Senator EAGLETON. Which of you gentlemen is from California, Mr. Dietz or Dr. Steinberg?

Mr. REILLY. Dr. Steinberg.

Senator EAGLETON. Mr. Dietz, you are here locally, right?
Mr. DIETZ. Right, Washington.

Senator EAGLETON. Dr. Steinberg, tell me about your study and, if you'd care, I would be anxious to have observations on this dialogue I have had with Dr. Binstock and others.

Dr. STEINBERG. Yes, I am not as constrained as my fellow panel members from commenting upon issues which might be pending in the forthcoming administration bill. My study did produce recommendations for changes for both the administrative side (AOA) and the legislative side (Congress).

Senator EAGLETON. Could you identify for the record who you are and what you have done, et cetera!

Dr. STEINBERG. Yes, Raymond M. Steinberg, from the Social Policy Laboratory of Andrus Gerontology Center, University of Southern California. I conducted a 2-year study of area agencies on aging under funding from the Administration on Aging. Prior to that I worked in training of the new area agency directors right after the comprehensive services amendments. I followed up last year with a survey to see if anybody was getting any use out of the research findings from my study and other similar studies. I believe I have, in effect, been close to what is happening at the local level for the past 4 years.

I could cite a number of findings, but I think you want to zero in on some of the issues raised, and I would like to participate in that discussion.

Senator EAGLETON. By the way, do we have a full copy of your study? Is that a public document?

Dr. STEINBERG. Yes, I have a 2-page summary as well-I think your staff has that with highlights of the study.

Senator EAGLETON. How big is your study itself?

Dr. STEINBERG. Oh, a 100-page report, I think, is what your staff

has seen.

Senator EAGLETON. Well, we may not put it all in the recordlet's decide that later. It's a shame to ask you to try to summarizebut could you

Dr. STEINBERG. Well, let me attempt it, Senator, if I may. My various reports have some good news and some bad news. Any research data you are going to hear cited here, if they are stated in means or averages, indicate that half the organizations are doing not so well and half are doing better than those averages.

I must say, however, that as a practitioner as well as an academic doing research, I was amazed by high levels of achievement among AAAS. I think that the Westat study, as well as my study, dramatizes some of the multiplier effect of the title III that has been obtained through this so-called network. I am one of the ones who doesn't wince when we say "network." When I pledge allegiance, I say "liberty and justice for all"-and I know we haven't achieved it; and I don't think we have yet achieved an aging network. I think it's very important in reauthorization of the act that you don't send all kinds of mixed messages to prevent that from becoming a network-and I would like to speak to that later.

Senator EAGLETON. Good.

Dr. STEINBERG. But as to the findings-sure, there was an overlay of regulations and administrative controls, that got in the way of carrying out a meaningful planning process in every community so they really came up with local priorities. It is much as Dr. Binstock described-there were a set of watering troughs, and agency people came up to get some. I, like he, attribute some of this problem to the earmarking which Congress did. First in 1973 it was the separating of title 7 from the rest of it-because that is so visible, it's much easier to identify. However, I would urge you to look at some of the studies which have shown that at least in the first year or two, title 7 Nutrition programs tended to draw in people who were already linked to church organizations, to social organizations, and so on. It takes more time, it takes more effort, to reach those people who are isolated; you can't do it in one fiscal year and you can't do it when you have got a 60-day limit on filling up your head counts. And area agencies and title 7 projects were not given incentives-like two points for getting the uncon nected people, as against the one point for just filling out their head count. These administrative practices can be remedied.

But I would like to stress, if I may, six legislation-related points and then, if you want justification from my findings, I would be glad to offer them, because I think they do speak directly to some of the issues raised so far.

One that hasn't been raised is the necessity for Congress to permit a biennial rather than annual funding of the planning process. A lot of creating the illusion of a network of service has been in part the result of trying to do an annual planning cycle. You barely get programs off the ground and you have to decide whether they are any good or not before you start recycling. And, as you know, area agencies

Senator EAGLETON. On that, your point is probably very well taken. We hear this in a whole host of areas of government-edu cation, health programs, et cetera. And maybe it's even more acute in the field of social services to the elderly than in some of those.

But, however, by tradition, we are stuck with the annual thingand I think the administration is contemplating some forward funding, in any event. So we are at least going to give careful attention to your proposal.

Dr. STEINBERG. I would like simply to point out: Then you have to put evaluation of performance in context. You want AAA's and State agencies to perform an open consulting process with the community. But agencies are kept waiting for the appropriations bill. Working under a continuing resolution-they make one plan. They tell the community this is what we are going to go with; and after the late appropriation, they have to go back and recycle that plan. You have got people too involved in repetitive and routine procedures. Certainly in private businesses it is recognized that daily routine drives out planning.

Senator EAGLETON. I understand.

Dr. STEINBERG. And that's what's happening.

Mr. REILLY. If I could just add a comment to that, Mr. Chairman. As you alluded to, the administration budget proposal for 1979 does

include advance funding for the Older Americans Act programs, so it would help this situation.

Dr. STEINBERG. I think it would reinforce some of the people who would rather spend money wisely and target it well than spend it in a hurry within the one fiscal year. I think there has been an excess of time pressure. I have certainly seen this in many other programs. But we could carry over unexpended balances in the foreign aid program, war on poverty, model cities, et cetera. Somehow the Older Americans Act has had much tighter limits on that, and many more checks and balances to attend to within each fiscal year. Second, certainly I would urge continuing the trend to integrate titles 3 and 7. It may be that those area agencies which have undertaken title 7 do suffer in their ability to do other catalytic work. For example, my data show that those who are funnelling title 7, or administering or monitoring title 7, have less staff elbow room to do the catalytic kind of thing, such as to get people to go to the State capital to make sure that the elderly get their fair share of title 20 and many other examples which I could recite. The merger of titles 3 and 7 is going to be traumatic: Nobody likes to be monitored who wasn't monitored before, or would rather be monitored from the State capital than from somebody close to home. It's going to be controversial, but I think the separation of title 7 from 3 makes for a mixed message about coordination which you have put into the

act.

Third, eliminate federally mandated programs. This cuts right to the central issue that was raised by Dr. Binstock.

Senator EAGLETON. Which federally mandated programs? Oh, the four priorities?

Dr. STEINBERG. In 1975-the priorities. With quotas attached. Senator EAGLETON. Should we just state them as being worthy areas of consideration?

Dr. STEINBERG. Well, I think it develops the wrong kind of thinking in that you are just giving a laundry list. I don't care how lightly you play it-you are getting people to define older people's problems by what services you have to offer. Now, when you legislate the vocational rehab program, you are funding a network of people who can diagnose people's problems, try to negotiate services for them where they already have entitlements; and if necessary, buy them so that these people can be more selfsupporting. Why can't that principle be applied here in the Older Americans Act? You don't, in vocational rehab, fund so many college educations, so many tool kits, you see. You have a planning and counseling network for individualizing responses. And, therefore, I would go one step farther than was mentioned earlier rather than saying that communities have to select one program, let them narrow down the target group; they can't do all good things for all people. Missouri is one of the States that said very early on, well

Senator EAGLETON. Would you knock out the home repair?

Dr. STEINBERG. I wouldn't State it in those terms, but rather-as I said, Michigan and Pennsylvania attempted to establish priorities for people over age 75. While we know there are frail people under 75 as well, we must develop locally, feasible ways of targeting— saying here are the most vulnerable elderly people.

In Senator Kennedy's introductory remarks, he said: Who are the people we ought to be serving? I would say let that local community identify that target population and then come up with a package of services-and I will repeat Mr. Reilly there. For example, I have seen some fabulous legal services. But while they are fighting the case about guardianship, the client is dying from criminally neglectful medical care. I don't think you can package it in terms of programs, but certainly target groups. If you specify individual programs, that's the way those agencies will define a person's problems. It's like giving a kid a new toy hammer-suddenly everything needs pounding. And we certainly discovered a lot of people who suddenly needed meals.

I don't want to knock that program, but I think when you visit them, you should not only see how satisfied the people are who are there—but also ask about what provision they have for reaching the people who are homebound, what kind of followup they have for people who drop out

Senator EAGLETON. What percentage of the people do you think we are reaching with nutritional programs, lumping together congregate and meals-on-wheels programs? Somebody tells me we are reaching one percent of the people that need it. Of the eligible population.

Dr. STEINBERG. But, you see, maybe we will have to live with the fact that you can't come up with enough dollars to meet 100 percent of the need, but let's make sure that the one percent receiving service are the people where that service can be most crucial. And I don't think the tools have been laid out there, particularly when there is no administrative money to do the careful job of identifying the people who most need help. And, as I stated, the Opinion Research Corp. study showed that participants were primarily organization-connected people who were recruited into the nutrition program. I have not seen later data and this may have changed over the last couple of years, because I think there has been a serious effort to get the nutrition programs to address themselves to vulnerable, underserved people as well as the fact that some of the people who joined 3 years ago are now beginning to have some troubles, and personnel aren't giving up on those individuals, though they were not able to seek out and identify similarly needy, but unknown, other individuals.

Again, I too, give a high priority to legal services, but not as a single best solution permitted to be isolated from a package of services. For example-in an outreach program in Los Angeles, over 10 years ago, we did a medicare alert outreach program. We found 5,000 people in south central Los Angeles, Watts, and east Los Angeles who not only didn't know about their medicare benefits, they weren't even getting the social security benefits to which they were entitled. Now, I don't think a legal services office alone can identify those 5.000 people. So in a given community when they say. OK. we want first to get to the people who have come into trouble, either legal or medical-but let's then bring the whole array of services and use those targetted people as test cases-rather than bringing legal services alone for everybody. I think you will find a lot have to do with wills and marriage status and so on, which certainly can

matter to a person and to their wellbeing, but I am not sure that's the priority. It's not legal services but legal services of a certain kind for certain people.

Senator EAGLETON. You want already targeted programs, more pinpoint? You want legal services for the elderly, but you want to use it for outreach to find out those 5,000 people who don't even know their entitlements under social security. So you want greater specificity, as I hear you.

Dr. STEINBERG. No; I am not asking for Congress to do that. On the contrary, leave that to local determination. But don't reinforce this behavior of defining problems by stating solutions; let them state the problem. For example: We have a lot of people in our area who are simply not using the entitlements that they have. Then this year we will do the aggressive outreach; we will have it backed up by legal services to have the test cases; we will have a medical screening related to that so that people aren't dying while their cases are being decided.

Senator EAGLETON. You would let all that be decided-you are from where, Los Angeles?

Dr. STEINBERG. Yes.

Senator EAGLETON. You would let that be decided by the Los Angeles Council on Aging or whatever you call it?

Dr. STEINBERG. Yes. I would state the mandate in terms of procedural standards: Stop trying to tell us it's first-come-first serve, because that means the well, active, ready people who are already connected with the system will get most of the services. Let's say: Tell us how you are going to reach or select a special target group, and do it.

You raised the issue earlier, by the way, about representation. I thought a very interesting thing was done in north Kentucky, where, as many area agencies have done, they did a random sample survey of the whole community. Well, I think there has been a little bit of overkill on that, because people aren't often motivated by what the statistics show. But they also had their advisory committee take that same questionnaire and interview older people that they had access to. When they got the two sets of results in, they saw that the people they were talking to who were elderly simply were much, much better off than this random sample of elderly. The comparison motivated that group to increase their attention to the vulnerable elderly. I think now the Cleveland study of GAO will give many communities

Senator EAGLETON. Well, there are a whole host of studies in a whole host of areas that show precisely that. It's like some of the youth employment programs. Government has come up with some brilliant information and studies-(a) that the class valedictorianhe gets a job better than the ninth-grade dropout. And in Government, we like successes, and we like to say we solve things, so we will cope with the easiest problems. The easiest problem is somebody who already knows about a program and knows that if they go to such and such center they will have a nutritional meal on Monday, Tuesday, Wednesday, Thursday, Friday-and we call that

success.