P

resident Carter has sent a budget

request package to Congress which includes $500 billion in outlays for the Nation's elderly-a record high.

Requests for Older Americans Act programs total $545.75 million up $7 million from the FY 1978 funding level. OAA budget requests include: National Information and Resource Clearinghouse, $2 million; Federal Council on the Aging, $450,000; Title III State and Community Programs on Aging, $187 million (area planning and social services, $153 million; model projects, $15 million; and administration, $19 million); Title IV, $29.3 million (training, $17 million; research, $8.5 million; and gerontology centers, $3.8 million); Title V, senior centers, $40 million; and Title VII nutrition, $287 million, including $37 million under proposed legislation to replace the Department of Agriculture's food commodity contributions with direct cash grants.

Almost $38 million is requested for the National Institute on Aging. Cash Benefit Programs

A 6.2 percent cost-of-living increase for social security beneficiaries is projected for July 1978. Estimated outlays for fiscal 1979 include $102.1 billion for the system's 35.3 million. beneficiaries. The Administration would reduce outlays by $600 million in fiscal 1979 by limiting student's dependency benefits to the maximum educational opportunity grant ($1,600), freezing the minimum benefit for current beneficiaries and eliminating it for future beneficiaries, limiting payment of retroactive benefits to 3 months (now 12 months), and starting entitlement for a retired worker's benefit the month after the person reaches age 62 (instead of the month in which the worker's birthday falls).

The Supplemental Security Income, also administered through the Social Security Administration, covers an estimated 4.2 million elderly, blind, and disabled recipients in fiscal 1979, including 469,000 receiving only a

State-supplemental payment. Projected outlays include $5 billion in Federal benefits and $1.5 billion in State supplemental benefits.

Other benefit projections include $9.6 billion for veterans and $4.3 billion in railroad retirement benefits.

Health Care Costs

Medicare outlays include $20.5 billion for 26.6 million persons covered under Hospital Insurance (HI) and $8.4 billion for the 26.4 million persons covered by Supplementary Medical Insurance (SMI) in fiscal 1979. Legislative proposals include increasing SMI by $7 million for end-stage renal disease home dialysis, and hospital cost containment measures which would save $630 million for the Hospital Insurance Program in fiscal 1979.

Nursing home costs are projected at slightly more than $15 billion in fiscal 1979. Medicaid accounts for approximately one-half-$7.6 billion in FY 1979. Nursing home charges account for almost 38 percent of total Medicaid payments. Medicare outlays for skilled nursing care are $469 million for fiscal 1979.

Housing, Transportation, and Social Services

In the area of housing, HUD's Section 202 would receive $800 million in loan authority for FY 1979. Lending authority for 1979 will finance 25,000 units, with at least $50 million earmarked for 1,400 units designed for the handicapped. The Department of Energy would also be given $189.95 million to weatherize 857,000 homes belonging to lowincome families.

Up to $28 million would be made available through the Urban Mass Transportation Administration's capital assistance grants to private nonprofit groups for transportation services for elderly and handicapped

persons.

Funds for the Community Services Administration include $10.5 million for Senior Opportunities and Services, $22 million for Community Food

and Nutrition, $10 million for Energy Conservation Services, and $381 million for Community Action Agencies. Title XX Social Service outlays are estimated at $2.45 billion compared to $2.4 billion in FY 1978.

Other appropriations requests include $6 million for Home Health Demonstrations and $5.8 million for Community Education. About 20 percent of the funding will be awarded to colleges and universities for training grants. The remainder will go to local and State educational agencies to establish and continue community education programs.

The Nation's 18 million Food Stamp recipients will receive $5.4 billion in benefits. Total cost of the program is projected at $5.8 billion.

Volunteer and Employment
Programs

Funding for the Title IX Senior Community Service Employment program will reach $190.4 million in July (compared with $150 million now), increasing the number of jobs from 37,400 to 47,500. The Administration requests an additional $30 million for the period January 1, 1978 to June 30, 1979 to cover increased program costs due to the minimum wage hike. The budget also requests $228.45 million to continue Title IX from July 1, 1979, through June 30, 1980, which would fund approximately 47,500 positions.

Authorizations for ACTION's Older American Programs amount to $57.94 million including: RSVP, $15.4 million; Foster Grandparents, $35.4 million; and Senior Companions, $7.14 million. The total request is $4.06 million below the fiscal 1978 appropriation of $62 million. RSVP volunteers would be reduced from 250,000 in fiscal 1978 to 220,000 in FY 1979, with the number of projects reduced from 692 to 554.

In addition, $2 million would be made available for the Service Corps of Retired Executives and $1.3 million for the Active Corps of Executives.

rthur S. Flemming, Chairman of the U.S. Commission on

A of

Civil Rights, has told a House subcommittee that the Civil Rights Commission was "shocked at the cavalier manner in which our society neglects older persons . . ."

Flemming's evaluation resulted from a recently-completed study of unreasonable discrimination on the basis of age in federally-supported programs, conducted by the Commission on Civil Rights.

The Commissioner pointed out that older people "desperately need" certain federally-supported services and benefits but can't get them.

"Reasons advanced for such neglect," he said, "are devoid of feelings of respect and compassion for women and men who have contributed much to their families, to their communities and to our nation."

Flemming called for "a vigorous and unequivocal implementation of the Age Discrimination Act of 1975." He said this would provide our nation with the opportunity of demonstrating by our deeds that "we intend to do everything within our power to help make the last years the best years of life."

The Commission transmitted the age discrimination report to the President and the Congress on January 10.

In addition to analyzing Federal statutes, regulations, administrative policies, guidelines, participant data. and other materials for the Federal programs in the geographic areas of San Antonio, Texas; St. Louis, Missouri; Jackson, Mississippi; Seattle, Washington; Augusta and the State of Maine; and Chicago, Illinois, the Commission held public hearings at San Francisco, Denver, Miami, and Washington. Testimony was taken from more than 300 witnesses.

After weighing the evidence, the

Commission concluded: "1. That barriers have been erected by both public and private administrators between persons falling within particular age groups-especially children and older persons and services which are financed in whole or in part by the Federal Government. 2. That erection of these barriers is having a serious adverse impact on the lives of children and older persons who need these services-it is a depersonalized approach which is in direct conflict with the concept of the dignity and worth of the individual."

The reasons advanced for using age as a barrier for the delivery of services did not, according to the Commission, "constitute a valid basis for disregarding the needs of individuals falling within" those age groups. The barriers constitute "unreasonable discrimination" on the basis of age, the Commission reported, and should be prohibited by the law. Exceptions

should be made only by the Congress and no authority should be granted to public or private administrators to make exceptions.

Major Findings

The major findings of the study were the following:

Discrimination on the basis of age in the delivery of federally supported services and benefits exists to some extent in each Federal program examined.

Members of of minority groups, women, and handicapped individuals are often victims of compounded discrimination based on age, sex, race, national origin, and handicap.

Age discrimination exists because Federal, State and local program administrators develop policies that narrowly interpret broad statutory goals, the application of which limits the participation of certain age groups. Age discriminiation takes place

when the Federal Government establishes program performance standards which effectively restrict participation to certain age groups in the program. Age discrimination occurs whenever State legislatures convert a Federal program intended to serve all age groups into categorical programs for specific age groups.

Young persons' access to mental health services is restricted by State laws requiring parental consent as a condition to receiving services.

Age discrimination takes place when, without express authorization in Federal statutes, State and local program administrators develop program policies or practices that in effect restrict participation to certain age groups.

Continuance of historical patterns of age discrimination in the allocation and use of funds for service programs is justified by some Federal, State, and local administrators on the grounds that more equitable allocations require additional funds.

The failure of public and private administrators to institute outreach programs designed to inform eligible persons of available services results in age discrimination.

The Comprehensive Employment and Training Act training and public service employment programs and the Vocational Rehabilitation program restrict participation of older persons because these programs rely for their success on the public and private employment markets, which often discriminate in employment on the basis of age, and which often maintain compulsory retirement policies.

Discrimination on the basis of age occurs when program administrators provide services to some age groups rather than others because of a belief that providing services to them will provide a better return on the government's investment.

Study Recommendations

Here are the principal recommendations contained in the report:

That age should be used as a criterion for eligibility in federally assisted services and benefit programs only when Federal legislation contains a specific authorization for doing so. The fact that they may be more difficult to administer does not constitute a rational basis for rejecting them in favor of some easier method of decision making.

The Commission does not believe that the Congress, in legislating programs to assist the general population, intended that persons responsible for their implementation should pursue administrative policies and procedures which have the effect of restricting services and benefits to persons of particular age groups. We do not believe that administrators should be permitted to introduce age as a criterion in administering their programs when the enabling legislation contains no such exclusionary criterion.

Only when statutorily-based age criteria are prescribed by Federal statute should age be used to distinguish among beneficiaries of federally supported services and benefits.

The implementation of this recommendation would lead to a major reduction in, as well as a simplification of, the regulations issued under the Act.

That any person aggrieved by violation of the Act should have the right to institute a civil suit in a court of competent jurisdiction.

That an Executive Order be issued granting to the Department of Health, Education, and Welfare authority to approve regulations developed by other Federal departments and agencies to implement the Age Discrimination Act.

That an administrative sanction be available to Federal departments and agencies when dealing with violations of the Age Discrimination Act of 1975 that may be applied without terminating or interrupting services to eligible persons. The Commission recommended that the following language be added to the Age Discrimination Act: When a determination has been made that a State or local government is out of conformity with the provisions of the Act and the regulations issued pursuant to the Act, if the State or local government is the only eligible entity according to the Federal statute authorizing assistance, then the head of any Federal department or agency may, in accordance with prescribed regulations, disburse any funds that would otherwise be terminated or discontinued directly to any public or nonprofit private organization or agency or political subdivision of a State which can meet the requirements of the Federal statute authorizing the program or activity.

That the units within the Federal departments or agencies responsible for administering Federally assisted services and benefit programs be required by regulation to . . . open up opportunities to participate in such programs to persons of all ages.

That as a significant step to participation in CETA and VR programs, the Congress enact a bill that would raise the ceiling in the Age Discrimination in Employment Act from age 65 to 70 and eliminate compulsory retirement in the Federal Government.

That age should not be included in the criteria which are used to determine eligibility for admission to medical and other professional schools that are supported in whole or in part by the Federal Government.

T

wo major AoA funded studies indicate that area agencies on aging are having a significant impact on the number and provision of services to the Nation's elderly. In testimony before the Subcommittee on Aging of the Senate Human Resources Committee on February 1, Donald F. Reilly, Deputy Commissioner on Aging, said that over 40 percent of all new or modified services for older persons involved the area agencies as contributors.

The study carried out by the Andrus Gerontology Center of the University of Southern California covered 97 area agencies located in the Western regions of the U.S. The second study, conducted by Westat, Inc., a private research firm, is much broader in scope. The longitudinal survey covered 39 area agencies, over 1,200 service providers, 37 advisory councils, 19 umbrella agencies in which area agencies are located, 27 State agencies, and 425 influential individuals. Both studies were initiated in FY 1974 when States were being divided into planning and service areas, and the first area plans on aging were being developed. Thus both studies surveyed the area agencies during a period of early development.

Data gathered from the surveys showed that area agencies are located in a variety of organizational settings. Over two-thirds are public, while the remainder are private, nonprofit agencies. The Westat study found that 64 percent of the AAA's were new organizations which had been in existence for less than a year. In addition to the director, the average area agency had only four full-time staff members, including those who were involved in providing direct services. The range in personnel was wide, however; 11 percent of the agencies reported no professional staff other

than the director, while one AAA had 60 professional staff members.

Funds, Mr. Reilly noted, come from a variety of sources. In FY 1966 Title III contributed an average of twothirds of the median total budget which was $310,000. Over 80 percent of the AAA's received local funds, and over 70 percent received local in-kind contributions. States provided funds to more than half the agencies. Over one-fifth of the agencies received Title XX funds while CETA funds went to over 40 percent of the AAA's. While matching funds are required, 71 percent of the area agencies reported that they received State and local funds which exceeded the required match. These ranged from a low of $218 for one agency to a high of $94,867 for another.

In terms of services supported with Title III funds, Westat found that even before the implementation of priority services called for in the 1975 amendments, more than 90 percent of area agencies funded at least one project in transportation, home repair, project in transportation, home repair, legal and other counseling, and inhome services.

Effectiveness of AAA's

The Westat study focused on changes in the delivery system and the relationship of area agency activities in achieving those changes.

At least two-thirds of the respondents rated the area agency as being either "highly effective" or "moderately effective" in bringing about improved services for the elderly in their area. And, with the exception of the service providers (21 percent), more than one-third of the respondents rated them as "highly effective." Although influential persons were not asked this question, for a similar query two-thirds of them said the AAA had had "a considerable im

pact," on the local service delivery system. One-third of the service providers agreed with this assessment.

Service providers receiving Title III funds in the Westat sample were also asked to evaluate the training and technical assistance received from area agencies; 61 percent of those who had received training from AAA's assessed it as "very useful."

The Andrus Center study looked at multiple funding of area agencies as a measure of pooling. They found that in FY 1975, 55 percent of the 97 agencies studied were obtaining multiple sources of funds beyond the required match; double the number receiving such funds in FY 1974. About onequarter of the agencies obtained more than one non-AoA dollar for each AoA dollar received with an average of 80 cents for each AoA dollar, including matching funds and in-kind contributions.

These findings are underestimated, however, because many of the pooling efforts do not result in actual dollars showing up in the area agency budget since they are channeled through other agencies which provide direct services to older persons.

One of the major findings of the Westat evaluation shows an overall improvement in the characteristics of services delivery to the elderly during the study period. This improvement is found in all three of the goal areas: comprehensiveness, coordination, and concern for the elderly.

Improvements in 17 possible areas of change were studied. These included the average amount of services provided to the elderly and their physical accessibility, a measure of efforts to coordinate community services involving the elderly in planning and priority setting, and the percent of clients who are from low-income or minority groups.

Westat found that over 90 percent of the service providers improved on at least one of these service delivery characteristics. They averaged improvement in seven out of 17 areas studied while only 32 percent of service providers showed a decline and they averaged a decrease in only one out of the 17 areas studied.

During the two-year evaluation period, about two-thirds of all service providers reported an increase in their volume of services to the elderly and an increase in expenditures for the elderly.

Service providers also reported a 26 percent increase in the median number of elderly they served-to approximately 500 elderly persons per service provider over the two-year period. This parallels the rate of increase in their median expenditures for the elderly, which was reported at 11 percent per year between FY 1975 and FY 1976. Among service providers who serve all age groups, this 11 percent growth in expenditures for elderly clients is the same percent increase reported for their total expenditures for services to all clients.

As this finding indicates, the period

relationship of area agencies to change, and found that area agencies contributed to about one-fifth of all improvements in the 17 possible areas of change in services for older persons.

Taking into account that area agencies did not attempt to influence the services of all their providers, the analysis showed that the AAA's were credited with contributing to an average of 31 percent of those improvements made by the service providers they attempted to influence.

Westat found that, on the average, area agencies succeeded in about 60 percent of their attempts to improve services to older persons. They were credited with helping to establish 48 percent of new services by providers to assist older persons or to increase the number served.

Based upon service provider descriptions of events leading to change, Westat found that coordination, pooling (which is the drawing down of other funds), training and technical assistance, advocacy, providing Title III and VII funds, and monitoring and improving their own information and referral services were the techniques

for social services. However, the elderly have witnessed a long history of being underserved by mainline programs and service providers which was documented by the recently published Age Discrimination Study of the Commission on Civil Rights. Thus growing at the same rate as services to other groups is simply not enough, Mr. Reilly said.

In another area of improvement, providers increased the variety of services offered to elderly clients over the two year period. Types of services. available to the elderly rose by 23 percent. Twenty-six percent of those offered in 1974 by providers currently serving the elderly have been modified to include the elderly or have increased the number of elderly served.

Westat developed two major measures of effectiveness to gauge the

used. Coordination, training and ing Title III and VII funds, and improving their own I and R services were the most effective techniques.

While the providers did not interpret planning as an activity directly leading to change, Westat found that area agency planning efforts were an important factor in the change proc

ess.

Westat also found that area agencies with low amounts of time spent on planning were found in areas with the least improvements per service provider.

Conclusions

Area agencies during the first two years, were setting priorities, developing two annual plans, and funding and monitoring service delivery. The data show that during the same period they were bringing about changes for the

better in the service delivery system.

The changes included the commitment of additional funds for services for older people by other agencies, and changes in policy which benefited the elderly. Twenty-one percent of all positive changes with regard to services for the elderly were attributed to the work of area agencies. Over 40 percent of all new and modified services for older persons involved the area agency as a contributor. The area agency is cited much more often for achievements in pulling together local area resources to serve the elderly than as a funding source. The findings are largely based on the opinions of service providers and other persons who receive no funds from the area agencies.

The most frequent recommendations for improving the program from service providers, influential individuals, and State agencies were to increase the funding available to area agencies, to increase the size of staff, and to give them more authority to carry out their roles.

Newsletter Covering Aging Programs Launched

GERIATRIC & RESIDENTIAL

CARE, a newsletter for professionals who work with the elderly, began monthly publication in January.

The newsletter provides information on major programs and legislation affecting the health and welfare of the elderly, including benefits programs and nursing home, home health care, and food service programs. The newsletter also includes a calendar of events and a listing of publications and new resources in the field of aging.

GERIATRIC & RESIDENTIAL CARE is available for $35 a year. Subscription requests should be sent to HRS Geriatric Publishing Corporation, 342 Pipe Stave Hollow Rd., Mount Sinai, New York 11766.