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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.