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being developed; however I am pleased to provide you with
information on the general directions in which we hope to move and
can tell you that what comes forward to you from the Administration
will not be the result of a "business as usual" mind-set.
Over the past year, we in the "aging community" have given new
and unprecedented discussion and debate to key issues relating to how
we can make the available resources go farthest in serving all older
people, while making certain that those who are in greatest need are
adequately targeted and provided with the needed services. This
debate continues, and you will, I expect, hear evidence of this today.
While approaches may differ somewhat from organization to
organization, our goals are most assuredly the same -- to provide a
decent quality of life for our elderly citizens, particularly those in
Because I think the debate is healthy, I would like to share with
you what I have heard to date, from my perspective as U.S.
Commissioner on Aging.
Beginning in March of this past year, I undertook the convening
of field forums in five locations around the country in an effort to
gain further insight into the needs of the nations' elderly population.
I sought, through forums held in Denver, Atlanta, San Francisco,
Philadelphia and Chicago, to learn the views of knowledgeable
individuals and organizations as they considered issues for
reauthorization of the Older Americans Act. I heard from directors
and staff of State and Area Agencies on Aging, from service
providers, from consumers of service and from representatives of
national, State and local aging organizations.
The topics identified for discussion by those persons who attended
the field forums were shaped by their perceptions that the size and
needs of the older population are rapidly increasing during a time
when it is increasingly important that we make the most cost-effective
use of the public dollars going into these and other programs serving
Forum participants observed that the numbers of those in the 75+
category are growing at a much faster rate than the older population
in general. The changing composition of the elderly population
coupled with decreasing available resources is placing increasing
strains on caregivers, many of whom are families and friends, who
provide over 75% of the care of older persons. Those caring for
functionally impaired elderly family members are predominately
One of the major topics of discussion at these forums was how
the Act might be amended to assure access to services for those in
greatest need as well as ways to assure access to potential
supplemental resources for Older Americans Act programs such as
the purchase of services by private sector firms on behalf of their
employees who are caregivers and ways to obtain other contributions
to expand community services.
There was substantial support, as well, for improved methods for
targeting services to those older persons in greatest economic or
social need, with particular attention to low-income minority older
persons. I want to clearly enunciate my belief that it is time to
engage in serious discussion and debate on some of the major issues
which emerged in the field forums held in various locations
throughout the country.
All participants were strongly dedicated to the concept of
targeting to those most in need of service and the forum participants
were highly articulate in voicing their recommendations on how more
effective targeting might be achieved.
Among the issues debated in the forums were:
Clearer definitions and targeting requirements in the Act;
Inclusion of a low-income minority factor in the inter-State
0 Commissioner approval of intra-State funding formulas;
0 Increasing outreach efforts;
0 Providing financial rewards to States who effectively target
o Developing a system of sanctions which States may impose on
Area Agencies on Aging which do not effectively target and
sanctions which Area Agencies may impose on service
providers who do not adequately target; and
o Providing special attention to the needs of rural elders.
, Finally, it should be pointed out that the issue of older persons
sharing in the cost of Older Americans Act services clearly emerged
as a corollary issue during the forums to the issues relating to
achieving more effective targeting. While this concept is not totally
accepted within the aging community, a large number of the forum
participants favored such a provision. Participants stated that cost
sharing should include the following elements:
o low-income older persons should be exempt from cost sharing
income determination for cost sharing should be established by
a simple self-declaration;