

Develop partnerships 
to identify key 
opportunities, 
pathways and 
possibilities; develop 
funding and marketing 
plan. 

2. Support employment opportunities for older adults through advocacy, training and on the 

job experience. 

Actions 

Goals/Measures 

Target Dates 

Promote Senior Community Service Employment 
Program (SCSEP) within senior community centers 
through distribution of electronic marketing materials. 

100% distribution to 
senior community 
centers 

Annual through 
2024 

Develop an outreach effort highlighting the need and 
value of older adults’ life experience in work and 
through volunteer opportunities.  

 

 

Provide ‘Benefits and Rights for Older Pennsylvanians’ 
to the following veterans advocates: DMVA’s Bureau of 
Veterans Programs, Initiatives, Reintegration and 
Outreach, Offices for County Directors of Veterans 
Affairs, VA Medical Centers, Vet Centers, Transition 
Assistance Advisors. 

Create and implement effective social media 
campaigns through Facebook and Twitter to support 
the ombudsman function. 

October 2020 
and ongoing 

31  |  2020-2024 Pennsylvania State Plan on Aging

3. Leverage experience of older adults to connect them to meaningful volunteer opportunities 

that maximize their talent. 

Actions 

Strengthen the areas of volunteer recruitment, 
retention, and recognition. 

Goals/Measures 

Target Dates 

Provide 4 tools each 
year to strengthen 
volunteer programs. 

Provide 4 
volunteer tools 
each year  

Enlist Statewide Volunteer Coordinators to identify and 
share volunteer program best practices. 

October 2020 – 
September 2024 

Annual through 
September 2024 

Conduct 4 Quarterly 
Statewide Volunteer 
Coordinator meetings 
each year to discuss 
best practices. 

Build an online 
resource tool for the 
statewide volunteer 
coordinators consisting 
of 4 modules. 

Provide an online resource tool to access volunteer 
program enhancement materials. 

Online tool – 
January 2021 

Objective #5:  Support families and friends who are caregivers to enable them to thrive in their 
caregiving roles. 

     Strategies: 

1. Enhance existing statewide marketing and outreach efforts to inform caregivers about 

benefits and services available through the caregiver support program, including respite 
assistance. 

Actions 

Goals/Measures 

Target Dates 

Enhance statewide inclusive marketing/outreach efforts 
to expand participation in the Caregiver Support 
Program, especially for grandparents raising 
grandchildren. 

Increase enrollment in 
the Caregiver Support 
Program by 5% over 
the next four years. 

Measured 
annually 
through 2024 

2. Advocate for the needs of caregivers, including grandfamilies, caregivers of those with 

dementia, and older caregivers of people living with disabilities. 

Actions 

Goals/Measures 

Target Dates 

Support AAAs in their collaborations with existing 
providers and organizations in developing, delivering, 
and promoting training for family and volunteer 
caregivers. 

Each AAA will provide 
two trainings per year. 

Measured 
annually and 
progress 
monitored 
quarterly 
through 2024 

2020-2024 Pennsylvania State Plan on Aging  |  32

Advocate for legislative changes to improve access to 
and utilization of the Caregiver Support Program. 

Enactment and 
implementation of 
legislation 

By December 
2023 

Goal Two: Improve services for older adults and the ability to advocate for them by using 
evidence-informed planning, committing to data integrity and being accountable for results. 

Objective #1:  Ensure excellence in service delivery through use of data and analytics to assess the 
outcomes, quality and value of services provided to older adults. 

     Strategies: 

Actions 

1. Use data to tell the story of our success in reaching target communities. 

Evaluate the value and impact of PACE and other PDA 
programs on the health and well-being of program 
enrollees by applying evidence-based research 
methods. 

Design and conduct 
research to complete 
evaluation. 

Goals/Measures 

Target Dates 

June 30, 2021 

Develop reporting that clearly measures the reach of 
our programs into diverse communities in order to 
ensure OAA services are reaching target of greatest 
economic and social needs population. 

Create fields in state 
system of data 
collection to reflect the 
diversity of participants 
in Aging programs.  
Create standard 
tracking reports based 
on new fields. 

Develop and 
implement new 
fields and new 
reports by 
December 31, 
2021. 

2.

Identify and analyze data on at-risk older adults and develop interventions to mitigate risk. 

Actions 

Goals/Measures 

Target Dates 

Enhance file-matching system that uses existing 
enrollment files from partners, such as community 
health centers and health information exchanges, to 
target outreach for PACE and other federal and state 
benefits based on discharge and patient level exchange 
data. 

Evaluate new 
applications and 
enrollments and 
measure value. 

Develop reporting method to identify consumers at risk 
for social isolation and develop interventions that can 
be offered and customized as part of care planning in 
order to improve the well-being of older adults.  

Annually 
through 2024 

Measured 
quarterly 
through 2024 

Development of 
reporting process for 
social isolation risk and 
related procedures to 
better support 
consumers using care 
management and 
ombudsman data 

 

 

33  |  2020-2024 Pennsylvania State Plan on Aging

2020-2024 Pennsylvania State Plan on Aging  |  34

Goals/Measures 

Target Dates 

Create new fields in 
case management 
database to collect 
SOGI data and develop 
relevant reporting.   

Develop and 
implement new 
fields in case 
management 
database and 
issue new 
reports by 
October 1, 2021. 

Goals/Measures 

Target Dates 

4th QTR 2020 

1st QTR 2022 
update 

rd QTR 2022 

publish 

  3

Establish workgroup to 
review, update, and 
publish updated 
Assessment Policy 
Chapter and related 
assessment tools. 

2. Ensure consumer engagement instruments are efficient, thorough, culturally competent and 

gather necessary information. 

Actions 

Redesign PACE Program’s “PACE Cares” website and 
program materials to align with web-based accessibility 
guidance provided by the PA Office of Vocational 
Rehabilitation. 

Completion and 
implementation of 
redesign 

Review and update assessment tools (NAT, CAT, NAT-E) 
to ensure cultural competence and efficiency of data 
collection. 

Objective #2:  Ensure that data capture is efficient, compliant, and provides meaningful 
information and knowledge. 

1. Collect data necessary to ensure our effectiveness in reaching target communities. 

     Strategies: 

Actions 

Develop, offer training on and implement method to 
collect SOGI data within state system of data collection. 

 

 

ACL Discretionary Grants & Other Funding Sources Focus Area 

Goal Three: Establish and enhance efforts to support healthy living, active engagement and a sense 
of community for all older Pennsylvanians. 

Objective #1:  Ensure a network of age and dementia-friendly providers and communities 
throughout Pennsylvania. 

     Strategies: 

1. Advance efforts to make Pennsylvania’s communities age-friendly for all older adults and 

respectful of their unique needs. 

Actions 

Goals/Measures 

Target Dates 

In conjunction with the Alzheimer’s Association, 
provide training to care managers and person-centered 
counselors to effectively work with persons living with 
ADRD.  

Measured 
quarterly 
through 2024 

Develop training and 
ensure all current AAA 
Care Managers and 
Person-Centered 
Counselors are trained.  
All new staff trained 
within first year of 
employment. 

Provide Dementia Friends Information Sessions to 
AAAs, senior center staff, and various community 
members/entities. 

Conduct 50 
Information Sessions 

December 2021 

Provide Dementia Champion training to AAAs, senior 
center staff, and various community members/entities 

Conduct 30 Training 
sessions  

December 2021 

Translate Dementia Friends/Champions materials into 
additional languages to recruit Champions from 
various cultural and ethnic backgrounds. 

Develop partnership with Penn State College of 
Nursing to expand and promote age-friendly care to a 
broader range of providers of services to older adults, 
in order to provide more age-friendly care that more 
effectively serves older adults. 

Materials translated 
and distributed to 
diverse partners and 
communities 

Development of 
program and measure 
of providers receiving 
training and 
effectiveness of 
program. 

December 2021 

Measured 
quarterly 
through 2024 

2. Advocate for and expand existing models of innovative housing that allow older adults and 

individuals with disabilities to age in place. 

Actions 

Goals/Measures 

Target Dates 

Expand innovative housing models to additional 
counties throughout the commonwealth and strive for 
inclusivity in new models 

Expand housing 
initiatives to 8 
additional counties. 

December 2023 

35  |  2020-2024 Pennsylvania State Plan on Aging

Measured 
annually and 
progress 
monitored 
quarterly 
through 2024 

Highlight 2 innovative 
best practices with the 
senior center network 
annually and measure 
improvements in 
participation levels. 
Interview new center 
participants on their 
satisfaction with 
programs and use first 
year as baseline for 
comparison to future 
year results. 

2020-2024 Pennsylvania State Plan on Aging  |  36

Launch media campaign to build awareness and create 
accompanying earned media to tell success stories and 
build momentum for program expansion.  

Launch campaign and 
measure effectiveness. 

Fall 2021 

Objective #2:  Advance efforts to reduce stigma associated with mental health disorders and 
connect older adults with mental healthcare resources. 

     Strategies: 

1. Raise awareness about mental health issues affecting older adults and ensure our network is 

properly leveraged to make referrals to mental healthcare providers. 
Goals/Measures 

Actions 

Educate AAAs regarding county-based cross-system 
protocols to better respond to mental health crises 
involving older adults.  

1 education session 
provided to AAAs per 
year 

Target Dates 

Measured 
annually and 
progress 
monitored 
quarterly 
through 2024 

April 1, 2021 

ctober 1, 2021 

  O

Partner with Department of Drug and Alcohol 
Programs (DDAP) and Single County Authorities to 
develop awareness and education partnership on older 
adults and substance use disorder.  

Develop action plan in 
conjunction with 
partners and deploy 
programming. 

Objective #3:  Expand the availability and use of programs that reduce social isolation. 

     Strategies: 

Actions 

1. Expand participation in programs that help reduce social isolation. 

Goals/Measures 

Target Dates 

Encourage innovation in the function, form and 
operation of senior community centers to improve 
participation and allow more older adults to find 
meaningful activities and connections. 

 

 

Develop partnership program with universities that 
engages students and older adults at risk for social 
isolation in supportive projects that are meaningful to 
both.  

Measured 
quarterly 
through 2023 

Onboard universities 
and older adults 
beginning fall 2020 
with a goal of 5 
university partnerships 
by 2022/23 academic 
year. 

Objective #4:  Promote engagement in healthy aging, nutrition, education and prevention 
programs. 

     Strategies: 

1.

Increase the number of workshops and participants in evidence-based health & wellness 
programs in communities of greatest economic need and/or greatest social need. 

Actions 

Goals/Measures 

Target Dates 

Increase number of evidence-based program (EBP) 
workshops in rural and/or medically underserved areas. 

Measure percent 
increase of EBP 
workshops in 
rural counties 
and in medically 
underserved 
counties from 
baseline by SFY 
2023-2024. 

Measure percent 
increase of low-
income and 
minority 
participants in 
EBP workshops 
from baseline by 
SFY 2023-2024. 

5% increase in the 
number of EBP 
workshops conducted 
in rural counties over 
baseline year of SFY 
2020-2021 

5% increase in the 
number of workshops 
conducted in medically 
underserved counties 
over baseline year of 
SFY 2020-2021 

5% increase in number 
of low-income 
participants in EBP 
workshops over 
baseline year of SFY 
2020-2021 

5% increase in number 
of minority participants 
in EBP workshops over 
baseline year of SFY 
2020-2021. 

Obtain and provide 
nutrition education 
materials in other 
languages 4 times per 
year. 

Increase number of EBP participants with a focus on 
minority and low-income populations. 

Provide nutrition education materials to AAAs for 
congregate and In-Home meal consumers that reduces 
food insecurity for older adults in Pennsylvania. 

Measured 
quarterly 
through 2024 

37  |  2020-2024 Pennsylvania State Plan on Aging

2.

Improve health & well-being by educating and enrolling older adults in the best Medicare, 
prescription drug, and other benefits appropriate for their needs that can help improve their 
health outcomes. 

Actions 

Goals/Measures 

Target Dates 

Coordinate with APPRISE to obtain data needed to 
focus outreach on the Medicare beneficiaries who are 
not enrolled in Part D and Low Income Subsidy.  

Obtain data, conduct 
outreach and measure 
enrollment results. 

Measured 
quarterly 
through 2024 

ACL Participant-Directed/Person-Centered Planning Focus Area 

Goal Four: Emphasize a citizen-first culture that provides outreach, embraces diversity, and honors 
individual choice. 

Objective #1:  Ensure aging services information and resources are accessible, inclusive, consistent 
and available through a variety of sources. 

     Strategies: 

Actions 

1.

Improve quality and availability of information about aging services. 

Develop and disseminate informational 
brochures/flyers specific to Medicare Part B and D 
penalties and how to avoid the penalties, including a 
brochure/flyer for those who do not take medications. 
Ensure these materials are available electronically and 
distributed to senior centers for print on demand for 
congregate meal consumers. 

Local State Health Insurance Programs (SHIPs) continue 
to host “Medicare 101” events with an emphasis on 
Medicare enrollment periods and penalties. 

Issue updated Policy Chapters and Aging Program 
Directives to the Aging Network. 

 

 

Goals/Measures 

Target Dates 

Develop brochure/ 
flyers first year; 
disseminate 
information Years 2–4 

Develop 
brochure/flyer 
by June 30, 
2021.  

Disseminate 
brochure/flyer 
July 2021-June 
2024. 

July 2020-June 
2024 

Measured 
annually and 
progress 
monitored 
quarterly 
through 2024 

Add 20 additional 
Medicare 101 
presentations each 
year statewide.  
Develop a virtual 
presentation to 
support this effort. 

Issue Care 
Management, 
Nutrition, Domiciliary 
Care, Assessment, and 
Senior Center Policy 
Chapters and provide 
training to the Aging 
Network. 

2020-2024 Pennsylvania State Plan on Aging  |  38

Objective #2:  Build a workforce that prioritizes and is responsive to the needs of older 
Pennsylvanians by listening, being inclusive, having empathy and respecting individual choice. 

     Strategies: 

1. Provide services to older Pennsylvanians in the manner they prefer by exercising 

individualized and person-centered planning. 

Actions 

Goals/Measures 

Target Dates 

Provide ongoing training to ADRC counselors on 
person-centered planning to empower older adults and 
persons living with disabilities to exercise self-
determination and make decisions on their own behalf 
across the spectrum of long-term care services to 
ensure their satisfaction with service and personal 
ownership of planning process. 

As part of the ADRC grant, provide person-centered 
planning materials, including access information to 
ADRC person-centered counselors to senior center 
directors to improve access to person-centered 
planning across the spectrum of long-term care 
services, including home, community and institutional 
settings.   

Provide person-centered training to volunteers and 
staff who serve as long-term care ombudsmen to 
ensure person-centered care to residents of long-term 
care facilities across the commonwealth. 

100% counselors 
trained  

Measured 
quarterly 
through 2024 

Measure referrals from 
senior centers, using 
first year as established 
baseline.  

Measured 
quarterly 
through 2024 

100% of ombudsmen 
trained 

Measured 
quarterly 
through 2022 

Enhance and expand assistance and placement services 
for Department of Corrections reentrants through the 
Patient Assistance Program Clearinghouse, particularly 
for ‘early release’ reentrants. 

Count recipients and 
identify specific 
benefits received. 

Measured 
quarterly 
through 2024 

Develop assistance and placement services for Deaf 
and Hard of Hearing individuals through the Patient 
Assistance Program Clearinghouse. 

Work with Office of Advocacy and Reform to provide 
trauma-informed training to AAA network and key 
stakeholders. Incentivize continued efforts to achieve 
elevated trauma informed requirements. 

 

 

Count recipients and 
identify specific 
benefits received. Use 
first year as baseline 
for future measures. 

Measured 
quarterly 
through 2024 

100% of AAA network 
trained and progress 
tracked on effort to 
achieve higher levels 
on trauma continuum 

Network trained 
by June 30, 2021 
and progress 
tracked annually 
through 2024 

39  |  2020-2024 Pennsylvania State Plan on Aging

Target Dates 

Ongoing  

ovember 30, 

2021  

pring 2023 

          N

    S

Goals/Measures 

Communicate monthly with 
the General Assembly and 
stakeholders on necessary 
components to be included in 
the Older Adults Protective 
Services Act 

Have a bill pass both 
chambers of the General 
Assembly and be sent to the 
Governor’s desk for approval. 

Update corresponding 
regulations to incorporate 
legislative updates. 

2020-2024 Pennsylvania State Plan on Aging  |  40

100% of centers certified 

July 1, 2022 

2. Educate Department of Aging, AAA staff and partners on the unique needs of diverse older 

adults, and provide training on cultural competence, implicit bias and other relevant subjects 
to help strengthen responsiveness to older adults. 

Target Dates 

October 2020 
and ongoing 

ecember 31, 

2021 

  D

Annually 

Actions 

Goals/Measures 

Provide training to the Department, AAA 
Network, and partners on cultural competence, 
implicit bias and other related subjects. 

Measure number of 
participants, satisfaction level 
and outcomes. 

Ensure the Department and AAAs stay current 
on SAGECare LGBTQ cultural competency 
training. 

Maintain Platinum Certification 
Level for PDA and AAAs 
complete Platinum 
Certification requirements. 

Expand SAGECare LGBTQ cultural competency 
training to make it part of training for senior 
center staff. 

ACL Elder Justice Focus Area 

Goal Five: Advocate for the rights of older adults and ensure their safety and dignity by raising 
awareness of and responding effectively to incidences of abuse, injury, exploitation, violence, and 
neglect. 

Objective #1:  Increase effectiveness in responding to elder abuse and protecting older adults 
through expanded outreach, enhanced training, innovative practices, and strategic collaborations. 

1. Ensure Older Adult Protective Services program is enabled to meet the unique and complex 

     Strategies: 

needs of Pennsylvania seniors. 

Actions 

Update the Older Adults Protective Services Act 
and corresponding regulations in order to more 
effectively provide protective services to 
Pennsylvania older adults.   

 

 

2. Enhance virtual training curriculum for protective services workers. 

Actions 

Goals/Measures 

Target Dates 

Develop and implement a standardized yet 
customizable and person-centered protective service 
care plan for protective services workers, in order to 
promote more self-determination for older adults 
receiving protective services. 

Fall 2021 

New service plan tool 
developed, gather 
feedback from workers 
on usefulness and 
compare to prior care 
planning process 

Provide training to protective services staff on self-
determination and least-restrictive service care 
planning. 

Network trained on 
new least restrictive 
care planning 

Spring 2022 

3. Ensure required entities and public are accessing and completing mandatory reporter 

training. 

Actions 

Provide outreach and education to the public, 
ombudsman program, legal assistance providers, law 
enforcement, healthcare and other providers regarding 
the availability of the on-line mandated reported 
training. 

Goals/Measures 

Target Dates 

June 2021, 2022, 
2023, 2024 

Conduct follow up on 
6/15/20 public launch 
(World Elder Abuse 
Awareness Day) with 
annual updates on 
how many mandated 
reporters have taken 
the training. 

Monitor usage of the training and outreach to any 
groups of mandatory reporters identified as not 
accessing the training. 

Follow-up with those 
identified as not 
accessing training 

Measured 
quarterly 
through 2024 

Objective #2:  Increase capacity and expertise in the ability to investigate and resolve allegations of 
financial exploitation. 

     Strategies: 

1.
Actions 

Implement recommendations of the 2020 Financial Exploitation Study. 

Goals/Measures 

Target Dates 

Implement annual training for PS Caseworkers 
regarding financial exploitation investigations in order 
to improve outcomes for older adults. 

Implement training 
and measure 
effectiveness 

1st QTR  
2021/2022 

Develop a multidisciplinary workgroup with protective 
services, ombudsman, legal assistance, law 
enforcement, healthcare, financial institutions, other 
state government agencies and other stakeholders, 
regarding financial exploitation and implement 
recommendations of the workgroup. 

Develop workgroup, 
implement 
recommendations and 
measure effectiveness 
of addressing financial 
exploitation issue. 

Measured 
quarterly 
through 2024 

41  |  2020-2024 Pennsylvania State Plan on Aging

Spring 2021 

easured 
quarterly 
though 2024 

  M

Develop and 
implement outreach 
strategy, track results 
of outreach, use year 
one results as baseline 
for future years. 
Develop and 
implement a plan to 
push outreach 
materials to senior 
centers serving target 
communities. 

Expand PEER program 
into all 67 counties in 
the commonwealth 
and increase the total 
number of PEER 
facilities by 20%. 

2020-2024 Pennsylvania State Plan on Aging  |  42

2.

Increase AAA network access to Certified Financial Examiner through statewide pilot 
program.   

Actions 

Goals/Measures 

Target Dates 

Identify and implement ways for Certified Financial 
Examiner to assist AAAs that need assistance with 
financial exploitation cases. 

Spring 2021 

Implement process to 
efficiently and cost 
effectively address the 
needs of AAAs. 

Outreach to those AAAs who could use assistance with 
exploitation cases and offer services of Certified 
Financial Examiner. 

Follow-up system 
implemented 

Summer 2021 

Objective #3:  Equip older adults, their loved ones, advocates and stakeholders with information 
needed to identify and/or prevent abuse, neglect and exploitation, and support them in their ability 
to exercise their full rights. 

     Strategies: 

1.
Actions 

Implement new approaches to increase public awareness of elder abuse and how to report it. 

Collaborate with financial institutions or other 
organizations to educate the public regarding financial 
fraud, financial exploitation and guardianships of older 
adults. 

Goals/Measures 

Target Dates 

5 new collaborations 
per year 

Measured 
quarterly 
through 2024 

2.

Increase public awareness of elder rights programs including legal assistance and long-term 
care ombudsman. 

Actions 

Goals/Measures 

Target Dates 

As part of the legal assistance grant, develop outreach 
and targeting strategies for the most vulnerable 
underserved older adults regarding legal rights and 
legal services available through Title IIIB Legal 
Assistance Programs in order to ensure underserved 
older adults have knowledge of and access to legal 
assistance and ensure outreach materials available 
through this grant are placed where benefitting older 
adults will reach them, such as senior centers serving 
target communities. 

Continue the expansion of the Ombudsman Office 
Pennsylvania Expert Empowered Resident (PEER) 
program. 

Measured 
annually 
through 2024 

Explore the expansion of Ombudsman advocacy 
services to home and community based consumers of 
long-term supports and services. 

Evaluate and develop recommendations of 
Ombudsman program organizational structure to 
improve efficiency and implement cost effective 
strategies.  

October 2021 

October 2020 – 
June 2021 

Expand HCBS/LTSS 
advocacy services 
beyond Allegheny 
County. 
Present 
recommendations 
including resources 
and level of effort 
required to support 
any proposed changes. 

 

43  |  2020-2024 Pennsylvania State Plan on Aging

Allegheny County  
412-350-4234 
www.alleghenycounty.us/Human-
Services/About/Offices/Area-Agency-on-Aging.aspx 

Beaver County 
1-888-548-2262 
www.bcoa.us  

Berks County 
610-478-6500 
www.berksaging.org 

Bradford County 
1-800-982-4346 
www.bsstaaa.org  

Clarion County 
814-226-4640 
www.clarionaging.com  

Clinton County 
570-601-9551 
www.stepcorp.org  

2020-2024 Pennsylvania State Plan on Aging  |  44

Bucks County 
267-880-5700 
www.buckscounty.org/government/humanservices.AAA 

Butler County 
1-888-367-2434 
www.butlercountypa.gov/292/Area-Agency-on-
Aging 

Cambria County 
1-844-242-8915 
www.cambriacountypa.gov/area-agency-on-aging.aspx 

Cameron County 
1-800-776-2191 
www.ohsaging.com 

Carbon County 
1-800-441-1315 
www.carboncounty.com/index.php/2-
uncategorised/44-agency-on-aging 

Centre County 
814-355-6716 
www.centrecountypa.gov/342/Aging 

Chester County 
1-800-692-1100 
www.chesco.org/aging 

Clearfield County 
1-800-225-8571 
www.ccaaa.net 

       

Contact Information 

Pennsylvania Department of Aging  
717-783-1550 
www.aging.pa.gov 

Pennsylvania Association of Area Agencies on Aging 
717-541-4214 
www.p4a.org 

Armstrong County 
1-800-368-1066 
www.co.armstrong.pa.us/services/aaa 

Bedford County 
1-800-892-7903 
www.hbfaaa.org 

Blair County 
1-800-245-3282 
www.blairsenior.org 

rea Agencies on Aging 

  A

Adams County 
1-800-548-3240 
www.acofa.org 

Columbia County 
1-800-598-5001 
www.cmaaa15.org 

Cumberland County 
1-888-697-0371 x6110 
www.ccpa.net/aging 

Delaware County 
1-800-416-4504 
www.delcosa.org 

Erie County 
1-800-769-2436 
www.gecac.org/work/aging 

Forest County 
1-800-281-6545 
www.experienceinc.org 

Fulton County 
1-800-892-7903 
www.hbfaaa.org 

Huntingdon County 
1-800-892-7903 
www.hbfaaa.org 

Jefferson County 
1-800-852-8036 
www.jcaaa.org 

Dauphin County 
1-800-328-0058 
www.dauphincounty.org/government/departments/are
a_agency_on_aging 

Franklin County 
1-800-642-6990 
www.franklincounty.pa/gov/index.php?section=human-
services_aging 

Crawford County 
1-800-321-1792 
www.activeaging.org  

Elk County 
1-800-672-7145 
www.ohsaging.com  

Fayette County 
1-888-300-2704 
www.swpa-aaa.org  

Greene County 
1-888-300-2704 
www.swpa-aaa.org 

Indiana County 
724-349-4500 
www.agingservicesinc.com  

Juniata County 
1-800-348-2277 
www.mymjrsc.com  

Lancaster County 
1-800-801-3070 
www.lancoaging.org  

Lackawanna County 
570-963-6740 
www.lackawannacounty.org/index.php/departments
agencies/human-services/area-agency-on-aging 

Lawrence County 
724-658-3729 
www.ccpgh.org/sslpage.aspx?pid=368 

Lebanon County 
717-273-9262 
www.lebcounty.org/depts/AAA/pages/default.aspx 

Lehigh County 
610-782-3034 
www.lehighcounty.org/Departments/Human-
Services/Aging-and-Adult-Services 

Luzerne County 
570-822-1158 
www.luzernecounty.org/847/Aging 

Lycoming County 
1-800-332-8555 
www.stepcorp.org 

Mercer County 
1-800-570-6222 
www.mercercountyaging.org 

McKean County 
1-800-672-7145 
www.ohsaging.com  

Mifflin County 
1-800-348-2277 
www.mymjrsc.com 

Monroe County 
1-800-498-0330 
www.monroecountypa.gov/Dept/Aging/Pages/defa
ult.aspx 

Montgomery County 
610-278-3601 
www.montcopa.org/148/Senior-Services 

45  |  2020-2024 Pennsylvania State Plan on Aging

2020-2024 Pennsylvania State Plan on Aging  |  46

Montour County 
1-800-598-5001 
www.cmaaa15.org 

Northumberland County 
1-877-622-2251 
www.ncaging.org/Contact.asp 

Philadelphia County 
215-765-9000 
www.pcacares.org 

Northampton County 
1-800-322-9269 
www.northamptoncounty.org/HS/AGING/Pages/default
.aspx 

Perry County 
1-866-926-5118 
www.perryco.org/Pages/default.aspx  

Pike County 
1-800-233-8911 
www.pikeaaa.org 

Potter County 
1-800-800-2560 
www.pottercountyhumansvcs.org/post.php?pid=10 

Schuylkill County 
570-622-3103 
www.schuylkilloss.org 

Somerset County 
1-800-452-0825 
www.somersetaaa.org  

Susquehanna County 
1-800-982-4346 
www.bsstaaa.org 

Union County 
1-800-533-1050 
www.usaaa17.org 

Warren County 
1-800-281-6545 
www.experienceinc.org  

Wayne County 
570-253-4262 
aging/waynecountypa.gov/149/Area-Agency-on-Aging  

Westmoreland County 
1-800-442-8000 
www.co.westmoreland.pa.us/397/Area-Agency-on-
Aging 

Wyoming County 
570-822-1158 
www.luzernecounty.org/847/Aging 

 

Snyder County 
1-800-533-1050 
www.usaaa17.org 

Sullivan County 
1-800-982-4346 
www.bsstaaa.org 

Tioga County 
1-800-982-4346 
www.bsstaaa.org 

Venango County 
1-866-452-4464 
www.co.venango.pa.us 

Washington County 
1-888-300-2704  
www.swpa-aaa.org 

York County 
1-800-632-9073 
www.ycaaa.org 

 

             

Service Area #14 
Bucks, Chester, Delaware, Montgomery Counties 
484-364-6981 
buckschestermontgomerylink@aim.com  
Delaware: 610-490-1842 
kingj@co.delaware.pa.us  

 

Service Area #3 
Allegheny, Beaver, Washington-Fayette-Greene 
Counties 
412-310-0961 
MOLeary@classcommunity.org  

Service Area #4 
Cameron-Elk-McKean, Clearfield, Jefferson, Potter 
Counties 
814-765-2696 
abell@ccaaa.net 

Service Area #5 
Armstrong, Indiana, Westmoreland Counties 
724-237-1242 
palinkcoordinator5@gmail.com 

Service Area #7  
Bradford-Sullivan-Susquehanna-Tioga Counties 
570-268-1246 
kahall@bsstaaa.org  

Service Area #6 
Blair, Cambria, Somerset, Huntingdon-Bedford-Fulton 
Counties 
814-233-9206 
palinkcoordinator6@gmail.com 

Service Area #8 
Centre, Columbia-Montour, Lycoming-Clinton, 
Northumberland, Union-Snyder, Schuylkill Counties 
570-428-3521 
mbottorf2016@gmail.com  

Service Area #2 
Butler, Lawrence, Mercer Counties 
724-431-1218 
bbuzzell@co.butler.pa.us  

Aging and Disability Resource Centers (PA Link) 
Statewide Toll Free: 800-753-8827 
www.carelink.pa.gov 

ervice Area #1  

Clarion, Crawford, Erie, Venango 
Warren-Forest Counties 
814-336–1792 
information@activeaging.org  

  S

Service Area #9 
Adams, Cumberland, Dauphin, Franklin, Mifflin-
Juniata, Perry, York Counties  
717-240-7888 
vmonsted@ccpa.net  

Service Area #10 
Monroe, Pike, Wayne Counties 
570-253-4262 
JDoyle@waynecountypa.gov  

Service Area #11 
Carbon, Lackawanna, Luzerne-Wyoming Counties 
610-392-4254 
ccaging14@ptd.net  

Service Area #12 
Lehigh, Northampton Counties 
610-782-3096 
kimberlymelusky@lehighcounty.org 

Service Area #13 
Berks, Lancaster, Lebanon Counties 
717-380-9714 
blllink@mail.com  

Service Area #15 
Philadelphia 
215-765-9000 ext. 4116 
Julie.mcnair@pcacares.org  

 

47  |  2020-2024 Pennsylvania State Plan on Aging

The 2020-2024 PA State Plan on Aging was prepared by  
the Pennsylvania Department of Aging.

Questions or feedback regarding the state plan should be directed to the  
Pennsylvania Department of Aging at:

555 Walnut Street 5th Floor 
Harrisburg, Pennsylvania 17101-1919

www.aging.pa.gov