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Senator EAGLETON. Here at Sacred Heart, is this one of the big. gest in terms of numbers of meals? Just give me a few statistics. Mr. Gates, we will get to you this afternoon. How many participants on an average basis?

Mr. Gates. There are about 75 participants here.

Senator EAGLETON. What is your biggest one in the New Orleans area?

Mr. Gates. We have one at a high-rise that serves about 180.

Senator EAGLETON. 180. Again, à rough percentage, of that 180, how many are rather constant repeaters, that is, if not every day, but frequently participate?

Mr. ĜATES. They are in a high-rise building that is for elderly people, so their level of participation is pretty high.

Senator EAGLETON. Now, are there others beyond the 180 who would like to participate in that program, but you just don't have the money or equipment or whatever to serve them?

Mr. GATES. Senator, why don't you let me give my testimony? I think we can delay lunch

Senator EAGLETON. No, no, I don't want to delay lunch. Why don't we have it after lunch.

Mr. GATES. I think it is in context with what has been said and we could clear up quite a bit. It is not that long.

Senator EAGLETON. I just didn't want to delay the lunch or havę it get cold. No; I am going to be here in any event.

Ms. PILLAULT. It is just whatever you decide.
Senator EAGLETON. I vote in favor of lunch and we will recess

now.

Mrs. Boggs. I was just going to say that as a part of Mayor-elect Morial's written testimony there is a very good breakdown of the nutrition program and how many people are served.

Senator EAGLETON. Thank you. I will read through that.

We will recess for lunch and we will reconvene at 1 when we will hear Mr. Gates and we have a panel from the Sacred Heart Nutrition Center.

[Whereupon, at 11:55 a.m., a luncheon recess was taken to reconvene at 1 p.m., the same day.]

AFTERNOON SESSION

Senator EAGLETON. Good afternoon, ladies and gentlemen. I think we will proceed with our hearing now. We are glad to have as our next witness Mr. George Gates, director of the New Orleans Council on Aging.

STATEMENT OF GEORGE GATES, DIRECTOR, NEW ORLEANS

COUNCIL ON AGING

Mr. Gates. Thank you, Senator Eagleton.

Some of the people in the back have said that they have problems hearing. If you can hear, raise your hand.

Senator Eagleton, I would like to thank you as the director of the New Orleans Council on Aging for coming down to New Orleans to get firsthand knowledge of the problems of the elderly. Prior to my testimony, you have been hearing testimony that deals more with planning and coordination from the State oflice on aging and the area agencies on aging. It is my intent to give you sort of a grassroots idea of what we see as the problems of the elderly in this community.

For the record, I am George M. Gates, executive director of the New Orleans Council on Aging. The New Orleans Council on Aging is an advocacy and service-oriented agency providing a multitude of services to the elderly in Orleans Parish. The Council on Aging was chartered by the Governor of the State in 1966 to be the parish agency to provide these services. There are presently councils on aging operating in every parish of the State.

I bring this to your attention because as you travel around the country acquiring information for the renewal of the Older Americans Act, you are going to find many variations in the methods of service delivery. I have found this system of service delivery (the Council on Aging concept) to be one of the better systems of effectively and efficiently carrying out the legislative intent of the Older Americans Act.

You are here today to get grassroots input of the problems of the elderly. As you may already know the problems of the elderly have compounded since the passage of the Older Americans Act of 1965. The amendments to the act have sought to alleviate some of these problems, but nevertheless, they continue to exist.

We have attempted to prioritize the problems by getting direct input from the elderly. We feel that the problem areas that will be outlined here reflect those areas that are of immediate concern to the elderly in this community.

Elderly persons face tremendous obstacles in getting transported from place to place. Whereas New Orleans has one of the better transit systems in the country, it falls short in meeting the needs of our elderly population. Older persons need a transit system that is tailored to meet their needs. It is no easy task to have to walk two or three blocks with an arm full of groceries.

Older persons have more medical appointments than younger persons and it is often very difficult to get to these appointments via public transportation. In many instances food stamps are stolen from senior citizens after they have left the food stamp office and are on their way home. We have found that our 60-plus population would participate much more in civic, cultural, and recreational activities during the day and night if they were assured of adequate transportation to and from the activity. "Taxi drivers are reluctant to transport older people especially from grocery stores because they fear the loss of another fare while assisting the person with his or her packages.

The New Orleans Council on Aging does provide transportation to its meal sites through an agency agreement with the Easter Seal Society, also, a limited amount of grocery store shopping and food stamp transportation, however, the demand far exceeds our capability of supplying service. We would recommend that there be more title III funds made available at the local level in order to provide transportation and that other governmental agencies responsible for transportation be mandated to be more sensitive to the transportation needs of elderly persons.

Another area of major concern is that of health care. We define health in the context of the World Health Organization's definition, that being “Health is a state of complete physical, mental, and social well-being and not merely the absence of disease or infirmity”.

Health problems of the elderly have been a major concern of the health advisory committee of the Council on Aging and on October 16, 1975, the committee went on record to urge our congressional delegation to support a plan that would provide comprehensive health care to all citizens.

Health problems are compounded for the elderly persons living on fixed incomes. We have numerous cases of elderly people who have medical bills of $80 and $90 a month and are attempting to live on an income of $200 a month or less.

There are instances where elderly persons go to physicians, receive medical treatment, and then are unable to continue the treatment because of lack of finances to purchase medication. There are also cases where persons purchase a prescribed maintenance drug every other month, thereby reducing the effectiveness of the medication.

A comprehensive health plan that would provide education and counseling on the proper use of medication is of a great need. Many times, a person changes doctors because of a difference in fee and continues to take old medication and the medication the new doctor prescribed. There have been instances where elderly persons have become dehydrated because they were taking two or more diuretics prescribed by different physicians.

There are many elderly persons who find themselves caught between not being eligible for medicaid but without sufficient income to pay for adequate health care. This group is often identified as the “medically needy." There are thousands of persons in the Or. leans area who find themselves in this predicament. These kinds of situations place hardships on the relatives of elderly persons.

For example, there is the case of the lady who had her 83-year-old mother living with her, the mother was receiving $170 a month in social-security benefits but her monthly medicine expenditure was $125 a month. The daughter, who was working, was concerned about her mother being alone but did not want her institutionalized, so she hired a person to be with her while she was working.

While this agreement allays the daughter's anxieties, the cost of this kind of care is placing a financial hardship on the daughter. If there were some health plan to provide for drugs, the mother's social-security benefits would help defray the cost of keeping her in a home situation.

Oftentimes, chronic illnesses that older persons suffer from could have been prevented had they had an opportunity or resources to be involved in a health program that placed emphasis on preventive medicine. The incidence of heart disease and stroke, which plague our elderly, could be reduced, if there was adequate screening and followup of persons with high-blood pressure. There has to be some type of health coverage that insures that hypertensive persons on fixed incomes have access to the maintenance drugs that are prescribed for them.

We have had many cases of elderly persons who have been in a state of depression for lengthy periods but when psychiatric counseling is made available and the person is prescribed a drug and where necessary provided the proper medication, the patient comes out of the depression and is able to again live a normal life. These kinds of experiences lead us to believe that a health plan that would encompass coverage of mental health as well as physical health would be beneficial to millions of older Americans.

There is a need for a national health plan that would insure the same quality of health services to everyone regardless of income. In the public health delivery sector, there are many instances where patients never see the same physician. There are instances where patients have three and four clinic appointments a month because of the lack of medical personnel staffing the facility. There are instances where patients wait 5 and 6 hours for clinic appointments, again, because of a lack of medical staff in specialty areas. We must have a health plan that will allow persons from all segments of our population access to a health delivery system that has the same standards for the less affluent as the aflluent.

I might also point out that there should be a move to expand the curriculum of medical schools to deal more in the area of gerontology and geriatrics. We find that our doctors do not know how to deal with older people.

Many elderly persons have problems eating the proper foods because they are in need of dental care or they have had teeth extractions and can't afford dentures. Illnesses emanating from improper diet could be significantly reduced if there was a health plan that provided for dental services and dentures.

We would urge that the Older Americans Act include some language that would assure that preventive and institutionalized healtlı care be available to older persons regardless of their socioeconomic status.

In the area of nutrition, we are presently serving 1,400 meals per day at 23 meal sites and approximately 140 home-delivered meals in the New Orleans area. We have estimated that we could double the number of meal sites and triple the number of home-delivered meals is sufficient title VII funds were available.

Senator EAGLETON. How many home delivered meals, 140 ?
Mr. GATES. 1.400.

We recognize that the intent of title VII was to bring older people together, but we have found that there is a tremendous need to service the home-bound elderly.

We also feel that title VII should be an integral part of a service delivery system for the elderly and that any effort to make it an autonomous title of the Older Americans Act should be ignored.

Surveys have pointed out that older people who remain in their homes outlive those who are living in nursing homes. With the proper supportive services such as homemakers and inhome health care, our senior citizens could enjoy their golden years with dignity and respect. We estimate that the homemaker program operated under the New Orleans Council on Aging which is a title XX funded program is meeting only 5 percent of the need. We would urge that more funds be made available for homemaker and inhome health care.

The New Orleans Council on Aging in conjunction with the Louisiana Center for Public Interest has provided legal services to the elderly.

We would urge the subcommittee that as they draft legislation for the renewal of the Older Americans Act, that they reinforce the language that stipulates that State offices on aging and area agencies on aging serve as planning and coordinating agencies and that implementation of services be provided by agencies with the expertise of service delivery. We have found this system to work very effectively and efficiently in this planning service area. As I stated previously, as you move around the country, you will be exposed to many types of delivery systems in the field of aging, but I have found that as I have traveled around talking to persons in other States and other cities who are delivering services, and as I have compared their delivery systems with what we enjoy in this immediate area, I would strongly suggest that this type of service delivery system, a working agreement with the area agency and the providing agency, that this kind of system be duplicated around the country as some type of model.

Thank you. [Applause.]

Senator EAGLETON. I have a couple of questions. I subscribe to your comment with respect to the lack of medical knowledge in the area of gerontology. It is in a sense a rather new_specialty, it shouldn't be. The aging process has been around since Day One, but it has only been relatively recent that gerontology, the physiological and psychological ramifications of aging has become a specialty. I am pleased that we offered to set up a national institute on aging. You realize there is a thing in Washington called the National Institutes of Health where they do marvelous medical research and they farm out many grants to large medical universities such as Tulane here in New Orleans, and there has been an Institute on Cancer and on heart, kidney, et cetera, so they could focus on these particular diseases. They all come under the umbrella of the Institutes of Health. We now have one on aging because we found in terms of research with respect to aging, it was the bottom end of the list. It is sort of like the bottom end that I mentioned earlier with the Commissioner on Aging in HEW; he was at the bottom end of the page. Aging, as a medical research area, was at the bottom of the list, too. So in order to get it up higher and in better focus, we created the institute.

Let me ask you this hypothetical question

Mr. Gates. Before you do, one alternative to having the Administration on Aging buried in HEW, it might be that the Commissioner could report to the Chairman of the Federal Council of Aging, who is also the President's adviser on aging problems.

Senator EAGLETON. If someone walked in here today and gave you $2 million, and said, “We want you to spend it on programs that help the aging in New Orleans," what would be your priorities?

Mr. Gates. OK. You know, we use the term “prioritize the needs." I think that we would have to develop a system that would coordi

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