HEARINGS HELD IN ALHAMBRA, CA, APRIL 6, 1999, SANTA CLARITA, CA, APRIL 6, 1999 and NORTH PLATTE, NE, APRIL 8, 1999

Statement Of Jo Anne Darcy, Mayor, City Of Santa Clarita, CA *

Statement Of Robert Ryans, Director, Los Angeles County Area Agency On Aging, Los Angeles, CA *

Statement Of Rosemary Regalbuto, Executive Director, Meals On Wheels, Santa Monica, Malibu, Pacific Palisades, CA *

Statement Of Joe Regalbuto, Producer And Actor, Meals On Wheels Advocate For Santa Monica, Malibu, Pacific Palisades, CA 125

Statement Of Sister Alice Marie Quinn, Executive Director, St. Vincent Meals On Wheels, Los Angeles, CA 135

Statement Of Brad Berens Brad Berens, Executive Director, Santa Clarita Valley Committee On Aging, Santa Clarita, CA 138

Statement Of Nate Golter, Mr. Nate Golter, Program Participant, Newhall, CA *

Appendix A - The Written Statement Of Jo Anne Darcy, Mayor Of The City Of Santa Clarita, CA *

Appendix B - The Written Statement Of Robert Ryans, Director, Los Angeles County Area Agency On Aging, Los Angeles, CA *

Appendix C - The Written Statement Of Rosemary Regalbuto, Executive Director, Meals On Wheels, Santa Monica, Malibu, Pacific Palisades, CA *

Appendix D - The Written Statement Of Joe Regalbuto, Producer And Actor, Meals On Wheels Advocate For Santa Monica, Malibu, Pacific Palisades, CA *

Appendix E - The Written Statement Of Sister Alice Marie Quinn, Executive Director, St. Vincent Meals On Wheels, Los Angeles, CA *

Appendix F - The Written Statement Of Brad Berens, Executive Director, Santa Clarita Valley Committee On Aging, Santa Clarita, CA *

Appendix G - The Written Statement Of Mr. Nate Golter, Program Participant, Newhall, CA *

Table Of Indexes *

FIELD HEARING ON THE OLDER AMERICANS ACT:

MEETING THE NEEDS OF OUR NATION'S SENIORS

The Committee met, pursuant to call, at 2:30 p.m., at Santa Clarita Valley Senior Center, 22900 Market Street, Santa Clarita, 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.

Mr. McKeon. Good Afternoon. I apologize for being late.

We had a little traffic accident just down the street and Congressman Martinez' brand new car has a dent in the back. If we all seem a little dizzy, it is not our normal dizziness.

Anyway, we are really happy to be here this afternoon and to see such a wonderful turnout, especially of our seniors, who we are going to be talking to here at the Newhall Senior Center.

As many of you know, this is the second in a series of field hearings. We held a hearing a few weeks ago in Washington, D.C., but this is our second in a series of field hearings. We held one this morning down in Marty Martinez' district, Congressman Martinez' district, down in Alhambra, and tomorrow we will be going to Nebraska to hold one in Congressman Bill Barrett's district. So it is good to be home, and it is good to be here with you at the Senior Center.

This afternoon we are excited, as I said, to have all of you here. Today's panel of outstanding witnesses does not just include dedicated individuals like Mayor Darcy, who you all know, there is not any bend in this town that is not_

[Applause.]

She is always here. We have Robert Ryans, Brad Berens, Rosemary Regalbuto, and Sister Alice Marie who run and manage seniors prograMs. The panel also includes folks who volunteer like Joe Regalbuto and who participate in the programs like Mr. Nate Golter.

When all is said and done, I think it will be absolutely clear to everyone how essential the programs of the Older Americans Act are to our nation's seniors, not just to their physical well-being, but also to their independence and self-respect. The longer we can help seniors stay in their own homes, the better they will be and the better off we will all be as a community.

We are looking forward to hearing the testimony of our witnesses, but first we will have an opening statement from Congressman Martinez, who is the Ranking Member on our Committee.

Mr. Martinez. Thank you, Mr. Chairman. Because we have several witnesses, and I am anxious to hear what they have to say, I am going to try to keep my remarks brief.

I just want to take a moment to commend you, Mr. McKeon and Mr. Barrett, for taking the initiative on this important issue which has been near and dear to my heart for a long, long time, 16 years to be exact, since I first came to Congress.

I would like to also thank both of them for their commitment to working on this reauthorization in a bipartisan manner. As those of you who are familiar with the Older Americans Act know, this historically has been a bipartisan initiative, and it has gone unauthorized for the last several years due to the partisan politics that ensued. However, I am extremely hopeful for successful reauthorization of this act this year because of Mr. McKeon and Mr. Barrett.

I believe we all three committed to seeing this come to fruition this session of Congress and we are not there to further our own interests or the interests of our respective political parties, but to further the interest of those that are served by this Act, the seniors.

Finally, I would like to thank Mr. McKeon and citizens of the 25th for hosting this field hearing and for the hospitality that we will receive while we are here.

Thank you very much.

Mr. McKeon. Thank you. There was one thing I did not mention regarding how we got to this point. Mr. Martinez mentioned that in the last four years, the last two Congresses were not able to reauthorize this pretty much because of partisan politics and problems in Washington. This year it was assigned to our Subcommittee, so it is new to me.

Mr. Barrett has been working in this area for years along with Mr. Martinez. Together they are providing the leadership to move this forward. Mr. Barrett, Mr. Martinez and I went to breakfast in the Capitol and started deciding how we were going to work on this, and Mr. Barrett put in a place holder bill. Mr. Martinez and I were co-sponsors.

Much of the leadership of our Committee is committed, and I think the leadership of the Congress is as well. So we should be successful as we move forward on this legislation this year.

Our first witness is the Mayor of the City of Santa Clarita, who is Mayor for the second or third time. Is it the third time now? Third time. And she gets better each time, and I do not know how she does it. Let us hear from Jo Anne Darcy, the Mayor of the City of Santa Clarita.

[Applause.]

Ms. Darcy. Congressman Martinez, I can empathize with you and your accident. I did that to myself last year, and I had a terrible neck for six months. At least you are still walking well.

Mr. Martinez. I will have the feeling tomorrow, I think.

Ms. Darcy. That is what I am worried about. Anyway, good afternoon, everyone. Good afternoon and welcome Congressman Buck McKeon, Chairman; Congressman Bill Barrett, sponsor of the Older Americans Act, I understand; and Congressman Matthew Martinez.

I am Jo Anne Darcy, Mayor of the City of Santa Clarita, former Mayor twice and Councilman for 11 years.

As Mayor of this fair city I wish to not only welcome you, but also express our sincere appreciation for your interest, assistance and concern for this community which includes the four communities of Newhall, Saugas, Canyon Country and Valencia. They were incorporated into this city on December 15, 1987, and our current population is 147,000 plus and soon to be 10,000 people larger when we finish the two annexations in the process.

I also wish to express my sincerest appreciation and commendation to Brad Berens, Director of this center for his outstanding and his dedicated, outstanding and many services that they give and the center provides and the ultimately care they extend to our seniors.

There is also a continual need to provide funds to keep up with the growing needs of ever increasing senior population, particularly in the area of Meals on Wheels, handyman services, housing outreach and dozens of other services they provide.

I hope you can and will help them. Thank you again for being here, for allowing me to be here today and for taking the time from your business schedules to help and care about our frail and elderly in Santa Clarita.

Thank you again.

[Applause.]

See Appendix A For The Written Statement Of Jo Anne Darcy, Mayor Of The City Of Santa Clarita, CA

 

Mr. McKeon. Our next witness is Robert Ryans, Director of the Los Angeles County Area Agency on Aging. He holds a master's degree in gerontology from California State University.

Mr. Ryans.

Mr. Ryans. Thank you and good afternoon, Mr. Chairman, Committee Members, I am delighted your accident was small. I am Robert Ryans. I am the Director of the Los Angeles County Area Agency on Aging. And I want to thank you for giving me the opportunity to discuss the reauthorization. As we see it there are issues of funding and equity, access to services and the expanding role of the AAA and long term care.

I want to laser focus on funding and equity in the interstate formula, its impact on our populations, our funding priorities and our program innovations.

I know my colleague has acquainted you with LA County demographics, but I want to emphasize we are a 4,000 square mile county. Our seniors have great needs. 1.3 million are disabled; 465,000 have severe disabilities; 250,000 are at nutritional risk. Our ombudsman program is responsible for 2,700 facilities and over 81,000 beds. We need more resources.

While you cannot give us more funds, you can correct interstate funding formula because we believe that it has been unfair to us in Los Angeles County. In a handout I have provided you I wish to indicate that. In Figure 1 it shows that the current law allocates Older Americans Act funds based on a 60 plus with a Fiscal Year 1987 hold harmless provision.

This penalizes California. Our population grew 50 percent faster than the United States. California suffers, as we can indicate on Figure 2 that it received 9.3 percent of the funds with 10.7 percent of population. Figure 3 indicates that since 1991 through 1998, that hold harmless factor has cost California $45 million. It would be as if this Congress had allocated $475 million Older Americans Act dollars to offset that.

Los Angeles County is roughly one third of that $45 million, so it has been a tremendous impact on

Los Angeles County, at the state level and has meant 6.7 million fewer congregate meals, 1.3 million fewer home delivered meals. Again, the Los Angeles County is roughly one third of that total.

Less funds have also hindered our ability to provide innovative new services at the local level such as our mobile health and our mental health programs, strengthening our home delivered meal programs and our ombudsman programs.

What I ask that you do today is not only reauthorize, but reexamine at the interstate funding formula, correct it so that California can begin to expand upon the needs and services in this county.

Thank you very much.

[Applause.]

See Appendix B For The Written Statement Of Robert Ryans, Director, Los Angeles County Area Agency On Aging, Los Angeles, CA

 

Mr. McKeon. Thank you, Mr. Ryans.

Next we will hear from Rosemary and Joe Regalbuto.

Ms. Regalbuto is the Executive Director of the Meals on Wheels Program for Santa Monica, Malibu and Pacific Palisades. Her husband, Joe Regalbuto_am I saying that correct?

Mr. Regalbuto. I am so grateful.

[Laughter.]

Mr. Regalbuto. Perfect, perfect, perfect. Thank you.

Mr. McKeon. _whose face should be familiar to many of us. You know, it is funny_ when I shook hands, it was like I had known you for years. When you see somebody on television all the time, you feel like you know them. You have been sitting in our home, and we appreciate having you there. But his face should be familiar to many of us.

He has lent his voice to the many needs of the Meals on Wheels Program. His background in front of the camera includes numerous movies and television shows, including the hit TV show Murphy Brown, and he is currently directing the NBC comedy Jesse. Good to have you here with us.

[Applause.]

Rosemary.

Ms. Regalbuto. Good afternoon, Mr. Chairman and other members of the Subcommittee.

My name is Rosemary Regalbuto, and I am the Executive Director of Meals on Wheels of Santa Monica, Malibu and Pacific Palisades. I am also a long time member of the Meals on Wheels Association of America. Today, I am pleased to testify on behalf of those organizations.

I am joined here today and you have already done my part of the speech here, by my husband, Joe Regalbuto, he may recognize and you have probably known him by many other names. He is not a member of MOWA nor is Meals on Wheels a part of his typical work day, but he is involved and does have something important to say about it. So I will turn the microphone over to him when I conclude my remarks.

Meals on Wheels is a part of my typical workday. It has been for about 12 years now that I have been involved in senior meal prograMs. Working as Executive Director of Santa Monica, Malibu Meals on Wheels and we have recently expanded into the Pacific Palisades area also.

Let me pause to tell you something that you each know well, particularly the two of you who represent Congressional Districts in the LA area. You know it, but others in Washington and the rest of the country may not expect it. There is a great need for senior meal services here in places like Malibu and Santa Monica, places that have the image of being glitzy and rich and inhabited by the young and the famous. There is a need because there are poor and there are elderly and frail people here. Folks age here too. As they do, we see an increasing need for services we provide.

I want to talk about meeting that growing need and to appeal to you to help enable us who work in the field to meet that growing need. My programs served 95,000 meals last year. When I began my work in 1988, we served 29,120. And I know as the baby boomers reach their majority that number will be even greater.

I also know that the federal resources are limited. While my colleagues in MOWA and I sincerely hope that the level of federal funds will continue to increase, we also know that it cannot possible keep up with the need. We do not expect that it will or should because part of the beauty and success of the Older Americans Act senior meal programs has always been that it is a public and private partnership.

The government furnishes seed money and the remainder of our budgets are raised from a variety of sources. The elderly themselves have been one source and we need to continue to look to them in the future to contribute.

Last month in Washington MOWA President Richard Lipner testified at a hearing before this Subcommittee. In his testimony, he outlined several principles relating to cost sharing to participant contributions. MOWA firmly supports these points and I want to tell you personally that I do as well.

In essence, these points say this, we believe that the elderly themselves should be encouraged to contribute what they can for their meals that they receive. No one should be denied a meal for inability or unwillingness to contribute. Meal programs should be able to assist their clients in determining the amount of their contribution and this assistance should be allowed to include sending written reminders.

Mr. Lipner testified that he is able to send reminders now and the ability to do so has enhanced the level of contributions the clients make. I also send reminders. And that has worked very successfully for my program. Unfortunately, we understand from our peers not all senior meal programs are allowed to do this.

We ask that you make it clear in the law that the practice is allowed. Each program should be permitted to determine whether or not sending reminders makes sense. If they determine it does, then the program should be able to do so. If they do not, then they would not be required to do so. No two programs are exactly alike, Mr. Chairman. We need flexibility to determine what works best in our own programs.

I said earlier that Mr. Lipner and I have the ability to send reminders to our clients, but what we send is different because our programs and our clients are different.

In San Francisco, he works with clients to determine individual mutually agreed upon monthly contribution amounts. Here in my program, I request, but do not require the same contribution of two dollars for each meal from our county funded clients. Not all contribute. Not all contribute the full request.

The amounts of funding we raise and put back into our program to expand it are not as great a percentage of our budget, but they are great as a percentage of our purpose, to expand the program, to involve the community, including those who receive seniors and helping others.

I have just seen my one-minute and I do want to pass the microphone over to Joe. I hate to do this though, but anyway, because he just, you know, takes over at home.

Anyway, I will conclude, hopefully with some questions later. Thank you.

See Appendix C For The Written Statement Of Rosemary Regalbuto, Executive Director, Meals On Wheels , Santa Monica, Malibu, Pacific Palisades, CA

 

Mr. Regalbuto. Thank you very much, Mr. Chairman. I am delighted to be joining you and your colleagues today at this hearing.

It is not often that someone in my profession is invited to testify at a hearing about the Older Americans Act. Perhaps it says more about Washington than it does about Hollywood.

Now I say this because there are, in fact, many celebrities who give time and money to support causes related to older people. I suppose one could say that in Hollywood, the time to volunteer is in shorter supply than the financial resource and contributions. That being the case, I am here today to highlight the need and the rewards of volunteering for Meals on Wheels.

You have just heard from Rosemary, and since she has been doing this for almost 12 years, I guess you could say I have been also dragged along for 12 years. As you no doubt recognize, this is more than just a job for my wife. This is, in fact, her life's work.

We have made a commitment to Meals on Wheels because it nourishes the lives of everyone involved in it. Those seniors who receive a hot, nutritious meal every day also receive a smile and a friend who shows up at the door. This is not a delivery program.

This is a people-to-people program, and that is why the volunteer is also nourished by the program. Everyone who volunteers for Meals on Wheels in any capacity does so at the risk of becoming hooked.

Once you have seen the difference it makes, once you have experienced firsthand the delight on the face of a senior who has been alone for many hours, once you have prepared a meal or delivered a meal, you are never quite the same. Your life has been enriched in the process.

Being a celebrity has allowed me to lend my name and experience to raise money for Meals on Wheels. I have been involved in golf tournaments for many years. By the way, the next one is October 4th, if any of you are in town.

[Laughter.]

And you want to play, you are more than welcome. I have acted in public service announcements here in our local community as well as a national public service announcement that was underwritten by the good folks at Reynolds Metals.

Through that one national PSA, we were able to raise awareness about volunteering for Meals on Wheels nationwide. I am proud to announce that a result of the television announcement, we garnered 50,000 new volunteers for Meals on Wheels programs from Alaska to Maine. This new volunteer army is out delivering in excess of 300,000 meals a year to America's elderly.

Now the reality is that none of this service is very difficult for me. What is tough, however, is watching how hard Rosemary and her colleagues have to work just to find the resources to keep up the level of service Meals on Wheels provides now, let alone what will be required into the new millennium.

And it is also important to note that all this work has to be done before even one meal can be delivered.

The thing about volunteering is that it is contagious. Once you become a volunteer for Meals on Wheels, your friends join in too. I am proud that there are very many in Hollywood who also lend their time and talents to help seniors. Most of them do it without making a big deal out of it. All of them do it because it is the right thing to do.

In my business, as in all other walks of life, older Americans are often forgotten and pushed aside. Meals on Wheels is an organization that works daily to see to it that our fellow citizens are not forgotten.

I am very happy to have volunteered here today and been asked to participate and I hope that with hearings like this and with your encouragement and support from all walks of life, people from all walks of life will volunteer for Meals on Wheels. I thank you very much for your time and consideration.

[Applause.]

See Appendix D For The Written Statement of Joe Regalbuto, Producer, Actor, and Meals on Wheels Advocate for Santa Monica, Malibu, Pacific Palisades, CA

 

Mr. McKeon. Thank you. Now I understand that you need to leave, and so if there are questions from the other Members, I think we ought to take that time right now. I will begin with one question.

Rosemary, you said when you first started in 1988, you had 29,000 meals and now it is 95,000. How has your budget changed? How much money were you receiving in 1988 versus what you receive now?

Ms. Regalbuto. We were not receiving any funds at that point. In fact, the budget was $86,000 and it was based upon a $20,000 grant that had not even been written for. So therefore, I was not surprised that we did not get it.

Since then_

Mr. McKeon. So this started out as a totally volunteer program?

Ms. Regalbuto. If you can think of $66,000 budget as, you know, barely covering the costs of our food to our food suppliers, yes. It still is very much a volunteer program. We have 300 volunteers that are involved with the meal delivery and all the staff works part-time and our goal is to just get out the meals and the two meals every day and then we close.

Mr. McKeon. How much do you get from the federal government now for Meals on Wheels?

Ms. Regalbuto. $68,000 funded through the County of Los Angeles.

Mr. McKeon. $68,000?

Ms. Regalbuto. I do not think we have met, but we should.

Mr. McKeon. And that provides for 95,000, in addition to the contributions that those_

Ms. Regalbuto. Right, not all of our clients are funded under the Older Americans Act. We originally are private, nonprofit. We still have a component that is private, nonprofit clients. And that program is for everyone regardless of age.

Mr. McKeon. Well, it must be a real thrill when you show up at their door with a meal. People must get quite a kick out of that. I have been out delivering meals for wheels. They do not know a Congressman from anything, but when you show up_

Mr. Regalbuto. You know, it is one of the great rewards, frankly. And what we do also is on the holidays, not all the time, but we bring our kids, and they will deliver. It is no joke that it is truly rewarding on the other side and to see that not everyone has all the gifts that we all have and share and that some people needed. So it is tremendous for the kids to see and it is tremendous for you to do. Other actors at Harris has delivered meals and they do it quietly and it is very rewarding.

Mr. McKeon. That is great. Thank you very much.

Mr. Regalbuto. Thank you very much.

Ms. Regalbuto. Thank you very much.

[Applause.]

Mr. Martinez. Thank you, Mr. Chairman. When they see you at the door, do they call you by the name they know you by on Murphy Brown?

Mr. Regalbuto. You know what? Not too many people say Regalbuto as well as_yes, you will get Frank, you will get oh, I know you from somewhere, were you at my cousin's party the other day? It could be anything.

Mr. Martinez. When Mr. McKeon asked you about what the federal contribution you get is, $68,000, you do not serve 95,000 for $68,000. What is the other part of that budget?

Ms. Regalbuto. Okay, as I said we do have a private, we are private, nonprofit also and that is a component and for those clients we do charge a fee of $4.50 a day for the two meals that we deliver, but there again also, no one is ever turned away.

We do not maintain a waiting list. We have not for about nine years and one merely has to request and has to have a need for Meals on Wheels and they will be put on the program starting the next day.

Mr. Martinez. That is great. Now the federal money you get is $68,000. What is the total amount of money you expend in the year serving 95,000 meals?

Ms. Regalbuto. Our budget is $400,000. Our meals costs every year, the actual true costs of those same two meals that we deliver is $7.95 per day for those two meals if you take all of the insurance and salaries and those types of things that you have to factor in.

We do pay our food providers for the meals that we deliver. We pay $3.45 a day for those same two meals whether we are paid for those meals or not. And that is the actual out of pocket costs.

We deliver a liquid nutrition in the form of Ensure or Ensure Plus. We have weekend frozen meals available. We have the county funded component of frozen meals and/or hot and cold, whichever works best for the client. We do have a breakfast program. There are not many clients who have taken advantage of that, but we do have that available.

So we are constantly assessing the needs in our community and we are trying to meet those needs and establish a program that will work for everyone.

Mr. Martinez. It sounds like you are doing it too. The thing I am trying to get at is you send out notices to all of the people whether you serve them the federal portion or whether you serve them on the private nonprofit portion.

Ms. Regalbuto. No, the clients that are private, nonprofit are billed $4.50 a day.

Mr. Martinez. They are billed. So you do not send them notices?

Ms. Regalbuto. No. No. The other ones receive a suggested donation along with their meal delivery and we will ask for $2 a day, but we just ask as a suggested donation. We are not allowed to require it and we would not require it.

Mr. Martinez. Yes, I cannot understand in your testimony you talk about peers who have reported to you that they cannot do that. There is nothing in the federal law that stops any particular person serving meals on the federal monies to ask for that voluntary_in fact, in a lot of senior centers, especially in my District, they will post on a wall a notice that if you are able to contribute, contribute. But I have heard repeatedly that same statement that somehow some areas have the feeling that they cannot send out those notices and I am wondering if it comes from the local area Agency on Aging or where it comes from because it is not in the federal law.

Ms. Regalbuto. That is my feeling that it might filter down from the local AAAs and I think Enid Borden from the Borden Group who represents MOWA would be the best person to address this and get further clarification, but it is my understanding that there are many programs that are working under the assumption they may not ask for a donation and so I am here really to support the fact that that is a very necessary thing. We can demand it, require it, no, but request it, I think it is very important.

Mr. Martinez. Last year, I mentioned this earlier at the earlier hearing we held, there was $171 million collected from voluntary contributions on the meals. So not everybody is flying under the assumption that they cannot ask for contributions. But if whatever we do, whether it_I hate to start anything that moves towards a means testing or moves towards requiring people coming in for that nutrition to have to establish what their level of income is so that they might contribute based on some sliding scale. I really would hope that we do not get into that, but whatever we do get into I think that we need to make very clear in either report language or in the law itself that local providers can ask for voluntary contributions because it does not seem to be that clear.

Ms. Regalbuto. Right, and that was the part that I really did not get to finish, maybe I am a slower speaker than I should be, but I really think it does need to be made clear in the law because I know it is there and it is just not being perceived that it can be done. I do not know, as I said, comes from the AAAs and trickles down to the programs, but it is very necessary that the programs be able to do this.

Mr. Martinez. Thank you very much. Thank you, Mr. Chairman.

[Applause.]

Mr. McKeon. Mr. Barrett.

Mr. Barrett. Thank you, Mr. Chairman. Let me take just a moment, Mr. Chairman, to say how pleased I am to be back in the Los Angeles area. I was back here a few years ago when Congressman Martinez was chairing a Subcommittee of the Education Committee, the House of Representatives. I enjoyed it very much and was pleased to be back in the 31st District, his district, again this morning for a hearing which was most successful. And Congressman McKeon, as Chairman of the Postsecondary Education, Training and Life-Long Learning Subcommittee is doing an exceptional job, and I am pleased to be in Mack's district this afternoon to participate in this hearing as well.

I told Congressman McKeon I would come out because Southern California, of course, would provide for me a beach, a sandy beach, a very sunny day, golfing in the morning and a good suntan before I went back to Nebraska. I must inform you folks that it is warmer in Nebraska than it is in Southern California today, but it is fun to be back. I have enjoyed it very much, and I think our hearings have been very productive as we proceed to draft a bill which, hopefully, will become the vehicle to become statute in the months to come.

I think Congressman Martinez made the comment, perhaps it was you, Buck, that this is a big bipartisan effort. It certainly is. This is now the fifth year, I believe, that we are going into a period in which we have not reauthorized the Older Americans Act, and it is time, passed time, that it is done. With the cooperation that the three of us have had and with other members of the Subcommittee, I have a very good feeling that it is going to be done this session. That is the least we can do for our seniors at this point in time.

A very quick question maybe, and a comment. Mr. Regalbuto, how is that?

Mr. Regalbuto. Very good, sir.

Mr. Barrett. You are, I understand, a gourmet Italian chef. How do you put that to use on Meals on Wheels?

Mr. Regalbuto. It is very hard to do for 300,000 meals.

Mr. Barrett. Rosemary, Ms. Regalbuto, I did it again_

Ms. Regalbuto. Wonderful.

Mr. Barrett. Good.

Ms. Regalbuto. I took lessons myself actually.

Mr. Barrett. I am sorry?

Ms. Regalbuto. I took lessons_it was Regalbuto, something like this.

Mr. Barrett. Thank you. I am interested in your approach in cost sharing. Will you share a little bit about that with us?

Ms. Regalbuto. I think initially we were approaching a cost sharing, but I think, you know, we sort of backed off from that a little bit

I personally think there is a lot of dignity in someone being asked to contribute, if they are able to. I do not think there should be means testing. I do not think anyone should sit there and say well you make $8,000 a year, so therefore this is how much I want.

I really do believe there is an honor system. I think people do want to contribute what they can contribute and that is why I have never had a problem with asking for a donation from our clients and the response has been there. We do not track it. We do not keep records of who does. It is strictly as they wish to support, but as I said, I do feel there is a tremendous amount of dignity in that.

Mr. Barrett. Would you again, for the record, share with us how your organization handles cost sharing?

Ms. Regalbuto. I am shying away from cost sharing a little bit, the terminology, because I see that more as a mandate. What we do is when we deliver the means to our clients, we ask for a suggested contribution of $2 a day for the meals that we deliver.

Mr. Barrett. And you, of course, continue to believe that cost sharing or some other term like it, is the way to go?

Ms. Regalbuto. Yes, definitely.

Mr. Barrett. Thank you very much. Thank you, Mr. Chairman.

Mr. McKeon. Probably the problem is in how you define cost sharing, and probably if we asked you to define it, you could come up with something you could feel good about. Maybe we should just get rid of that word and start over, but I like what you said about how it gives dignity to those who participate in the program, to be able to participate and contribute what they feel they are able to do. I think there was something said this morning at the hearing about this generation, that they have come through a period where their whole life, they have been giving to others. They have World War II through many other situations, and I know my parents have passed on, but they were part of that generation. Their whole life, everything they did, was dedicated to their children and to helping others. The concern was, I think, what happens with the next generation, the baby boomers, who may not be quite as self-sacrificing as this generation is?

Thank you very much. We really appreciate your taking part in this hearing today and for what you do with all of the people that you serve in Meals on Wheels. Thank you.

Ms. Regalbuto. Thank you.

Mr. Regalbuto. Thank you.

[Applause.]

Mr. McKeon. Next, Sister Alice Mary Quinn is the founder and Executive Director of the St. Vincent's Senior Citizen Nutrition Program. A registered dietician, Sister Alice Marie joined St. Vincent in 1975 as Assistant Director of the Dietary Department. Three years later, the Meals on Wheels program was established. Sister Alice Marie is a member of the Daughters of Charity of St. Vincent de Paul. Glad to have you with us this morning.

Sister Quinn. Thank you very much for having me here. They all assured me you were harmless, but if I brought my ruler, it would have been better.

Mr. McKeon. Just mentioning it is sufficient.

Sister Quinn. I was educated by the Sisters too, and I have calluses.

Good afternoon, my name is Sister Alice Marie Quinn and I am the Director of St. Vincent Meals on Wheels in Los Angeles. I am delighted to be joining you here today, Congressmen McKeon, Martinez and Barrett. We in the Los Angeles area are blessed to have two Congressmen representing the surrounding areas of Los Angeles as dedicated as you, Mr. Chairman, and Mr. Martinez. The citizens of Nebraska are also blessed to be represented so ably by you, Mr. Barrett. I say all of this not be politically correct, but because I mean it.

Mr. McKeon, I know that you are the new Chairman of the Subcommittee on Post-secondary Education, Training and Life-long Learning and while I do not understand how the Older Americans Act program fits into that Subcommittee, I am awfully glad it does.

Some angels have told me that because of the commitment of the three of you to seniors, you have made reauthorizing the Older Americans Act the top priority. On behalf of all seniors who are affected by the Older Americans Act programs, I thank you for ensuring that the bill will be passed in this Congress.

The Older Americans Act has a long and excellent history of helping to preserve the health and the dignity of millions of seniors who have been touched by it throughout its history. The many facets of the act are important, but the Title III meal programs are particularly important to me and my fellow members of the Meals on Wheels Association of America, and Meals on Wheels and the congregate meals have literally meant the difference between life and death for thousands of seniors since the inception of the program.

As you are probably aware, I do spend a great deal of time in prayer. I pray daily for those recipients of the St. Vincent Meals on Wheels that they should never have to know hunger again. I pray that no one should be hungry in this the richest nation on earth. I will pray for all the Members of Congress that as you begin the process of reauthorizing the Older Americans Act, you will bear in mind that there are hungry seniors who depend on meal programs and that they, in turn, are depending on you to be their champions in Washington.

This is not an easy burden that we are placing on you, but one in which you are more than capable of excelling. When we elect our leaders to represent us in Washington, we do so with much thought and great expectations. For the most part we have not let down. I believe in you three, the voters have chosen quite well.

Mr. Chairman, I will say special prayers for your leadership and guidance as you move this bill through the Washington process. I am confident that anyone with a good name like McKeon will do a Sister Quinn proud.

I mentioned that there are hundreds of thousands of seniors who are affected by Older Americans Act prograMs. In fact, I must clarify that and say that all seniors are affected by the Act. Our program is not a strictly, federally funded program. And yet, I can tell you that my program and the seniors we serve are affected by the Act. You see, if other programs were not receiving those life sustaining Older Americans Act's monies, there would that many more seniors here in the LA area that would be desperate for meal services.

One of the great lessons to be learned from senior meal programs is that we know that in order for them to work, there has got to be a public-private partnership.

I do not believe that any of us think that it is solely the responsibility of the federal government to pick up the entire tab. All of the programs that make up the Meals on Wheels Association of America proudly work within their local communities to raise monies on the local level. We all understand that we are all in this together. We know that we all must do our part to insure that our neediest senior citizens are well taken care of in their twilight years. They have all made contributions to our society. They have raised our children, fought our wars, built our highways, tilled our farmlands, educated our young and have only recently required a hand.

It is our job to make sure that they receive the proper nourishment and the compassion that comes with the task to enable them to live their lives with dignity in their own homes.

St. Vincent Meals on Wheels covers an area of approximately 50 square miles surrounding Hollywood. Most people think that Hollywood and its environs are pretty glamorous and much of it is, however, there is also Skid Row and many other extremely poor neighborhoods. These are our streets. The elderly who live alone on these mean streets are our elderly. This is America and yet there are people starving to death here. There are hundreds of lonely, poor elderly living amongst us and these are our elderly.

Our goal is to feed as many of them as possible. At our program we are distributing over 2,400 meals every day seven days a week to these good people. The hot nutritious meals that they are receiving are good, wholesome and quite tasty. The meals cost $4.35 each . For those clients who can afford it, we ask a donation of $2 . Others pay what they can. Most cannot afford much, but try to give anything they can. We offer them food and by telling them the price, they should contribute, we offer them some dignity. You see, being poor does not mean giving up your pride.

We are not offering a handout, we are offering a helping hand and no one is ever turned away because they cannot afford to pay for their meals. In all my years in the Meals on Wheels program I have raised millions of dollars in private contributions. This money has been put to good use. The look on the face of an older person who is receiving a meal and a smile from the St. Vincent Meals on Wheels volunteer or staff person is priceless. You cannot put a dollar figure on that, but you can put a dollar figure on the cost of hunger.

You can feed a senior citizen at Meals on Wheels for an entire year for the cost of one day's stay in a hospital. Hunger does come with a price tag. By allowing our programs the ability to collect voluntary contributions from our recipients you allow us the flexibility to raise more money to feed more seniors.

I am not a lobbyist, but I am an advocate on behalf of those who do not have a voice in Washington. My friends, the lonely, poor elderly are counting on me to help them. In turn, I am counting on you to help them.

Do senior nutrition programs need more money? Of course, they do and if you could help us get more funding for senior meal programs I would really appreciate that. I know that everyone always asks for more money for their causes and each cause probably is important or they would not be asking, but I only ask that you remember that proper nutrition is vital to the health and well being of all of us. When we are properly nourished, we are much healthier and when we are healthier our society benefits greatly.

I want to thank you, Mr. Chairman, for allowing us to testify before you today. I prayed for you all this morning at mass and will continue to do so as you work on behalf of our nation's seniors. I know that you will do what is best and right for those seniors who have no voice in Washington. I know that you will look out for them and their nutritional needs.

I have a sign on my desk that is apropos for this occasion and for all occasions. I share it with you today because I know that is. It says ``When the prayers go up, the blessings come down.'' I will be praying for you all. God bless you and thank you very much.

[Applause.]

See Appendix E For The Written Statement Of Sister Alice Marie Quinn, Executive Director, St. Vincent Meals On Wheels, Los Angeles, CA

 

Mr. McKeon. Thank you very much. Next we will hear from Brad Berens who is the Executive Director of the Santa Clarita Valley Committee on Aging. Mr. Berens has a varied background in serving those in need. He worked as a Program Administrator for Free Men, Inc., which is a skilled nursing facility serving adolescents and adult drug detox and rehabilitation clientele. He also served as Program Director and Administrative Director for B-R-I-D-G-E-S, Bridges, a program that serves the mentally ill, and he was a community relations specialist for the Community Development Commission of the County of Los Angeles. The Subcommittee wants to extend special thanks to Mr. Berens for allowing us to be here today and making this hearing possible and for giving us such a big turnout.

[Applause.]

I have known Brad now for a number of years through his position here and from when we come here for meetings and different reasons. He always comes up and puts his arm around me and lets me know where the importance is and is doing an outstanding job. I did not know he had had all these other jobs. I thought he had been born and raised here and had been here forever, but Brad, thank you for what you do and thank you for being here today, and we look forward to your testimony.

Mr. Berens. Mr. Chairman, and Members of the Subcommittee, thank you for the opportunity to testify before your Subcommittee on issues related to the Older Americans Act, the aging process and service delivery at the local level.

I am personally gratified that you, Mr. Chairman, and your leadership will lend itself to the reauthorization of the Older Americans Act and provide for a sound public social policy and programs for our nation's elderly in need as we prepare to enter the 21st century.

Our great strides in this community in awareness, recognition of need and our abilities to address these issues were, in part, due to your cognizance and leadership as Mayor of Santa Clarita over nine years ago.

Our mission here in the Santa Clarita Valley in Los Angeles County and across this nation is to enhance the independence, dignity and quality of life for our older residents in need. Our mission has its roots in the Older Americans Act. Indeed, our abilities as an agency, as a county, and across this nation to address the needs of the elderly from the minor vicissitudes of the aging process to the abject fear of living day to day in isolation or in conditions of poverty without support networks has core remedies inherent in the Older Americans Act.

Our agency, the Santa Clarita Valley Committee on Aging provides services in a 300 square mile area with a senior citizen population of 30,000 who are 60 years and older. Each year an approximate 7,000 seniors access at least one of our many services and most access far more.

Services are delivered to elders in need in high-density suburban, rural and isolated geographic locales. It is my hope that our perspectives on the vital need for reauthorization of the Older Americans Act may serve you well as an extrapolation in lesson drawing as you craft this most profound and timely public social policy.

It is with a sense of urgency we prepare for 76 million baby boomers that will impact our abilities to provide services that are in my mind under-funded at this time.

The continuum of services provided by the Older Americans Act was visionary in origin and its evolution thus far in that many of its components like congregate meals, transportation, benefits counseling, health and wellness promotions, fitness programs, information assistance, adult day care, etc. are as much prevention oriented as they are remedial. This dual conceptual approach is perhaps one of the many reasons that as a public social policy and program implementation, the Older Americans Act is so effective, both in practical application and cost.

It has been my observation over the last decade that funding for the Act was simply diminishment of one program counterbalanced by incremental increases in other prograMs. The overriding concern in Congress seemed to be to hold the line because of fiscal constraints. I have witnessed small increased funding in home delivered meals, which while vital and imperative, serve only to prevent cognitive dissonance in the collective consciousness of Congress. Home delivered meals are only one component allowing for aging in place and the continuum of care provided by supportive services must be commensurately applied and funded to truly avoid the premature institutionalization of our frail elderly.

The underlying dramatic cost savings in the Older Americans Act notwithstanding the ethical and altruistic measures is evidenced in the reduction of subsidized long-term care costs. The savings to Medicare from service delivery of Older Americans Act programs lies in the prevention and/or deceleration of needs exhibited by the elderly that require skilled nursing services.

Using the Santa Clarita Valley Committee on Aging as an example, these savings are viewed as quite dramatic. Our Agency provides for an average of 500 senior annually requiring some degree of case management. If only 50 percent of these clients are at imminent risk of institutionalization and are currently aging in place with the assistance of Older Americans Act programs in their homes, the savings are an astounding potential of $9 million per year, just from our agency.

When one considers there are 655 area agencies on aging, each contracting with several dozen community based organizations one would surmise that the Older Americans Act pays for itself, albeit savings in another program.

Mr. Chairman, you have requested that I speak to the Subcommittee about the programs provided by the Santa Clarita Valley Senior Center. I would like to preface and underscore that our programs and services provided by our agency are the widest spectrum available in Los Angeles County.

The salient point with our success is the cornerstone on which we have built for the last decade. That cornerstone is the core of services funded by the Older Americans Act, most notably congregate meals, home delivered meals and supportive services. Our supportive services department includes Older Americans Act programs that include assessment and case management, counseling with components of individual and support groups, care giver and groups for adult children of aging parents, telephone reassurance, in home respite services, social day care, information assistance, legal assistance and the Title V senior employment program.

The Older Americans Act funding is the requisite mortar that allows for a process of pragmatic incrementalism and innovation that enabled our agency and those of our colleagues to expand to include other vital services that are also preventative and remedial. In our case, these other programs and services include advocacy, Alzheimer's resource center, consumer services, counseling internships, financial planning, disability services, employment referrals and placement, escort services, specialized exercise programs, peer counseling, friendly visiting, home modifications, crime prevention, housing assistance, and intergenerational programs.

This decades long journey to where we are today is directly tied to the core services of the Older Americans Act. The Older Americans Act allowed us to educate our community and our civic leaders where collaborative efforts and shared missions on behalf of our elderly are commonplace today. It is a tribute to the Older Americans Act that federal public policy filters down to local communities through the leadership of regional area agencies on aging and has the widest and best application on the local level.

In our case, you have enabled us as an agency to create partnerships that are being replicated both nationally and internationally. Two such associations spawned by funding of the Older Americans Act include an association with the Anders Foundation of Gerontology in the University of Southern California to form a local home modification action coalition. This has allowed members of our staff to become literally hands on experts in home modification addressing accessibility issues allowing for aging in place.

This model is earmarked to be replicated nationally by the University of Southern California. One more association that is relevant is our recent venture with Hamilton Larkin, a national development company specializing in affordable housing. Our innovative partnership is allowed for critical needed lower rent housing for our senior population wherein Older Americans Act programs are delivered to tenants and seniors from around the community. It also provides for over 20,000 square feet of recreation and life long learning space and provides an additional funding stream to augment the Older Americans Act programs.

Our collaborative partnerships have brought delegations from Japan who are currently studying our programs and innovations to be replicated for their elderly in need. One could term this collateral positivism of the Older Americans Act.

In closing, I want to touch on just a few specific topics that I know are of concern to your Subcommittee. In regard to means testings of Older Americans Act participants, we view this as a detriment to those seeking assistance that has the potential of stigmatizing those most in need. Cost sharing is best accomplished through less formal mechanisms allowing for each senior to give to the best of their ability.

In our agency, we engender a support network that educates those who cannot afford to do so to contribute more, allowing for those who cannot afford to contribute the suggested donation.

The issue of targeting from our perspective is still essential. Cultural barriers exist that hamper access to vital services of the Older Americans Act. Our mandate is to reach those elders in greatest social and economic need and it dictates a targeting modality that engenders cultural sensitivity and multi-lingual skills on the part of our staff.

Our experience speaks of a diversity in our agency that allows for an appreciation of our cultural differences and cognizance of shared concerns amongst our elderly population. Our diversity becomes our strength in advocacy and provides positive role modeling from the older generation down to the youngest generations throughout the community.

Our agency, I believe, is also representative of difficulties due to clouds of misperception from our community at large, despite our significant efforts of education and advocacy. In a word, ageism is still prevalent. A full 45 percent of our Older Americans Act participants are of very low income. The life choices that they must make every day are anxiety provoking and bring to mind two programs that at least in my estimation are critical in alleviating these burdens.

First and foremost, is the congregate meal program that acts as a gateway to program participation and its components of nutrition and socialization that serve as a lifeline.

The Title V senior employment program is also in critical need of enhanced funding. This program is underappreciated in that it allows our very low-income seniors to re-enter the job market and provide for their own day to day needs. This Older Americans Act program is again a tremendous example of dual objectives, providing critical income and prospects for a brighter future while each individual dispels the ageless attitudes of the community.

The Older Americans Act is perhaps one of the finest examples of public social policy in the nation today. Your predecessors have given you a formula from which to improve and enhance at this critical juncture as we anticipate more older Americans, more caregivers and more challenges facing our society. As a nation, as a community, we are counting on you.

Thank you for your time.

See Appendix F For The Written Statement Of Brad Berens, Executive Director, Santa Clarita Valley Committee On Aging, Santa Clarita, CA

 

Mr. McKeon. We have heard from several who are caregivers working in the program. Now last, but not least, we would like to hear from one of the elderly, one of your representatives who has participated in the program. We turn to Mr. Nate Golter who lives in Newhall, California.

Mr. Golter. Good afternoon, Mr. Chairman and Members of the Committee. It seems that I am the oldest person appearing before your Committee this afternoon and I appreciate the honor of being the anchorperson.

Allow me to introduce myself again. I am Nate Golter, 88 years old, shortly to be 89. I reside at Friendly Valley, a senior complex in nearby Newhall. My wife Sally and I have lived there for the past 9 years. From 1975 to 1990, we have lived in our retirement home built on a mountainside of 13,000 foot Mount Wheeler, the main attraction of the great Bateson National Park outside of Baker, Nevada. During 1987, I detected a change in my wife's mental capacity. We were living 60 miles from the nearest doctor and 90 miles from the nearest adequate hospital. As 1990 approached, I realized we needed to be closer to medical and hospital facilities, so we returned to Southern California and settled at Friendly Valley.

In a relatively short time we discovered the Santa Clarita Valley Senior Center. I enrolled my wife in the center's daycare respite program. The program engages enrollees in many activities to stimulate and enrich their lives. I firmly believe that Jackie Rivets and her loving, tender care staff through their efforts to lay the inroads that Alzheimer's tends to eventually victimize those caught in its clutches.

During this period I also availed myself of the excellent counseling program for caregivers. I took part in the group sessions every Friday and also took advantage of a one on one session. These two sessions with Judy Harris have been a lifesaver to me. Through the years when I was caring for my wife, these sessions preserved my health and sanity.

Alzheimer's takes a heavy toll of caregivers, burning them out before that of the victims unless the caregiver avails himself of outside support. That is when such programs at the Senior Center more than earn their keep and that is why many of us feel strongly that such programs and other similar activities at the senior center need more funding for their growth.

My wife had to be hospitalized in September 1996 when she could no longer bathe herself, dress herself and feed herself. She passed away on March 12, 1999. I will continue the therapy sessions so long as I can and once again become a volunteer at the center. Some of the other services I have availed myself are 55 Alive, recreation activities, Live, Love and Laugh, congregate meals, information and referrals, health and wellness and consumer lectures.

From a personal view I do not adequately possession command of the English language to express how I feel about the senior center's program for senior citizens of Santa Clarita Valley. Through my own experience I recognize the needs and appreciation the needs of other elderly citizens.

God bless the Older Americans Act.

[Applause.]

See Appendix G For The Written Statement Of Mr. Nate Golter, Program Participant, Newhall, CA

 

Mr. McKeon. Mr. Golter, you may feel that you do not possess an adequate command of English, but I think you did an outstanding job.

[Applause.]

What we will do is ask questions. The mike comes free and you can pass it around. If one of the others cares to join you at that table, that would be good_88 years old. You are almost as old as some of us up here. We have been trying to compare which one of us is the oldest, and as you can see, we are all getting close to where we are able and eligible for the programs, so I guess you can say that you have good support among the three of us who are all strong supporters of the program and getting stronger by the day.

Mr. Martinez. Did not we decide that Bill was the oldest?

Mr. McKeon. Yes, we decided that. We took a vote, Bill, and decided you were the oldest.

Mr. Barrett. Really? It took two of you to decide that? You guys are Congressmen.

Mr. McKeon. That reminds me of the time I was playing golf with Duke Cunningham and Duncan Hunter, and we decided we wanted Duncan, who is a much better player, to give us strokes. We decided democratically that we would have a vote, and Duke and I voted that Duncan would give us strokes. So you always want to check things out before you hold the vote as to how things are going to go and then you go ahead and vote.

Okay, we really again appreciate you being here, appreciate your comments. There are some questions, I am sure, that we would like to ask. I had a couple of them of Brad.

Sister, I have a good friend in Congress named Jack Quinn, and we are all Irish, so I understand that is what you were referring to. I will tell him of your testimony here.

Your comment, Brad, on the savings by being able to provide programs and help 50 percent of the people, you figured that that saved about $9 million a year by people being able to remain in their home versus having to go to some kind of an institution. Then if you multiply that across the country with all the different programs, how do you arrive at those numbers? I think that is a great selling point.

Mr. Berens. First of all, before I answer your question, I would probably be lynched by the crowd if I did not tell you that Stan C. Rand sends his best regards, and he is having eye surgery today. But he sends his regards.

[Applause.]

Mr. McKeon. I am sure nobody else has ever received one of his blue birds of happiness, but I have one on my desk here, and I have a whole little cubby on my desk in Washington that Stan has given me. Will you please give him my best.

Mr. Berens. I shall. To answer your question, as I mentioned in my testimony, I view the Older Americans Act as both preventative and remedial, but as I mentioned also that approximately 500 individuals out of these 7,000 who access services here at our agency are on the case management program. Now some may enter in and float out once we have done a quick assessment and done the information and assistance, they may get out. Yet, about half of those have been on case management for quite some time.

Again, it is my belief that these programs are remedial that is allowing them to stay in their homes. And how I arrived at that $9 million figure was and I am acutely aware of the differences between the Older Americans Act and those criteria for somebody to receive subsidized long term care.

Mr. McKeon. It is still all money, so_

Mr. Berens. Yes, but out of those 500 people, I figured that 250 are at imminent risk. Now at the average cost from $3,000 to $4,200 a month to provide for long-term care and I use the lover figure, I simply multiply 250 times 3,000 times 12 and you get $9 million and I believe that that is an accurate depiction of what this Older Americans Act does for our country.

Mr. McKeon. Thank you. I had one other question. You said the issue of targeting from your perspective is essential.

Mr. Berens. Yes.

Mr. McKeon. Could you expand on that?

Mr. Berens. I will have to give just a little personal background. I was brought up in the South Seas and parts of the Orient, my father being a Navy aviator, so I realized first hand as a white boy going into other cultures and naive of those cultures how the barriers that existed for me. So ins our own community and I am very proud to say that 25 percent of our 7,000 people come from minority households, but (a) our mandate under the Older Americans Act is to reach those in greatest social and economic need. And cultural barriers do prevent elders to come in here and access prograMs. It is only with a very viable outreach effort and a staff that reflects the demographics of the community that we can break down those barriers, build bridges and bring them in here. Once they are here, the appreciation that bounds from our 7,000 seniors is frankly, a magnificent feeling. I do not believe that we have broken down those barriers yet. I believe we have a long way to go. And I honestly, in my heart of hearts feel too that the older residents in our community serve as absolute role through the younger people who because they are young do not appreciate those cultural differences.

Mr. McKeon. Thank you very much. Mr. Martinez.

Mr. Martinez. Thank you, Mr. Chairman. Just to carry on with what you were saying, that was one of the big debates last session of Congress and I believe the session before when we were unable to authorize the Older Americans Act, the idea of targeting. The language there that those with the greatest need had been there since the inception of the Act, but there was in the last reauthorization added with particular attention to minorities. Now you just addressed that. And you give a very good reason. There are differences, cultural differences do create barriers. It is more than that. With the first language that we had, without particular attention to minorities, those minority populations were not being served. You just said it today, we have not completely closed the gap. Some of them are still not being served. So why would we change the language again and what does the language hurt if we are really trying to take care of those with the greatest need? You will find that in many cases among the minorities are some of the greatest needs. So I have had that argument and I will continue to make that argument, retain that cognitive language.

The aspect of cost sharing that disturbs me and the more I hear that terminology the more I am disturbed because it is really, when I got to thinking, this is really a false or misnomer. Cost sharing is when you cost share with something, with somebody and especially in the case of the government to produce a product that both will benefit by, the government and the person that is developing the product. That is cost sharing. This is not cost sharing. I think we ought to get rid of that terminology and start referring to it what it really is, encouraging, encouraging voluntary contributions and leave it at that. We can save ourselves a lot of misery and a lot of debate and a lot of headache. Now there are going to be some in Congress that you will never convince of that because they are of the opinion do not confuse me with the facts, my mind is made up.

[Applause.]

I would hope that people who are supposedly respected elected leaders of our country would stop being that way and would start thinking more in terms of what are the facts and let us operate from those facts. I am very encouraged because I think since I first met Buck McKeon, one of the things that struck me about him was his complete objectiveness and his fairness. Those are the two ingredients that you cannot build into a person, you cannot develop in a person. They have to be there to begin with and he has got them. And Bill Barrett, the same way. And I will always be grateful to Bill Barrett for fulfilling one of my life long dreams, that of visiting Boys Town which is in his district. And even there I learned that they have overcome all the barriers, cultural barriers that separate people and have learned to live as a real community. We could learn a lot by that. It is a community. They have their own police force, their own mayor, etc. and I saw that picture when I was a very young boy and it really impressed me. I always wondered if there really was a place like that because when you see it in the movies you know it has got to be fiction. You know, there is no such thing. Well, I always thought about it and I had to I guess to get closure on that idea see it and I saw it. So I am always going to be grateful to Bill for that.

But these are two people that I am working with now that are so different and earlier Buck McKeon said I do not know how we inherited the Older Americans Act and I think it was someone that said, Sister, you said, how does that get to be life-long learning, post-second and life-long learning, how does the Older Americans Act get into that? Because I think through the graciousness of a very good chairman, Bill Goodling, he saw that Buck McKeon would probably be the most ideal person to head that program up. And so I am very grateful. Somebody said earlier, the gratitude that they have given it over to Buck, I say amen to that. But I really think that we are going to get something done. I hope we can get away from this hearing and start referring to rather than cost sharing, encouraging contributions or voluntary contributions. I hope we can get our mindset on the fact that we still need to target. Those are two important things.

The other things that we need to concentrate on are and I think you have pointed it out very well that it is a cost saving plan because I think you are accurate in your figuring what it would actually save us in dollars. And we in government have always preached that, especially my colleagues from this side of the aisle, be cost effective. Nothing would be more cost effective than preventing something that is going to happen that is going to cost you more. It is like the guy with the oil filter, remember that ad? Pay me now or pay me later. And you are going to pay a lot more later. And so I think we have got to start thinking in terms of that as we move forward with it.

But I really appreciate your testimony. I really do.

And yours too, Sister. Oh, by the way, Sister, I know Buck was taking credit for being Irish and you may look at me and laugh at what I am about to tell you, but I am Irish too.

Sister Quinn. I will not laugh. I believe.

Mr. Martinez. Actually, my grandfather was from Ireland.

Sister Quinn. Is that right?

Mr. Martinez. He came to the United States and joined the Cavalry. In fact, I have got his discharge and pension from the Cavalry certificate in my office. My mother's maiden name was Helen Hayes.

Sister Quinn. Okay, then we should have no trouble getting this passed.

Mr. Martinez. Not the Helen Hayes. I used to have a lot of fun with that whenever_everything they require you to put down your mother's maiden name and I put Helen Hayes all the time and everybody looks at me like yes, sure.

Sister Quinn. We used to say Anthony Quinn was our cousin, but nobody would believe us.

Mr. Martinez. Anthony Quinn actually is from our neighborhood.

Sister Quinn. Is he?

Mr. Martinez. Yes. And he is half-Irish actually.

Sister Quinn. I think everybody is half-Irish.

Mr. Martinez. They have got to be, with those people that you see smiling all the time with a great disposition, you have got to be.

Sister Quinn. I have a little bit in him anyway

Mr. Martinez. Thank you, Mr. Chairman.

Mr. McKeon. Thank you. I did not know you were Irish. He has kept that from me. So now I know even more why I like him.

Okay, Mr. Barrett.

Mr. Barrett. Thank you, Mr. Chairman. Barney, I have got Irish blood in me too, okay?

Sister Alice Marie, I was touched by your moving testimony and your sophisticated approach to fund raising. I thank you for those comments very much.

Mr. Golter, I was impressed with your heartfelt testimony as well, very much so. I agree with Congressman McKeon_ you did a very nice job.

Mr. Golter. Thank you.

Mr. Barrett. I guess, Mr. Berens, my district is overwhelmingly rural, as you might expect, and in my part of the world we are faced with the problems of ruralness. I guess that would be a fair statement, and the Older Americans Act is designed to address all seniors and, of course, there are differences in Los Angeles and rural Nebraska. I guess my question to you is, what do you find to be the most challenging things facing you in your program in Los Angeles? What is the biggest problem that you have in urban America?

Mr. Berens. Well, as you might guess I wrote my testimony with you in mind.

Mr. Barrett. Other than dollars.

Mr. Berens. I am not blowing smoke here when I say that_well, first of all, I feel that those of us here in Santa Clarita are very blessed, but it is beyond that when we talk about the Older Americans Act. This gentleman sitting in front of me, Mr. Robert Ryans, and by prefacing this I am going to answer your question, takes a tremendous_from their jurisdiction in the area Agencies on Aging, allows me, especially going into this new year to treat each community and their needs differently. And he structures the funding that comes from the Older Americans Act, but gives us the ability to address the needs of the seniors in our community with flexibility.

One of the things that has really been a problem for us as an agency in the past in rural areas is that frankly it costs us a heck of a lot more to deliver those meals than it does for somebody, to one of the speakers before, who may do it in a 50 square mile area, they may do it in a 50 block square area, yet we are doing 300 square miles. So Mr. Ryans and his staff have heard us over the years and they are allowing us to submit our proposals to access those with some flexibility, recognizing the needs.

Now having said that, addressing the needs in our rural communities, it requires additional staff. There is travel time. It costs us a heck of a lot more money to do the same services that it takes in the city. But then that brings me full circle back to our community. The Older Americans Act gave us the ability to put together these core prograMs. It gave us the abilities to go to our City Council. Buck, in the beginning when I came here, now Mayor Darcy, the community now rises, a lot of the community, and the seniors, mostly themselves, rise to the community to fill that gap in terms of funding that we need out here to serve our rural community, if that answers your question.

Mr. Barrett. Yes, and that is one of the reasons I asked the question because that is one of the primary problems that I have in my district. I chuckle when my two colleagues talk about their districts, the size of their districts being several dozen or perhaps a few hundred square miles. My district is one of the largest in the United States. My congressional district is larger than 30 states in these United States, over 63,000 square miles. We have problems which are entirely different than some of yours.

Mr. Ryans, would you care to address the same question that I asked Mr. Berens.

Mr. Ryans. And let me thank Mr. Berens for those kind remarks. I was particularly taken by the size of your district and that is why we have a lot of innovation prograMs. I mentioned we have 4,000 square mile county. What we do is have a mobile mental health programs and mobile nutrition at risk programs that allow us to go to the at risk senior. We find that mobility is a more increasing issue, especially up here you have home delivery meal routes which I think McKeon may know are quite extensive, 45 to 90 miles, so we have to give the kind of flexibility to the programs that will allow them to address some of that, but having innovation programs that are interdisciplinary and mobile in nature, I think fit our area and would possibly fit your area as well and we did provide some fact sheets on that which I would hope you could include as part of your testimony.

Mr. Barrett. Thank you very much. Thank you, Mr. Chairman.

Mr. McKeon. That concludes our hearing here today. What I would like to ask those of you on the panel is if you will keep watch as we go through this process, and if you think of something more that you would like to add, we will keep the record open. If you send it to us, we will add that to the record. As we go through the process, if you see us kind of heading in the wrong direction or if you see or think of something else that we should be looking at, please let us know, because that is how we will hopefully make this something that will be responsive to the people that are using and administering the program.

Thank you very much. And again, thank you all for being here today. We really appreciate your attendance.

Thank you.

[Whereupon, at 4:03 p.m., the Subcommittee was adjourned.]

Statement Of Mark Intermill, Administrator, Division Of Aging, Department Of Health And Human Services, Lincoln, Nebraska. *

Statement Of Andrew Mueller, Director, West Central Nebraska Area Agency On Aging, North Platte, Nebraska. *

Statement Of Sydney Byrd, Director, Winnebago Senior Center, Winnebago, Nebraska. *

Statement Of Donetta Nye, Howard County Service Director, Hastings, Nebraska. *

Statement Of Marjorie Mickelson, Program Participant North Platte, Nebraska. *

Statement Of Mary Rucker, Program Participant, North Platte, Nebraska. *

Statement Of Betty Kenyon, Nutritionist, Panhandle Community Service, Gering Nebraska. *

Statement Of Debra Holcomb, Associated With Green Thumb *

Appendix A- The Written Statement Of Mark Intermill, Administrator, Division Of Aging, Department Of Health And Human Services, Lincoln, Nebraska. *

Appendix B- The Written Statement Of Andrew Mueller, Director, West Central Nebraska Area Agency On Aging, North Platte, Nebraska. *

Appendix C- The Written Statement Of Sydney Byrd, Director, Winnebago Senior Center, Winnebago, Nebraska. *

Appendix D- The Written Statement Of Donetta Nye, Howard County Service Director, Hastings, Nebraska. *

Appendix E- The Written Statement Of Marjorie Mickelson, Program Participant North Platte, Nebraska. *

Appendix F-The Written Statement Of Mary Rucker, Program Participant, North Platte, Nebraska. *

Appendix G- The Written Statement Of Betty Kenyon, Nutritionist, Panhandle Community Service, Gering, Nebraska. *

Table Of Indexes *

The subcommittee met, pursuant to call, at 9:00 a.m., in the West Central Research and Extension Center for University of Nebraska, Hon. Howard P. "Buck" McKeon [chairman of the subcommittee] Presiding.

Present: Representatives McKeon, Barrett, and Martinez.

Staff Present: Cindy Herrle, Lynn Selmser, and Maryellen Ardouney.

Chairman McKeon. Good morning. It's a pleasure to be here in North Platte, known for Buffalo Bill and Congressman Bill Barrett; that's a great combination of "Bills."

I want to thank Congressman Barrett and his staff for helping us with this Older American's bill. He has put in a bill, co-sponsored by Mr. Martinez, myself as the leader of the full committee and has really been the force that is driving us on getting the Older Americans Act reauthorized this year. And it has been a real pleasure to be working with both of them on this.

We held a hearing in Washington, and then we've held, in the last couple of days, two hearings in California, and now this hearing; and then we'll be moving back to Washington and holding a couple more hearings. And I hope to get the bill passed early this year, before we get too much into the political season.

Being in Congressman Bill's district, I would like to yield to him for an extensive opening statement.

Mr. Barrett. Mr. Chairman, you're taking advantage of that sore throat, you know that.

Thank you; but let me say that it's nice for me to be back home too. We have been on an extensive two-week Easter recess, and we'll be returning to Capitol Hill next week to continue our work in the 106th Congress, the first session.

It's been a pleasure for me to work with my colleagues here today, Congressman McKeon from the 25th District of California and Congressman Martinez from the 31st District of California. We have formed an interesting and friendly relationship.

Mr. McKeon and I represent the majority party in the House of Representatives, and our good friend and colleague, Mr. Martinez, represents the minority party in Congress.

Interestingly enough, at a breakfast earlier this morning, Mr. Martinez . . . "Marty" as we know him, and "Buck" as we know the chairman . . . Marty made the comment when he came into the House of Representatives he came as . . . the minority when you started?

Mr. Martinez. Yes.

Mr. Barrett. And then you went to the majority and now it's back to the minority. So things do change in the House of Representatives in spite of what you folks might think.

The hearings for the last two days in California have been very interesting and very productive. I think we all agree that the information gleaned from Southern California will be most helpful as we begin drafting the bill which will reauthorize the Older Americans Act.

As most of you know, this hasn't been done for the last four years; the 104th Congress was unsuccessful, the 105th Congress also unsuccessful; now the first session of the 106th, the three of us are convinced the Older Americans Act will be reauthorized in a bipartisan way.

Interestingly enough, things do happen in a bipartisan fashion in Congress, and we think that this is an excellent example of how that will happen again.

We have been in Southern California for a couple of days. One of the reasons that I told Buck that I would join him in Southern California is because I look forward to the sunshine in Southern California; I look forward to going to the beach; I look forward to even playing a quick round of golf if we have time in beautiful, sunny Southern California.

I've got to tell you folks, it was nicer in Nebraska the last few days than it was in Southern California. I haven't let these two gentlemen forget it.

Interestingly enough also, the warm is turning because I understand the weather report calls for rain, wind and lower temperatures in Nebraska today.

Chairman McKeon. We brought it.

Mr. Barrett. Yes, you brought it.

Well, I want to take also a moment to thank the people of North Platte for their time and their trouble in providing this forum for us.

And I thank those of you that are here this morning for your attendance, interest and consideration in the Older Americans Act.

Obviously the Older Americans Act is the major federal vehicle for supplying the organization and the delivery of services, nutritional and otherwise, to our seniors. And it's imperative that we reauthorize this legislation this year. And I repeat myself, but I'm convinced that we will get it done.

I made a statement earlier at breakfast that Marty and Buck and I met in Washington a couple of months ago for a breakfast meeting to talk about how we're going to handle the reauthorization of this very important piece of legislation.

One of the questions that we discussed at that breakfast, just the three of us, was: "Shall we try to reauthorize the act for five years or four years?"

Well, I happen to believe that we should authorize it for five years.

Marty said, I tend to believe that maybe we ought to reauthorize it for four years.

So Mr. Chairman, McKeon, said, Well, how are we going to handle this? How are we going to resolve this little problem between four and five years?

Marty said, Let's flip a coin. We flipped a coin; I lost; it's now four years.

That's the way we've been working together in a cooperative manner, again in a bipartisan way, which is so important to what we are about, to provide the services that are so essential to our seniors.

So I think we're off on a fast track. We will be trying to elicit information from our outstanding panel of witnesses here this morning as we did in the two hearings in California as well.

So, Mr. Chairman, thank you very much for allowing me this time. Thanks for being with you again and also for you, Mr. Martinez. Glad you're both in rural Nebraska where you can now learn the problems of rural America as opposed to my learning the problems of no sunshine, no water, and no golf in Southern California.

Chairman McKeon. We're never going to get over that. I can see it. Years from now we'll be hearing about "Sunny California.".

Mr. Martinez. Liquid rain.

Chairman McKeon. Right. I told him that our sunshine wasn't always dry; sometimes it's liquid.

Mr. Barrett. And it was.

Chairman McKeon. Mr. Martinez?

Mr. Martinez. Thank you, Mr. Chairman. I'm going to submit the opening statement for the record and try to be very brief because I'd like to hear from the witnesses. And besides both of you had a very good opening statement, as you did at the other two hearings, and I need not bore these nice people with what some people might consider rhetoric.

I just want to say that what we're doing here today and why I feel more confident than ever that we'll get it done is because of the people that I'm working with.

The last two congresses have been very difficult and the extremes were too extreme, would not come to the center and compromise. I don't believe that is the case now. I think we can pretty much work out any problems we have or any differences we have.

One of the reasons why it is so important to get this thing reauthorized is because for the last four years it really has been in the hands of the appropriators as to the levels of funding.

And there are improvements that we need to make to the bill to make the systems more efficient and more effective in the way we deliver them to the seniors.

And, of course, there are always little improvements that have to be made from the experiences that the people who are administering the services have encountered. I, for one, believe that some funding levels should be increased and we should try to do that. I also believe that some of the services and the way they are delivered have to be modified.

And I think that over the next couple of hearings we're going to have in Washington, D.C., we will have more evidence of that; and when we come together and sit down and start to sort of bumping our heads together and try to figure what the best thing to do is, we will come to a mutual agreement, and we will come with a bipartisan bill.

I'm hoping that when we get to the floor it can be the last time we reauthorize the Older Americans Act. The same way, we didn't get one dissenting vote off of the floor of the House. And I think that was testimony of the fact it was a bipartisan bill.

And, traditionally, the Older Americans Act has always been bipartisan. And it's only been over the last four years that it's kind of gotten into a partisan wrangle over certain parts of the Act; but like I say, I'm more confident than ever that we'll be able to move forward to get something done.

So thank you, Mr. Chairman.

Chairman McKeon. Thank you.

Mr. Barrett, would you please be so kind as to introduce our witnesses.

Mr. Barrett. I'd be happy to. Thank you, Mr. Chairman.

Again, we have an outstanding panel today. Leading off, Mark Intermill, the Administrator for the Division of Aging Services, Department of Health and Human Services for the State of Nebraska. Prior to coming to this state, Mr. Intermill was the Director of the Kansas Coalition on Aging, the public interest advocacy organization based in Topeka.

We have also next, Mr. Andrew Mueller, Director for West Central Nebraska Area Agency on Aging here in North Platte. He's also held that position, the position of fiscal officer for West Central Nebraska Area Agency on Aging. Andrew, nice to have you as well.

Mr. Mueller. Thank you.

Mr. Barrett. Sydney Byrd is the Director of the Winnebago Senior Center in Winnebago, Nebraska, and obviously she came a long distance to be with us today. Thank you, Sydney.

Donetta Nye currently holds the position of the Howard County Services Director. She's also a former president of the Nebraska Association of Senior Citizens from St. Paul, Nebraska, also coming from a distance to be with us.

Marge Mickelson is an active member of the North Platte Senior Center. She is also a resident of North Platte.

Mary Rucker is the Community Service and Coordinate Program participant. She has obtained a position with the Red Cross through the Green Thumb program, which is an integral part of the Older Americans Act.

And Betty Kenyon serves as the nutritionist with the Panhandle Community Service out in Gering, Nebraska. She's also a consultant for numerous health care facilities, meal programs and human services programs. She comes to us from Mitchell, Nebraska. I understand she got up at 3 o'clock this morning to drive to North Platte with her husband to be with us and to be also a member of this panel.

We thank you each and every one of you very much for being here.

Thank you, Mr. Chairman.

Chairman McKeon. Thank you.

We have a system that we would like to follow. You each will have five minutes. Your full statements will be incorporated in the record, but if you have more than five minutes please consolidate your comments. Usually, we have a green light that comes on that says your time is now going; and when you have a minute left, a yellow light comes on; and when your time is up, a red light comes on and the trap door opens up and you're sent into never-never land.

But we don't have the lights, so we have . . . Lynn is going to raise "time." .

[Staff raises a card showing time remaining.]

Chairman McKeon. You will know; I won't know it, but please if you will follow whatever card is up.

This morning Ms. Nye was asking that if we ever get nervous, and I assured her that we're always nervous; but don't be nervous. I know we are all among friends here, and the important thing is we are here, all of us are here to learn and gain from your expertise.

So we'll begin with Mr. Intermill, please.

Mr. Intermill. Thank you, Mr. Chairman. I want just want to express my appreciation to the members of Congress who are here today and for their efforts in reauthorizing the Older Americans Act.

There has been sort of a sense of unease in the aging network, I think, over the past four years as the Older Americans Act has sort of languished. And I'm very encouraged by the words I've heard today and the bipartisanship with which you're addressing reauthorization.

And I also appreciate the way the decisions are made in Washington with the coin flip; and, Congressman Barrett, I do have a two-headed coin back at the office I am going to send you.

Mr. Barrett. I'll talk to you.

Mr. Intermill. Between the time that I submitted my written testimony and today, I received a summary of the Administration on Aging's proposal on reauthorization of the Older Americans Act, so my comments today within the five-minute time frame will be made in context of that proposal comparing it with some of the key points that were included in the written testimony with similar experiences in administrating the Older Americans Act in Nebraska.

And one area that I want to focus on is there is a new section in the Older Americans Act or the proposal from the Administration on Health Care Information Counseling Advocacy and Coordination. This is a service that . . . this is important.

I think that the Older Americans Act is an underutilized resource in efforts to contain Medicare and Medicaid costs. And in Nebraska we are attempting to use the aging network to contain Medicaid costs in the long-term care arena and also in our efforts in health promotion and disease prevention.

But my comments with regard to this section are related to allotment of funding for the State. This section requires that the state assure that demonstrable efforts remain to take certain actions in support of providing health care information and counseling advocacy and coordination.

As is the case for all states, assurance is required by the Act; it applies to a state whether it has a 60-plus population of 300,000 or 41/2 million.

There's a basic level of activity that must be performed just by virtue of being a State unit on aging. Allotments that are based solely on population fail to take this into account, and as noted in written testimony, I would like to see a base allotment incorporated into the intra-State funding formula to assure that less populated states have an opportunity to effectively administer the Act.

The Administration's proposal on cost sharing, they . . . I agree with the proposed language except for the provisions that prohibit cost sharing for certain services. I have some reservations about cost sharing, but in Nebraska the prohibition of using cost sharing for case management services may create a conflict with State statute.

There are some certain services that I don't believe cost sharing makes sense, but I prefer to see that decision arrived at locally or at the state level as opposed to a blanket coverage.

There is a provision in the Administration's proposal on waivers of certain parts of sections of the Act, and this will increase opportunities for creativity and flexibility in our administration of programs in state and area agencies on aging. And it also may provide a means of resolving potential State statute conflict on cost sharing.

The Administration proposal continues the current method of allotting USDA cash in lieu of commodities, which we support. We believe this is the best way to provide incentives to provide additional meals through that program.

The AoA proposal had a section on performance outcome measures, and AoA is proposing to develop a set of performance outcome measures in collaboration with a representative group of states and their Area Agencies on Aging.

Performance outcome measures are an important tool and a show of accountability for the expenditure of taxpayer funds, but they'll be most useful if they are developed at the point where decisions are being made about how funds are going to be used.

To be effective they need to be developed at the state and area level. It may be more appropriate for AOA to establish a method for states to use rather than actually determining what those outcome measures will be.

The final thing I would mention as section 126 of the Administration proposal is the National Family Caregiver Support Program. This is an important initiative. Caregiver support is one of the seven outcomes that the State of Nebraska the aging network in Nebraska has selected. It makes sense for a lot of reasons.

My reservations about the sub-part of the title is that all of the services that are proposed for the new title III-D can also able funded by title III-B, so the proposal, in essence, earmarks supportive services funding for specific subclass of older persons, persons who have a family caregiver.

My time is expired. Thank you very much.

See Appendix A For The Written Statement Of Mark Intermill, Administrator, Division Of Aging, Department Of Health And Human Services, Lincoln, Nebraska.

Chairman McKeon. Thank you. Mr. Mueller.

Mr. Mueller. Distinguished Members of the House of Representatives, let me take this opportunity to welcome you to Central Nebraska and North Platte again. I'm here to testify on behalf of the eight Area Agencies on Aging across the state of Nebraska.

The Older Americans Act is a marvelous piece of legislation. We often hear about certain documents or legislation as being living documents meaning that they change, grow, and adapt as the country changes.

The Older Americans Act is certainly a living piece of legislation. The authors of the original act back in the early to mid '60s penned a statute that allowed the individual local governing units administering the Act to decide what services and programs are essential to the older individuals in the service area.

As you're all aware, over the past few years the Older Americans Act reauthorization has encountered many stumbling blocks. Nebraska has divided these issues into three categories: Streamlining of programs and services, prevention, and financing.

And I'm going to address the issues related to streamlining of programs and services.

As you are maybe aware, the funds come to the states in the form of title programs. Title programs are designed to fund specific activities. As I mentioned before, the funds come down in the title programs, and in some instances it ties the hands of local policymakers.

The Nebraska aging network would recommend the combining of title IIIB and title IIID because both provide for the provisions of home-based services. In the same note it is our feeling that title IIIC1 and IIIC2 should also be merged. The difference between the two has to do with where the meal is provided.

The role of an area agency on aging is to develop a comprehensive and coordinated system of aging services and its planning and service area.

As the service delivery systems have developed, the roles of the area agency on aging have changed. We realize and understand the importance of using community organizations and resources to provide services; however, there are legitimate times when it is necessary for an area agency on aging to provide the direct delivery of services.

We believe the title V funding should be administered through the State units on aging. The states would then be free to engage services of existing national contractors if it was determined that such actions would best meet the program priorities established.

If the current system of using national contractors is mandated, we feel there should be additional reporting by the national contractors for State units on aging.

Also as a part of the national contractors' annual plan of operation, the State units should be required to provide feedback relating to the performance of the national contractors to the U.S. Department of Labor.

As Mark mentioned, the Administration has proposed increased spending on respite care for America's older citizens. The aging network in Nebraska supports this legislation. In Nebraska there are over 35,000 older Nebraskans that have a mobility or self-care limitation indicating the need for community long-term care.

In the most recent fiscal year nearly 13,000 individuals have received community long-term care services from the aging network in Nebraska.

Historically, Nebraska has had a high proportion of its elderly population who reside in the nursing facilities. In 1990 Nebraska's nursing facility rate was 52 percent higher than the national rate.

The difference between Nebraska's rate and the national rate is narrowing. Nebraska's rate in 1996 was only 36 percent higher than the national average.

People in need of long-term care services have the possibility of financial disaster because neither private medical nor Medicare covers long-term care depleting the assets of most before Medicaid eligibility occurs.

If the National Family Caregiver Support program were enacted, the area agencies on aging would receive additional dollars through the Older Americans Act to provide critically needed services that support caregivers.

My message today is quite simple. As you know, we need to reauthorize the Older Americans Act in this Congress. As well, we need to take a long look at how America is funding its long-term care.

We need to continue to make sure that the Act remains a living piece of legislation allowing local decision making to insure that these quality services are provided for older Americans.

Thank you for allowing me the opportunity to testify, and I'd welcome your questions.

See Appendix B For The Written Statement Of Andrew Mueller, Director, West Central Nebraska Area Agency On Aging, North Platte, Nebraska.

 

Chairman McKeon. Thank you very much. Ms. Byrd?

Ms. Byrd. Good morning, Mr. Chairman, Mr. Martinez, and Mr. Barrett; thank you for inviting me here to testify.

My name is Sydney Byrd; I'm from Winnebago, Nebraska. I'm the title VI . . . I'm chairman of the National Association of Title VI for the needy.

I also represent the National Indian Council on Aging and the National Association of Area Agencies on Aging and a board member of each organization.

The Older Americans Act is a very important one for Indian country. Title VI of the Act is a major source of support for social services for our elders and especially for provision of meals.

Chairman McKeon. Ms. Byrd, could you please get the mic a little closer?

Ms. Byrd. Can you hear me now?

Chairman McKeon. Okay. Thank you.

Ms. Byrd. If you need to, tell me to slow down. I speak too loud anyway.

The other part of the Act that we are concerned is with title V that is employment for our low-income elders. We have many elders who are in need of employment, who lack training, who do not qualify for any kind of services. And with this program a lot of them would be able to support themselves until they reach the age of 65.

We also have title IV that has been instrumental in providing research and training opportunities to many of our elders and those who serve them. We have lost our training for our title VI directors and we are in great need. There are a lot of under-educated directors who are unprepared on how to provide services for our elders.

We also have the family caregivers support--the family caregivers support program. We also recognize that the Indian population is not being included in this. Indian family caregivers also are in need of support and assistance and should be available and include them. Already established mechanisms that should be consistent with the trust and responsibilities of the U.S. Government.

We have several people on our reservations throughout the country that are striving to get by; and with incomes that are lower than the poverty guidelines, it's very hard for them; they are very dependent on our program. We are in need of having the reauthorization of the Older Americans Act this year.

I would like to thank everybody for inviting me here to testify on behalf of my elders. And one of the things we always ask is that you come and visit our programs across the country. We have programs almost in every state, and if there's anything that we can do to show you the need that we have out there, you can see firsthand the needs that are there and the needs that are not being met.

With this I thank you for inviting me here.

Chairman McKeon. Thank you very much.

See Appendix C For The Written Statement Of Sydney Byrd, Director, Winnebago Senior Center, Winnebago, Nebraska.

Chairman McKeon. Ms. Nye?

Ms. Nye. Good morning.

Chairman McKeon. Good morning.

Ms. Nye. Chairman McKeon, Mr. Martinez, and Mr. Barrett, my name is Donetta Nye, Howard County Service Director, St. Paul Senior Center in St. Paul, Nebraska, and I work for Midland Area Agency on Aging, Hastings, Nebraska.

I want to thank you for the opportunity to speak about the reauthorization of the Older Americans Act. I've been asked to speak on our outreach work in Howard County that has connected members of Howard County to our senior center, and also cost sharing.

Senior centers represent an important entry point into the aging system and into the continuance of long-term care.

Centers work with a wide variety of organizations and through these linkages provide their users with a wide range of services and a continuum of care that ranges from the least intensive to the most intensive.

Senior centers are often the first support service sought by individuals, his or her family or friend.

The role of our senior center is to reverse or delay the downward spiral toward the need of more intensive services. We believe that senior centers are a preventive social service in action. Senior centers have a mixed public identity. The term senior center is used to refer to a broad range of organizations and meal centers and social clubs to complex and sophisticated multi-service agencies.

The St. Paul Senior Center's goal is to be recognized by the people of Howard County as a source of information and referral and a provider of a variety of services and programs making us a community focal point.

In some areas the senior centers are nothing more than a glorified aging colony, places for poor people, women, frail elders and other old people. The poorly defined image that senior centers represent of older people, the general community and professionals has resulted in low visibility, and has oftentimes created a negative view of centers by the public.

In Howard County there was a need to create a positive, clear, and consistent image of the St. Paul Community Center in the comprehensive services provided to a wide range of elders and not just a meal and/or recreation provided.

The St. Paul Community Senior Center has tried to be thought of as an education, information, and wellness center.

This center has . . . we have taken an aggressive approach to marketing the senior center as a community focal point by providing outreach to all seniors in Howard County by doing home visits to newcomers and presenting them with a goody bag which contains center brochures, free coupons for transportation, a meal coupon, other surprise items, along with our phone number and address in a magnet for easy viewing.

To improve our image the St. Paul Community Senior Center has gained recognition, respect by capitalizing on our own uniqueness, being responsive to all needs of the community, seeking to have individuals as members of our board and advisory council and to continue to develop these promotional materials describe the benefits of the Senior Center Outreach and Care Management programs.

The center aggressively markets our services both to the targeted population and to the more affluent as well and the younger elderly.

It is the participation of the latter group that will help to ensure the financial soundness of senior centers now and in the future.

In order for the St. Paul Community Senior Center and other centers across the state of Nebraska to continue to promote our senior centers and to create a focal point for all seniors there has to be an increase in funding to aggressively market ourselves.

Today both the aging process and our youth orientated society tends to erode the self-esteem and sense of worth of many older persons. At the same time, retirement, decreased mobility, reduced income, and lack of friends and relatives isolate many elderly from basic social contact.

The senior center with its variety of programs and services can enhance the lives of its participants by providing them with a daily peer contact and meaningful opportunities to participate in mainstream society.

Senior centers play an important role in the lives of many older Nebraskans by providing a facility in which they can meet one another and fulfill many other social, physical and emotional intelligent needs.

On cost sharing, I realize that cost sharing is not a new thing for senior centers. In its basic form, meal contributions and intensive volunteerism has been an element of senior centers since inception.

Also we found that, you know, if we explain to them about the need for increase and treat them as intelligent adults, that they will . . . the ones that can afford to . . . contribute more to it.

Also I believe that the upcoming generations are going to want to pay for services that they receive.

Again, I thank you very much and didn't realize five minutes could go by so fast.

Ms. Selmser. You've still got ten seconds left.

Ms. Nye. That's okay. If you let me, I'll talk longer. You're better off cutting me off now.

See Appendix D For The Written Statement Of Donetta Nye, Howard County Service Director, Hastings, Nebraska.

 

Chairman McKeon. Thank you. Ms. Mickelson?

Ms. Mickelson. Okay. As you know, my name is Marjorie Mickelson, and I'm going to be talking more about the senior center in North Platte because the meeting is held here, but it's about Older Americans Act too, but mostly about our senior center.

And our senior center is 20 years old, and I've been coming to it for eight years. And then we . . . about five years ago we had a fund raising, and so we updated our senior center and it is really nice. And we had some outside landscaping to do and they're going to put some horseshoe pits in and some shuffleboard for the seniors there; and that might be an idea for other people.

And so inside our senior center now we have a fantastic kitchen, and our kitchen help loved that. And then we have a beautiful dining room, and at one end of our dining room we have card tables set up with all kinds of cards: Pinochle, pitch, cribbage, anything you want.

And then over in the corner somebody donated us a big beautiful table, and there are jigsaw puzzles on there. And right now it's a thousand pieces and a lot of people love doing that.

And then we have beautiful bathrooms now; we don't have to stand in line for a long time. And then we have another older room that was an older part of our senior center. And in this room we have three pool tables that's full all the time; we have shuffleboard tables that are used.

And then we have a TV and exercise bicycles and then they have videos where they can put in and they have line dancing, and they teach line dancing and square dancing and they have dances at night that come in there.

And then twice a week we have an exercise class and it is full. This room is a big room, and it is full of people that will get most creative exercising.

And we have a Handi-Bus that comes, and there's lots of people out there that can't drive cars or anything, so they come early so with all this recreation we have, people can do something instead of just sitting there waiting for their dinner and everything. And if they want to stay in like the afternoon till three or 4 o'clock, the bus will come back and pick that party up, so that's very nice.

Also our meals cost $2.50 for senior citizens and if you're younger than 50 then it is $3.50. There are people out there and everywhere that haven't the money to have a meal, so the senior center or some others pay for that meal, so those are free. And nobody ever thinks about that and there are probably a lot of people that don't know that. And thank goodness they have something to eat.

And we have meals on wheels, and we have about 160 of them and we have volunteers that need lots of pats on the back that do this for meals on wheels. That's not an easy job. And we have a lot of volunteers anyway.

And then on Saturday we have woodcarving, people come in there and sit in our centers and carve wood and make beautiful things. And then Saturday night we have bingo, which they serve a lunch, and it helps the senior center.

And now, does everybody know about Nebraskaland Days? Okay. We get to have the senior Olympics this year at the senior center. And we're hoping all the staff and everybody, because there's lots of people that do all the games and come and they will be the first time to come to our senior center, and I think as nice as our senior center is, they'll be back. And we're all hoping that. And I like that.

And my husband, he's a pool player and a golfer, so see, he could have went golfing here because it was nice; it was 70 degrees. Anyway... Sorry about that, but . . . and they were golfing; Sunday they were golfing.

But it's great. And I think my time is about up too. No?

Ms. Selmser. You've got about 40 seconds.

Ms. Nye. Well, anyway, I like to talk a little bit, but this is not really my thing, but I like to talk about the senior center, and I love it.

And my brother said . . . I said, Well, I don't know. Five minutes.

And he said, Don't worry, he said, because they will turn on the green light and the red light for you.

But anyway, thank you for coming and letting me talk, and I hope I did a good job.

Chairman McKeon. Thank you. You got me really excited by the . . . .

Ms. Nye. The golf, I know.

Chairman McKeon. No, no. I kind of like the wood carving idea and some of those other things.

Ms. Nye. Oh, that is really neat. They have . . . Well, I have a little bit of time yet. RSVP has their offices there and AARP come and then potluck and things at our senior center. And they have a weight class that comes in and meets once a week. And we do really lots of things and a lot of volunteers. And then it's greeting people and we know each other and it's fun to be with older people.

See Appendix E For The Written Statement Of Marjorie Mickelson, Program Participant North Platte, Nebraska.

Chairman McKeon. Thank you very much. Ms. Rucker?

Ms. Rucker. I am Mary Rucker, a lifelong resident of rural western Nebraska. I currently live in North Platte. Most of my life I lived on the farm. After I married, I quit teaching to stay home and raise my family. We raised three children; two daughters and a son. We were farmers and ranchers. When my children were older, I took a part-time job as a waitress and a cook in Maywood.

In 1975 we discovered my husband had cancer, and it became necessary that I quit my job in Maywood to care for the family farm while my husband was receiving treatment in Omaha for eight weeks.

In 1980 we moved into Maywood; his cancer was in remission. However, 1984 he had a heart attack. Soon after that we discovered his cancer was active again. It was too late for treatments, and he spent many days in the hospital in Grand Island and passed away in 1985.

After that I worked as a cook and housekeeper in Curtis about six miles from Maywood. A couple years later I was offered a job as a manager's assistant and moved to North Platte. I also worked as a bookkeeper for six years here.

I had an opportunity to care for my sister who was ill and her husband who had Alzheimer's.

My first contact with Green Thumb was when I volunteered to sell tickets at a softball game where I met Harvey Wallace. Harvey was a program aide for Green Thumb and he told me if I ever needed a job to contact him.

When my sister and her husband entered the nursing home, I called Harvey. He interviewed me a few days later and asked me what I'd like to do. I told him that I like clerical work. So Lutheran Family Services consented to be a host agency. I worked there for almost two years. While there I learned some new skills including how to process insurance claims.

My Green Thumb field coordinator constantly encouraged me to continue learning and suggested that I transfer to the American Red Cross that I did in January 1998.

This assignment offered me newer opportunities to learn and develop my skills. In addition the subsidized housing facilities where I live is very close to the Red Cross. So the new location limited the amount of driving I had to do in winter as well as my transportation costs.

The Red Cross gave me the title of director of volunteers. My top priority is the blood drive that we have every Monday. It is my responsibility to organize the volunteer shifts for the blood drive from these sponsor groups.

On Monday morning I clean and sanitize the kitchen and canteen area, we furnish supplies and host the sponsors for the day.

After the caller sheets come in I transfer them to the regular schedule and make as many calls to the donors as time permits. I monitor the activity throughout the day.

Red Cross also offers health and safety classes. I register the class participants, make reminder phone calls, type up the instructor cards, set out supplies, and assemble the mannequins for each class.

After the class I put all the supplies away, transfer the class information onto the instructor cards, send invoices and mail certificates to the attendees. I schedule the classes at which the instructors who they too are volunteers.

The Red Cross is supported largely by donations and volunteers, and I am privileged to work with such giving people. Since my resources are limited, I very much appreciate the compensation from Green Thumb.

This income I receive from Green Thumb gives me the opportunity to meet my needs without assistance. I understand the goal of the program Green Thumb operates is finding a job. I have made some inquiries concerning work, but I feel I cannot give 100 percent to any employer because of my diabetes and arthritis.

I am interested in learning more computer skills and intend to check into computer training at the North Platte Public Library.

I believe these skills would give me more employable. Working with Red Cross and Green Thumb has given me an opportunity to learn and to gain experience and to contribute to my community. It gives me a reason to get up in the morning. Thank you for your time.

See Appendix F For The Written Statement Of Mary Rucker, Program Participant, North Platte, Nebraska.

Chairman McKeon. Thank you. Ms. Kenyon.

Ms. Kenyon. My name is Betty Kenyon, I'm a registered dietitian. And I don't consider North Platte as western Nebraska because I live 175 mile west of here. And yes, I did get up very early this morning.

As a registered dietitian I have about 40 . . . more than 40 years of experience in nutrition, and so I'm going to address this mainly in areas of nutrition, since that is my expertise.

I think one of the most important parts of the congregate meals is the nutrition, but also the socialization that occurs. It was very interesting to me to hear what Marjorie had to say about all the things that go on in North Platte.

Ms. Mickelson. Thank you.

Ms. Kenyon. I am very concerned about the nutrition of an older population . . . and I don't say old, because that includes me.

I was director of a commodity supplemental food program when I first came to work for Community Action Agency. When we opened that program to the elderly, people over 60, we had many people standing in line, and there were many women who at that time were living on $300 a month social security. And that additional box of food made a great deal of difference to those women; however, it did not provide the socialization that you will find in a congregate meal site.

I do have some specific concerns about nutrition in congregate meals. At least in our local program, there is a requirement that there be butter or margarine every day. I don't understand why. We are trying to cut fat in the American society. Why is this a requirement?

There is also a requirement there be a half-cup of dessert a day. I'm sure that that dessert is sometimes fruit, but why is dessert a requirement? It's nice, and I wouldn't want to cut dessert out, but let's not make it a requirement.

Congregate meal sites don't generally provide modified diets, diets for diabetics, diets lower in sodium; but it seems to me like it's time the congregate meal sites in general provide diets that are more with the healthy guidelines. School lunch has done it. Isn't it about time the congregate meals did this as well?

I do not believe the meals should be spartan. I wouldn't want to put everybody on a no sugar, no salt, no fat diet; but I think it's time congregate meals go the direction that school lunch has gone with things like two percent milk and . . . not like farm women cooked, but more like people really should be cooking in this day and age.

Some healthcare facilities provide modified diets for meals on wheels. I happen to work as a consulting dietitian, I have one hospital and one nursing home that provides these meals.

These meals are modified diets, and they do need to be checked by a dietitian or by a nutritional . . . nutrition professional on a regular basis. And at least in our area the meals from the congregate meal sites are not really checked by a dietitian at all.

I have one other concern about congregate meals; it has nothing to do with the nutrition, and this is the population that I see is not being served, and that is the low-income population.

There were two sites in Scottsbluff, one in the lower income part of town, one in a more affluent part of town. When funding apparently got short, it was the southeast Scottsbluff site that was closed. And I know that population, having worked . . . working for a Community Action Agency to know that they do not feel comfortable going to the site in the other part of town. So you have a group that is a senior meals site, which have these people out here who are probably not being served who need the nutrition and certainly the socialization.

I was talking to one of my nurse friends who has done a lot in community health. And she told me there was really a sense of community in those people that were at the site that is no longer in existence. So I guess my concerns are that we meet the whole population . . . the needs of all the population and that we provide good nutrition by modern standards. Thank you.

See Appendix G For The Written Statement Of Betty Kenyon, Nutritionist, Panhandle Community Service, Gering, Nebraska.

Chairman McKeon. Thank you. This has been an outstanding panel, and I know I said earlier we're here to learn, and I know I've learned a lot. And I appreciate the things that each of you have said that contributed to my knowledge bank.

Finances are a concern, but it's unfortunate that many times when they become limited, the ones that need it the most are hurt the most when there are cutbacks.

Ms. Kenyon, you said that there's a requirement for butter or margarine and deserts. This is a federal requirement?

Ms. Kenyon. I do not know whether it's a federal requirement. It is a requirement of our agency on aging.

Chairman McKeon. I'm assured, which makes me feel good, that we have not, at the federal level, mandated butter; that's probably something from the dairy . . .

Ms. Kenyon. Well, butter or margarine, but still . . .

Chairman McKeon. Right. What I understand is we don't have a mandate other than to meet dietary guidelines.

Mr. Mueller. Congressman, that's part of the requirements of USDA that we receive the USDA money.

Chairman McKeon. Which is separate from . . .

Mr. Mueller. Which is separate from the Act.

Chairman McKeon. I figured that's . . . .

Mr. Mueller. That's what is required of us.

Ms. Kenyon. That's interesting because USDA does not demand that in school lunch anymore.

Mr. Mueller. It is required with us.

Chairman McKeon. Okay. We will look into that. But the dessert; what about the deserts?

Mr. Mueller. Dessert is not required. Several years ago a colleague group got together multi-state group got together and they put, you know, because we need to meet one-third RDA for the USDA funding. And what they did is they put together a listing of like, three ounces of edible meat, one cup of vegetables from two or more sources, bread, milk, those kind of things, and they sort of set that as a sort of a minimum guideline. And by doing so then you . . . it sort of guarantees that one-third RDA will be met. And that's kind of where some of that stuff came from, but dessert . . . in our area in everything I've seen . . . is an optional item. Some centers do; some centers don't. Most do.

Mr. Martinez. But the notion that it is a federal requirement stems from the lack of knowledge of the people. That really was more a suggestion by the state.

Mr. Mueller. It was . . . Like I said, several years . . . it was a group of dietitians from a multi-state region in this area that got together and set up minimally what probably should be served in order to ensure that one-third of RDA was met.

Mr. Martinez. What I'm getting at, it wasn't a federal requirement really . . . it wasn't even a requirement; it was a suggestion . . . .

Mr. Mueller. No.

Mr. Martinez. . . . by these multi-state . . . .

Mr. Mueller. No.

Mr. Martinez. . . . dietitians that determined that these would be the best . . . .

Mr. Mueller. I thought the bread and butter were part of USDA though.

Mr. Martinez. Well, the bread and butter might be, but we on our committee don't have any jurisdiction . . . .

Mr. Mueller. And you're exactly right. No, no, no, no.

That's right.

Mr. Martinez. The thing I'm trying to get at here is that many times because of there's a lack of information coming from the federal level, from, let's say, either the Department of Labor that handles the RSVP programs or the Health and Human Services which handles the most of the rest, that . . . and this comes back to that point that you were talking about in your testimony. Flexibility. You know, one of the reasons that these things can happen is because there is flexibility there in the law.

Mr. Mueller. Exactly.

Mr. Martinez. I'm sorry, Mr. Chairman.

Chairman McKeon. We are operating on an informal basis. One of the things that bothers me about some of our Washington hearings is that we have to be so rigid in how we conduct things that you can't have this kind of interplay. I like this kind of thing where we can just sit around and talk. And I know I learn more that way.

Long-term care, it was Andrew talked about that. This has not been part of the bill at this point, long-term care funding.

Ms. Byrd. It hasn't been fully funded as the Administration would like it to be. They're putting added focus on it now.

Chairman McKeon. One of the things we've picked up on in the hearings is that if we could do a better job of helping the senior centers do a better job of helping people age in place where they can come and participate and stay younger longer, then there's less time that they have to maybe go into an institution, and that ends up costing a lot more.

So we're better off funding the programs that help people to remain independent and to remain in their homes. And if we could do that and use that to justify increased funding, perhaps in those programs, then actually we're saving money.

Mr. Mueller. May I comment?

Chairman McKeon. Yes.

Mr. Mueller. One of the things I didn't have a chance to mention, back in I think it was 1987 or '89, I've got it in my testimony, my written testimony, the Nebraska legislature passed the Nebraska Long-Term Care Act.

And what it did is it provided State funds for case managers. It didn't provide funds for direct services, but it did provide for the case manager. And the nice thing about that is we're able to remain independent, we don't have ties to a particular entity or a particular doctor or a facility or whatever.

And a lot of us use . . . because obviously we run into individuals who simply cannot pay for services; cannot pay for the homemakers; cannot pay for the housekeepers, personal care, whatever it might be. And we do use this title IIIB in-home funds to fund a lot of those programs. So any increases that we see in the title IIIB program, you know, will always help for in-home services.

And, you know, we know that by doing so, a little help . . . we call it "The right care at the right time" is the phrase that we sort of target here in Nebraska because what we've found out, a little bit of preventative care early on before things get to a point where they can no longer remain in their home and the much more expensive one-on-one care is necessary. So that is one of the programs that we operate and it's quite successful.

Chairman McKeon. And you suggest combining IIIB and IIID?

Mr. Mueller. Yeah, we mentioned combining IIIB and IIID because they both provide for in-home services. IIID, I believe, was earmarked for the frail in-home specifically. Well, in most cases that's what IIIB is paying for also and it just would ease the mathematical business and the accounting and those kind of things.

And also IIID is a very small program, the dollars are not very large. And they usually would get mixed in with the IIIB . . . within those programs, you know, anyway, at least in our programs.

Chairman McKeon. Thank you very much.

Mr. Barrett?

Mr. Barrett. Thank you, Mr. Chairman. I appreciate again this excellent testimony from this panel. It's been very revealing, I think.

Mr. Intermill, your position with the Department of Human Health and Human Services, I'm interested . . . curious maybe, about your experience with USDA. As a member of the Agriculture Committee, this of course becomes of interest to me, and the reimbursement that is there or is not there, apparently reducing somewhat?

Mr. Intermill. Right.

Mr. Barrett. There is a lot of concern been raised about that portion of the Older Americans Act. In fact, some of the funds had to be returned, is that right, or have been depleted? Share with the committee kind of.

Mr. Intermill. First of all, the USDA reimbursement is an integral part of providing nutritional services, and we really benefit from that.

What we run into with USDA funding is that there is a fixed amount appropriated for the elderly nutrition program. And the allocation is based upon a per-meal reimbursement; the estimate of the amount of funds that are available divided by the estimated number of meals that would be provided.

Over the past few years the number of meals that's been provided has been gather than what's anticipated. So mid year, we will see a reduction in the rate of reimbursement.

Mr. Barrett. So the problem is then reimbursement remains the same and the number of meals increases.

Mr. Intermill. Yes, the amount of the appropriation . . . .

Mr. Barrett. Therefore you're underfunded as the case may be.

Mr. Intermill. And what complicates it is the reduction in the reimbursement rate is retroactive to the beginning of the year, so we have meals that we thought may have been reimbursed at 58 cents now are reimbursed at 56 cents.

Mr. Barrett. This is obviously a problem in Nebraska. How are you handling it in Nebraska? And I assume that this is a problem all over the country.

Mr. Intermill. Yeah, I think it probably is. The reduction rate applies across . . . through all the states. The Area Agencies on Aging will know that they will have less money to work with.

In Nebraska we've been fortunate in the last few years that our contributions at nutrition sites have been doing fairly well. In fact, the growth in the program has been financed by the contributions of seniors.

We have had to rely upon that as a resource to make up the funding, but we haven't had any increases in state funding so it has been . . . it's a management problem.

Mr. Barrett. Then your specific recommendation in this regard would be to increase the appropriation?

Mr. Intermill. That would . . . Yes.

Mr. Barrett. That simple, correct?

Mr. Intermill. Yes.

Mr. Barrett. What specific issues do you think are the unique challenges for this program in a smaller, rural state?

Mr. Intermill. Okay. We have in Nebraska close to 250 meal sites. We have . . . in Nebraska we have a population that is not large but it is dispersed over a wide geographic area, so we can't realize the economy as a scale. We may have a community that is a county seat, but there may be another one that may be 15 miles away that may be too far to combine as a meal site, but still the people in that community have a need for service. So as a result we have established a fairly large number of nutrition sites given our population in order to try to spread the program to meet the needs of the population.

This can increase your overhead costs and just your building rental and staffing for something of that type of system. But we feel that if we have to have a viable statewide program we have to try to reach out to as many parts of the state as possible.

Mr. Barrett. Thank you very much.

Mr. Mueller, I was interested in your testimony, your comments initially about cost sharing. How do you really feel about cost sharing?

Mr. Mueller. I didn't . . . I'm not sure whether I made any comment about cost sharing, but I guess I have an opinion on everything.

Cost sharing has its place. I know in Nebraska the area agency directors we've talked about it, and I guess our feelings is that one of the things we don't want to see a mandatory cost sharing concept move into the senior center level simply because for a long time the senior centers have sort of maybe have had a little bit of a welfare atmosphere or the idea well, you know, I don't need to go there and it's a free meal and it's a government handout and that type of thing.

And we're dealing with a group of very proud individuals. And the centers, you know, the amount of fund-raising and the amount of contributions that are made are what keeps the center going. It's not necessarily the Older Americans Act or USDA funds. They do a lot of supplementing, but without the additional fundraisers that go on every month at the centers and the contributions, they wouldn't be there. So I would caution against the idea of sliding fee scales or something like that at the center level because I think it would be a detriment to the activity.

I'm just familiar with our senior centers in this area. If you pop over to the Lincoln County Senior Center . . . or the North Platte Senior Center, it is just a wide diverse of people. You've got the younger seniors, you've got the old seniors, you've got the very old seniors. You have got people, you know, that drive up in very nice cars and people that drive up in really old cars, and you've got people that are dressed up really well, and you've got people that aren't dressed quite as well. You have a very diverse group of people. And that's really, really wonderful there just to see that the number of people that use that.

And I'm afraid if we move to a cost sharing, that that might change the whole mix of that center and really damage it.

In the area of perhaps in-home services, you know, where they're provided, in those particular areas we would like to see the states have the option of trying different ways to perhaps put some cost share options in there because we do have a number of in-home programs where individuals are able to pay and those kinds of things, but since everything is a suggested contribution, if you tell me I only have to pay 50 cents or the suggested contribution is a Buck and a half or two bucks or three bucks, then you might make it; but I think those who are able to pay, perhaps we should look at those areas. But I think it's got to be, you know, something that's tried state by state because I think we can't put something in nationally and expect it to work all over the country.

The Older Americans Act is a wonderful document to allow us to try different things within our own geographic region and find things that work; but I think it's an excellent supplement to the in-home tech program.

Mr. Barrett. Cost sharing should be voluntary in your opinion?

Mr. Mueller. For the in-home programs, I think . . . I'm not necessarily sold on the voluntary cost sharing on the in-home programs.

Mr. Barrett. Should it be mandatory?

Mr. Mueller. I think we need to take a look at both sides of the coin and see, you know, I think there's a possibility of both. I don't think there should be any mandatory cost sharing at the center level; but I think on the in-home services and that I would not personally be opposed at looking at some type of cost sharing option.

Mr. Barrett. Should not be means tested?

Mr. Mueller. Well, if you're going to cost share there probably needs to be a means test. Otherwise we're back to a voluntary contribution.

Mr. Barrett. Do your people have a problem with the term cost share? Does this bring some kind of a defensive mechanism to people's minds? If so, should it be changed; and if that's the case, do you have a suggestions?

Mr. Intermill. The term cost sharing in Nebraska we have a care management program where we have a sliding fee scale, a mandatory sliding fee scale in that program and we also have a nutrition program that is a voluntary contribution. Both of them are kind of cost shares; it's a question of whether it's mandatory or voluntary.

In the nutrition program with the voluntary cost sharing, we have about 30 percent of the cost of the program is covered by client contributions. On the other hand with the care management program, we've never seen more than three percent of the cost of the program covered by the fees.

Part of that is when you institute mandatory cost sharing with a sliding fee scale, we see the nature of the clientele change. Those individuals who have may have a mandatory fee don't avail themselves to the service. So we don't have those individuals who have a higher percentage on the fee scale actually using the service. So that's kind of a pitfall of cost sharing or mandatory cost sharing, using a sliding fee scale.

Cost sharing, I think the term creates a little confusion in my mind, I guess, as to what we're talking about. I think that maybe some people have a different perception of what we're discussing, whether it is mandatory or voluntary and maybe those are some distinctions that need to be made. But I think . . . I guess what I would urge is to allow states some flexibility in deciding which types of mandatory or voluntary cost sharing to use with different services.

Mr. Barrett. Thank you. That certainly is one of the things this Subcommittee has in mind is providing more flexibility to you folks that work with the program every day.

Thanks for your indulgence, Mr. Chairman.

Chairman McKeon. Mr. Martinez.

Mr. Martinez. Yeah. Just on that last note, I am adverse to mandatory cost sharing, and I'm adverse to the term cost sharing because I don't think it's accurate, as you stated yourself.

And it does create confusion. And the main thing that you stated was that it changed the kind of clientele you have. Because there are people who are seniors who figure, It's nobody's business what I make and what I earn and where my income comes from.

And rather than have to self declare . . . even in the terminology, the last session of Congress we got to the situation, the compromise was self-declaration.

Well, how many people do you think are there that are put on a self declaration notification are actually going to come forward and make an honest declaration, number one; number two, how many people do you think that are required to make that declaration are actually going to say forget the services.

I think the majority would say, Forget the services, I don't need them. And it's the same thing, coming back to the same thing. Every time the federal government does something for us, they attach a million strings to it. They make it so difficult for us in reporting--figure about the reporting costs that you and I are going to have to keep records of.

And we're trying to get away from and getting federal government off of people's backs so they don't have to do all that reporting. And now here again in a program as old as the Older Americans Act, you know, we're talking about, yeah, I believe the states should have some flexibility. I think the states if they've had that flexibility and they started going to mandatory cost sharing, they would find themselves that it doesn't work and immediately do away with it. But, you know, there still is the cost. The faster that . . . you know, I believe even in the in-home services that you still ought to have what I would call voluntary contribution. Because you'd be surprised and we had testimony from someone who is pretty well recognized as an expert in the field of aging. He's the dean of gerontology at UCLA . . . and he was at USC before UCLA wooed him away . . . it's a generational thing.

The generations out of World War II and that age era were people who had a feeling of self worth and they didn't want to have a dole out or handout to them, they wanted to pay their own way.

And that's why you find in the voluntary contributions that they earn so much of the money; $171 million nationwide in voluntary contributions in the program. That's a lot of money.

And you know, what we don't realize in the federal government too when we're writing these laws and thinking about this legislation is that the bulk of the money that comes for the support of these programs comes from two other places than the federal government--the bulk of the money; that's from the states themselves and in voluntary contributions and the fund raisers that the senior centers are able to hold.

So we ought to be very careful as what we're doing as requirements to the state, you know.

I want to ask you, Mr. Mueller, because you expressed in your testimony that the Act would require consolidation of several different programs.

Are you aware that every time that we as authorizing committees consolidate programs that it gives rise to the appropriators--and this is what we're trying to keep away from--to cut the funds since it's one act now?

In every case--you go through the history of Congress; in every case where they've combined acts, they have cut the funding because appropriators think differently than the authorizers. Are you aware of that?

Mr. Mueller. No.

Mr. Martinez. Well, that's a fact. That's why I would be very careful of what I wished for because you might get it; you might get less money too. The thing we're talking about here is there isn't sufficient money coming from the federal level anyway.

The other thing I'd like to ask Mr. Intermill is you expressed concern over the language of target. And I can understand that has been . . . in fact, that was one of the big debates in the last attempt at reauthorization because the chairman, Frank Ridge, actually comes from a very rural area.

And so being parochial he was trying to make sure that they got the funds they needed, which is the same problem you have, right?

Mr. Mueller. Right.

Mr. Martinez. And in the Act itself as it states now, it says in consultation with area agencies in accordance with guidelines issued by the assistant secretary and using the best available data, developed and published for review and comment a formula for distribution within the states of funds-- within the state of funds received under this title that that formula take into account the geographical distribution of older Americans in the state.

Now, that was intended . . . that's part of the targeting language. That was meant that if you have older Americans in remote areas, you're still supposed to take those in consideration in your state formulas how you provide funds there.

Somehow it's the same thing in the controversy we have with the targeted language that exists now when we talk about the special concerns of those people of minority.

For years we had just the original language that did not include that targeting of minorities, and the minorities went underserved. They continue to go underserved now with the new language that says, You will pay special attention to those populations with minorities.

I'm wondering . . . but it has decreased; I mean, the lack of service has decreased. We've actually started to target those areas because they are conscious of that language that indicates that they should more now because it was spelled out.

I'm wondering if in the legislation that if we would write in there--where did I write it down here--that we would write into the language just the same as when targeting minorities, and targeting older Americans living in rural areas. Would that take care of the problem?

Mr. Intermill. The point that I made in the written testimony was that if we look at . . . If we do those things, say we included a rural factor in the population formula, which is basically a way of deciding how to distribute funds between the states, if we did something that was to the advantage of Nebraska, for example, and was to a disadvantage of an urban state that may have a rural population, the effect is possibly to hurt the rural population of that urban state.

It doesn't guarantee the direction of funding to that population we're trying to reach, I guess is the point I wanted to make.

And the same is true with the minority population. In Nebraska we have a relatively small minority population compared to a number of other states.

I am pleased to say that we are serving--the proportion of our clients in title IIID and title IIIC2 program who are minorities is greater than the percentage in the population we're still working on IIIC1 to try to get that up.

But if we would have language that would address both or either minority population or rural population, it doesn't guarantee that those funds get to the intended purpose.

Mr. Martinez. Well, that's the reality of it all is that nothing we do in Congress in any language we work out and put down is going to guarantee anything.

The same . . . it goes back to the same thing, you know, we even wrote a bill giving as much flexibility in design of nutritional meals as we could, yet a restriction from the FDA comes in and hinders that flexibility we have; and that's something else we have to take care of.

But still, a lot of times it's the interpretation of the people who are administering the program on a local level. The agencies . . . area agencies on aging, you know, they have a lot to say with what the rules are, you know, and sometimes they dictate--and even referred to the fact that it's in the legislation when it isn't.

I was at a hearing in L.A. Where the Los Angeles County Aging Area director--Agency on Aging director stated that it was in the federal law that you could not serve any more meals the next day than you served the previous day. That's nowhere in the legislation. That's nowhere in the legislation.

But it was her way of trying to administer the limited funds she had to all the centers she had in a big area like L.A. County to say that there be no waste, hey, try to figure out what you're actually going to be able to serve so that you don't have all these wasted meals.

And in her mind it was, Well, serve what you served the previous day. But those people coming into those centers, that population fluctuates from one day to another. You've got to have some flexibility.

Well, when I explained at that center that that was not in the federal law; that was some criteria, here again, because the federal law did give them flexibility for them to determine that.

So, you know, sometimes we're damned if we do and damned if we don't. So when we write the thing here, we've got to be very careful that you do not step on the toes of the flexibility of the individual localities, because after all, they are the ones that see and know more than we do in Washington--in my case 2,800 miles away--what's happening.

I know I'm taking a lot of time here, and I beg your indulgence, Mr. Chairman. But, Ms. Byrd, in your testimony you expressed your support for maintaining the current 78/22 split in the Title V funding which is another area of contention in the last Congress.

We finally got to the end of the session hoping that we would get something out by saying that new moneys would be distributed at 50 percent/50 percent; 50 percent to the federal organization, 50 percent to the state.

It's the contention of the state and from testimony given here by someone . . . I forget who it was . . . that states that contract with those organizations that the state would know better when to contract with the organizations and when not to. But it's your belief that the formula funding should stay the same.

Ms. Byrd. It seems to be working for us right now according to our National Council on Aging because with the other . . . the way it was before with the Green Thumb in our area, you could only have one slot in the whole county. And we have a county with a number of rural towns that really do need support. And in our area most of the slots from Green Thumb were either in central Nebraska or western Nebraska.

And we had, like I said, I had five ladies that have all widowed, don't qualify for anything, they could use a job. When I went back . . . When I became a member of the National Council on Aging, I asked them how does that work. You know, why do they have a program of Green Thumb, but we can't qualify for it?

There was no way that any of our people could get on. We had non-Indians put in our community but we have Native American people who could qualify. But it was always that they brought in a non-Indian and put them in our community in the slot we could use.

In the meantime they ended up swapping slots, I guess, how that worked. That way they could reach us because they more or less target Native Americans. And we feel we were being treated more fairly this way, and we had to give up the Green Thumb, but we have didn't really have it in there anyway.

Now we have title V that comes to the area, and recently they just moved that one but they're opening up more slots for us because of the Native American population.

And under my understanding was before I was supposed to testify in Washington, but when I asked for information to come from the National Indian Council on Aging, this is some of the information I got and at that time evidently they are satisfied with it. If it's changed since that time, I'm not aware of it.

Mr. Martinez. Very good. That's something we need to reconsider because I'm sure that . . . in fact, just before these hearings started, Mr. McKeon approached me and said we'll go ahead with the rest of the bill because there's so many things in there that we've already agreed on that should be in the bill and set the bill that way without title V because I think title V is going to be of some concern to us and we're going to have to put our heads together and come up with a solution for it.

Ms. Byrd. Right. And part of that is the national sponsors themselves, you know, they . . . like the National Council on Aging is one who more or less looks at Indian country and with the population increasing the way it is, and our funds are being cut, the title VI funds are being cut, we can't hardly serve enough people. And everybody's population is increasing basically . . . in the urban areas they have more people so they should receive more money. Some of our title VI programs because of their funds the population increasing, they were cut. And we fought for an increase last year for title VI to receive a $2.4 million increase. And this year our funds are cut. So something is not making sense here.

Mr. Martinez. I agree with you. She raised her hand back there.

Chairman McKeon. We're going to change protocol for just a little bit, but we won't tell anybody what we're doing.

Mr. Barrett. If you say so, Mr. Chairman.

Ms. Holcomb. I'm Debbie Holcomb with Green Thumb, and Sydney and I have worked together. And the way our title V funds work in the state is that all the title V providers in the state of Nebraska meet annually and the State of Nebraska sets out a formula that says how many authorized physicians there are by county and each title V provider then provides services then to the respective counties they're assigned and they are required to provide services to that number of people in that county based on the formula that we're given by the State.

Mr. Martinez. So the State is the one that sets it on the slots?

Ms. Holcomb. Yes.

Mr. Martinez. That's good to know. I didn't know that. One last question if you'll indulge me.

Margie.

Ms. Mickelson. Yes?

Mr. Martinez. You talked about, which was very interesting to me, about the people that don't pay for the meals.

Ms. Mickelson. Right.

Mr. Martinez. And you refer them to some other agency. But nobody knows who those people are?

Ms. Mickelson. No.

Mr. Martinez. Because I think . . . and maybe I'm going back through my childhood and I've got a warped sense of it, but when I was a kid going to school during the depression. And for us to get a free lunch at school, my mother had to work in the cafeteria.

And as a result, all of those kids whose parents worked in the cafeteria so they could have free lunch . . . or worked in the school anyplace, they had to do some kind of work in order for their children to qualify for that . . . all of those kids were put in an individual line and everybody knew who they were. And, you know, it's a heck of a stigma that takes years to overcome. So I'm delighted that nobody knows who these people are?

Ms. Mickelson. There might be somebody, but really, nobody does because they don't tell . . . the Senior Center don't tell. And there is all over the world there is people that can't do that, and it's just great that it can be done like that.

Mr. Martinez. That brings me to the point that when you have, if you have any kind of mandated cost sharing, more readily than the way you're doing it now, people are going to know who those people are and it's going to drive people away.

Ms. Mickelson. That's it. And we don't want anybody to know it. I know it, and there's some other people that probably know it, but nobody thinks anything . . . I haven't heard one person ever thought anything about it, and we don't make it, like, He gets a free, and he gets a free meal. You don't go out and tell that.

Mr. Martinez. But the other thing is that you refer them to some other agency that picks up the cost of the meal. How do you do that exactly?

Ms. Mickelson. I don't know for sure how the Senior Center does it. I don't know. They just do it. I don't know about other senior centers, but maybe this will help some of them. We have a bread day. Do any of you have a bread day? We have a bread day a week. We also have a product that they can bring a month, like ours is powdered sugar and something else this month. A lot of the people do that. It comes out in our bulletin and that really helps the seniors for putting meals out because at $2.50 for a meal that you get at the senior center, how they ever pay for it, I don't know, because it's so big and so good and everything.

And then we have volunteers that make cards out of Christmas cards and all kinds of cards. Some of the ladies they crochet, they crochet around a beautiful verse on it. They're old cards that they bring in and they redo them. That helps. They pay a quarter, and 50 cents for the ones that are crocheted. You can't believe how many people buy those cards. Well, that helps . . . maybe that's one of the things that pay for the meals. I don't know about that. You might ask Kathleen about that.

Mr. Martinez. I'd be interested in finding out. Who would I ask?

Ms. Mickelson. You might ask Kathleen back there. Kathleen, stand up, but you don't say. You can go talk to him privately. She is the head of the senior center.

Mr. Martinez. Thank you, Mr. Chairman.

Chairman McKeon. Well, let's see. There was a question. I think one of the main things we wanted to learn about coming here is how we address rural concerns.

And, Mr. Intermill, you talked about a base amount of funding that would not be based on population, much like the way we divide up the Congress where every state gets two senators and then they get their house members based on population.

So the funding now comes all on population, which hurts you; but if we could break that up so we have a base funding and then go over and above that based on population, that would help the rural problem?

Mr. Intermill. There is for states that have less than one half of 1 percent, they receive a base allotment. They're guaranteed a certain amount of funding.

Chairman McKeon. Is that sufficient?

Mr. Intermill. Nebraska is .7 percent, so we're based on population. But this is something that we do with Area Agencies on Aging when we have our intra-State funding formula because we recognize that there's just a basic level of work that needs to be done by an area agency on aging. There's an essential function there that needs to be financed so I would just like to recommend that we do a similar type of thing for the intra-State funding formula.

Mr. Martinez. He read that recommendation in the . . .

Chairman McKeon. It takes me a few times to get the message. I've heard once the definition of a genius is one that hears something six times and then understands it. I'm far from a genius. Find me a sinking group.

Any other questions?

Mr. Barrett. Perhaps, Mr. Chairman, I want to go back to Ms. Byrd. I was struck by your testimony rather moving testimony. And I was struck by the level of poverty and of course this is not anything new to me, but I was struck by some of the comments that you made.

And as Chairman McKeon has said, one of our purposes is to direct our thoughts and our efforts towards rural or smaller states like ours.

I wonder if you could share with us a personal experience or two that you had in providing services to your people, to Native Americans, as well as to rural Nebraska. Give us a couple of personal experiences, would you, and the problems that you incur or have incurred.

Ms. Byrd. Well, one of the problems that we've had, the population, the age requirement itself. Many of our Native American elderly were not even living to the age of 60. And we've had several veterans themselves who came back from the war, gave of themselves, and yet didn't have anything.

And according to Veterans Administration, you have to reach a certain age to qualify for services. I have two individuals, in fact, that I had personal experience with, and they were trying to live on $222 a month. The individual who tried to live in his homestead was on a rural area about six miles out of town.

Mr. Barrett. Pull that mic a little closer, please.

Ms. Byrd. He lived six miles out of town. And he was so proud of his home, but he would not accept any kind of assistance because they want to know your income, and he was ashamed that he did not have . . . he did not qualify for VA. VA pension was $600 a month. If he had that money, he would have been living like a king.

But the way it was, he was satisfied; he had a roof over his head, and he didn't have running water, he had to haul water. This is the 1990s. So four years ago we finally got him into a housing authority into an apartment. And even that, he wonders . . . our people have signed so many papers and they've lost so much through their lives that they hate to sign anything. For him to sign a lease, he wondered when are they going to take his land. When are they going to take his little shack out there.

And we kept telling him, no, you're not going to lose it; it's not livable. You can't live in that place. There was no water. And it was so dilapidated there was no way it can be renovated anyway. So when we took care of him and put him in a home in town and he had no way of buying his groceries after he paid his bills. So he was dependent on the senior center.

When we tried to sign him up for other services under social services, and they're real reluctant to sign anything because back in the depression when the Native American people needed groceries or needed any kind of assistance, they had to put up their team of horses, they had to put up their homes, they had to put up their land base that they owned. Everybody came into an allotment.

Well, the grocers robbed them of this. By making them sign this paper, they said, yeah, we'll give you the groceries now, but you have to come in with money by next month. And in the depression you didn't have any money to come up with. And they lost it. So when you ask them to sign these papers and say, Here, you will qualify for services, they say no, I don't need them. And this individual lived like this.

And we did all we could for him through the center, to make sure he came to eat. We had a hard time finding someone to help support him because he wasn't even 55 yet. And when one of the tribes waived that age limit for them to be 55 to serve them from 55 to 60 but the Winnebago tribe is the one that supports us to provide those meals to him.

Without that I don't know how he would have made it, and he wasn't qualified as a client of ours. But the year before that and the year before that, I have no idea how he did.

When I went to see his house I was shocked. When we got him to come to the center he has a meal every day; he has activities with the seniors; he comes in there and gets to visit with them; his outlook had changed a lot.

His health is not very good and by coming to the center he is able to communicate more and we've gotten a lot more people out of their homes who have been widowed and widowers and they didn't want everybody to know their business.

Mr. Barrett. Do you have any special way of alerting your people to the services that you offer? Do you have any special outreach?

Ms. Byrd. Well, it's more or less . . . the community itself is small enough that we can . .

Mr. Barrett. Word of mouth?

Ms. Byrd. Yeah, word of mouth.

Mr. Barrett. Okay.

Ms. Byrd. We network with the community health-nursing department with the hospital with the Department of Social Services and with the local community health representatives. And we make sure that anybody who comes home from the hospital receives a meal, receives some kind of service.

We have some people that have been homebound for the last . . . I've been working with it since 1973 and they have been on the homebound list all that time. And those people themselves never see anybody except the driver or myself when I deliver the trays. And we give them and talk to them and sometimes this lady who just went to a nursing home, she's a hundred years old, she looks forward to that, that made her want to get up in the morning; that made her, you know, the van is coming, they're going to bring my meal. Even if she couldn't eat it, she was awake and made sure that she was up and dressed and ready to greet the driver whenever he came in. So that was one of the ways of our making sure that she was receiving our services.

Mr. Barrett. Thank you.

Ms. Byrd. The other people that we serve out there, they themselves are reluctant to ask for them and so we try to offer it without making them feel like they have to. When they were talking about this cost sharing, that was another area. We have some people that are non-Indian people who we were serving who were real reluctant to say, you know, I make this much money, but I don't own anything. You know, they're like we're backing them up against the wall and you have to tell us how much money you make; otherwise you can't get the services.

Mr. Barrett. Thank you for those comments. I think it was page six of your testimony you referred to cost sharing and it was obvious that you had problems with cost sharing. A real concern.

Ms. Byrd. Yeah.

Mr. Barrett. You do not support it. If we did continue with cost sharing, would you agree that the decision should be left or made at the local level?

Ms. Byrd. Right.

Mr. Barrett. Thank you very much.

Donetta Nye?

Ms. Nye. Yes.

Mr. Barrett. You've been terribly quiet this morning. In the notes that I have made, I was particularly interested in how you have expanded the senior services in your area, St. Paul and that area, because you saw a need. How are you handling it? How are you paying for it? What problems?

Ms. Nye. Actually, again, cost sharing, I have some different views on cost sharing.

Mr. Barrett. Cost sharing has different views? Share it with us please.

Ms. Nye. Again, first of all, I think we need to reach elderly people with intelligence. I don't think we need to assume that they're not intelligent, so I've learned through my experience that if I give them information, clear direct information that this service is going to cost you or at least a part of this service is going to cost you, and the reason why, the end result is they'll accept that.

And some of that maybe is because my own personality comes forth. You know, I know you have a choice here, but we also want to keep you safe at home versus the cost of the nursing home.

I have an in-home service program that has no federal or state funds in it. And they pay for what the service is.

I have also another in-home service that is called Attendant Care that is 24-hour personal care in home. Same thing, the people pay for the cost. I'm not saying in the beginning it was easy, but at least when the family members came, there was a need there for mother to stay at home rather than a nursing home, and our costs are lower than a nursing home. And the family has the money to do it. It's not for the poor elderly, but it is for the affluential elderly to stay at home. Again I guess the need was there. We just try our best to provide the needs. Talking to families.

And not that we abuse or don't serve the low elderly, but there are . . . And I guess too with the younger generation coming up I think they're socially their education is going to be stronger than the old elderly.

And so again if we provide information and if we have done our job in the aging network in the past maybe the younger generation will be more interested in understanding cost sharing versus getting it free. I don't know. I don't know all the answers.

I just know in Howard County that we've had some needs that we had to meet and we didn't want to look to the federal or state government so we tried our best.

You asked on some people paying for meals. Organizations; we have people in our community like the Rotary we approach, or we approach the churches, and they'll buy a meal ticket for some senior that doesn't have the money to pay for it . . . that really doesn't have the money to pay for it.

Mr. Barrett. Thank you.

Mr. Martinez. See, that's part of the problem is in certain areas people are very ingenious as to how they go about serving that population that can't afford to pay for themselves.

You mentioned to that the distribution of funds sometimes goes to the urban areas because there's a greater need there or more population there. And that may be true, but if they're doing it that way, they shouldn't be doing it that way because the law specifically directs and targets the money . . . the money is targeted to those with the greatest need wherever they are.

It doesn't say . . . in fact, it refers to taking in the same geographical regions, but oftentimes, like I said before, it's in the interpretation. And, you know, sure, there are larger populations in urban areas that are in need, but the urban areas also have a greater number of people that can contribute to help. There are a greater number of Rotary clubs; there's a greater number of Lion's clubs, a greater number of Kiwanis clubs, and there's all kinds of corporations that are willing to take the lion's share of the cost of many of these programs because they believe in helping the community.

So where . . . I don't think rural areas has as much opportunity to raise the moneys to support the programs as urban. So I think . . . we ought to somehow in the language in this law write it in such a way that the people who are going to administer the funds or distribute the funds make sure they take care of the neediest, wherever they are.

I bit into your time, didn't I, Bill? I'm sorry.

Mr. Barrett. Yes, you did. Thanks, Donneta. Ms. Kenyon.

Ms. Kenyon. Yes?

Mr. Barrett. You talked about specific nutrition needs, and I appreciated that.

Ms. Kenyon. Well, that's what I know about.

Mr. Barrett. And I realize that, and you're the expert.

And that's why we're glad you're here.

In a few words, are the nutritional needs of our seniors more prevalent in rural America do you think? Do you have an opinion whether the needs are greater here than they are in Southern California, for example?

Ms. Kenyon. I would say there probably is not much difference.

Mr. Barrett. Not much difference.

Ms. Kenyon. The needs are there, where ever. And I truly believe that if people have good nutrition, that's part of what keeps them out of nursing homes.

Mr. Barrett. Thank you very much.

Mr. Chairman, one final question, I guess.

In Southern California we had an issue and a concern that was raised that surprised me a little, but it got my attention.

A couple of witnesses shared with us the concerns about senior abuse. Senior abuse. Not necessarily physical, but many other forms of abuse.

And I have a question to the whole panel. Do you agree? And if so, would you care to elaborate. Very briefly. Let's start with you, Mark.

Mr. Intermill. I agree that that is an issue in Nebraska as well. And we . . . there is an adult protective services program within state government that receives complaints about abuse, neglect, and exploitation, and they continue to receive complaints.

It's something in the aging network that we're trying to address through title VII; the elder abuse prevention section of that act. We have . . . and I'll let Andy talk about what the area agency on aging association is doing with that in that regard, but it is something that we feel needs to be addressed, and through our elder rights programs we're attempting to do that.

Mr. Barrett. You would agree that we should take a very good look at it?

Mr. Intermill. Absolutely.

Mr. Barrett. Andy?

Mr. Mueller. One of the good things about the case management or the care management program that I talked about and the state program that I talked about some time ago, a lot of times our care managers go with law enforcement, go with the APS workers or the Department of Health and Human Services in Nebraska. So even though we don't have the power-- we're not true APS workers, we don't have the statutory authority . . . we can provide some of the case management some of those other things that are not provided.

One of the things that the Association of Area Agencies on Aging, which I am a member of, we've put together or we're in the process of putting together a statewide training that we will take out across the state. It is designed for APS workers; it is designed for law enforcement, county attorneys, the individuals that deal with this problem on a day-to-day basis.

And one of the things that we have found out is that perhaps there might not have been enough training or something like that. There's a lot of . . . a lot of . . . in the law enforcement fields and such, people don't know exactly what they can and can't do.

We're not working with children here; we're working with older adults; we're working with people that have the right to make their own decisions, have the right to live in circumstances that you and I may not want to live in, but if they're happy and they are safe and their needs are being met, there's not much we can do about it. They're able to make their own decisions.

So we put together a panel of experts from the UNMC and some other areas and it will be available statewide this summer, to bring law enforcement and APS workers and that up to date on what the current statutes are and how things can be dealt with and what you can and can't do and a pretty extensive training manual that goes with it.

And I believe the training manual is also kind of like a pocket guide that can be kept in the law enforcement vehicle, those kind of things, for handy reference. And we're hoping that will solve some of the problems.

Mr. Intermill. Funded by title VII.

Mr. Mueller. Funded by title VII, a good project.

Mr. Barrett. Okay. Ms. Byrd, you talked very briefly advantage had been taken of your people; I would consider that certainly a type of senior abuse.

Ms. Byrd. Yeah, we haven't received anything to support elderly. We have some things coming up. We've worked with the tribe to change the tribal codes to adhere to those rules and to watch out for the benefits of our elders and we have a few individuals that also have to be taken into consideration that when they refuse to go to the doctor or something and it's for their own good, their own benefit, nobody will make them; nobody will say, you know, This is for your own good.

And we had to change the tribal code to . . . they are also abusing themselves by refusing to go to these and tend to their own affairs this way.

And it's . . . everybody is kind of reluctant to step into that because it causes family problems, family disputes, that-- well, one daughter is more interested than the other; then they turn around and go back and forth.

And it ends up being, Well, who takes care of him?

Well, I take care of him; you don't. And you just want him for his money. And, you know, things like that, but yet the individuals themselves, those who are being neglected, there isn't any support that we can give them because of that. You know, we have the funds to do it, we could have something said, we could have an individual out there helping us to enforce some of the codes that have been changed, making sure that the abuse is prevented, you know, working with . . . you know, all of this falls in together because of the title VI title VII. Our people, we're taught to take care of our own. They're reluctant to put them in a nursing home. They have families living together. They have younger generations taking care of the older generation. And when it gets to be too much for them, there's no support out there for them. So here they are trying to make do and have their own families to raise, and yet when they're raising . . . they're taking care of their mother and father or grandfather they're just like children and, you know, they're overwhelmed by it. So the family support part would really benefit the Native American population.

Mr. Barrett. Thank you very much.

Donneta, briefly, your account?

Ms. Nye. Financially, we have more financial abuse than we do actual physical abuse in our county. Again that's why I'm saying senior centers are a community focal point. I can't stress that enough, because that's where we have people come in, and it doesn't matter if they're elderly or young, you know, Where can I get help or how can I see that this can be changed.

The financial, but I do want to say for the state of Nebraska, that we are very lucky. We have an attorney general who puts out information on fraud, et cetera, and sends it out to hopefully local senior centers I think the information goes to put in our local newspapers and then we put it in our newsletter. And I think that again has helped. He's also very open to phone calls. You know, this is happening to you I know sometimes the person or individual doesn't want to do it personally, but maybe by a phone call. Financially, I see this happening big time.

Mr. Barrett. Thank you.

Marge?

Ms. Mickelson. I'd like to say something to help maybe senior centers. Maybe they have done this. The railroad, you know, is . . . North Platte is a railroad town. Well, the ladies of the railroad, they give a card party. And so this year . . . all over, you know, but it wouldn't have to be the railroad, it can be anybody. Anyway they give a card party and they can play pinochle, pitch, or whatever they want.

And all the money goes into the senior center. And this could be something they might could do. And there was a big turn out. And you paid $10 a table, and then you played. And the four people that bought the table they could play together or whatever they chose to do.

And all this money went to the senior center. Well some of this went to meet meals, like free meals and stuff. That could be used for things like that. And it wouldn't have to be just the railroad; it could be, you know, some club.

And you couldn't believe how many seniors got their table because they love to do that. And we had a lot of them. I don't know exactly what they made, but it was a big amount of money, and it would help for a long time for meals.

Mr. Barrett. Thank you.

Mary, is it a problem in your opinion?

Ms. Rucker. What.

Mr. Barrett. Senior abuse.

Ms. Rucker. I know of some . . . not personally, though. I don't believe so.

Mr. Barrett. Betty?

Ms. Kenyon. I've had a chance to think. I spend a fair amount of time in nursing homes. And the form of abuse I see are families who are paying the cost of nursing homes and deny their family care because it's going to cost more money.

For example, Grandma loses her teeth or breaks her teeth. Well, Grandma's old, why don't you just give her a pureed diet, then we won't have to pay for new teeth.

Or not too long ago we were giving supplements to a lady with bed sores . . . could use a more proper term . . . and the family decided they were expensive and they didn't want to pay for them anymore so would we please discontinue them. To me that's a form of abuse.

Mr. Barrett. It sure is.

Ms. Kenyon. And just because someone can pay their bills, doesn't mean they're not abused.

Mr. Barrett. The reason I asked the question because it was certainly raised rather dramatically in Southern California.

Mr. Chairman, thank you very much for your indulgence.

Chairman McKeon. Thank you. Mr. Martinez?

Mr. Martinez. Thank you. I just have two questions because I think the information has been good and valid and we can use it in determination.

Donneta, you said in your testimony that the money that you collect from the contributions for the meals that you use them for trips?

Ms. Nye. No, the seniors use that. That was like cost sharing. You know, I've felt . . . they've always done their share of cost sharing the seniors because if we provide them with a trip, that they pay for.

Mr. Martinez. Oh, they pay for the trip?

Ms. Nye. Yes.

Mr. Martinez. It doesn't come from the money that you're given for meals?

Ms. Nye. No. Jeez, don't say that. I'll be coming to you for a job. This gentleman down here kind of pays my wage. I'm sorry that . . ..

Mr. Martinez. I was surprised at that.

Ms. Nye. No. And maybe I didn't word it right. But they do pay their own . . . if we promote a trip or . . ..

Mr. Martinez. Almost everybody does fund-raisers.

Ms. Nye. Right. And then also that . . . as part of a fund-raiser, you know, we do keep . . .

Mr. Martinez. Well, I do know there's a requirement that the money you get from the meals provides more meals.

Ms. Nye. Will you drop . . . you may come and check my books out here or whatever.

Mr. Martinez. I just wanted to end this thing on a note of excitement.

Ms. Nye. You did. And I might be coming to see you about a job.

Mr. Martinez. The other question I have is the in-home care that you provide.

Ms. Nye. Yes.

Mr. Martinez. That is not federally funded at all?

Ms. Nye. Huh-uh.

Mr. Martinez. Because you do have a cost sharing . . . .

Ms. Nye. Right.

Mr. Martinez. When the people say, Well, I can't afford it.

Ms. Nye. Then we go to title XX, which I guess that is some federal money in that but we basically started it because the need was there. So again, ran in the red for a lot of months because we provided the service and then we charged them, but if they can't . . . and again, I've found good Samaritans that will pay for this.

Mr. Martinez. But if they can't afford it, they have to find a good Samaritan to pay for it?

Ms. Nye. Or social services, title XX will pay for some of that.

Mr. Martinez. Very good. Mr. Chairman, thank you very much.

Chairman McKeon. Thank you.

Mr. Barrett?

Mr. Barrett. Thank you, Mr. Chairman. I just want to take a moment, because I know you're wrapping this up, to thank the people at the Research and Educational Center out here that had anything to do with this hearing. We appreciate your efforts very much. We hope to be back again another day. Thank you.

Chairman McKeon. I think also we would like to thank our staff and people who have made this trek with us and who will have a lot of responsibilities to go forward and actually write the bill and helping to that end.

And thank you the members of the panel and you in the audience who have been here to participate in this. We thank you very much.

One thing we would ask is as we go through the process of writing the bill and seeing this through to the conclusion that you would watch what we're doing and let us know if you see us heading off in the wrong direction or if there's something that we aren't picking up on, please keep in touch. And if you think of something that you would have said and didn't think of it today, let us know that as we go through our process.

Again, thank you very much. That will conclude our hearing today.

[Whereupon, at 11:00 a.m., the subcommittee was adjourned.]