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SERVICES TO THE ELDERLY ON PUBLIC

ASSISTANCE

A Report by the Subcommittee on Federal, State, and Community Services to the Special Committee on Aging

I. INTRODUCTION

2,125,810 Americans over 65 were receiving old-age assistance in October 1965. According to figures supplied by the Welfare Administration, these were distributed as follows among the States and other U.S. jurisdictions: 1

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The old age assistance program was first authorized by law as titles I and XI of the Social Security Act of 1935. Since then it has been a joint Federal-State program of matching grants administered at State and local levels by State and local welfare agencies. At present, the Federal share in State payments of OAA equals thirtyone thirty-sevenths of the first $37 of a maximum average monthly payment of $75 per recipient plus a proportion (the Federal percentage) of the next $38 of such average payment, which varies according to the average per capita income in the State for the most recent 3 years, except that the Federal percentage in any State cannot be less than 50 percent or more than 65 percent. The Federal share of the costs of State and local administration, exclusive of the costs of

1 The complete table appears on p. 167 of the appendix of "Services to the Elderly on Public Assistance," hearing before Subcommittee on Federal, State, and Community Services, Senate Special Committee on Aging, 89th Cong., 2d Sess., hereinafter referred to as "Appendix."

providing certain services discussed in this report and the costs of staff training under certain conditions, is 50 percent.

The Subcommittee on Federal, State, and Community Services has been aware of efforts to go beyond mere cash assistance to recipients of old-age assistance and to provide needed services for them. In undertaking the study and hearings on which this report is based, it was interested in finding out what types of services are being rendered the elderly on public assistance, the extent to which Federal statutory provisions on services have been effective in their objective of encouraging and stimulating the provision of needed services to this segment of our Nation's elderly, and what, if any, legislative changes are needed to perfect Federal statutes on this subject and to make them more effective in contributing to the goal of happiness, selfsufficiency, and independence in old age. To answer these and other pertinent questions on this subject, the subcommittee conducted 2 days of hearings 2 in Washington, D.C., on August 18 and 19, 1965, and solicited additional expert advice and opinions from those who are best qualified to advise on the subject under consideration. In offering the findings and recommendations of this report, it trusts that they will be helpful in improving services for our Nation's elderly on public assistance.

2 "Services to the Elderly on Public Assistance," hereinafter referred to as "hearings".

II. HISTORICAL BACKGROUND

Until recent years, the objective of the old-age assistance program was almost exclusively to provide money assistance. To administer such a program of money assistance, it was necessary to employ social workers to maintain personal contact with recipients to determine need and eligibility and to prevent fraudulent claims. Over the years, social workers and their supervisors found that recipients had needs which were not being met by the mere dispensing of cash. There was a growing realization that those needs could only be met if certain services were developed and provided by old-age assistance programs. Applicable Federal statutes did not specifically authorize Federal matching for providing such needed services. Matching could only apply to the cash grants and to the cost of their administration. In effect, there was Federal matching to the extent that services could be provided by caseworkers in the course of their work on the cash grants. States which recognized the need for services and which developed State service programs that went beyond the services provided by social workers employed primarily to administer cash grants had no alternative to bearing the total costs of such service programs. Despite the apparent lack of authorization for Federal matching for service programs, during this era it was recognized at the Federal level that the spirit and purpose of public assistance laws were well served by the rendering of certain services, and a few types of services were administratively approved for 50-50 Federal matching. Examples of services thus approved for matching during this era are information and referral and short-term counseling.

In 1956 Congress gave official recognition to the desirability of developing service programs for public assistance recipients by enacting a provision as part of the 1956 Social Security Amendments which specifically authorized 50-50 Federal matching for services including direct services (e.g., short-term counseling and intensive casework service); organized special resources (e.g., homemaker service, fosterhome finding for the aged); community planning, and enabling services and facilities (e.g., use of medical and legal resources limited to consultation, diagnosis, and planning).

While the 1956 amendment was helpful in developing service programs, there was a growing opinion that the Federal Government should go beyond support of service programs initiated by the States and should actively encourage and stimulate the development of such programs. In 1962, the administration recommended amendments to this effect which formed the basis for the service provisions of the "Public Welfare Amendments of 1962," (Public Law 87-543). Under these provisions, States were offered matching funds at the rate of 75-percent Federal contribution for service programs. When President Kennedy signed that legislation on July 25, 1962, he expressed the philosophy of its service provisions when he described the new law as

*** a new approach stressing services in addition to support, rehabilitation instead of relief, and training for useful work instead of prolonged dependency.

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III. SERVICES RENDERED RECIPIENTS OF OLD AGE

ASSISTANCE

Finding No. 1: A wide variety of services have been rendered to the elderly on public assistance since enactment of the Public Welfare Amendments of 1962.

Services rendered pursuant to the services provisions of the Public Welfare Amendments of 1962 are of two general types: "prescribed services" and "optional services." For a State to qualify for 75percent Federal matching for services, it must provide the "prescribed services," which are those administratively designated at the Federal level as the most important to be rendered. Forty States currently provide the "prescribed services," and thus qualify for 75-percent Federal matching. They are Alaska, Arkansas, California, Colorado, Connecticut, District of Columbia, Florida, Georgia, Hawaii, Idaho, Illinois, Indiana, Iowa, Kansas, Kentucky, Louisiana, Maine, Massachusetts, Minnesota, Missouri, Montana, Nebraska, Nevada, New Hampshire, New Jersey, New Mexico, New York, North Dakota, Ohio, Oregon, Pennsylvania, Rhode Island, South Dakota, Tennessee, Utah, Vermont, Virginia, West Virginia, Wisconsin, and Wyoming. There are four types of "prescribed services":

(a) Protective services, which are those provided older or disabled persons who because of mental or physical condition are incapable of managing their own affairs;

(b) Services provided older persons to enable them to remain in their own homes outside institutions or to assist them to return from institutions to their own homes;

(c) Services to the blind and disabled with potentialities for self-support; and

(d) Short-term services to all applicants for public assistance under adult categories.

Seventy-five percent Federal matching can also be obtained for "optional services," but only if the State is providing the "prescribed services." If it does not provide the "prescribed services," it can nevertheless qualify for 50-50 matching for "optional services."

The principal types of "optional services" now being provided to older adults in the program (e.g., under titles I, X, XIV, and XVI) are as follows:

(1) Adults with potentials for self-care.-Aged, blind, or disabled persons with physical or mental impairment affecting their mobility or community participation. Services are provided for such individuals with respect to home management, meeting daily needs for care, enlistment of relatives, and securing and using medical resources.

(2) Adults isolated or estranged from families.-Adults separated from family and living in isolated circumstances. Services are provided which encourage communication with the family and participation in community activities.

(3) Services under medical assistance for the aged.-To allow aged persons with medical needs to receive all of the prescribed services.

(4) Services for former or potential applicants or recipients.Services to such individuals include information referral service, services to secure and maintain appropriate living arrangements or care, protective services, services in planning use, and management of financial resources and in addition, for titles X and XIV, services to maintain or secure employment.

Finding No. 2: Despite the growth of services programs in the States since 1962, the States are not approaching full development of services for the elderly on public assistance, and there remains much potential for growth.

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Dr. Ellen Winston, Commissioner of Welfare, testified at our hearings: *** the response of the States to date is beyond expectation

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While there is ground for encouragement over development of these services, it is clear to the subcommittee that there remains much potential for growth.

Along this line, Norman V. Lourie, executive deputy secretary, Pennsylvania Department of Public Welfare, who spoke for the American Public Welfare Association at our hearings, testified:

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Present services are thinly scattered: a foster home program in 5 counties of a State, homemaker services in 13 counties in another State, protective services for 500 or 600 persons emerging from a mental hospital in a State; day centers located in a few of the major cities of a State, and so on.

The 1962 Public Welfare Amendments sought to take advantage of an important characteristic of public welfare; the fact that there is a public welfare office in every county in the United States. Within this unusual system, matched only by our vast educational system in scope, there lies the potential for creating a complete social welfare service system for the aged. In the testimony referred to, Dr. Winston also noted the spottiness of our social services. "This," she said, "is to be expected in a field so new and undeveloped, but the situation must change. We do not expect every man to dig his own water well. Women now bear their children in hospitals, although not so long ago childbirth took place at home. In the same progressive manner, an advanced society must provide services in the community to older persons, rich or poor.'

The potential which existed when the 1962 Public Welfare Amendments were passed by the Congress still exists and is being developed.

It is estimated that $26 million will be expended from the fiscal year 1966 appropriation 5 "Grants to States for Public Assistance" for the Federal share (75 percent) of matching for services to recipients of old-age assistance as provided for under the authorization of the Public Welfare Amendments of 1962.

Hearings, p. 4.

4 Hearings, p. 50.

Title II, Public Law 89-156 (Appropriation Act for Departments of Labor, and Health, Education, and Welfare, and related agencies).

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