Serial No. 106-7



Printed for the use of the Committee on Education

and the Workforce




















Tuesday, March 2, 1999

House of Representatives

Subcommittee on Postsecondary Education, Training, and Life-Long Learning

Committee on Education and the Workforce,

Washington, D.C.




The subcommittee met, pursuant to notice, at 2:00 p.m., in Room 2175, Rayburn House Office Building, Hon. Howard McKeon [chairman of the subcommittee] presiding.

Present: Representatives McKeon, Goodling, Barrett, Ehlers, Martinez, Holt, Roemer, Owens, and Tierney.

Staff Present: Jay Diskey, Communications Director; Victor Klatt, Education Policy Coordinator; Bill McCarthy, Press Secretary; Reynard, Media Assistant; Lynn Selmser, Professional Staff Member; Kent Talbert, Professional Staff Member; Bailey Wood, Legislative Assistant; and Cindy Herrle, Professional Staff.

Chairman MCKEON. [presiding] Good afternoon.


Opening Statement of the Honorable Howard P. "Buck" MCKEON

Today's hearing marks the first of what will be a series of hearings on the reauthorization of the Older Americans Act.

Several weeks ago, Mr. Martinez, Mr. Barrett, and I sat down over breakfast and agreed that if we are ever going to get this law reauthorized, we are going to have to do it by working together. I have no problem whatsoever with that. Mr. Martinez is a good friend. Mr. Barrett is a good friend. I think we are going to have a real good association here.

No sooner had we had that breakfast, than Mr. Barrett, my friend from Nebraska, got things moving by introducing a bipartisan placeholder bill. The bill, H.R. 782, the Older Americans Act Amendments of 1999, is co-sponsored by Chairman Goodling, chairman of the full committee, Ranking Member Clay, Subcommittee Ranking Member Martinez, and myself.

However, there is still much work to be done when it comes to reforming and streamlining the provisions of the Older Americans Act. My hope is that the panelists we have here today will help us to begin to fill in the legislative blanks, so that those seniors who depend upon the essential programs of the Older Americans Act can live a more meaningful life, one which is filled with dignity and self-respect, and can remain longer in their homes.

With that, I would like to yield my remaining minutes to Mr. Barrett, who not only has taken an interest in this matter, but has also been willing to take the lead on it.

Mr. Barrett?


See Appendix A for the Opening Statement of the Honorable Howard P. "Buck" MCKEON

Mr. Barrett. Thank you, Mr. Chairman.

Today we are starting down the road toward reauthorizing the Older Americans Act which provides, of course, valuable senior citizen services for millions of our senior Americans.

As Chairman McKeon has said, last week Mr. Goodling, Mr. McKeon, Mr. Clay, Mr. Martinez, and I did introduce a bipartisan bill to reauthorize the Older Americans Act. I hope that this bill will be the first step in a bipartisan effort to refocus our attention on an important group of Americans.

Our goals for this legislation are lofty, but certainly not unattainable. We need to make the programs more flexible. We need to improve and simplify nutrition services such as Congregate Meals and Meals on Wheels. We need to protect senior citizen programs from abuse, fraud, and waste. We need to improve employment opportunities for low-income seniors. We need to eliminate complicated requirements that cause wasteful duplication and burdensome paperwork for both seniors and many of our service providers.

All members need to come to the table in good faith in order to reach these goals. We owe it to our citizens who depend on these valuable services to create the most effective legislation that we can. We need to keep in mind the importance of serving those most in need for whom these programs serve as a lifeline to services, nutrition, and opportunities for fellowship.

In the coming weeks, Mr. Chairman, we will be hearing from a variety of folks discussing different aspects of the Older Americans Act. An important part of providing those services is making sure that resources are being used in the most efficient way possible. Flexibility helps local organizations serve communities better, allowing them to distribute resources according to the needs of their clients and the unique requirements of their communities.

Today we will be hearing from people serving seniors in a variety of locations and a variety of situations. We have an excellent opportunity to hear from folks in the field who through their daily work, are exploring ways to improve these services.

More than anything, I hope that we can keep the needs of seniors foremost in our minds as we work together to reauthorize the Older Americans Act.

I thank you, Mr. Chairman.

Chairman MCKEON. Thank you, Mr. Barrett.

Mr. Martinez?

Mr. Martinez. Thank you, Mr. Chairman.

As you know, Mr. Chairman, many of us on both sides of the aisle have had a deep personal interest in the Older Americans Act. I have had a commitment to the Older Americans Act, since I first came to Congress in 1982. But beyond that, over the last 26 years, as a State and local official, I had the opportunity to see firsthand how the Older Americans Act works through communities to keep seniors healthy, active, and productive.

Having served on this committee through three reauthorizations, and as the author of the last successful reauthorization of the act in 1992, I don't think anyone has been more frustrated or disappointed than myself by the inability of the 104th and the 105th Congresses to pass the reauthorization legislation for the Older Americans Act.

However, I enter the 106th Congress with renewed sense of hope, especially since we had that breakfast the other morning that you mentioned. I came away with a very, very strong feeling that we are going to work together to achieve what we haven't been able to achieve in the last two Congresses. And our mere presence here today indicates to me that there is a revived interest in and enthusiasm about the act, and perhaps even a fresh start.

Just last week, as you mentioned, I joined with you and Mr. Clay and Mr. Goodling and Mr. Barrett in introducing what we consider a bipartisan Older Americans Reauthorization Act as a placeholder. This bill, I am confident, is a first step in a joint process to strengthen and improve the Older Americans Act.

The Older Americans Act is the primary Federal vehicle for services intended to specifically help the elderly remain self-sufficient. The nutrition and support services provided under the act are especially significant to low-income minority seniors, given their many disadvantages.

I look forward to today's testimony about the importance of the act's minority and targeting provision and on the potential impact of cost sharing on poor and minority individuals.

In addition to today's hearing, over the next several weeks, this subcommittee will conduct a series of field hearings in communities across the country collecting information and ideas on how we can make this program better.

Undoubtedly, members will have differences of opinion as we proceed with the process of reauthorizing the many programs and services provided under the Older Americans Act. However, I am encouraged by the very bipartisan beginning and the commitment demonstrated thus far by yourself, Mr. Chairman, and Mr. Barrett, Mr. Goodling, to working through those differences and keeping the best interests of those who are served by the act, the seniors, in the forefront.

Thank you, Mr. Chairman.

Chairman MCKEON. Thank you.

Our first panel today will be comprised of two of our colleagues who have been very interested in this bill. First we will hear from Representative Jim Kolbe, from Arizona, representing the 5th district in Arizona. Mr. Kolbe is a strong advocate for seniors' issues. His commitment to American seniors is evident through his efforts to save Social Security, reauthorize the Older Americans Act, and reform private pension law to provide increased savings for retirement. In addition, Mr. Kolbe is a member of the Older Americans Caucus.

And then we will hear from Representative Peter DeFazio from Oregon, who represents the 4th district there. Prior to his seven terms here in Congress, Peter had significant experience in older American issues beginning with a master's degree in gerontology from the University of Oregon. He was also a counselor for the Jewish Home for the Aging in San Francisco, the assistant director of the Lane County Senior Companion Program in Oregon, and a senior specialist for former Congressman Jim Weaver.

It is a pleasure having you both here today. We will hear first then from Representative Kolbe.



Mr. Kolbe. Thank you very much, Mr. Chairman, and I appreciate your accommodating us in this fashion.

I have to chair an Appropriations subcommittee in just a few minutes. My comments will be very, very brief.

I am delighted to be here today and delighted that you are holding this hearing. I want to add my voice of strong support for the reauthorization of the Older Americans Act. I applaud your efforts to bring the plight of the Older Americans Act to the forefront of the legislative agenda of Congress. I know you have an ambitious agenda, so I will keep these remarks very brief.

Mr. Chairman, as you know, the Older Americans Act governs many programs that are of critical nature to our Nation's elderly. Although the act is relatively small in terms of the dollar amounts that are involved, $1.4 billion in last year's Omnibus spending bill, the Older Americans Act has a significant impact in all of our communities, and certainly with older Americans. Specifically, every year the Older Americans Act provides or helps to provide: 240 million meals for seniors through Meals on Wheels and Congregate Meal services; 40 million rides_vans bring frail seniors to meal sites, doctors' offices, and other locations; 12 million responses for information and referral for help; 1.3 million home care visits; 1 million legal counseling services; and jobs and training to approximately 100,000 low-income seniors over the age of 55. In my district alone, the Older Americans Act has touched lives of nearly 22,000 senior citizens just last year.

Unfortunately, the future of these important programs, I think, are at significant risk. As you know, the Older Americans Act was last reauthorized in 1992, and it expired in 1995. It has languished, virtually unattended, ever since. Now, although the Appropriations Committee on which I serve has continued to provide funds for the individual programs governed by the Older Americans Act, many senior groups are concerned, and I think with considerable justification, that the continued lack of reauthorization endangers future funding, or at the very least, the lack of future funding raises such doubts about these programs, the stability of these programs. It is very hard to maintain the kind of consistency in the services that we provide.

Moreover, the programs have been level-funded since 1995. Without some increase at some point in the funding, it is hard to see how these programs are going to be able to keep pace with the needs of the growing, aging population. So, I believe it has become essential for authorizing committees to signal their spending priorities and their priorities for programs through this reauthorization.

Mr. Chairman, two programs vital that are to retired people, Social Security and Medicare are in crisis. They are the subject of major legislative initiatives this year. Anxiety among senior citizens is high. While we work on the reforms that are necessary to fix Social Security and Medicare, it seems to me that reauthorizing the Older Americans Act quickly and without controversy, is one way that we can reaffirm our commitment to older Americans and their programs that serve them.

Mr. Chairman, thank you for the time today. I appreciate this opportunity to add these words in support of the Older Americans Act, and I look forward to working with you. I hope to pass this very important legislation.

Thank you.

See Appendix B for the Written Statement of Hon. Jim Kolbe, a Representative in Congress from the State Of Arizona

Chairman MCKEON. Thank you.

Mr. DeFazio?


Mr. DeFazio. Thank you, Mr. Chairman.

Mr. Chairman, I want to thank you and Ranking Member Martinez for the leadership you are showing by bringing this issue before us for hearing so early in this Congress. It gives me hope that after four and a half, going on five long years, we will reauthorize the Older Americans Act.

I don't think anyone has set a formula in stone for reauthorization. We all know the very many vital programs that are authorized and funded by the act. In particular, you referenced in your opening remarks my experience.

I started a senior companion program with another person when I was still in graduate school at the University of Oregon. The program was the first one in the Northwest and the first senior companion program. It still exists. You know, they still invite me back. I don't think any of the original companions who I worked with are still working, but a tremendous program employing low-income elderly Americans to work with less capable, at-risk elderly Americans in the community, help them maintain their independence and, you know, just a tremendous expenditure of Federal funds. Very few Federal dollars go into that program, but we save so much money in terms of preventing institutionalization.

There are other programs within the act that help contribute to independence, the Congregate Meal program, in particular. It is not just the nutritional sustenance, it is also the companionship, delivery point for other social service providers to locate seniors that are having problems. You know, these programs are all so vital.

I have got to say that I believe, Mr. Chairman, if you and the ranking member bring forward a bill, we could probably do it on suspension [of the rules]. This is something in offering my own version in last Congress, I found out is about the easiest bill I have ever offered to get co-sponsors for in my life here in Congress. I think, you know, a wise and well-thought out reauthorization will be incredibly popular in this Congress. Now, the other body, who knows? But I think we will get through the House just fine.

You know, we don't have to stand still. I think there are some programs, particularly those that emphasize independence, in-home care, or maintaining people in the community, could use more emphasis as we struggle with our Medicare and Medicaid budgets. Seniors are, you know, looking at the cost of institutionalization.

Any additional emphasis that we can put on those programs that maintain people in a community-setting will both improve their quality of lives and limit Federal expenditures. So I urge you to look particularly creatively and carefully at those aspects of the Older Americans Act reauthorization.

I just wanted to thank you for your work, and be here today and offer my support.

See Appendix C for the Written Statement of Hon. Peter Defazio, A Representative in Congress from the State of Oregon

Chairman MCKEON. Thank you very much.

I know that you both have other committee assignments, but do we have any questions of this panel?

Thank you very much.

Mr. DeFazio. See I told you it wasn't controversial, Mr. Chairman.


Thank you very much, Mr. Chairman.

Chairman MCKEON. I appreciate your enthusiasm, and I hope you are correct.

We will just set up for the other panel right now. We have Ms. Neetu Dhawan-Gray, Neetu Dhawan-Gray_did I get that close? Dr. Steven Niebler, Ms. Marilyn Mower, Mr. Carl West, Ms. Geneva Shedd, Mr. Richard Lipner.

Now we have the chairman of the full committee here with us today, and he has asked if he could introduce Mr. Niebler, from his State.

Mr. GOODLING. Mr. Chairman?


Chairman MCKEON. I said that you would like to introduce Mr. Niebler.

Mr. GOODLING. Yes, I would.

First of all, I would like to say that I understood from your opening remarks that you and Mr. Barrett are good friends, and you and Mr. Martinez are friends. The gentleman from Indiana was sitting there, and I was sitting here, so I don't know where we are on his pecking order, but obviously_


The second observation I would make before I introduce him is that I am the older American on this committee.


I am old enough to be the father of a large percentage of the people on this committee. I think I know what we older Americans think we need and what we want. Your biggest job probably will be, there may be too many little pieces of the pie that we older Americans don't get a big enough slice. So that will be a job you will have to figure out, how you get me a bigger slice.

I am very happy to introduce Steve Niebler to the discussion. I visited his program on many occasions, and I count on him constantly to counsel me as to the direction he believes we should go. He represents a rural area. I always say there is nothing more difficult than when you are trying to meet needs of individuals than trying to meet needs of rural individuals, because there aren't all the opportunities that there are in an urban setting.

At a time when low-income home energy assistance was only available through the welfare office, an awful lot of those proud Adams Countyans weren't about to go into the welfare office to get their assistance, so Steve was the home visitor who took care of the applications. Then he took the applications to the welfare office so that no one saw them going to the welfare office in Adams County.


That is just one example of his going beyond the call of duty. So I look forward to his testimony, as well as everyone's testimony.

We got this out of committee in 104th, I believe, but then it sort of fell apart. So, we will try again.

Chairman MCKEON. Thank you, Mr. Chairman. My good friend, the chairman.


I guess I didn't realize how old you were. I guess we will have to start calling you ``Dad.''


Anyway, we are very happy to have this committee here today_this panel. We will begin with Ms. Neetu Dhawan-Gray. That's a neat name.


Ms. Dhawan-Gray. Thank you.

Chairman MCKEON. I will learn how to say it. You are the president of the National Association of Area Agencies on Aging and the executive director of the Baltimore City Commission on Aging Retirement Education?

Ms. Dhawan-Gray. Yes.

Chairman MCKEON. We will hear first from you.

What we do, you see that little green light? That will mean that we have five minutes. When it goes to yellow like that, it means you have one minute. When it goes to red, hold on to the table if you are still talking, because a trap door opens up.


Ms. Dhawan-Gray. Thank you.

Chairman MCKEON. We will hear first from Ms. Dhawan-Gray.


Statement of Ms. Neetu Dhawan-Gray, Executive Director, Baltimore City Commission on Aging Retirement Education

Ms. Dhawan-Gray. First of all, good afternoon to all of you and thank you for taking the time to spell and say my name correctly. I do appreciate that.

It is a distinguished honor to be here to represent the National Association of Area Agencies on Aging_throughout my testimony, I refer to it as N4A_and I want to thank you for inviting me to do so.

Mr. DeFazio and Mr. Kolbe have already indicated to you some of the programs, and so has Mr. Martinez and Mr. Barrett indicated to you the programs of the Older Americans Act. I would like to just share with you that the fundamental mission of N4A and the AAAs is to help older Americans stay in their homes and communities through the very services that you have heard about, whether it is Meals on Wheels, home delivery, transportation, or in-home services.

AAAs often serve as the single point of information of the complex and fragmented range of home and community-based services for older adults and their caregivers, including congregate and home-delivered meals.

The Older Americans Act binds 655 area agencies on aging and 232 title VI Native American agency grantees across the country, providing a support structure for planning, coordination of services, oversight, and advocacy. AAAs have the infrastructure in place to provide access to a host of services to older adults, link them to local services, and address issues of concern to their families. As such, the role of AAAs has steadily expanded to include programs that were not necessarily envisioned in the original Older Americans Act.

The typical beneficiary served by a AAA is a woman over age 75 with limitations in activities of daily living such as bathing, eating, and dressing. AAAs throughout the country find that they are working more and more with vulnerable and hard-to-reach populations, as well as those persons with chronic disabilities of all ages.

Many of us manage a variety of funding sources in addition to the Older Americans Act, including Medicaid waiver for home and community-based care, social service block grants, transportation funds, and State-funded in-home services. In fact, it is not uncommon for a AAA to coordinate 5 to 10 different funding sources to meet the service needs of one senior citizen. Of the 655 of us across the country, approximately 67 percent are public agencies such as in cities, counties, or regional planning commissions, and 33 are private, non-profit organizations.

The strength of the AAA network is a nationwide network of agencies that share a common mission and core services. Since the 1970's, the AAAs have demonstrated an extraordinary record of achievement in stretching limited dollars and leveraging millions of un-Federal dollars such as local government, foundation, private sector, participant, and volunteer contributions.

Each AAA is unique in our country because it reflects what the needs of the locals are_residents are_as well as what the capacity of each community is. I would like to tell you a little bit about what we do in Baltimore City.

Ours is an agency that was started in 1973 by one of your colleagues on the Senate. She was then City Councilwoman Barbara Mikulski. She is now our Senator from Maryland, but she was the one who created the city ordinance that established the Commission on Aging and Retirement Education.

I think our name is significant because it not only tells you that 25 years ago when we were created that our leaders in the city not only wanted to address the issues of concern to the elderly, but also issues of retirement education, so those people who were planning to retire in 10, 15 years could make educated decisions about choices of their lifestyle, financial, leisure-time activities. And that is part of our mission as our agency.

We have developed unique outreach strategies and programs to meet our citizens' needs for information and services, with a particular emphasis on reaching individuals who are most vulnerable and the risk of institutionalization. The typical senior receiving assistance through our CARE's homebound assistance service is low-income, homebound, isolated, with physical and/or mental impairments that make them unable to perform activities of daily living such as eating, dressing, and bathing.

CARE caseworkers, often student interns, perform individualized case management and link services for seniors such as home health, home-delivered, medication management, and transportation. This program was specifically designed to serve the needs of our Meals On Meals population. We felt very much that as our elderly population aged, that they were also isolated living at home, and we needed to address their other needs beyond meals. So we put together a program with case managers to go out and do some assessments and follow-ups.

In a complex urban setting as Baltimore, there are specific challenges in targeting isolated seniors, such as housing facilities, work with neighborhood organizations, religious groups to inform seniors and their family members about services available. Advocacy programs_Curbing Abuse in Medicare and Medicaid, Elder Abuse Prevention, and Health Insurance Counseling, just to name a few.

AAAs are called on regularly to offer new services, and one of the things that we are very proud of is that in the advent of Medicare choice, that we were a prime example of an area where services were demanded, and we rose to the occasion to fill those gaps that were happening in the community.

About two-thirds of the AAAs serve as health insurance counselors under the Health Care Financing Administration's HICAP Program. We are finding that beneficiaries want Medicare choice information to be available in local communities through organizations that are accessible and trusted by seniors. Moreover, as more HMO's terminate their involvement with Medicare, AAAs are the local site to where seniors turn for current information on what options are available to them.

In the long-term care arena, we are seeing increased involvement of AAAs in providing information on caregiver resources and providing counseling, training, and peer support groups.

With all these initiatives, N4A is particularly concerned about vulnerable and hard-to-reach populations such as those; one, with language and cultural barriers; two, mobility limitations and other disabilities; cognitive impairments; and, four, surrogate decision makers; and, five, persons who are geographically isolated, either in urban or rural settings. These beneficiaries are most often excluded from having access to the broadest range of health care choices. In most cases, active outreach at the local community level is needed if these beneficiaries are to be identified and reached, as those we have served in Baltimore.

Chairman MCKEON. We will include your complete testimony in the record.

Ms. Dhawan-Gray. Yes. I am trying to be as brief as I can.


Chairman MCKEON. We are past the_

Ms. Dhawan-Gray. I am going to go_let me go right to the Older Americans Act, if that is what you would_

Chairman MCKEON. We are past your time.

Ms. Dhawan-Gray. Oh, I am sorry.

Chairman MCKEON. So to give everybody else enough time, then we will come back and answer questions.

Ms. Dhawan-Gray. I am sorry.

Chairman MCKEON. But we will include your full report there in the record.

Ms. Dhawan-Gray. Okay. I apologize.

Chairman MCKEON. Thank you.

Ms. Dhawan-Gray. But I didn't look at the lights.

Chairman MCKEON. Thank you. You notice I didn't pull the trap?


Ms. Dhawan-Gray. Sorry, sorry, sorry.


Chairman MCKEON. It was because you were doing such an outstanding job. Thank you.

Ms. Dhawan-Gray. There are issues on the act that I would like to make sure that you read in our written testimony on flexibility and cost sharing.

Chairman MCKEON. We will.

Ms. Dhawan-Gray. Thank you.

See Appendix D for the written Statement of Ms. Neetu Dhawan-Gray, Executive Director, Baltimore City Commission on Aging Retirement Education

Chairman MCKEON. Thank you very much.

Mr. GOODLING. If it had been a man, he would have pulled the chain.


Chairman MCKEON. Next we will hear from Mr. Carl West, director of the Mercer County Office on Aging. He has been the director of the Mercer County Office on Aging since 1967.

Mr. West?



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

And with that admonition to Ms. Gray, I will be very brief. I would hope that you would not pull the trap door on me.


I would like to thank the chairman and members of the committee for this opportunity to provide testimony on an important issue.

As the chairman of the National Caucus and Center on Black Aged, and as executive director of the Mercer County Office on Aging for the past 32 years, I have witnessed the birth and evolution of the Older Americans Act into what many consider a classic piece of legislation which has served our Nation's elderly well over the past 3 decades.

The framers of the Older Americans Act had the vision and foresight to recognize that a program whose eligibility was based solely on age, needed additional provisions to assure the delivery of service to those in greatest need, including America's minority seniors. Pioneers such as Claude Pepper, Bob Ball, Art Fleming crafted a document which has stood the test of time, and with some tweaking here and there, produced an outstanding piece of legislation unlike any other.

I appear before you this afternoon as a professional in aging service and not as a representative of the two aforementioned organizations. My presentation will focus on issues relating to minority participation.

At the outset, I want to emphasize that the Older Americans Act is one of the more effective laws, if not the most effective law, ever enacted to promote older minority participation in employment and service programs. Aged minorities have accounted for a significant percentage of all enrollees in the Senior Community Service Employment programs, also known as SCSEP. Minority participation in title III Supportive and Nutrition Services program has risen during the recent years, but is still below the far impressive levels achieved by the title V SCSEP Program.

One of the key reasons for the generally commendable minority participation rate of Older Americans Act programs is the existing targeting language to direct services to older Americans with the greatest economic or social needs, with particular attention to low-income minorities.

Congress developed this language in recognition that the Older Americans Act did not have sufficient funds to serve all people 60 years of age and older. Consequently, Congress decided to target the limited resources of the Older Americans Act to those seniors with the greatest need. I believe this was a wise decision and one that I wholeheartedly endorse. Today, virtually every mainstream national organization in the Leadership Council of Aging organizations fully supports the retention of the existing targeting language.

Earlier equity studies of the Administration on Aging emphasized that older minorities have a greater need for services than non-minority aged population, in large part because elderly minorities have a much higher poverty rate than aged non-minority populations. However, older minorities have generally been underserved by nutrition and supportive services programs when measured against their greater need for services.

This development provided impetus for the Congress to adopt stronger targeting language in 1987 and 1992. I am deeply concerned that the attempt to dilute or delete the existing targeting language would do grave damage, both to the Older Americans Act in general, and more specifically, to the participation by aged minorities and low-income elderly persons. I urge you as strongly as I can to retain the existing targeting language because it is the right thing to do. Past research reaffirms that targeting is both necessary and desirable.

Another critical issue affecting minority participation in Older Americans Act programs is cost sharing. I reverently believe that an income-based fee-for-service arrangement undermine minority participation for older programs, particularly title III Supportive and Nutrition programs.

The harsh reality is that fee-for-service arrangements will be perceived by many older minorities as the imposition of a means test. A fee-for-service arrangement would provide a built-in incentive for service providers to cater to beneficiaries who can pay a higher percentage of actual cost of service. Aged minorities and other low-income persons would suffer with this kind of arrangement.

I am aware of the fact that many of my core colleagues are supporters of cost sharing. However, I do believe that in many cases they fail to understand the true nature of the Older Americans Act and the fact that, although misguided and well-intentioned, I think they need to reflect on what the intent of the Older Americans Act when it was first created.

In conclusion, just let me say that I would wholeheartedly support inclusion of both targeting and the Older Americans Act as it currently exists.

Mr. Chairman, I implore the committee to retain the minority language and the voluntary contribution provision of the Older Americans Act. To otherwise do so would deny me, as an American, the opportunity of qualifying for these needed services which they are currently receiving.

Thank you very much.

See Appendix E For The Written Statement Of Carl West, Director, Mercer County Office On Aging, Trenton, New Jersey

Chairman MCKEON. Thank you, Mr. West, and, likewise, your full statement will be included for the record.

Mr. Niebler?



Mr. Niebler. Let me begin by thanking Congressman GOODLING for that nice introduction, and to tell him publicly how much your stock rises as an Office for Aging director when your Congressman becomes chairman of the committee that reauthorizes the Older Americans Act. It is great to have the opportunity to talk to Office for Aging directors from around the United States who know that my office and Mr. GOODLING's office have a good working relationship.

The Older Americans Act has allowed States and AAAs to provide a broad array of both in-home and community-based services. State units on aging and local AAAs have been able to choose their own ways, within the confines of available funding and regulations surrounding the Older Americans Act, in how best to provide services to local older people. The Older Americans Act has a great deal of flexibility included in it already, and we are here today to support the further expansion of that flexibility.

I would like to talk a little bit today about two basic issues: cost sharing and minority targeting. Because of the high percentage of State lottery dollars in our Aging Block Grant in Pennsylvania, the State Department of Aging has permitted us to cost share for approximately the past 11 years. This has permitted AAAs to develop an alternative stream of funding that has a great deal of flexibility to it and can be used to meet those needs in each community that are most acute.

Cost sharing has become a much maligned concept, I believe, for several reasons. First, many believe that cost sharing automatically means that all of those who use a particular program or service will pay a fee. In our State, cost sharing is usually done based on a sliding fee scale, which begins to assess fees only for those with incomes that exceed at least 150 percent of the Federal poverty guidelines. Many fee scales actually begin at 200 percent of Federal poverty guidelines. Fees usually begin at only $1 per unit of service received. By structuring cost sharing this way, many of our clients do not pay any fees, and those that do pay fees, pay only modest amounts.

The second concern regarding cost sharing is the belief that those who feel that they cannot afford fees will avoid using Older Americans Act programs. This has not been our experience in Adams County. We use a very aggressive letter to inform our clients of how much service they received in a given period of time and the dollar value of that service. In the 11 years that we have done this, our contributions have gone from approximately $25,000 annually to about $100,000 annually. In addition, we have heard many times from people who were pleased to learn that they could not only contribute to us, but that they could also take pride in helping to actually pay for the cost of their service.

It is important in any cost-sharing program to assure that no one is denied services based on their inability to pay. By setting high thresholds for the beginning of the fees, keeping the unit-of-service fee cost at a modest level and providing a fair appeal process for those with fee-related issues, Congress, through the Older Americans Act, can actually enhance the dignity of older people and their families and provide a much needed source of revenue for AAAs.

With regard to minority targeting, we would encourage Congress to again study what we have done in Pennsylvania. Because of our extensive use of State lottery monies, our Department of Aging has been able to add a ``ruralness'' factor to our funding formula. This ``ruralness'' factor has allowed our agency to receive funds from the State based upon the lack of population density in the county.

Currently, the Older Americans Act Federal funding formula places a great deal of emphasis on the number of elderly poor and elderly minorities in each planning and service area. These are important and necessary. We believe, however, that delivering services in a rural area presents unique challenges that must be met.

For example, the distance that an in-home care worker must travel between clients and the mileage that is incurred in the delivery of both congregate and home-delivered meals are unique to rural areas. Our county is relatively small, yet we have care managers who can put 75 to 100 miles per day on a car. We have volunteers who must drive 30 or more miles to deliver meals on a home-delivered meals route. We believe that the inclusion of a ``ruralness'' factor in the Federal funding formula for the Older Americans Act would be very beneficial in helping us meet the unusual circumstances that present themselves in rural America.

In closing, we believe that the Older Americans Act is working, and working well at the local level. It has provided States and local communities with the opportunity to develop their own ranges of in-home and community-based services to meet the needs of their older population. With the implementation of cost sharing and the inclusion of consideration of the unique needs of rural communities, the act may be made even stronger and more successful.

We would like to leave you with a plea to reauthorize the Older Americans Act. Without Federal-authorizing legislation, a serious void has been created. We must assure our older citizens that these vital and important programs and services will continue to be available.

I look forward to trying to answer any questions that you all may have.

See Appendix F For The Written Statement Of Statement Of Steven D. Niebler, Director, Adams County Office For Aging, Inc.

Chairman MCKEON. Thank you very much.

We have how much time for the vote? We have about eight minutes left. We have two votes, a 15-minute and a 5. So if we could go vote and then vote quickly for the second vote and come right back. I think we wouldn't have time to get another testimony before, so we will recess for as long as it takes us to get over there and vote and get back.

Thank you very much.


Chairman MCKEON. Well, thank you for your patience. The votes are over, and we will hear now from Ms. Mower, who currently serves in the Montgomery County Division of Elder Affairs as the nutrition director. As a professional nutritionist, she directs the county's numerous nutrition programs for the elderly. Great. We will turn the time over now to Ms. Mower.



Ms. Mower. Okay. Now I want to make sure this is working right. Okay.

I am here to relate 10 years of experience in providing nutrition services funded by the Older Americans Act in Montgomery County.

The nutrition program promotes good health by providing nutritious meals to older adults in settings where they can eat with others and obtain other supportive services, and providing meals to those who are homebound due to illness or disability, and also providing nutrition education for all.

Socialization is one of the most important aspects of the nutrition program. Research shows that people eat better when they eat with others, and that when people enjoy their meals, they get more nutrition from the food they eat.

Another key feature of nutrition sites is that they are important focal points in the community where they provide access to other supportive services and programs, including physical exercise, to meet the special needs of older adults.

A recent national evaluation of the nutrition program found that people in the program need the services, and that the program is successfully meeting nutritional needs. More than 65 percent of participants are at nutritional risk; 60 percent of participants live alone; 80 to 90 percent live below 200 percent of poverty level; 50 percent have at least one chronic disease and may require a special diet. The study found that the program meals provides 40 to 50 percent of participants' daily intakes. Indeed, program participants have higher daily intakes of key nutrients and more social contacts than similar non-participants.

As the program manager and professional nutritionist for the Senior Nutrition Program in Montgomery County, my job is to administer a program budget of $1.2 million to provide nutrition services that include the congregate and home-delivered meals, nutrition education, nutrition screening, and nutrition counseling. These are all provided through some 25 contracts and memorandums of agreement with other county departments, the county school food service, local non-profit and community organizations, and restaurants.

The Older Americans Act allows great flexibility in program development and implementation. The act is flexible. Implementation is the key.

The Maryland Department of Aging supports local innovation in program design and implementation. Staff are flexible in interpreting the Older Americans Act and providing guidance and professional assistance to local programs. Flexibility and effectiveness are enhanced locally by having a nutrition professional directing the nutrition program.

Meals are the basic service. The meals are required to provide at least one-third of dietary needs and to follow the dietary guidelines. I develop or approve all menus for meals served in the program, including menus from 15 different caterers, plus five private Meals on Wheels. The menus are used in programs that serve a variety of ethnic groups. Because I have professional knowledge about nutrient sources, cultural preferences, the effect of aging on food needs, and nutritional status, I can help caterers to be flexible and adapt their food preparation and menus to meet the needs of older adults.

Because the menus follow the dietary guidelines, most people on special diets can eat these meals. The meals are lower in sodium than a no-added salt diet and provide fewer than 30 percent of calories from fat. They are well balanced and plan to be the main meal of the day. When people call to ask about meals, I advise them about the content. If they are on a special diet, I help them with making food choices for all eating occasions.

I am going to skip on because I see the light.


The nutrition program is flexible in recognizing cultural diversity by contracting with Korean, Vietnamese, and Jewish organizations to provide meals and programs that address the needs and special interests of their participants.

Let's go on. The Older Americans Act requires services be targeted to older adults with greatest economic or social need. In Montgomery County, this is accomplished by locating nutrition sites in areas with a high concentration of low-income persons. No preference is given regarding who may participate. Everyone is welcome.

Nutrition programs are very successful in leveraging additional dollars. The nutrition program effectively uses voluntary cost-sharing to obtain contributions toward the cost of the meals from all participants. Last year, Montgomery County participants gave over $200,000 for meals.

Montgomery County does not oppose cost-sharing. The nutrition program has been very successful in voluntary cost sharing, as required by the Older Americans Act. If the program were required to charge those who could pay for meals and provide free meals to those who could not afford to pay, total contributions would likely decline.

Having to individually determine how much each person could pay and make sure they pay it would be an administrative burden and increase the administrative cost of the program, which would mean less money for meals. It would also change the image of the program and the atmosphere at the sites. The program would be seen as a welfare program, and drive away many people who would not want to participate in a welfare program.

The percent of population over 60 years is increasing, especially those over 85 years, and there is an increasing need for home-delivered meals. But funding has not kept up with the increased needs, and funds have had to be transferred from congregate to home-delivered meals to meet the need.

But there is also an increase in low-income ethnic population needing congregate nutrition services. Nutrition programs need to have increased Federal funds for both congregate and home-delivered meals so that older adults can remain independent in the community and avoid premature, expensive institutionalization.

See Appendix G For The Written Statement Of Marilyn T. Mower, Nutrition Director, Montgomery County Area Agency On Aging

Chairman MCKEON. Thank you very much.

And, again, your full remarks will be in the record. We have many more members on the committee that aren't here that will get the information through reading the report anyway.

Next we will hear from Ms. Shedd, who is president of the National Association of State Units on Aging, and is the director of the Indiana Bureau of Aging and In-Home Services.

Ms. Shedd?



Ms. Shedd. Mr. Chairman, members of the committee, I am honored to be here today representing the National Association of State Units on Aging.

NASUA looks forward to reauthorization of the Older Americans Act that will enable the States to flexibly respond to the changing needs of the elderly, to support families and their caregiving responsibilities, to effectively manage resources, to reduce fragmentation, and to expand opportunities for older people to remain independent.

My comments today will focus on NASUA's position on reauthorization and will be presented in two parts, recommended changes to the act, and features of the act that work well and in NASUA's opinion, should be retained and reauthorized.

Specifically, NASUA supports the following changes to the Older Americans Act: Authorize a family caregiver support program under title III to provide assistance to older people and their caregivers. Research indicates that approximately 80 percent of the care is provided by relatives and friends. Our society could not afford to replace this informal caregiving system with paid care, nor should we attempt to do that. However, these volunteer caregivers need support in order to continue with this very important role. This new initiative would enable the aging network to build and expand a system of support services that would enable many older people to remain in their own homes and their own communities, as an alternative to more expensive institutional care.

Give States greater authority to transfer funds between various components of the act to allow them to allocate resources for an array of services based upon consumer need and preference, rather than through overly prescriptive Federal requirements that may not necessarily reflect individual and community needs.

Eliminate Federal priority service requirements.

Coordinate, consolidate, and streamline Older Americans Act programs by combining the current funding for title III(d) in-home services and title III(f) disease prevention and health promotion, with title III(b), social services and senior centers. This will allow the aging network to continue to fund in-home and health promotion services while reducing the current burdensome administrative reporting and contracting procedures needed to manage these separate funding streams.

Consolidate funding streams for congregate and home-delivered meals. Combine the subtitles of the current title VII programs into a consolidated Federal/State elder rights program.

Allow States to develop cost-sharing arrangements with those older people who are able to pay, while continuing to seek voluntary contributions for services that are not cost shared. States already use cost sharing for many non-Older Americans Act programs such as State-funded in-home and community-based services. NASUA believes that cost-sharing arrangements will provide equity in Older Americans Act programs and will enhance coordination and targeting of services. While cost sharing is not appropriate for all services, our experience tells us that it can be used effectively for some services and will allow States to serve more people in need.

Include a statutory requirement for the continuation of a national toll-free system to connect older people and their families with community services. The Eldercare Locator has been funded under title IV for the last eight years. This has proven to be an effective program. We think that it should have permanent authorization in the program.

While NASUA believes that these changes would enhance the Older Americans Act, there are many features of the act that work well and we hope to retain in reauthorization. Continue to ensure Older Americans Act service funds are targeted to those most in need. However, we oppose Federal efforts to mandate specific weights and factors in the intra-State funding formula.

Continue to promote service coordination and avoid fragmentation by allowing area agencies on aging to directly provide case management and information and referral upon approval from State government.

I will close there because the red light has come on.


I appreciate this opportunity to present our views today. We look forward to working with you on reauthorization so that we can have an updated, modernized act that retains the integrity of the program that has served older people so well for the past 30 years.

Thank you.

See Appendix H for the Written Statement of Geneva Shedd, President, National Association of State Units On Aging, Director, Indiana Bureau Of Aging And In-Home Services

Chairman MCKEON. Thank you very much.

Our final panelist is Mr. Richard Lipner, president, Meals on Wheels Association of America. Since 1988, Mr. Lipner has held the post of executive director for Meals on Wheels Program in San Francisco.

Mr. Lipner?



Mr. Lipner. Thank you.

Mr. Chairman, and members of the subcommittee, I am pleased to represent my association, on whose behalf I am testifying, but I also speak from the perspective of a local senior meal provider.

My organization serves 2,400 meals each day to seniors in their homes and in a congregate setting. When I began work with the program, we served 970 meals. The growth in my program is typical I believe of other programs throughout the country. We have been growing as needs have increased.

The work you are doing here today is of critical importance. The Older Americans Act is a lifeline for many of this country's seniors. It is the foundation on which a large and vital national, yet distinctly local, system of home and community-based services has been built.

In the past two Congresses, cost sharing for nutrition and other Older Americans Act programs has emerged as a contentious issue. We want to address this matter head-on because we believe the disagreement is rooted in the words we are using and not in the concepts we are discussing.

We support cost sharing because it will give meal providers the ability to do our jobs better. What we mean by cost sharing is allowing participants to share in the cost, or really the payments of the costs. What we do not mean is a Federal mandate, and we certainly opposed means testing.

What we do mean is finding ways to encourage clients who are willing and able, to participate financially to the programs that serve them, and to help programs develop and implement effective, fair, and reasonable participant contribution and solicitation programs. The purpose of this type of cost-sharing is to provide additional resources that can be dedicated to program expansion.

We have been on record for a number of years insisting that there be adequate protections to ensure that no individuals is ever denied a meal due to inability or unwillingness to pay. We are motivated by the goal of providing nutrition services to more of our elderly, not of denying a single meal to any needy senior.

Clearly if we could encourage those seniors or even their families who are willing and able to contribute more, to do so, then other needy seniors who are now on waiting lists would benefit enormously.

We urge this subcommittee to craft legislation that will increase meal programs' ability to maximize voluntary financial participation by meal clients in ways that are appropriate to the particular program of the population involved.

Mr. Chairman, we must provide flexibility to local meal programs to develop and implement effective cost-sharing plans within their individual programs, and allow programs, if they choose, to furnish clients with written information. Such information might include the number of meals and services they have received, the actual cost of providing these meals, and a suggested contribution or cost share. I make this suggestion because I know from experience that such a system can work. In fact, I have one in place in my own agency.

Each month, Meals on Wheels of San Francisco furnishes clients individual reminders that includes the mutually agreed upon client contribution amount. Contribution levels vary from client to client, based on their self-declared ability to contribute. Services are never denied or curtailed because a client does not contribute.

We have found that clients and their families and/or responsible representatives appreciate this monthly reminder. They generally want to make a contribution, and they are grateful for information that helps them determine an appropriate level.

Not all programs share the option that my program enjoys. I send the contribution reminders to clients because the AAA with which my program contracts allows me to do so. It is my understanding, however, that some area agencies do not allow contractor meal programs to engage in this type of activity.

We ask that the committee state explicitly in statutory language that, under the act, meal programs, should they choose to do so, may send individualized client benefit summaries or reminders to program participants as a part of a cost-sharing plan to increase voluntary contributions.

Enhancing flexibility is another critical point. Currently nutrition programs are subdivided into two categories: congregate and home-delivered. We believe that the program should be modified by combining these programs into one broad nutrition service category.

We also urge the committee to enact increased authorizations for Older Americans Act programs and to seek the cooperation of colleagues on the Appropriations Committee in funding them. Those funds represent vital seed money which programs throughout the Nation leverage other revenue from States, local government, non-profit agencies, foundations, corporations, and private donors. Federal dollars fuel an effective public/private partnership that literally improves the quality of life of millions of America's seniors.

In closing, let me commend the committee for its interest and early attention to the reauthorization of the Older Americans Act. We look forward to working with you in the weeks and months ahead to forge a forward-looking bill that preserves the fundamental principles on which the act was created, by which it has been supported on a bipartisan basis, and which will equip us to continue meeting the needs of America's seniors as we walk together into the next century.

Thank you for your time, commitment, and energy, and especially for this opportunity to come before you to express the views of the Meals on Wheels Association of America.

I would be pleased to answer any questions you may have.

See Appendix I for the Written Statement of Richard Lipner, President, Meals on Wheels Association of America

Chairman MCKEON. Thank you very much.

Outstanding panel. I know I have learned so far, without even getting into the questions, I have learned things today.

Mr. Barrett?

Mr. Barrett. Thank you, Mr. Chairman.

Ms. Neetu Dhawan-Gray_did I do it?

Ms. Dhawan-Gray. Yes.

Mr. Barrett. I was sorry that you didn't have an opportunity to finish your testimony, and you specifically called our attention to flexibility and cost sharing. Could you describe what you had in mind in the few minutes that we have for questioning?

Ms. Dhawan-Gray. Yes.

Specifically on the reauthorization of the Older Americans Act, our association has taken the position to increase local flexibility, which to us means at the local area agency level.

We are also wanting to support an option, and we have supported an option for cost sharing at the local level. You have heard different views here today. We are very clear that we do not support means testing. We do not support a mandated cost sharing at the Federal and State levels.

Mr. Barrett. Voluntary?

Ms. Dhawan-Gray. Voluntary.

Mr. Barrett. Not mandatory?

Ms. Dhawan-Gray. That is right.

And that also, it would be self-declaration of income. Low-income individuals would be exempt, and no individual would be denied service because of inability to pay, and that AAAs should choose the right tools to institute cost sharing, be required to develop a local system in consultation with consumers, especially minority consumers. And we believe that information assistance outreach ombudsman protective services should be exempted from cost sharing.

Mr. Barrett. Thank you.

Mr. Lipner, with regard to cost sharing, isn't that essentially what you were saying as well?

Mr. Lipner. Yes, it is, Mr. Barrett.

Mr. Barrett. Thank you.

Ms. Dhawan-Gray, I was also interested in_you didn't get to it_but in your written testimony, you talked about title VI and the Native American Program.

Ms. Dhawan-Gray. We would like to maintain title VI as its own title in the act, with a separate line of funding that provides program flexibility for the Native Americans.

We also support retaining the Office for the American Indian, Alaskan Native, and Native Hawaiians at the Administration on Aging with a director who would perform such duties.

Mr. Barrett. You are saying also that we should retain that separate title, title VI?

Ms. Dhawan-Gray. Yes.

Mr. Barrett. For_it would be Native Americans, Hawaiian seniors, and_

Ms. Dhawan-Gray. And Alaskan Natives.

Mr. Barrett. Alaskan, yes.

Mine is a rural district, and as you might expect, I do have a Indian reservation.

What differences do you find in serving that group of people as opposed to others that you are serving?

Ms. Dhawan-Gray. Access to health care is a big issue for Native Indians. I think access to general services among their reservation and in the greater community. Transportation tends to be a big issue, also, and housing.

Mr. Barrett. How are the Native Americans specifically addressing the problem? Or are they?

Ms. Dhawan-Gray. I'm sorry?

Mr. Barrett. How do you find the reaction of the Native Americans in taking advantage of some of these programs?

Ms. Dhawan-Gray. We have two Native Americans on our board for the specific reason of making sure that we are sensitive to those issues. I think outreach is very difficult in that community because the distances are so great, as you have said, in rural areas. Sometimes information coming down to them does not get connected into the same area agency network as it does_they don't get connected to the area agency network because they are connected more to their tribal organizations.

In some areas, there is great connection between AAAs and the tribal organizations, but information and assistance, access to services like health care, nursing homes, I think, is pretty critical.

Mr. Barrett. You mentioned outreach. Would you not agree that perhaps the cost of providing these services and outreach in a rural area could be at least as great, if not greater, than serving some of the urban areas?

Ms. Dhawan-Gray. Instead of making the comparison that one is greater versus the other, I think both can be situations where there are people who are isolated from our mainstream. And the reason I say that, in rural areas obviously distances are a great, great issue, which one of the panelists has said. But in an urban community, what we find is that there are people who are isolated in an apartment building. There may be 300 senior citizens living in an apartment building and the perception is that they are being taken care of. But in fact, they are aging in place in that apartment building, and the housing managers, the food service, the caseworkers that are working with them are not necessarily networking in the community.

So, I believe that you can't necessarily, respectfully, make the conclusion that one is worse than the other. I think they are equally in need.

Mr. Barrett. Thank you.

I know that my time has expired. Mr. Chairman, may I ask if any other panelist would like to address that question or not? Or are you going to open the trap door on me?


Chairman MCKEON. I wouldn't dare. No.


Mr. Barrett. We will come back to it. Go ahead. My time has expired.

Thank you.

Chairman MCKEON. I think with the number of members we have, we will have time for a second round.

Mr. Barrett. Okay, fine.

Chairman MCKEON. Mr. Martinez?

Mr. Martinez. Thank you, Mr. Chairman.

Mr. Niebler, in your testimony_well, before I go to that, I want to ask a question of Ms. Dhawan-Gray.

You support voluntary cost sharing. That is what you just stated. That you do not want Federal mandate. How_

Ms. Dhawan-Gray. Nor State mandate.

Mr. Martinez. Nor State mandate.

Well, how does that differ from what exists today in the law under the act? Because you can, under the act, do voluntary cost sharing.

Ms. Dhawan-Gray. Which is true. There is voluntary contributions right now for the meals programs, but in not all States is it for in-home services or for transportation.

Mr. Martinez. So you want to extend it to in-home care and transportation?

Ms. Dhawan-Gray. That is right. And have the flexibility to be able to do that.

Mr. Martinez. Well, you know, I have listened to this debate for several years now, and I know for a fact_and from most people that we have heard from, people that are in the field_that when you start getting into cost sharing, then you start getting into determining who can afford to do the cost sharing, the you get into what we call ``means testing.'' You get into a great deal of problems, and turning seniors away. Because some seniors who may not be destitute poor but may not be real well off, but at least a little bit secure, are going to be very wary of divulging to anybody what they are making because they figure that somebody is going to take it away from them. And who else is going to start charging them fees for service? So it is a very complicated thing.

I am definitely against it. The fact is, is if you want to extend cost sharing to in-home care, I think it could be done very simply. Just simply send a notice out to those people that are receiving the services encouraging them, if they have the ability, and if they were willing to share part of the cost, if they could afford it, on the basis that it would provide service for more people.

You know, tweaking people's conscience sometimes gets a lot of volunteers. For example, voluntary cost sharing in the meals programs raises nearly $171 million in a year for that. So what would you collect on the other if it was done that way?

I think it would be better to think about how we already allow you to send notices to people advising them that they can share in the cost.

Ms. Dhawan-Gray. I hear what you are saying. I would just like to make sure that you understand we are not talking about means testing at all.

Mr. Martinez. Well that is what I want to make sure the panel understands.

Ms. Dhawan-Gray. I truly want you to understand that our association is very clear that there would be no means testing, that it would be self-declaration, and none of us would go behind and say, ``Well, I know for a fact that this is not the case, that your income is higher.''

I can honestly tell you from my city, which is an urban community, 65 percent of my city is African-American. I believe that our staff_and I think they have proven that_would do everything they could to provide the services and not deny them services.

Mr. Martinez. Thank you.

Mr. Niebler, in your testimony you mentioned that due to the structure of your sliding fee scale, many of your clients do not pay any fees at all. I don't know what you mean by ``many,'' what percentage it is. You don't mention percentage, and you say those that do, only pay a modest amount.

You have also mentioned that you aggressively inform the clients regarding the amount of services they have received. That means making out a statement for each one of them, almost like an income tax form at the end of the year. To me, it seems like that is a lot of work and it takes a lot of time and effort on the part of your staff.

Have you ever tried to determine the cost of administration was versus what you do collect? Is it offset by the administrative cost of this cost-sharing scheme?

Mr. Niebler. We test about every 12 to 18 months exactly what you are talking about. We run a test on the program to make sure that we are not spending more in sending out letters and generating letters than we are getting back from people. What we found every time we have tested_what we will do is we won't send letters for a month and we see if the contributions continue to come in, and they don't. So we do a variety of things. That is one thing we do to test.

We are confident, and we can document over a number of years that what we are spending to generate letters, and ours are letters, they are not bills. We make very sure that it is not a statement, a very formal kind of thing that people get. It is a letter from us explaining how much service they got, each unit of service, and what the value of those were to the agency. We give them a total, and then we ask them to make a contribution based on what they can afford to contribute.

Congressman, I was in this program back in the old days when we used to do title XX means testing. We would literally sit by the front door of a senior center with a form that ran the whole front side of a piece of paper. It was an impediment to getting people into senior centers. It was an impediment to serving people. I would not come before you for a minute and want to return to that, for the simple reason that my staff would mutiny if we tried to do that.


That was a dreadful system.

We believe that what we are doing in Pennsylvania with letters, aggressive letters, trying to make people aware_and I think you said it well_in letting people know what the value of the service is. Even if they can only give us 5 cents on the dollar, or nothing, at least they will try. It really does enhance the dignity of the older person. It has to be done right, but it can be done.

Mr. Martinez. Yes. I agree with you. You know, I am glad you said that because in last Congress, one of the impediments to passing out a reauthorization bill was that sticking point right there. Where there were those of us on the committee that are absolutely adamant against a means-tested way of cost sharing and those on the committee who were in charge then and I want to make it very clear, it is not the same people any more.


We are very serious about doing this cost sharing on a needs basis. And that stymied the whole thing, that along with other things.

I would ask the chairman to just indulge me for one more question because you talked about the ``ruralness'' requirement in the targeting.

You are aware that right now the language states that in developing a formula for distribution, States should take into account the geographical distribution of the seniors, which if the seniors are in the rural area, they should be served. If they are in the urban areas, they should be served. Wouldn't that cover the idea of ``ruralness'' targeting?

Mr. Niebler. My understanding, Congressman, in Pennsylvania, is that our funding formula takes into account basically two things. One is the number of older folks in a particular area, and the other is the number of older_I am sorry_the number of older poor people and the number of older minorities. Those are the two key things in most funding formulas.

Pennsylvania has added a third which is that ``ruralness'' factor, which my understanding is that does not exist in a lot of States. In my county, less than 1 percent of the population is African-American, and less than 1 percent of the population is Hispanic. Without that ``ruralness'' factor, our funding would be seriously impacted.

So we believe that providing services in a rural area generates some unique kinds of challenges that ought to be factored in. It is something for Congress for think about. It certainly worked well in Pennsylvania.

Mr. Martinez. Thank you.

Mr. Chairman, I would suggest that in the language in the law, which I have right before me here, states that "the geographical distribution of the older individuals in the State, they should be taken into consideration". I think that maybe, like so many times when we pass laws and we put down legalese language, the departments tend to misinterpret or not interpret accurately at all. I think in that section of the law, there might need to be some clarification as to what the geographical distribution of older Americans means.

Thank you very much, Mr. Chairman.

Chairman MCKEON. Pretty good. Thank you.

As Mr. Martinez said, it was different leadership in the last Congress. This is a new assignment for me, and I am in a learning mode.


I have visited senior centers. I have been there when the meals are delivered in my district. I have gone on the trucks to deliver Meals on Wheels. But still, I am learning here today.

I think, philosophically, it sounds like we are in sync on cost sharing, if it is not means-tested or if it is not driving people out of the program.

My experience with people over the years, especially older people_you know, I send out letters for my campaign, and I get letters sometimes from older people with a $5 check, you know, saying, ``I wish I could send more.'' It almost makes me want to cry. You know, I want to send it back because I know they need it more than I do, but they have learned in their life, they are willing to give.

I think when it is made on a purely voluntary basis, generally people pay more than if you put a price on it or if you charged something.

How does this work now? You have each talked about cost sharing and it sounds like there is not a lot of disagreement here. What happens if you collect $200,000? Is that then just distributed, and you are able then to provide more meals for more people?

Mr. Lipner. Yes.

Chairman MCKEON. How does it work in your different areas?

Mr. Lipner. In my program, we have a waiting list in San Francisco for our home-delivered meal clients. That waiting list is something that we don't think is going to go away, frankly. It just continues to grow. We go out and we fundraise very hard. We fundraise from the private community very hard to help to eliminate that waiting list. But we also send out those contribution reminders to our current clients. The money that comes in from contributions goes directly into paying for the food costs of the meals that are being provided.

So the answer, Mr. Chairman, is yes. You just expand the number of people that you can serve.

Chairman MCKEON. But when you do send out those reminders, you do it such that you are not making them feel guilty if they are not able to contribute?

Mr. Lipner. Absolutely.We come to an agreement before. When they start the service, we ask them if they can contribute, and we ask them what level they can contribute at. We then send out a reminder each month telling them that we had last received their payment or their contribution of $30, January 1, and we will continue to provide service whether you pay or contribute or don't contribute. So there has never been a question of not serving people who don't contribute.

Chairman MCKEON. Do you have, each of you, do you have copies of those letters you send out that we could have for the record that we could review also?

Mr. Lipner. Yes, I do.

Chairman MCKEON. You say you have gone from 970 meals when you started up to 2,400 now. What period of time was that?

Mr. Lipner. Twelve years.

Chairman MCKEON. I assume when you had 970, you had a waiting list, and you say you have a waiting list now with the 2,400?

Mr. Lipner. Yes.

Chairman MCKEON. How did you get from 970 to 2,400? Did Federal funding go up? Or has it all been_

Mr. Lipner. No. No, not a lot.


I am sorry.

Chairman MCKEON. You went out and raised money.

Mr. Lipner. We raised money. My program has a $3 million budget, and we fundraise $780,000 of that $3 million. We receive about $220,000 from client participation, and the remainder comes from the leveraged Older Americans Act dollars. The city and county of San Francisco contributes fairly substantially to their senior service programs, as does the State of California.

Mr. West. Mr. Chairman?

Chairman MCKEON. Excuse me. Yes, sir?

Mr. West. If I may comment. I think what has been demonstrated here is the fact that the voluntary contribution is working. I think Government studies have indicated that in terms of many of the nutrition programs, that sufficient dollars are coming into the system that allows for the expansion for the services.

I think one of the things that we are concerned about is the fact that we don't want the Older Americans Act to begin to look like other existing programs that have income guidelines regarding service.

We are very concerned about protecting the dignity of older people. We have seen in certain cases where people have put washers in envelopes, and the reason they have done that is because they want to make it appear as if they are making a contribution. We recognize the fact that in many cases, they don't have the opportunity.

Again, I think this is very important that when we talk about cost sharing, and we are talking about serving those who are in greatest need, that they go together. That in fact if we are not going to have a cost-sharing kind of program that dictates that you have cost-sharing arrangements, that you do targeting.

I think that if the area agency network continues to target service of those who are in greatest need, I think the existing legislation allows for voluntary contributions.

I think the most critical area that has been identified is again, in-home services network. If there is a mechanism that we can develop that would be designed to protect the integrity of that collection system, I am sure that we could increase significantly the contribution in those areas.

So again, I think my concern is the fact that we not destroy or do anything that would infringe upon the dignity of those poor people who are currently receiving service, and for those many millions of Americans who have the opportunity to benefit from our programs but who do not meet income guidelines if they were so established.

Chairman MCKEON. Well my time is up, but I know the people that I have seen come into the senior centers and the people that I saw that we delivered meals to, probably were not wealthy individuals. And if you have lists_I imagine if you all have waiting lists, you are probably not_it is probably not wealthy people. I don't even know where we got into this means testing thing. But I think that we can put that to rest. I don't think we have any desire to do anything like that.

This is different than any Federal program I am involved in. We don't go out and raise money in the community to build the bombers.


And I am a strong defense supporter, you know.


But I mean what other programs do we have where people go out in the community and raise money in addition to the_we have some matching dollars from the State programs.

Mr. Martinez. No, Mr. Chairman, most of the Federal_

Mr. Tierney. Most kids go to neighbors for basketball and baseball, unfortunately.

Mr. Martinez. Yes. For most of the Federal programs we provide seed money, and that is why I really get in a dilemma up here sometimes when I listen to the members acting as if all the funding for all these programs is coming from the Federal Government, when in fact, almost every Federal Government program that we provide money for, we only provide seed money. Then the people in the programs, not only America's senior programs, but a lot of other Federal programs in order to keep the programs going, have to go out in the community and raise money to support these programs, because the Federal monies does not support them alone.

But you look at a lot of the programs we have, and as you go through the different committees here and listen to testimony from different groups of people that come before us when it is time for reauthorization of any particular program, you will find that in most cases if you ask the question which is very seldom ever asked, ``How much of your budget is the Federal portion?'' you would be surprised. It is only 10, 20, 30 percent of the program, something like that. The money is really raised at the local level.

Chairman MCKEON. Okay.

Mr. Holt?

Mr. Holt. Thank you, Mr. Chairman. I would like to thank you for assembling such a fine panel, and especially for inviting the very distinguished Mr. Carl West, from Ewing, New Jersey. I have followed his work, and I think we should listen carefully to what he has to say.

He has established a remarkable record, not only working through the State-wide conference, but also the National Caucus on the Black Aged, but especially in New Jersey's Mercer County, for many years has been an effective advocate and in the service in the aged.

I have a couple of questions that I would like to first direct to Mr. West. And I guess I don't want to drop cost sharing yet.

Mr. West, you have expressed your opposition to cost sharing. I just want to make sure that you have the opportunity to get into the record any instances that you know of where cost sharing has resulted in directing services to those who are most able to pay for the services.

Mr. West. Well, in most cases, many of the Federal programs that do exist have categorical criteria that must be met by the recipient of the service. One of the unique_and as we have indicated_unique situations about the Older Americans Act is that it provides us an opportunity to pull resources and in many cases target services to those individuals who may be just above those income guidelines. I think we have not heard one instance today of where there has been any indication of any significant abuse of the system by people who could very well afford to pay who are not paying.

I think the big problem that we are having now is the fact that the resources are limited, and we are looking for ways to increase our resources. I think the current system provides us with that opportunity. I think the Older Americans Act is very unique in that there are some people who may not normally get the service if they were to have to rely upon the title XX or other categorical programs, but they are eligible under the Older Americans Act. In many cases they are in need of the service.

But again, the key issue in terms of the current regulations and requirements is that there has to be targeting language that ensures that the area agencies target those services to those people who are in greatest need.

I think it has worked. I think what we need to do is begin to look at other ways in which we can develop revenues. We in New Jersey, just created the New Jersey Foundation for Aging, which is designed to provide private support to public agencies in expanding services for older New Jerseyans.

I think those kinds of initiatives are desperately needed, and that we must be very careful that even in some cases we will find that there is a perception by older people that when we start talking about going into modified kinds of cost sharing that in fact, that you are means testing. So we have to be extremely careful. As it was indicated here, it would be dependent upon each area agency to be very careful in the development of any kind of cost-sharing system that would be beyond what we are currently doing.

Mr. Holt. Thank you, Mr. West. That is clearly stated.

Let me turn to another question. With regard to the minority targeting language in the act, what kinds of activities are made possible by that language that allows serving minority seniors that have different needs than other seniors?

Mr. West. Well as we all know, many minorities have significant disproportionate incomes and needs than the non-minority population. I think we have witnessed from when the reauthorization has taken place in the past to incidences that there have been significant increases in minority participation. It is still lacking, however, and that there is a need to continue to target services. Because again, we talk about going into the minority communities. In many cases, minority communities do not have the resources available, nor in many cases the kind of personnel that is required and sensitivity that is needed to recognize the cultural differences, to recognize the plight of many minority individuals.

So I think it is extremely important that that be continued within the reauthorization, and that in fact, we monitor it very carefully to ensure that the low-income minorities do receive a proportionate share of the services.

Mr. Holt. I see my time has expired, so we will have to let it go at that. But thank you very much, Mr. West.

Chairman MCKEON. Thank you.

Mr. Tierney?

Mr. Tierney. Thank you.

I don't want to beat a dead horse, but something you said Mr. Lipner raised some concern with me. You talked about going to seniors at the initial stage of their signing up for the program and at that time trying to discuss with them the value of the services provided to them. Do you find that somewhat chilling to some of the folks that, you know_

Mr. Lipner. No.

Mr. Tierney. _might feel the pressure in some way or feel that they have to do something in order to qualify.

Mr. Lipner. Not really. I think we are very careful and very sensitive to the seniors that we serve, and our approaches reflect that.

We have a suggested contribution rate. We make it very, very clear that seniors will never be denied a meal whether they contribute anything or whether they contribute the full suggested rate or over the suggested rate.

But, no, I don't feel like it_

Mr. Tierney. Well, I don't know why, but just intuitively, I think I would feel better about that if they were getting that after they were already signed up, than getting that information_

Mr. Lipner. Well, what happens_

Mr. Tierney. _then ask them if they could volunteer something.

Mr. Lipner. What happens is that it is a question of waiting. It is not even a signing up. I mean, you apply for the benefits or for the program. And depending on where you live in our city, you may wait for a week or you may wait for five weeks until a spot becomes open.

Once the spot is identified as open, meals start. After the end of the first week, the client is visited by a social worker and her staff. The social worker then goes and talks about the contribution policy.

Mr. Tierney. So it is after the_

Mr. Lipner. It is after the startup, but it is within the first week, yes.

Mr. Tierney. Ms. Dhawan-Gray, your written testimony indicated some desire to be able to transfer funds between both nutritional services and other services. Can you give me some example of where you are being handicapped in any way by presently not being able to do that?

Ms. Dhawan-Gray. Certainly. In our in-home services program specifically, we serve almost 600 people, and for the last 14 months, we have had 430 people waiting for services. I would like to be able to move money if I needed to serve those. I also run two adult day care centers, and we only have 65 slots for those two day care centers, and I have a waiting list of 117.

Mr. Tierney. Do you have a waiting list also on your meals program?

Ms. Dhawan-Gray. Not on our home-delivered meals. What our Meals on Wheels program has done is, instead of maintaining a waiting list, they literally are very careful to serve those people that need them for the period of time that they need them, rather than for a long period of time and, therefore, they don't maintain a waiting list. That is how they have addressed that issue.

For my congregate, I don't have a waiting list. I have about five new places that would like to open up with about 30 people per site, and I have not been about to do that in about three years.

Mr. Tierney. So are you telling me that you have got excess money on the meal side of it that would just be sitting there doing nothing if you didn't have the ability to put it over to the other side?

Ms. Dhawan-Gray. I am sorry? Say that again.

Mr. Tierney. Are you telling me that you have excess resources_

Ms. Dhawan-Gray. No, I don't have excess, but I would like sometimes to be able to serve the in-home services people quickly, get them into a system, and try to prevent hospitalization and institutionalization versus just waiting for a site to open. Sometimes it takes one or two years for a new site to open.

Mr. Tierney. And you think you could do that without handicapping the other programs?

Ms. Dhawan-Gray. Yes. Yes, and I think that addresses the issue of local flexibility. We tend to see a crisis on our hand, and say we need the money to be able to do that. That is a long time for people to wait for services.

Mr. Tierney. I am just curious to know how the others on the panel feel about that type of flexibility, if anybody cares to comment.

Ms. Shedd?

Ms. Shedd. NASUA has gone on record of supporting flexibility to allow the States to determine best how those funds could be used at the local level, based upon the needs. It would streamline the operation and enhance the program by not having to have authority on a specific transfer, which at the present time, in some cases we can transfer funds, but that takes authority from the Federal level. So it would give flexibility and would enhance the program to be able to have that authority without doing that paperwork and waiting for that paperwork to be approved.

Ms. Mower. Well in Montgomery County, we do not have extra nutrition money. We need more money for home-delivered meals and for congregate meals, especially to serve the ethnic populations. We have been contracting with Korean and Vietnamese groups to provide so that those organizations can provide the special services targeted to their population. They can reach them better, and they provide special meals for those groups. We need more money to do that.

Ms. Dhawan-Gray. Can I just add something, Mr. Tierney?

Mr. Tierney. Sure.

Ms. Dhawan-Gray. I think it is important that in the discussion of cost sharing, that we also keep in mind that we are wanting an increase in the Older Americans Act.

Mr. Tierney. I don't think anybody ever missed that part.


Ms. Dhawan-Gray. Okay. I just wanted to be on record that we said that.

Mr. Niebler. One thing I would like to add. As I sit here with Mr. West and I am listening to him, and I am thinking how different his area agency on aging is from my area agency on aging, and yet we are in adjoining States that share a common border. I think the challenge is to construct an Older Americans Act, both law and regulations, that allow us to serve our unique needs and our unique populations with as much flexibility as we can possibly build into the act. I think it is very difficult to prescribe things for him that would not work for me, and for me that would not work for him.

So it seems to me that if we can put our heads together here and collectively craft an Older Americans Act that allows all of us on this panel and all of us in the aging business at the local level to move money around, to be flexible, to do things that meet the needs in our communities, that is what we ought to be striving for.

The price you pay for that, and we argue about this in Pennsylvania all the time, is that maybe the services in Adams County, Pennsylvania, don't look a lot like they do in Mercer County, New Jersey, yet we are both area agencies on aging.

We have not come to the solution in Pennsylvania about how to deal with that. We have Philadelphia and Pittsburgh, which have very different challenges than Adams County. We are continually, all of us, working with our State government to say, ``Don't prescribe something for them that hurts us and vice versa.''

It seems to me we keep coming back to the theme here of ``flexibility,'' that that is what the Older Americans Act really needs, allowing us to do things that work in Trenton that may not work in Gettysburg and vice versa.

Mr. Tierney. And we keep accountability when we do that. That is the issue, right?

Mr. Niebler. I think that is_you have got enough history now with the act. We do basically the same kinds of services. Accountability to me doesn't seem to be as big a problem, given that we all have these unique challenges and needs to meet. I mean I think our system_certainly in Pennsylvania where we are doing 40 pages of reporting each month to our Department of Aging_certainly builds in the accountability.

Philadelphia does the same reporting, by the way.

Mr. West. On the issue of transferring funds from one provision to the other, I think it is important that we maintain separate funding streams, but that there be maximum flexibility to transfer. Because I want to be very pragmatic in terms of the fact that we want to look at_when you see [Title] III(d), you know that you have very little money in there. And if you fold that into Title III(b), then suddenly it looks like we have got a lot of money.

So pragmatically, I think it is important that we maintain the separate funding streams, and then allow a maximum degree of flexibility and the ability for the area agencies to transfer those funding sources.

Mr. Tierney. You see the danger, then_

Mr. West. Yes.

Mr. Tierney. _in going down this path.

Chairman MCKEON. That was a good discussion.

Mr. Martinez?

Mr. Martinez. Thank you, Mr. Chairman.

During the last reauthorization effort, we discussed this issue quite a bit, and part of the disagreement was that we insisted that we have separate funding streams for the elder abuse program and the ombudsman program. We did talk about separate funding streams with the ability to transfer back and forth, which makes good sense.

But even since then, I have visited several senior citizens centers, and it seems to me that in most senior centers where they serve congregate meals, the in-home, delivered meals are growing at a greater rate than the congregate meals are. I ‘ve been wondering, and maybe you can answer this for me, one of the reasons why in the beginning when the act was initially enacted, congregate meals were the mainstay of the program was to get the seniors out of their isolated situations in their homes and get them into a place where they could congregate with other seniors, and there could develop from that, other activities, which is what has happened.

I am beginning to wonder that if some people who are now asking for home-delivered meals aren't people that can get to the congregate meals, but for some reason or another have become introverted and want to stay in their homes. Are we sure that when somebody requests an in-home meal, it is because he is recuperating from an illness or because he has just been discharged from the hospital, et cetera, et cetera? Are we checking to make sure, and trying to encourage that person that wants the in-home meal, that if they are able to get that congregate meal, that we should get them to that congregate meal?


Ms. Mower. Well, then we would need money for transportation.

Mr. Martinez. Yes. Right_

Ms. Mower. That is a real serious problem.

Mr. Martinez. _but I am not suggesting that. I am talking about a person who would otherwise be able to get to the congregate meal. Let's say they did drive, and they did have their own car, or they had some method of transportation but they just want to stay home rather than get involved and socialize with other seniors. That defeats the purpose of the congregate meal program.

Mr. West. Well, Congressman, I can speak from a historical perspective. That is the fact that when the Older Americans Act was first created and nutrition programs were first started, we had a much younger population that we were serving. Many of the seniors have aged in place. We are in some cases, still serving some of the same people who came into the program 25 years ago, are still receiving service.

What we are finding is that the age is going up. There are some people who are 65 and 70 years old who wouldn't be caught dead in a nutrition site. Twenty-five years ago, the average age might have been sixty-two and a half. What we are finding that, for any number of reasons, that we are not getting the replacement.

We are also seeing some resistance, because what we are finding is a much more frail participant in the program, one that needs more services. So in many cases, we find that there is a tremendous demand for home-delivered meals, because many of those same people who at one time were congregate participants are now in need of in-home services which would include the home-delivery meal program.

So we have seen the phenomena of the attitudes changing and the people aging in place which has shifted in many cases some of the emphasis from congregate to home-delivered.

Mr. Martinez. They get less mobile as they get older?

Mr. West. I beg your pardon?

Mr. Martinez. They get less mobile as they older?

Mr. West. Yes. As a matter of fact, most of our programs, the home-delivered meals programs, require an assessment to ensure that we are not isolating individuals by providing them meals in the home. There are periodic reassessments to ensure that in fact, if they can come to the congregate program, that we make every attempt to do that.

Mr. Martinez. Yes. Let me say that I was just was asking this for my own information, because I am a strong advocate of the flexibility that you talk about.

Almost everywhere I have been, there is a long waiting list for home-delivered meals. There is not that kind of list and nobody gets turned away from a congregate meal.

Thank you very much, Mr. Chairman.

Chairman MCKEON. It seems to me when I have gone out delivering meals, that the majority of them pretty much are homebound. But there are some I felt that could come to get them. I think that is a good point. I am glad to hear there is that assessment. Sometimes we lose the fact, you know. A program gets going, and we are out delivering meals. We forget that really they would be better off if we could get them together to rub shoulders with other people. So these reminders I think are good.

One of the things I have also seen is it seems to me the people that are working, as each of you are, with people that are aging, are really very caring people and really want to do what is best for the most number of people that they can help. I haven't seen anybody that I felt was pretty hard-hearted working in that program. If they were, they would be in another program. I mean it is just not_so, if we could give that flexibility.

How does it work? You say, Ms. Mower, you need more money?

Ms. Mower. Well_

Chairman MCKEON. Well, I don't think anybody that ever comes in here that_


Ms. Mower. Of course, of course.

Chairman MCKEON. _doesn't need more money.


Ms. Mower. Right.

Chairman MCKEON. But I am wondering how the organization works. In other words, if you have the director of the area agency_I don't know how this is set up. Do you have a director? And then do you have somebody in charge of Meal on Wheels, somebody in charge of congregate meals? So that you each come to that director and say, ``Look, you know, I have a waiting list of 600 people that need home care.'' Or, ``I have a waiting list of 600 people that need Meals on Wheels.'' Then you get together and decide who gets the priority? How does it work?

Ms. Mower. It is not quite so informal. When we are doing the budget for the next year, that kind of thing could happen. But the budget is planned a year ahead, and contracts are issued, and then you have so much money in contracts to use.

Now I just want to say something about a comment we heard before, that no one is turned away from a congregate meal. Yes and no. If you don't have a congregate site where someone can get to it, you may not be turning him or her away from the meal, but you are not providing them the opportunity to have a meal. So that is part of what I am talking about.

We heard that in Baltimore City there were several sites that wanted to open but couldn't. That is the kind of thing I am talking about, that we may need to open more congregate sites. And unfortunately, that takes money to do.

We tend to protect the most frail, and so that is why I think we have been trying to provide as many home-delivered meals as we can, transferring money from congregate meals to home-delivered meal programs.

Another point. You know, the oldest old are growing at the fastest rate, as we have heard many times. These are the people who are generally getting the home-delivered meals. So we are seeing an increase in the population that needs home-delivered meals. But we are also seeing an increase in the total older population that is going to benefit from all of the services that we provide.

Chairman MCKEON. Well, it is_we have had a lot of food for thought.

When I hear of one district that has 65 percent minority and another has 1 percent minority, it seems to me that we sure need to give you the flexibility to run your areas, get you as much funding as we can possibly come up with, but then give you the discretion, the ability to help the most that you can.

I know if you can help people stay at home, it is a lot less money than putting them in the hospital. I think they are a lot better taken care of, and they are a lot happier with family. I saw that with my dad.

I see you have a comment?

Ms. Dhawan-Gray. I just want to make one comment on whether it is the congregate meals or home-delivered. What we are finding is people are aging and living longer. Their needs are growing and getting complex. We are talking about 40 years worth of life after retirement for most people now. It is not just 65; it is not just 70. We are talking about multiple generations coming to our sites, a 65-year-old taking care of a 90-year-old mother, and they are a still a generation apart, a lot of conflictual relationship issues still between mother, daughter, son, and mother. I think what we are seeing is the issue of needing more than one single purpose service.

When I talk about flexibility, it is having the flexibility to not only provide the meal, but if it means that adult day care would work for them or an Ensure product would work for them, something that allows them to stay in the community. I just wanted to share that with you.

Chairman MCKEON. Well, I think this has been a very good hearing. I appreciate all of your input.

Now we are going to move forward with the reauthorization. I would hope that as we go through this process that you will stay in close touch that you will watch as we flush out a bill.

The administration we met with_I met with the Assistant Secretary this morning, and they say they will have a bill up in the next couple of weeks. So, we will be working with them. We will all work together, but we need you to be involved in and give us the advice, because you are on the firing line. You know what the real problems are. Let's join hands, and make this work, and get this passed.

Thank you very much.

[Whereupon, at 4:15 p.m., the subcommittee adjourned.]