MINORITY PARTICIPATION 1. Strong mission statement in terms of rights of access to services. Older minorities should be targeted for services in proportion to their need. 2. 3. 4. 5. 6. Provide for training/technical assistance to local minority groups and coordinate Language on outreach emphasis on minorities and other special populations. Require area agencies to conduct annual needs assessment concerning the effectiveness of the service delivery system to reach minorities and the low income elderly; determine extent of the unmet need. Require area agencies to revise funding formula to more effectively target resources accordingly. Require state agencies to conduct periodic evaluations regarding success in serving low income and minorities, revise formula to more effectively target resources. Add language in state and area plans to provide special outreach informing the low income and minorities of Older Americans Act programs and other services. 1. 2. 3. LEGAL SERVICES At least 6% of funding must go to each of priority areas, including legal services; require annual monitoring of funding levels. Language on private right of judicial action for procedural actions to permit applicants for grants and grantees or interested parties to have an opportunity to seek redress at the administrative level. Establish hearing requirements for grantees, applicants and beneficiaries to insure due process of law; strengthen confidentiality requirements. 1. 2. FOOD STAMPS AND SSI OUTREACH Provide authorization for information, referral and outreach to assist eligible individuals in understanding application procedures for food stamps and SSI. Require periodic outreach campaign, in coordination with the Social Security Require that states set up consumer hotline(s) tied to Ombudsman program. Require that States ensure that the Ombudsman program and personnel are free of conflict of interest. Require that State programs be closely coordinated with other Older Americans Prohibit provider retaliation against employees and patients/residents. Create separate section and authorization under Title III for the Ombudsman program. Increase authorization for existing nursing home and board and care activities to $30 million (or "such sums"), set minimum funding level per state. Provide additional $1 million in each of the first two years for training and technical assistance in nursing home and board and care ombudsman activities. Require study by December, 1988, on effectiveness and options for increasing role of program in carrying board and care provisions of Act. Increase Advocacy Capability Require, as a condition of receipt of Ombudsman funds, that States make legal Require statutory immunity for ombudsman for "good faith" performance of duties. Require that state and federal licensing/certification agents be informed promptly Grant federal right of access to nursing home, board and care, and (as appropriate) home care agencies, patients/residents of same, patient/resident records of same, and other records of state licensing/certifying agents and (as appropriate) PROS to make determinations on complaints and quality problems, provided this occurs with the approval of the beneficiary or with protections that ensure their confidentiality is otherwise preserved. Clarify language specifying that substate programs are agents of the State office and entitled to same rights and protections. Expand to other care settings Provide $2 million for demonstration projects on expansion into home care in each of the first three years, require annual reports on demonstration progress/results. Require that such projects be designed, implemented and reviewed in consultation with a national advisory board of providers, consumers, ombudsman, and others. Provide $2 million in the third and fourth years for training and technical assistance to states in home care ombudsman activities. Provide separate funding of $15 million in fourth year to implement home care ombudsman capability nation-wide. Grant discretion to the chief executive officer on the administration of the home care ombudsman capability, with preference given to existing ombudsman programs. Require that if long term care facilities and home care ombudsman activities are organizationally separate, that they be closely coordinated such that the interests of the beneficiary are equally protected under separate as under fully integrated ombudsman programs. Require study (due December, 1990) on feasibility of extending ombudsman function to cover consumers of all health care (physician, in-home, nursing home (all levels), hospital). 1. 2. COORDINATION WITH THE VETERANS ADMINISTRATION Add Veterans Administration under section 203(b)(15) specifying agencies with whom the AoA is to consult. Encourage AoA to enter into joint demonstrations with the VA under the discretionary grants program and require coordination with VA representatives in the development of state and local area plans. MENTAL HEALTH 1. 2. 3. 4. 5. Add the phrase "including mental health" in sections where "health" is mentioned; specifically, Functions of the Commissioner, 202(a)(5); Grants and Contracts, 411(a)(1); Multidisciplinary Centers, 412(a). Add ADAMHA to federal agency consultation list, specifically 203(b). Include "older persons with functional impairment, either physical or mental" as a special population group for targeting of Older Americans Act services; specifically, state agency 305(a)(2)(E); area plan 306(a)(5)(A). Specify that grants/contracts should be developed to provide training programs to Title IV service providers and nursing home providers to meet the special needs of minority, low income, and frail elderly, including those with functional impairment, either mental or physical; specifically, Title IV, Part A. Request studies to document the targeting of Older Americans Act services to special population groups, including older persons with mental impairments. 6. Include mental health among the areas of research for the Long Term Care Centers. TITLE IV - TRAINING, RESEARCH AND DISCRETIONARY PROGRAMS Title IV Overall 1. 2. Broader definition of aging network. Authorize funding to assess future national personnel requirements with special emphasis on responding to the needs of the minority elderly. Promote training to prepare minorities for careers in gerontology. Specialized Long Term Care Research, Education and Training Centers 1. 2. 3. 4. 5. 6. 7. 8. Provide separate authorization as part of Title IV each year of $5 million to fund up to 10 centers. Specify intent that the center approach build a strong base for research, education and training related to consumers and providers of communitybased long term care - with particular emphasis on Older Americans Act programs. Require that centers be funded on competitive basis for three year intervals with understanding that preference will not be given to current recipients. Specify that eligible applicants include: State Offices on Aging, AAAs, institutions of higher education, other public agencies and non-profit organizations and need not be limited to those affiliated with medical schools. Require that funds support programs equitably distributed throughout the Nation and between urban and rural areas and that the research, education and training activities of centers be focused by topic (not by region) and not duplicative. Require an annual evaluation of center activities and performance to be submitted to Congress and that results be factored into contract renewal decisions. Specify a research, education and training mandate consistent with original intent to (drawing from language already in law): 1) support the development of comprehensive, coordinated community-based service systems and service delivery methods (including family support), 2) provide training and technical assistance in such methods, 3) support community education on long term care, 4) engage in research, education and training in close collaboration with community agencies including, but not limited to, agencies funded under the Older Americans Act. Center activity should focus on services designed to support alternatives to institutionalized living and the assessment of need, the development and coordination of plans of care, linkage among institutional (including hospital) and non-institutional providers, and family support. Further specify that center activities emphasize interdisciplinary and intergenerational approaches to service delivery and training and shall include projects addressing the needs of special populations including the indigent, the oldest old, persons with Alzheimer's disease and related disorders, the mentally impaired, minorities, rural elders. Require collaboration and encourage joint funding of research and training projects with NIA, HCFA, VA, ADAMA, and other federal agencies. TITLE V-SENIOR COMMUNITY SERVICE EMPLOYMENT PROGRAM 1. Reinstate allowable administrative costs to 15%. 2. 3. Increase authorization level and average per enrollee cost which has remained the same over the past five years. Focus Title V employment and training funding on areas with the highest unemployment. 1. TITLE VIGRANTS FOR INDIAN TRIBES Make grants available to all Indian tribes which can demonstrate that they have an organizational entity and can administer a Title VI grant. Mr. BIAGGI. Mr. Rinaldo. STATEMENT OF REPRESENTATIVE MATTHEW J. RINALDO Mr. RINALDO. Thank you very much, Mr. Chairman. Mr. Chairman, when Congress enacted the Older Americans Act, we put into place a nationwide network we hoped would provide aging services to all of the elderly at the local level. For a large percentage of Americans, we have been successful. Local area agencies on aging we created are currently serving residents with a variety of services which are easily accessible. However, in some areas, our success has been limited. Today, after over twenty years of service, some elderly populations are still underserved. The elderly in inner city neighborhoods, rural areas, some minority populations and the frail elderly still need service. That is the purpose of this hearing today to discover their needs and how the Older Americans Act can better serve them. The witnesses we'll be hearing from today will provide the Committee and Congress with the perspective we need as we approach reauthorization of this important Act. The problems presented by underserved populations are real and if we hope to improve the Older Americans Act, it is vitally important that we have hearings of this type. Unfortunately, Mr. Chairman, at the same time as this hearing is going on, the full committee on Energy and Commerce, on which I serve, is marking up the very important trade bill. I have two amendments to that bill and I will not be able to remain here because I must return to that meeting. Hopefully, if that ends early enough, I'll return here. However, I want to assure you that I will be examining the testimony of our witnesses carefully with an eye towards working with them in order to improve the effectiveness of the Older Americans Act because it is, in my view, the most important piece of legislation we have on the books for the older Americans of this nation. Thank you again, Mr. Chairman. Any further comments that I have, I will reserve the balance of my time and insert in the record. Mr. BIAGGI. The young woman from New York, Ms. Slaughter. STATEMENT OF REPRESENTATIVE LOUISE M. SLAUGHTER Ms. SLAUGHTER. Thank you, Mr. Chairman. The Older Americans Act provides an important resource in providing the elderly with needed nutrition, transportation and supportive services. In my district in upstate New York there are 45,000 senior citizens served by the Older Americans Act. The three counties in my district of Monroe, Ontario and Genesse receive almost two million dollars under this program and are able to leverage thousands more in State and private funds to provide services. While we are fortunate in my district to have a very progressive system of service delivery and medical services to the elderly, there is more that needs to be done. Some data points to several problems. One out of every four of New York's older households is headed by persons 65 or older. By the year 2,000, that number will increase by 40%. One out of every eight persons in New York State is a female age 55 or older and women, on average, are living almost eight years more than men and are therefore more likely to end up living alone and poor. Nearly three-quarters of the elderly poor are women with incomes slightly more than half that of the older man. In 1986 the Governors Task Force on Aging was charged with the responsibility of formulating new directions in State policies on aging. Some of those recommendations are pertinent to the hearing today and I look forward to hearing from our witnesses to help us find the solutions to the problems that face our elder Americans. Thank you, Mr. Chairman. Mr. BIAGGI. Mr Volkmer? STATEMENT OF REPRESENTATIVE ROBERT A. BORSKI Mr. BORSKI. Yes, thank you, Mr. Chairman. First of all, let me thank you for convening this important hearing, Mr. Chairman. It's nice to be with you again as we examine the reauthorization of the Older Americans Act from the perspective of certain populations which may be underserved. Today, one in nine Americans is age 65 or over. By the year 2020, approximately one in four of us will be age 60 or older. Clearly, now is the time for us to plan for the aging of our nation. As you know, the Older Americans Act has provided millions of older Americans with valuable nutrition and transportation services, adult day care, legal assistance, employment and housing opportunities and other supportive services. This legislation established a national network on aging which administers the largest federal state program designed exclusively to serve the social and nutrition needs of older Americans. Since its inception in 1965, the program has been an outstanding success. The agencies have represented the interests of more than forty million of the nation's older persons and have helped senior citizens lead healthy and independent lives through the development of comprehensive system of community services currently reaching over four million older persons a day. It is clear that this important program should continue. However, as we examine the reauthorization of this Act, we must consider ways to improve upon current programs to insure that all older Americans are being served. It has been noted that certain minority populations such as the frail elderly and the mentally impaired have fallen through the cracks. Because of their special circumstances, these individuals have unique needs which have not been adequately addressed. As members of the House Select Committee on Aging, I believe it is our responsibility to examine new ways of serving these individuals through this successful program. I look forward to hearing the testimony of our distinguished witnesses to investigate ways to address the needs of these Americans. Mr. BIAGGI. Thank you. |