STATE OF NEVADA DEPARTMENT OF HUMAN RESOURCES, Hon. JOHN BRADEMAS, DIVISION FOR AGING SERVICES, Carson City, Nev., February 25, 1975. Chairman, Select Subcommittee on Education, Committee on Education and Labor, Washington, D.C. DEAR CONGRESSMAN BRADEMAS: The following is testimony from the State of Nevada referencing your qustions asked of Mr. Harry F. Walker, President of the National Association of State Units on Aging: Q. 1. Do you believe that there is yet any conclusive evidence that the Area Agency on Aging (AAA) strategy is working? That is, has the money been better spent in this planning mechanism than had it been spent on direct services for the elderly? A. We have been operating with Area Agencies on Aging for more than two years and firmly believe that the funds used for support of area agencies on aging would have had a much greater impact if they had been spent in direct services for the elderly. There is too much theory being placed on expectations of area agencies on aging and such excuses as being too early for conclusive evidence or other theoretical excuses does not justify the continued spending of Title III funds for support of area agencies on aging in this State. Supposedly area agencies would develop services with funds other than Older American Act funds, however, this is not the case in this State and as a result a great amount of direct services are lost due to the administrative costs for area agencies on aging. Q. 2. In an analysis of June 1973 data, GAO found that nationwide only twotenths of 1 percent of the revenue sharing funds had gone toward programs to specifically benefit the elderly. Is there any evidence that Area Agency on Aging (AAA) activities have increased this percentage? A. Again area agencies on aging should be expected to draw more money from the so-called untapped resources within any given area for aging programs. Specifically speaking, revenue sharing funds are at the command of those who initiate the proper strategies for securing such. In this State consortiums developed through the State agency with advisory committee members, representatives of local projects, project directors and general populous of senior citizens have gone before city and county governmental structures in securing revenue sharing funds. My question is then, would an area agency on aging office cost expenditure-wise justify their existence of the above strategy if it can be carried out with ongoing State unit strategies. It has been the experience of this State that the greatest influence in securing revenue sharing funds has been by the local voting populous. Q. 3. Are you satisfied with the current mix of funds, between administration and services, under the local Title III program? A. There is some question as to the formula strategy as to both the 15% limit of Title III funds for area agencies and the no more than 20% funding limit for a planning and service area not having a designated area agency on aging. The formula tends to discriminate in part by limiting Title III funds to an area not designated with an area agency on aging. Also the 20% formula would tend to inhibit the State's decision in awards of funds as to the most efficient and effective manner possible. Our State could best use all Title III funds for direct service programs benefiting the elderly. Q. 4. We have heard comments that it is difficult for some AAAS to build the nutrition program into their area plans because the nutrition projects are often funded through a separate mechanism. A. In the State of Nevada Title VII nutrition programs are funded and administered directly by the State Agency on Aging. If area agencies funded and administered Title VII programs I believe it safe to say that area agencies would need additional funding for increased responsibility of administration. At present all nutrition programs are closely coordinated with Title VII programs. It is the practice to fund projects or to locate meal sites where a senior center is in operation so that programs are mutually supporting and administration costs are kept at a minimum. Close coordination can be accomplished under present legislation but it is recommended that states be given the option specifically spelled out in legislation for management without the necessity of area agencies on aging and taking out the 20% limitation for geographical area not specifically supported by an area agency on aging receiving Title III funds. Experience has proved, at least in this State, that it is unrealistic to fund area agencies when the administrative costs of area agencies use approximately one-half of the total allotment of Title III funds to such state. Q. 5. Do you think the extension of the Title III program should continue the general prohibition against the provision of direct services by area agencies on aging? A. By removing the provision of direct services of both the State Agencies and area agencies would only lead to increased administrative costs. The exceptions noted in providing direct services such as information and referral are necessitated and justified. Q. 6. Regulations specify a general limit of three years on the funding of any social service under an area plan. (A) Do you have any indications as to how feasible it will be for communities to pick up the costs of these programs? A. I believe that the general language of the Older Americans Act placing a limit of three years on funding with the expectation that programs initiated with Title III and Title VII funds would continue from other sources of funding by way of State and local resources is basically a dream. Very few programs would be able to continue such without the support in part at least of a Federal share. The State would have the best knowledge in making final determinations as to what programs could maintain their status quo without receiving additional Federal funds in future years. Therefore, it is recommended that a five to ten year limitation be placed on such funding or that no limitation be placed on such funding in the language of the Older Americans Act. Q. 7. (A) What kind of statistics do you have on the socio-economic status of persons benefitting from the AAA Programs? (B) Are low income elderly actually receiving priority in all states? A. No formulated or realistic statistics are being captured from area agencies on aging on the socio-economic status of persons participating in programs under the area agency on aging guidance. Philosophically all programs are aimed toward the elderly most in need. No reliable information is available to those actually served in regards to socio-economic status. Q. 8. What is the relaionship between information and referral (I&R) services provided by the State Agencies and by the Area Agencies on Aging? A. It is the policy of all agencies that can be identified of providing direct or indirect services pertaining to needs of the elderly that such services be rendered to the best of our capabilities. It is believed by this State that Information and Referral should be given a top priority in developing a coordinated and comprehensive plan in assisting the needs of both direct and indirect information to the elderly. If the area agencies on aging are to provide a comprehensive and coordinated system of information and referral undoubtedly this would increase the overall administrative costs in support of area agency on aging administration. Q. 9. I have heard that some states are experiencing a strained relationship with their Area Agencies on Aging. How common is this? Do you think any legislative changes would help the situation? A. Legislative changes in Public Law 93-29, as amended, would certainly enhance the role of various states in carrying out the purpose and intent of the act and that is administering programs in the most efficient and effective manner possible. Flexibility is needed in the legislation for states to determine their own needs as to planning and service areas and the establishment of area agencies on aging. To establish an area agency on aging so that States may exceed the 20% limitation of areas without a designated area agency is a blatant disregard to utilizing allocated funds under the Older Americans Act in the most efficient and effective manner possible. The strategy of the creations of AAA's seems to parallel the strategy of the Federal office of OEO. Q. 10. I know that AoA devised joint objectives with Action for FY 1974 which included the establishment of Older American Volunteer Programs funded by Action in every planning and service area with an area plan under Title III; and that such volunteer programs were to be developed in coordination with the appropriate state and area agencies on aging. To your knowledge, to what extent was this objective carried out at the local level? A. Joint objectives and/or signed agreements may be of value, however, for coordination and administration we believe that programs involving the elderly should be administered from one central body. Thus, I would recommend con. sideration in combining the programs under one administration. Q. 11. Do you know if all states have routinely been given the opportunity to review and make recommendations on RSVP, Foster Grandparent, and Senior Companion applications? Does Action usually go along with State Agency on Aging recommendations. A. Lack sufficient data for comment. Q. 12. Were you consulted in the development of the recently issued program operations handbook for the Retired Senior Volunteer Projects? A. This State Agency did not have input for subject handbook entitled "Operations Handbook for the Retired Senior Volunteer Projects". Q. 13. How many staff do you think are needed in each State Agency on Aging? (Currently over 1,000 total or 20 per state.) A. The number of State Agency Staff needed would depend upon the depths of involvement in carrying out the purpose and intent of Public Law 93-29. As an example, the State Office on Aging could utilize direct service staff in such areas as the following: (1) A housing specialist to coordinate activities promulgated under the HUD Act that pertains to the elderly. (2) A transportation specialist (same reason as above). (3) A nursing home specialist. (7) A counseling specialist. (8) Etc., etc. (not to mention present staff makeup.) To my knowledge there is no rule of thumb that would justify the number of dollars the State unit on aging would receive in conjunction in trying to carry out the intent and purpose of the Older Americans Act, as amended. A great amount of time is spent by State Agency staff in trying to coordinate other sources of Federal funding allocated to other Federal departments and agencies. The amount of time necessary to track down proper information procedures in applying for funds is both burdensome and frustrating when evaluating the success in securing Federal funds from other sources. At the same time States are to look into both the public and private sectors for other sources of funding such as foundations, etc. I hope that these comments will have a positive purpose in consideration as to any changes and amendments made in regards to the Older Americans Act. Sincerely, Hon. JOHN BRADEMAS, JOHN B. MCSWEENEY, AMERICAN SPEECH AND HEARING ASSOCIATION, Chairman, House Select Subcommittee on Education, DEAR MR. BRADEMAS: These few remarks and the articles to which they refer are submitted on behalf of the American Speech and Hearing Association, a national scientific and professional society of more than 20,000 doctoral and master's degree level speech and hearing professionals. We ask that this offering be made part of the Subcommittee's formal record of deliberations relating to the extension and possible amendment of the Older Americans Act. Because older Americans often face special problems of adjustment and uncertainty, presbycusis (i.e., loss of hearing which accompanies old age) can be of critical concern. Besides adding one more problem to the many already extant for this group, a restricting hearing loss may cause the greatest difficulty in adjustment because of the limitation it places on communication. Elderly persons themselves have reported that hearing and vision are first in importance for a healthy old age. And auditory (i.e., hearing mechanism) deficiencies have been shown to critically limit the aging person from participating in and profiting from the cultural and psychological warmth of verbal (language) and nonverbal (environmental) sounds. Several program efforts have been made to meet the great need for geriatric aural rehabilitation and management, but most of these have touchd only a few localized populations of older Americans; others have failed outright. A principal cause of failure relates to the general perception on the part of the elderly that hearing loss is inevitable and untreatable. Another cause has to do with the paucity of information available to the elderly and their families on the existence and location of professional aural rehabilitation (i.e., audiological) assistance. Yet another cause relates to the disenchantment the elderly experience when they succumb to misleading hearing-aid advertisements that suggest a return to normal or "natural" hearing, and subsequently learn that a hearing aid, absent the rehabilitation guidance a salesman cannot provide, is of little assistance. ASHA hopes the Subcommittee will address the need for increased emphasis on the aural rehabilitation needs of geriatric populations. Specifically, we would ask that the Subcommittee empower State aging agencies to develop model information programs that will encourage elderly Americans to seek aural rehabilitation assistance when needed, and identify for such individuals local professional aural rehabilitation resources. We would ask further that State agencies be encouraged to create model or special projects for the delivery of aural rehabilitation services to the elderly. In this regard, see the Harless and Rupp Article, infra., which recounts the establishment in Ann Arbor, Michigan, of an aural rehabilitation program for noninstitutionalized elderly, and the Hull, Traynor article, infra., which details a Greeley, Colorado, program for older persons in nursing/retirement homes. Finally, it is our hope that the U.S. Administration on Aging will be encouraged to support graduate (master's and doctoral) training and research in geriatric aural rehabilitation as well as national consumer and professional conferences and workshops dealing with the special problems and needs of hearing-impaired elderly Americans and the delivery to them of quality aural rehabilitation services. The three following articles, offered for the Subcommittee's information, will hopefully also provide models for national, state, and community agencies interested in initiating geriatric aural-rehabilitation information and delivery programs. "The Specter of Aging-Golden Years or Tarnished?" appeared in the November-December, 1971, Hearing and Speech News, a publication of the former National Association of Hearing and Speech Agencies; "Aural Rehabilitation of the Elderly" appeared in the May 1972 Journal of Speech and Hearing Disorders (Vol. 37, No. 2), an ASHA journal; “A Communitywide Program in Geriatric Aural Rehabilitation" appeared in the January 1975 issue of Asha, a journal of the American Speech and Hearing Association. We appreciate this opportunity for providing input to the Select Subcommittee on Education, and your and the Subcommittee's interest. Sincerely, Enclosure. RICHARD J. DOWLING, Director of Governmental Affairs. THE SPECTER OF AGING-GOLDEN YEARS OR TARNISHED? With the almost daily bombardment of new scientific and technical information, it becomes an increasingly urgent matter to examine closely the extent and nature of this "progress." For example, advances in medical science during this century have resulted in extending man's life span. Unfortunately, while increasing the number of life years expected, these advances have not been especially effective in simultaneously improving the quality of life during these extra years. As Donohue (1968) observes, these so-called golden years of retirement may be more tarnished than golden. Membership in the "senior" age group present many problems. Four of the most commonly cited are failing health, costly medical care, generalized frailty and death. Health problems, real or anticipated head the list of concerns for older people. Senior citizens rank vision and hearing first in importance for a healthy old age. Unfortunately, many older individuals encounter increasing vision and hearing problems with increase in age. Ninety per cent of individuals 65 years of age and older need glasses, and 66 per cent of them have serious hearing difficulties by the age of 80 (Davis, 1947). Presbycusis is the descriptive term given to the concomitant loss of hearing acuity and sensitivity which accompanies old age-the gradual progressive reduction in hearing efficiency. Because the aged face generalized problems of adjustment and uncertainty as they grow older, reduced hearing ability can be of critical concern to them. Campanelli (1968) has stated that auditory deficiencies may critically limit the aging person from participating in and profiting from the cultural and psychological warmth of both verbal and nonverbal sounds. The specter of diminished hearing ability is a real one to most of the elderly When an older client comes to the speech and hearing center or medical facility for assistance in resolving his hearing problem, the audiologist and otologist must understand the complexities and complications of the aging process itself, as well as the specific problems of presbycusis as they attempt to help the elderly person. Statistically it has been shown that for a broad population of elderly people, hearing loss associated with aging is approximately “a decibel a year" (Gaeth, 1948). This means that between the ages of 65 and 85, the average elderly person may anticipate a cumulative 20 dB loss of hearing. Not all elderly people will fit into this easy-to-compute pattern, but the older person will experience a gradual decline in hearing ability as age increases. Beasley (1940) also observed this relationship in a national survey which attempted to determine the amount of hearing loss in our country. He found that at ages 35 to 44, 1.3% of men and 1% of women had a hearing loss of 47 dB or greater. In the age range 65 to 74, one out of every 14 men (7.1%) and one out of every 18 women (5.5%) was hearing impaired. From an observation in the 1960's, and with the bias that the subjects were volunteers rather than random samples, the Detroit Hearing and Speech Center (Rupp, 1965) reported the following figures for its Michigan State Fair Project for the years 1960 to 1965 from 20,680 subjects: The criterion for pass-fail was a screening test at 15 dB (ASA). A "fail" classification was based on two or more failures at the set intensiity level. Age range efficiency for hearing according to pass-fail classifications showed the following results for the representative year of 1963: The reduction in hearing efficiency with increasing age, again, is a dramatic one. A Public Health Service publication, "Hearing Levels of Adults by Age and Sex: United States 1960-1962," reviews hearing efficiency for adults. Using a probability sample of 7,710 citizens in the age range 18 to 79 years, inferences were made for the 111 million adults who were noninstitutionalized civilians. The findings show that 8.4% of the population had hearing efficiency that was less than 15 dB average (ASA) for the better ear for speech frequencies. Males tend to have about 50 per cent more hearing loss than do females. Again, the prevalence of hearing impairment is shown to progress with age. Those under age 25 years showed 0.8% with hearing loss; those individuals in the 65 to 74 year range showed 13% with loss; and those over 75 years showed 26% with deficient hearing. In contrast to many studies, the work of Rosen and co-workers (1962, 1964) in the Sudan strongly indicates that it is the total environment in which an individual lives which may be responsible for either good or poor hearing. In this remote region in Africa, the Mabaan tribesmen in the age range 70 to 79 years showed only minimal loss of hearing at the high frequencies. For example, the mean hearing level at 6000 Hz was only 23 dB (ASA). We may conclude, therefore, that hearing efficiency appears to be culturally related. As any worker in the field of audiology will agree, there are many causes for hearing loss. Hoople (1960) reports that it is difficult to accept the aging factor alone as the full culprit in this emerging problem. If no insults from infection had ever occurred, or if no exposure to noise had ever taken place, might there not be a difference in the loss of hearing, decade by decade, which so many surveys have demonstrated? |