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A. Extension of the Act
I strongly support the reauthorization of the Act and all of its titles for either a three year or four year period. If major changes are made in the Act, a three year reauthorization might be in order. Either a three year or four year authorization would symbolize the strong support of the Congress for the Older Americans Act program.
B. Role of the Commissioner and the Administration on Aging
The recent decision by HHS Secretary Sullivan to make the Administration on Aging an independent agency again in the Office of the Secretary is a most important one. But, I would urge the Congress to add to 1t by including a provision in Title II of the Act that would require the Commissioner on Aging to have the control over the budget and personnel of the Administration on Aging clearly and unequivocally. In addition, it is time to support a major strengthening of the staff and resources of the Administration on Aging if it is to function as a strong advocate for older people and as a source of technical assistance and direction to all of the public and private agencies involved in the administration of the older Americans Act programs.
The field of aging is very fortunate to have Dr. Joyce Berry as the Commissioner on Aging. She is extremely competent, but Commissioner Berry needs more help to carry out fully all the functions assigned to the Commissioner under the Act's Title Il provisions.
Increased Authorizations and Funding for Title III
The Title III grant program should have greatly increased authorizations and funding if it is to meet the growing demands being placed upon it to meet the
needs of an increasing older population. As presently constituted, Title III has become the major delivery system in the nation for the provision of many social and nutrition services for older persons. As the result of both past Congressional mandates in previous amendments to the Order Americans Act and the present stringent budget situation, the Title III grant program is under extreme pressure. There is competition for its funds from those interested in supportive services and senior centers, from those interested in congregate and homedelivered nutrition services, from those concerned with legal services for the aging, and, from those concerned with the needs of the developmentally disabled aging, the minority aging, and with such serious problems as elder abuse and neglect. I believe the scarcity of funding, especially at the area and state level, is what is behind the interest, almost the preoccupation it seemed, with such proposals as mandatory cost-sharing and the public-private partnerships put forward by the Administration on Aging.
Increasing Minority Participation
Mr. Chairman, the General Accounting Office has just completed a comprehensive report on minority participation in the act. The GAO made several constructive recommendations, most notably the development of a more adequate data base for the collection of information on minority participation in the Title III program.
But, other steps are needed to help the aging "network" reach the objectives in the Act for the participation of the low income minority population. Either by regulation or by language in the Act, state units on aging and area agencies on aging should be required to provide technical assistance to minority service providers, utilize the services of HBCUs and other minority agencies in the field of aging in the development of area and state plans for various Title III services and carry out continuing outreach programs to low income minority populations as part of an approved area and state plan of services.
Both the National Association of Area Agencies on Aging and the National Caucus and Center on Black Aged have produced excellent reports and recommendations in this area that should be consulted in the development of any new targeting provisions.
Once again, mandatory cost sharing for Title III Supportive and Nutrition Services has been proposed by the National Association of State Units on Aging. This was first advanced in 1983 by the National Council of State Public Welfare Administrators and later became the position of the American Public Welfare Association. It is based on the assumption that in an era of soaring costs of care of the frail elderly and declining budgets at the state level, the States should have the option of implementing a mandatory cost-sharing program for Title III of the Act. It is argued that this approach would permit much greater coordination of Title III programs with the Title XX Social Service block grant program and Medicaid as well as with other programs serving older persons which are means-tested. Those advocating this approach also argue that mandatory costsharing would result in improved targeting of the low income population, including the minority aging.
As you may already know, I am strongly against the introduction of mandatory cost-sharing. It would be an abandonment of the intent and philosophy of the Older Americans Act. Mandatory cost-sharing is not just a significant new way to raise funds in the title III program. It also implies a shift in OAA programs to a highly residual and selective models in which services are basically for certain sub-groups of older persons. The widespread use of income eligibility forms and assessment will stigmatize the program in the eyes of older people. And this will result, in my opinion, in reduced participation rates not only among middle-class older persons, but low-income seniors as well.
It is interesting to note the strong opposition to mandatory cost-sharing that has been voiced by the National Caucus and Center on the Black Aged. It is their position, a carefully developed one, that mandatory cost-sharing would discourage minority participation in Older Americans Act Programs. I agree. .
The Older Americans Act has worked well with voluntary contributions. I am unimpressed with the arguments for mandatory cost-sharing. The Older Americans Act has always operated under the assumption that its services would be available to all older persons without eligibility and income reviews as a condition of eligibility. The introduction and implementation of mandatory cost-sharing in the Title all grant would convert it eventually to a traditional "welfare"
The public-private partnerships being carried out by the "aging network" with private non-profit organizations requires careful attention by the Congress.
I do feel that there is considerable potential here. The elder-care" initiative started recently by the Administration on Aging is an interesting innovation, and one that clearly is designed to increase the involvement and participation of the private for profit sector in developing various "elder-care" programs. Also, the Administration on Aging has 1ssued guidelines that are designed to assure that the major statutory missions of the state and area agencies are not compromised by any elder care initiatives.
These public-private partnerships will need to be carefully monitored by both the Administration on Aging and through Congressional oversight. There is, as some have expressed, the possibility that the area agencies on aging, in their efforts to develop such income-producing partnerships, will lose sight of the needs of the low-income and minority older populations.
There are two new initiatives which have been made recently by national organizations in the field of aging that have considerable appeal.
The first is the proposal of the National Association of State Units on Aging for a new Title VII-Grant for Elder Rights Programs. Its actual provisions may need some careful drafting since the new title would cover somewhat diverse programs, ranging from the State Long Term Care Ombudsman program, the Prevention of Elderly Abuse program, and a permanent outreach program regarding the Supplemental Security Income, Medicaid, and related programs. There should be particular interest by the Congress in strengthening the State Long Term Care Ombudsman program by complimenting 1t with one for in-home services as well.
The second is the proposal made to have a major health promotion and prevention program that would be based at senior centers and other sites. This is a most innovative proposal. The proposal is one that has been proposed by the National Council on the Aging and its National Institute of Senior Centers. Its nucleus is already contained in section 361(a) of the Act. This would be a major prevention health services and education program. There are over 12,000 senior centers in the nation, and several of these would be appropriate sites for such a constructive program.
Mr. Chairman, this concludes my testimoniy. Thank you again for inviting me here today. I would be glad to provide additional information on any part of my