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Testimony on Reauthorization of the Older Americans Act by William F. Benson
Acting Principal Deputy
Assistant Secretary for Aging
U.S. Department of Health and Human Services
Before the
House Committee on Education, Subcommittee on Education and the Workforce
July 9, 1997
Mr. Chairman and Members of the Subcommittee:
On behalf of the Administration on Aging (AoA), I appreciate this
opportunity to testify in support of the reauthorization of the older Americans
Act (Act) and the critical home and community-based services provided to
millions of older Americans and their families. Your leadership and commitment
to the Act is important to the Administration and to the aging network made up
of states, area agencies on aging, tribes and service providers across the
nation.
I would like to begin by acknowledging the progress made by this
subcommittee to reauthorize the Older Americans Act of 1965 during the 104th
Congress. The reauthorization of the Act has traditionally enjoyed bipartisan
support, and we look forward to continuing to work with you and your
colleagues to complete final action on this important matter.
As the only federal agency mandated by law to serve as an effective and
visible advocate for the elderly, the Administration on Aging wishes to take
this opportunity to reaffirm the views of the Department of Health and Human
Services (HHS) as it relates to the reauthorization of the Act. We commend
aspects of the legislation approved by the Subcommittee during the 104th
Congress that incorporated Administration recommendations to streamline the
operation of state programs under the Act, provide flexibility to the states by
eliminating unnecessary federal requirements, and enhance customer orientation.
We are encouraged by efforts to meet these goals, and we look forward to ongoing
dialogue on ways to improve the efficiency and effectiveness of this important
legislation.
We also would like to propose some new ideas that we believe will enhance
the Act's effectiveness and complement progress made on improving delivery of
services to those who need them the most. These new ideas all emanate from the
key priority areas that guide the Administration on Aging -- home and community-
based long-term care; consumer empowerment and protection; and consumer
information and education.
We continue, however, to have concerns about certain provisions agreed upon
during the 104th Congress that eliminate or weaken certain critical safeguards
the Act has historically provided for older Americans and their families,
particularly for those who are most vulnerable. I would like to briefly discuss
those concerns, and then propose some new areas we feel will improve the outcome
and services provided by the Act.
- We believe the ten objectives contained in title I of the Act should not
be eliminated. These objectives have served as the guiding principles for the
development of services and systems by the aging network forever 30 years.
Unfortunately, their elimination may signal a diminution of the nation's
commitment to achieving these important objectives.
- We remain concerned about the proposed elimination of the separate title
for Elder Rights Protection for Vulnerable Older Individuals (title VII)
established to ensure attention and funding for particularly vulnerable and
at-risk older individuals. We urge you to retain this title and its support, for
the development of state systems of long-term care ombudsman programs; the
prevention of elder abuse, neglect and exploitation; elder rights and legal
assistance development; and outreach, pension and benefit counseling and
assistance. These programs are central to the advocacy role mandated by the
Older Americans Act. Later in my testimony, I will return to the topic of title
VII and a proposal we have to consolidate the programs within that title.
- The Administration feels it is essential to retain the Act's requirement
that legal assistance remain a priority service under area plans. Many older
Americans are confronted with a variety of legal and related matters that
require the help of legal assistance providers and for which legal assistance is
not available from traditional sources, especially for those who are low-income,
minorities or isolated.
- We strongly oppose any action that would eliminate provisions designed to
ensure that a fair share of funds available under the Act are used to meet the
needs of low-income minority older individuals who are among those with the
greatest social and economic needs.- In addition, dedicated funding for services
for elder members of federally recognized American Indian tribes and Alaskan
Native villages are consistent with the federal government's historical and
unique legal relationship with these tribes and villages.
- We believe that the elimination of a distinct and separate title for
training, research, and discretionary projects and programs title IV) and its
related funding severely jeopardizes our ability to prepare our nation for the
dramatic demographic changes anticipated early in the next century. Title IV has
been used to test and develop the majority of the Act's programs and services
upon which older persons and their families rely to maintain their independence
and dignity. To effectively face the growing challenges of an aging society, it
is critical to retain this applied research and demonstration authority because
it places practical tools in the hands of states, tribes and local providers,
and also provides an essential supplement to the biomedical research conducted
by the National Institutes of Health, including the National Institute on Aging.
Some of the programs developed through title IV include the home-delivered meals
program, the long-term care ombudsman program, the creation of area agencies on
aging, and adult day care, among others.
Additionally, title IV traditionally has assured assistance for elderly
victims of presidentially declared disasters. This assistance, targeted to those
elderly victims who are often overlooked in the chaotic aftermath of a disaster
and often the most traumatized, has been crucial to saving lives and property
and quickly setting older persons on the road to recovery. We are proud of our
efforts to respond to the critical needs of older persons impacted by Hurricane
Andrew in Florida, the Northridge Earthquake in California and past flooding in
the Midwest. Unfortunately, without sufficient support, we have been unable to
provide this essential service to elderly victims in the most recent disasters.
- We acknowledge efforts by your Subcommittee to allow states to utilize
cost sharing, as recommended by the Administration. We are concerned, however,
by efforts to permit states the option of requiring cost sharing by recipients
in the Act's nutrition program. The nutrition program represents the cornerstone
of the Act, addressing a host of elderly issues ranging from socialization to
maintaining good nutrition. This program's popularity is based on the fact that
it is not an income-based program and that it encourages a sense of ownership
shared by individual older people and communities. As a result, personal
contributions have been consistently high, with approximately $171 million
collected in FY 1995.
- The transfer of the administration of the Senior Community Service
Employment Program (SCSEP) from the Department of Labor to AoA is consistent
with the Administration's budget.. The Administration is willing to work with
the Congress and the affected committees to determine the best approach to
affect this transfer. However, the Administration believes that wherever this
program is administered, it should continue to be carried out through grants to
the states and national sponsors. We strongly oppose the elimination of direct
grants to national sponsors and believe that such a measure would significantly
diminish the effectiveness of this program. The national sponsors have many
years of experience in administering the SCSEP and have demonstrated an
exceptional ability to focus the program's activities on grassroots concerns and
solutions. Because of the experiences of states and national sponsors, each is
able to address distinct interests and target populations of eligible
participants and to develop a variety of employment prospects and training
opportunities.
- We strongly oppose efforts to move the National Senior Volunteer
Programs--Foster Grandparents, Senior Companions, and RSVP (Retired and Senior
Volunteer Programs) from the Corporation for National and Community Service
(CNCS) to AoA. These programs, and the field structure to support them and other
volunteer service programs, should remain with the CNCS. A transfer of these
programs to AoA would be extremely disruptive to this network and the support
systems that enable these programs to thrive.
We hope you will consider our concerns as we work together to ensure that
the fundamental principles of the Older Americans Act are protected and
preserved.
Similarly, we urge you to consider several new concepts that we feel would
enhance the Act's overall effectiveness.
- Highlight the Importance of Disease Prevention and Health Promotion
Programs. We wish to maintain the distinct program and funding authorization for
Disease Prevention and Health Promotion in the current Act in order to highlight
the importance of these activities. This important program enhances public
awareness and increases the physical health of older individuals by focusing on
activities designed to increase the years of healthy life and reduce the
incidence of chronic illnesses and diseases that are more costly than preventive
activities.
- Streamlining in the Nutrition Programs. We support the increased
authorization of funds for nutrition services, including nutrition services for
Native Americans. Nutrition programs can be further enhanced by streamlining the
administration of the Nutrition Program for the Elderly, run by the U.S.
Department of Agriculture (USDA), to reduce duplicative reporting and to
eliminate the uncertainty of the funding and contract levels experienced by
state and local providers. The bill submitted by the Administration in the 104th
Congress proposed to correct these administrative difficulties in addition to
transferring the program operation from USDA to AoA. Based upon recent
discussions with USDA and with states regarding the usage of commodities, we
believe that the program should remain with USDA and that we share with USDA the
data and reports sent to AoA as a means of simplifying the program and reducing
paperwork required of.states and tribes. To correct these administrative
difficulties, we are joined by USDA in continuing to support the proposal from
last year to convert the "per meal" reimbursement program based on estimates, to
one based on a percentage of the actual number of meals served in prior fiscal
years. This would eliminate the need for mid-year retroactive readjustments in a
"per meal" rate.
- Fostering the Public Mission Through the Private Sector. We propose
authority to enable us to develop public-private partnerships that encourage the
private sector to contribute its experience and resources to public purposes and
missions. The AoA has often used its resources to leverage private sector
funding for collaborative ventures consistent with our public mission.
Recently, AoA has been approached by private entities seeking to provide in-kind
contributions in the form of printing and publication of materials, as well as
by private foundations in search of noble public purposes and the management or
administration of their funds. We propose authority to receive such in-kind
contributions and to assist in administering private funds for public
purposes. Similar authority was provided in the 1992 amendments to the Act for
the White House Conference on Aging.
- Increased Flexibility for Native American Programs. We strongly support
increasing the flexibility in the administration of the title VI program, and to
take into account subsistence needs, local customs, and other characteristics
that are appropriate to the unique cultural, regional and geographic needs of
the Indian populations to be served.
- Additionally, we propose to correct a technical interpretation in the title
VI program related to entities eligible for a grant. We clearly believe the
intent is that each federally-recognized Indian tribe would be eligible for one
grant under title VI, not multiple grants. Given the static funding level, it is
not prudent to facilitate a large increase in the number of grants, resulting in
a reduction in the size of the grant awards, should tribes be permitted to apply
for more than one grant. The more appropriate manner to address the concerns of
larger tribes would be through administrative adjustments to the funding
formula.
- Consolidation of Title VII. In addition to retaining title VII for the
development of state systems-to protect the rights of vulnerable older
individuals, we propose that streamlining occur by consolidating the four
separate authorizations into one. This proposal would provide the states greater
flexibility in addressing their elder protection activities consistent with
their local needs, while maintaining a base funding level for the long-term care
ombudsman program.
- Health Care Information Systems Development and Health Care Ombudsman
Demonstrations. We also support, as a part of fostering the development of
comprehensive and coordinated service delivery systems by states and area
agencies on aging under title III (Supportive Services), the development of
information and counseling systems in the states to help vulnerable populations
make informed choices regarding health care systems and issues. These would
facilitate education and training, and would assist consumers in making
appropriate health care choices, while empowering individuals to resolve
complaints and understand their rights. Such systems would also focus on
consumer protection and quality issues, and could be modeled after the
successful long-term care ombudsman program. This proposal is in response to the
rapidly-evolving health care environment older individuals face today. The aging
network is currently attempting to address these issues, but in many instances
has not integrated the functions as part of a comprehensive consumer
information, education, counseling system.
We also propose authority to conduct health care ombudsman demonstrations
through title IV and to highlight and disseminate best practices as a means of
assisting states to develop systems and projects in this area.
In summary, this Department looks forward to working with the Congress in a
bipartisan manner to achieve our common goals of streamlining and consolidating
functions within the Act in order to provide greater flexibility in the
administration of its progr
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