BEFORE THE

SUBCOMMITTEE ON POSTSECONDARY EDUCATION,

TRAINING AND LIFE-LONG LEARNING

OF THE

COMMITTEE ON EDUCATION AND

THE WORKFORCE

HOUSE OF REPRESENTATIVES

ONE HUNDRED SIXTH CONGRESS

FIRST SESSION

Printed for the use of the Committee on Education

and the Workforce

Table of Contents

The Statement Of Fernando Torres-Gil, Former Assistant Secretary On Aging *

The Statement Of Ms. Laura Medina, MPA, Program Manager, Planning And Development Services, Los Angeles County Area Agency On Aging, Los Angeles, CA *

The Statement Of Ms. Carmela G. Lacayo, President/CEO, National Association For Hispanic Elderly, Pasadena, CA *

The Statement Of Mr. Don Herring, Director, YWCA Intervale Senior Services, West Covina, CA *

The Statement Of Ms. Betty F. Malks, M.S.W., C.S.W., Director, County Of Santa Clara Department Of Aging And Adult Services, San Jose, CA *

The Statement Of Mr. Michael Feuer, Los Angeles City Council Member, 5^th District, Los Angeles, CA *

Appendix A- The Written Statement Of Ms. Laura Medina, MPA, Program Manager, Planning And Development Services, Los Angeles County Area Agency On Aging, Los Angeles, CA *

Appendix B- The Written Statement Of Ms. Carmela G. Lacayo, President/CEO, National Association For Hispanic Elderly, Pasadena, CA *

Appendix C- The Written Statement Of Mr. Don Herring, Director, YWCA Intervale Senior Services, West Covina, CA *

Appendix D- The Written Statement Of Ms. Betty F. Malks, M.S.W., C.S.W., Director, County Of Santa Clara Department Of Aging And Adult Services, San Jose, CA *

Appendix E- The Written Statement Of The Statement Of Mr. Michael Feuer, Los Angeles City Council Member, 5^th District, Los Angeles, CA *

Appendix F- The Written Statement Of California State Senator Jim Levy *

Table Of Indexes *

Table of Contents for Field Hearing held in Santa Clarita, CA, April 6, 1999……...119

Table of Indexes……………………………………………………………………..225

Table of Contents for Field Hearing held in North Platte, NE, April 8, 1999……….227

Table of Indexes……………………………………………………………………...353

The Committee met, pursuant to call, at 9:36 a.m., at Alhambra City Hall, 111 First Street, Alhambra, California, Hon. Howard P. ``Buck'' McKeon [chairman of the subcommittee] presiding.

Present: Representatives McKeon, Barrett and Martinez.

Staff Present: Cynthia A. Herrle, Professional Staff Member; Mary Ellen Sprenkel, Legislative Associate; Cheryl Johnson, Legislative Associate.

Mr. McKeon. Good morning. We will call this hearing to order.

It is a pleasure to be here in Alhambra where my good friend and Ranking Member Mr. Martinez has so ably represented his constituents here for the past 16 years. It brought back real memories today driving down here. I grew up in Tahonga, and my Dad and his brothers were in the grocery business in East Los Angeles, so we would drive through Alhambra. This was in a time before freeways, and I have real good memories driving back down here. It has changed a lot, but I remembered a lot of the streets.

Mr. Martinez. I wondered why you had such sensitivity to the area.

Mr. McKeon. This is where we grew up. As many of you know, this is the first in a series of field hearings that we are having this week on the Older Americans Act.

The second will be held later today in my district in Santa Clarita out in North L.A. County, and on Thursday, we will be in North Platte, Nebraska, in Congressman Barrett's district. We accused him of bringing this rain, but he says it is clearer out there and warmer.

Before I turn to Mr. Martinez for his opening statement, I would just like to repeat the story that I told at our D.C. hearing in March. The three of us have been friends now in Congress for a few years. I have been there, the junior member really, I guess I have been there six years.

They have been there a little longer, but Mr. Barrett has had a great interest in the Older Americans Act and is really taking the leadership in this year’s reauthorization. We met together in Washington for breakfast and talked about how we could work together in a bipartisan way to get this bill reauthorized.

It is very important that we do that. We know that the only way we will get this done is working together in a bipartisan way, so I have really enjoyed working with these two good men and look forward to seeing us bring this reauthorization to completion. I appreciate working with them.

With that, we will turn the time now to Mr. Martinez for his opening statement and for the introduction of witnesses.

Mr. Martinez. Thank you, Mr. Chairman. You know, I am gratified to hear you talk about getting this done.

First and foremost, before I get into my written text, I would like to thank you and Congressman Barrett for taking time out of your schedules to grant us this hearing in this district. I think it is very important. Los Angeles County is one of the largest counties in the United States of America and probably, as a result, has the largest number of senior citizens that are served by this particular program. I would like to thank you all for being here.

As many of you know, the Older Americans Act has been near and dear to my heart since I started in Congress in 1982, and I have been a vocal advocate of the Older Americans Act and the essential services it provides since I was elected.

In fact, I look around this morning and I see many familiar faces, both on the panel and in the audience, and I worked closely with many of you on previous reauthorizations of this act and a number of other senior-related services.

I want to refer back to something that Buck said about us being friends. Many times Members of Congress sit in the well and say, when they are about to lambaste one of their colleagues, ''and my very good friend'' and lay into them.

That is not so with us. We have really been friends and I refer back to Bill Barrett when he first came to Congress and he took me to Boys Town. Well, Boys Town is a part of his district. And he invited us, when I was Chairman of the Committee, to go to Boys Town to visit there and I will never forget that experience with him. I was really amazed. I was amazed at the number of very wealthy and successful people that have graduated from Boys Town.

I was really impressed by the jacket of Billy Mitchell, General Billy Mitchell, which they have there. He is an outstanding American and is a part of history. And I really appreciated that and I think ever since then Bill and I have been real good friends.

So we are friends and we are working on this thing. Not like before. I have been frustrated by the previous Congress’ inability to authorize this Act. However, I am extremely hopeful for a successful reauthorization this year, for the reasons I just outlined.

Mr. McKeon, Mr. Barrett and myself are committed, not to furthering our own interests or our political party's interests, but to furthering the interests of those whom are served by this Act.

Now, because we have several witnesses and I am anxious to hear what they have to say, let me briefly introduce our distinguished panelists so that we can go on to their testimony.

Although I am sure our first witness needs no introduction, I cannot miss an opportunity to sing the praises of my good friend, Fernando Torres-Gil. For the past 20 years, Dr. Torres-Gil has made innumerable contributions in the area of aging policy, both as an academic and a policymaker.

However, he is probably best known for his appointment by President Clinton in 1993 as the first Assistant Secretary on Aging in the U.S. Department of Health and Human Services. As the President's chief advisor on aging, Dr. Torres-Gil consolidated and streamlined federal aging programs and organized the 1995 White House Conference on Aging, which I hope we will have again some day.

Today, Dr. Torres-Gil is an Associate Dean for Academic Affairs at the School of Public Policy and Social Research at UCLA. He is also the Director of the School’s Center for Policy Research on Aging.

Next, I am pleased to introduce Los Angeles City Councilman, Mike Feuer. Since his election in 1995, Councilman Feuer has added funding for 75,000 senior meals to the city's budget, provided additional affordable senior citizen housing, worked to improve the city's response to elder abuse, and created the safety net program which trains citizens to identify and assist isolate seniors during national disasters. Prior to serving on the City Council, Mike was Executive Director of Bet Tzetic Legal Services, which provides free legal assistance to elderly, poor and disabled clients.

Next, we will hear from the program manager for the Los Angeles County Area on Aging, Laura Medina. And, as I have called your names, will you please come up and take seats here in the front where you will be testifying. There are place cards that identify where you will sit.

Next, we will hear from the Program Manager for Los Angeles County Area on Aging, Laura Medina. As the Program Manager of the Los Angeles Area Agency on Aging, Ms. Medina's responsibilities include developing and implementing the county's strategic service delivery plan; conducting a competitive bidding process for the $16 million in federal and state program funds; and developing and administering the county's in home and community based long-term care system.

I am also pleased to introduce Don Herring, the Director of the YWCA, Intervale Nutrition Services. Mr. Herring has been in the business of delivering senior services for over 20 years. As Director of the Intervale Nutritional Services, Mr. Herring provides anywhere from 600 to 1,000 congregate meals and over 500 in-home meals a day to senior citizen centers in the 31st District and around Los Angeles County.

Next, we will hear from Carmella Lacayo, the President and Chief Executive Officer of the National Association for Hispanic Elderly. Founded in 1975 by Ms. Lacayo, the National Association for Hispanic Elderly serves all segments of the older Hispanic population, as well as other low income populations through the employment program and other direct services; research and technical assistance; and bilingual media production and dissemination. Ms. Lacayo has received numerous awards for her commitment to community service.

Finally, we will hear from Betty Malks, the Director of the Department of Aging and Adult Services for Santa Clara County. Trained as a social worker, Ms. Malks has been working with children and seniors, and training other social workers to work with children and seniors, for over 20 years. As the Director on Aging and Adult Services for the County of Santa Clara, Ms. Malks is currently developing a team approach to addressing the important issue of elder abuse.

I thank you all for coming today and for your input. As those on the front line, your testimony will be taken very seriously as we undertake the monumental task of improving a program that has served so many, so well, for so many years.

Thank you, Mr. Chairman, for allowing me to introduce the guests.

Mr. McKeon. Thank you. We will then proceed first with Mr. Fernando Torres-Gil. We have a little thing up here that says when you start, you have 5 minutes. Then it shows one minute remaining and then when your time is finished. I would like to have one of these at home. The problem is everybody else would use it, and I would not be able to do it. So we would appreciate if you could make your statements fit within that time. Your whole printed statements will definitely be put into the record.

Mr. Torres-Gil?

Mr. Torres-Gil. Thank you, Mr. Chairman. I will keep my comments to five minutes, is that correct? No more than five minutes.

I want to thank you, Mr. Chairman and Congressman Barrett and I might add, I too, have been in your district and at Boys Town and visited your wonderful senior programs there. And of course, my Congressman and friend, Congressman Martinez who has been not just a leader, but a long-time advocate for older persons and the Older Americans Act.

It is good to be here before you as a civilian, as opposed to being a public official because, in part, I can say what I want to say which will not be different than what I used to say and it is I think the reason we are all here, the absolute importance to reauthorize the Older Americans Act.

When I served, and had the honor of serving all of you as the first Assistant Secretary for Aging, I must admit we were somewhat frustrated because we were unable to get the Act reauthorized.

And yet, it was a dilemma of sorts because if there was any one issue which engendered bipartisan support, even in the midst of the difficult days of 1994 and 1995, the Older Americans Act brought together Republicans and Democrats from both sides of the aisle because many Members could see first hand how crucial the Act is in providing a support system, a safety net for elders who wish to remain in their home, for family members and care givers who want to take care of their loved ones.

We are receiving great attention today on issues of aging which is wonderful for us gerontologists who have labored in the vineyard for 20 years. Gerontology is now, if I may use the word glamorous and trendy. The public and elected officials and the White House certainly recognize that we have a tremendous demographic challenge, that within 20, 15, 20 years, the numbers of older persons will double from roughly 33 million to 77 million.

Much of the attention by the Congress and the Executive Branch and the media has been on Social Security and Medicare and to a lesser extent Medicaid and how to handle the budgetary dilemmas facing those programs and debates over various reforms of those very two important entitlements.

However, little attention has been given to the Older Americans Act and even though it is a small program in terms of dollars, roughly $1.2, $1.3 billion, it is a very large program because it is the only one that provides the home and community based services necessary to give older persons and their families the choices of staying at home and staying with their loved ones.

You will certainly hear about the specific benefits and services from other witnesses.

What I would like to do is to focus on one area, the need to prepare for the aging of the population by developing long term care services and home and community based services. President Clinton in his State of the Union address not only mentioned Social Security, Medicare and how he would work with the Congress to address those important programs, but also mentioned a series of long term care initiatives, including a program to provide $625 million over the next five years for respite, home care services and INR services for families who take care of their own. This benefit should it be enacted by you, would be part of the Older Americans Act.

The Older Americans Act is now at an important crossroads where it can be the catalyst, the core, the anchor for establishing and expanding home and community based services. The Older Americans Act has a wonderful opportunity now to establish integrated service delivery systems, not just for older persons who are frail and chronically disabled, but younger persons with disability. And with the important and efficient work of the area agencies on aging and the aging network, the Older Americans Act does not only continue what it has done, but can prepare us for the next century by being the basis of expanding home and community based services.

And this is why I commend you for coming here. I welcome the tremendous work that you will do and I look forward to working with you in insuring that the Older Americans Act is reauthorized, but that it will be a program and a benefit and a law that will take us into the next century.

Thank you very much.

See Appendix A for the written statement of Mr. Fernando M. Torres-Gil, Ph.D., Former Assistant Secretary for Aging, Los Angeles, CA

Mr. McKeon. Thank you. Let us hear now from Ms. Medina.

Ms. Medina. Good morning, my name is Laura Medina. I am the Planning Manager of L.A. County AAA responsible for the entire county of Los Angeles, except for the City of L.A. I want to thank the Chairman of the Subcommittee and you all for the opportunity to testify today regarding the reauthorization of the Older Americans Act.

Besides the AAA, the Department also oversees a vital service called Adult Protective Services which is responsible for the investigation of adult abuse and neglect situations. In our written testimony, we are conveying three key priorities: funding equity, access to services and long term care expansion. The AAA Director Robert Ryans will be testifying in the afternoon here and will be focusing on the first two priorities.

I am here to support the AAA's role in long term care expansion. L.A. County AAA is strategically positioned to take advantage of any new Older Americans Act funds such as those offered by the proposed National Family Caregivers Support Program. It builds on strengths of the act and moves us forward to more cost effective and compassionate care.

It also builds on two County AAA long-term care models that we have achieved through collaboration and funding blending strategies. The first is the impact pilot already operational. It partners in home supportive services, the largest community based long term care program in the state; social case management providers in private hospitals to help low income high risk patients about to be discharged to home.

And the second is integrated care management demonstration project. With this we expand the safety net to vulnerable populations including disabled adults. We are standardizing care management across the county, using four sources of funds and will be implemented July 1st.

The National CareGiver Program complements the models of care that I have just mentioned, especially in us being able to offer more respite care. However, we do have two concerns. One is that cost sharing should be voluntary not mandatory, and the second is that the funding allocation should be consistent with program's intent which is to help family members care for their loved ones. So we are proposing that the allocation be based on the state's percentage share of all persons aged 60 or older living with relatives.

In the design of the program, we also must listen to the voice of the constituents such as the availability of care that should be available on weekends and evenings. We need to think about the quality of care. All respite workers should be screened and trained and care giver and care recipient satisfaction surveys to be incorporated into the program.

We also need to insure access to care by making sure that services are user and culture friendly and by contracting with culturally competent providers.

Finally, the program should be results focused so that we can maximize resources and help as many families as possible.

We appreciate your leadership in aging issues. We urge you to reauthorize the Older Americans Act this year and I am available for questions. And I have one minute.

See Appendix A for the written Statement of Ms. Laura Medina, MPA, Program Manager, Planning and Development Services, Los Angeles County Area Agency on Aging, Los Angeles, CA

 

Mr. McKeon. Thank you very much. Do we transfer the minutes over to the next witness? That will give us more time for questions.

Ms. Lacayo. Congressman McKeon, Congressman Martinez, Congressman Barrett, I appreciate the opportunity to testify before this Committee and I ask that my written testimony be submitted for the record and any additional comments.

I will be brief and I will summarize some of the key points that we feel are important from our perspective as a national aging organization.

Obviously, there are two realistic options for reauthorizing the Older Americans Act. One would be a simple extension. Obviously, in the last Congress, Senator McKeon's reauthorization proposal got 67 Senators to support it. Congressman Defazio in the House also has gotten bipartisan, 200 plus Members of Congress to support a simple extension. We are also realists and we realize that there has to be some fine tuning and some changes made to the Older Americans Act and we would like to discuss a couple of those issues that are important to our organization and other national minority aging organizations.

My first comments are going to be directed to Title V, the Senior Community Service Employment Program of the Older Americans Act. This program is one of the most successful, one of the least rampant with fraud in the history of the Older Americans Act. It is a program that is a mainline, frontline program. It serves the most vulnerable in our society, the poorest, the hardest to employ, those who have been left out of the mainstream in terms of economics. Title V has been an extremely successful program and we at the National Association for Hispanic Elderly realize that we must be pragmatists, that there are issues that must be dealt with respect to this program. We are in favor. We have recently reviewed the Administration's proposal on the reauthorization of the Older Americans Act and are in concurrence with the recommendations by the Administration with respect to the, should we say, adapting of certain models in terms of performance standards for the Title V program.

In addressing performance standards, we realize that we would prefer to have administrative performance standards such as the unsubsidized placement goals and so on which have historically worked very effectively in serving the most vulnerable, the poorest, those with the hardest to employ perspectives, etc.

We are realists and we know that there are Members of Congress that would like to restructure this program, perhaps to refocus this and we cannot emphasize enough how much we believe that the program, the old adage that if it is not broken, why try to fix it? It has worked very successfully. It is a program that has been, I think, fiscally conservative and it is a program that under the Department of Labor has been very effective in its management of the various aspects. We believe that the national sponsors/state partnership should remain, that the states and the national organizations who administer this program have been very effective in meeting the goals of the program and the performance standards of the program.

We also would like to see that the Department of Labor continues to administer the program. We also believe that we must continue to emphasize that those older persons with poor employment prospects be given the emphasis for targeting for the program.

We also would emphasize too that if statutory performance standards are required, that we be careful that the statutory performance standards not create a creaming type of situation where then we start looking for the easiest to employ, the people who are not the most vulnerable and therefore create a program that becomes just an ordinary old manpower program that is not targeting as the Older Americans Act intended originally those with the greatest social and economic need and especially with respect to low income minorities, limited English speaking older persons who are very vulnerable and who need to have access to these programs.

Finally, let me bring two issues that are of extreme importance to our organization and to the Hispanic community nationwide. And that is the issuing of targeting language. I believe that we must retain in the Older Americans Act that the historic language that has been there that the Older Americans Act programs will target those older individuals with the greatest social and economic needs with particular attention to low income older minorities. It is very important. As we know, the money is very limited, the resources are scarce. We must be serving the most vulnerable in our society rather than trying to reach the whole community and the targeting language is extremely important to us.

With respect to cost sharing, we would strongly urge the Committee to look at continuing the present cost sharing relationships in the Title III programs with respect to making sure that the lowest, the poorest and the most vulnerable have access to these programs without demeaning them and making this is means tested program.

If I can be of any other assistance to the Committee, I welcome this opportunity. I congratulate Congressman Martinez for getting you to come to his District and may I say I am a resident of Sunland Tahonga and good things come from that area, Congressman McKeon.

See Appendix B for the Written Statement of Ms. Carmela G. Lacayo, President/CEO, National Association for Hispanic Elderly, Pasadena, CA

 

Mr. McKeon. Thank you.

Mr. Herring. Good morning. My name is Donald Herring and I am the Director of Intervale Community Services, which is a division of the San Gabriel Valley YWCA. I want to thank the Committee and the Chairman for having the hearing here in the San Gabriel Valley. We feel that the Los Angeles County area has a large constituency of seniors and there are many needs here that need to be addressed.

I am going to focus more on day to day services that the Older Americans Act funds. I have directed senior programs for 20 years, both in Pennsylvania and here in California, and I have seen many instances of how the Act and the services that were funded by the Act have improved the lives of many, many seniors. And I think this is the major point, that we should consider, is that the services that are provided actually increase dignity and independence for seniors. And as we talked about in home services and community based services, this is a very important goal.

I would like to focus on three issues that I think the Committee needs to consider in preparing legislation regarding the reauthorization of the Older Americans Act, and these issues are first one is targeting services to persons of greatest need. I believe this is very important. I feel that a significant value of the Older Americans Act is that it is inclusive legislation. We do try and serve persons aged 60 or more, however, Congress, years ago when they crafted the Older Americans Act, were ingenious in allowing the targeting language, including that targeting language so that those at greater risk tend to be provided services. As an example, the majority of the clients we serve in our programs in San Gabriel Valley are members of a diverse mix of cultures and ethnicities and I know firsthand how important access is to these services. As an example, we were able to begin a Vietnamese senior outreach program in the City of San Gabriel Senior Center. One of the objectives of this program was to provide ESL classes, citizenship information and information and assistance services. During the past year we were able to offer services to over 100 Vietnamese seniors and these seniors were able to more easily access all of the community-based services that were available. Many of these seniors did not know about services, how to access these services and simply by targeting services in a senior center milieu we were able to accomplish, I think, our goal.

In fact, we do not believe any senior was denied any services by targeting. We think that, in fact, we were able to foster cultural bridges in our senior center and foster inclusive bonding between everyone who participated in the program of various ethnicities. It was a very meaningful experience for us to observe.

Regarding means tests. I think that the Older Americans Act, the current language, is quite clear in this issue and the legislation allows seniors to contribute what they can. We use a suggested donation as a guide. And I think Congress' intent, when the original act was passed was to allow to older persons the ability to pay their own way while fostering inclusive and positive and social interactions among older persons of various and different economic levels. This inclusive concept, I think, has greatly contributed to the success of the Older Americans Act programs and has helped older persons accept services, not as handouts, but as services designed to meet their needs as senior members of the larger community.

Over the years I have observed that this voluntary and confidential donation system has helped us accomplish one of the major goals of the Older Americans Act and that is to increase the dignity and independence of older persons and I have seen this many times.

I had attached several letters. I would just like to read this very briefly because it demonstrates a point I think. It says, ``Thank you for your tolerance and any way or amount I can pay it is truly appreciated.'' This is a letter from a senior who receives home delivered meals. ``I am not accustomed to feeling like a free loader and I felt that way almost every month. I was raised the old fashioned way and until all my bills, the usual ones, are paid, I do not eat, buy gas, or God forbid smoke, my one and only indulgence.'' At any rate, the ability to contribute what a senior can, I think is very important to the program and I hope you will consider this language, retain this language in the Act.

Thank you very much. My time is up.

See Appendix C for the written statement of Mr. Don Herring, Director, YWCA Intervale Senior Services, West Covina, CA

 

Mr. McKeon. Thank you.

Ms. Malks. Yes, good morning. Thank you, Mr. Chairman and Members of the Subcommittee for giving me the opportunity to address you today on the reauthorization of the Older Americans Act.

I know that you are aware of the importance of the reauthorization and I am appreciative especially of your commitment and leadership in this bipartisan effort. In fact, on March 2nd, I was in Washington, D.C. for your very first hearing and was quite impressed with the knowledge of the Committee and the Panels.

I am the Director of Santa Clara County Aging and Adult Services Department and one of my responsibilities is the administration of the Adult Protective Services Program. I will be speaking to that Title VII in the Older Americans Act today.

One of our primary partners in providing aging services to older residents is our area Agency on Aging which is a free standing, nonprofit private organization in our county. And in discussing the AAA's allocation of the Title VII funds, I was dismayed to learn that the entire available allocation of Title VII, Section 702(b) was approximately $21,000. $21,000 for the fourth largest county in California and the fifth largest of California's 33 planning and service areas for AAAs.

We have an estimated population of 60 plus of 235,000 in our county at present and we all know that that will multiply. While our area agency has made this funding available to support our joint elder abuse efforts, absolutely no funding has ever been allocated for subpart C, elder rights and legal assistance development, or subpart D, outreach counseling and assistance services.

Our sheer numbers alone would indicate that the vast majority of elder abuse happens outside of institutional care settings and yet the nursing home ombudsman program receives the bulk of this elder abuse funding from Title VII.

It is estimated that our county alone has 21,400 older persons who are victims of physical, emotional and/or fiduciary abuse and our Public Guardians' Office which is under my jurisdiction has recently seen a 60 percent increase in fiduciary cases alone.

As a result, our Department is forming two fiduciary abuse specialist teams, a rapid response team and a consultative team and due to time I will not get into that.

I want to give you a real life example of what we recently experienced. An Adult Protective Services Social Worker referred an 82-year-old widow with a history of profound alcoholism and some short-term memory impairment. She was diagnosed as having Alzheimer's at her autopsy, so that tells you something. This person was referred to our Public Guardians' Office due to her impairments. At issue were the isolation of this woman from her family and the financial exploitation of her funds by the branch manager of her bank. The client originally obtained the services of an estate planner regarding setting up a trust in which she left the bulk of her estate to a banker . . . I am sorry, to relatives. This trust was never executed as the bank manager unduly influenced this client. The estate planner later prepared a revised trust which named the bank manager as a beneficiary and trustee of the estate. During this time the client closed her accounts totaling approximately $300,000. She with the assistance of this bank manager subsequently used the funds to open several joint accounts with the manager and his wife at another bank. Money was later transferred from joint accounts into accounts solely owned by the bank manager and his wife. Various gifts were given to his family members, and repayment of the banker's parents' lines of credit. Upon notification of this situation, a Public Guardian was able to help in this situation and I will tell you that we reunited the family and were able to take this banker to court and he was found guilty. It was a very difficult situation, but we made our point.

Since I have very little time I just need to impress upon you the importance of outreach and education in prevention of elder abuse. It is important to reach out to the many diverse cultures. We speak 52 different languages in Santa Clara County. It is very important that isolated minority, frail, non-English speaking elders are able to benefit from outreach and education.

So what I would like to recommend is that reauthorization of the entire Older Americans Act and full funding of the entire Title VII program would greatly enhance our community efforts now in progress and would raise public awareness about a problem that has been hidden far too long.

At this time, late in their years, this time for people should be marked by dignity and appreciation for accumulated knowledge and wisdom instead of suffering depravation, loss of hope and tragically sometimes their lives.

The challenge of our nation is to prevent this from happening and we believe that the Title VII Older Americans dollars would do that if fully funded. Thank you very much.

See Appendix D for the written statement of Ms. Betty F. Malks, M.S.W., C.S.W., Director, County of Santa Clara Department of Aging and Adult Services, San Jose, CA

 

Mr. McKeon. Thank you.

Mr. Feuer. Thank you, Mr. Chair, good morning, Members of the Committee. I am very grateful for the opportunity to speak before you today, especially in this short time. My name is Michael Feuer. I represent the Fifth Council District in the City of Los Angeles. I am the Chair of the City Council's Arts, Health and Humanities Committee which, among other things, both oversees the city's Department of Aging and Senior Citizen issues in the City of Los Angeles, in general.

While I am here in my capacity as a Los Angeles City Council member, I also served for eight years prior to becoming a City Council member as the Executive Director of Beth Sedic Legal Services, the House of Justice, here in Los Angeles which is the Older Americans Act funded provider of free legal services to seniors for both the city and the county of L.A. I am very grateful for the opportunity to testify this morning.

The Committee is very well aware of the demographic trends that all of us in this nation are confronting. Our senior population is growing rapidly and that population is getting older. And we have seen these trends specifically here in the City of Los Angeles. Our city is already home to a half million senior citizens, one in ten of whom live in poverty. By the year 2020, more than a million senior citizens are going to live here in the City of Los Angeles and if trends continue, one can assume that we could have more than 100,000 of those seniors living in poverty here in our city.

Given this context, I want to focus on how the Older Americans Act can speak to two particular national crises, elder abuse and the deficit in senior nutrition and then talk about how the rules of the Act can be formulated to most benefit the target populations that we deal with.

First, let us talk about elder abuse. I have been focusing on this issue in the committee which I chair and it is been an astonishing conversation here in Los Angeles. As you know, some nationwide calculate that as many as one in two of our seniors will suffer abuse or neglect. Here in Los Angeles, the numbers are staggering: an estimated 40,000 cases of elder abuse in our city every year. Adult Protective Services which has the responsibility to intervene on an emergency basis when elder abuse is first spotted, reports 3,000 of those cases every year. The number of prosecutions in the City of Los Angeles, fewer than 200 every year. We have a system that very much needs to be enhanced.

Simply put, elder abuse is out of control. It is a disgrace and the Older Americans Act can help. First, I urge that the Older Americans Act specifically fund case management for seniors who are confronted with elder abuse. Perhaps we can find specific pilot projects pursuant to that mandate throughout the country. I'll give you one quick anecdote. In the committee I chair, we heard testimony from one of the very few case managers out there because funding does not come from the act. It comes from other sources. This case manager who works in a senior center in the South Los Angeles area has a case load of more than 300 cases and gets eight or ten more a week. There is no way that such a person can keep track of seniors who have been identified as suffering abuse or neglect? The Act can help.

The Act can also help by allowing for funding for law enforcement and prosecutorial resources to confront elder abuse because there are not enough lawyers or police officers specifically devoted to this particular issue.

Nutrition is another crisis that we face for economically disadvantaged and isolated senior citizens. I was delighted when Congressman Martinez joined me for a hearing which you will recall we conducted on the senior nutrition issue. I urge you to give your strongest support to President Clinton's call for dramatic increases in funding for home delivered meals. I have delivered those meals myself with my kids and I can tell you that when those meals are delivered, the senior places that little half-size TV dinner portion on their counter and that is the only meal they are going to take all day, so they save it for a moment when they are going to be most hungry. In that situation when we do not fund meals on weekends, we do not fund a second meal_and Congressman Martinez and I heard that one meal is far short of the basic daily nutritional needs of our seniors, we have to do better.

Very quickly, I want to recommend that significant funding for respite care is provided. The Act must take into account the exhausted and emotionally drained caregivers for parents and grandparents and give them some relief.

Thirty seconds more, please. When you talk about these specific needs, they come in the larger context of the basic rules. First, maintain the targeted funding of the Act to those in greatest social and economic need. Do not water down that provision. Next, require that the federal Agency on Aging approve all state funding formulas here in the State of California. Urban seniors, those most likely to live in poverty, are given short shrift by the state's funding formula. Federal approval could change that. Do not impose cost sharing. Please, if you are going to require_there are two ways to do this. You could require cost sharing for everybody which would inhibit those people most likely to need the service from getting it. Or you could require that only those who could afford it by some measure, via share cost and if you do that you are going to have to put in place a bureaucracy to determine who meets the means test and who does not and for having provided this service you are going to spend more in putting that bureaucracy in place and you are going to save by reallocating a few resources at the margins.

Finally, when you put in place the new reauthorized act, please be sure that there is some funding put in place in each of these areas to administer these programs. I know from personal experience when the Department of Aging in each city in the country is charged with administering these programs and there are inadequate funds to them to do that basic function, the monitoring suffers and the quality of programming can suffer and that is the antithesis of what you want.

You have been very generous both with your time and by accommodating my schedule and I am extremely grateful for the opportunity to speak before you. Thank you very much.

See Appendix E for the written statement of The Statement of Mr. Michael Feuer, Los Angeles City Council Member, 5^th District, Los Angeles, CA

 

Mr. McKeon. Thank you. Thank you for being here. We will put your full statement in the record. Thank you.

We do have some questions.

Mr. Martinez. Mr. Chairman, before we get into the questions, if you have no objections, I would like to submit the testimony of State Senator Jim Levy into the record.

Mr. McKeon. No objection, so ordered.

See Appendix F for the Written Statement of California State Senator Jim Levy

 

Mr. McKeon. Ms. Lacayo, in your testimony you mentioned means testing in your written testimony.

Ms. Lacayo. Yes sir.

Mr. McKeon. However, to date no version of the Older Americans Act authorization legislation has included mandatory means testing language. Instead, what the bills have proposed is that contributions should be based on income, which is determined by self-declaration. This could be as easy as a participant looking at a chart with various income and contribution rate categories, choosing one and reacting accordingly.

That said, do you still have concerns about such a process?

Ms. Lacayo. Yes sir, we do because first let me say to you I come out of a social work background and historically we know that when poor individuals from a dignity point of view are put into a position where they walked into, let us say a senior center and they see on the wall a list of incomes and so on and they are asked to just voluntarily declare.

It creates an embarrassment. It creates in a way a disincentive for that person to walk in. We have done studies, for example, in Texas, where nutrition sites in rural Texas were really forcing older Hispanics to pay for that nutrition meal. It was actually when we were in the process of filing civil rights complaints because it was mandatory in part of the valley in

Mid-Texas that older Hispanics were forced to contribute and what happen, as you can see the total breakdown of the system and the people who were needing the meals were not going because they were so embarrassed to have to declare any kind of economic status. It is a disincentive. I think the system can work. I understand that there is an economic problem in terms of area agencies on aging needing to balance the need for more resources with providing the meals, but I really believe that once we start even making voluntary declarations that that is going to be a disincentive for the poor, for the limited English speaking older person, for those people who are not highly educated, they are not going to understand and I think it is going to be really, really_make them not come to the services that are much needed.

Mr. McKeon. Okay, we are not talking about force. We are talking about voluntary. We did have testimony in our hearing in Washington that people were able to do that satisfactorily and that gave them an opportunity to be able to help more people. Plus, the people felt better about being able to contribute.

I think you have to be very sensitive and careful about the way that it is done. A big chart, or forcing somebody, probably is not the best way to do it.

Ms. Lacayo. I think anybody who has a nutrition program will say that in most cases seniors do want to contribute something if they can. You see that. We run a nutrition program in one of our housing projects and we know that at the end of the month seniors do not have money. They cannot give a dollar or 50 cents, so they do not. But if they feel in any way that they would have to, they will not come to eat, very simply.

Mr. McKeon. And that is not the goal.

Ms. Lacayo. Right.

Mr. McKeon. It is just how you do it.

Ms. Lacayo. I think you can fine-tune it, Congressman. I think there is a way of doing it that will allow the area Agency on Aging, that service agencies who get the revenue that they are looking for, but not create that barrier that I think_

Mr. McKeon. The tough thing is doing it in a law.

Ms. Lacayo. I know, yes.

Mr. McKeon. And then somebody writing regulations and then reaching out. How do you really teach people to be sensitive? I kind of find that you either are or you are not.

Ms. Lacayo. Exactly.

Mr. McKeon. And if we have someone that is administering a program that is doing it in the form of a drill sergeant versus someone that is more sensitive, there is the potential to do harm.

Mr. Herring, in your testimony you refer to the confidential manner in which seniors currently contribute towards services received under this Act. Thank you very for doing that.

We will all follow the rules, right? Mr. Martinez.

Mr. Martinez. Thank you, Mr. McKeon. Cost-sharing, and whether or not to permit service providers to implement a fee schedule based on self-declaration, is probably going to be, as it was over the last two years, one of the most contentious debates we have within the Committee.

Those who promote cost sharing say that it is voluntary. Seniors will self-declare. They will tell us. We are not going to dig into their records and find out what they really have, but there is still that sense that the senior will have to come forward and declare their income. Seniors will think, "If I declare too much, maybe I will not be eligible for the program, however, if I declare less and they find out that I lied, I will be prosecuted." If it is voluntary, it is voluntary. If you go back through the history of the Act, one of the reasons we never made it a means tested program was because every individual in a community is eligible to participate. We are not going to get people from Beverly Hills or West L.A. coming down and participating in these programs, but if they did, they saw what great need there was out there, I think they would voluntarily contribute a heck of a lot more, as long as it was voluntary. The key here is voluntary. So why require seniors to voluntarily self-assess themselves as to what they can give? It contradicts itself. It is either voluntary or it is not voluntary and you cannot have it both ways.

The fact is that if you go around to these senior citizen centers, let us say around here_ and I would invite my colleagues to do this some time_ go in and take some time to visit several different places where they are serving congregate meals and ask how many of them are from Santa Fe Springs? You will have about one third, maybe one quarter raise their hands. And then you ask the others, "Well, where are you from?" They will say that they are from some other community that serves congregate meals. But you know what? This is how seniors get more than one meal a day in many cases. If you start telling seniors to self-declare and put them on record somewhere, you will discourage the most needy seniors from trying to get more than one meal a day by going to another center.

I believe that self-declaration will destroy the intent of the Act which is to enable seniors to come together from all walks of life and from different levels of social strata to enjoy meals together. They learn from each other. They avoid isolation. They engage in conversations with other people and they make friends. That is a big part of this whole program too.

The other thing is cost sharing. I want to ask you, Ms. Medina, about your statistical information that suggested that when the donation went from $1 to $1.25, the participation rate dropped drastically?

Ms. Medina. Yes.

Mr. Martinez. Could you elaborate on that? And you did document this?

Ms. Medina. Yes, it is in our written testimony. As you know, AAAs is required to convene public hearings also for needs assessments. That was the testimony submitted by one of our largest providers in Long Beach. And just by raising the donation $.25 for the congregate meals programs they saw a drop off in the low-income ethnic participant group.

Mr. Martinez. Mr. Herring, in your testimony you expressed support for the President's National Family Caregiver Support Program. Are you aware that the President’s plan_and I will get these words right_encourages mandatory cost sharing? Encourages, you see? There is still that sense of volunteerism. Encourage. I do not know how you encourage. You either require it or you do not require. He may be our President on our side of the aisle, but I still have problems with that because of the stigma we just talked about.

You know, you actually create a stigma on people when you start getting them to have to declare their income.

It was the same thing when I was a kid going in the lunch line. We had to go in a special lunch line because our mother had to work in the cafeteria for us to be able to get free lunch and every kid knew the kids that were poor and the kids that needed to get their parents to work in the cafeteria so they could get free lunch. It was like putting a uniform on us, you know?

Mr. Herring. Yes, Congressman. I would agree with you. Over the years_it is either one way or the other. The old story if it walks like a duck. A means test is a means test by whatever tag_where you hang it. I think the intent of the Older Americans Act means voluntary and confidential

Mr. Martinez. Thank you. I looked up and saw my red light.

Mr. McKeon. Mr. Barrett.

Mr. Barrett. Thank you, Mr. Chairman. Let me take just a moment to respond to your opening remarks and also the remarks made by the Ranking Member.

It is a pleasure for me to be back in this area. Mr. Martinez, our host today, and I became friends several years ago, as he said, when he visited my District and I was hosted in this District at another point in time, in the Los Angeles area. I look forward to coming back to this area again.

When Mr. McKeon invited me to come back when I was a member of the Subcommittee, I was thrilled because I knew that I was coming back to Southern California where I could go to the beach, where I could play golf, where I could go out and tan myself, but I must inform you that it is warmer in Nebraska than it is in Los Angeles. I am anxious to get home.

But the Chairman indicated that this reauthorization must be a bipartisan effort. I agree. We have been unsuccessful in reauthorizing the Older Americans Act as most of you know since the 104th Congress. I believe 1995 was about the end of it. That is when the authorization expired. So it is incumbent now upon this Subcommittee and, of course, the full Committee and the House of Representatives and ultimately the Congress and the President, to make sure that it is reauthorized again this year. This is our main target today, to make living for our seniors more comfortable. I am glad that the Chairman, Mr. McKeon, has invited me to come back. As he mentioned, we will be over in his District, the 25th District, this afternoon, and we will be in my District in Nebraska on Thursday. We will probably have a couple of hearings still in Washington once we return. I would hope that then we can begin putting this thing together, putting it to bed, as we say, and perhaps start the real serious business of getting this through the legislative process.

As Mr. McKeon remarked, this has been an interest of mine for quite some time. I am one of you, obviously, and I am interested in making sure that this succeeds.

Thank you for coming. It is the input from people like you that make the system work. We take your suggestions back to D.C., process them and hopefully come up with a bill that can succeed.

With that, Ms. Medina, you talked a lot about respite care. You suggested that it should be based on states' percentage and shares and so forth. A question occurred to me when you were talking about it. The allocation is based on the number of seniors in the state, and I think you suggested that the allocation should be based on the number of seniors with relatives in the state. Why, first of all, and secondly, does this create another bureaucracy? Do we have those numbers available to us now?

Ms. Medina. Yes, those numbers are available right now. Unfortunately, they are 1990 census numbers, but they are available. The reason why is that is the intent of the program to help family members care for their loved ones so that relative number should be incorporated into the allocation amount.

Also, there are seniors, if you just base it on the number of seniors, there are some that are institutionalized already, so that does not work. So we need to consider those that are actually recorded in 1990, at least, that were living with relatives.

Mr. Barrett. Are those numbers available all over the country or just in L.A. County?

Ms. Medina. We have statistics for_that we just gathered from six different states. They are available. I do not think it is going to be a statistical data problem.

Mr. Barrett. Thank you for that suggestion.

Ms. Medina. You are welcome.

Mr. Barrett. I was also particularly interested in Ms. Malks and Mr. Feuer's comments and concentration on Title VII, elder abuse. This is an area which, at least I, have not been focusing on. My focus has been primarily Title III and V.

So tell me, Ms. Malks, how do you let the community or the seniors in your community know about this program? What kind of outreach do you do, if any?

Ms. Malks. Right now we have a stakeholders group consisting of 45 people who have been convening for 10 months in preparation for new funding we anticipated on the state level. To look at education and outreach and to recommend_it is attached to my testimony, the recommendations for this effort in adult protective services.

The AAA and the City of San Jose, our neighboring city have donated only $45,000, but that is the funding from AAA is the Older Americans Act funding and the City of San Jose has matched that for a public relations effort because we really believe the professionals are the only ones who know about elder abuse. The community at large does not. Just like child abuse was unknown many years ago, this is the road we need to travel now in order to educate and teach people so that they will understand and know when to suspect elder abuse.

We have another difficulty in that there are new mandated reporters in the State of California, in home supportive services, independent providers. And that is a huge group of people in every county in California and I am sure all over the country, who are the care givers for many people in home supportive services. These people are now mandated reporters. They need training and education in order to suspect possible abuse in the home or out of the home. It has been a very undetected, unreported issue and we need to help people understand what this means. And the numbers speak for themselves.

Mr. Barrett. That is why I asked the question, because I have the same feeling that it is underreported, almost undiscovered in some parts.

Ms. Malks. Yes.

Mr. Barrett. Mr. Feuer's comments on how there are 40,000 cases each year, here, is astounding to me. He also suggested using fund case management, a pilot program of some kind. Would you concur? I would assume that you would.

Ms. Malks. Absolutely. I think that is very important. We need funding for case management in this arena. The issue of remediation is the case management. We need to look at intervention, which is case management and prevention which is very, very important. Our numbers, of course, will exponentially multiply and we will not be able to detect abuse. There are other forms of abuse now in the new law in the State of California, SP2199, such as self-neglect, isolation. These were not areas that we even addressed for many, many years as professionals, so the public certainly does not know that this is the case, that these are parts of abuse.

So we have a big job to do and we need a lot of help.

Mr. Barrett. Mr. Chairman, may I ask your indulgence for one more question? Obviously, I want to focus on this area or am focusing on it now. I am aware of cases of fraud which I consider to be elder abuse in addition to physical abuse. And I am aware of some cases in which the embarrassment has been so great that they did not report it, would not report it. You have been involved in similar cases.

How do you respond to that? How do you get them to report?

Ms. Malks. This is so typical. I cannot even tell you what you are talking about is unique. It is not unique. This is 9 out of 10 times or more than that. People are too embarrassed. This is my family member. I have read studies that we think that it is the caregiver or some neighbor coming in to take care of this elderly person who is exploiting them and committing fraud, no. It is the family member. We have seen that it is the child in many cases. Unfortunately, there is a profile now that has been done and it is really unfortunate because this is such a familial embarrassment, that people are_first of all, they are afraid that if the person themselves reports or says there is a problem in the home, they will be put in a nursing home. Put them in an institution, that is how you get rid of them. Or they are afraid because this is the child that they raised. It reflects on them. I mean there are such familial issues here that need to be evaluated, assessed and we need to do something about this.

We had the same problems many years ago with children in the home, but there is the issue of self-determination with adults. We cannot not tell them what to do. It is a person's right to report or not to report. And so if the community at large starts understanding what this is about, maybe community people, neighbors, gatekeepers, postal carriers, people who deliver groceries to someone, Meals on Wheels people, those are the people we need to educate and make sure that if they are seeing something that looks funny, that they report it.

It is the people in the community we need to address who know nothing about this.

Mr. Barrett. Ultimately, it is one on one, somebody reporting it. Is that it?

Ms. Malks. Yes.

Mr. Barrett. How do you help the person, the individual, get over that embarrassment? Again, one on one?

Ms. Malks. Well, you know, if we increase case management, if they are already known to us and we increase prevention monies as well as case management and intervention, we will talk with people about_ counseling is a very important piece of this as well. Dignity and self-respect need to be reinforced at all costs, but the most important thing is that we need_ we have not even broached this subject. That is the problem. To begin to look as professionals on how do we help people to understand this happens so often and they have a right not to be abused. People do not know they are entitled not to be abused.

Mr. Barrett. Okay, I have overstayed my leave. Thank you, Ms. Malks. Thank you, Mr. Chairman, very much.

Mr. McKeon. I think we have time to go another round, if you do not mind. We could spend a few more minutes and ask a few more questions. I will finish the question I started with Mr. Herring.

All of the drafts of bills introduced by the Committee include self-declaration. I thought a donation was a donation or a contribution was a contribution. But if you raise something from $1 to $1.25, how do you call that a contribution? I mean that becomes a fee, doesn’t it?

Anyway, if the language does include self-declaration with regard to cost sharing, do you still feel that that language would be too restrictive?

Mr. Herring. Yes. And I only use my experience as a Director of a program where I had to deal with this on a daily basis. We use suggested donations as a guide. There are some programs that may calculate what a meal costs. This is what the meal costs for a contractor to provide. Donate what you can. So there is various mechanisms that can be used.

Our advisory council comprised of seniors comes with a suggested donation, but that is strictly _ the donation system in each center is a voluntary and confidential system. We try to use envelopes to maintain that. We put the donation box in an area where people cannot observe what is going in it and I think the_I think once you open that box, self-declaration, you set a stage for abuse of how that money is collected.

Mr. McKeon. Dr. Torres-Gil?

Mr. Torres-Gil. If I may amplify on this issue which has been a tough one, I would like to suggest that we also take into account the unique characteristics of the cohort of older persons we are serving today. They come from a generation, World War II, the Depression, the Cold War, where they have certain values and we see it all the time at senior centers where they truly believe they should give back, they should not receive a handout.

When I was Assistant Secretary for Aging, overseeing the Older Americans Act, we did a study and we found that a significant proportion of the income or cost for the congregate meals was, in fact, coming in from the voluntary contributions. I cannot recall what percentage, but it was close to 10, 15, 20 percent, was actually coming in from the participants themselves who were giving voluntarily because they grew up at a time when you gave back.

So I believe that we should continue to foster those values and I too would be very uncomfortable with even a voluntary self-declaration because it sends out a message and I think it is working just fine right now. However, I am not sure that we can say that for the next generation of older persons, in this case, that post-World War II generation, the baby boomers. That may be a different story. But you have got at least ten years before you have to worry about us. But for this generation, we are doing just fine in terms of their willing to give back.

Mr. Martinez. In fact, $171 million in voluntary contributions last year.

Mr. Torres-Gil. You are right on from what I have seen. Was that George Will who wrote the book?

Mr. McKeon. Right, The Great Generation.

Mr. Torres-Gil. I have not read the book, but I have heard about it and I know that generation because_

Mr. Martinez. Bill and I are part of that generation.

Mr. McKeon. I was not going to say anything_

Mr. Barrett. Then do not.

Mr. McKeon. You must have noticed that we are not kids here, that we have great concerns about this program because we are there. I know when I send out letters for campaign contributions, I will sometimes get back $1, $5, and a little note saying, ''I wish I could send more.'' It hurts you to take that; you want to give it back. But they are of that feeling, and it is important to them to be able to give.

Where did this self-declaration come from?

Mr. Martinez. Frank Riggs.

Mr. McKeon. Okay. We are starting all over. This was just assigned to our Subcommittee this year, so this is new, mostly to me. We have two veterans here and they are the authors of the bill; I am getting educated about it. I think some of the problems we have had before; we are not going to get hung up on.

We may have some other problems. I do not know that we are going to be able to do a lot of new things in the bill, but we certainly should be able to hopefully keep the good things that are in the bill and get it done and get it reauthorized. That is what our hope would be. And my time is up again.

Mr. Martinez.

Mr. Martinez. Thank you, Mr. McKeon. I do not mind doing new things when they improve the situation, but just to do new things for the sake of change is what we ran into, in my opinion, during the last couple of attempts at reauthorization.

Now, I want to ask Fernando a question, but I also want Ms. Lacayo to respond to it too. However, before I ask that question, I would like to ask you, Fernando, a specific question because of your present role.

Title IV is the research and development title. It seems to me that we spend very little money on trying to figure out what direction we should really be going in. Have you a response to that?

Mr. Torres-Gil. Yes, I do, thank you, Congressman Martinez for raising Title IV again when I was in office. The Congress essentially cut back practically eliminated the Title IV funding. It was roughly $30 million in 1993 and it dropped to about $3 million in 1995. That Title IV money was, in a sense, the only source of R & D, research and development dollars that allowed the aging network and state governments and local governments to experiment with a variety of delivery systems to see what works, what does not work. Out of that, many years before came Title VII, came the area agencies, came the integrated home and delivery services, came on law, for example, in San Francisco, came out of Title IV. We were able to experiment and try out different ways of using our dollars more efficiently, effectively and adjusting to the changing social and demographic trends.

The real focus right now in the Congress, if I may say this, is on biomedical research. The National Institutes on Aging, the National Institutes on Health almost do not know what to do with all the money that is being given to them by both the President and the Congress and to that we can all be grateful, but I might say that I believe there is too much attention right now on seeking magic bullets through biomedical research, whether it is cancer, AIDS, arthritis. We need that money, but insufficient attention is being given to how do you better deliver services to people with the mix of needs and problems and how do you provide the dollars to allow us to experiment, do the model projects and demonstration programs? The Congress has increased Title IV, I believe, to a $10 million or a $13 million, I do not recall the exact amount, however, most of those dollars are mandated, meaning they are given to specific groups who have successfully worked the legislative process through lobbying, to get dollars for their own organizations. And that is not to take away from the organizations that can play the game well, but it does take away from the ability to get the objective demonstration programs to make better use of your money, so I would certain encourage bringing back the Title IV demonstration dollars so that we can prepare for what is going to be new and complex needs in the next few years.

Mr. Martinez. You know, one of the hang-ups in the last two Congresses was Title V, and I really do not understand why, but when you were Secretary of Aging, you had to work with these organizations_there are ten of them_which have been providing seniors with employment opportunities. I do not know there was an idea that because the same organizations have been in place for many years, we ought to give other organizations an opportunity to compete for funding. There was also talk about developing standards for the organizations_performance standards_ in order to justify receiving funds and if they did not meet those standards, then we would open that portion of funding to someone else for bidding.

It would seem to indicate that somebody had some information that these people were not working up to par, but in everything I have seen so far, they have been. Now I am one of those in government that does not believe the same people should get government money all the time. I oppose it when every time funding goes out, it goes to the same people rather than being spread around to a broader perspective of people so that more individuals are able to take advantage of these dollars. But in this particular program, I am not sure it would help because these people have been doing such a fantastic job for so long. Furthermore, what would happen to the people that are being served now?

During your experience as Assistant Secretary on Aging, did you find that there needed to be some adjustment to the way in which funds are currently allocated?

Mr. Torres-Gil. I believe if I may provide just a very brief historical backdrop. This issue had a genesis during our watch and as Ms. Lacayo has said it is certainly true that the Title V contractors have by and large done a very good job in meeting the needs of that part of the legislation. Back in 1993, 1994, 1995, there was a big push both from the Executive Branch reinventing government, if you recall, REGOs 1, 2 and 3 by the Vice President. There was a deep concern by the Congress that there be performance measures, that there be open, competitive bidding for any and all federal contracts and that shed a spotlight on Title V, that we are not open to competitive bids that had been a long time tradition of giving them to certain national minority organizations. But thirdly, there was also an effort during that time, supported by both the Congress and the Administration to begin to consolidate aging related programs in the federal level in the federal government and to try to bring back some of those programs into the Department of Health and Human Services, including some of the programs in the Department of Transportation, Department of Housing and Urban Development and the Department of Labor, in this case, a Title V program, under the principle, the goal that if the federal government could consolidate programs it would make better use of the money and encourage states and local governments to also do that type of integration.

I believe some of the politics around that has centered around the dollar split between the states and these national grantees and that has certainly created tremendous controversy and I am not sure if that is been settled or can be settled, but that is a historical background to it.

Mr. Martinez. Ms. Lacayo, as Mr. Torres-Gil just said, we did develop a formula where a portion of the money went_allow me to try to get the staff to refresh my memory. Do you remember if we agreed that the percentages would shift from 78-22 to 40-60 over five years, and that 40 percent would go to the states and 60 percent would remain with the 10 organizations.

Can you respond to that?

Ms. Selmser. We were talking about current law versus appropriations. The 78-22 split is in appropriations. It is not listed in current law. Current law envisions more of an equal balance.

Mr. Martinez. All right, current law says_

Ms. Selmser. I do not know the exact language, but it was indicative of the time that it would be_

Mr. Martinez. Was it 50-50?

Ms. Selmser. No, it is not 50-50. It is not 50-50. It is just that envisioned over time. It is going to grow that way.

Mr. Martinez. I thought that was something we were debating in the last Congress as to what percentage we would shift. Regardless, we are still going to be in that dilemma regarding their Title V program.

Ms. Lacayo. Well, Congressman, I think the issue came down to really a state versus national contractors and we can understand where the states would under the Older Americans Act like to really control all the moneys. We go back to that old adage if it ain't broken, why try to fix it. The historical program where the national organizations were created way back in I think it was 1968 with a pilot program and then it evolved from that.

This program is rather unique in the sense that once you start switching monies around you start displacing older workers. It is not a program where your population is changing daily. It is not. There are constants in this program. For example, as a minority organization, we are one of the smaller contractors. If we had not been admitted by the Department of Labor in 1978 to participate as a minority contractor, Hispanic older persons would not have the type of participation levels they have now because we have a very unique ability to deal with monolingual limited English speaking older workers and we deal with the poorest, the hardest to place, the least educated and yet we constantly meet our performance goals set by the Department of Labor which is the unsubsidized placement goal. We have been audited many times by the Inspector General with no findings, no outstanding audit issues whatsoever over a 20-year history which I think is rather a stellar history. The program is the type of program that is a front line, serve the hardest to place. These are the persons who are displaced out of the employment work force.

To start putzing around with formulas it totally up to you, but there will be tremendous disruption in shifting positions from the national organizations to the states.

Now we are willing to look at any new appropriations being split in some kind of a formula. We are not obviously tied to the 78-22 percent formula. Obviously, we are sitting here with a vested interest. I will be very frank with you. We have done a very good job in managing this program. So the political battle over this program which started in 1994 is a political battle. It did not come down to lack of performance either on the part of the state or the part of the national organizations. It really became apolitical issue and the question is going to be resolved from what is best for the people being served, rather than what is the politically expedient thing to do at this time. I hate to put it in those terms, but you can go into all of the history you want, but it was a political issue. There were national organizations that had some political issues with Members of Congress and they became targets and quite frankly those of us who had not been political targets kind of are part of that whole battle inadvertently because I think we do a damn good job. So we have to look at the program from is it really serving its intent; its original authorized intent? Yes, it is. Is it fiscally conservative? Yes, it is. Do the national contractors outperform the states? Yes, they do. Have they been clean in the administration of the program? Yes. Eighty to 82 percent of the dollars actually go to the older workers.

We have to be very careful that we do not start establishing performance goals and statutory performance goals that creates a creaming program where the most vulnerable, the limited English speaking, the poorest of the poor are creamed out of the program because we have to meet these goals. And I think that is where you start losing the essence and the intent of the original program.

Mr. Martinez. You are absolutely right. Initially, it was a political thing. One of the contractors happened to contribute to the wrong political party.

Ms. Lacayo. That is right, sir.

Mr. Martinez. There was a bipartisan reaction to it; I mean a partisan reaction to it. There is a bipartisan effort now and I hope that is not going to enter into the consideration.

Ms. Lacayo. Congressman, let me just add for the record, it hurts those of us who are the smaller contractors, especially the minority contractors to get caught in this battle over the larger organizations, some of whom get $100 million, some of whom get $79 million. I have a $12 million annual budget. If you compare apples to apples, it does not, yet I am having to live with the sins of my companions, which is fine. Everybody has their_but let us not hurt a program that in partnership with the states, many of us receive monies from the states. For example, the State of Florida turns around and gives us their state monies to operate their part of the program in the State of Florida, so there has been a very healthy state-contractor relationship over the years. I think we can look at different formulas. I am not opposed to that. I just think we have to be very careful in not ultimately hurting that senior who I serve on a daily basis, the hardest to place, the most vulnerable and the poorest.

Mr. Martinez. The last thing that I want to make clear regarding the shift is that, we were talking about new money versus old money.

Ms. Lacayo. Yes sir.

Mr. Martinez. We will just get the sinners.

Mr. McKeon. Mr. Barrett.

Mr. Barrett. Thank you, Mr. Chairman. Dr. Torres-Gil, I was most impressed with your background, the fact that you are formerly an Assistant Secretary for Aging?

Mr. Torres-Gil. Correct.

Mr. Barrett. I was pleased with the historical background that you have brought to the hearing today. You have obviously seen, over the years, a lot of changes. You were probably in the embryo stage of the Older Americans Act.

Mr. Torres-Gil. Correct.

Mr. Barrett. You have seen a lot of changes, both good and bad. What would you tell the Committee today_what is the number one thing that we ought to be looking at to change, to modify, to improve, and to delete as we embark on the reauthorization of this act? The number one thing.

Mr. Torres-Gil. The number one thing out of the many things that I would be passionate about, let me_

Mr. Barrett. Maybe two.

Mr. Torres-Gil. Thank you. I appreciate that, Congressman, and before I go on, I might just say I feel like I have grown up and grown old with the Act. I worked with Secretary Pat Harris and Joe Califano back in the 1970s when the targeting provisions first came to us. I worked on the Hill as Staff Director of the House Elect Committee on Aging during the mid 1980s and there is not too many Members around now that were around during that time with Congressman Roy Ball and as I said, I had the honor of joining the Administration and working with all of you.

I think if I had two things, and this is just my own personal bias, long term care and preparing for the aging of the baby boomers. Long term care, so that we can provide the home and community base services so that people can take care of their own and themselves as they best see fit. You have heard different ways to do that and long term care broadly defined elder care, adult protective services, the respite care program, the care giver programs, the transportation, the housing and if we can somehow use the Older Americans Act to bring that together.

The baby boomers are a much different generation. We do many different studies about their attitude, their predilections, how they view their aging. Right, now they are in a big denial, but within 10 or 15 years they will have to accept the fact that they are old and their longevity will increase and in many respects they are not well prepared to go grow and do not have the kind of values, the strength, the sense of character that their parents and grandparents have had that allowed them to persevere.

I personally believe the Older Americans Act will go through some fundamental changes in 10 years that will lead towards a different way of delivering services, much different than how we do it right now and as I think some of my colleagues that provide services can tell you, it is not easy to bring in people in their early, mid, late 60s to come to a senior citizen program for a congregate meal because people in their 60s do not think of themselves as old any more. So you are going to start seeing those changes.

So while we address the needs of today's elders, your generation, we must also get ready for a different cohort of older persons, my generation, that will require a different set of premises of the Older Americans Act.

Mr. Barrett. Interesting. I was in probably the best senior citizen center in my district last week. This was also the number one thing that the administrator of that center told me, that they cannot get the aged 60 people into that center. They are frustrated, trying desperately to encourage them to come in, but they say they are not old, that they are not ready.

You are suggesting then that the present OAA is not or will not provide for the baby boomers in the next 10 or 15 years?

Mr. Torres-Gil. I am not sure if I would say it would not provide, but the Older Americans Act may become somewhat irrelevant to this generation of middle aged persons who will not face the kind of basic critical needs for dependence of basic services until they are in their 70s, 80s and 90s.

The Older Americans Act will be relevant always to people who are in their 70s, 80s and 90s and have the frailties, the disability, the poverty and the other problems that require these kind of services, but the success of aging in this country is that we have pushed Th envelope at which we feel like we are old people. We live longer, healthier and more active than ever before with important exceptions, minorities, older women, persons with disabilities, persons that live alone or that have low incomes, are going to feel old and have needs in their 50s and 60s, but by and large we push back that envelope.

So the Older Americans Act will always be critical and play an important role, but it may not be relevant to those of us that have the luxuries and the opportunities to be younger at later years and to the extent you want to reach out to those populations, we are going to have to be more creative.

Thank you very much.

Mr. Barrett. Thank you. Very quickly, Mr. Chairman and Ms. Medina, you indicated that you felt that case management is a critical link between the client and community-based care and should be available to people at all times, etc., etc. I guess my question is, in your opinion, what exactly is case management?

Ms. Medina. Case management is about coordinating care. As you have heard from all of us here and in our written testimony, it is very complex and fragmented and an aging population with multiple needs to have that care coordinated. But it also has to have strong standards in there so that care plans are driven by comprehensive assessments and the proper resources are linked to the client. It is about keeping the frail at home in our communities.

We have been able to through some creative work blending in some monies, including APS expansion funds to grow our case management programs and hopefully July 1st we will be able to almost double the number of providers that we are going to have out there because it is a really essential and critical link.

Mr. Barrett. My time is up. Mr. Chairman, thank you.

Mr. McKeon. Thank you very much and this will terminate our hearing. We need to get Mr. Barrett to the beach.

Thank you all for being here, and we especially want to thank this panel. I think you have been outstanding, and one of the things we would encourage is that you watch us closely as we go through the writing of the bill and continue to give us input and help.

I think that would be very, very helpful as we go through this process. We appreciate your participation today and thank you very much.

[Whereupon, at 11:08 a.m., the Subcommittee was adjourned.]