ESTHER R. LANDA, NATIONAL PRESIDENT NATIONAL WOMEN 15 EAST 26th STREET, NEW YORK, NY 10010 (212) 532-1740 MARJORIE MERLIN COHEN, EXECUTIVE DIRECTOR STATEMENT SUBMITTED FOR THE RECORD OF The National Council of Jewish Women is a volunteer organization founded in 1893, dedicated in the spirit of Judaism to advancing human welfare and the democratic way of life by working through a coordinated program of education, service and social action in the Jewish and general communities, locally, nationally and internationally. Our 100,000 members in 220 communities throughout the country have long recognized that older Americans had special needs that were not being addressed. - Over the years the NCJW has pioneered a wide variety of services for senior citizens. The NCJW organized the first nationwide "golden age" program with clubs and centers where initially the elderly could find friendship, recreation and hobbies. The program began with a single club in 1945 and grew to 50 clubs five years later. In another 10 years (1960) more than 200 Sections (local chapters) had senior citizen activities which had expanded to include a wide range of services to meet local needs congregate meals, sheltered workshops, and meals-on-wheels among them. Individual Sections pioneered new services, such as employment bureau for older workers in recognition of discrimination in employment on the basis of age (Atlanta, Georgia) and the Senior Service Corps (Essex County, New Jersey). The latter inspired Senator Williams to introduce legislation to establish the National Senior Community Services Corps, now called RSVP (Retired Senior Volunteer Program) under ACTION. In some communities Sections sponsored senior citizens housing. In 1975 the NCJW published Continuing Choices, a comprehensive handbook for work with older adults. The foreword by Dr. Arthur S. Fleming states that the handbook "shows how local groups and organi - 2 zations can assist in making use of the energy and experience of older Americans." We have been asked to focus our testimony on age discrimination in programs under Title XX of the Social Security Act, because of our activities in support of passage of Title XX and the follow-up monitoring of its implementation by our State Public Affairs Chairwomen and their committee members in the local communities. The NCJW endorsed the new approach to eligibility for services based on a percentage of state median income (adjusted to family size), rather than on receipt of a cash grant under Title IV-A and VI financial assistance programs. We also endorsed the active citizen participation spelled out in the legislation and implementing regulations, and encouraged our members to become involved in needs assessment, as members of the citizens advisory committees, and at public hearings. Our examination of the Title XX Comprehensive Annual Social Services Program Plans and implementation of those plans has indicated to us that there is age discrimination under Title XX of the Social Security Act, providing grants to the States for social services. This discrimination has been caused in the various states by different factors, but essentially due to 1) Funding; 2) Regulations; and 3) Attitudes. Some details of what we found and possible changes to rectify some of the problems follows. The Federal ceiling on social services, adopted with passage of the State and Local Fiscal Assistance Act of 1972 (Revenue Sharing), plus the ballooning inflation since that date have combined to greatly reduce the effective funds available for services. This has produced a competition for the limited funds to meet the needs of different age groups because of the nature of the services, the delivery system itself, and the lack of lead time in implementing Title XX, not permitting a detailed needs assessment. Everywhere reports came back to us that initially old contracts, developed under Titles IV-A and VI, were continued. The great expectation -3 that a realistic needs assessment would bring about a reordering of priorities and services for the second year's plan was fulfilled in very few places. Where this was undertaken example, Nassau County, New York, there was indeed a major reordering of services. But such needs assessments took place in few communities, in part because inflation has caused an actual decrease in services provided. For effective use of current funding, the following are needed: a) Adequate, realistic needs assessment -- a continuing process as neighborhoods and needs change. b) Citizen input before the annual social services plan is developed only minimal changes can be made after the draft of the proposed plan is distributed for comment. c) Effective evaluation of service delivery, with participation of both the voluntary and public agency sectors. a) e) Examination of the total funds available for services from all a requirement of the legislation, but never funded. sources - Two year plan in many States where the legislature meets in alternate years. The importance of the citizen participation and input was indicated in several states. In Kentucky, $12 million was siphoned off from Title XX to cover a community mental health deficit and replace an eight year phase-out. It occurred because there was insufficient time to educate about Title XX, but it was indeed found. - Lack of community education was also responsible for a clamor in California about inequities in the use ot Title XX funds, especially from the elderly. Yet Homemaker-Chore Services for the elderly use one-third of Title XX funds and actually 53% of all HomemakerChore Services are from State funds. There was also agitation because little or no Title XX funds go for child day care. In fact, California has a highly developed child day care system, totally funded by the State. In Tucson, Arizona, citizen participation forced the use of revenue sharing funds to meet the needs of neglected parts of the community, but there has been no such citizen participation with Title XX, because there is very little provision of services by the State of Arizona. 2. Regulations Title XX Federal Regulations ( first published June 27, 1975 with several amendments and changes in the year that followed) permit payment of administrative costs without the earlier restrictions and specifics of the Title IV-A and VI regulations. Local and State departments of social services/human resources/welfare consequently charge against the Title XX funds for services (with 75% Federal Financial Participation instead of the 50% of AFDC) the salaries of supervisors and of caseworkers whose primary function is related to income maintenance budgetting, etc. In California this is called case management services; in New York it may be called counselling or social adjustment services. This results in less and less purchase of services, or provision of services, such as Homemaker-Chore for the elderly or day care for children unless the State actu - ally provides such services itself, as in New Jersey. More and more complicated reporting/evaluating forms are developed in pursuit of "accountability" paper work for computer programs which do not provide the expected information. This also in turn further reduces the money for needed purchase of services from the voluntary sector, hitting hard both the elderly and children. In addition, the differing definition of services under SSA's Titles XX and XIX Medicaid is responsible for a heavy drain on Title XX funds to provide assistance toeiderly to remain in their own homes with the assistance of homemaker-chore-home health aides. Elderly clients not able to take care of themselves fully may also be denied services if the State/local CASSP plan does not provide homemaker-chore services and the client is not eligible for the Medicaid service because of the slight difference in definition. Moreover, Title XIX is open-ended at 50% Federal Financial Participation, while Title XX has a ceiling but provides 75% FFP. 5 The regulations do not provide the formal linkages needed to ensure that those elderly receiving SSI (Supplemental Security Income) make application for the services they need and that are available. To ensure that there will be some Title XX money available for purchase of service, the following are needed in Regulations: a) Specific definitions of what administrative costs may be charged to Title XX and service definitions consistent with other Titles. b) Limitation as to what percentage of Title XX can go for administrative costs, including supervision. c) Specific linkage between the local Social Security Administration office and the local social services agency. d) Limitation on the paper work for accountibility, recognizing that one cannot account for time with clients in the same way as for time spent in manufacturing, and that accountability functions that consume the funds for services are no longer productive. 3. Attitudes: State and local options for services, instead of mandatory Federal categories of services, have caused serious inequities within a state There are also the extremes in inequities between neighboring states. Some local officials may not recognize the needs of a specific age group, or they may have personnel biases, It is truly discriminatory when where an individual lives determines if or what services are available. Perhaps the grossest example of this is the State of Arizona, where there is no Medicaid and very few State social services. Consequently, the large and growing elderly population cannot receive such services as homemaker-health aide or homemaker-chore which enable them to stay in their own homes, a sharp contrast with neighboring California. In Arizona all people with severe financial problems suffer from discrimination unless the private voluntary sector is able to fill some of the needs. - In many communities who gets services may depend on the effec |