STATEMENT OF WILLIAM BECHILL, ASSOCIATE PROFESSOR, SCHOOL OF SOCIAL WORK AND COMMUNITY PLANNING, UNIVERSITY OF MARYLAND

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

I am delighted to appear before the subcommittee again and, in the interest of time-I know you have a very long witness list-I would merely ask that my full statement be submitted for the formal record. I will make only a few observations off the formal testimony.

Before I do that, Mr. Chairman, I wish to commend you for the great leadership that you have given to the strengthening of the Older Americans Act since you assumed the leadership of this subcommittee approximately 6 years ago.

I also want to commend you for your recent action in submitting a House concurrent resolution to disapprove the 5 percent limit recommended by the President on increases in social security benefits. Mr. BRADEMAS. Thank you very much.

Mr. BECHILL. I would like to turn to my comments on the title III legislation.

I think the 1973 amendments that provided for a restructuring of title III were an attempt and a serious one to legislate a more equitable and rational system of social services for older people than we had seen or experienced before 1973. The amendments dramatically increased the responsibility of State agencies on aging, especially their intent to create a rational, coordinated, and planned delivery system of social services.

To me, the most significant change in the title III provisions were those related to the establishment of area agencies and the attendant emphasis on the development of area plans.

As Dr. Flemming pointed out, there are now over 400 area agencies that have been established. The area agency concept and strategy as it has been called by some was a significant organizational change in both the Federal-State relationships that existed under the act prior to 1973 and, indeed, the usual manner in which services have been organized and provided in general.

There are a number of various Federal-State programs.

Frankly, I think there are many problems inherent within area agency strategy. Its emphasis perforce must be on structure rather than on direct services.

Dr. Flemming referred to the building of a system or network. Its implementation also must be more laborious simply because it involves dealing with more specific organizational units than the usual Fedearl-State approach.

Because of its emphasis on decentralization, there are higher risks involved in meeting any standard of equal and equitable treatment of people regardless of where they live under a federally authorized program.

I think that all of these issues have surfaced, to some extent.

I do believe the implementation of the title III provisions to date. have been very laborious. It has taken a long time to move money through this network. I don't place any blame on the Administration on Aging nor the State agencies for this. In fact, I think both deserve great credit for the manner in which they have proceeded to carry out

the title III provisions at a time when both were also heavily involved and committed to starting up the national nutrition program and other major responsibilities.

A long lead time is almost inherent with the approach now embodied in title III. There is no simple way to build comprehensive and coordinated services for older people.

Despite the concerns I have, and I have others that I am not mentioning, in my view it would be a mistake to abandon the present thrust of title III, including the emphasis on area agencies and area planning.

The potentials of the approach, while fraught with several issues and problems, has yet to be fully tested and fully evaluated. For this reason, Mr. Chairman, I would respectfully urge that the authorizations for the title be extended for at least another two years and that the funding level now set forth in the act be increased to $200 million for fiscal year 1976 and to $250 million for fiscal year 1977.

I would remind you, Mr. Chairman, that these were the authorization levels that were originally included and were originally recommended by both Houses of the Congress when this legislation in its essential form was enacted in 1972 and then later vetoed by then President Nixon.

I have other recommendations on title III. I would like to particularly mention one, the suggestion that the act be amended to permit any urban areas, city or county, with a population of 500,000 or more to automatically qualify as an area agency under the law.

Further, I would propose that there would be some reaffirmation either by amendment or by statements of congressional intent that acknowledge and give further support to the role of State agencies on aging in carrying out the broad mandate of title III.

In my view, I do not believe that the Congress intended that the State agencies' authority would be diminished or circumscribed when they enacted the 1973 legislation.

I am aware from some of my recent studies of developments and trends in State government that there have been some tensions building between State agencies and the newly formed area agencies about their respective roles and responsibilities. I, personally, think some of this tension is natural and some of it is quite healthy. But I have heard questions raised about whether there still is a need for State agencies on aging and I believe that sort of dialog is counterproductive. If title III is to work as intended we need to have both effective and strong State and area agencies.

I then turn to a point that was discussed in his testimony today by the Commissioner. I would like to elaborate my own views on the need for a more formal linkage and coordination of the programs of the Older Americans Act with the existing public social service titles of the Social Security Act that will be incorporated into a new title. effective October 1, 1975, title XX of the Social Security Act.

I believe that some formal legislative and statutory direction by the Congress to link these two programs is necessary if there is to be the adequate kind of funds available for services for older people that is envisioned by the major goal of title III of the Older Americans Act, namely, comprehensive and coordinated services for all older people.

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Right now, there are only three major and reliable sources of federally assisted funding for services for the aged. Two of them are located in the Older Americans Act, title III and title VII. The others are the public social service titles that now have an authorization, an annual authorization, of some $2.5 billion, although the actual spending level is about $1.6 billion, I believe.

This program, although in existence several years now, has never been fully utilized to the extent possible to provide services to older people. It is one of the major resources available today for the funding of most direct services needed by the elderly.

I think it is imperative in some way that these programs be linked closer together so that that major source of funding is available to the State and to the area agencies developing these service plans.

I would also mention and would hope that my friends in the American Public Welfare Association would support this recommendation as well because on the State level it is largely the State public welfare agencies that control and have the administrative responsibility for the use of these funds.

Mr. Chairman, I have three specific recommendations in the area of health care and nursing home care. Frankly, I wish I had more time to develop fully my ideas in this area.

In November of last year, one of the most significant reports and studies ever made in the field of aging was submitted to the Senate by the Subcommittee on Long Term Care of the Special Committee on Aging, the report entitled "Nursing Home Care in the United States, Failure in Public Policy", and the subsequent supporting papers that have been published since that report was issued documents the desperate situation that older people face in this country when long-term care in a nursing home is required. It is a haunting report to read and the situation and conditions that are so graphically described are a disgrace and a discredit to our civilized society.

There are no easy answers or solutions to the many problems that now exist in the area of long-term care for the elderly and in how to improve and upgrade the quality of nursing homes and other types of facilities that provide care to older people. The fact is that, historically, we have had no coherent policy in this area.

As a result, we have permitted, through official sins of both omission and commission, this area to be largely dominated by proprietory interests and to have based much of our present public policy around a concern with the costs of care rather than the quality and level of care received.

Moreover, until very recently at least, the governmental intervention that we have had in this area has usually been far more oriented to the interests of the various providers of long-term care services rather than the consumer of such services, the elderly and the disabled.

I will not elaborate on that point further, except perhaps this. That is, I believe some source of support should be provided to institutionalize the advice of the consumer and the legal rights and entitlement of consumers or potential consumers of nursing home care and long-term services.

I believe there is a need for some form of financial assistance to non-profit organizations who represent older people and their families who may be living in nursing homes or homes for the aged or other

care facilities for the purpose of enabling such organization to provide service to older people and their families, with regard to any abuses, violations, and/or complaints of alleged mistreatment or neglect by duly licensed facilities and their staff, including the power to provide legal representation in such matters and issues.

Mr. Chairman, there are many other parts of the Act upon which I would like to comment. However, I am sure you will hear from many other informed witnesses who will articulate several other matters of personal interest to me in such areas as research and training, multipurpose senior centers, the role of the foster grandparent and RSVP programs.

I will be glad to answer any questions about the points that I have made in my comments today or in my formal testimony.

I again want to express my most sincere appreciation in having received the invitation to appear today.

[The prepared statement of Mr. Bechill follows:]

PREPARED STATEMENT OF WILLIAM D. BECHILL, UNIVERSITY OF MARYLAND SCHOOL OF SOCIAL WORK AND COMMUNITY PLANNING, BALTIMORE, MD.

I. INTRODUCTION

Mr. Chairman and members of the subcommittee, thank you for this opportunity to appear before your subcommittee to discuss any possible changes or modifications that may be required in the current content and implementation of the Older Americans Act.

As you know, this year will mark the tenth anniversary of the Older Americans Act legislation. Over the last decade, the Older Americans Act has become one of the basic legislative cornerstones of our national social policy in the field of aging. During that period of time, the Congress has, on several occasions, enacted amendments to the original law that have resulted in an increased role and responsibility for the federal agency primarily responsible for the overall administration of the Act's various programs, the Administration on Aging. Also, it has provided an expanded base of federal financial support for state and community programs for the elderly, for training and research in the field of aging, for a national nutrition program, and, under the auspices of the Secretary of Labor, a permanent community service employment program for low income older persons. In addition, the Act's present language authorizes a program of Federal financial support for the development of multipurpose senior centers and their initial staffing. And, in 1969 and 1972, the Act was amended to provide permanent authorization for the excellent Foster Grandparent Program, the R.S.V.P. program, and related community service programs featuring the utilization of the skills and talents of older people in "person-to-person" supportive services. I believe that the national Nutrition Program for the Elderly Act of 1972 and the Older Americans Comprehensive Services Amendments of 1973, both of which originated in this subcommittee, were the key turning points in the history of the Older Americans Act. These were major breakthroughs in public policy in the area of aging. Both gave large-scale responsibilities to the Administration on Aging and to their counterpart agencies at the State and community levels, particularly in the area of social and other community services. The 1973 legislation clarified and strengthened the role of the Administration on Aging as the major focal point within the Federal Government for overall planning, coordination, evaluate, and stimulation of more effective programs and services for older people.

In my view, the Older Americans Act now ranks as a major piece of social legislation. Together with the Social Security, Medicare, and the new Supplemental Security Income Program. The Act is a basic part of a national commitment to sustain and improve the well-being of older people in the United States.

However, Mr. Chairman, this is not to suggest that the Older Americans Act, or the other major laws that the Congress has enacted in behalf of the elderly in recent years, are complete and perfected, or being implemented in the manner and the spirit in which the Congress may have intended. The Social Security program, despite the many improvements made in it by the Congress in recent

years, still does not provide an adequate retirement income for many older people, especially in this period of high inflation and ever-rising food, housing, clothing, and energy cost.

The Medicare program still has many gaps in the coverage it offers to older people in helping meet many of their medical care expenses, especially if longterm nursing home care is required. The new Supplemental Security Income, which contains the important principle of a national minimum income for the needy aged, blind, and disabled, has gone through a tortorous period of initial implementation. It still has not reached many of those who are potentially eligible and ought to be beneficiaries of that program. And, in the case of the Older Americans Act, there also have been problems of implementation, especially of the 1973 Amendments, that need to be carefully examined and evaluated by the Congress as it considers further extensions of the law.

In my testimony today, I wish to discuss these four areas of interest in particular:

1. The need for an extension and improvements in the Title III provisions of the Act.

2. The need for formal linkage and coordination between the Title III and Title VII provisions of the Act and the new Title XX public social services program of the Social Security Act.

3. The authorization of a national demonstration program of home health care and nursing home care programs, including the training of personnel in such, programs.

4. The reaffirmation of the importance of multipurpose senior centers in the provision and delivery of social, health, educational, and other services for older people, and the conversion of the Title V authority of the Act to a direct loan rather than a mortgage insurance program for the acquisition, alteration, or renovation of multipurpose senior centers.

II. EXTENSION AND IMPROVEMENTS IN TITLE III OF THE ACT

Under the Title III provisions of the 1973 Amendments to the Act, the Administration on Aging and the State agencies on aging were given the important mandate for the development of comprehensive and coordinated systems of social services for all persons age 60 and over in the respective States. Overall, I believe that the Amendments were an attempt to legislate a more equitable and rational system of social services for older people than had been the case in past years, and also, a major effort to give some substance to one of the basic objectives of the law, namely "efficient community services, including access to low-cost transportation, which provide social assistance in a coordinated manner and which are readily available when needed."

The 1973 Amendments, by their very nature and scope, dramatically increased the responsibility of state agencies on aging with their intent to create a rational, coordinated, and planned delivery system of social services. Also, under the regulations issued for the restructured Title III program, Commissioner Flemming broadly defined "social services" to include a very comprehensive and wide range of social, health related, educational, and legal services that were to be ultimately considered in the development of such social service systems. But, the most significant changes in the Title III provisions of the 1973 Amendments, were those related to the establishment of area agencies and the attendant emphasis on the development of area plans. The new area agencies on aging were assigned functions under the 1973 Amendments, among them: planning, periodic evaluation of all activities carried out for older persons under the area plan, need assessment, the entering into contractual agreements with both public and private nonprofit agencies for the provision of services, and other related activities. As articulated by the Administration in testimony during the hearings held by this Committee in 1972 and 1973, and as subsequently implemented, the area agency was not viewed as an agency primarily responsible for service delivery itself, but rather seem as a planner, coordinator, evaluator, and a "service broker" acting in behalf of older people within designated planning and service areas.

There are now over 400 area agencies that have been established since the final regulations on the current Title III program were issued in October, 1973. I also understand that most of the area agencies that have been established are fully operational, although there are many that are still in a very initial phase of development.