But there are many thousands out there that we are not reaching who maybe need that one meal more than the fellow and the lady that do show up.

Dr. STEINBERG. But don't mandate the meals then. Mandate that a genuine process be shown whereby people are targeted, identified, drawn in and responded to as whole people. And that means there might be a variety of services some of which they have entitlement to, some might have to be developed to fill in the gaps.

And, you see, you get out of this kind of trough mentality which says let's divide up the pie according to program.

And, again, I think this Cleveland study that your GAO is doing at this point will show that there are multiple problems, and to simply work on the one to the neglect of the other is really a waste of resources and a human tragedy.

Fourth: One of the things that is perhaps more controversial I haven't heard spoken of here today-when comes legislation time, we all tend to think maybe all these things could be done with no administrative cost. I think this needs to be reexamined. I don't know what the optimum is, but I think universally trying to set 15 percent for all communities across this country is

Senator EAGLETON. Any figure suggested, sir, is arbitrary by the very nature of suggesting the figure. However, Congress has found itself in the position of creating programs where the largest amount of the money appropriated is consumed in administration. We don't like that.

So I will be the first to admit that 15 percent is arbitrary; pick any figure you want-it's arbitrary. But we find ourselves helpless in trying to keep the whole damn thing being consumed by people on public payrolls.

Dr. STEINBERG. I think the wording of the act is not "administration," but 15 percent for "planning," is that correct? To my mind, planning is not the same as administration.

I would support a limit of 10 percent to monitor programs, hold them accountable for the funds they use, make sure that they are delivering services in the most effective and efficient way-fine. But when you are talking about the planning needs in Los Angeles as against Pocatello, Idaho, as against a really declining rural area in Montana-I think you are talking about different degrees of need for spending money on building new agencies, creating a system, developing comprehensive and coordinated systems of services you are really calling in specialists to work at that. And I don't think that's administration. I won't belabor that point, but I think it's one that I have data on, and I think so does Westat-that those who underattend to the planning function often have not as good a success record in getting changes in aging services. You get what you pay for.

Five: As you know, there is a mixed message as to who is to be served by the Older Americans Act. We don't turn anybody away with a means test. But I think the consequence is: First come, first served; and they are not the most needy. I am by no means sug gesting a means test. On the other hand, title 3 says "with special emphasis upon minority, poor and the homebound."

Here again I think some incentives have to be devised so that the program which more successfully targets and responds to the

vulnerable elderly or the frail elderly-to use the Federal Council on Aging's terminology-then should be regarded more highly than those who have high head counts because they are skimming.

Senator EAGLETON. Very good. And I think your observation on the nutrition program is appropriate. As much as I like the program, I am not sure that the most needy are there every day or even 1 day a week. And, again, another dilemma: If you have a means test-well, our experience with that in other situations has not been terribly satisfactory.

Dr. STEINBERG. Just one other comment on the nutrition program. I certainly don't want my remarks to suggest that some valuable work isn't going on. But if the emphasis is upon head counts and meals served, you see, then is it really serving as a revolving door, which is one of the concepts? But that revolving door policy means that somebody has to be on hand who is not serving meals, who is helping people get acquainted and organizing those who are capable of sustaining mutual aid groups-that if indeed you have the legal service coming once a week that it is used effectively. It needs someone on hand who is a good listener, who is seeing people come and go, to make sure they get connected, because it doesn't happen automatically. The people who hurt most, often ask for least.

Senator EAGLETON. Would you philosophize with us a little on this dialog I have had with Dr. Binstock about lumping all those things together, forgetting social security, and upping the ante considerably, maybe up to $1 billion, and then letting Albuquerque decide how to do it and what to do.

Mr. REILLY. Mr. Chairman, if I could, just to clean up the record, to pick up on Mr. Steinberg's recollection about what it says in the act about that 15 percent. It's a short paragraph. "Such amount as the State agency determines, but not more than 15 per centum thereof, shall be available for paying such percentage as such agency determines, but not more than 75 percent of the cost of administration of area plans" is the language. It is not planning per se.

Go ahead.

Dr. STEINBERG. Yes; in terms of the risks of letting local people decide, I opt for that, knowing that they will make mistakes and hopefully learn from those mistakes. I would certainly be for putting in some process provisions ratther than what kind of program they have to come up with. For example, you were talking earlier about how do you make sure you have representation of the "at-risk" elderly in decisions and I liked the idea mentioned earlier that sometimes children of frail elderly people might better represent the homebound on councils than someone who is active in some recreation center program.

But I think holding local decisionmakers accountable that they undertake a genuine process of working with the community, in identifying needs and developing solutions, is adequate.

The setting of priorities at the national level doesn't work. In addition to demographic differences across communities, you have communities in different stages of development in terms of human services agencies. And I think the monitoring, for example, in a large city which already has people far more able than I would be as a generalist in monitoring them, is one thing, whereas in some

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.

As 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.

Thank you.

[The subcommittee adjourned at 12.43 p.m.]

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 worth 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 PRESIDENT, 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