73 333 6. Area Agencies' Methods of Achieving Their Responsibilities Issue: What are the minimum functions which an Area Agency on Aging (AAA) should directly perform? Background: Area Agencies on Aging are contracting with private and public agencies their responsibilities, including planning. Some Area Agencies located in planning districts with A-95 Planning Agencies already established, have developed contracts with the A-95 agencies to do planning for the older Americans in the Planning and Service Area. The AAA may never develop its' own capacity to plan for older Americans if it buys the service from another agency. The core function of the Area Agency is planning. Service providers frequently perceive the Area Agency on Aging as a conduit of Title III Older Americans Act Funds What are the functions the AAA must directly conduct in addition to being a conduit of Federal money to local service providers? Alternatives: 1. Allow Area Agencies to contract for planning only with prior 2. Establish a minimum of functions which must be directly per- 3. Make no changes in existing legislation and regulations. Senator BEALL. Our next witnesses are Mr. Harry Walker, the executive director of the Maryland Commission on Aging, who also serves as the President of the National Association of State Units on Aging. It is always a pleasure to see you-we appreciate your good. work. And Mrs. Joan Tadeo, the title III coordinator of the Maryland Commission on Aging, and the former State director of the MAC project. We are happy to have both of you with us today and we appreciate the kind of splendid cooperation we have received through your offices. So you may proceed. STATEMENT OF HARRY WALKER, EXECUTIVE DIRECTOR MARYLAND COMMISSION ON AGING, PRESIDENT, NATIONAL ASSOCIATION OF STATE UNITS ON AGING Mr. WALKER. Thank you very much, Mr. Chairman and members of the Senate committee staff. And before I start, I would like to return the compliment, because I have found that in the State of Maryland, and also in representing the other State units on aging, we have had the fullest cooperation from you and your staff in all matters concerning legislation affecting older people, and we deeply appreciate it. My name is Harry Walker, I am the executive director of the Maryland Commission on Aging, which is the State agency that applied to the Administration on Aging for the special grant to start the areawide model project in the four counties of the Lower Eastern Shore. I am pleased to appear before this committee to say a word about the area wide project, and the subsequent evolution into an area agency on aging. When the Administration on Aging offered discretionary funds to those States wishing to submit a proposal, in competition with other States, the Maryland Commission on Aging, with assistance from others, particularly the State department of mental health and hygiene, and local individuals, drew up a proposal setting up a program which was designed to help older people stay independent in their own homes for as long as possible. Thus we have the acronym for the project, MAC, which is maintenance of the aged in the community. For the first 2 years, this program was funded at a ratio of 75 percent Federal funds and 25 percent local funds, or non-Federal. It was administered by the State commission on aging with a project director at the State level, with local staff at the local level, and a local advisory body made up of representatives of the county commissions on aging, county governments, other interested participants, service organizations and concerns. It was during the second year of this project that the Older American's Act amendments called for the termination of the area wide model project and in its place, the area agency on aging strategy was substituted. One of the problems that this presented immediately was that the Federal funding for the program would no longer come directly into the State as a discretionary grant. The State had the option of either reducing services, or providing a share of its title III funds to continue the program. In order not to reduce services, the commission on aging earmarked sufficient money out of the special grant for model projects to supplement the allocation that would have gone to the four counties of the lower Eastern Shore as a share of their State money, on a formula basis, to be sure that the project was continued at its present level. And I want to say that it is our intention to do everything possible to enable the MAC project to continue at its current level of operation, despite the change in Federal strategy from a 5-year Federal program that is funded directly from Washington to the area agency on aging concept, which means that the State must now divide the money that it has among all area agencies in the State on the basis of the number of elderly people in that area, as a percentage of the total elderly in all areas embraced by an area agency. The MAC project is now one of six area agencies on aging currently designated in the State of Maryland. These six area agencies cover about 85 percent of the older people in the State. When the MAC project first started, the project director was an employee of the State commission on aging, but the local project director and staff and advisory bodies were all local individuals. We believe that under that arrangement, the MAC project would have achieved its intended results, and on the change over to the area agency on aging, we also fully expect that this will produce the desired results. I think that the area agencies can be effective and useful in providing local coordination, pooling of local resources, the providing of local planning, and subcontracting for services with local agencies. However, it is possible that this may be done as well, and perhaps better, in certain instances, by the State agency creating the local advisory bodies and supervising the planning at the local level. Under the present Federal regulation, the State does not have this option, but is instead required to create independent sub-State planning units. I would hope that in the months ahead, in which studies will be made by Congress of the effectiveness of area agencies throughout the county, consideration will be given to the effectiveness of providing service to older people by providing more options to the State. And that is, perhaps the option of setting up the area agencies as a mandated requirement, as is now the case, or looking at those cases where it might be more efficient for the program to be operated similar to the way the areawide model project was started in the beginning, that is, having a State person supervising the program planning, with local staff and local planning. In closing, I would like to compliment all those citizens and officials, and employees, in the four counties of the lower Eastern Shore who have supported and contributed so much to the success of this fine MAC project. I know that Mrs. Tadeo, who testifies next, who had so much to do with the very successful start of this program, will tell you of some of the fine services that are helping senior citizens who live on the lower Eastern Shore. Senator BEALL. Thank you, Mr. Walker. Mrs. Tadeo, do you want to proceed, and then we will direct questions to you and Mr. Walker. STATEMENT OF MRS. JOAN TADEO, TITLE III COORDINATOR, MARYLAND COMMISSION ON THE AGING, FORMER STATE DIRECTOR OF MAINTENANCE OF THE AGED IN THE COMMUNITY (MAC) Mrs. TADEO. The program goals of the areawide model were to provide alternative services to avoid unnecessary institutional care to at-risk elders, aged 60 and over, to insure independence within the community, through mobility, stimulation, activation, education, socialization, more adequate medical services, knowledge of resources, extension of current aging services, and development of new services, in order to bring about a comprehensive system of care for these older adults, alleviating isolation and dependence as much as possible. An original task force of 70 members, of elders, county government and nonprofit and government agencies, was called together during the planning phase of the MAC project, and this membership divided into four ad hoc committees, to define more specifically the needs of the MAC model area. These 70 members were all from the model area-the local fourcounty area. The committees were in the areas of community service, nutrition, health, and education. Through the input of these committees, the needs of the model area were defined, prioritized and integrated into the model project development. The task force, through the collection of two persons from each of the ad hoc committees, formed the steering committee, which served to guide the project during most of the first year of operations. During the fourth quarter of the year, a permanent advisory board for the project was selected. This board consisted of 51 percent consumers, county government representatives, and agencies concerned with programing for the elder population. There was also an insurance that low-income and minority persons were members of this board. The second year, the advisory board was spun off in the third quarter, as a board of directors, under independent nonprofit status, taking over the full responsibility of obtaining the goal of the MAC area wide model, which was to be a 5-year pilot program at the local level. Local task forces are under continual development in each county. They provide input from the county level back to the regional board. Local county governments were each initially approached regarding the model being developed within their counties, and all four supported and requested that the model cover their county areas. In both Worcester and Somerset counties, the local governments responded immediately to the director's request that a Commission on Aging be established. These commissions became active and in Worcester County they applied for and received an additional grant of regular title III funds to compliment the model's activities. During the first year, local support from each of the four counties involved in the model was extremely positive, and much beyond the initial expectation of the model project staff. Community in-kind support and donations totalled over $20,000, above and beyond the required match of the MAC grant. All of these activities, as well as-excuse me. All of the major agencies serving the aged entered into the development and coordination of activities as well as actively participating in training programs provided by the model. Space has been donated by the local governments, churches, housing authorities, libraries and organizations, and Pine Bluff State Hospital also provided space for the MAC regional operations. The Ministerial Association, as well as many other agencies and organizations, gave either volunteer time, programs, articles and funds to the model. Sometimes these were in combinations of the above. The program objectives were in three major areas. The first objective was a community services network with specific objectives to identify 1,500 at-risk elders, through an outreach effort, coordinate existing services, the expansion of existing services, and the creation of new, needed services, and the development of educational programs and training opportunities for elders and staff serving the elderly population. These goals were accomplished as follows: The 1,500 at-risk elders were identified and referred to existing services which could meet their specific needs. If no such service existed in the model area, assistance was provided to secure the services elsewhere or the project staff itself would attempt to meet the need. When services could not be secured, information was documented for use in planning efforts. In order to coordinate services to the elder, multiservice senior centers were established in each of the four counties participating in the area wide model effort. Although they had no actual authority to coordinate services, they did develop liaison relationships with all major existing agencies, both public and private, that provided or were potential providers of services to the elderly. Development of information referral services and active use of media services also were very instrumental in meeting this objective. Second, the expansion and creation of new services was met as follows: The new services created were minibus transportation service in each of the four counties, multiservice senior centers were established in each of the four counties-and satellite centers functioning in conjunction with the main multiservice centers were established in each of the counties. Outreach services to elders, information and referral and follow-up services in each county; repair services were developed in Dorchester and Somerset Counties, also home-care services were developed in Worcester, Somerset and Dorchester Counties. Dorchester County had home helpers already in existence, and they were simply paid on a fee-for-service basis, so that the existing agency would be utilized. There were also socialization programs developed; these were for both noninstitutional and institutional elders. Community physical therapy programs were developed, a dental screening program, screening and outreach services to the visually impaired, an aging services unit of the University of Maryland Extension Program, and an adult education service, which was a pilot project and joint effort between the Department of Education and the MAC project. 45-427 - 75 - 6 |