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estimates that 80% of facility residents have some form of dementia. The average age of nursing home residents continues to increase. In Iowa the volunteer Care Review Committee members are local advocates for residents. State surveyors, evaluating care facilities, do not take on this mediating role. Care Review Committee members are trained to address early intervention while the State Ombudsman has more of an investigative role.


We recommend creation of a new Urban Mass Transit Administration title for social, health and nutritional services transportation, to include senior transport for non-emergency health and medical services. Funds should be available for both capital and operational expenses. Also, create a separate UMTA title for rural transportation to: a) replace Older Americans Act funding with UMTA funds; b) utilize Area Agencies on Aging for coordinating senior transportation; c) provide equitable funding for rural and urban areas based upon distances traveled; and d) allow cost sharing. Create a transportation subtitle under the OAA to coordinate paratransit. Funds should not be diverted from OAA Title III.


Both the national and intrastate funding formulae should include factors of age sixty plus, low-income, rural and low-income minority.


The counseling provision of OBRA 1987, as related to changes for nursing homes, should be funded and administered by and through the Administration on Aging and its national network of State Units on Aging and Area Agencies on Aging. I would also encourage Congress to use this network for outreach and counseling for other programs such as outreach for Supplemental Security Income and counseling related to Health Promotion.


Support S. 504 through S. 510. These seven bills address the issue of what it costs not to do something in the area of health care prevention activities. Especially S. 510 amending Section 361 (Part F) of the Older Americans Act could have a tremendous impact upon the quality of life for seniors. My area is currently supervising an individual completing her practicum for a Master's Degree in gerontology. She is a County Extension Home Economist implementing a wellness education program over an eight week period. She does one-on-one counseling, assessing lifestyle in terms of nutrition, exercise and general health practices, concluding with a look at possible changes for improvement. Her review of current research indicates the cost of treatment for illness far exceeds the cost of preventive care. Health care professionals continually remind us that even a little lifestyle change can dramatically improve quality of life for most individuals.


The Administration on Aging has been effective at promoting with the National Associations of State Units on Aging and of Area Agencies on Aging access to services for older persons through this network. This is a network of professionals of which Congress should increasing call upon to bring to the local level a variety of funded services. Iowa has created a Long Term Care Coordinating Unit of which the State Departments of Elder Affairs, Public Health and Human Services are a part. Through their cooperation, an agreement is in place which helps local agencies get past the barrier of sharing client information. Under this network, forty-two service providers in two of my area's counties have signed written agreements to work cooperatively, including the City of Bettendorf Police Department. This network is the only national network planning for a coordinated services system for all older persons. I encourage this committee to continue that mandate and to integrate other funded programs as appropriate into that planning and management system.

Thank you.

Senator HARKIN. Thank you very much, Marvin, for a fine statement.

One point here on the Older Workers Program. You mentioned it in your statement, but did you know the minimum wage has gone up?

Mr. WEBB. Yes.

Senator HARKIN. Will restoring the program to last year's level be good enough if we are going to meet the increase in minimum wage? It seems to me if we keep it at last year's level and minimum wage went from $3.80 to $4.25, we are still not going to be at the same level.

Mr. WEBB. Right. I would encourage an increase. We had a very successful program in our area especially combining the State match money for title V and also working with the 3-percent_setaside under the Job Training Partnership Act program. Those three programs together have given us a lot of success. And as I mention in my written testimony, we have been identified by the Department of Labor as a national example of the pooling of those kinds of resources.

I think employment for older persons does get overlooked. We do serve persons in extreme situations. We may not think of divorce in later life, but that does occur at an alarming rate. We, I think, are aware of the health care needs of seniors, but we also serve especially older women that may have health problems themselves and need the income for medical expenses and so forth. So I think the Older Worker Program is one that tends to get pushed back. And we encourage this committee to bring that forward as much as possible.

Senator HARKIN. Well, thank you very much, Marvin. Congratulations on a fine job in Iowa.



Senator HARKIN. Next is Lynn Cooper Breckenmaker and Jill June on behalf of the National Family Planning and Reproductive Health Association.

Welcome to the subcommittee. Your statement will be made a part of the record in its entirety. Please proceed.

Ms. COOPER. Thank you.

Mr. Chairman, members of the subcommittee and staff, thank you very much for the opportunity to testify today. And as you have stated, my name is Lynn Cooper Breckenmaker. I am vice president for the Family Health Council of Central Pennsylvania. I am very proud to be here today to testify on behalf of the National Family Planning and Reproductive Health Association, of which I am a member.

Sitting with me today is Jill June, president of the Planned Parenthood of Greater Iowa and a member of the National Family Planning and Reproductive Health Association Board of Directors. The written testimony that you have received is full of important information. It describes NFPRHA and the services that family planning provides. It also contains some incredibly startling data.

But what I hear is that this subcommittee consists of bottom line Senators. So what I would like to do is tell you the bottom line. Title X saves money. Title X prevents abortion. Title X strengthens families. And title X prevents disease and saves lives.

I repeat, title X saves money. When a poor teenager becomes pregnant in this country today, she almost immediately goes on welfare. And unfortunately, she stays there often until her child becomes a teenager. And to make matters worse, that teen of that teen mother often becomes pregnant herself and the cycle goes on endlessly.

We have proven through a study done in central Pennsylvania that was funded by the Ford Foundation that tailoring family planning services to the needs of adolescence prevents unintended pregnancy. This funding results in enormous savings for this county.

Title X prevents abortion. A friend of mine who is in the Pennsylvania House of Representatives, whose name is Peck Foster, he is opposed to abortion. He stood on the floor of the house in 1981, 10 years ago, and asked a very simple question to my legislators: What is the No. 1 cause of abortion? And the answer is very simple. Pregnancy, he stated. What we have to do if we want to stop abortion is prevent the unintended pregnancy.

Title X strengthens families. The American family today needs as much help as they can get. An unintended pregnancy, an unwanted and undesired pregnancy can plunge a marginally poor family into poverty. And it can keep an already impoverished family there for many years to come.

Title X prevents disease and it saves lives. It is the only source of health care for many women. And many folks are really unaware of this important fact. In rural Pennsylvania counties like mine that I cover many of the women that receive service through our program have no other source of health care at all other than the family planning agency that they attend.

Title X prevents cancer. It prevents sexually transmitted diseases and it prevents AIDS.

We need six things and we ask that this subcommittee do the following.

One, support the reauthorization of title X as a categorical grant. Reject the idea of a block grant.

Two, appropriate at least $180 million to this program.

Three, appropriate funds for the administration of this program separate from those funds for family planning activities.

Four, reject again the idea of centralizing our regional offices.
Five, fund contraceptive research.

And, six, fund AIDS and HIV research and services and appropriate funding to the title X network for these critical care and services.

Despite continued struggles, subsidized family planning services have endured. Title X and the National Family Planning and Reproductive Health Association have had many successes. I am proud to have devoted a great deal of the last 15 years of my life to this program.


If you remember nothing else that I have said today, please remember the bottom line. Title X saves money. Title X prevents abortion. Title X strengthens. And title X prevents disease and saves lives.

Thank you.

[The statement follows:]


Mr. Chairman and Members of the Subcommittee:

I am Lynn Cooper Breckenmaker of the Family Health Council of Central Pennsylvania and a member of the National Family Planning and Reproductive Health Association (NFPRHA). I am testifying today on behalf of NFPRHA and in support of an increased appropriation for the Title X national family planning program.

NFPRHA is a non-profit membership organization, established to improve and expand the delivery of voluntary family planning and reproductive health care services nationwide. As the only national organization representing the entire family planning community, NFPRHA represents almost all agencies funded under the national Title X family planning program including: state-county-local health departments; hospital based clinics; Planned Parenthood Federation of America affiliates; family planning councils; independent freestanding clinics; and individual providers, researchers, and consumers. Our members provide reproductive health care services to nearly five million women, men, and adolescents.

Originally established in 1970, the Title X program provides access to contraceptive and reproductive health services to poor women and adolescents through a network of over 4,000 clinics. The average Title X client is young, female, and has a low or marginal income. For many, the Title X program is the only source of health care readily available. The network of Title X clinics reach a population of people whose only other access to health care is through the emergency room.

A typical visit to a Title X program offers an array of preventive and public health services including physical examinations, contraceptive information and services; pap smears; screening and treatment for sexually transmitted diseases; AIDS/HIV testing and counseling; breast and cervical cancer screening; hemoglobin tests; urinalysis; pregnancy and infertility testing; parent/teen communication; maternal and child health services; diagnosis of problem pregnancies; services for men such as counseling, education and the provision of condoms; special teen clinics; adolescent health education; and community education programs. Through these free services, Title X clinics are in a unique and vital position to reach a population of women who are at particular risk for AIDS and sexually transmitted diseases.

Currently 3.5 million low income women and 1.5 million adolescents depend on the Title X clinic services. However, it is estimated that an additional 5.3 million poor women and 3.4 million adolescents are in need of reproductive health care but cannot obtain services. Currently, the Title X clinics are overwhelmed with poor and low income clients. The Reagan and Bush administrations have eroded the family planning program over the past decade in an attempt to save money. We submit that this "savings" has been no savings whatsoever instead there has been a tremendous cost. A cost both in dollar terms and in human terms.

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I urge you to concentrate on the numbers that I have just quoted. 3.5 million low income women served - but 5.3 million poor women unserved. 1.5 million adolescents served but 3.4 million adolescents unserved and in need of reproductive health care. Although millions of unintended pregnancies are averted each year as a direct result of services provided by Title X clinics, the increase in the number of unintended pregnancies and abortions is staggering. Over 50 percent of the six million pregnancies yearly in this country are unintended, with 1.1 million of these pregnancies occurring to teenagers. Eighty percent of all teenage pregnancies are unintended and more than 400,000 of the 1.5 million abortions occur to teenagers. I repeat those numbers: 5.3 million low income women unserved and 3.4 teenagers unserved.

This nation will redeem true savings with full funding for family planning. The authorization of the Title X statute expired on September 30, 1985. The result of its unauthorized status has been a reduction in the funds appropriated despite the overwhelming evidence for the need to expand and to improve the delivery of family planning services. Funding for the Title X program has not increased in real dollars since 1973. Funding for family planning services under Title X have dropped from $162 million in FY81 to $144.4 million in FY91. Inflationary increases alone would have brought the current level of Title X funding to over $239 million this year.

Let's reflect a moment on what that would mean to those earlier figures - 3.5 million women and 3.4 million adolescents unserved. Full funding for Title X at $239 million

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