Good morning. I am pleased to convene today's hearing of the Aging Subcommittee of the Today's hearing will show the significant and diverse roles the OAA and the aging network Debate over developing a comprehensive long-term care system for our nation is well The fact is, in many states and local communities across the country, the Older Americans Act is having a significant impact in long-term care as we speak. Many states and communities already have in place innovative long-term care efforts. And, at the heart of many of these programs is the "aging network" — that is, state and area agencies on aging and local OAA-funded service providers. The aging network, in the absence of a national long-term care program, has become the principal source of key home and community-based services in many parts of America. Moreover, the aging network is serving a crucial role as a catalyst for planning, coordination and development of long-term care. Surprisingly, however, the contributions made by the OAA and the aging network in this area often go unnoticed. Today's hearing will help to correct that oversight. We will not only hear about the Act's current roles, but consider potential future roles for the Act and the aging network in long-term care. Most of the public funds, excluding the OAA, spent on long-term care are spent for The chart to my far right illustrates this fact. As you can see, 84 percent of those needing The other chart to my right shows expenditures on long-term care for the elderly by five states that have similar sized aged 60 and over populations. This chart shows that the OAA the red columa is but one component in the home and community-based care system and the total dollars spent on non-institutional long-term care are small. Today's witnesses, including Charles Reed, a leader in long-term care from Washington State, will show that OAA funds, however, provide a important foundation for home and community-based long term care. The OAA dollars are not large but their impact is. With OAA dollars, homemakers and chore workers can cook meals, grocery shop, and do difficult household chores for those who are unable to do these tasks. The OAA also provides congregate and home-delivered meals, case management, adult day care, and respite care, and other needed services. The best part is that the recipients of these services can stay in their homes rather than a nursing home. We will hear from several brave older Americans about how these services have helped them maintain their autonomy in the community. The need for long-term care is clearly on many people's minds. National polls repeatedly show the great concem Americans have about long-term care. The recent Pepper Commission report provides us with a thoughtful and important starting point. Senator Rockefeller will tell us more about the Pepper Commission's recommendations and discuss its relevance to the Older Americans Act. I hope that we can make real progress toward a national long-term care program. Regardless of what form a future long-term care system takes, this hearing will show that the OAA has helped to lay the groundwork and its experience should be carefully taken into account in the future. ## For more information, contact William Benson or Jo Ann Lee at (202) 224-3239. STATEMENT FOR SENATOR PAUL SIMON (D-IL) HEARING BEFORE THE SUBCOMMITTEE ON AGING THE OLDER AMERICANS ACT AND THE AGING NETWORK: THE IMPORTANCE OF HOME AND COMMUNITY BASED LONG-TERM CARE April 26, 1991 Mr. Chairman, I want to congratulate you and your staff for the hard work and effort your committee has done on the reauthorization of the Older Americans Act (OAA). The topic this hearing addresses, long-term care, is one that I have been seriously concerned about and involved with during my years in Congress. I want to tell you about a constituent I met in Springfield, Illinois a few weeks ago, Naomi Fowler. Ms. Fowler has spent more than ten years taking care of her mother, who has Alzheimer's disease. The long-term caregivers who are here today know what sort of a sacrifice this is. For ten years, Naomi Fowler has been a mother to her own mother. For ten years she has fed her, bathed her and been on call 24 hours a day. Ten years of being strong and patient and kind, even when her mother did not recognize her. This represents an enormous devotion to a loved one, and an enormous personal burden that many thousands of Naomi Fowlers across Illinois and the nation face today. On top of the emotional strain, there are financial problems. In today's world, most families depend on two incomes. It is a serious problem if one breadwinner has to take too much time off to provide long-term care. Many caregivers have to reduce their work hours or even give up jobs to provide care full-time. Some families simply can't provide constant care for a loved one at home. Many say that if they could get even a few hours a week of paid home care at a reasonable price, they could cope. But home care costs up to $150 a day. Most families can't afford it. We have a situation today where Medicare won't pay for long-term care and although Medicaid will pay for institutional care, it won't pay for the home care that can keep people out of institutions. Millions of families are forced to institutionalize loved ones for financial reasons, not medical reasons. Nursing home care is a growing need among seniors. A recent article in the New England Joumal of Medicine reported that 2.2 million Americans tumed 65 in 1990 and an estimated 43% of these individuals will enter a nursing home, for at least some length of time, during their lifetimes. But the average cost of nursing homes, from $25,000 to $30,000 a year in most areas and up to $45,000 in other areas, is out of the range of most Americans' budgets. The only alterative is to apply for Medicaid and try to find a Medicaid space in a nursing home. This means the family has little choice where the patient goes or what quality of care he or she will get. It is devastating emotionally, and it is often devastating financially since the individual must spend himself or herself into poverty to get what help Medicaid can offer. There is a better way. America needs a comprehensive program for long-term care. We need a program that everyone will contribute to and |