"a

Other priorities looked beyond county borders to solve
administrative problems: "state plan consolidation,'
defined role for each county within its area agency on
aging to avoid overlap," "grantsmen at county, state or
regional level," and "cabinet-level representation for
aging programs at federal, state and local levels."

Overly restrictive or complex federal and state laws
and regulations were the most commonly cited obstacle
to efficient delivery of services. Priorities that were con-
stantly repeated included:

Federal and state funding procedures evidently also
create problems for efficient management. County of
ficials' priorities on this subject include:

•"simplified funding procedures,'

•"coordinated state and federal finances," "consolidation of funding sources,'

services and cycles,
"flexibility on state and federal levels for funding

•"open-ended funding to meet locally identified
tance.
needs rather than needs identified from a dis-

Local barriers to good management also were addressed.
Priorities directed toward county-level problems included
calls for: "a mechanism for coordination of services at
county level," "interagency coordinating council," "city
and county cooperation,' "increased linkages between
aging programs and other social, alcoholism, mental
health, and employment programs,' "establishment of
conversation between medical and human service per-
sonnel," "establishment of interagency client advocacy."

Increasing local resources for aging services was a
priority among slightly less than half the groups. Most
such priorities called for using revenue sharing funds to
support services for the elderly. Other priorities were:

•"increased county general fund dollars for admin-
istration and planning,"

⚫"counties that assure input of cities,"

"increased religious and industrial sector support,"
⚫"community responsibility for fiscal operation and
monitoring of existing programs.'

Only two groups-both in the midwest-advocated a
special mill tax levy to support services to the elderly.

In addition to coordinating the efforts of various local
service agencies, county officials expressed a keen desire
and delivery:
to involve the elderly in all phases of services' planning

"let seniors decide what's important,'

⚫involve the elderly in planning,'

"the community should identify the expectations

of the elderly."

⚫"learn who elderly are and where they are,'
•"formal linkages between service and client,'
⚫"involvement of elderly in program delivery,'
•"input from consumers,'

"

⚫"create county policy requiring that at least half of
members of council on aging be elderly,"

•"utilize the individual in assessment of his or her
needs when planning for long-term care.

Finally, one group mentioned a need which bureau-
cratic requirements may often thwart: "allow the elderly
to obtain a single unit of a service." Whether one visit by
a nurse, one home delivered meal, or one trip to a doctor's
office-county officials say the elderly are entitled to it
without difficulty.

Direct Services

Although administration was the subject that received
the most attention at the three conferences, most of the
groups' priorities concerned services that directly benefit
the elderly. Ranked in order of the number of times they
were listed as priorities, they are:

1. health care,

476

The top five categories were mentioned by every group
at all three conferences. The last five were mentioned, on
the average, by about a third of all the groups. Mental
health services were cited by only one group in the east,
two groups in the midwest, but by six groups in California.

caring.'
ity may be the hardest of all to achieve: "more one-to-one

medical services.
Health Care. This broad category includes all health and

Hospitals, nursing homes, in-home and neighborhood
services are represented-but very unequally. Hospitals
and acute care were mentioned only two or three times.
One group expressed a need for "pre-discharge programs
for elderly patients in acute care hospitals." Another
mentioned the need to assure ambulance and emergency
medical services to the county's elderly. On the other
hand, every group mentioned the need for clinics, preven-
tive health screening, and in-home health services. About
two-thirds of the groups mentioned nursing homes.
the major problem of the elderly.
Clearly, county officials see long-term chronic illness as

Several services were mentioned only once or twice,
but should be noted. Among these: eliminating language
barriers for non-English speaking senior citizens; respite
centers*; disaster preparedness programs; library ser-
vices; better research and evaluation methods (including
better collection and recording of data); accessibility to
buildings, especially public buildings; and "death and
dignity options" including hospices.** One group's prior-
family relet-
•Respite centers board elderly people for a day or two They allow a
or respite from the often arduous task of caring for an

aged relative.
**Hospices first appeared in England about 1967. In a hospice, spe-
cially trained staff administer to the needs of people with terminal
New Haven, Connecticut
illnesses The best known hospice in this country in Hospice, Inc in
Luke Hospital Center in New York

City began a pilest tomgital tinsel honger program in 1976

Some representative health care priorities are:
•"affordable and accessible primary health services,'
"comprehensive health assessments,'
"preventive medical and dental services,'
"alcoholism and drug services,'

"prosthetics assistance,'

•"provision of items not covered by Medicaredentures, eyeglasses, hearing aids,'

"better trained doctors,'

"a doctor and dentist in each county."
"coordinated home care services,"
certified home nursing services,"

•more in-home supportive services,''

expanded health insurance for home care,** •"homemaker and chore services,"