Nebraska

A disaster planning booklet for elderly persons, prepared by the Eastern Nebraska Office on Aging (ENOA) and the University of Nebraska at Omaha (UNO) Gerontology Program, is being distributed nationwide.

The booklet is being sent to the 489 area agencies on aging and to the 50 State and 10 regional offices on aging.

The booklet is the result of the first National Conference on Disaster and the Elderly, held in Omaha last May. The conference was sponsored by ENOA, the UNO Gerontology Program, and the regional office of the Federal Disaster Assistance Administration with funds from the Administration on Aging.

The booklet is designed to help area agencies on aging prepare for natural disasters by assuming complementary roles with other local, State, and Federal agencies in serving older victims. It is an outgrowth of the experience of ENOA and the UNO Gerontology Program following the tornado of 1975 and subsequent research conducted by UNO in a survey of the tornado's victims.

The booklet covers transportation needs after disasters, filling out insurance claims, and relocation problems. The bulk is devoted to establishing cooperation and coordination among agencies before disaster strikes, and how to work with them following an actual disaster.

New York

A revised edition of the "Directory of Services Available to Senior Citizens" has been published by the Nassau County Department of Senior Citizen Affairs in New York.

Printed in large face type, the Directory is an updated guide to programs, services, and agencies serving the elderly in Nassau County.

The Directory has been researched for accuracy and cross-indexed for completeness. It provides answers to

questions on social security, Medicare, Medicaid, Supplemental Security Income, food stamps, insurance and drug plans, veterans pensions, property tax reductions, discounts, and recreation. Other topics discussed are senior citizen clubs and centers, transportation, education, volunteer services, employment, home health care, emergency, nursing and therapy services, sickroom equipment, hospitals, clinics, mental health counseling, nutrition, legal services, consumer information, tenant-landlord problems, and pre-retirement workshops.

Over 50,000 copies of the first edition were distributed to individuals, as well as to public and private agencies, libraries, and professionals throughout the country.

The Directory may be obtained free from the Nassau County Department of Senior Citizen Affairs, One Old County Rd., Carle Place, N.Y. 11514.

Ohio

The Senior Citizens Council of Lake County, Ohio is launching a program for "Self Discovery," a film discussion series of life situations on aging.

The five films lend themselves to group discussions, designed for raising consciousness about growing old.

"Self Discovery" is a packet containing five film-related discussion guides with instructions. "Where Mrs. Whalley Lives" deals with the tensions of intergenerational living, "Journey's End" delves into the psychological and financial preparation for death, and "When Parents Grow Old" questions the responsibilities of adult children and a man's struggle to maintain independence. "Attention Must Be Paid" shows the effects of life-long values on later years. "Trigger Films" deals with living on food stamps, loss of one's job, conflicts between generations, nutrition, housing relocation, and loss of possessions.

The five films can be obtained on a rental basis from Lake County Senior Citizens Council, 105 E. Main St., Painesville, Ohio 44077.

The packet of five film related discussion guides is on sale for $5.

Rhode Island

The Rhode Island State Division on Aging, has mailed 7,672 survey questionnaires to residents 65 and older for a statewide needs assessment survey of the elderly.

"The last attempt at documenting the condition and needs of the State's elderly was in 1970," Division on Aging Chief Eleonor F. Slater says. "That study, however, is far outdated, and the time is due for a new one."

"After its completion, this survey will be a blueprint for the coming years on exactly how to spend money and where to expand programs for the elderly in specific geographic locations," says Mr. Skip Centazzo who is conducting the study. "Information sought in the survey is grouped in five major categories: housing quality, neighborhood quality, social relationships, income, and health. Questions in each category are aimed at revealing specific information. We'll come to know the structural condition of their housing, the elderly's satisfaction with their living conditions, the type of housing they reside in, their proximity to services, and a lot more.

"All information will be crossanalyzed by the 38 Rhode Island cities and towns, with the exception of Providence, which is broken into 10 neighborhood areas."

Mr. Centazzo said that once the survey study is released to local governments, it will give them the opportunity to help their older citizens through the use of information they might not have had up to this time.

One of the Division on Aging's programs, the statewide Nutrition Program for the Elderly, comes under scrutiny in the survey. Meal sites are located in areas where many lowincome or minority elderly reside. Information drawn from the survey will indicate how many low-income and minority older people are attending the meals, and also the reasons why they might not be participating.

"The philosophy behind the survey is similar to the Division's policy of holding public hearings annuallyto get input from the elderly themselves. The major exception is that several thousands will be polled through this survey, while many fewer elderly testify at public hearings," Mr. Centazzo said.

Tennessee

The Tennessee Commission on Aging reports that telephone reassurance programs for the elderly are being promoted in West Tennessee.

"Reassurance to the Elderly", published by the Southwest Tennessee Development District, explains the operation and benefits of the telephone reassurance service and offers instructions for volunteers.

According to the brochure, volunteers are given the names of seniors desiring to be called. An information form is completed, including the name, address, and phone number of the client along with the name of a person to be notified in an emergency. A volunteer caller's card, with the caller's name, address, telephone number, and day and time the call

will be made, is given to the client.

The first service, called Telecare, was inaugurated in Jackson, Tenn. by the Junior Contemporary Woman's Club. The club began calling about 19 elderly persons in September 1975; by December, the list had expanded to 100 persons. Other volunteer organizations in the eight-county Southwest Tennessee Development District have also become involved in the project.

Virginia

The Office on Aging and the Council for the Deaf of Virginia have entered into an agreement to determine the problems and needs of the deaf elderly, and to initiate a plan for programs which address these needs.

The estimate of deaf elderly people (age 55 and over) in Virginia is approximately 14,442. Of this figure about 1,684 lost their hearing before the age of 19 (prevocationally deaf), while the remaining 12,738 lost their hearing after age 55.

The prevocationally deaf have been easier to locate because they participate in special programs and activi

ties for the deaf, such as schools, clubs, churches, and other organizations. On the other hand, those who became deaf late in life rarely participate in such activities and subsequently are difficult to locate.

The majority of elderly persons located for this study, who lost their hearing late in life, have been found through the Title VII nutrition sites in several planning and service areas.

A sample of the identified prevocationally deaf has been taken, and these persons also participated in the survey. A total of about 250 elderly deaf persons were interviewed.

The questionnaire administered to the elderly deaf determined the problems they have in receiving services in the areas of health, transportation, housing, employment, recreation, retirement benefits, and communication, among others.

Survey results, with recommendations on meeting the needs of the deaf elderly, are contained in the report sent to the Office on Aging in December 1976.

Convention Focuses on Curbing Medicaid Fraud

Top officials from across the Nation met in Dallas, Tex., Nov. 9-12 to study ways of combatting fraud. and abuse in the $15 billion-a-year Medicaid Program.

The conference involved HEW's Medicaid Commissioner Dr. M. Keith Weikel, and U.S. Deputy Attorney General Harold R. Tyler, as well as senior officials from most States and

territories. Losses owing to fraud and abuse by healthcare providers are estimated to be at least $750 million annually. (The Federal share of the overall Medicaid bill cost taxpayers $15 billion last year and is expected to rise to $18 billion this year.)

Providers include physicians, dentists, pharmacists, laboratories, nursing homes, hospitals, and other individuals and institutions which furnish basic medical care to the needy. HEW officials believe only a small

minority of the providers engage in fraudulent or abusive activities.

At the conference Dr. Weikel said, "We have developed an automated Medical Management Information System that can alert State officials to possible fraud and abuse and identify the providers involved. We are also offering financial incentives for States to adopt the system. Ten States are using it now. Twenty more are working to install it."

During 1976, HEW's investigative

clout has been augmented appreciably. A Medicaid Fraud and Abuse Unit of 119 persons has begun operations. Their efforts are linked with those of 74 criminal investigators in a separate component reporting to HEW Under Secretary Majorie Lynch.

Teams of Federal-State examiners are currently probing Medicaid records in States with the largest programs, and have already completed on-the-spot reviews and investigations in Massachusetts, Ohio, and Georgia. A report on the Massachusetts review, the first of the series, is being prepared.

Medicaid programs are Stateoperated, under broad Federal guidelines. The anti-fraud efforts are therefore mutual involving both State and Federal governments.

Among the State officials at the Dallas conference were welfare commissioners, medical service directors, attorneys, public prosecutors, auditors, and a variety of public welfare and health officials.

The workshops and panel discussions at Dallas focused on topics such as innovative fraud prosecution programs, development of cases for prosecution, and the role of the American Medical Association and other professional groups in curbing and prosecuting Medicaid fraud.

Regulations Published On
Reimbursement of HMO's

Final regulations establishing principles of reimbursement for Health Maintenance Organizations (HMO's) receiving Medicare payment on a reasonable-cost basis or an incentive basis became effective December 1976.

James B. Cardwell, Commissioner of Social Security, said the regulations implement, in part, the Medicare HMO provisions of the 1972 amendments. HMO's reimbursed on a cost basis are paid the "reasonable cost" of the covered services furnished to Medicare beneficiaries enrolled in the HMO. HMO's that qualify as "mature" and meet certain. requirements in terms of operating

experience and enrollment size can elect to be reimbursed on an incentive basis, rather than a reasonablecost basis.

Those that qualify to participate in Medicare on an incentive basis may share in whatever savings may accrue, up to prescribed limits. Under the new regulations, an HMO's actual expenses will be measured. against an "adjusted average per capita cost," which represents the dollar amount of providing the same services outside the HMO to a similar beneficiary population.

Those HMO's whose expenses are less than the adjusted average will have an equal share of the savings with the government up to 20% of the adjusted average per capita cost. Savings above 20% go to the govern

ment.

Those HMO's whose costs are more than the adjusted average per capita are required to absorb the difference. Such losses may be offset against future savings, under the regulations.

SRS Appoints Director to Monitor Medicaid Abuses

James S. Bailey has been appointed Director of the Division of Fraud and Abuse Control in the Medical Services Administration of HEW's Social and Rehabilitation Service. MSA conducts the $15 billion-a-year Medicaid Program at the Federal level.

Mr. Bailey will provide leadership for HEW's efforts to carry out the fraud provisions of Public Law 92603. His duties will include liaison with State officials to ensure monitoring and investigation of fraud and abuse in the Medicaid program.

Federal, State, and sometimes local tax funds finance the Medicaid program which assists about 23 million medically needy persons a year. The Federal Government matches 50% to 78% of a State's Medicaid expenditures. States with higher per capita incomes receive the smaller Federal matching percentage. Thus, the Federal share of the overall U.S.

Medicaid bill is about 55%.

Prior to this new appointment, Mr. Bailey was Assistant Director of Cook County Hospital in Chicago, Ill., with responsibility for the direction and supervision of major hospital departments, and Associate Director of Michael Reese Medical Center, Chicago.

Mr. Bailey has had extensive investigative experience, beginning as a Special Agent with the U.S. Treasury in 1956 and later serving as Special Agent in charge of Northern Ohio with the U.S. Justice Department.

Mr. Bailey received the U.S. Treasury Department Award for Special Acts and Services in 1961, 1962, and 1963. He was also awarded the American Legion Commendation for dedication to duty in 1969. From 1964 to 1967, he was an Attache with the U.S. Diplomatic Corps serving in East Africa and South East Asia.

Few Job Opportunities
For Mature Women

The U.S. Labor Department recently reported that although the rate of women over 45 joining the American labor force has increased substantially since 1950, a mature (over 45) married woman still has a high degree of difficulty in obtaining employment. In addition, while the rate of employed older women has risen since 1950, the rate for men in the same category has declined.

In a study entitled "Mature Women Workers: A Profile," the department said the labor force participation by women in the last 30 years has shown a marked increase, but mature married women are still less likely to hold down a job than their widowed, divorced, or separated counterparts. According to the report, those women who do find employment most often do so in low skill, low-paying jobs requiring little specialized training and affording limited advancement opportunities. Among mature women who worked year-round on a full time basis, the average income was $7,773 in 1974,

substantially below the $14,817 for men 45 or older.

Census Report on the
Aged Population Issued

The Census Bureau recently reported that women outnumbered men by 4.3 million among the Nation's elderly last year, and that the gap will widen to 6.5 million by the end of this century. Americans 65 and older totaled 22.4 million last year, and made up 10% of the U.S. population.

As America's elderly population continues to grow there will be more educated, widowed, older women living alone in the Nation than ever before. The report shows that women continue to outlive men by an average of almost eight years. As of 1974, women could expect to live an average of 75.9 years and men an average of 68.2 years. A woman reaching 65 today can expect to live an additional 17.5 years. A 65-year-old man can expect to live only another 13.4 years.

Today there are 69 males for every 100 females 65 and older, whereas 40 years ago the ratio was about even. By the year 2000, the figures show that there will be about 65 males for every 100 females in the same age category. As of March 1976, three out of four men 65 and older were married and living with their wives, compared with one out of three women of that age who were married and living with their husbands. Women 65 and older are much more likely to be widowed than married, and a sizeable portion of them live alone.

The report indicates that in 1975 New York and California had the greatest number of people over 65 with nearly 2 million each. These two States are followed by Pennsylvania, Florida, Texas, and Ohio, each of which has more than one million persons over 65. The figures show that rapid growth in the number of elderly occurred between 1970 and 1975 in Arizona, Florida, Nevada, and Hawaii. Each of these States has experienced a gain of nearly 30% of its 1970 population of persons 65

and over, compared with 12% for the country as a whole.

Another portion of the report indicates that death rates vary inversely with educational level, income, and occupational level. The chances of reaching 65 are clearly better for the more affluent, better educated person.

Health Care Costs for
Elderly Rise in 1975

The Social Security Administration reports that the average health care bill for a person 65 or older was $1,360 in fiscal 1975, almost three times that of people aged 19 to 64. Health care expenditures for the aged rose 18% in FY 1975, compared with an 11.4% increase in 1974. For the young and intermediate age groups, the increase in expenditures was 12% and 13.5%, respectively.

Government spending for health care rose to $41 billion in 1975, an increase of 22% over fiscal 1974. The largest increase was for the aged (27%) reflecting a rise of 31% in Medicaid spending and 29% in Medicare for this group. Medicare payments accounted for 72% of the hospital expenditures for the aged and 54% of doctor bills. Third party payments (government, private health insurance, philanthropy and industry) accounted for 71% of the aged's health care expenses in 1975; nevertheless a person 65 or over had direct expenses of $390.

Nursing Home
Data Published

A National Center for Health Statistics report shows that, on the average, nursing homes spent $15.63 for each day of care per patient in 1972, the last full year of operation before the survey was made. The report, "Selected Operating and Financial Characteristics of Nursing Homes 1973-74," also shows that non-profit homes spent more per patient and had more employees for each 100 beds than did homes operating for a profit. If these expenses increased at the same rate as the medical care component of the Consumer Price

Index, the 1975 average would be $20.60.

In 1972, non-profit homes spent an average of $17.71 per patient per day while proprietary homes spent $14.86. The higher expenses in nonprofit homes were due to higher labor costs. Those institutions employ an average of 83.5 full-time persons per 100 beds, compared with forprofit homes which employ an average of 57.4 full-time persons per 100 beds. The study also found that expenses per person per day of care were higher for homes certified for Medicare-Medicaid, for homes located in the Northeast, and for homes with more than 200 beds. Higher expenses for certified homes result from expenditures they must make to meet Federal standards for staffing, construction, equipment, and services. The higher expenses of large nursing homes reflect their tendency to offer more varied services than do smaller homes.

Judicial Review for
Medicare Providers Granted

HEW has published regulations under which Medicare providers may obtain judicial review of any decision by the Provider Reimbursement Review Board, or review of any reversal, affirmation, or modification by the Secretary.

The five-member Provider Reimbursement Review Board hears appeals by institutional health care providers who disagree with the cost determinations made by health insurance organizations acting as fiscal intermediaries in the administration of Medicare hospital insurance. Members must be authorities in health care costs.

Under the regulations, a Medicare provider may file for judicial review by a Federal court after the final decision of the Board or the Secretary, but must do so within 60 days of the final decision.

The Department may review any decision of the Board but must do so within 60 days after the provider has been notified of the Board's decision.

Australia

"Granny Flats" are blossoming in Australia, sponsored by the Victoria Council on Aging and the Rotary Club of Melbourne.

"Granny Flats" are movable, selfcontained architect-designed mini houses. For couples who wish their parents to live nearby, the Council will install one of the units in their backyard.

A unit comes complete with bedroom, living room, kitchen, and bathroom and is 400 square feet in all. Weekly rental is $9.45 for a couple or $6.70 for one person.

France

According to officials in public and private non-profit social agencies, the French government is changing its approach to the problems of "the third age."

The new approach is designed to help elderly persons on fixed incomes to live independently, rather than in institutional settings.

The government's mounting concern was underscored recently in a nationally televised speech by President Valery Giscard d'Estaing. The President announced that the minimum annual payment to the elderly would increase next year to $2,200 from the current level of $1,800. This measure is expected to enable more older people to live in their present accommodations, rather than entering institutions for the aged, where 250,000 elderly now reside.

The state also plans to subsidize new services for the aged with about

$20 million a year for the next five years. These services will include homemaker aides to assist with housecleaning and shopping chores and the creation of "third age" clubs providing social and recreational activities.

The number of persons over 65 in France now totals seven million or about 13% of the population. Most have pensions, but the two million who do not must accept financial help from relatives and government payments of about $5 a day plus subsidies covering up to 40% of rent in a private dwelling. Medical and psychiatric services are free or low-cost depending on the client's ability to pay.

The government has opened 8,000 clubs in the past few years with the aid of non-profit associations. Home services for 500,000 aged are being planned for the next five years.

Dr. Eliane Bourgeon, a psychiatrist at the medical-social services center in Issy-Les-Moulineaux, notes that the new official approach toward the elderly satisfies the French person's need for individualism and independence. Because of this need, Dr. Bourgeon observes, older people in France often go to self-damaging extremes to live alone, outside an institution.

According to a government social agency official in Paris: "France is just going through an awakening of conscience about its old people. In many areas, the subsidies are not enough. But we have changed the nature of the approach to the problem and think it is working."

Great Britain

A mobile unit which exhibits aids and equipment available for the handicapped is visiting several communities in England and Scotland. It remains in the center of large towns for three months before moving on.

The Visiting Aids Centre exhibit is sponsored by the Spastics Society, but contains equipment covering a wide range of disabilities.

According to the Pensioners' Voice, a magazine for the elderly published in England:

"Over 180 pieces of equipment are available for visitors to try out, incorporating eating and drinking aids, bath and toilet items, and many recreation aids . . . In addition to the display items, a detailed, illustrated index system, featuring some 500 ideas to make life easier in the kitchen, bathroom, living-room, for walking, driving and other outdoor activities is featured."

A reference library provides comprehensive information on holiday opportunities, charities which aid the handicapped, and manufacturers' catalogs. The unit also has an occupational therapist and facilities for wheel-chair visitors.*

Pakistan

In July 1976, the government of Pakistan inaugurated a retirement and disability program for over a million workers. This is the first such plan among the countries of Southeast Asia.

Under the program, employees.