Section 909.36, "Nutrition Requirements." Section A specifies one hot meal per day at least 5 days a week at the congregate meal site. This is a most commendable goal for urban areas where participants are within walking distance; but it is not feasible, practical, nor acceptable for rural seniors.

However, if the proposal would allow several sites to make up an award area, then within that award area, 5 miles a day or more could be served.

The national guidelines for the nutrition program for the elderly can be adapted for both urban and rural needs if the state agency has liberty to implement the program to fit the geographic, economic, and cultural needs of the older Americans.

If the specifications in Section 909.34, "Selection of Congregate Meal Sites," could be expanded to include a composite site area of several small sites which would function in the same capacity as a congregate site, then and only then, rural America would be able to enjoy the benefits of the nutrition program for the elderly.

PREPARED STATEMENT OF IVAN SIMONSEN

I would like to thank Senators Kennedy and Percy, their staff, and the other Senators and Representatives whose efforts made it possible to extend the Research and Demonstration Nutrition Program to a fourth year; and thus provided the basic foundation for the proposed Nutrition Program for the Elderly, under the new Title VII of the Older Americans Act. As a project director from Idaho, I am especially grateful for the work which our Senator Frank Church, as chairman of the Senate Committee on Aging, has done to promote the welfare of older Americans.

Scattered across America-in small villages; little hamlets; in homes where they have raised their families, and are perhaps now surrounded by the second and third generations raising their families; on farmsteads which have seen subdivisions slowly creeping out to meet them are the rural elderly. Although they may not be concentrated in one area, since they tend to remain in the homes they have had, their needs do not differ from those of the elderly in the cities and ghettos of America. They know the loneliness of a meal with no one to talk to, and the hunger when that meal is skipped-or eaten as a snack from the bread board-simply because there is no incentive to cook properly for "just me." Four years of work with the Nutrition Program for the Rural Elderly in six counties of Idaho has shown that success is possible when several small sites are combined under one project. We have witnessed and experienced the end results of the purposes stated in the Proposed Nutrition Program for the Elderly. Around the meal program we have built a program that stimulates the whole person, and makes them a brighter, more alert citizen-a real asset to the community.

A study of the origins of these people indicates a rather limited living background: working in the fruit industry, farming, cattle ranching, logging and lumbering. These are people who have worked and labored long and hard, many have "retired" only because they were no longer physically able to work. Life has been hard, but home and memories are good, and friendships strong. Most of the social outlet was found in family gatherings, neighborhood visits and occasionally some activity in the community.

Retirement is a difficult task at times. Suddenly, from one day to the next, you have to find a whole new way of life. Having a period of retirement following the work career is now a part of our civilization, but it's acceptance is not yet complete. When we think of old age, we consider it a period of dependency with activity being greatly curtailed. Often times the oldster's attitude toward the aging process may be resentful, when instead retirement should open wide the door to a host of new activities.

As we outreach Seniors in these communities, we find a very proud, patriotic, independent and friendly citizenry; but, on the other hand individuals who were extremely bored, lonely, preoccupied with themselves, thinking and reflecting on

the past. It is our goal to help them find, in their later years, nutrition tailored to retirement needs, added happiness, usefulness and a new concept of their own worth.

From the new proposed rule making sheet, may I call your attention to several sections and their effect on the rural elderly.

909.33 PROJECT COUNCILS

This section implies a large central site with a project council elected from its participants, but in rural areas, there are several senior meal sites, separated by a considerable distance, and each of these sites has their own advisory board, composed mainly of Seniors. To establish the proposed Project Council, rural areas must have the option to select from these local advisory boards representatives to a regional project council, who could deal with the state agency. It is most important that the advisory board of each Senior site has a chance for input into the daily operation of the project.

909.34 SELECTION OF CONGREGATE MEAL SITES

In section A, it states that the project area selected to receive awards will be chosen from locations having major concentrations of older persons from the low income brackets. The term "major concentrations" does not apply to a non-urban situation. Although Idaho has a high percentage of elderly citizens, our low income elderly are scattered throughout our counties. Because of these factors, it is essential that the State Agency be allowed much flexibility in choosing project areas. Depending on geographic limitations, one project area may consist of one county or of several counties with sites in numerous small towns, composing the award area.

909.36 NUTRITION REQUIREMENTS

Section A specifies one hot meal per day at least 5 days a week at the congregate meal site. This is a most commendable goal for urban areas, where participants are within walking distance; but, it is not feasible, practical nor acceptable for rural Seniors. However, if the proposal would allow several sites to make up an award area, then within that award area, five meals a week or more could be served.

These national guidelines for the Nutrition Program for the Elderly can be adapted for both urban and rural needs if the state agency has liberty to implement the program to fit the geographic, economic and cultural needs of the older Americans.

If the specifications of 909.34 (Selection of Congregate Meal Sites) could be expanded to include a composite area of several small sites which would function in the same capacity as a congregate site; then, and only then, rural America would be able to enjoy the benefits of the Nutrition Program for the Elderly.

WHAT PROPOSED REGULATION WOULD DETER PROGRAMS?

Senator PERCY. I want to thank all of you very much indeed. My questions are very brief.

How will your projects have to change-I would only be interested really in detrimental changes, if these regulations do go into effect. Are there any ways your program would change to the detriment of the program if the regulations go into effect without change?

Mr. KRAMER. The only concern I have is on fees. I think the experience we found is that older people want to pay a small fee and that the guidelines are somewhat vague. What we would like to see is that at the local site, the governing board, in consultation-the governing board, which I hope will be elected like ours is at the present time by the members of the program, will decide on the fee; and then it will be made very clear to everyone that if they really cannot afford it, they do not have to pay, like we do now.

There are many people on scholarships. They can be given a meal ticket. It does not ostracize them from the rest of the group. I think on the whole, most of the older people want to pay something; and it should be left up to be determined by the older people at the site, whether it be a dime, a nickel, 60 cents.

Senator PERCY. Would anyone else care to comment on the question of fees and give us your recommendation on that? Any of you disagree with the statements made?

Mrs. BARNES. Except there should be a fee. Not having a fee takes away the dignity of the program. So there should be a fee, be it ever so small.

Senator PERCY. All concur on that?

Do you want to comment on the size of the fee?

Mrs. BARNES. No; that should be left to the individual area. Senator PERCY. You all agree it should be left to the individual area? The staff asked the question for clarification, should it be a decision for the individual site or should it be a decision for the area?

For instance, in Chicago, should we try to have an individual fee established for each different site, or should it be an area wide decision? Mrs. BARNES. Senator Percy, I think from where I sit it would be a problem. I think it should be a-for that particular locale, I think it should be the same thing throughout the city. If one area is paying 20 cents, another 25 cents, why do I have to do that?

Senator PERCY. All of you concur with that?

Mr. KRAMER. I believe it should be the site. For example, in New York-in an area four blocks, two blocks may be tenements. Maybe the people in the tenements can only pay 10 cents. Then two blocks further than that, you have public housing projects. Many of those people can pay 25 cents. I think it must be left to the individual site. Mr. McLOUD. I concur with Mr. Kramer. It should be left with the site.

Mr. SIMONSEN. Individual site.

Mrs. BARNES. I think there is discrimination when you do that. Senator PERCY. I think we can see that it is not always possible to get agreement even among yourselves.

If there is some disagreement with the regulations, as it is promulgated so far by the agency, then we can understand they are made by humans who will not get 100-percent agreement on anything. We never agree on everything on the floor of the Senate, anyway.

I have no further questions. If there is any comment, you can go ahead, if you are brief enough. I have a rollcall vote I must go for. Mr. SIMONSEN. You mentioned would our projects change if we took the rules as stated at this time? Yes. With our demonstration scattered, with the many areas, we cannot comply with, in each site, the five meals per week. So we would be wiped out if they went through this way as would many other rural areas.

Senator PERCY. I do want to thank you very much indeed. The vote we have on the floor is one that all of you who work with low-income people will be interested in. It is the Lead-based Poisoning Amendments of 1972. I can assure you it will pass overwhelmingly. I should be able to get back, because it is the end of the rollcall, in less than 5 minutes.

So, Mr. Martin, if you would be prepared to start in, we will excuse this panel with deep gratitude, and I express gratitude on behalf of the chairman, Senator Kennedy, as well.

[Recess.]

Senator PERCY. Our last witness, at long last, is Mr. John B. Martin, Commissioner of the Administration on Aging, Department of HEW, and, Mr. Martin, maybe you want to identify your colleagues.

STATEMENT OF HON. JOHN B. MARTIN, COMMISSIONER, ADMINISTRATION ON AGING; ACCOMPANIED BY DONALD REILLY, DEPUTY COMMISSIONER; CHARLES WELLS, ACTING DIRECTOR, STATE AND COMMUNITY SERVICES; DR. MARVIN TAVES, DIRECTOR, TITLE IV RESEARCH AND DEMONSTRATION GRANTS PROGRAMS, DEPARTMENT OF HEW

Mr. MARTIN. Yes, Mr. Chairman. Here with me is Mr. Donald Reilly, Deputy Commissioner on Aging; Dr. Marvin Taves, Director of Title IV Research and Demonstration Grants Program, Social Rehabilitation Service; and Mr. Charles Wells, on the right, acting Director of the Office of State and Community Programs, Administration on Aging and he has some direct responsibility for the carrying out of this program.

I might say, Mr. Chairman, at the beginning of this testimony that this has been a very useful day for us. The whole purpose of drafting regulations and then publishing them with a time limited to 15 working days for the furnishing of comments is because these regulations are not written in stone in the first instance and because in publishing them, we seek to get as much comment as possible.

We have not only sought to get comments at that point, but we have been conferring with as many people as we could, right through from the beginning.

This program, of course, is of vital importance to older Americans because it has significant potential for reducing isolation and malnutrition among the elderly. These are both important aspects of the program. It is not just a matter of food; it is a matter also of isolation and how we can eliminate that.

We therefore share the committee's concern that the program be implemented as promptly as possible. We believe it is equally important to plan carefully for the nutrition program, so that when the State nutrition programs and local projects become operational, they can most effectively serve and efficiently help the older Americans who

need nutrition and related social services.

I will address my remarks to the steps AoA has taken to implement the nutrition program; and the major elements of the proposed regulations for Title VII, which we have developed and which were published on June 6, 1972.

STEPS TAKEN TO IMPLEMENT TITLE VII

Immediately after Title VII became law on March 22, AoA convened three task forces-one on planning, another on nutrition, and a third devoted to the question of social services which the bill contemplates should be part of this program. These task forces consisted of

Administration on Aging staff, State executives on aging, representatives from the Office of Economic Opportunity, the Department of Agriculture, the Health Services and Mental Health Administration, and the Community Services Administration, project directors from Title IV nutrition demonstrations, a representative from the Baltimore Meals on Wheels program, and three regional associate commissioners on aging. The task forces identified issues, analyzed alternatives, and made recommendations as to the options to be chosen.

This initial input from experts with a variety of perspectives, working closely with our staff, was necessary to develop the most effective method of putting together a program of the scope and complexity of Title VII. This action was also consonant with the law, which requires that AoA consult with other agencies and departments of the Federal Government.

The material developed by the task forces was then synthesized into a comprehensive nutrition issue paper as the basis for decisionmaking prior to the development of regulations for the new Title VII.

During the first week of May, we met with the Subcommittee on Nutrition of the Advisory Committee on Older Americans to review the issue paper.

On May 8, representatives from 16 national organizations, including the American Dietetic Association, the National Association of State Units on Aging, the National Council on Aging and representatives of minority and Indian groups, attended a meeting conducted by AoA in Washington. They, too, were asked for their advice and recommendations on the nutrition program issue paper.

The views of the advisory committee, the organizations, and department staff were analyzed and decisions made as to the content of the draft regulations. The notice of proposed rulemaking, published on June 6, 1972, is the result of these sequential steps.

AoA staff has met with the Office of Economic Opportunity regional staff, to explore ways in which we may work closely together. The Office of Economic Opportunity senior opportunities and services program and emergency food and medical services program have funded some 185 nutrition and services programs for the elderly. We hope to incorporate this experience with the elderly poor, as well as our knowledge gained from the Title IV nutrition demonstrations under our own Title IV program into the Nutrition Program for the Elderly. We have also been working with two consultants, who were formerly with the Department of Agriculture, on guidelines for implementing the proposed regulations for the nutrition program.

Yesterday, AoA met with experts from the Department of Agriculture to further review and analyze the proposed regulations.

Staff is also currently working with project directors from the Title IV nutrition demonstrations on a nutrition services handbook, which will contain how-to-do-it information. This handbook will be extremely useful to State agencies and local projects in the development and operation of meal projects.

Early in April, we conducted week-long training sessions for staff from the State agencies. Although these training sessions were focused primarily on planning rather than nutrition, we believe that such planning assistance will have an important impact on the way Title VII is implemented.