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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

most need.

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

older persons.


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

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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

funding formula;

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;

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