RESEARCH IN AGING AND NUTRITION PROGRAMS FOR THE ELDERLY, 1971 MONDAY, JUNE 14, 1971 U.S. SENATE, SUBCOMMITTEE ON AGING OF THE COMMITTEE Washington, D.C. The subcommittee met at 940 a.m., pursuant to call in room 4232, New Senate Office Building, Senator Thomas F. Eagleton (chairman of the subcommittee) presiding. Present: Senator Eagleton. Also Present: Senator Charles H. Percy. Committee staff member present: James J. Murphy, counsel to the subcommittee. Senator EAGLETON. Good morning, ladies and gentlemen. The Subcommittee on Aging of the Senate Committee on Labor and Public Welfare is now in session. The subcommittee held 2 days of hearings on June 1 and 2 to hear testimony on legislation relating to two disparate issues: (1) Biomedical and behavioral research relating to the aging process, and; (2) nutrition programs for the elderly. Witnesses appearing on behalf of the administration were originally scheduled to appear at that time. However, at their request that appearance was postponed to allow additional time for the formulation of the administration's position on this legislation. Today's hearing will be devoted exclusively to the administration witnesses. With respect to S. 887 and S. 1925 we heard witnesses attest to the decline in funds allocated for aging research. It seems remarkable, in light of the miniscule amounts previously provided for such research at the National Institutes of Health, that cuts have been recommended that would limit even further biomedical research in this area. Under the administration's budget proposal, the amount available for research grants will be reduced from $3,592,000 to $2,251,000. Fellowships will go from $263,000 to $251,000. The result will be that no new aging research grant awards can be made in fiscal 1972. The request for research funds under title IV of the Older Americans Act was recently increased to $2.8 million-the same figure as last year-only after hearings held jointly by this subcommittee and the Special Committee on Aging demonstrated the deplorable effects of the reductions originally proposed. The legislation which the subcommittee is considering would not, of itself, provide increased appropriations for aging research. It (243) would, however, remedy the existing fragmentation of responsibility for such research and eliminate the duplication of effort, lack of coordination and gaps in overall approach. It would introduce, for the first time, a systematic plan and centralized focus for the conduct of this research. These bills look to the future in an effort to improve the lot of the elderly through the acquisition of a greater knowledge about the problems that most commonly afflict them. The other bill we are considering, S. 1163, looks to their immediate needs through the establishment of nutrition programs for the elderly under the Older Americans Act. Congress recognized the special nutritional problems of the elderly in 1968 when it earmarked funds, under title IV of the Older Americans Act, for a special research and demonstration program to improve nutritional services for the elderly. The demonstration projects conducted under this authority are now being terminated, leaving a large gap in the range of services provided for the elderly. However, our experience with these programs provides a sound base for the establishment of a permanent program of the kind embodied in S. 1163. Such a program has been recommended by both the Panel on Aging of the 1969 White House Conference on Food, Nutrition, and Health, and by the President's Task Force on the Aging in its April 1970 report. The Administration on Aging, it its preliminary evaluation of the demonstration nutrition programs, has reported that "the provision of meals in a group setting is a highly desirable approach because it fosters social interaction, facilitates the delivery of other services, and meets emotional needs of the aged while improving their nutrition." We welcome this opportunity to hear the administration's views on these bills. I, for one, am extremely hopeful that the witnesses today will give us the benefit of constructive comments and suggestions that will contribute to our effort to meet these problems afflicting so many older Americans. We have as our witnesses Mr. Stephen Kurzman, Assistant Secretary for Legislation, Department of Health, Education, and Welfare, and he is accompanied by Mr. John B. Martin, Commissioner of the Administration on Aging; and Dr. Gerald La Veck, Director of the National Institute of Child Health and Human Development; Dr. Charles U. Lowe, Associate Director for Intramural Research, National Institute for Child Health and Human Development; Dr. LeRoy E. Duncan, Director, Adult Development and Aging Branch, National Institute of Child Health and Human Development; and Mrs. Isabelle M. Kelley, Assistant Deputy Administrator of the Food and Nutrition Service, Department of Agriculture. Senator Packwood of Oregon has asked me to welcome you on his behalf, as well as mine. Senator Packwood had planned to be here today to hear the testimony of this distinguished panel of adminisistration witnesses but other committee responsibilities have prevented him from attending. Mr. Kurzman, are they going to appear after you? I don't know what procedure you wish. STATEMENT OF STEPHEN KURZMAN, ASSISTANT SECRETARY FOR LEGISLATION, DEPARTMENT OF HEALTH, EDUCATION, AND WELFARE; ACCOMPANIED BY JOHN B. MARTIN, COMMISSIONER, ADMINISTRATION ON AGING; AND DR. ROBERT MARSTON, DIRECTOR, NATIONAL INSTITUTES OF HEALTH Mr. KURZMAN. Thank you, Mr. Chairman. We very much appreciate your courtesy in permitting the administration witnesses to appear on a single day rather than on separate days for these bills. Mr. Chairman, I am pleased to appear before this subcommittee to present the administration's position on three bills: S. 1163, a bill which proposes to establish a national nutrition program for the elderly; S. 887, a bill which proposes to establish a National Institute of Gerontology; and S. 1925, a bill which proposes the development of a comprehensive Federal research strategy in aging. I am accompanied by John Martin, Commissioner on Aging, and Dr. Robert Marston, Director of the National Institutes of Health. The hearings before this subcommittee come during a period of increasing public and congressional interest in the very wide range of problems related to the process of aging, including the physical and psychological process, and—perhaps more important to many—the human and social problems of aging. I should like initially to direct my testimony to the problems of the aged generally and our strategy toward them. The White House Conference on Aging is scheduled for the end of this year, the first such conference since 1961. We expect that the conference will provide us with guidance and recommendations to help develop a national strategy for meeting the problems of the aging. This strategy will provide a framework for suggesting appropriate changes in the Older Americans Act which expires in June of 1972. One of the most important elements of this administration's domestic policy is reform of income maintenance programs. Through an effective income strategy, many health, nutrition, and related problems will be alleviated to a significant extent. Greater income benefits to the elderly should serve to reduce malnutrition since malnutrition is often related to poverty. H.R. 1, recently reported by the House Ways and Means Committee, will have the most significant impact on the well-being of the elderly of any single piece of legislation in decades. The administration's welfare reform proposal embodied in this legislation will provide a floor of income to needy adults who are aged, blind or disabled, administered by the Social Security Administration. The income floor for an individual under this measure will rise from $130 per month in July 1972, when the program is scheduled to go into effect, to $150 by July 1974. Couples will be eligible for $195 per month beginning July 1972 and $200 the following July. These benefit levels substitute cash for food stamps. H.R. I also contains many of President Nixon's social security initiatives designed to improve the lives of virtually all older Americans. A far-reaching change is that social security benefit increases would for the first time be tied by law to increases in the cost of living. As the Consumer Price Index rises, unless Congress has enacted a benefit increase, social security benefits will rise automatically, thus protecting the elderly against inflation. As a downpayment on this cost-of-living adjustment, a 5-percent benefit increase would be provided beginning in June 1972. Another major change under H.R. 1 calls for an increase in widow's benefits. A widow would generally get a benefit equal to the benefit her husband would be receiving if he were still living, rather than 822 percent of his age 65 benefit as under present law. Finally, for older persons who wish to continue working, H.R. 1 liberalizes the amount of annual earnings exempt under the retirement test. This amount would be increased from $1,680 to $2,000 for 1972 and thereafter would be adjusted to increases in wage levels. Where annual earnings exceed the exempt amount, benefits would not be reduced by more than $1 for each $2 of earned income. In addition to its income maintenance aspects, a provision in H.R. 1 also directly provides for nutrition services for the elderly. Under this provision, nutrition services are included as one of the social services a State may elect to provide to its older citizens, with 75 percent Federal matching funds. By making it explicit that this definition of social services includes nutrition services, the States are encouraged, if they so desire, to launch a program of nutrition services for their elderly citizens. I would like to direct myself now to S. 1163. S. 1163 would utilize a categorical grant approach to carry out a national nutrition program of extensive scope and complexity. The Federal Government, under a 90-10 matching formula, would underwrite the costs incurred by local projects for equipment, labor, management, supporting services, and food. Grants to meet these costs would be awarded by a State agency. To be eligible for Federal funds, a State would submit a plan which would guarantee that any nutrition project it supported would provide at least one hot meal per day for elderly participants, and that that meal would contain a minimum of one-third of the recommended daily dietary allowance for an elderly person. Under the program, one hot meal would be provided at least 5 days a week. The proposed national nutrition program would be administered by the Administration on Aging, a bureau within the Social and Rehabilitation Service of the Department of Health, Education, and Welfare. The proposed nutrition program in S. 1163 is based on the experiences of a series of demonstration projects supported during the last 3 years by the Administration on Aging. Thus the experience requires close examination. The fiscal year 1968 budget of the Administration on Aging contained $2 million for demonstration projects under title IV of the Older Americans Act to test alternative means of coping with the nutrition problems of older persons. All of the projects funded have shared one common characteristic: the provision of group meals in a social setting. As the projects matured, outreach to locate older people in need of nutrition problems services and nutrition education were added to most projects. Many of the projects have also attempted to include such supportive services as transportation, recreation and health and social service information and referral. Briefly summarized, we can say on the basis of these projects that group dining is a useful technique for delivering nutrition services to the elderly and that outreach is essential to any effective program of nutrition services to the elderly. Other important components include transportation, relationships with the other community agencies, and opportunities for older persons to be employed or to render volunteer service. In addition, we have learned that older participants want to pay at least a part of the cost of their meals. However, a categorical feeding program for the elderly can not be effective in meeting their multiple needs. Service programs need to be comprehensive. Adding another categorical program with a focus on a small piece of the problem faced by the elderly will only complicate an already tangled service delivery system. We are working within the Department to develop methods for delivering services on a more comprehensive basis to the needy and others who require assistance in obtaining services, with emphasis upon integrating the various service delivery systems. The passage of a service program which establishes still another system to be integrated into a comprehensive system for the aged only creates more difficulties in achieving that objective. Thus, just as we were opposed last fall to H.R. 17763, a similiar measure, because of its narrow focus on one aspect of problems facing older people, we are equally opposed to S. 1163 for the same reason. In addition, we believe the costs of a national nutrition program for the elderly modeled on the AOA demonstration to date would be prohibitive, if the goal on the program is to reach a substantial number of older persons who would want such services. Moreover, in the AOA projects the meal cost is only part of the cost of nutrition and related services. Other costs include ancillary services, such as transportation and outreach, and administration. Thus, the total cost of project activities, including meals, varies greatly and is beyond the cost of merely providing meals. We believe another sound reason for opposing the enactment of S. 1163 at this time is that as of now we do not know how to reduce these costs. We are actively engaged in trying to discover whether sufficient economies of scale and other management efficiencies will result from large scale delivery of nutrition services. We also need to find out if there is some way that the private sector can be involved in the provision of nutrition services as a way of reducing costs of nutrition services. I understand that previous witnesses have described offpeak-hour meals furnished at a reduced price by cafeterias in various parts of the country. Finally, we believe that additional research must be still undertaken to test and validate the proposition that not only are nutrition services effective, but that they are more cost effective than other means for reducing isolation amon gthe elderly. While we do not support S. 1163, we do intend to continue to experiment with nutrition projects for the elderly-but focused on more comprehensive objectives. We are presently developing a plan to continue funding approximately 21 nutrition demonstrations for a fourth year. You will be pleased to know that while we are deciding the best administrative means of effecting this refunding we have also supplemented existing grants so that older persons who have been participating in projects are not denied meals until refunding is accomplished. We believe that with restructuring to include a heavy |