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other communities where they never had a visiting nurse association, then my job is to create one.

Another provision, sir, that was lightly touched on, I believe, by you earlier-would every municipality have one? I think already others have said there is no intention to have an area agency in every jurisdiction of those 80,000.

Aš my sixth point, I would set some limits on a critical massPennsylvania attempted one; at least there should be 10,000 elderly in the planning and service area of an Area Agency on Aging. I think to have a single-purpose planning organization where you have more sparse population than that is carrying a good idea to an absurd level.

Senator EAGLETON. I would agree.

Dr. STEINBERG. You may need to put some constraints on having several hundred more area agencies. I think there are places where that is not appropriate. There are other more suitable models of planning, services, and advocacy for those places.

Senator EAGLETON. Thank you very much, Mr. Steinberg. I will not only read your summary of the report, but I will even read parts of the full text.

That will conclude today's hearing. We will hear from Mi Reilly or Mr. Benedict at a later stage in these hearings; we have got other days already scheduled Friday and 2 days next week.

And I want to thank everybody for their interest and for their participation.

Mr. Dietz, could we have you back at a later date?
Mr. Dietz. Yes, sir.

Senator EAGLETON. I am ignoring you because you are local and I wanted to hear from Mr. Steinberg, because he came quite a distance, and I hope you understand.

[The subcommittee adjourned at 12.43 p.m.]

Thank you.

OLDER AMERICANS ACT OF 1978

FRIDAY, FEBRUARY 3, 1978

U.S. SENATE,

SUBCOMMITTEE ON AGING
OF THE COMMITTEE ON HUMAN RESOURCES,

Washington, D.C. The subcommittee met, pursuant to recess, at 9:40 a.m. in room 457, Russell Senate Office Building, Senator Thomas F. Eagleton (chairman of the subcommittee) presiding.

Present: Senators Eagleton, Williams, Cranston, and Chafee.

Senator EAGLETON. The Senate Subcommittee on Aging of the Committee on Human Resources is now in session on continue its hearings with respect to the Older Americans Act.

Senator Clark is detained, but he will be with us momentarily. We do have a witness further down on the list that has a plane to catch, so we will start with him if that is permissible to the others.

Mr. Robert Ahrens, president of the Urban Elderly Coalition.

I have a brief statement for the record that I will read at this time.

OPENING STATEMENT OF SENATOR EAGLETON On Wednesday of this week, the subcommittee received testimony from several Senators and Mr. Nelson Cruikshank, Chairman of the Federal Council on Aging; Dr. Robert Binstock, director of the program in the economics and politics of aging at Brandeis University; and Mr. Ray Steinberg, project director of a recent study on area agencies on aging.

Much of Wednesday's discussion centered on the multiplicity of Federal service programs for the elderly and my concern that we are attempting to promise too much in too many areas without the resources with which to back up those promises. The witnesses presented several ideas to deal with this problem.

It was suggested that the bill be revised toward a block grant approach; that is, repealing the authority under the various titles of the act and providing a lump sum to each area on aging from which the area agency could fund_what it perceived to be the priority needs of that community. The only restriction might be that the grant would be 70 percent, or so, be spent on what was determined to be the top priority need in an effort to insure that there is a real impact on at least one problem within a given community.

Later witnesses argued that area agencies should have the flexibility to target their funds to a particular segment of the elderly population-for example, the frail elderly—in an attempt to provide a full range of services for that group.

Clearly, such approaches are not as simplistic as I have outlined. It would require certain guarantees to insure that a path of least resistance is not taken at the local level, but I do believe these ideas have some merit and are certainly w th exploring

Today, the subcommittee will receive testimony from a variety of national organizations concerned with the health and well-being of the elderly. I look forward to further exploration of this approach with all of you present today.

We have a long list of witnesses so I will ask each of you to summarize your prepared statements for us, giving us the highlights.

I am pleased that we have our good colleague, Senator Chafee from Rhode Island here, and I will yield to him at this time.

Senator CHAFEE. Thank you very much, Mr. Chairman.

I don't have a statement. I want to echo what you said about the possibility of a block grant approach because I share your view that we do have a multiplicity of programs, none of which carry the funding which any of us think is adequate and I think we have got to have some reliance on the local people to know what they think is their top priority.

We look forward to hearing the views of those this morning. Thank you, Mr. Chairman.

Senator EAGLETON. Thank you, Senator.

Mr. Robert Ahrens, president of the Urban Elderly Coalition. Good morning, Mr. Ahrens.

STATEMENT OF ROBERT J. AHRENS, DIRECTOR, MAYOR'S OFFICE

FOR SENIOR CITIZENS AND HANDICAPPED, CHICAGO, AND PRESI.
DENT, THE URBAN ELDERLY COALITION
Mr. AHRENS. Good morning, Mr. Chairman and Senator Chafee.

First off, let me say I appreciate your generosity in rescheduling for my convenience.

I am Robert J. Ahrens, director of the mayor's office for senior citizens and handicapped in Chicago and president of the Urban Elderly Coalition. Today, I appear before you as a spokesman for the coalition, an association of the Nation's urban offices on aging, and in behalf of the urban elderly whom we represent to request reauthorization of the Older Americans Act for at least 3 years and to make such recommendations as will enhance the ability of the Older Americans Act to meet its goals.

We will be leaving with you a paper that we developed. As I go through it I will make some points and omit the argumentation since it is in the paper.

I did want to start with some demographic information that bears on the urban elderly. The population of those in this country age 60 and over is 28.6 million of these, 15.9 million live in the urban areas, and of the total of people age 65 and over, 76 percent who are black live in the urban areas with 55 percent concentrated in the central cities; for Spanish origin, 86 percent over 65 are in the urban areas with 71 percent in our central cities; and, of the Asian, 87 percent live in our urban areas with 55 percent in our central cities; while 73 percent of the white people 65 and over live in the urban areas with 55 percent in the central cities.

The Urban Elderly Coalition is a young organization. Even if we are counting only the member cities of 100,000 or more population, we already represent more than 9 million of these 16 million people aged 60 and over who live in the urban areas. That representation includes the offices or departments on aging of the Nation's largest cities–New York, Chicago, Los Angeles—who are also designated as area agencies on aging. It includes the area agencies from Seattle-King County, Wash., Pima County-Tucson, Ariz., Broward County-Fort Lauderdale, Fla., designated by their mayors respectively to represent their cities, and it includes such cities as, Long Beach, Calif., Jackson, Miss., and Jacksonvill, Fla., who are seeking to be designated as area agencies on aging.

Dr. Flemming, the present U.S. Commissioner on Aging, has been attuned to the needs of the low-income and minority group elderly who are concentrated in our urban centers. The yearlong delay of the administration in proposing its nominee for Commissioner has been mitigated only by Dr. Flemming's willingness to continue to serve until a successor has taken over. We have been promised a new urban policy. Yet, we note that the proposed fiscal 1979 budget does not provide additional funds to administer aging programs, nor take into consideration the factors of inflation and the increasing numbers of older persons to be served.

We hope that the new administration will deal forth-rightly with the needs of the urban elderly and the cities that serve them, and will reflect this in the experience, concerns, and programs of the next Commissioner on Aging.

The next Commissioner should be concerned that the allocation of Older Americans Act funds, made by the States to the area agencies on aging should reflect the intent of the Congress to emphasize service to both low-income elderly and those who are minority group members.

Last August, the Commissioner designate stated :

The second tier of the national policy structure must address itself to the very special needs of those older people who are alone, disabled, or functionally dependent, very old, isolated, and on low income. This group of persons must receive the very highest priority in the target population of our service delivery system.

We agree. The Administration on Aging, unfortunately, is unable to supply data about funding formulas in State plans that it approves, but I can assure you that in my own State of Illinois we achieved per capita funding of area agencies with title III and title VII moneys only this year for the one-third of the State's elderly who live in Chicago, and no dollars have been added by the State for program emphasis on the one-third of the State's low-income elderly or the three-fourths of the State's minority group elderly who also live in my city. I would expect that my State's action or inaction is indicative of the other States' lack of commitment to emphasize the special needs of low-income and minority group elderly.

I earlier mentioned the delay of the administration in proposing a new Commissioner. There has been a similar neglect in acting upon the many vacancies in the Federal Council on Aging. These delays, the standpat budget proposed for the Older Americans Act in which services for the elderly will be diminished because of inflation as well as the additional elderly to be served, the actual cut proposed for RSVP funds, and any number of other signals people feel they have received over a period of months have led many to lose confidence in the concern of this administration for older people, a concern they had hoped to see reflected in action rather than delays, and in leadership that to date has not been evident.

Older Americans Act title I sets forth a series of worthy objectives. I won't name them, but these goals clearly establish a framework for addressing the needs of the elderly. However, given the existing level of appropriations and program structure, the Administration on Aging cannot begin to achieve this mission. These goals require that title I make clear the responsibility of the Administration on Aging, and the State and the area agencies on aging to provide advocacy and leadership to achieve them. It is presently silent on the advocacy point.

To achieve the goals of title I we must restructure the existing service delivery system. This process, while it should begin at the Federal level must encompass State and local levels. The structure should be built upon a coordinated service delivery system providing a continuum of care. Inherent in this approach is administrative coordination of the full range of aging-related services. We cannot realistically continue to charge the aging network with responsibility to coordinate all aging services, which title III presently does, without providing it with both the resources and administrative authority to achieve this.

The current system requires an elderly person with compounded problems of poor health, limited mobility, and meager financial resources to apply for services from a number of agencies with varied eligibility requirements. Thus, because of the Administration on Aging's responsibility as the Federal focal point for programs on aging, any effective evaluation of it must deal with programs that also impact upon the elderly.

Chief among those which should be coordinated with Older Americans Act programs are titles XVIII, XIX, and XX of the Social Security Act. This coordination requires a mandate and initiation at the Federal level, but must be implemented also at the State and area agency level. Consistent with this responsibility, we recommend that the Administration on Aging be made an independent office in the Department of Health, Education, and Welfare, headed by an Assistant Secretary for Aging. We also support transfer of certain programs to the Administration on Aging; namely, the Senior Volunteer programs currently operated by ACTION and the Senior Community Services Employment program, now administered by the Department of Labor.

We further recommend that the Administration on Aging have review and signoff authority on programs of all Federal agencies and departments that are related to the purposes of the Older Americans Act. We must similarly strengthen the State and area agencies on aging by channeling all Older Americans Act funds through the Administration on Aging to the State and area agencies

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