necessitates an expansion of the role of the Ombudsman to permit more effective monitoring and advocacy on behalf of older persons. AARP opposes an extension of Ombudsman authority into home health care services at this time. However, the Association does endorse authorization of specialized centers for long term care research, education, and training. AARP supports reinstatement of the 15% administrative cap for national sponsors of Title V senior employment programs to encourage job development, increase unsubsidized placements, and prevent termination of program enrollees. The Association also supports statutory changes that encourage coordination of the Older Americans Act programs with programs administered by other agencies, especially programs for the disabled and American veterans. The Association further recommends that a 1991 White House conference on Aging be held with a single unifying theme to focus attention on the more critical issues of aging trends in America. TESTIMONY OF THE AMERICAN ASSOCIATION OF RETIRED PERSONS PRESENTED BY DR. KERMIT C. PHELPS Good afternoon Mr. Chairman, Members of the Committee, ladies and gentlemen. I am Dr. Kermit C. Phelps, Chairman of the Board of the American Association of Retired Persons. On behalf of the Association's more than 24 million members I would like to outline some trends in aging in America, and share with you some of our recommendations regarding reauthorization of the Older Americans Act. For over twenty years, the Older Americans Act has served as the sole federal social and community service statute designed exclusively for older persons. In order to foster maximum independence, the mission of the Act has been to provide a range of services to those older persons with the greatest economic and social need. As Congress deliberates the many issues of reauthorization under the Act, it is important for the aging community and policy makers to consider demographic and social trends in aging. This will allow us to frame our policy recommendations not just around immediate needs, but also the needs of older persons in the future. Size and Growth of the Older Population Everyone is aware of the rapid growth in the nation's older population. What is startling about the aging trend today is the rapid pace. In the last two decades alone, the 65 and over population grew by 54 percent while the under 65 population increased by only 24 percent. In 1940 there were just over 20 million persons 55 years of age or older and about 9 million over age of 65. By 1980, the number of persons 55 and over increased by 141 percent and those 65 and over by 183 percent. Increases in these two populations pale when compared to increases in the oldest age groups, those 75 and over. The number of persons 75 and over has increased by more than 275 percent between 1940 and 1980. This trend is expected to continue into the next century. By the year 2035 every fifth American will be 65 years of age and over. As the older population has increased, there has been a substantial shift in its sex and racial composition. Since 1940, women 55 and over constitute a greater proportion of the older population. The survival rate for women at age 65 is 30 percent greater than men of the same age. As a result, older women now outnumber men three to two. Census projections indicate that by 1990 there will be 11.3 million women 65 and older who will be single and living alone, compared to approximately 8 million today. These changes will have a great impact on the demand for income supports, social services, and health care. The By the year The increase in the number of older minorities has also contributed to the significant growth in the older population. number of older persons who are members of minority groups has increased faster than the number of older white persons. 2025, the portion of older persons who are minorities is projected to increase 75 percent compared to a 62 percent increase for the white population. Older minorities, however, will continue to comprise a smaller group in absolute numbers than older whites. Major changes in public policy will be essential to coping with the effects of the changing numbers in different age groups. Presently, there are about twenty persons 65 years and over for every hundred persons of working age. After baby-boomers turn 65 around the year 2030, however, this ratio is expected to double. Such variations in the dependency ratio will have a significant impact on the provision of adequate housing, health and social services, employment, and social security due to the decline in the number of workers to support such publicly-funded programs for older persons. The Older Americans Act program can respond to the needs of this changing older population in a variety of ways: Health and Long Term Care As the incidence of frailty, disability, and chronic illness increases in a growing older population, the OAA can play an important role in the development of a comprehensive coordinated system of health and long term care services. While most older persons are somewhat healthy and active in their early retirement years, health and mobility decline with age. Important issues for the future will have to focus on health service needs and cost containment, including services designed to help older persons function within their own homes. The problems associated with rising health care costs will continue perhaps beyond this century. As this occurs, we need to pay equal attention to access and quality of health and medical care. O Income Maintenance The provision of adequate income for older Americans is one of our greatest challenges. An adequately funded and expanded Title V program is essential to meet the employment needs of older Americans. While there is a growing perception that the economic status of older persons has improved significantly, when the cash income of the elderly is compared to that of the young working population, there remains a substantial discrepancy. While the proportion of elderly poor has dropped by two-thirds since 1959, our future concern must focus on how to meet the public costs of income maintenance for older persons given the increased older population, expanded longevity, and inflation. In order to stretch limited resources we must continue to focus on building public and private program structures that increase retirement income opportunities, particularly those serving older persons with lower incomes. O Housing Few issues will be more important to the future well-being of older people than their living environments. Adequate supportive service programs under the Older Americans Act such as homemaker, friendly visitor, and chore services are essential to prevent premature institutionalization of many older persons. Expanding and strengthening such services will be essential to a properly designed housing policy in the future and may contribute in saving public resources expended on older persons. Current demographic projections indicate that the number of households headed by older persons is steadily increasing. More than one-fifth of all U.S. households are headed by persons 65 and over and this figure will rise by 33 percent in 1995. As the proportion of older persons increases, particularly the frail elderly, the dominant issue will be how can we design and implement interventions to assist older persons in coping with their housing and independent living needs. Social Services Much of our success in meeting the future needs of our older population will lie in our ability and willingness to strengthen provisions under the Older Americans Act. As funding for social service programs declines in the face of increasing demand, the Older Americans Act, as the focal point for federal assistance to older persons, becomes even more critical. The present system is plagued by fragmentation, duplication, and ineffective coordination efforts at all levels. Increasing life expectancy will have major implications for the way we must revamp our human service delivery systems. Coordination will be critical if we are to adequately address the needs of older persons in extremely varied circumstances and with varying levels of need. This means that the Act should continue to target services to special populations while providing sufficient flexibility to state and local agencies to meet local needs. The following are some of our specific recommendations that directly affect the most vulnerable and disadvantaged elderly persons. AARP believes these needed improvements in the Act would facilitate better service to all of the nation's elderly population. Extension of the Older Americans Act and Heightened Visibility of the Administration on Aging AARP strongly believes that the legislation should be extended for at least three years. This would enable service providers and others to make long-range plans and to chart their activities more effectively. Morever, it would still allow appropriate congressional committees to perform oversight responsibilities. Also, because many programs have operated with no increased funding or cuts, AARP will continue to advocate adequate funding for all programs under the Act, especially those targeted to vulnerable populations. This could be achieved through authorization of such sums as necessary. The Older Americans Act and subsequent amendments make clear that Congress intended the Administration on Aging (AoA) to be a highly visible and strong advocate for the aged. However, AoA is currently a subunit along with several other agencies (such as the Administration on Children, Youth, and Families or the Administration on Developmental Disabilities), within the Office of Human Development Services at the Department of Health and Human Services (HHS). The net impact is that AoA has not fulfilled its intended role because of its lower status in the HHS organizational structure. We strongly believe that the aging agenda should be elevated within HHS by having the Commissioner report directly to the Secretary rather than to the Office of the Secretary. Advocacy, Coordination, Facilitation, and Care Management Roles of Area Agencies on Aging (AAAs). The role of Area Agencies on Aging (AAAs) as service providers by contrast to their role as facilitators/coordinators and advocates is a major concern of the Association. Congress recognized when the law was enacted that there would always be insufficient funds under the OAA to serve all eligible elderly persons. In order to maximize the benefit derived from each OAA dollar, AAAs should be required to reaffirm their commitment to a coordination/facilitation/advocacy role. The current requirement to justify direct provision of services to older persons in the state plan needs stronger emphasis, and more attention needs to be placed on coordination, facilitation and referral. Although there may be a need in some situations for AAAs to assume the role of service providers, use of OAA funds for service delivery should not take priority over the ability of AAAs to perform the coordination mandate of the Act. AAA involvement in case or care management should be considered only in the context of the above comments and recommendations. Additionally, it should be noted that in situations where the AAAS become the direct deliverers of service, there is great potential for conflict of interest between their marketplace provider role and their statutory role to facilitate, monitor, and advocate. In light of these concerns, it seems appropriate that AAAS be involved in case or care management only as part of a carefully controlled demonstration that includes a broad array of other non-profit entities besides AAAS. The exception would be where other providers (private and non-profit) are not responding to the need for services. |