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into a new block grant along with several housing, community development, environmental, and education programs?
Answer. The Social Services Block Grant is included on the list of several programs which the Administration proposes to consolidate into a single, larger, multipurpose program of grants to States. The Administration's stated approach for design of the new block grant is to enter into a dialogue with the States and the Congress on what programs would be included. The rationale driving this proposal is to allow for a reduction of Federal administrative overhead, to increase State flexibility, and to place power and decisionmaking closer to the people being served by these programs.
We can not with any specificity predict the impact on social services programs if the Social Services Block Grant program were folded into a new "super" block grant. The specific impact of a consolidated block grant on social service programs in the States would depend upon decisions made at the State level. Currently under the Social Services Block Grant program, the States have wide flexibility to select which services are most needed in their particular circumstances. The new block grant would only increase their ability to tailor programs to best meet the needs of their citizens. As evidence of this, the National Governor's Association has endorsed the proposal in concept and praises the Administration's flexibility and general attitude of partnership in formulating the design of the new block grant proposal.
Question. Each day, about 6,000 people turn 65 years of age. By the year 2000 just nine short years away
13% of the population will be 65 or over. Iowa's 65 and over population is already at 15.1 percent, and we have one of the largest 85 years of age and over populations in the country. In spite of the fact that the "AGING OF AMERICA" is very real, no increases -- not even cost of living increases have been requested that will put programs into place to deal with this population growth. What steps is the Administration taking to put into place long-term strategies and programs to deal with this population growth?
Answer: The Department of Health and Human Services is keenly aware that the growth of the aging population poses major challenges to policy makers and program administrators at all levels. aware, as is the Congress, that the population aged 65 and older increased from approximately 25, 700,000 in 1980 to 31,000,000 in 1989, an increase of some 21%. We are equally aware that these increases will continue in the next decade and into the next century
In view of these developments, the Department has assigned a high priority to assuring that adequate resources are available to support the program efforts required to address the pressing needs of the Nation's older citizens. We note that Administration on Aging programs have received on-going budgetary increases during the past decade. During that period we have also encouraged programs to solicit increased contributions from older recipients able to pay and have emphasized efforts to improve the management of service efforts. We believe that the results have been very positive.
For example, over the seven year period 1982-1989, meals provided under the title III-C program have increased by more than one third, from 190,000,00 to 250,000,000. Voluntary contributions have more than doubled from $69,000,000 in 1982 to $150,000,000 in 1989. Where opportunities present themselves, the aging services network will make additional efforts to expand services through increasing voluntary contributions and further improving service program administration.
In addition, the Administration on Aging has recently launched its national Eldercare Campaign designed to mobilize additional resources from both the public and private sectors on behalf of older persons at risk of losing their independence. The Campaign is nation-wide in scope and will assist the aging services network to draw upon significant resources which have not been available in the past.
OLDER AMERICANS HEALTH PROMOTION AND DISEASE PREVENTION
Question: Ms. Gall, as you know, I have introduced the older Americans Health Promotion and Disease Prevention Act. This bill expands Part F of the older Americans Act to establish a state grants program that would provide disease prevention and health promotion services and information at senior centers, congregate meals sites, home-delivered meals programs or at other sites. Prevention and health promotion is important at any age however, to the elderly, disease prevention and health promotion could well mean the difference between independence or nursing home care. I just think that prevention makes good sense and will save money in the out years.
with this as background, it is of concern to me that Administration has never requested funding for Part F of the older Americans Act Health Prevention for older Americans. Is it felt that these services are unimportant for older Americans, and if you feel that these services are important, why have you not requested funding for Part F?
Answer: The Department of Health and Human Services assigns tremendous importance to health promotion and disease prevention activities. We share your conviction that such activities not only enhance the quality of life for persons of all ages and that they also contribute significantly to helping individuals maintain their independence. This latter consideration is, as you suggest, especially important for older persons.
Because of the great significance which the Department attaches to health promotion programs, we continue to make major investments in this area. The Administration on Aging has directed title IV funds in substantial amounts to a variety of health promotion activities in recent years, including support for projects in Health Promotion/Health Education, Mental Health Promotion, and Dental Health Promotion. In addition, Title IV funds have also been used to establish the Health Promotion and Wellness National Resource Center, which is operated by the American Association of Retired Persons.
Concerning title III, Part F, of the older Americans Act, the Department believes that Title III contains ample authority for any
type of health promotion and disease prevention activity which States and communities might wish to pursue on behalf of older persons. Section 321 of the Act delineates a variety of activities related to promotion/prevention which are authorized under Title III, Part B. Similarly, Title 111, Part c, authorizes providers to offer nutrition education programs, which can play a vital role in health promotion, at congregate meal sites.
We believe that the best strategy is to allow States and communities to use the the broad-ranging authorities In Title III, Parts B and c, to fund health promotion and disease prevention activities tailored to their individual needs. Use of the Title III, Part F, authority could well lead to fragmentation of program efforts at the local level. Therefore, we believe that the policy Congress has followed since Part F was enacted in 1987, i.e., of not appropriating funds for III-F, is well- advised.
Question: When does the Administration expect to submit its bill on the reauthorization of the older Americans Act to Congress?
Answer: The Administration's proposals are currently under development within the Executive Branch. While a particular target date cannot be specified at this point, we are committed to submitting our proposals to Congress within the very near future.
Question: Will this proposal include mandatory contributions for older Americans Act nutrition programs? Inasmuch as there is a good track record for voluntary contributions at nutrition sites, what analysis has been done on the impact of mandatory contributions on the voluntary program?
Answer: As indicated in the previous answer, the specific provisions of the Administration's proposals for amending the older Americans Act are still under development. Therefore it would be premature to comment at this point on what the final provisions might include. The formulation of any proposals related to costsharing would take into account the experiences which states and communities have had with other programs which provide services based on the recipient's ability to pay. The possible effects which cost-sharing arrangements might have on various aspects of the title III program, e.g., participation rates, program administration, maintenance of contribution levels, etc., would be carefully considered in light of available data.
Question. What is the estimate of the cost of administering a mandatory cost-sharing program?
Answer. No estimate has been made of the cost of administering a mandatory cost-sharing program. The General Accounting office (GAO) study of this proposal did not estimate administrative costs. However State program administrators with cost-sharing programs interviewed by GAO usually indicated that their experiences with cost-sharing have been favorable. A majority of States also indicated to GAO that cost sharing allowed them to serve greater numbers of elderly clients and has broadened the range of services offered. This is a strong indication that the administrative costs are substantialy less than funds received from cost-sharing clients.
In our opinion, it would take a great deal of time and money to estimate the cost/benefits of this program change and considerable uncertainty would remain about any such estimate.
Question: What are the budgetary implications associated with the Administration's proposal?
Answer: As indicated above, the Administration's proposals for amending the older Americans Act are still under development. Therefore it would be premature to comment at this point on what the final provisions might include and what their implications might be.
Question. Current law permits older persons to make voluntary contributions toward the costs of services. The amount collected in 1989 was $179 million, which was equal to 21 percent of the federal funds appropriated for title services that year. What estimates, if any, can you provide as to increased revenues that might be generated through expanded voluntary or mandatory cost-sharing programs?
Answer. No estimates have been made of the effects of expanded voluntary or mandatory cost-sharing programs.
Our experience with voluntary cost-sharing programs would lead us to expect that the level of voluntary contributions will continue to grow at their current rate, particularly for Title III-C (meals), if the encouragement to contribute is maintained at its current high level.
Question. Has the Department conducted an analysis, study, or survey on which these estimates are based?
Answer. The Department has not conducted any studies on the issue. However, based on a GAO study of cost-sharing, we are convinced that the administrative overhead related to cost-sharing would be small compared to the program income raised to expand services. Many States already collect the needed information and/or have a mechanism for cost-sharing. The existing systems for collecting voluntary contributions are a natural foundation for administering cost-sharing.
Question. Congress has consistently tried to increase funding for nutrition programs. However, each year, monies provided for congregate meals are transfered at the State and local level to home delivered meals or supportive services. Does this suggest that the need for congregate nutrition services are not as great? Given the fact that these monies for congregate meals are being used for other purposes, why doesn't the 92 budget request increases for home-delivered meals and supportive services?
Answer. Although the Congress has consistently increased funds for nutrition programs, the Congress has also, provided authority in the older Americans Act for states to make limited transfers between program categories. This enables States, based on their particular circumstances, to reallocate limited amounts between program categories. This is critical flexibility for States enhances their ability to manage the program to best meet the needs of the elderly
in their jurisdictions. We would point out that in spite of these transfers, the overall number of meals served in congregate and home settings each year continues to increase. We encourage the Congress to leave this important, but limited, flexibility to reallocate funds in the Act.
Question: Indications are that instances of elder abuse continue to increase. However, nothing in this budget reflects any recognition of this problem. Did the Administration on Aging propose an initiative in its original budget to deal with elder abuse? How much did the Administration on Aging request?
Answer: The Administration on Aging and the Department of Health and Human Services determined that the most effective approach to funding programs to combat elder abuse was to base the FY 1992 request for Title III-G activities on the level established by Congress for FY 1991. Please note that States and localities are free to supplement their title III-G allocations by using title III-B (Supportive Services and Senior Centers) funds for programs and activities to combat elder abuse.
Question: What implications does the most recent report completed for AOA on the role of the ombudsman program in board and care facilities have for funding of the ombudsman program?
Answer: AOA will continue to evaluate the needs of the ombudsman program on a regular basis to assure that State and community-level ombudsman service providers have adequate resources to meet their responsibilities under the older Americans Act. Reports such as the assessment of the board and care issue will obviously be considered in making these judgements, as will relevant information from other sources. For FY 1992, the Administration on Aging and the Department of Health and Human Services have determined that the funding level established by Congress for FY 1991 was appropriate for the ombudsman program for FY 1992.
Question. At the request of the office of Human Development Services, the Inspector General is currently undertaking a needs survey to determine the availability of training, staffing, etc., an expanded Head Start program. When will the results of this survey be available.
It is expected that the survey will be completed by May
What is the timetable for awarding FY 1991 funds to
Answer. A Program Instruction was mailed to all grantees on March 19 explaining how the FY 1991 increase will be implemented. The grantees' requests for quality improvement funds are due on May 3; the expansion requests are due on June 3. The PCC increase will be awarded through a competitive process this summer as will be the