4

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.

5

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

women.

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

し

6

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:

0 Clearer definitions and targeting requirements in the Act;

O Inclusion of a low-income minority factor in the inter-State

funding formula;

Commissioner approval of intra-State funding formulas;

o Increasing outreach efforts;

o Providing financial rewards to States who effectively target

services;

7

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

requirements;

o income determination for cost sharing should be established by

a simple self-declaration;

8

o the fees for cost sharing should be based on a sliding scale

according to the participant's income;

State and Area Agencies on Aging should have options and

flexibility in how they administer Older Americans Act cost sharing provisions; and

o cost sharing should be prohibited for advocacy services and services designed to provide access to the delivery system

such as information and referral, outreach, elder abuse and protective services, and long term care ombudsman services. Indeed, I share the concerns expressed at the forums, and in my testimony today I would like to discuss a number of steps which the Administration on Aging has already undertaken during my tenure as Commissioner to ensure that the national network on aging, at the

Federal, State and local level, moves in a responsible manner to more

effectively target services to all eligible individuals including the lowincome minority elderly.