include home care, this is a giant step which will be very costly. I don't know of any other reasonable alternative. Thank you for this opportunity to respond to these critical questions. Ms. SLAUGHTER. Thank you, Mr. Stallings. I think we have heard very important testimony today. Like many, many other Americans in this country, I've been faced with this problem just recently with my elderly parents in Kentucky. I know the heartache it brings and the difficulty in trying to find an adequate place, someplace where you feel that they'll be cared for and looked after. It is difficult to turn over people that you love so much to the care of strangers that you hope will have some understanding. We thank you for coming here today and I want to assure you that your testimony will play a very important part in our deliberations. Chairman Roybal wants me to thank you very much; he wishes he could have been here. This hearing testimony will be kept open for two weeks so if there are any additions or any changes or anything else you want to say to us, please feel free to make them. On behalf of Chairman Roybal, I want to thank you for being with us here today. The hearing is adjourned. [Whereupon, the hearing was adjourned at 3:45 p.m.] APPENDIX COMMENTS ON 1987 REAUTHORIZATION OF THE OLDER AMERICANS ACT SUBMITTED TO THE SELECT COMMITTEE ON AGING February, 1987 Submitted by: Southwest Virginia's Aging Team (SWAT) Marilyn Pace Maxwell, Executive Director, Mountain Empire Older Citizens Our group consists of the Executive Directors of the four western-most Area Agencies on Aging in Virginia. Our service areas are rural in nature with mountainous terrain. We appreciate this opportunity to share our views on the proposals for reauthorization of the Older Americans Act. Basically, we think the Older Americans Act is an excellent document which needs to be updated periodically but which is not in need of a major overhaul. (1) Direct Delivery of Service Language concerning the waiver for direct delivery of service should remain unchanged. In many rural areas alternate service providers simply do not exist and the direct delivery of service is the only option which is economically feasible. Many rural agencies on aging are the only agencies with expertise in providing the services and are viewed as being more responsive to local needs. We are not aware of any problems being caused by the current waiver procedure and see no reason to change a part of the law which seems to be working well. Many rural areas have fewer resources and must depend on a high level of cooperation among existing service providers. The current waiver procedure gives states and localities the needed flexibility to determine the best way to serve elderly clients. (2) Targeting We wholeheartedly concur that limited resources should be targeted to individuals most in need. Given the limited resources, Older Americans Act programs have moved toward a targeting of those scarce resources to the individuals who need them the most. Perhaps the language which gives preference to those in social and economic need, with emphasis on racial minorities, could be expanded to specifically include disabled elderly and those living in areas which are economically depressed. 1 1 However, we oppose the proposal to target services exclusively to persons over the age of 70 because such a step would discriminate against minorities and against persons living in areas where there is a high incidence of occupational disabilities, because both these groups tend to have shorter life spans. It is also significant to note that a substantial portion of premature institutionalized elderly are between the ages of 60 and 70. Since prevention of institutionalization is a major goal of our efforts, we feel that a substantial amount of our preventive services should be geared to people in the age 60 to 70 group. (3) Rural Issues The language in the Act concerning spending levels in rural areas (rural bump) should be updated in acknowledgment of the high costs of providing services in these areas. Numerous studies have shown that service levels are must higher in urban areas although higher levels of need can be demonstrated in rural areas. Some of the factors which make it difficult to provide services in rural areas include high transportation costs, the lack of alternate or competitive services, the shortage of supplementary funding sources such as United Way and local tax revenues, a high level of need, and the dilution of support staff resulting from travel time required. 4) Ombudsman While Ombudsman services are sorely needed at the area agency level, current resources are inadequate to meet the demand for such conventional services as home delivered meals and home care. Any additional mandate for the provision of Ombudsman services must be accompanied by additional, new funding to provide this much needed service. (5) Voluntary Cost Sharing Voluntary cost sharing is a new phrase that apparently implies that clients should be contributing more for the services they receive. However, too much emphasis on contributions tends to deter participation by clients who need the services most. Every participant should have an opportunity to contribute anonymously, as the law now provides. The current legislative language seems adequate in this regard. (6) Block-Granting We are opposed to the suggestion that Older Americans Act funds should be block-granted. In recent history, block-granting has been a prelude to indiscriminant budget cutting and has served no useful administrative purpose. The Act is sufficiently flexible as it is, with authorization to transfer funds from: one title to another. Block-granting is unnecessary and potentially harmful. (7) Waiver Authority Nothing would undercut the Older Americans Act more than to grant the Federal Commissioner broad powers to waive its requirements at the state level. If the law is defective, it should be changed. If pilot studies are needed, they should be funded and administered under Title IV of the Act, as intended. The proposal to waive Title III requirements is apparently an effort to get around the act rather than improve it. Thank you for this opportunity to share our thoughts concerning some key proposals related to reauthorization of the Oluer Americans Act. TESTIMONY OF Carl Elsdorfer, Ph.D., M.D. on behalf of AMERICAN NURSES' ASSOCIATION AMERICAN PSYCHIATRIC ASSOCIATION THE AMERICAN PSYCHOLOGICAL ASSOCIATION THE NATIONAL ASSOCIATION OF SOCIAL WORKERS to the U.S. HOUSE OF REPRESENTATIVES SELECT COMMITTEE ON AGING Hearing on the "Reauthorization of the Older Americans Act" March 25, 1987 On behalf of the American Nurses' Association, the American Psychiatric Association, the American Psychological Association, and the National Association of Social Workers, I am pleased to present this testimony for the record on the House Select Committee on Aging's hearing on "The Reauthor Ization of the Older Americans Act." We welcome this opportunity to comment on the mental health care needs of older Americans. The American Nurses' Association (ANA), comprising 53 state and territory constituent members, is the national professional organization representing the Interests of the nation's professional nurses. The purposes of the ANA are to work for the Improvement of health standards and the availability of health care services for all people; to foster high standards of nursing; and to stimulate and promote the professional development of nurses and advance their economic and general welfare. The The American Psychiatric Association is the nation's oldest medical specialty society, representing over 33,000 psychiatrists nationwide. objectives of the Association Include: Improving the treatment, rehabilitation, and care of the mentally ill, mentally retarded, and emotionally disturbed; fostering cooperation of all who are concerned with the medical, psychological, social, and legal aspects of mental health and Illness; and promoting the best interests of patients and those actually or potentially making use of mental health services. The American Psychological Association, representing over 87,000 members, is the nation's major psychology organization. The Association works to advance psychology as a science, a profession, and a means of promoting human welfare by promoting responsive concern by the profession on a variety of social and public policy issues; disseminating psychological knowledge to enhance and Increase human progress and well-being; developing standards of education, ethical conduct, and professional practice; promoting research; and Improving research methods and conditions. The National Association of Social Workers (NASW) is the largest organization of professional social workers in the world, with over 102,000 members nationwide. The primary objectives of NASW Include: promoting the quality and effectiveness of social work practice; Improving social conditions through the utilization of professional knowledge and skills; and providing opportunities to work toward alleviating or preventing deprivation, distress, and strain through social work practice and social action. Our primary concern is the need for a coordinated approach to the delivery of mental health and social services to older persons living in the community. As the Committee develops its recommendations for amendments to the Older Americans Act, we urge that the needs of older persons with mental and behavioral disorders, and other severly Impairing conditions, become a priority issue. We believe the Act can, and should, serve as a legislative foundation for programs designed to reach many of the nation's elderly In need of Information about, and access to, mental health and social services. However, before detailing our recommendations and concerns in this regard,. we believe it is important to describe the populations with whom we are most concerned, and to point out some serious obstacles to meeting the care needs of these populations. Mental Health Needs of Older Persons: Background While most older persons are emotionally healthy, it has been estimated that 10% to 28% of older Americans living in the community (2.6 to 7.3 million Individuals) have mental disorders ser lous enough to warrant professional attention. Unfortunately, it has also been estimated that over 80% of the elderly in need of mental health services will not receive them. Older persons who are in need of mental health services are a heterogenous population, but may be grouped into three broad categories. These categories represent different etiological factors for the mental disorders and may represent different service needs. First, Individuals with a history of chronic mental Impairment who have reached old age. The predominant mental disorders of persons in this category Include: schizophrenia, severe depression, severe character disorders, and chronic addictive disorders. Many of these individuals were once residents of state psychiatric hospitals, but were transfered to nursing homes and board and care facilities during the deinstitutionalization movement begun in the 1960s. Some have become homeless persons. These older Individuals are sometimes participants in senior centers and nutritional sites. The second category Includes older persons who develop mental disorders |