Three legal services programs funded by the Corporation have had considerable impact on the elderly as a group.

One of these is the Center for Social Welfare Policy and Law in New York which deals exclusively with public benefits programs. Since the enactment of the Supplemental Security Income (SSI) program in 1974, a major portion of the Center's practice has focused on that area of the law. Most of the SSI beneficiaries are elderly.

Another of these programs is the National Health Law Project in Los Angeles. About 20 percent of its litigation time directly involves elderly clients. Other activities that benefit the elderly include work in the fields of Medicare and home health care.

A third program funded by the Corporation that affects the elderly as a whole is the National Housing Law Project in Berkeley, California. This program devotes over half its efforts to such issues as mortgage foreclosures and public housing, which are of immediate concern to the aged.

Other divisions within the Corporation are concentrating their efforts on helping the elderly poor. The Office of Program Support has made grants to individual centers wishing to conduct special training regarding problems of the aged. The Research Institute on Legal Assistance is conducting studies in such areas as social security, SSI, veterans' benefits, hospital services, pensions, and housing.

The Corporation's National Clearinghouse for Legal Services disseminates materials relating to the legal problems of the aged. As part of the Corporation's research regarding methods of legal service delivery, it is testing ways to serve the elderly

more effectively which involve the extensive use of telephone consultation and referral.

Agreement Between LSC and AoA

Corporation President Ehrlich observes, "It is essential that there be cooperation between organizations to which Congress has given responsibility for meeting the legal needs of the elderly poor. It is only through cooperation between those entities. that the elderly poor will realize the maximum benefits of the resources currently available."

In order to achieve this cooperation, the Corporation and AoA have entered into an agreement to promote working relationships between AoA and the Corporation, and between Corporation - funded projects and AoA-funded agencies at the State and local levels.

Specifically, the agreement will seek to expand the awareness by legal personnel of legal problems confronting the elderly and increase older persons' understanding of their legal rights. Other goals of the agreement are increasing the number of legal personnel trained to serve the elderly, as well as the number of communities in which legal services are available.

Cooperation has already been achieved between local legal services programs and the aging network. Fifty-five programs funded by the Corporation have received approximately $1.5 million in funds available under Title III of the Older Americans Act to provide legal services to the elderly poor. Some of the programs have used these funds to establish special units or offices for the elderly.

Others have hired paralegals or community workers to carry on outreach work among the elderly. Some

programs have purchased mobile units staffed by legal services personnel to go to the elderly in their own homes or nursing homes.

According to Mr. Ehrlich, "The availability of Title III funds has focused the programs' efforts toward the elderly in a way that would not have been possible because of the wide range of demands for Corporation funds."

Mr. Ehrlich contends that a greater degree of cooperation is needed to obtain maximum benefits from the resources of legal services programs and the National Network on Aging. In order to achieve this, he asserts that legal services developers should work closely with Corporation grantees. Programs, he suggests, should be encouraged to send staff to senior centers, nutrition sites, and nursing homes for intake and community education. Legal services literature, he notes, should be distributed widely among the elderly poor to help them understand "the difference legal assistance can make."

Mr. Ehrlich proposes that legal services developers arrange for funding so that community programs could hire older paralegals to do outreach work.

Another measure he cites to achieve greater coordination between Corporation grantees and the network on aging involves close contact between legal services developers and the regional offices across the country through which the Corporation operates.

Mr. Ehrlich concludes:

"These steps-and there are undoubtedly many more-are all necessary if we are to make the most of the scarce resources available to provide equal justice to the elderly poor."

Ron Wyden*

For years, Oregon's elderly have

been struggling with the fine print and 150-word sentences in the health insurance policies they purchase to supplement their Medicare coverage.

Medicare does not cover many of the medical costs of the aged, including most nursing services, prescription medicine, prosthetic devices, and custodial care. Over 11 million elderly purchase private health insurance policies, dubbed "Medigaps," in the hope that these policies will help them with part of the bills that Medicare does not pay.

In reality many of these policies are of little value to the Nation's elderly; they are not standardized and are so dominated with "legalese" that many seniors cannot understand them. The end result is that part of their typically small fixed incomes is wasted on private health policies that do not meet their needs or duplicate existing benefits.

Moreover, because many agents prey on the older person's legitimate fear that illness will bring financial disaster, they often persuade them to buy four or five supplementary policies that extend the same basic coverage.

Under Federal legislation, Congress has assigned insurance regulation to the States. Each State has

an insurance commissioner, and this office is usually delegated comprehensive power by the State legislature to regulate insurance transactions "in the public interest."

In Oregon, two low-income elderly women, Alice Wolverton and Rosa Carter of Salem, and four agencies that serve the needs of the elderly, including an area agency on aging and the Gray Panthers, decided to challenge the long-standing practice of writing supplementary medical insurance in incomprehensible legal language.

With the aid of their attorney, Steve Goldberg of Salem, the seniors asked the Oregon insurance commissioner to adopt a new regulation requiring that any agent who sells supplementary medical insurance should give the prospective purchaser a form showing the coverage available under Medicare or Medicaid, the gaps in that coverage, and how the new policy would fill those gaps.

Cited as legal authority for adopting the proposed rules were the commissioner's general rule-making authority, and his specific authority to issue regulations regarding information that must be furnished to prospective clients.

In the beginning, the senior cause did not fare well. Several weeks after

the petition was filed, the seniors received a letter denying their petition. The reason stated was that existing rules gave the insurance commissioner authority to regulate advertising, police forms, and assist senior citizens. But, the commissioner's office declared, "These rules do not permit us to advise each purchaser" about what type of policy he should buy. The seniors then wrote to the Governor and the press, explaining that they were not seeking and would not seek advice about specific policies. However, they stated, they did want the insurance commissioner to adopt rules that would give them the information necessary to make intelligent choices about private health insurance coverage.

In July 1976, they received a note from the Governor stating that he had been in touch with the insurance commissioner and that a public hearing on their request would be scheduled shortly.

On Sept. 1, 1976, the hearing took place. Over 400 senior citizens filled the State Capital's largest hearing room to overflowing.

* Ron Wyden is the Legal Services Developer for the Elderly for the State of Oregon. He is also a member of the Iowa Bar.

Those who could not get into the hearing room listened to the proceedings from loudspeakers in the hallway.

Thirty seniors testified at the allday hearing on behalf of the adoption of the rules. Most persuasive testimony in favor of the rule came from several retired insurance salesmen and 86-year-old Grace Lapray of Salem, who was asked why she purchased four policies with identical coverage from the same agent. "He said 'trust me,'" she explained. Most of the Nation's biggest insurance companies sent representatives to speak against the rule's adoption. John P. Hanna, a lawyer with the Health Insurance Association of America, a Chicago-based trade organization of the Nation's largest health insurance carriers, seemed to speak for most of the industry when he stated, "The burden is on the buyer to decide what he or she wants."

At the conclusion of the hearing, the commissioner told the elderly present that he would have an answer for them within "several months." But in early October, Mr. Goldberg learned that the commissioner had given the industry opportunity to comment on possible courses of action being considered without giving similar opportunities to the petitioners. While this practice was legal under Oregon administrative law, Mr. Goldberg protested and earned the right to view the Commissioner's proposed forms.

On Dec. 21, 1976, the Commissioner stated at a press conference that he had filed Oregon Administrative Rules 836-52-105 and 836-52110 with the Oregon Secretary of State's office as required by Oregon law. The rules filed were very similar to those proposed by the petitioners,

despite the omission of references to several issues important to the petitioners. These included information about the average length of stay in an Oregon hospital, an enforcement provision, and a clear distinction between skilled and intermediate care nursing facilities. (Most nursing homes are the latter, and Medicare does not cover these costs.) Several witnesses and petitioners at the hearing had asked the commissioner to require that the forms be printed in large type. That request was also denied.

But on balance, Oregon's senior activitists had won a major reform. No other State has yet provided the elderly with such a valuable reference tool to help with the purchase of supplementary medical insurance.

There is little question that the spark behind the rules enactment was the collective show of political strength by the elderly at the hearing, and that without it the rules would not have been adopted.

Number of Elderly

In Institutions to Rise

Says Expert in Field

Some 1.2 million older persons are living in long-term care institutions -more than the one million beds which exist in general hospitals-and the number will continue to grow. The projection was made by Elaine M. Brody, MSW, who presented the Seltzer Award Lecture in Gerontology at the Daughters of Jacob Geriatric Center in New York City.

Mrs. Brody, Director of the Department of Human Services for the Philadelphia Geriatric Center, was honored with the distinguished award in May.

Projecting the needs of the aged for the year 2000, Mrs. Brody reported that more than 11 million elderly may need long-term support because of chronic disabling illnesses and the "normal" declines that are part of the aging process.

"The sober fact is that it is unlikely that the foreseeable future will witness 'cures' of the 'normal' dependencies of old age, particularly those of advanced old age," she said.

Mrs. Brody pointed out that we regard children's dependency as "expected, accepted and provided for by society. In the main, the dependencies of old age have not yet been similarly legitimized."

She spoke of the "myth of alternatives," with regard to care of the aged, noting: "The myth assumes that if only there were an adequate number and type of community care services, there would be little or no need for institutions."

She advocated that older people should remain in their own homes, if it is possible for them and their families to do so at "a decent level of health and well being. Even if we assume that abundant 'alternatives' appear, the number of institutional beds would increase to about 1 to 11⁄2 million by 2000," she predicted. "What will probably happen is that community services and new types of facilities will increase, but by no means will institutions be eliminated."

Mrs. Brody said that institutions can serve the elderly who require institutional care as well as those who live in congregate arrangements with a smaller range of services. She also foresaw the possibility that institutions might expand their services to a third target population-those who remain in their own homes.

Over 450,000 Tennesseans are 65

or older, and 36.8 percent of them are below the poverty level. In most counties of the State, they have no access to public legal aid. Although private law firms help some with their legal problems, thousands of the indigent aged are bedridden or lack transportation. In addition, many elderly have a fear or suspicion of lawyers. It is probably true that the vast majority of older Tennesseans have never consulted a lawyer in their lives.

Even in counties where legal aid offices are found, older people are not adequately served. For example, in Davidson County, Legal Services of Nashville, Inc., served 3,258 clients during a 12-month period ending in 1976. Only 126 of these, or about 4 percent, were 65 or older. Yet, an estimated 15-20 percent of the poor in Davidson County are elderly.

In addition to the kinds of problems that beset people of all ages, older people have other problems that are more pressing, or even unique, to their age group. These include age discrimination by banks, mortgage companies, insurance com

panies, and employers; violations of their rights in nursing homes and other institutions; the problems connected with pensions, VA benefits, social security, Medicaid and Medicare; and the compelling need to make their wills and get their affairs in order.

A large percentage of the legal problems of the elderly fall under the heading of public benefits claims. This area of law attracts few private lawyers. Administrative hearings and appeals are time-consuming and financially unrewarding. In some cases, fees are ridiculously low. For example, the most an attorney can receive for representing a claimant before the Veterans' Administration is $10!

The Tennessee Commission on Aging, with the help of Federal money made available under Title III of the Older Americans Act, has set itself a goal to make legal aid available to older people in all of Tennessee's 95 counties by 1978. The Commission works with the various area agencies on aging (of which there are nine in the State-one for each de

velopment district) and coordinates all programs with the local bar associations.

Each of these new legal aid programs for older Tennesseans is headed by a full-time directing attorney who rides a circuit of three to 15 counties, depending on the size of the development district, its legal aid resources, and available funding. The attorney visits the major senior citizens' centers on a regular schedule, conducting seminars or lectures on legal subjects of particular interest to senior citizens. Regular office hours at one or more locations in each county are kept, and a close working relationship is maintained with the local bar association. This relationship is essential if older people are to be adequately represented. Practicing attorneys can then refer suitable cases to legal aid, and, in return, the legal

* Mr. Stephens is Executive Director of the Legal Services Unit of Upper East Tennessee in Johnson City. He was formerly Staff Attorney for the Tennessee Commission on Aging.