Senator HARKIN. Rocky, thank you very much for your testimony And obviously these are all programs of importance to many disabled Americans, and specifically, the various groups that you represent in the deafness and hard-of-hearing community. So we take your testimony seriously, and obviously we are going to do our best. Mr. STONE. Well, thank you very much. I think the ADA is beginning to really impact on the thinking of an awful lot of people in this country, and you all should be very proud of that.

Senator HARKIN. Thank you very much, Mr. Stone.

STATEMENT OF MARVIN C. WEBB, DIRECTOR, GREAT RIVER BEND AREA AGENCY ON AGING, DAVENPORT, IA

Senator HARKIN. Next is Marvin Webb, director of the Great River Bend Area Agency on Aging from Davenport, IA.

Mr. WEBB. Thank you, Mr. Chairman.

Because I have submitted previously written testimony, I want to use that as an outline and just highlight some comments that you already have before you.

Each time the Older Americans Act has been reauthorized, Congress has been responsive in focusing services and reaffirming policy direction in support of the Nation's elderly. Congress has also continually asked the network of area agencies on aging to remain accountable while offering the flexibility to tailor services implementation to local situations. These are key principles that I would encourage this subcommittee to keep in mind as it considers the appropriations for Older Americans Act services.

Fiscal year 1991 Older Americans Act appropriations reflected the first substantial funding increase in over a decade. This was a very welcome increase, but it was not enough to meet neither the services mandate of the law nor the increasing numbers of older persons nationwide.

Literally, older persons in rural areas and some urban centers are outliving support structures of their immediate communities. Consolidating funding and funding the Older Americans Act services to the maximum extent possible provides for maintenance and continued development of the continuum of support services to the Nation's senior citizens.

In 1989 Iowa had an estimated 530,000 persons aged 60 years. and above, nearly 20 percent of the State's total population. This placed Iowa third behind Florida and Pennsylvania as States having the highest percentage of their population in this age category. Of Iowa's over 60 years population, there were 139 females per 100 males.

Iowa ranked first in the Nation regarding the percent of its population age 85 years and above, or nearly 10 percent of its senior residents and 2 percent of the State's total population. Of this age group, again, there are substantially more females than males.

The good news is that Iowa ranks only second behind Hawaii in life expectancy. The bad news is that the statistics for Iowa bring to mind a scenario of an 85-year-old widow isolated in a small town, on a farm, or in a central city area without access to community services.

From my perspective, and that of my colleagues in Iowa, I would offer the following recommendations regarding fiscal year 1992 appropriations for the Older Americans Act programs.

First and foremost, increase funding. With consideration for inflation, Older Americans Act funded programs have hardly had maintenance funding from year to year during the 1980's. For example, 3(b) supportive services funding has increased only slightly less than 10 percent during that same period.

Although other funded programs have been added, very significant programs such as ombudsman, title 3(d) and 3(g). Nutrition has been increased as well. Title 3(b) provides basic outreach and access services for senior citizens. An increase for fiscal year 1991 comparable to that received in fiscal year 1992 would have a significant impact. The National Association of Area Agencies on Aging will provide additional information to this committee following my testimony.

I would highlight some programs that I would like to see continued funding for, at least at the same level as this past year: the Older Worker Program, a very significant program. We work with people in extreme situations of need. We would like to see you increase funding for the State Ombudsman Program. We would like to see you increase funding for transportation for senior citizens, either through renewal of urban mass transit administration or channeling those funds through area agencies on aging.

The issue of equitable funding, distribution of funding throughout States is also very critical, keeping in mind that we have a mandate to serve low-income rural and low-income minority. Also, outreach and counseling are critical as you can look at consolidated funding under the aging network, for example, outreach for supplemental security income and counseling for health promotion.

With regard to health promotion, I think this committee is considering the issue of what it costs not to do something in the area of health care prevention, rather than the cost of taking some action.

PREPARED STATEMENT

My final comment to the committee would be to use as strong as language as you can in your recommendations encouraging the coordination of funded programs. And I give an example of what we have done in the State of Iowa, for example in the area of longterm care we have one program where we have 42 participating agencies. And I would like to say we also include the city of Bettendorf Police Department in that program serving seniors in that area.

Thank you.

[The statement follows:]

STATEMENT OF MARVIN C. WEBB

Mr. Chairman, members of the Committee, my name is Marvin Webb. I am Director of the Great River Bend Area Agency on Aging, serving Clinton, Scott and Muscatine Counties, Iowa. I am grateful for the Committee's interest in obtaining comments from persons involved in different areas of service to older adults. Each time the Older Americans Act has been reauthorized, Congress has been responsive in focusing services and reaffirming policy direction in support of the nation's elderly. With each reauthorization, Congress has also reaffirmed a network of State Units on Aging and local Area Agencies on Aging. Congress has continually asked this network to remain accountable while offering the flexibility to tailor services implementation to local situations. These are key principles I would encourage Congress to continue as it considers both the reauthorization of the Older Americans Act and the appropriations for its services.

Fiscal Year '91 Older Americans Act appropriations reflected the first substantial funding increase in over a decade. This was a very welcome increase in helping to maintain the continuum of community based support services for older persons. It is just as important for Congress to invest in this services continuum as it is for communities to invest in their infrastructure, maintaining streets, water and other services. Area Agencies on Aging are involved in adding to the social services infrastructures of communities, the less visible services yet those which contribute significantly to the quality of life for the older person and for the caregiver of a dependent adult.

This comparison of services systems is meaningful when we consider the needs of an aging population within both urban and rural areas. The situation, however, is intensified in rural Iowa in communities affected by recent changes agriculture and related business and industry. Businesses have closed and younger persons have relocated, leaving elders without the necessary economic and social supports. Literally, elders in rural and some urban centers are outliving support structures of their communities. Consolidating and funding the services to the maximum extent possible provides for maintenance of the infrastructure of support services to the nation's senior citizens. In 1989, Iowa had an estimated 553,000 persons age sixty and above. Nearly twenty percent of the state's total population, this placed Iowa third behind Florida and Pennsylvania as states having the highest percentage of their population in this age category. Of Iowa's over sixty population, there were 139 females per 100 males.

lowa ranked first in the nation regarding the percent of its older population age eightyfive and above, or nearly ten percent of its senior residents and two percent of the state's total population. Of this age grouping, there are 276 females per 100 males.

Despite the fact that Iowa ranks only second behind Hawaii in life expectancy, with an average exceeding seventy five years, the statistics for Iowa bring to mind a scenario of an eighty-five year old widow isolated in a small town, on a farm, or in a central city area without access to community based services. The situation for Iowa is even more critical when this trend is considered: in 1980 Iowa's age sixty population was 1.461% of the nation's older population, but in 1989 it was reduced to 1.321%. The latter is approximately equal to the state's portion of Older Americans Act funding.

From my perspective and that of my colleagues in Iowa, I would offer the following recommendations regarding FY '92 appropriations for and reauthorization of the Older Americans Act programs:

OLDER WORKER PROGRAMS

At least maintain the FY '91 funded level of the Title V older worker program. It is estimated that 8,000 seniors nationally will lose their jobs if the proposed $47 million reduction is accepted. We work hard at placing enrolled older workers in permanent unsubsidized jobs within both the public and private sectors, but without the advocacy support of trained aggressive Older Worker Specialists to help them it can not be assumed that they will find private sector jobs. My own area works cooperatively with Job Service of Iowa and the local Administrative Entity for the Job Training Partnership Act to combine older worker program resources of each under the administration of the Area Agency on Aging. The Department of Labor has reviewed our program and considers it a model for pooling resources.

STRENGTHEN THE STATE OMBUDSMAN PROGRAM

Take steps to strengthen the role of the Ombudsman to specifically include in Sec. 307 (12)(A)(i) of the Act mediating between the nursing home administrator and the resident and his/her family. A University of Iowa nursing home consultant

estimates that 80% of facility residents have some form of dementia. The average age of nursing home residents continues to increase. In Iowa the volunteer Care Review Committee members are local advocates for residents. State surveyors, evaluating care facilities, do not take on this mediating role. Care Review Committee members are trained to address early intervention while the State Ombudsman has more of an investigative role.

TRANSPORTATION

We recommend creation of a new Urban Mass Transit Administration title for social, health and nutritional services transportation, to include senior transport for non-emergency health and medical services. Funds should be available for both capital and operational expenses. Also, create a separate UMTA title for rural transportation to: a) replace Older Americans Act funding with UMTA funds; b) utilize Area Agencies on Aging for coordinating senior transportation; c) provide equitable funding for rural and urban areas based upon distances traveled; and d) allow cost sharing. Create a transportation subtitle under the OAA to coordinate paratransit. Funds should not be diverted from OAA Title III.

MINORITY TARGETING

Both the national and intrastate funding formulae should include factors of age sixty plus, low-income, rural and low-income minority.

OUTREACH AND COUNSELING

The counseling provision of OBRA 1987, as related to changes for nursing homes, should be funded and administered by and through the Administration on Aging and its national network of State Units on Aging and Area Agencies on Aging. I would also encourage Congress to use this network for outreach and counseling for other programs such as outreach for Supplemental Security Income and counseling related to Health Promotion.

HEALTH PROMOTION AND DISEASE PREVENTION

Support S. 504 through S. 510. These seven bills address the issue of what it costs not to do something in the area of health care prevention activities. Especially S. 510 amending Section 361 (Part F) of the Older Americans Act could have a tremendous impact upon the quality of life for seniors. My area is currently supervising an individual completing her practicum for a Master's Degree in gerontology. She is a County Extension Home Economist implementing a wellness education program over an eight week period. She does one-on-one counseling, assessing lifestyle in terms of nutrition, exercise and general health practices, concluding with a look at possible changes for improvement. Her review of current research indicates the cost of treatment for illness far exceeds the cost of preventive care. Health care professionals continually remind us that even a little lifestyle change can dramatically improve quality of life for most individuals.

FACILITATE COORDINATION OF PROGRAMS

The Administration on Aging has been effective at promoting with the National Associations of State Units on Aging and of Area Agencies on Aging access to services for older persons through this network. This is a network of professionals of which Congress should increasing call upon to bring to the local level a variety of funded services. Iowa has created a Long Term Care Coordinating Unit of which the State Departments of Elder Affairs, Public Health and Human Services are a part. Through their cooperation, an agreement is in place which helps local agencies get past the barrier of sharing client information. Under this network, forty-two service providers in two of my area's counties have signed written agreements to work cooperatively, including the City of Bettendorf Police Department. This network is the only national network planning for a coordinated services system for all older persons. I encourage this committee to continue that mandate and to integrate other funded programs as appropriate into that planning and management system.

Thank you.

Senator HARKIN. Thank you very much, Marvin, for a fine statement.

One point here on the Older Workers Program. You mentioned it in your statement, but did you know the minimum wage has gone up?

Mr. WEBB. Yes.

Senator HARKIN. Will restoring the program to last year's level be good enough if we are going to meet the increase in minimum wage? It seems to me if we keep it at last year's level and minimum wage went from $3.80 to $4.25, we are still not going to be at the same level.

Mr. WEBB. Right. I would encourage an increase. We had a very successful program in our area especially combining the State match money for title V and also working with the 3-percent setaside under the Job Training Partnership Act program. Those three programs together have given us a lot of success. And as I mention in my written testimony, we have been identified by the Department of Labor as a national example of the pooling of those kinds of resources.

I think employment for older persons does get overlooked. We do serve persons in extreme situations. We may not think of divorce in later life, but that does occur at an alarming rate. We, I think, are aware of the health care needs of seniors, but we also serve especially older women that may have health problems themselves and need the income for medical expenses and so forth. So I think the Older Worker Program is one that tends to get pushed back. And we encourage this committee to bring that forward as much as possible.

Senator HARKIN. Well, thank you very much, Marvin. Congratulations on a fine job in Iowa.

STATEMENT OF LYNN COOPER BRECKENMAKER, NATIONAL FAMILY PLANNING AND REPRODUCTIVE HEALTH ASSOCIATION

ACCOMPANIED BY JILL JUNE, NATIONAL FAMILY PLANNING AND REPRODUCTIVE HEALTH ASSOCIATION

Senator HARKIN. Next is Lynn Cooper Breckenmaker and Jill June on behalf of the National Family Planning and Reproductive Health Association.

Welcome to the subcommittee. Your statement will be made a part of the record in its entirety. Please proceed.

Ms. COOPER. Thank you.

Mr. Chairman, members of the subcommittee and staff, thank you very much for the opportunity to testify today. And as you have stated, my name is Lynn Cooper Breckenmaker. I am vice president for the Family Health Council of Central Pennsylvania. I am very proud to be here today to testify on behalf of the National Family Planning and Reproductive Health Association, of which I am a member.

Sitting with me today is Jill June, president of the Planned Parenthood of Greater Iowa and a member of the National Family Planning and Reproductive Health Association Board of Directors. The written testimony that you have received is full of important information. It describes NFPRHA and the services that family planning provides. It also contains some incredibly startling data.