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in creating private and public partnerships because they do believe that they can do that, and they have already had corporations willing to come and put that money.
Along those same lines, Mr. Fawell, in several of the hearings, has asked (and I don't mean to be speaking for him) but he has asked the question of state matching funds. I have a problem with that because if the state doesn't have the funds to begin with because a lot are on very desperate, austere budgets; if they don't have the funds, they are not going to provide the service because they have got other priorities so there must be some base, and if there is a base funding for it and then they can through private partnerships gain more funding; that would create an incentive for the Federal Government to put more money, would the Department or your office support something like that?
Ms. BERRY. I think, Mr. Chairman, we have certainly seen increasing difficulty with States to come up with a match. I must confess that I have not reviewed Mr. Fawell's proposal, but I would like to do that.
Chairman MARTINEZ. Well, he doesn't have a proposal, Dr. Berry, but what he has asked is if something like, if people were in support of something like that, actually most people say no because of the fear of the state then not being able to match the fund and not having any monies at all for it, but I am the one that suggested that maybe if there were a base, a guaranteed base, and understand that what I am contemplating is a base that increases funding from what it presently is because of various things that have happened: the increase in number of clientele, the increase in costs of services, a whole raft of other things that have caused them to not have the ability to serve as many people as they have with a base in the past, I believe there has to be an increase of funding.
Ms. BERRY. I agree. Public-private partnerships are very important in this regard.
Chairman MARTINEZ. But if, aside from that increased funding level, if there were a program that created the incentive for states to come up with more money through maybe private partnerships, Ms. BERRY. I think that seems reasonable. Chairman MARTINEZ. Thank you. Ms. BERRY. Certainly, Mr. Chairman
Chairman. MARTINEZ. I think the Chairman was getting ready to smack his gavel so I will end with that, but there are some other questions that we need to ask, and I know that we will be continuing our dialogue. Thank you.
Chairman ROYBAL. You know, Dr. Berry, I never used a gavel when a Chairman has the floor, and I was just waiting for that opportunity. It just didn't come about, but there will be a time. The Chair now recognizes Mr. Barrett.
Mr. BARRETT. Thank you, Mr. Chairman. Dr. Berry, most of the debate on the reauthorization seems to be centering around those most in need, particularly minorities, and cost-sharing. Are these the two areas where we should be directing most of our attention in your opinion, or should we be focusing elsewhere?
Ms. BERRY. I think they are clearly the areas that are indicators, of the growing numbers of seniors who need services and the limit
ed amount of resources. The issue of targeting has come up, obviously, because there is a concern that we focus the money on those most in need as was required in the 1987 amendments. However, very few States have a low-income minority factor in their intraState funding formulas. The whole area of targeting remains a very important one.
The issue of contributions and cost-sharing is obviously not a new issue. However, because of the growing demand for services, we are at a point where we should ask seniors who can pay to help provide protection for the poor, we envision a sliding fee scale for those seniors who can pay. We also need to focus on the types of services to which cost-sharing would apply. We must strongly consider whether to provide States this cost-sharing option. These are critical issues.
I did mention in my opening remarks that there are many objectives laid out by the Older Americans Act related to housing, transportation, and employment. I hope that we don't lose sight of those issues. However, I am glad you raised the question about cost-sharing. We have always had bipartisan support for Older Americans Act programs, and I would hope that the issue of cost-sharing does not become a divisive one. I think that we must do whatever can be done to work through this together, as we have done in healing the network and in bringing back a partnership over the past two years.
Mr. BARRETT. Thank you. One of the states involved in the Inspector General's cost-sharing study was my own state of Nebraska, which again piques my interest in that area. In all of the people that were talked to, did any of them mention that the money that they were being asked to contribute was too much money? Did this ever come up?
Ms. BERRY. No, sir. That has never come up, at least not in the information I have received. I have not been advised verbally or through written information that seniors have complained about the amount of money that they have had to pay. It is interesting because we are the advocates for all older people not just those who receive services under Older Americans Act programs. I am the Commissioner on Aging on behalf of all older people. No seniors who are participating in cost-sharing programs in the 36 States have contacted me; I have not heard from them in terms of being mistreated, so I think it is something that we ought to consider.
Mr. BARRETT. You mentioned a moment ago a sliding fee schedule. Do many of the states have any kind of a sliding fee schedule in the studies?
Ms. BERRY. I believe the GAO survey looked at the type of fee schedules, and they looked at the types of services being provided. Many of the States do, in fact, have sliding fee scales. These arrangements protect the poor. Most of the poor are not, in fact, participating in cost-sharing. I think there seems to be some fear that cost-sharing will adversely affect the poor. However, the poor are not involved in cost-sharing.
Mr. BARRETT. Uh-huh. One of the areas that I think this committee will be looking into or should look into is perhaps an expansion of cost-sharing into some of the Title III programs, particularly nutrition. Would cost-sharing encourage or discourage people from en
rolling in nutrition programs? What would your thoughts be on that area?
Ms. BERRY. I guess I would have to go back to permitting flexibility to the States. We are at a situation where our State directors tell us that in some places there are thousands of seniors waiting for services. Clearly, the State directors are closer, and the Area Agency on Aging directors are closer to the needs in individual communities. I spoke to their credibility in my opening statement. I think it is now time to rely on those officials to give us their recommendations. The National Association of State Units on Aging has done that as well as the National Association of Area Agencies on Aging. Those are the folks who are daily confronted with having to serve these seniors.
With regard to the nutrition program, that has been the program where we have received most of the contributions, and so, of course, there could be a debate as to whether or not that program should be included in cost-sharing.
Mr. BARRETT. Thank you. Thank you very much. Thank you, Mr. Chairman.
Chairman ROYBAL. Ms. DeLauro.
Ms. DELAURO. Thank you, Mr. Chairman, and thank you for your testimony, Dr. Berry.
Ms. BERRY. Thank you. Ms. DELAURO. You mention the decrease in minority participation in these efforts, and I just wanted to get some sense of what is your view as to why this is occurring, what kinds of remedies are you looking at in order to increase minority participation under the Act.
And I am a little bit concerned as the cost-sharing effort impacts all seniors and maybe minorities, in particular, that what we are going to do is to lose some of the folks that we would be most wanting to serve, who the Act was designated to try to serve, and so that is, essentially, what my concerns are.
Ms. BERRY. Those are important concerns. Ms. DELAURO. If you could address that? Ms. BERRY. Yes. I certainly spoke to the issue of targeting which is particularly important now as we try to reach out to the many seniors who need assistance. We have not found that there is a substantial decrease in minority participation in Older Americans Act programs.
Ms. DELAURO. Yes.
Ms. BERRY. There are those who would argue and question the data. Certainly we need to do much more in terms of making sure that we have a sound data base.
Ms. DELAURO. Yes.
Ms. BERRY. But the 1989 and 1990 figures for minority participation in B, C-1, C-2, and D are fairly stable. Ms. DELAURO. Yes. Ms. BERRY. So there is not a decline, as the current data shows. Ms. DELAURO. Then let me just ask you a question on targeting. When you talk about targeting, what are you talking about? What methodology? How are you going about targeting the population? I mean, I know that in my own community in New Haven we are concerned with the area of infant mortality. We now have a van
that goes from the Hospital of Saint Raphael into the community in a station somewhere, and they are actually really almost going door to door looking for people. What kinds of processes are you talking about?
Ms. BERRY. Well, State Agencies are to provide an assurance that preference will be given to those with the greatest economic and social need with particular attention to the low-income minority.
Ms. DELAURO. Yes.
Ms. BERRY. The States, as they try to implement this provision of the Act, have been innovative in their procedures. The Administration on Aging has funded four national aging minority organizations over a number of years to provide technical assistance.
We also have a resource center on minority aging that is providing technical assistance, offering information in terms of targeting of services; but I think we do have to pay more attention to the Title III intrastate funding formula. As the dollars go out to communities in the State, we have to make sure that those dollars are, in fact, going to the places where there are greatest concentrations of minority individuals and those who are economically and socially needy as well.
Ms. DELAURO. Pardon me, maybe it is a naive question: In terms of your own jurisdiction over that intrastate funding and monitoring, just tell me what that is?
Ms. BERRY. At the moment I have review and comment authority on Title III intra-state formulas.
Ms. DELAURO. Okay.
Ms. BERRY. And many of our forum participants clearly expressed the interest in the Commission on Aging having actual approval authority over the intra-state formulas.
Ms. DELAURO. Okay. Thank you. Chairman ROYBAL. Mr. Nichols. Mr. NICHOLS. Madam Commissioner, I would like to ask you a question a little different, but I think it is something you have an interest, I have heard. We are always looking for money; and when I dealt with these issues at the state level, one of the things I found was that about 30 to 40 percent of the people, sometimes higher, that they were putting in the nursing homes didn't really need to be there; and after they were in there about four months, they got public assistance generally because all their assets were gone, and so we picked them up.
And we tried to start a program called Elder Care with Options which is more of an in-home health care that would attempt to try to keep people more cost effectively in an environment that they are healthier in at a less cost by providing some of these services to them in that environment. But when you look at these proposals, do you have any studies going on that could impact this type of Older Americans Act with that type of program in encouraging states to conserve resources by doing it because these generally are middle income people that we force into poverty and force under the public rolls which cost us even more? Do you share that concern, and how do we work with that?
Ms. BERRY. Yes. You have touched on an issue that is critical in the provision of services to older people. It is probably one of the most important issues in the field of aging right now. That is how
do we provide services to the growing numbers of older people who are at risk of becoming totally dependent. Furthermore, we know that older people want to stay in the community.
We have funded six long-term care resource centers that are looking at a number of issues related to the whole matter of the provision of services in the community. We have a center that is trying to link our network with hospitals and residential long-term care facilities. We are trying at another center to improve some of the decisions that are made by families that impact on the care provided to seniors.
We also have another center that is looking at how we can shore up our community-based systems of care. I agree with you wholeheartedly. I think that the whole matter of in-home and community-based services is key to the Act. We have a clear mandate to keep older people in the community for as long as possible. I think, quite frankly, that the whole notion of doing business differently will help us in reaching out to some of the institutions that traditionally have not been involved in helping provide some of that care.
For example, some of the religious institutions, have offered to provide care, as well as some of the voluntary organizations, such as the Red Cross and the Salvation Army. I am asking the network to be more creative and to step up its efforts to link up with some of these organizations to address home and community-based care needs.
We know that the home-delivered meals program is critical. There are many transfers of resources from the congregate program to the home-delivered program. In fiscal year 1990 a total of $36 million was transferred to the home-delivered meals program from congregate meals. These transfers increased home delivered meals resources by 41 percent.
Mr. NICHOLS. If I may, do you have any idea why there has been a reluctance for states to move more rapidly into this area? It would seem to me that it is much more cost effective, it is much healthier, but there has been a resistance to providing the network.
Ms. BERRY. Well, actually, the States have taken a leadership role in trying to set up creative financing mechanisms to keep older people in the home and in the community. The State of Pennsylvania, for example, has a State lottery which, in fact, is targeted to help the vulnerable elderly. There are many other creative programs across the country where the State directors have set up measures to prevent institutionalization of older people. I think it is to the State's credit that less than 5 percent of our seniors are in institutions.
The concern is that there are many seniors who are in their homes who do need home repair, who entered public housing facilities at 60 and are now 80 and who do need the support of services. At the national level, I personally can exercise my authority under Title II of the Older Americans Act by trying to get other Federal agencies, like the Department of Housing and Urban Development, to work with aging network officials as they try to strengthen the community-based system of services.
Mr. NICHOLS. While I have you, I will ask one last question. I hope that someday we can figure out a way for the middle income