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The Impact of Consolidating AAA on the Delivery of HCBS: Evidence From Iowa

In this study, the authors evaluate the 2013 consolidation of Iowa’s Area Agencies on Aging (AAA) on the delivery of home and community-based services (HCBS) to older adults in the state. A mixed-methods approach combined a quasi-experimental design using longitudinal service delivery data with qualitative analyses of surveys and interviews with AAA staff and clients. Overall, consolidation had no detectable effect on the proportion of older adults served by the AAAs. Subgroup analysis showed that consolidation increased the average proportion of older adults served in nonmetropolitan counties and the proportion served through congregate meals. AAA staff and clients described both positive and negative aspects of consolidation: better collaboration across agencies, improved consistency in services, significant challenges with completing consolidation processes, and serving expanded geographic areas. As the American population ages and budgetary allocations tighten, findings from this evaluation can inform other states considering similar restructuring efforts.