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Proposed Changes to the Older Americans Act:
Irrect a Participation and Service Delivery

Testimony of

The American Association of Homes for the Aging, Inc.

for submission to the

House Select Committee on Aging


House Subcommittee on Human Resources of the

Committee on Education and Labor

May 17, 1991


Regional offices in Albany•Chicago. Denver


AAHA is pleased to submit written testimony to the House Select Committee on Aging Committee and the subconmittee on Human Resources of the Committee on Education and Labor for the record of the hearing held April 25, 1991 regarding "Proposed changes to the Older Americans Act: Impact on Participation and Service Delivery." The Older Americans Act has become an increasingly important vehicle in filling home and community-based service gaps in the long term care continum due to the rapid growth of elderly individuals and because of the lack of a comprehensive federal long-term care system. In an effort to improve the effectiveness of the Act, AAHA recommends using increased ombudsman funding for state ombudsman services to further educate and inform ombudsman of the complexities of nursing home operations and regulatory requirements. AAHA further supports the use of elder abuse prevention funds to train and educate community-based advocates in an effort to prevent elder abuse in unregulated community-based settings where the majority of abuse occurs. To improve targeting efforts, AAHA recommends including the intra-state funding formula in the state plan for Secretarial approval, establishing a panel to make reconmendations regarding more effective targetting strategies, and developing linkages between Federally-assisted housing and supportive services provided by the Act. In consideration of the growth of aging-related issues, AAHA supports the White House Conference on Aging and recommends that it remain under the direction of the Administration to sustain the importance of aging-related issues at the highest level of visibility. AAHA also recommends that the Administration move expeditiously to begin the planning and preparation required for a national conference of this magnitude. Finally, AAHA supports the right of the elderly, as well other populations with special needs, to be served in settings appropriate to their needs and preferences, based on the availability of need-specific programs. Further, AAHA supports federal funding of programs to assist special need populations, including elderly and non-elderly. The Association seeks clarification of the Age Discrimination Act which was enacted as part of the 1975 OAA Reauthorization to ensure that age continues to be an appropriate factor for admission to facilities whose mission is to serve the elderly.

OLDER AMERICANS ACT REAUTHORIZATION TESTIMONY The American Association of Homes for the Aging (AAHA) is a national, nonprofit association representing over 3,700 not-for-profit facilities providing health care, housing, continuing care retirement, and connnity services to more than 600,000 older individuals every day. Seventy-five percent of AAHA homes are affiliated with religious organizations, while the remainder are sponsored by private foundations, fraternal organizations, government agencies, unions, and community groups. AAHA is pleased to submit written testimony to the Subcommittee on Aging of the Senate Labor and Human Resources Conmittee for the record of the hearing held April 26, 1991 regarding arrent and potential roles of the Older Americans Act (AA) and the Aging Network in home and conmnity-based care. The OAA has become increasingly important in meeting the social and human needs of the elderly since it's initial enactment in 1965 due to the vast growth in the elderly population. When the Act was passed in 1965, there were approximately 17.5 million elderly individuals over the age of 65, according to the Statistical Handbook on Aging Americans. According to the U.S. Bureau of the Census, the 65 and over population will expand from 12.7% of the population (31.5 million persons) in 1990 to 21.8% (67.5 million) in 2050. Subsumed in this growth are individuals 85 years of age and over. This age group, the fastest growing segment of the elderly population, is expected to quadruple by the year 2030, according to the American Association of Retired Persons. In the absence of a comprehensive federal long-term care system and because of the institutional bias of existing federal programs such as Medicare and Medicaid, as the numbers and percentage of elderly continue to grow, the Act will become an increasingly important vehicle in filling home and community-based service gaps in the long-term care continnm. In view of the significant role the Act plays in providing much needed long term care services that otherwise would be unavailable, it is vital that the Act receive full, continued funding for the variety of home and community-based services it supports. Additionally, any new programs created under the Act should not undercut existing programs. The 1991 reauthorization of the QAA provides AAHA the opportunity to clarify several issues affecting AAHA members: (1) the purpose of the ombudsman program and the role of ombudsmen in nursing home advocacy; (2) the intent of the elder abuse prevention program regarding community-based and institutional advocacy; (3) strategies for targeting QAA services to insure that the intent of the Act to serve low-income individuals is being met and to strengthen linkages between senior housing and supportive service programs;

(4) support for the White House Conference on Aging; and (5) preservation of the ability of senior housing and health care providers to use age as a criterion in admission policies.

OMBUDSMAN Ombudsmen traditionally have functioned as advocates for nursing home residents. FY 1991 appropriations included $2.4 million to fund ombudsman activities (a 40 percent increase over FY 1990 funding). Clarification regarding the role of the ambudsman is critical to determining how new funding for this program should be targeted. The number of ambudsmen and level of training differs dramatically across states. In some cases ambudsmen are professionals who understand the needs of the elderly and constraints under which providers often operate programs. In other cases, they are volunteers with little experience relative to long-term care services and facilities. Furthermore, the relationships between ombudsmen and providers, families and residents vary substantially. In some cases, ambudsmen and providers work cooperatively to ensure that residents' needs are met. In others, the relationships are either adversarial or non-existent. The increase in FY 1991 funding could be used in several important ways: (1) to strengthen training programs for ambudsmen and the facility staff, families and residents they interact with; or (2) to increase the competency of ombudsman. AAHA strongly supports educational efforts designed to better inform ombudsmen of the complexities of nursing home operations and regulatory requirements. The training requirements currently outlined in section 307 of the OAA are limited to training programs for facilities conducted by ombudsman. We also support education of facility staff, families and residents designed to foster collaborative efforts with ombudsman toward the improvement of resident care.

ELDER ABUSE PREVENTION PROGRAM The Elder Abuse Prevention program was created to prevent abuse of older individuals. This program was authorized in 1990 and funded for the first time in FY 1991 at $3 million. It specifically provides for public education and outreach services to identify and prevent abuse, neglect and exploitation of older individuals. Congress stressed that this program should be designed to complement, not to duplicate, existing programs. Clarification regarding the use of elder abuse prevention funds is needed. The law provides states discretion in spending these Elder Abuse Prevention funds, stipulating that part of the funding be targeted toward ambudsman activities in long-term care facilities. The Administration on Aging (AOA), in a recent draft program instruction sent to State Units on Aging (SUAS), stated SUAS must distribute the new elder abuse prevention funds via their intra-state funding formula to Area Agencies on Aging (AAAS) and recommended the funds be used for public education related to elder abuse. AAHA strongly supports this instruction. Since the majority of elder abuse exists in community-based settings where care is unregulated, AAHA believes that Elder Abuse Prevention funds given to AAA's should be used to train community-based advocates including social workers, adult protective

services workers, clergy, legal services staff and others. These individuals should be trained how to identify instances of abuse (physical, psychological, financial) and appropriate remedies for corrective action. AAHA also recommends that a technical amendment to Title I - Section 102 of the QAA be included to define board and care facilities. Under the FY 1991 appropriations, the law stipulates that a portion of the elder abuse prevention funds be used to prevent abuse of older persons living in these settings. While AAHA supports the intent of this provision, there are a wide variety of residential settings serving the elderly that provide some level of personal care and supportive services. AAHA'S Assisted Living Task Force arrently is working toward standardizing and clarifying definitions of such facilities based on their nature and scope of services. since we believe that Congress intended "board and care" facilities to refer to those that arrrently are unregulated by the state and have demonstrated questionable practices relative to the care provided and treatment of the elderly, we wish to ensure that the appropriate facilities are targeted in this regard through clarification of the term "board and care". AAHA supports the instruction from the AA and recommends conference report language that:

* clarifies that elder abuse prevention funds be targeted toward

training, education and outreach programs directed toward
preventing elder abuse in conmmity settings. Such activities
could include: targeting special educational programs an elder
abuse to the police, lawyers, bank employees, financial
planners and clergy; offering a wider range of support and
intervention programs for abused seniors, including marriage
counselling, self-help groups for victims and emergency
shelters; providing respite care, homemaker services and support
groups to reduce caregiver stress.

TARGETING QAA SERVICES While states have discretion in the allocation of QAA funding, the intent of the Act clearly is to provide services to low-income elderly. Questions have arisen as to the effectiveness of targeting efforts among states. First, are outreach efforts successful in targeting QAA funding to the low-income elderly? Second, if elderly individuals of financial means are taking advantage of QAA programs and services, should they make a voluntary or mandatory contribution for services, providing additional funding that would enable more low-income elderly to be served? A 1986 AOA study showed participation rates of the low-income and minority elderly to be greater than their proportionate share of the population. A subsequent study conducted by the American Association of Retired Persons (AARP), however, indicated that participation in AA services is difficult to evaluate since information about income levels cannot be collected and data gathering techniques are not uniform across programs and states.

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