REAUTHORIZATION OF THE OLDER AMERICANS ACT: THE PLIGHT OF THE UNDERSERVED

WEDNESDAY, MARCH 25, 1987

HOUSE OF REPRESENTATIVES,
SELECT COMMITTEE ON AGING,

Washington, DC.

The committee met, pursuant to notice, at 2:05 p.m., in room 1310 Longworth House Office Building; Hon. Mario Biaggi (acting chairman of the committee) presiding.

Members present: Representatives Biaggi, Bonker, Borski, Vento, Volkmer, Stallings, Louise M. Slaughter, Rinaldo, Jeffords, Bentley, Schuette, and Morella.

Staff present: Fernando Torres-Gil, staff director; Nancy Smith, Brian Lutz, professional staff members; Diana Jones, Carolyn Griffith, Valerie Batza, staff assistants; Don Canestraro, intern; Joe Fredericks, deputy minority staff director; Anne O'Donnell, minority legislative assistant. Subcommittee on Human Services: Robert Blancato, majority staff director; Brian Lindberg, professional staff; Barbara Kaplan, minority staff director.

OPENING STATEMENT OF REPRESENTATIVE MARIO BIAGGI Mr. BIAGGI. The hearing is called to order.

On behalf of our distinguished chairman, Mr. Roybal, who is actively participating in a key markup on the supplemental appropriations, I convene this hearing today.

This is the full committee's first formal hearing on the Reauthorization of the Older Americans Act scheduled for later this year, yet this is the fifth hearing held under our committee's auspices, the previous four being conducted by the Subcommittee on Human Services.

I'll operate with several basic premises in mind. The first is that the Older Americans Act is a success story and it will be reauthorized.

Second, the reauthorization process should produce nothing more than a fine tuning of the Act.

The last premise relates to our topic today. The Older Americans Act has fallen short of meeting its mandate of serving the elderly in the greatest economic or social need and we must correct this problem during this reauthorization.

Our hearing is entitled "The Older Americans Act Reauthorization: The Plight of the Underserved." This is not a term of rhetoric. It is, in fact one of the central challenges facing us in the reau

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thorization, namely how to improve targeting so we reach the underserved.

We define the underserved as older minorities, the frail, the developmentally disabled and mentally impaired and the rural elder

ly.

Chairman Roybal and I, over the years, have shared many similar views on the Older Americans Act, yet the issue we feel most passionately about in this reauthorization is that the legislation must contain a new commitment to reach the underserved and the aging network must be more accountable to achieving this goal.

There is perhaps one central statistic that motivates us today. Participation rates among minority aged in Title III programs under the act has dropped by nearly 25% during this decade. This has occurred when poverty among Hispanic elderly has nearly doubled and that of the general elderly population and when nearly half of all black old Americans have incomes at or below 125% of the poverty level.

Further, this has occurred in a decade when overall funding for Title III has increased by over 125 million dollars.

We know the problem, yet what is the cause? Is the law vague on this subject?

To the contrary. The law states clearly that in both State and area agency on aging annual plans, they are to provide assurances that preference will be given to providing services to older individuals with the greatest economic or social need with particular attention to low minority individuals.

One would note that the underserved we talk about today are by definition the same group we are supposed to be targeting funds to. The language is clear. The mandate is there, yet the overriding factor remains that at best, only one out of every two seniors served by the Older Americans Act is in the greatest economic or social need.

Is that what we call giving a preference?

We must embark on a plan to improve our record in this area. A number of ideas have been and no doubt will be proposed. Let me, for my purposes dispose of one right away.

I am unalterably opposed to any income based means test which establishes a specific criteria which results in people being cut off from services. I realize there are also a number of variations on this and I would prefer to judge each one on a case by case basis before giving a final position whether it be a cost sharing plan or one for sliding scale contribution fees.

I have contended for considerable periods of time that the answer to the targeting problem does not rest in some radical new proposal. Instead if one simply followed the dictates of the law more clearly and focused on outreach, we might improve our efforts quite dramatically.

Chairman Roybal shares this view, I know. We are not doing enough outreach and the outreach that we are doing is not focused enough to locate those elderly in the greatest economic or social need, especially among the minority aged.

We must both more strictly enforce outreach requirements and back it with additional resources.

I am confident that Congress will take positive and progressive steps to alleviate this problem. I am afraid that I do not share that same confidence with respect to the Administration, thus far over the course of the past eight months they have disclosed two different proposals representing their authorization position.

The first, which was the subject of a hearing we held in September, would have raised the eligibility age for services from 60 to 70. The impact among the underserved in especially the minority aged would have been devastating.

In my home city of New York, we learned that of approximately 254,000 minority elderly, over 150,000 are between 60 and 70. For them this change could have meant a reduction, if not outright elimination of eligibility for services. This proposal seems to have vanished into thin air, perhaps pushed by a strong wind of public opposition.

Earlier this week before the subcommittee on Human Resources on which I sit, the Commission on Aging unveiled a new proposal. This one would permit the Commissioner, on a demonstration basis, the authority to waive any requirements under Section 305, 306 and 307 of the current Act, if this would help to better promote the objectives of Title III.

This sounds innocent enough, but it could be most devastating for the underserved elderly we focus on today.

Among the requirements in Section 305 and 306, is the aforementioned mandate that States and area agencies on aging give a preference to serving the elderly in the greatest economic or social needs, especially to low income and the minority aged.

I for one would not want to see the option to eliminate this requirement in the hands of the Commission on Aging, especially since the 25% decline in minority participation has occurred during the lifetime of this administration.

There are scores of other issues that we will confront in this reauthorization, yet none may be as important as the one we discuss today.

How do we reduce the number of elderly underserved by the Older Americans Act? How do we achieve a closer relationship between the concept and reality of the Act?

It is the central issue that we must address today and in the future until we get it right. I would ask at this point that my prepared statement be included in the record.

Without objection, so ordered.

[The prepared statement of Mr. Biaggi follows:]

PREPARED STATEMENT OF REPRESENTATIVE MARIO BIAGGI

I congratulate the chairman on calling this hearing today to consider the Older Americans Act reauthorization in light of the many underserved older adults in our Nation.

Chairman Roybal and I have a strong and longstanding commitment to the Older Americans Act programs and their improvement. We share a concern for a number of particularly vulnerable elderly sub-populations including minorities, the frail, the mentally impaired, and the rural elderly, whose access to Older Americans Act programs is critical for us to successfully reach the primary goals of the law.

With the chairman's consent, I will ask that an excellent article titled "Meeting the Needs of America's Minority Older Adults", which appeared in the March 1987 issue of Aging Network News and was authored by Mr. Roybal, appear at the appro

priate place in the hearing record. I think that it will add some important insights to the issues we discuss today; I congratulate the chairman.

Before I address the issues of today's hearing before the full committee, I would like to briefly remind the Members and those visiting us of the recent hearings that we have conducted on the Subcommittee on Human Services. Thus far we have held four hearings which addressed the reauthorization of the Older Americans Act. The first hearing was prompted by the Administration on Aging's draft reauthorization proposal and considered several rather radical changes which that draft included. The second and third hearings considered the California and New York experiences with the Older Americans Act programs respectively. The most recent hearing that we held addressed legal services for the elderly in relation to the act. In addition to our hearings, we have kept in touch with the aging network on a regular basis. We have found this to be one of the best ways to learn the strengths and weaknesses of the Older Americans Act.

I believe we can be proud, both at the subcommittee and full committee levels, of our serious consideration of the issues surrounding reauthorization. Although the Education and Labor Committee is on a fast track toward a May reauthorization, it is safe to say that the select committee will continue to gather information and insights into ways to strengthen this already healthy set of programs, which benefit millions of older adults each year. We take our oversight responsiblities quite seriously on the Select Committee on Aging.

Today we will hear from four witnesses who are acutely aware of the plight of the underserved elderly, which often equates to no services at all. In a sense, this hearing focuses on how successful we have been in meeting the requirements of the act laid out in two short, but very important phrases in section 306, which defines the role of area plans in the provision of services. The Act, in section 306 (5)(a), states that each plan must "Provide assurances that preference will be given to providing services to older individuals with the greatest economic or social needs, with particular attention to low-minority individuals, and include proposed methods of carrying out the preference in the area plan." Now, those words are not meant to serve as some pie in the sky unreachable goals. They match up perfectly with the basic tennet of most human services programs-that we should help those that need our help the most. Practically speaking, this does not mean that those currently being served by the Older Americans Act who are not the very poorest poor or possessing the very greatest of social need should be turned away at the doors of our senior centers and nutrition sites. I should also say, as I have said on many occasions, that I am strongly opposed to income-based means testing for the act's programs, and I don't think that the language in section 306 means that we should use this approach either.

It does mean, however, that we must continue to send out a strong message to States and area agencies that every effort must be made to reach the underserved elderly. We all must work to reach out to them.

This is not a new approach. Directly following section 306(5)(a), in (5)(b), it is stated that each plan must also "assure the use of outreach efforts that will indentify individuals eligible for assistance under this act, with special emphasis on rural elderly, and inform such individuals of the availability of such assistance." As I implied earlier, today we will see our report card with respect to these important elements of the Older Americans Act statute. We, I hope, will learn how well we reach out to those in need and how well we utilize those persons who are best equipped to reach out-the members of the communities where those in need are living. I also hope our witnesses will offer some possible solutions to the problems that they have encountered.

I am extremely pleased that several issues that are close to my heart will be discussed this afternoon. My district includes the Bronx and Yonkers, and I am sensitive to the difficulties faced by the graying urban population. We know that metropolitan areas have pockets of poor and minority elderly, often isolated from the community and services.

At a recent hearing the Subcommittee on Human Services held in New York City, we learned a good deal about Older Americans Act services in the urban setting. For example, there are approximately 254,000 minority elderly in New York City, and over 150,000 of those elderly are between 60 and 70 years of age. Many of these citizens need and deserve OAA services. Administration on Aging included in its draft proposal for reauthorization last year, language to change the formula used to allocate grants to States so that a State would receive funds based on its population age 70 or over as compared to all States. This is an assault on minority participants, who on average are less likely to live to age 70 and whose existance would be ignored by such a formula change.

Again, this past Monday, March 23rd, the administration proposed a change in current statue that would be detrimental to the welfare of low-income and minority elderly. The Commissioner on Aging appearing before the Education and Labor subcommittee on Human Resources, recommended that the law be modified to allow the Commissioner to waive compliance with any requirements of sections 305, 306, and 307 of the act. Section 306, as I mentioned earlier, works to assure that those "older individuals with the greatest economic and social needs", particularly lowincome minority individuals, receive preference. I believe we are here today to talk about bolstering this concept, not to tear it down as one might believe the administration would choose to do.

Another strong interest on mine lies in the act's ability to serve Indian elders. My gut feeling is that this is a minority group within our society with a unique set of problems and needs, to which we have failed to appropriately respond. This Nation's treatment of Native Americans has been hothing less than despicable thoughout our history. In 1987, our Indian elders deserve more services, better coordinated services, and more responsiveness than we have been willing to provide in the past. I am currently working with my distinguished colleague on the Aging Committee from the State of Washington, Mr. Bonker, on legislation to right this situation. I hope that as we move forward, our colleagues will join us in this important endeav

or.

One of the great characteristics of the Older Americans Act is that of the diversity of services it funds and coordinates depending on the needs of each community. I think it is safe to say, however, that a strong long-term care ombudsman program is desirable in every community across the country. We have all heard of and seen far too many horror stories of abused and neglected individuals living in nursing homes and board and care facilities. The ombudsman element of the Older Americans Act provides for the investigating and resolving of complaints regarding care in longterm care facilities, and I believe this is one of the most important aspects of the act for our families, friends, neighbors, and someday possibly for our own protection.

I am very interested in hearing the testimony_today regarding how we can expand and strengthen the ombudsman program. The need seems obvious to me. We are witnessing a dramatic growth in the number of frail older adults who need assistance. Also, during this same time, the Medicare prospective payment system has placed a greater demand on community-based services including the ombudsman programs, which attempt to protect the health, welfare, and rights of long-term care facility residents. Investigations have shown us the large number of nursing home residents still subjected to substandard levels of care, and we have no reason to believe that these incidents will decrease as the number of resident increases.

During this year's reauthorization, I am confident that this program will be improved. We need to strengthen the ability of ombudspersons to carry out their difficult duties. If we strengthen the tools that they use to monitor the quality of care that residents receive and to react to reports of mistreatment, the program will grow. This should be done by improving the access of ombudspersons to long-term care facilities and their residents. Improved access to inspection reports, notices of deficiencies and sanctions, and peer review organization findings is also essential. At the same time, it is important to add to the current law provisions to protect complainants from misuse of the information ombudspersons obtain, and from retaliation of the long-term care facility where the complainant lives or works. Problems reported by residents, their families, and employees of facilities must be held in the strictest of confidence, and complainants must be protected from reprisals. Otherwise, reports of poor treatment will not be made.

In addition, good faith performance of duties by ombudsman program personnel must be guaranteed appropriate counsel in the future. States should be made responsible for providing needed legal counsel and advise to ombudspersons who under current law, in many States, are in a position of legal vulnerability.

There are several other aspects of the ombudsman program that I hope will be modified during the next couple months, including its training and conflict of interest policies, and its deficient level of funding. Several of us on the select committee are working on language to improve and strengthen this excellent program and I'm sure that we are all interested in the forthcoming testimony relating to long-term care quality assurance and the frail elderly.

I am also anxious to learn more about the particular problems faced by individuals with developmental disabilities and mental impairments as they grow older. I know that the challenges this creates for their families and support systems are unique, and that we should at a minimum be including such considerations in our State plans for the act.