Table of Contents

The Opening Statement of Chairman Howard P. "Buck" McKeon. *

The Opening Statement of Mr. Matthew G. Martinez, Ranking Member *

The Statement Of The Honorable Frank A. Lobiondo, Representative From New Jersey *

The Statement Of Jeanette Takamura, Assistant Secretary For Aging, Department Of Health And Human Services *

The Statement Of Raymond Uhalde, Deputy Assistant Secretary For Employment And Training Administration, Department Of Labor *

Appendix A The Written Statement of Chairman Howard P. "Buck" McKeon. *

Appendix B The Written Statement Of Jeanette Takamura, Assistant Secretary For Aging, Department Of Health And Human Services *

Appendix C For The Written Statement Of Raymond Uhalde, Deputy Assistant Secretary For Employment And Training Administration, Department Of Labor *

Appendix D The Written Statement Of Gema G. Hernandez, DPA, Secretary, Florida Department Of Elder Affairs *

Table of Indexes *

HEARING ON REAUTHORIZATION OF THE OLDER AMERICANS ACT

Thursday, April 15, 1999

The subcommittee met, pursuant to notice, at 2:04 p.m., in Room 2261, Rayburn House Office Building. Hon. Howard P. ``Buck'' McKeon [Chairman of the subcommittee] presiding.

Members present: Representatives McKeon, Barrett, Martinez, Owens, Mink, Roemer, and Kind.

Staff present: Cindy Herrle, Professional Staff Member; Michael Reynard, Media Assistant; Lynn Selmser, Professional Staff Member; Bailey Wood, Legislative Assistant; Mary Ellen Sprinkel, Legislative Associate, Education; Cheryl Johnson, Legislative Associate, Education; and Roxana Folescu, Staff Assistant, Education.

Chairman McKeon. [presiding] Good afternoon. As most of you know, this is the fifth hearing that we have held on the reauthorization of the Older Americans Act. Last week, the subcommittee held three very informative field hearings: one in Alhambra, in ranking member Martinez's district; one in Santa Clarita, my district, and one in North Platte, Nebraska, Mr. Barrett's district.

After hearing what folks in the field have to say about the essential programs of the Older Americans Act, I think it is more than appropriate that we have the administration here today to discuss their Older Americans Act proposal.

However, before we begin, I would like to stress that to date this process has been bipartisan, and my hope is that it will continue to be so in the future. We have every intention of making this a bipartisan bill and one that we can agree on and work with and get passed, hopefully, very quickly.

And I remind everyone, as we work toward reforming and streamlining the provisions of the Older Americans Act, it is absolutely imperative that we keep in mind those who we are trying to help, the frail and the elderly, foremost in our minds.

Mr. Martinez.

See Appendix A for the written Statement of Chairman Howard P. "Buck" McKeon.

 

Mr. Martinez. Somewhere around here there is a microphone that I can reach.

[Laughter.]

You know, that's all right. I was going to commend you, Buck, and I am still going to commend you for the manner in which you have carried out this hearing. But even more than that, I think it was awfully nice of you to arrange the meeting to be held in this room, which is just five steps from my door. I don't have to walk very far.

Chairman McKeon. I wondered how you got here.

[Laughter.]

Mr. Martinez. Anyway, I want to thank Assistant Secretary Takamura, and Deputy Assistant Secretary Uhalde, for taking time out from their busy schedules to come here to discuss the administration's proposal for reauthorizing the Older Americans Act.

You are probably aware, but it bears repeating, that this subcommittee is extremely interested in the reauthorization of the Older Americans Act. As Buck mentioned, we have been working in a bipartisan manner so far. I am confident that it will continue to be bipartisan so long as we are careful to communicate with each other.

The initiative that Mr. Barrett, Mr. McKeon and I have introduced is really moving forward at a pretty good pace. Last month, Mr. Barrett introduced H.R. 782 with the support of Representative Goodling, McKeon, Clay, and myself. This was intended to be a place-holder while the subcommittee pursued input from the community through a series of hearings. As of today, we’ve held three hearings.

Those hearings, and I'm not kidding you, were the best three hearings that I have ever attended in all the years that I have been in Congress, both from the information that was provided to us and the fact that they were informal, to the degree that we could have a dialogue with the witnesses, rather than having the witness just testify to us while we sit as judges deciphering what they have told us.

In an attempt to gather information, we have been to Los Angeles, to my district in Alhambra and to the Chairman’s district in Santa Clarita_ and to Bill Barrett's district in Nebraska. And in all three places our hosts were outstanding. We not only had some serious business to do, but we had a good time as well.

We went there to find out how we can improve the already exemplary services that are provided by the Older Americans Act.

The plan is to consider the comments and suggestions as we receive them. And Chairman McKeon has taken the time, after each of these hearings, to advise the people to keep abreast of what we are doing and keep us advised if they feel we are going in the wrong direction.

We need to ensure that we create a product that really provides services to the people we are trying to help. That is why I am especially pleased that the administration is here today. I understand that you have some ideas about the Act, and I am interested in learning more about that.

So, without further delay, I will turn the hearing back to my good friend, Chairman McKeon.

Chairman McKeon. Thank you, Mr. Martinez. Mr. Barrett has said that he doesn't have an opening statement if we won't give him at least 30 minutes.

Mr. Barrett. Right.

[Laughter.]

Chairman McKeon. As for Mr. Martinez, he has put in the placeholder bill and is really providing the leadership on our effort here. We have another member with us, who has been very involved in this issue and has asked, even though he is not on the committee, if he could take a couple of minutes to talk to us about this issue. And I would like to ask unanimous consent to ask Mr. LoBiondo_Frank LoBiondo, we will give you the time to take everything as much as you want up to two minutes.

[Laughter.]

Mr. LoBiondo. Thank you for your generosity, Mr. Chairman.

[Laughter.]

Members of the committee, thank you. Congressman Barrett, thank you. I am very pleased with the progress that you have made on this, and some of you may know my involvement with this issue comes from the fact that I had introduced with_in a bipartisan bill_with my colleagues, our colleagues, Jim Kolbe, Jo Ann Emerson, and Peter DeFazio, H.R. 773, which is a straightforward three-year reauthorization of the OAA.

But it doesn't matter whose bill it is. What matters is that we do it. So I wanted to be here today to offer my strong support to you, Mr. Chairman, Congressman Barrett, members of the subcommittee, to work with you in a bipartisan way to move this forward. I have had the opportunity as a county elected official_in New Jersey they are called freeholders_that administer a lot of the OAA programs, and then as a State legislator. I have been on deliveries for the Wheels on Meals, seen the looks on the faces of the seniors that that's their only contact of the day from a human being.

It's a wonderful program that is cost-effective, saving Medicare dollars. I have visited with numerous Green Thumb employees. I have seen the looks on their faces where they are able to lead productive lives. And, in fact, have a supplement to their income that very often is the difference between them being able to do it on their and not on their own.

So it is a wonderful, worthwhile program, and once again, I want to commend you, Mr. Chairman, and thank the members for allowing me the opportunity and once again pledge to work with you in any way possible.

Thank you.

Chairman McKeon. I want to thank you for being here and for the work that you have done. I know that we will continue to work very closely as we move through on this process.

Mr. Barrett.

Mr. Barrett. Thank you, Mr. Chairman. I have just been yielded, what, two minutes, one-minute?

Chairman McKeon. Whatever you need.

Mr. Barrett. Frank, your comments triggered a thought or two that I wanted to share as well. Mr. Martinez and Mr. McKeon, and you have indicated as well, a bipartisan nature that is now underway in the reauthorization of this bill. I will share with those of you that are here, one example of that.

Buck, excuse me, the Chairman, Mr. Martinez and I had a breakfast over in the Members' dining room some, what, a month ago, six weeks ago, deciding among other things that we would proceed in a very non-partisan basis to reauthorize this bill, which has not been reauthorized in, now, five years, I guess.

And to give you an example of the nature of that conversation, one of the questions was, how many years should we reauthorize, try to reauthorize?

I suggested five. Mr. Martinez suggested four. And I asked Mr. Martinez, "How are we going to handle this?"

He said, "I don't know . . .Let's flip a coin."

We flipped a coin. The reauthorization is four years. I lost.

[Laughter.]

Chairman McKeon. Thank you. We may have to resort to other measures on some of the more complicated matters.

[Laughter.]

But it does show that we have the ability and are working together. And we are friends. I think that is very important.

We have a special guest with us today, Mrs. Mink, who is a member of the full committee, not a member of this subcommittee. She is ranking member on another committee. And she has a constituent here that she has asked if she could introduce. We are happy to have her do that.

Mrs. Mink. Appreciate it very much, Mr. Chairman. I first would like to suggest that you have a hearing in my district.

Chairman McKeon. Hey.

[Laughter.]

Mr. Martinez. I will second that, Mr. Chairman.

Mrs. Mink. I'm sure that by such a visit, you would learn why I am so proud to be here today to join with the subcommittee in introducing our first witness, who is the honorable Jeanette Takamura, the Assistant Secretary of Aging for the U.S. Department of Health and Human Services.

I have known Ms. Takamura for many, many years, and am a very great admirer of hers. We were absolutely thrilled when the President appointed her to this very high office. She was a first deputy in our State Department of Health, and prior to that, a director of our executive office of aging, and has spent a considerable number of years in this field of aging. She served on the National Advisory Committee for the White Conference on Aging, served as an officer of the National Association of State Units on Aging, and a member of the board of directors of the American Society on Aging.

She has an extensive academic background as well. Was an assistant professor at our school of social work, and comes to this distinguished committee with a Ph.D. in social policy from Brandeis University and attended many other distinguished universities, including Harvard, University of Michigan, University of Southern California, and has a long list of articles that she has written, contributing many, many new ideas and, certainly, is a leader, not only from our State, but from the whole perspective of national leadership in this whole area of aging.

So I am really proud, Mr. Chairman, to be here today to introduce a very, very distinguished citizen from my State, of whom we are all very proud.

Thank you, Mr. Chairman.

Chairman McKeon. All that talk about aging. How come she doesn't.

[Laughter.]

Ms. Takamura. I do.

Chairman McKeon. Okay. And our second witness will also be Mr. Raymond Uhalde, the Deputy Assistant Secretary for Employment and Training Administration with the U.S. Department of Labor.

We have had the opportunity of working before on the Job Training Bill. So we really look forward to hearing what you have here to say.

In 1977, Mr. Uhalde began his Federal career with the Department as an economist, working on welfare reform. After a short stint with the Nevada Employment Security Agency, he joined the Office of the Assistant Secretary for Policy. After several years in the policy office, he joined the Office of Employment and Training Administration.

We are happy to have you here today. You know how our light system works. When you start, you get the green. When you have a minute left, you get the yellow. And just before the bomb goes off, you get the red.

[Laughter.]

Ms. Takamura. Sounds ominous. Thank you, Mr. Chairman, members of the committee, and, particularly, to Mrs. Mink, who represents me in Hawaii. Good afternoon, and thank you all for the opportunity to participate in this hearing on the administration's proposal to reauthorize the Older Americans Act.

Chairman McKeon, we appreciate your leadership and commitment to working in a bipartisan manner. I am pleased, of course, to be joined today by my colleague, Deputy Assistant Secretary Uhalde from the Department of Labor, with whom we have worked to develop the administration's reauthorization bill.

We truly are on the threshold of an extraordinary time in our country's history. There will be more older persons, more caregivers, and greater generational and ethnic diversity in the 21st century. These demographic realities present us with a myriad of possibilities, opportunities, and challenges.

Today, one in six American is 60 years of age or older. Early in the next century, 76 million baby-boomers_and I am one of them_will join the ranks of older Americans.

Chairman McKeon, in your subcommittee alone, approximately one-half or your members are baby boomers. According to the Census Bureau, one of every nine baby boomers will live to at least 90 years of age.

The need to reauthorize the Older Americans Act has never been more evident. A strong act will ensure that older persons and their families will have access to critical supported services as they address their own longevity.

Our reauthorization proposal sets the stage for the more strategic, effective, efficient delivery of home-and community-based services and programs for present and future older Americans and their caregivers. It preserves the act's unique place in history as a strong advocate for frail and vulnerable older Americans.

It also presents an essential new vision and agenda to prepare America for the growing longevity of its people. In building upon the proposals presented and supported by this administration during the last two Congresses, it continues essential services and programs for older persons and their families. And the targeting of programs and services to those in greatest social and economic need, with particular attention to low-income minority elders.

It allows States the options of instituting cost-share for certain services except critical access, protective, and nutrition services.

Recognizing the importance and distinct role of each title, our proposal maintains all seven titles, cut consolidates and integrates groups of programs into broader categories. It simplifies and streamlines title IV and renames it ``State and Local Innovations and Programs of National Significance'' to better reflect its important and historic role in expanding knowledge and understanding of the older population and the aging process through innovative ideas and best practices in programs and services around the country.

It maintains a separate title for the provision of critical services to Native American elders who are among the most disadvantaged groups in our country. And it preserves title VII vulnerable elder rights protections but consolidates funding for its four components, elder abuse, long-term care ombudsman programs, legal services development, and outreach counseling and assistance, to give States a funding flexibility and to allow them to develop systems and provide information and assistance, and establish life-course planning efforts.

Chairman McKeon, to adequately and successfully address the challenges of the new millennium, we must improve and strengthen the flexibility of the act. Hence, we propose to streamline the operations of State programs, add flexibility by eliminating unnecessary Federal requirements, and build a more dynamic customer orientation.

The proposal acknowledges the promise of evidence-based research and of technological advances in modernizing service programs and in developing solutions to current and future challenges.

Three significant changes in our reauthorization proposal address issues faced by a diverse and rapidly changing society. And I would very quickly like to go through these.

First of all, we propose to establish an unprecedented national family caregivers support program to provide services and support for family caregivers of vulnerable and at-risk older individuals. This program establishes a critical new focus on family caregivers of older Americans, paralleling the long-standing emphasis of the act on services for older persons.

The proposed program will be established by amending title III (d) and is funded at $125 million in our budget proposal for the year 2000. It will assist approximately 250,000 families each year.

I see the red light is on. Caregiver support would include information and assistance, counseling, caregiver education and support groups, respite and supplemental services.

Mr. Chairman, the second thing that we are proposing in our reauthorization proposal is for a new authority for States to modernize service delivery in response to demographic, technological, and environmental changes, as well as to meet the needs of diverse segments of the older population.

In order to sustain and improve program quality and effectiveness, the administration proposes to facilitate the updating of Older Americans Act services and programs, many of which were organized three decades ago.

You know, each day, an equivalent of a small American town, about 6,000 people, turn 60 years of age. This pace will only increase, and we expect a larger and increasing diverse population of older Americans and their families.

At the very same time, we are seeing technology and other advances emerge. And they must be transferred and incorporated into our programs and services.

I would also just note for you very quickly, that we, in our recent symposium in Baltimore, noted all of the advances in technology that are emerging in the field. We actually propose to use the greater of $300,000 or 4 percent from title III supportive and nutrition service funds to develop tests and implement innovative service delivery approaches.

Our final new proposal affects each and every one of us. It is for life-course planning. That is, to prepare this country for longevity. You know, more people in America spend more time planning for their vacations and for their holidays than they do for their future and for their lives.

We believe that the aging network is well positioned to actually provide leadership for a systematic approach to prepare our country, individuals, and families for population longevity. Women and others would particularly benefit from this emphasis.

We propose to amend title VII of the Older Americans Act to actually accommodate and initiate this life-course-planning initiative.

We are very excited about these three new proposals and their promise and potential. We hope that the subcommittee will give us the opportunity to not just work with the reauthorized act but also to work with three new initiatives that can make a difference in America.

Thank you very much. We look forward to working with you.

See Appendix B For The Written Statement Of Jeanette Takamura, Assistant Secretary For Aging, Department Of Health And Human Services

Chairman McKeon. Thank you. Mrs. Mink just reminded me, or informed me, that she is a member of the committee, and she wasn't on our committee last year. She just changed over. We are really happy to have her on the committee.

Mrs. Mink. Thank you.

Chairman McKeon. Mr. Uhalde.

Mr. Uhalde. Thank you, Mr. Chairman, members of the subcommittee, for the opportunity to appear before you to discuss the senior in community service employment program, or SCSEP and the reauthorization of the Older Americans Act.

Though as Ms. Takamura said, we as a nation are living longer, and some of us are retiring at relatively young ages. Some people can't quite retire for economic reasons, and others want to keep working. The only employment training program aimed exclusively at low-income older people is the SCSEP program, which is authorized by title V of the Older Americans Act.

SCSEP provides community service employment to low-income people 55 or older. Over 90,000 people get part-time jobs each year, and they help a lot of people. Participants work at a wide variety of jobs and are paid the minimum wage or slightly higher. They meet community needs by working at non-profit and government agencies.

This program has had strong bipartisan support, as it should.

A typical participant is a woman with a high school education in her mid-sixties. She may be a nutrition aide feeding seniors, a clerical worker for a human service agency, or a child-care worker watching our kids. Nearly 75 percent of the participants are women. Over 40 percent are minority. And 80 percent are age 60 or over.

I recently visited several SCSEP projects, and met a participant who is 74, has several disabilities, and is the principal switchboard operator for a District of Columbia agency. Before entering the program, her income was below the poverty level. Now she is self-reliant and has highly impressed her employer with her ability to handle a large volume of telephone calls and to calm irate customers.

Two kinds of organizations operate the program, national non-profit organizations and the States.

As directed by the Labor Appropriations Bill, the national organizations receive 78 percent of the appropriation and the State-operated programs 22 percent. This formula has worked well for over 20 years.

While the focus of SCSEP is on community service, the department has increasingly encouraged program operators to move more enrollees into unsubsidized employment.

Last year, about one of five participants was placed in an unsubsidized job. Increasingly the program is serving as a bridge for people who want to enter or re-enter the unsubsidized job market.

The administration supports reauthorization of the Older Americans Act, including title V. While SCSEP has continued to run through annual appropriations bills, it is critical to reauthorize the program.

Reauthorization would provide stability and show individual that Congress recognizes the importance of the program and intends for it to continue. Although we think SCSEP is working well, there are improvements that can be made, and updating that can be achieved in reauthorization.

It's important, however, that we not let differences over specific details of these changes result in the prevention of the enactment of a reauthorized bill.

The Department of Labor has worked closely with the Department of Health and Human Services to develop the administration's draft bill, which was submitted to the_transmitted to the Congress on March 31.

The principles underlying the proposed changes in title V fall into four areas. First, strengthening linkages with the workforce investment system. The Workforce Investment Act of 1998 is the first major reform of job-training programs over 15 years, and, Mr. Chairman, I pay tribute to your leadership in passing this landmark legislation.

SCSEP is a mandatory partner in the new one-stop delivery system, which is a key point of access for all individuals to employment-related information and services. Our proposal adds complementary language to the Older Americans Act to reinforce the connection of SCSEP to the one-stop system.

We are proposing other changes as well to better coordinate the activities between the two pieces of legislation, such as permitting waivers of statutory and regulatory requirements.

The second principle is promoting flexibility. Because of the expected growth in the eligible population for the program, we are seeking more flexibility to better serve older workers, seeking authority to expand training with private-sector employers, and reallocate unexpended funds to improve program operations.

The third principle is improving performance. The administration proposal provides the Secretary of Labor, after consultation with grantees, to establish performance measures for SCSEP projects.

These measures include the performance indicators from the Workforce Investment Act that are appropriate to the SCSEP program. Currently, performance measures are established administratively.

The bill also provides the Secretaries to annually award incentive grants to grantees that exceed the performance measures.

Final principle is the equitable allocation resources. Current statutory formula used for allocating funds to States, includes a 100 percent, hold-harmless provision based on 1978 allocations. As you might expect, the eligible population has shifted geographically since then. We recognize the difficulty created by proposing a formula change but believe the hold-harmless should be reduced incrementally to allow gradual movement of resources to where the eligible population resides.

Thus we propose the 95 percent hold-harmless provision.

We also propose a study of the formula as a basis for possible future improvement. We do not intend to change the

Share of funds going to national sponsors and the States. Instead, we have incorporated in the bill the relative distribution of funds between national grantees and the State agencies that has been specified in the appropriation acts.

Generally, the national sponsors have done an excellent job, and therefore, their funding should now be reduced.

Finally, we are considering changes to delete obsolete provisions and incorporate some current administrative practices in the statute.

Mr. Chairman and members of the subcommittee, I look forward to working with you and your Senate counterparts on reauthorizing the Older Americans Act.

Thank you.

See Appendix C For The Written Statement Of Raymond Uhalde, Deputy Assistant Secretary For Employment And Training Administration, Department Of Labor

 

Chairman McKeon. Thank you very much. We have people standing back here. We have some seats over here.

Sorry. Well, live and learn. Okay. Ms. Takamura, there is some concern among members of the committee that current language on targeting funds under the act within the States does not place adequate emphasis on rural areas where costs of providing services may be higher. Have you performed any studies on the costs of providing services in the rural areas? Do you believe that this is a problem?

Ms. Takamura. One of the things that we do routinely because of the way the act is constructed is require States and area agencies to include in their development of State and area plans consideration of all of their communities, whether they are rural or urban. And in that process, they have got to also consider the cost of services.

From what I have seen so far, I think our States and localities are very diligent in considering factors, including rurality and other things in developing their State and area plans.

Chairman McKeon. Thank you. Would you please expand upon how your proposal handles the USDA cash and commodities?

Ms. Takamura. Oh, yes. Yes. Actually, we have been in discussion with the USDA, and we actually have come up with an agreement whereby we receive reports on an annual basis and then submit these reports to USDA again annually. So it much streamlines the process as opposed to going to quarterly and monthly reports.

Chairman McKeon. Thank you. Mr. Uhalde, in your testimony you indicate that the national grantees have done an excellent job and should continue to receive the 78 percent of available program funds. Now I am kind of new to this. We have some veterans here who have worked on this before, but my understanding is that the original intent of the law envisioned a 50-50 split between the national sponsors and the States. It would appear that States have not really had a strong opportunity to demonstrate what they can do because they have not received adequate funding.

Any comments on that?

Mr. Uhalde. Well, I was not around at the origination of the act, but for the last 20 years we have operated under the 78-22 split between national and State programs. We think this is a good relationship. There are important roles that are played by both.

The national partners have consistently, with the resources they have provided, provided excellent service. Their performance has, in many respects, on several measures, exceeded the State grantees. But I think they work in very complementary manner. The national partners, after all, by and large, are private entities, and they are very focused, for example, on placing participants in unsubsidized jobs at a higher rate, nearly 32 percent versus 23 percent for the State agencies.

They consequently have a lower unit cost. They consequently are able to have more participants flow through each slot. But they also provide important complements. Many of the State agencies sub-grant to the national grantees as well at the local level.

So we believe that it has been working well. Certainly the customers in the older Americans are satisfied with the program.

Chairman McKeon. Would you explain to the subcommittee how the 10 national organizations are chosen to administer the program?

Mr. Uhalde. Apparently, again, back at the creation, five of the national grantees were founding members, if you will, at that point. We have additional_in 1979, we had additional resources, and on a competitive basis, I believe, two additional grantees were selected. In 1989, we had additional resources, and three additional grantees were selected.

And so that is how we have gotten to the 10.

Chairman McKeon. Thank you very much. My time is just about up. Mr. Martinez.

Mr. Martinez. Thank you, Mr. Chairman. I have many questions and will probably have to direct some of these questions to you by mail. I hope the Chairman will keep the record open so that we can receive those comments because we do have a lot of members of here who all want to ask questions.

Right now I want to concentrate on one of the issues that prevented us from reauthorizing the Older Americans Act last Congress, and that is the idea of targeting. And in all the hearings we have had so far, most of the witnesses have been in support of retaining the language that targets minorities.

The question does arise, however, that rural areas are being neglected. Now, over the history of this act, when the initial language did not have this special attention to minority populations, they were ignored too. And it wasn't until we put that language in that there started to be a recognition of those populations and the necessity to serve them.

In your legislation, do you eliminate the language targeting minorities? No.

Well, let me ask you this then: Do you feel that if you added language requiring special attention to rural populations, then the area agencies would start paying attention?

Let me tell you why I ask. Local agencies and area agencies on aging sometimes interpret things differently than we intended and refer to certain conditions that they place on their service providers as being written in law when they are not.

And they then set up what I really consider to be policies of that area, which are not, in fact, based on law.

For example, some area agencies are telling their people that they cannot ask for voluntary contributions when there is nothing in the law that says they can't ask for voluntary contributions. But we heard from a service provider at one of the hearings that he didn't ask about voluntary contributions because he felt he couldn't because he was were restricted by the law in asking.

I only mention that because it is another question we have to take up. Also, it is to give you an idea of what I am referring to when I say that sometimes the local agencies do not pay close attention to the law, and as a result, misinterpret it. For example, in the law it says that geographical factors should be taken into account when developing the formula.

Can you respond to that?

Ms. Takamura. Congressman Martinez, I am going to provide you with perhaps an answer that you don't quite expect, but it is an honest answer. To be honest with you, you know we do have a very large aging network, and I am sure there are people on that network who misunderstand what he provisions of the act are.

If ever you feel you need our assistance to clarify that, we would be more than happy to provide that kind of information because sometimes it takes repeating things time and again so that people understand the rules of the game.

That's the first thing. The second thing is that truly as State and area plans are developed, all of those concerns that you raised should be taken into account.

Having said that, one of the reasons that we introduced this year in the Older Americans Act proposal from the administration besides the family and caregivers support program, the two other elements, which is life-course planning and modernization, is that we think that those two additional new proposals give Americans across the country a new opportunity to get ready for, to deal better with aging and longevity.

You know, some of our rural communities may best in the long run be assisted if we can begin to introduce more technological assistance. Telemedicine is something that is coming, maybe not here right now, but it is coming.

Telehealth is another thing.

We would like to have the opportunity to use technology and innovation to make our service delivery more effective. That's the first thing.

The other thing is that with life-course planning is what we are suggesting is everybody knows now, what the demographic realities are. But it is time to get ready, it's time to do something about this instead of waiting for the crisis to hit and then try to put together programs.

With the life-course-planning initiative, we are suggesting that communities can address this issue, can say we have aging population, what are we going to do to get ready for this. It gives that elbowing so communities will do that.

And on the individual and family level, it does the same on this kind of thing. So beyond just looking at a formula solution, we are looking at a program and service delivery solution, at a way to make the future something that we can meet effectively, cost-effectively, as sell as effectively through programs and service delivery.

Mr. Martinez. Yes. I can understand that if you become more effective because of modern technology, you are going to provide better services to a greater number of people.

That is not the problem at this time. My question to you, and my problem is, that too many times the local area agency on aging do not understand the law. How do we communicate with them to eliminate this idea that they can't ask for voluntary contributions, as many service providers are already doing and how do we ensure that rural populations are being served?

You see, there is concern, and it was expressed in Nebraska, that because all of the problems seem to be in the urban areas, that we concentrate our resources in the urban areas, while close by, there may be a rural area that is not getting served.

So the question is, how do we create equity? How do we emphasize the need to serve that rural population?

Does that make sense?

Ms. Takamura. There are two things that I hope that we can do together. First of all, I will be going to speak to the National Association of Area Agencies on Aging tomorrow. And I will raise this concern and ask them to emphasize the importance of serving our elders in rural communities.

The second thing is that I hope we can have further discussions on this because it is clear that there may be things that we both need to trade information on.

Mr. Martinez. Those five minutes go really fast.

[Laughter.]

Chairman McKeon. Mr. Barrett.

Mr. Barrett. Thank you, Mr. Chairman. Mr. Martinez, I appreciate your calling attention to the problems in rural America. This was a topic of conversation in our four previous hearings, and to a person like myself who comes from a small, rural State, it is of major concern and interest to me and my colleagues who are in similar predicaments.

I guess I appreciated your three initiatives. In your testimony, and at the top, the number one was the caregiver support program, which we have discussed at previous times as well. I think all of us would agree that it is in the best interest, of course, of our seniors to be taken care of at some point in time by family, by spouses, by relatives, whatever, in order to prolong the time when they might have to go to a care home.

I guess the question is a concern of mine that I have regarding adding to the Federal bureaucracy. Are we looking now at another program, a new program, which you suggest estimated cost of $125 million? Is this seed money? Are we looking again at an enlarged Government program, the new program that it is? And how can it be served?

Are we establishing a new agency? Answer that one first.

Ms. Takamura. That is a very good question and I appreciate your giving me the opportunity to answer it. Actually, we see this program as saving money, as opposed to spending money because we know the cost of long-term care is exorbitant. In Hawaii, I know of people who are paying for nursing home care, and they are paying $80,000 a year.

I know that because I have been one of the caregivers in my family, when my grandmother was very ill, for example. I know that most families want to be cared for, older people want to be cared for by their family members.

What we have proposed to the President's budget is a new program that would essentially be run by the administration on aging. It calls for 88 percent of the money to be given to the States by population-based formula grant. Ten percent of the money would go for national innovations, and about 2 percent of the money would go for public awareness and public education so that people can understand this whole thing of long-term and caregiving.

We are prepared to move forward with this without asking you for a huge number of staff to be added to our agency. We are cognizant of the budget cap, and we are cognizant of all the, you know, caveats and things that we must be careful of.

And so this is a program that we view you to be an essential first step in addressing the long-term care needs of our family members.

Mr. Barrett. The Administration on Aging, of course, would be the umbrella?

Ms. Takamura. That is right.

Mr. Barrett. Do you see, is it possible that this could be administered through our existing senior citizens?

Ms. Takamura. That is what would happen. It would go to the States and to the area agencies.

Mr. Barrett. This is the focal point for_

Ms. Takamura. Absolutely. Absolutely. It goes through the same funding channels, the States. The States would then go to the area agencies, and they would use the State planning and area-agency-planning process to determine how to allocate the monies and how to build their system.

We feel that is very important to give our States across the country the opportunity to build an infrastructure that works. We need something that caregivers can go to with some sense of reliability.

Mr. Barrett. Thank you. Could you_in previous hearings, the subject of cost sharing has always come up. Could I ask for your position on cost sharing?

Ms. Takamura. Yes, and thank you for that question as well because there is a lot of confusion, and certainly lots of concerns around cost-sharing. It has really been the administration's position since 1995 that cost-sharing be a State option except in the case of access services, nutrition services, and elder protective services. With those three sets of programs, we feel that there should be no cost sharing because they really are things that people will need to get to immediately.

Mr. Barrett. No cost sharing you say?

Ms. Takamura. Not for access, nutrition, and elder protective services. In other words, if a person is being abused. The reason that_there are actually four elements which under-gird the administration's rationale for State option for cost sharing. And let me share those with you, if you will permit me.

The five minutes are up.

Mr. Barrett. Well, let's go back to my question. How do you feel about cost sharing on meals, number one?

Ms. Takamura. No. We are opposed to that.

Mr. Barrett. Okay. Thank you. How do you feel about cost sharing on other services, like what home_

Ms. Takamura. Not information. Not, you know, information and assistance. Not elder-abuse protective kinds of services.

Mr. Barrett. You do not support cost sharing on any basis, even voluntary?

Ms. Takamura. Well, I suppose people could voluntarily contribute.

Mr. Barrett. Okay. Fine. Thank you. Thank you, Mr. Chairman.

Ms. Takamura. You're welcome.

Chairman McKeon. Thank you. This topic of cost sharing came up at the entire other_I think we need to define what we are talking about in cost-sharing.

We'll have probably more chance to talk about that. Mrs. Mink.

Mrs. Mink. Thank you very much, Mr. Chairman. I am very much in support of the administration's proposal on the caregivers support program. I think that is a very excellent idea, and I don't quite know how the $125 million is to be spent. But it is certainly a program that needs to be given some priority.

My concern, however, is that on the one hand we are establishing this new program; on the other hand, as I recall under Medicare, the home-health provisions were transferred to Part B. And seniors are now expected to pay for home health-care services through their contributions under Part B.

Isn't that somewhat inconsistent? If on the one hand you find that this is an essential need and were providing these services, and on the other hand, we have transferred it to a contributory part of the Medicare program?

Ms. Takamura. Mrs. Mink, I won't presume to even suggest that I understand exactly HCFA's, you know, program design, et cetera. But I will say that, certainly home health-care costs have risen over the last several years. And I think the point that I do want to make is that what HCFA is paying for, by and large, is for services for people who have limited income, who are nursing home eligible.

In this case, we are talking about is an infrastructure of support, not for older people, but for the caregivers. And the reason for that is that 95 percent of the elders in need of long-term care are being cared for by caregivers.

I will give you an example. Back in Hawaii, someone you know and I won't name because they would be embarrassed, actually is caring for her husband who had a stroke and was caring for her sister, who had Hodgkins Disease. She was the sole caregiver. She has no children, no other siblings. Her husband has no other siblings. So she was the sole caregiver for her older husband and her older sister.

On a daily basis, she would drive to Kailua and back in order to care for her sister, and when she was at home, she would care for her husband, who cannot actually ambulate by himself. She is exhausted, and I would say she has lost a lot of weight. She really needs some kind of support.

So what we are talking about is an infrastructure of support: Information specifically tailored for caregivers, assistance specifically to assist caregivers. We found that particularly caregivers of spouses actually have a higher rate of depression, particularly when their spouse becomes immobile. And I know that from my own personal experience in my own family.

So rather than saying that we will forestall or wait to support caregivers, what we are attempting to do is to sustain their efforts, to make sure that we prevent nursing home care, you know, prevent their need for institutional care. And at the same time, of course, HCFA is working on those home-care and institutional-care issues.

Mrs. Mink. So what you are saying is that under the Medicare Part B or Part A, wherever it was previously, the costs of that program was the provision of health care for the person who needed health care.

Ms. Takamura. Right.

Mrs. Mink. And under your program, you are providing the support to the caregiver and not to the person for whom that care is being given.

Ms. Takamura. That's right. In the Older Americans Act, so far, we have targeted specifically older folks. And our services are gap-filling. So whatever Medicare and Medicaid does not cover, we fill in the gap as much as we possibly can, given the limitations of funding. We have not paid attention to caregivers, and that is where we want to target.

Mrs. Mink. But isn't_just to finish in my last three seconds_but isn't the major support that you can give a caregiver the idea of respite care, which means someone coming in to provide just a day or so of relief from that care responsibility, which is a cost item ultimately?

Ms. Takamura. Right. And if you will excuse me, actually I should have been more accurate. We do also include an element that is respite care. And it could be in-home, it could be through adult daycare, or through overnight stays in an assisted-living facility or a nursing home.

But, again, the States have a limited amount. In some cases, some States have a limited amount of monies available for respite care, generally through Medicare waiver and, generally then, for people who are low-income for who are nursing home eligible.

In our case, what we would be looking at is the vulnerability of the elder and the caregiver, and then we would look at providing respite care to support that caregiver so that they could sustain themselves.

I am sorry. Thank you for giving me that chance to clarify that.

Mrs. Mink. Thank you.

Chairman McKeon. Mr. Kind.

Mr. Kind. Thank you, Mr. Chairman. I want to commend you, Mr. Chairman, as well as the ranking member for the effort, bipartisan effort so far in trying to reauthorize. It's long overdue, and hopefully, we in the committee can work together and get it right and move this along and try to get this accomplished this session. I think it should be a top priority for this session in Congress.

And I, too, want to just echo what Mr. Barrett and Mr. Martinez were pointing out earlier in regards to the necessity to keep an eye on the rural aspect of all of this. Obviously, we face some unique challenges in the rural areas, from emergency care to health care to nutritional services, employment opportunities, and I know in traveling around my district in western Wisconsin, this often comes up as a topic of conversation.

And at the town hall meetings that I have experienced over the last couple of weeks, meeting the seniors, especially during that, they place a healthy emphasis on reauthorization of this program as well. There were a lot of questions as far as where it is, how it's moving, and whether they can hope to see this reauthorized.

And I do want to welcome you two and thank you for your testimony today. Ms. Takamura, couple of questions.

I, too, like Ms. Mink, applaud the effort in the administration and the recommendations on the caregiver support program. The question I have is in regards to the dissemination of the information or the education that obviously is going to be needed in order to get the information out in regards to what this entails.

I know that in the State of Wisconsin, legislation that in all likelihood is going to be passed, which is going to set up a one-stop, long-term health-care center in various communities throughout the State. And would just hope the administration is keeping an eye on what is happening at the State and local levels so we can dovetail the education into what's taking place already.

Ms. Takamura. Right. Actually, to be hones with you, Congressman Kind, we looked at Wisconsin as one of the model States. So we are very familiar with the elements of the Wisconsin approach. And we would, in fact, look for our program to integrate with that one, or that one to integrate with our program.

Part of what we are calling for is for some national activities that would include public education because we think that we have got to make an understanding about long-term care and caregiving part of the fabric of everyday life. If we don't do that, people are caught short and surprised, and often times can find themselves involved in situations where they really cannot respond well.

Mr. Kind. Right. I would also be interested to hear any observations that you have made in regards to the modernization effort, or the goal modernization effort. And gain in my district, with telemedicine. We have got long-distance learning centers set up now in the State universities and technical school campuses. We are trying to dovetail this into access for seniors as well.

But what have you observed, if you could expound upon that.

Ms. Takamura. You know, because there are so many rural advocates here, let me just make a little comment and then say something about that.

I have spent three years of my younger professional life actually making about 250 trips to Molokai and Kauai, which are rural islands in the State, trying to figure out how best to deliver health and social services. So I have a full appreciation for the challenges that are entailed in delivering services and meeting the needs of rural communities.

Having said that, I have also has some experience with working with telemedicine and other technological innovations. We know that there actually are communities across the country that are beginning to experiment with the use of technology. For example, bar coding is being used to, in work with clientele, so that we can quickly identify clients and the kind of programs that they are using.

In Washington State, we have an ethnic nutrition specialist who is able to actually work with nutrition programs so that meals are appropriate for them. And I could literally go across the country and tell you about Wausau, Wisconsin, where Catholic charities have a very innovative nutrition program. Again, a modernized effort.

We want to see this sprout up all across the country because it is more cost effective, it's customer friendly, and quite frankly, it meets the needs of people.

Mr. Kind. Right. Finally, there hasn't been much discussion with regards to Title VI, Native Americans. Is there any significant or proposed changes with Title VI?

Ms. Takamura. Well, you know, we maintain a strong support for Native American Indians, and we have not by any means changed the language in title VI. We feel that this is one of the most, you know, one of the populations with the greatest needs. And we appreciate their concerns. In the proposal for the national family caregivers support program, under something that we call National Innovation Grants, we have actually set aside 20 percent of the sum that we would request for Native American Indians because we know that there is some work that needs to be done there.

Mr. Kind. Thank you. Thank you, Mr. Chairman.

Chairman McKeon. Thank you. Mr. Roemer.

Mr. Roemer. Thank you, Mr. Chairman. I hope that I don't have the same effect you did earlier_

[Laughter.]

But I will try to welcome all the Closeup students that we have in the hearing room here today without, hopefully, scaring them away.

[Laughter.]

Chairman McKeon. There they go.

Mr. Roemer. There they go.

We are two for two, Mr. Chairman. I didn't do any better than you. You know, that is even worse for me. I tried to learn from your example and still didn't do any better.

We are having a hemorrhaging here of students. Well, goodbye to those that left and welcome to those that are staying. We have had a host of Closeup students visiting from Indiana all week, and we think that is a great program, and we are delighted to see you up here learning about how the hearing process and the legislative process works.

My question to whoever would like to take the first stab at answering it centers upon the growing problem that we have with elder abuse, particularly in the fiduciary area. We find that in our field hearings and from requests that we have seen from local agencies and service providers that this is becoming something that is proliferating throughout all our communities. It is not State-dependent. It is not area-dependent, North or South. It seems to be happening everywhere.

Just yesterday on NPR I heard a report indicating that people were using the Y2K problem to scare seniors into moving their bank accounts. And that once the bank account was moved that all their assets were then taken away.

This is something that we have to keep an eye on. This is something that I am concerned about. And I guess that I would ask in Title VII how you address this specifically? And then I would have a couple of follow-up questions, depending upon how I read your testimony and then get your oral answer as well.

Ms. Takamura. I think you probably know that under title VII there are monies appropriated both to the long-term care ombudsman program as well as elder abuse. And we certainly agree with you: The number are growing with respect to elder abuse. Some of it, quite frankly comes, because people are very much involved in caring for their older parent or relative. With respect to the fiduciary or financial considerations_

Mr. Roemer. Do you have studies or factual evidence to back that up?

Ms. Takamura. We just, yes, we just completed a report that was released, I think, late last year. And we can send you a copy of that.

Mr. Roemer. So do you have a percentage of that? Do you find that the overwhelming number is the caregiver himself, you saying, rather than some outside source or_?

Ms. Takamura. Well, Congressman Roemer, to be absolutely accurate, I would rather send you the report because I don't have that number right off the top of my head. But on your concerns about financial exploitation and your mentioning the Y2K problem, you may be happy to know that the Administration on Aging on Tuesday of this week actually met with the FDIC. The Chairman is a very good friend of mine.

And the Administration on Aging and the FDIC are looking at how we can partner to get the word out to seniors that, in fact, their monies are very safe in banks and that they need to raise some questions sometimes about the communications messenger. We are working in this entire area of consumer protection, and we think that it is important.

And that is one of the reasons why, again, we put forward the life-course-planning proposal in the reauthorization that we submitted.

Mr. Roemer. How often do you find that you are cooperating and working proactive, rather than reactively, with the FDIC and other agencies to try to prevent this?

Ms. Takamura. Well, actually, the FDIC is an independent agency, and I can't really give you any history of partnership because I just came on the job a year and five months ago. But I can tell you that there is a very strong interest in cooperating with them, and that we have under the Administration on Aging through its funding things like the Women for Secure Retirement, I think it is called CENTER, which actually provides women with information about how to plan wisely for their future. We also have a number of pension counseling programs. All of these we view as central to the work that one must do to be prepared for potential longevity.

Mr. Roemer. Well, finally, I will just conclude by saying that I am not sure if I am reading it right or whether I am construing your comments correctly, but from what you have said and what I have seen in your comments, you have consolidated in Title VII a number of programs, elder abuse, prevention, legal assistance, ombudsman programs, which would allow either all of the funds to be used for those programs or none of the funds to be used for a prevention program. For instance, fiduciary abuse.

Ms. Takamura. Actually, what we have done is consolidated the authorization for the appropriations of funds that are title VII programs. There is, in fact, a floor that we have established or we are suggesting for a long-term-care ombudsman program. Current, there are two programs that generally receive funds as things are set up now, the long-term-care ombudsman program on the one hand and elder-abuse programs on the other.

Legal services and outreach, information and assistance tend not to be funded under title VII. They may be funded under title III or title IV. So what we are attempting to do by consolidating and establishing a floor for the ombudsman program is give States the option to use that money where they feel the needs are, you know, lie.

Mr. Roemer. So the short answer is_

Ms. Takamura. More flexibility. More flexibility. That's right: based on need.

Mr. Roemer. Thank you, Mr. Chairman.

Chairman McKeon. Are we getting a message? Do we_

Mr. Roemer. We are supposed to amend the Constitution now.

[Laughter.]

Chairman McKeon. Is it one vote, two votes?

Mrs. Mink. One.

Chairman McKeon. I was thinking we could go through probably one more round, but it doesn't look like we would have time. And by the time we go vote and get back, we would probably pretty well expended our time.

But, as Mr. Martinez mentioned earlier, we have asked each of the witnesses we have had before us to make sure that they continue to watch us. In your case, we not only ask you to watch us but we will, of course, be working together with what we come up with.

And so we will be working to dovetail all these proposals in together to come out with our final legislation.

Thank you for being here, and we look forward to working with you as we go through this process. We want to move quickly on this if we can and get this bill written and passed as quickly as possible.

We have waited too long already.

Thank you very much.

Ms. Takamura. Thank you.

[Whereupon, at 3:07 p.m., the subcommittee was adjourned.]