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ACTION,

Washington, D.C., February 14, 1975. Hon. JOHN BRADEMAS, House of Representatives Washington, D.C.

DEAR CONGRESSMAN BRADEMAS: I was delighted to read the Christian Science Monitor's article on the future of ACTION's programs for the elderly. You are to be congratulated on your astute handling of the figures which Director Balzano has been spreading across the news media in which he has endeavored to demonstrate the accomplishments under the direction he has given it. Regrettably, if the truth were known, ACTION will never recover from the unbelievable poor direction he has given it. It is understandable that the domino theory is about to set in, first the loss of SCORE/ACE, now hopefully the older American programs, and then VISTA, which certainly has outlived its purpose. With strong leadership at the head of VISTA, perhaps VISTA could have changed direction to some degree and been considered for it's extension, but it too has fallen on dark days. It is another layer in the welfare field where supposedly qualified-trained professionals are administering a complex program.

I wish I could sign my name to this letter, however, Balzona has one quality that you perhaps did not detect, revenge, and if he found out the author of this letter I would become the center of his diabolical approach to rid the agency of all who do not support his very limited experience in government philosophy.

Keep up your good work.

[From the Christian Science Monitor, Feb. 2, 1975)

"ACTION" MAY LOSE 3 PROGRAMS FOR ELDERLY-TRIO OF PROGRAMS MAY BE

TRANSFERRED FROM VOLUNTEER UNIT BY A BRADEMAS AMENDMENT

(By Louise Sweeney, Staff correspondent) Three major volunteer programs for the elderly may be moved out from under the wing of Action, the official United States agency for volunteers, this newspaper has learned. The programs, RSVP, Foster Grandparents, and Senior Companions, are cornerstones of the agency, constituting approximately half of Action's domestic budget.

During House hearings, which ended Tuesday, on the extension of the Elderly Americans Act, Michael P. Balzano, director of Action, was questioned sharply about the effectiveness of his agency in representing the best interest of the elderly in the three programs.

The questioning came from Rep. John Brademas (D) of Indiana, chairman of the House subcommittee with jurisdiction over programs for the elderly.

AMENDMENT HINTED

According to one source, Mr. Brademas will suggest amending the Older Americans Act to transfer the three programs to Administration on the Aging, under the department of Health, Education, and Welfare. Several experts on aging testifying at the hearings had recommended that move. Mr. Brademas' office said that he was unable to be reached to comment.

The issue came to a head at the hearing when Mr. Brademas asked Mr. Balzano how many Action employees were working full time on the three programs dealing with older Americans and at first was told between 400 and 450.

"Vy information is many times less than 400,” contradicted Mr. Brademas. "You're telling me everybody cares about the old folks at Action,” he said, and repeated this request for the number of persons working full time on RSVP, Senior Companions, and Foster Grandparents programs.

FIGURES TALLIED

"Sixteen," Jir. Balzano finally said, explaining that there was a total of 71 employees working in the domestic operation of Action at headquarters, and 321 in the field or a total of 392 (A check by this newspaper with other Action figures indicated 71 at headquarters, 372 in the field, or a total of 443.)

Dr. Balzano then said, in relation to the figures he gave. that the 16 employees working full time on programs for the elderly were all at headquarters,

that “there are no full time employees working on programs for older Americans in the field.”

"That's quite startling, isn't it?" Mr. Brademas observed.

SHARP CONTRAST

As Mr. Brademas indicated, if the approximate figure of 400 employees is used, it means that only 4 percent of the Action employees are working on programs for the elderly, a sharp contrast to the fact that 60 percent of the agency's volunteers are in programs for the elderly: 117,000 in RSVP, 12,676 in Foster Grandparents, and 799 in Senior Companions.

Just as important is a budget comparison : Action has a $100 million budget for fiscal 1975 for domestic operations (the Peace Corps $77 million is a separate budget). Of that $100 million, $16.8 or nearly half is allocated for the three older Americans programs: nearly $16 million for RSVP, $28 million for Foster Grandparents, and $2.5 million for Senior Companions.

“As soon as one block of the castle falls, the whole castle falls," said one source in discussing Action's reasons for wanting to hold on to the trio of older Americans programs. If Action lost these programs, he speculates there might be a government move to return its others to their original agencies: "Ace and Score, involving retired executive, to the Small Business Administration, VISTA to the Office of Economic Opportunity, and the Peace Corps to the State Department.”

PREPARED STATEMENT OF NATIONAL COUNCIL FOR HOMEMAKER-HOME HEALTII

AIDE SERVICES, INC.

INTRODUCTION This testimony is presented by the National Council for Homemaker-Home Health Aide Services, Inc., a national, non-profit 501(c)(3) membership organization, with offices at 67 Irving Place, New York, N.Y. 10003.

The National Council's goal is availability of quality homemaker-home health aide service in all sections of the nation, for individuals and familie in all economic brackets, when there are disruptions due to illness, disability, social and other problems, or where there is need of help to achieve independent functioning and self-sufficiency.

MEMBERSHIP The National Council is a membership organization composed of 608 members of which 256 are agencies providing homemaker-home health aide service; 155 are organizations; and 297 are individuals. (1974 year-end figures.)

DEFINITION OF SERVICE Homemaker-home health aide service helps families remain together or elderly persons to remain in their own homes when a health and/or social problem occurs or to return to their own homes after specialized care. The trained homemakerhome health aide, who works for a community agency, carries out assigned tasks in the family's or individual place of residence, working under the supervision of a professional person who also assesses the need for the service and implements the plan of care.

The following recommendations are made to the Select Subcommittee on Education to take into consideration as it reviews and revises the Older Americans Act.

1. The National Council for Homemaker-Home Health Aide Services recommends that the established terminology of homemaker-home heatlh aide service be used throughout the Older Americans Act wherever there is reference to this basic service. Such consistency will contribute to an understanding of this generic service where one trained and supervised person serves an older individual rather than having two persons go into a home, one to undertake home management and the other to provide personal care. C'se of the term homemakerhome health aide services throughout the legislation will also be consistent with the established practice of the growing number of agencies which now provide this essential in-home service.

2. It should be noted that in the current Igeislation under Title II—Section 201 (b) (4) there is a list of "programs designed to meet the needs of older

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persons for social services." Homemaker-home health aide service is not included in the list. This appears to be a simple omission since the service is referred to inany times later in the legislation. It is recommended that homemaker-home health aide service be included in the redrafting of this sub-section.

3. There is no provision in present legislation for statewideness of available services. At this time, in order to receive services, an older person must be in the right place at the right time. This is inconsistent with our belief in the rights of older persons to receive basic services when they are desired and appropriate regardless of where the older persons live. It is our recommendation that with the continuation of the Older Americans Act there be a requirement that basic services be available statewide to all older persons in need of and desiring specified services. Such a provision would be consistent with the provision for statewideness in Title XX of the Social Security Act. When public funds are involved, there should not be discrimination among older persons in like circumstances of need for services. This requirement could well be palceel in Title III, Section 304 and Section 305 of the present legislation.

4. The present legislation is almost silent about standards. Experience in the nursing home and other fields shows how important it is that basic standards be formulated and met by agencies which give services to older persons, a highly vulnerable group. Such standards should be in conformity with the standards of national voluntary non-profit agencies concerned with services for older adults. A requirement in the legislation that standards be met is the most direct way to guarantee the quality of services provided at the state, area, and local levels and to establish essential protection for older adults.

5. In reviewing the Older Americans Act and its implementation, it is obvious that much greater attention needs to be placed upon written policy at all levels for the effective administration of services for older adults. There have been many delays in the promulgation of written policy as the basis for operation of programs. It is recommended that a requirement for prompt issuance of policy at all decision-making levels be incorporated into the revised Act. This will facilitate improved administration at all levels of governments and establish the clear bases for accountability which do not now exist.

6. Experience at state and especially at local levels, indicates the need for lessened emphasis on planning and more emphasis on active promotion of direct service delivery to meet the already documented needs of older adults. Planning without action to assure delivery of needed services is ineffective at best.

7. In addition to listing services it would be well to define them in the statute itself or redefine them in related materials. The National Council has learned from many parts of the country about the confusion which exists between homemaker-home health aide and chore services. One way to help correct this situation is to redefine these services to make clear that they are sepa rate and distinct services. Recommended definitions of each follow: Definition of Homemaker-Home Health Aide Services

"Homemaker-home health aide services means professionally directed personal care and home management services by trained and professionally supervised homemaker-home health aides to maintain, strengthen and safeguard the functioning of eligible persons in their own homes where no responsible person is available for this purpose. The term professionally directed means individual assessment and implementation of a plan of care." Definition of Chore Services

"Chore services means services in performing minor home repairs, heavy cleaning, yard and walk maintenance which eligible persons are unable to do for themselves because of frailty or other conditions and which do not require the services of a trained and supervised homemaker-home health aide or other specialist. Chore services may include such activities as: Help in lawn care, periodic heavy cleaning, simple household repairs, running errands, etc.”

Thank you for the opportunity to make recommendations to your Subcommittee as you revise this important statute.

THE PAPAGO TRIBE OF ARIZONA,

Sells, Ariz., February 7, 1975. Ilon. John BRADEMAS, ('hairman, Select Sub-Committee on Education, Committee on Education and

Labor, U.S. House of Representatives, Washington, D.C. DEAR HONORABLE BRADEMAS: We are enclosing written testimony to your sub committee which reflect our problems and our experiences in attempting to work within the framework of the Older Americans Act as it was written and legislated.

Our experiences bear out the great need for Tribes to be directly funded and monies to be set aside specifically for Indian Programs.

We will continue our efforts to advcate strongly for this and appreciate the efforts of your committee in trying to voice our needs.

We hope that when the Older Americans Act of 1965 is amended it will include those revisions that will allow Tribes to get funding directly.

JACOB ESCALANTE,

Chairman, The Papago Tribe. Enclosure.

THE PAPAGO TRIBE OF ARIZOXA (A report on Problems Inherent in Operating Programs under the Older Americans Act of 1965 as presently administered under State government and our recommendations. Compiled for United States. House of Representatives. Select Sub Committee on Education, Committee on Education and Labor on this oth day of February, 1975, by Mrs. Alice S. Norris, Director Papago Elderly Programs, "The Wise Ones.")

Mr. Chairman, Distinguished Members of the Committee: On behalf of the Papago Tribe I hereby submit this testimony for your consideration and for the record.

Within the last few years, the Federal government has directed special efforts to identifying the needs of older people, and developing services to respond to these needs. The highlight of this effort was seen in the 1971 White House Conference on Aging, where representatives of communities throughout the country, gathered in Washington to formulate some national policies with regard to the provision of services to our older people. Essential to the hundreds of recommendations developed during the conference, was the underlying attitude that services for the elderly needed to be placed in a much higher priority in community efforts, if in fact, new avenues of service were to be developed. The increasing size of the older population, the complications of developing and delivering services to this older population, had to be addressed in order to tind new avenues for meeting the needs of the older persons.

The problem of understanding and developing new services for the elderly is yet complicated by the mutliplicity of federal programs that offer alternatives and resources, and the structure by which individual communities may represent themselves to the Federal or State governments, in order to obtain these monies. When the Older Americans set was written and passed in 190.5, there was no special consideration for Tribes given, nor was there any Indian input. ('onsequently, a bill was passed and Tribes were left out of the funding route, and the money allocated under the various titles of the Act went directly to the States for administration and implementation of services to the elderly.

Unfortunately, the traditions and operational patterns established with the Older Americans Act of 1967, which provided no direct relationship between the federal government and the Tribe, now places the Papago and every other Tribe in the dilemma of needing to choose between a relationship with a State office or via their locally designated area planning agency. These relationships were new to us and had limited experience working with Tribes. Also, neither a zeney had overall plans which supporter or fully recognized the uniqueness of Indians residing on reservations, nor did they or do they yet fully under

stand Tribal governments and how they function. In our experience, the State would have perferred to ignore Iudian needs and did not consider serving Indians a priority.

During the 1971 White House Conference on Aging, several recommendations concerning the Indian elderly were made. Made, put on paper, filed and then forgotten the common plight of so many of our elderly today.

The Older Americans Act, as amended in 1973, permits Indian Tribes to establish their own planning and service areas, a concept promoted by the Older Americans Act, to expand the responsibility for planning and delivery of services right into the local community. In permitting the Indian reservations to develop their own planning and service area, this intent is clearly identified. In Arizona however, we were unable to establish our own planning and service area because Governor's Executive Order 70–2 states that only six established Planning and Developmental Districts of Arizona, known as Councils of Governments or their delegates may be recognized for purposes of area wide planning. This put the Tribe in the position of working with the local agency whose priorities were directed to serve the metropolitan areas where there was a higher concentration of people over age 55.

For example, in Tucson (Pima County) there is a continuing internal struggle toward justification of the need for additional long-term care beds. Local planning authorities have been reluctant to acknowledge recent expert consultants' reports which demonstrate a need for more than 1,200 additional nursing home beds in Pima County itself. When confronted with such challenges, the bed need demonstrated by the Papagos, in terms of the "numbers of elderly requiring institutional services" do not receive priority attention. The problem, obviously, is that the "numbers" themselves do not represent the full scope of the problem, and do not begin to measure the type of social and cultural catastrophe that happens.

Unfortunately, widely adopted artificial standards do not recognize the unique cultural and logistic circumstances that establish, as essential, the need for local, accessible, and acceptable services for those Indian people already past age 65 living on the reservation, and hundreds who are a decade or more younger, and who reflect the chronic illnesses and personal care needs so often typically attributed only to the eighth and ninth decades of life.

BACKGROUND, AND STATEMENT OF THE NEED

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With an area on nearly three million acres (larger than the State of Connecticut) and population of more than 10,500 persons, residing in 72 widely scattered villages, the Papago Indian Reservation encompass a major portion of South Central Arizona.

The Papago people like all other Indian Tribes have always recognized the importance of the elderly in their culture * * * calling them “the wise ones"! *

* implying a functional integral resource essential in Papago tradition and life style. A “wise one" need not have attained that demarcation of aging typified in federal programming; i.e., 65 chronological years, as their life style has reflected exposure to harsh environmental conditions, and a life span that may be shortened by, or required survival of, widely prevalent chronic illnesses including diabetes, hypertension, and arthritis.

Like other Tribes there is no long term health care resource such as shelter care or nursing home on our reservation. Therefore, there is no alternative available to the Papago people needing high degrees of personal care and service, than acceptance of the alien world of nursing homes in Tucson or Phoenix. To them, a nursing home placement not only reflects the usual trauma of institutionalization, but also a relocation away from the world of the Reservation which they have known all of their lives, and what not must represent a permanent displacement from the culture they have known. This dispalcement represents far more than just resignation to a foreign cultural environment, strange physical surroundings, and acceptance of strange foods and schedules. Jany cannot effect even simple communications, possessing only the Papago language. Forced physical separation from the Reservation constitutes near-total social isolation, inactivity to meaninglessness, while kuowing that they could retain a valued role in Papago society if they were within reasonable proximity to their families, friends, and their accustomed war of life.

Such deprivation and separation does, as it must, manifest itself in accelerated physical and mental deterioration in anticipation of, if not hope for,

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