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Ms. SNOWE. Dr. Berry, I would like to welcome you here today as well. It is always good to hear from you and your expertise on issues that are very important to all of us. And I just would like to reiterate what the gentleman from New York, Mr. Downey, indicated about a White House Conference on Aging. I have introduced legislation that will require the President to call a conference in 1993. I do think it is important; so I certainly want it to be on the record where I stand on this issue because it is a good way of identifying the current needs, as well as the future needs of the senior citizens in this country.
First of all, I would like to ask you what do you intend, or perhaps you have already done so, to recommend with respect to costsharing? Have you made recommendations to OMB and to the President for cost-sharing proposals, and for what services if you have made that recommendation?
Ms. BERRY. I would like to be able to say that the Administration's bill is here. It is obviously not, however. It is in process. We have had internal discussions about cost-sharing. We certainly recognize it as a very important issue as you do. I have to mention again the fact that the network officials were very vocal on the fact that they should be permitted the option of providing services on a cost-shared basis. I personally am very attracted to that.
Ms. SNOWE. Do the services on a cost-sharing basis vary from state to state in terms of what they require for cost-sharing? I mean, do they all do it for adult day care and in-home services, or do they go beyond that, to home-delivered meals?
Ms. BERRY. While there are some— yes. While there is some commonality of cost, there is variability across state lines. And that is one issue among many that we have to look into as we try to move forward with proposals related to cost-sharing. However, I think the point that I made earlier about the low-income and the poor erderly not being adversely affected by cost-sharing programs should be kept in mind.
Chairman MARTINEZ. Would the gentlelady yield on that point? Ms. SNOWE. I would be glad to yield.
Chairman MARTINEZ. You know, I think there is something that the committee has to get clear here, and maybe Dr. Berry can allude to this. Of the 29 states that have cost-sharing, they are dealing with state monies because they can with state money, not with Federal monies. They can do a mandatory cost-sharing, and they are doing it.
Ms. BERRY. Right.
Chairman MARTINEZ. The Federal money is where there is not mandatory cost-sharing. It is done on a voluntary basis where there are only Federal monies; again, I say where there are only Federal monies used. In the congregate meals, they raise $120 million on a voluntary basis, in the in-home care meals they raise $50 million, and then for the in-home care services, they raise another $20 million, but none of those places where they did it on Federal monies were there any information that was other than self-declaration, and I would not want to see a Federal program move to anything other than that.
If the states want to and Mr. Fawell, in several of the hearings, talk about state matching funds, that is the place to do it. If the
states want to put up money to do it, then they can require anything they want to. Thank you.
Ms. SNOWE. I appreciate the gentleman's comments. To that point then, why not have demonstration projects with a state waiver as a way of assessing whether or not this is workable? There are so many questions in terms of the impact and changing the entire intent of the Older Americans Act. There are questions about what kind of revenues would be gained, if at all, under this kind of proposal.
Ms. BERRY. I think that while the concept is new to the Older Americans Act programs, as GAO has reported, 36 states already have cost-sharing programs for non-Older Americans Act programs. In fact, as the information I have indicates these programs are funded by Federal, State, and private sources—36 States; and so those States indicate to us that they have found cost-sharing to improve the equity of services, to enhance the State's capability to serve more low-income people, to reduce the welfare stigma associated with receiving free services, and to prevent cutbacks in services. Thus we do have some experience with this issue.
I recall in the 1987 reauthorization process the issue of cost-sharing came up, and we said then that we wanted more information, and I think we have some additional information from the GAO survey and certainly from the Inspector General's report.
Ms. MORELLA. I would ask if the gentlewoman would yield?
Ms. MORELLA. Okay. It was simply that I find it rather confusing because when we talk about states that have cost-sharing agencies, I notice I am looking at Maryland, as a matter of fact, and I find that there are 19 area agencies within the state. They did a survey, and they found that 11 responded. Of the 11 that responded, 3 said they had no cost-sharing, so there is diversity within each state. If a state has cost-sharing, it doesn't mean the whole state is costsharing. It means individual agencies within the state for older Americans may have it—it is like a rag bag, isn't it? It must be hard to make an assessment. Thank you.
Ms. SNOWE. I think that is exactly the point. The concern I would have if we would move forward on this issue is that we really don't have a general framework at this point that we could say that it would be workable at the Federal level. It is a major change in direction and to be sure we must have the valid research that is necessary to implement cost-sharing at the Federal level.
Ms. BERRY. I wish I could present more information. In addition to the GAO study, the IG report, and the survey that Mr. Downey mentioned. I think that those collective findings, along with the presentations and the testimony that we have from our network officials, have to provide us with some framework for moving forward beyond where we are now.
The fact is that I would say close to 50 percent, and I could be somewhat in error here, of our seniors can afford to pay. Something toward the cost of Older Americans Act services. The issue before us at this point is do we fall back simply on the traditions of the Older Americans Act and the way that it was originally designed and say that cost-sharing is not for us, that cost-sharing is one step towards means testing which, in my opinion, it is not, or
do we at least look at the data and look at the information we do have and perhaps pick up on your point of maybe looking at it further?
Ms. SNOWE. Dr. Berry, one more point. I notice that you held your field forums in many major cities across the country, and you were limited to five in Denver, San Francisco, Chicago, Philadelphia, and Atlanta. My concern is there no orientation to rural states in rural areas. I have introduced legislation that would make the Older Americans Act targeted in terms of the state formulas. It would require them to include and reflect geographical access to these services because oftentimes these services are more costly in rural areas. I am concerned that there has been no orientation towards rural areas in your field forums in collecting data that would impact differently on rural areas than in urban areas.
Ms. BERRY. That is a point well-taken. Some of our forum participants did come from the more rural areas; we actually had people come from all over the different States attend to those forums. I would just add that we have asked our rural center to give us some recommendations as well in terms of proposals that need to be put forward with regard to improving services for the rural elderly.
Ms. SNOWE. Okay. Thank you very much. Nice to see you.
Chairman ROYBAL. Thank you. The Chair now recognizes Mr. Nussle.
Mr. NUSSLE. Thank you, Mr. Chairman. I have already learned on my brief time on the committee that I take second chair to the member that has just spoken in her advocacy for rural America. I am also concerned about that subject, and I am interested not only in associating myself with her comments about the rural perspective but to ask about the center that you just spoke about and to find out a little bit about the kind of perspective that you are getting when it comes to rural America.
Ms. BERRY. I think that we could hear a bit more from rural America, quite honestly. I don't hear that much from rural America although, as I mentioned, there were participants from rural areas at the forums. The center that we have at the University of Missouri has been providing technical assistance to the network officials. All of us know that one of the most significant problems in providing services to the elderly in the rural areas is transportation. It is one of the most costly services that we have, and coordination of transportation is key to getting folks to the services.
I believe that the word "rural" is in the Act partly due to some of the advocacy efforts that I undertook when I was the rural elderly specialist at the Department of Agriculture where we advocated on behalf of the rural elderly. Housing for seniors in the rural areas is of critical concern, so I don't want to downplay the efforts of the rural advocacy aging groups. I would welcome input from them. I am not hearing from them as much as I probably should. We have a Memorandum of Understanding with the Farmers Home Administration which I just signed to try to promote better services for seniors in rural areas, better supportive services at the housing facilities. We also have an agreement with Brian Klimer at UMTA in terms of trying to get better transportation services to the rural elderly.
Mr. NUSSLE. It appears that you seem frustrated on the amount of information and background that you are getting from rural areas. Is that true, and if it is, I guess I would be willing to help, and I am sure there is a number on the committee that would be willing to help in trying to provide that information or at least giving you the vehicle to get that information about the plight in rural America.
Ms. BERRY. I come with a particular sensitivity to the issues that are dealt with in rural America. Oftentimes we debate issues and we plan programs without due consideration to the significance of those issues for the rural areas. we have to remind ourselves when we develop demonstration programs to keep in mind the diversity that exists, particularly in the rural communities.
I do have the privilege of listening to many of the Triple A directors who are from rural communities, like Nancy Peace from Upper Cumberland in Tennessee, and certainly State directors like Herb Sanderson in Arkansas. Ruth Zeigler in South Carolina, and Edwin Walker out in Missouri, who have shared with me some of the dilemmas they face. However, I would certainly like to hear more. Access to services is one of our priority concerns, and so anything more we can do there would be useful.
Mr. NUSSLE. I would be happy to work together with you on that: Some of the information I have received on the budget especially for this year has pointed out to me that it does include $1 million for the White House Conference on Aging so I would associate myself with the comments of Mr. Downey in pushing for that conference especially this year since it is in the budget.
Ms. BERRY. Thank you.
Mr. FAWELL. Thank you, Mr. Chairman. I am sorry I had to miss your testimony Ms. Berry. I did read it in toto last night so I am not bereft of knowledge of what you had in it, and I think it was a very fine statement.
Ms. BERRY. Thank you.
Mr. FAWELL. I had only just one or two comments. First of all, some reference has been made to my feeling about matching grants. I have no formula -nothing definite at all. In the hearings we have had with the Human Resources Subcommittee under the fine chairmanship of Chairman Martinez I have several times asked what the actual potential would be for more matching grants but that is about all.
I am just seeking knowledge. I did so only and do so only because of the tragic lack of funds which we have at the Federal level and because of the positive effects of the Older Americans Act. It has been tremendously successful in providing seed money, even though it wasn't meant to provide seed money. It was meant to provide programs, but it has caused the states and local entities to come up with all kinds of innovative, creative ideas, and that is a plus and a blessing. Overall we probably have in toto more, a lot more money than we ever thought we might have when the program commenced even though Federal funds, unfortunately, have gone down. I would support the Chairman's view that more Federal funds are definitely needed.
The only other point I have noticed is that 36 states, in effect, have bolted the Older Americans Act and simply gone out on their own in cost-sharing. It is pretty clear how the states feel about this, and I question whether it is wise for us to ignore the fact that the states are pretty much making it clear that we seemingly have the demonstration-as many demonstration projects as we would want to look at it and, indeed, you did look at it, and your findings, I think, are very significant.
Most of those, I think, were in the in-home health care-
Mr. FAWELL. -area which is the burgeoning area I think now, and it is going to grow more because people are so deeply concerned about doing everything possible to keep the senior citizens within their own home environment and not in custodial nursing home care.
I think we are going to find that we have more and more pressure
Ms. BERRY. Absolutely.
Mr. FAWELL. -in this area, and if it can be done and there is not loss of targeting of low-income minorities to accomplish the basic purpose, which I think we can, then I would in that one area especially believe that the time properly has come for the authority at least
Ms. BERRY. Uh-huh.
Mr. FAWELL. -not a mandate but the authority to be granted to the states to consider utilizing cost-sharing in this area of in-home services so I thank you for what I believe is a very fine statement though, again, I wasn't here to hear it
Ms. BERRY. I appreciate your comments.
Mr. FAWELL. -although I know I missed a great deal in the give and take in the questions too. Thank you, Mr. Chairman.
Chairman ROYBAL. Thank you.
Dr. Berry, I would like to thank you for your testimony, and there are various questions that are still to be answered, but we hope there will be another time. The two important things that have been brought up in the hearing up to this point are: our cor cern with regard to cost-sharing, and the fact that no methodological study has been made with regard to the effects of cost-sharing or mandatory cost-sharing on the participation of the elderly in Older Americans Act programs.
I understand a study was made by GAO with regard to the same subject but focusing on food stamps and the result of that study was the elderly would not participate because of the stigma attached to it. It is also my understanding that none of the current studies underway have specifically zeroed in on cost-sharing and its impact on low-income minority elderly.
I think that before a decision is made one way or the other, a study should be made to find out the effects of what we are doing, I think we will find the elderly are quite concerned. Sure they can afford it, and those that can are willing to pay it now without having to go through a means-test, but there is an indignity, a stigma attached to a means-test procedure of any kind. That we want to avoid.
I know, Dr. Berry, that you are doing a doggone good job.