FLOW CHART OF FUNCTIONS AND RESPONSIBILITIES

[U.S. Administration on Aging units, regional office aging program staffs, State agencies on aging, area agencies on aging]

Hon. JOHN BRADEMAS,

DEPARTMENT OF HEALTH,

EDUCATION, AND WELFARE,

OFFICE OF THE SECRETARY,

OFFICE OF HUMAN DELELOPMENT,
Washington, D.C., February 5, 1975.

Chairman, Select Education Subcommittee, U.S. House of Representatives, Washington, D.C.

DEAR MR. BRADEMAS: The enclosed is my response to the questions you submitted to me on January 31, 1975.

Please feel free to call me if I can be of any further assistance.
Sincerely,

Enclosure.

STANLEY B. THOMAS, Jr., Assistant Secretary for Human Development.

ANSWERS TO ADDITIONAL QUESTIONS RE: TESTIMONY BEFORE THE SELECT
SUBCOMMITTEE ON EDUCATION

Q. 1. Can you describe the relationship between the Office of Human Development and the Administration on Aging? For example, to what extent are budget decisions, personnel decisions, grant award decisions, and policy decisions such as those set forth in regulations and guidelines affecting AoA operations to review by the Office of Human Development?

A. The Administration on Aging within the Office of Human Development is directly responsible for program and policy decisions with respect to the development and execution of budget initiatives, justification and selection of personnel and the determination of grant recipients. The Commissioner of AoA develops and recommends program regulations, guidelines, and operational and long range plans, which are reviewed and approved by the Office of Human Development and other components of the Office of the Secretary.

Q. 2. Which staff functions, which were directly under the control of the Administration on Aging prior to the formation of SRS, are now centralized under the control of the Office of Human Development rather than Ao0-at the headquarters and field offices?

A. The Administration on Aging receives centralized staff stupport from the Office of Human Development in the areas of grants management, budget planning and Administrative services. These technical processing services are provided by the Office of Human Development in support of the decisions reached at the program level in AoA. Other Office of Human Development staff support is available on a continuing basis in response to the specific needs of AoA. With the exception of grants processing (i.e., the mechanical execution of grant applications and awards or denials), these support services were provided by the Office of the Secretary for AoA prior to the formation of SRS.

Q. 3. Which functions and how many staff has the Office of Human Development usurped from AoA in addition to those which SRS had taken over?

A. There has been so usurpation of functions or staff by OHD since the transfer of AoA. SRS staff previously assigned to provide support to AoA in the areas. of operational planning, research and demonstration, evaluation and legislative affairs have been reassigned to AoA. SRS staff previously assigned to provide support to AoA in the areas of grants processing, administrative support and budget planning are continuing to support the Administration on Aging through centralized service units in OHD.

Mr. BRADEMAS. Next we shall hear from William Bechill, associate professor, School of Social Work and Community Planning, University of Maryland. Mr. Bechill was also a former Commissioner of the Administration on Aging.

Mr. Bechill, we are pleased to see you here.

The hour is late. We will go ahead and hear from you.

The Chair will announce that we shall simply go on as long as we can, perhaps up to 1 o'clock, and then, if we have not completed the other witnesses, we will take them in order beginning tomorrow morning.

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.

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