of funding which is necessary to carry out both the successful existing programs as well as new initiatives.

That is what this series of hearings is all about. We need to identify improvements that can be made in the Older Americans Act and to insure that sufficient funding is provided to fund existing and new services.

Today we will hear from a series of witnesses who will speak to many important issues, including the need to improve in-home care services for the frail elderly, the need to improve services related to housing, the need to spur public/private partnerships under the act, the need to provide older Americans with better information and assistance with respect to their private pension rights, the need to improve and expand nutrition programs and the need to provide comprehensive services at senior citizen centers.

We will also hear from a long-time client and volunteer at a local congregate meals program about the importance of that program to her and to her community.

These are all important issues which must be fully explored, but if there is one theme to this hearing, it is the importance of improving essential health care services under the act. The health care needs of older Americans continue to grow, and their health care costs continue to skyrocket. However, we can cut those costs significantly in the long run if we begin to emphasize preventive health and wellness programs.

I am hopeful that we will make significant improvements in this area. In fact, I have introduced legislation, H.R. 1739, designed to increase access to and participation in health promotion and disease prevention services.

One of the most important components of a comprehensive strategy to reduce health care costs is to emphasize preventive health care programs. If we prevent disease before it occurs, we will not only save huge sums of money but we will also substantially improve the quality of life for Older Americans, and improve the quality of life for all Americans.

Recent studies have shown that older Americans are able to benefit significantly from health promotion and disease prevention services. Some senior centers and congregate meal programs funded through the Older Americans Act are already providing these services but only on a limited basis. The Older Americans Health Promotion and Disease Prevention Act is designed specifically to increase older Americans' access to these services at sites which are already visited by thousands of seniors every day.

These sites are ideally suited for the provision of preventive health services such as blood pressure screening, exercise programs, smoking cessation programs, nutritional counseling, weight reduction programs, alcohol control and injury prevention, among many others. These wellness programs will help senior citizens take responsibility for their own health care needs. The result will be higher quality care for our seniors and significantly reduced costs for the taxpayers.

Across the Nation there is nothing more critical to senior citizens than responding to their health care needs. The Older Americans Health Promotion and Disease Prevention Act will make a significant contribution in this regard. This bill has been endorsed

by the National Council of Senior Citizens and the National Counsel on Aging, and I'm hopeful that it will be enacted during this reauthorization process.

The Older Americans Act sets forth important goals for our Nation-goals of providing our senior citizen with lives of freedom, opportunity and dignity. While meeting these goals is a difficult challenge, it is a challenge that we must address, and under the able leadership of Chairman Martinez, I am convinced that we will move our Nation significantly closer to meeting the essential needs of our senior citizens.

Once again, Mr. Chairman, I thank you for holding this very important hearing and I join you in looking forward to the testimony of our witnesses.

Thank you.

[The prepared statement of Hon. Nita M. Lowey follows:]

STATEMENT OF HON. NITA M. LOWEY, A REPRESENTATIVE IN CONGRESS FROM THE STATE OF NEw York

Mr. Chairman, I want to welcome you to Westchester County and to express my sincere appreciation that you have taken the time to come here to hear the viewpoints of local experts on the Older Americans Act.

Under your leadership, this subcommittee has already held a series of important and thought-provoking hearings on the reauthorization of the Older Americans Act, which provides essential social services to our Nation's elderly citizens.

I think all of us present here today understand that the Older Americans Act has been particularly successful in meeting the needs of our elderly citizens. But we cannot afford to be complacent.

The number of elderly Americans continues to grow, and their need for comprehensive services continues to grow. It is absolutely essential that we act, during this reauthorization process, to strengthen the Older Americans Act and to authorize the full level of funding which is necessary to carry out both the successful existing programs as well as necessary new initiatives.

That is what this series of hearings is all about. We need to identify improvements that can be made in the Older Americans Act, and ensure that sufficient funding is provided to fund existing and new services.

Today, we will hear from a series of witnesses who will speak to many important issues, including: the need to improve in-home care services for the frail elderly; the need to improve services related to housing; the need to spur public/private partnerships under the act; the need to provide older Americans with better information and assistance with respect to their private pension rights; the need to improve and expand nutrition programs; and the need to provide comprehensive services at senior citizen centers. We will also hear from a long-time client and volunteer at a local congregate meals program about the importance of that program to her and her community.

These are all important issues which must be fully explored. But if there is one overarching theme to this hearing, it is the importance of improving essential health care services under the act.

The health care needs of older Americans continue to grow, and their health care costs continue to skyrocket. However, we can cut those costs significantly in the long run if we begin to emphasize preventive health and wellness programs. I am hopeful that we will make significant improvements in this area.

În fact, I have introduced legislation, H.R. 1739, designed to increase access to and participation in health promotion and disease prevention services.

One of the most important components of a comprehensive strategy to reduce health care costs is to emphasize preventive health care programs. If we prevent disease before it occurs, we will not only save huge sums of money, but we will also substantially improve the quality of life for Americans.

Recent studies have shown that older Americans are able to benefit significantly from health promotion and disease prevention services. Some senior centers and congregate meal programs funded through the Older Americans Act are already providing these services, but only on a limited basis.

The older Americans Health Promotion and Disease Prevention Act is designed specifically to increase older Americans' access to these services-at sites which are

already visited by thousands of seniors each day. These sites are ideally suited for the provision of preventive health services such as blood pressure screening, exercise programs, smoking cessation programs, nutritional counseling and weight reduction programs, alcohol control, and injury prevention, among others.

These wellness programs will help senior citizens take responsibility for their own health care needs. The result will be higher quality care for our seniors, and significantly reduced costs for the taxpayers.

Across the Nation, there is nothing more critical to senior citizens than responding to their health care needs. The Older Americans Health Promotion and Disease Prevention Act will make a significant contribution in this regard. This bill has been endorsed by the National Council of Senior Citizens and the National Council on the Aging, and I am hopeful that it will be enacted during this reauthorization process.

The Older Americans Act sets forth important goals for our Nation-goals of providing our senior citizens with lives of freedom, opportunity and dignity. While meeting these goals is a difficult challenge, it is a challenge that we must address. Under the able leadership of Chairman Martinez, I am convinced that we will move our Nation significantly closer to meeting the essential needs of our senior citizens. Once again, Mr. Chairman, I thank you for holding this very important hearing, and I join you in looking forward to the testimony of our witnesses.

Chairman MARTINEZ. Thank you, Mrs. Lowey.

With that, we'll call our first panel, and before I do, let me announce to the panel that your prepared statements will be entered into the record in their entirety and we will ask you to summarize.

The first witness is Ms. Laura Bolotsky, Program Administrator, Westchester County Office of Aging, White Plains, New York, and we're going to start in a different order.

Ms. Bolotsky, I'm just announcing the members of the panel now. Dr. Marilyn Shilkoff, Research Analyst, Westchester County Office of Aging, White Plains, New York; miss Eleanor Litwak, Executive Vice President of New York State Council of Senior Citizens, District Counsel; Mr. David Bradley, Director of National Community Action Foundation, Washington, DC, and I would like to announce that we had planned to start with Ms. Bolotsky, but I understand Ms. Litwak has to leave for a particular reason so we'll start with you.

STATEMENT OF ELEANOR LITWAK, EXECUTIVE VICE PRESIDENT, NEW YORK STATE COUNCIL OF SENIOR CITIZENS Ms. LITWAK. Thank you, Mr. Chairman. I am a new grandmother and have to go back to help my daughter and the little ones.

I want to thank you for permitting me to testify today, and particularly express my thanks to Congresswoman Lowey who's constituent I am proud to be.

I want particularly to speak on behalf, not only on behalf of the reauthorization of the Older Americans Act but also in support of the Older Americans health promotion and disease prevention in 1991.

I am indeed executive vice president of the New York State Council of Senior Citizens, but I work as head of the retired education program of District Council 37 of the American Federation of State and Municipal Employees, and I am also the chairperson of the Subcommittee on Aging which is the umbrella of the 3,500 unions in New York City, but it is on behalf of the New York Council that I speak this morning.

As its name implies, it is an advocacy organization with 150 affiliated clubs across the State representing more than 10,000 sen

iors. We are an important affiliate of the National Council of Senior Citizens.

Normally, our activities are confined to issues that effect the elderly and their families here in the State of New York. However, we understand the enormous importance, both historically and currently, of the Older Americans Act.

Its passage marked a major commitment to the well-being of the elderly of this country. It asserted that it is the responsibility of the Federal, State and local governments to assist our older people to secure equal opportunity to the free, and full enjoyment of a wide variety of services and conditions must follow. The original act and the decade immediately following its passage served that very important purpose of identifying older persons as an important constituency whose needs had to be addressed and met.

By the late 1970's, however, while the OAA remained relatively unchanged, the realities of the groups for whose benefit it had been promulgated changed in significant ways. The elderly were living longer and represented an increasing proportion of the population. Because of this, issues of health began to assume new and proportionately greater visibility. Chronic illness like Alzheimer's Disease and Parkinson's Disease became known to ever-increasing numbers of people and terms like "continuum of care" entered into the vocabulary of all helping professions.

By the late 1980's, we came to realize that the continuum of care is precisely that: Older people, as they age, and their families required a well-articulated system of interconnected services and sites that correspond to their ever-changing and interrelated psychological, social and health needs. The goal is clearly to insure a good quality of life and to keep the older persons functioning at as high a level as possible and to maintain him or her in the community as long as possible.

Now, interesting enough, among social scientists, biological researchers and health professionals, recent decades marked new directions in research which linked health status to social supports which are defined many different ways but which include spouses, children, neighbors and voluntary associations.

There is also a rapidly growing body of research which provides incontrovertible evidence that preventative health measures can keep seniors healthy longer so that their quality of life improves. It is in union headquarters, community and senior centers, church halls and other gathering places that older people get together for the purposes of meeting new people, developing comfortable relationships, sharing meals and obtaining support.

These places, although apparently social in nature, become major underpinnings for the lives of the elderly they serve.

Scientists have long noted in an association between social relationships and health. More socially isolated or less socially integrated individuals are less healthy psychologically and physically and more likely to die.

In the last decade, moreover, research has shown conclusively that social relationships, or the lack thereof, constitute a major risk factor for health rivaling the effects every well-established risk factors such as cigarette smoking, blood pressure, obesity and physical activity.

Locations where elders meet offer remarkable opportunities to combine preventive health measures and social contacts. In such places a whole series of preventive health practices can be established. Blood pressure screening, nutrition and weight reduction counseling, exercise programs, behavioral modification programs for smoking cessation and excessive alcohol intake are only a few of the preventative measures at a very minimal cost.

I emphasize, an effort can be undertaken to enable an older person to live a healthier life. In these familiar places, elders are able to participate in these programs with others who lend support and encouragement to their efforts. If I may use the program which I direct as an example, I can tell you that in 15 years of developing programs in history, literature, art, music, language, exercise, health education, just to name a few activities, I have seen hundreds, nay thousands, of city retirees come together, at first hesitantly, and then with greater enthusiasm and frequency, to expand their minds and warm their souls.

At a time when they suffer increasing losses, DC-37's retirees find renewed purpose in living, make new friends with whom they continue to associate by phone and by visiting, and thereby become more, rather than less, independent. They flock to our health seminars, listen intently, ask important and necessary questions and seek always to improve the quality of their lives in the full knowledge they that in so doing take control of their own lives even as they make their childrens' and grandchildrens' lives easier.

Many of our retirees are alone in this world. They come to the union depressed and fearful. Many come five days a week because they have discovered that there are people in this world who care for them. Of course they enjoy the classes, most came to maturity in the years of the Great Depression and had to forego higher education, but more importantly, their lives become enriched and happier as they come together in a warm and supportive community. Evidence that our retirees are healthier and happier because of this combination of social and preventive programs is anecdotal indeed, but it is bolstered by the scientific evidence to which I alluded to earlier.

Now, my program is not paid for out of public funds, and in any case reaches only a few thousand people. However, I cannot urge too strongly that you authorize funding to enable senior centers and other voluntary associations to undertake on a much larger scale the kinds of health prevention programs that have proved so beneficial to our retirees.

In 1987, Part F of Title 3 of the Older Americans Act was added as a health, education and promotion amendment, but it has remained unfunded. S510's authorization level of $25 million introduced by Senator Harkin is too low for a program of this importance. $100 million would more adequately meet the need.

I am fully cognizant of the budget constraints which you must always consider. But it is incumbent upon me to point out that of the billions spent on health care, less than one percent is spent on disease prevention and health promotion, and an even lower percentage is spent on health promotion for older persons despite the growing evidence that such programs have wide ranging and long lasting positive consequences for the social and physical well-being