VI. RECOMMENDATIONS

While there are serious problems in developing and improving services programs for the elderly on public assistance, the subcommittee feels there are positive steps toward this important goal which could be taken. It, therefore, offers the recommendations enumerated hereinafter with the hope that they will contribute toward attainment of the goal of more and better services for these older Americans. Recommendation No. 1: The subcommittee recommends that the Welfare Administration review its administratively established requirements (in connection with services programs) for keeping records, filing reports, and performing other paperwork chores to determine whether these requirements can be made less burdensome and time consuming.

There are two possible extremes in establishing red tape requirements for obtaining 75 percent Federal matching funds for services programs. First, the Welfare Administration might have insufficient requirements for keeping records, filing reports, and following other procedures of this type. It is obvious that this would be undesirable, since it would make it impossible for the Federal agency to determine whether the funds were, in fact, spent for the purposes for which authorized and appropriated by Congress, and, if so, whether they were wisely and effectively expended.

The other possible extreme would be to make such requirements so detailed, burdensome, and time consuming that the inauguration of services programs would be discouraged, or, where such programs were adopted, the valuable time of the caseworker and his supervisors would be so taken up with meeting such requirements that they would be required to reduce their time available for rendering the services. Again, the purposes of Congress would be frustrated, at least in part, inasmuch as it can be presumed that Congress never intended to authorize and appropriate funds merely to "make work" for social work personnel.

Evidence reaching the committee indicates that of these two extremes, the present administrative requirements more nearly approach the latter. In a perceptive analysis of the 1962 amendments. which appeared in the January 1965 issue of Public Welfare-The Journal of the American Public Welfare Association, Dwight O. Weiser, a caseworker in Fond du Lac, Wis., discussed this aspect of the implementation of the 1962 amendments. In his article which is reprinted in the appendix of the hearings beginning at p. 168, he commented:

The foregoing criticisms regarding accountability, interview reporting, and recording, all have one thing in common, they take time-time away from the client. Time spent with the client is time spent helping that client to help himself. At the worker's level of functioning, nothing is so valuable in performing service as the time spent in a face-to-face casework interview, to foster that "interplay of personalities through which the individual is assisted to desire and achieve the fullest possible development of his personality."

While not intending to dwell on basic casework methods, I do want to bring home the belief of most workers that if we are going to provide more service, we have to have more interview time with the client. We feel that the increased time spent at our desks as a result of implementing these amendments has in this respect ironically limited our effectiveness.

This difficulty was also reported by various State officials in answering the subcommittee's questionnaire, as shown by their answers in the appendix, beginning on p. 128. They were asked what Federal requirements, if any, have impeded the establishment of services programs for the elderly on public assistance. Some of their replies were as follows:

Requirement for reporting services statistically is cumbersome, time consuming, reducing the amount of service available to the recipient.-Director Raleigh C. Hobson of the Maryland State Department of Public Welfare.

The complex Federal financial and statistical processes required as conditions precedent to qualifying for additional Federal matching for "services," have adversely affected the ready availability of new funds that would supposedly facilitate the staff increases required for intensification of services.-Director Irving Engelman of the New Jersey Division of Public Welfare.

The complicated requirements for determining eligibility, the audit review, review teams, reports, etc., are extremely time consuming-Director Augustine W. Riccio of the Rhode Island Department of Social Welfare.

The State officials were next asked what Federal actions would stimulate and encourage the establishment of services programs for the elderly on public assistance. Among the replies were the following:

It should not be necessary to make a statistical count of the variety of services given, just a count of the persons receiving services for any purpose within a broad spectrum of needed services.-Director John E. Hiland, Jr., of the Delaware Department of Public Welfare.

There are too many reports and too much paperwork. Rules and regulations should simplify_administrative procedures to allow more time for services.Director V. E. Griffin of the Utah Division of Program Operations.

Simplification of recording, reporting, budgeting, and eligibility determination requirements***.-Commissioner L. L. Vincent of the West Virginia Department of Welfare.

Reduction of paperwork *** would enable the Departments to establish improved service programs for the elderly on public assistance.-Director Louis M. Groh of the Wyoming Department of Public Welfare.

The subcommittee makes no pretense of having the technical competence to suggest revisions in the Welfare Administration's paperwork requirements which would reduce the time and effort needed properly to apprise that agency of the use of Federal funds for services. However, it is impressed with the evidence that present requirements are too stringent, and it urges the Welfare Administration, with its own expertise in this area, to make a concerted effort to reduce such requirements to the barest minimum needed to carry out the purposes of Congress in its authorizations and appropriations for this purpose.

In fairness to the Welfare Administration, it should be noted that the State and local welfare agencies themselves are probably responsible for some of the paperwork burden in rendering services. They should cooperate fully with efforts of the Welfare Administration to reduce paperwork tasks, and should constantly be alert to opportunities to simplify and streamline procedures on their own initiative.

Recommendation No. 2: The subcommittee recommends that the services provisions of the Public Welfare Amendments of 1962 be amended to permit 75-percent Federal matching for the purchase from private nonprofit organizations of nonmedical services by State and local welfare agencies, with appropriate safeguards.

One impediment to development of services is the prohibition in the 1962 amendments against the purchase of certain services, such as homemaker services, from nongovernmental sources. As a consequence, the State or local welfare agency which wishes to provide services for its elderly public assistance clients must either purchase the service from another Government agency or create its own organization for doing so, even though there is already in existence a competent nongovernmental organization which is rendering the service for a charge. Where there are insufficient numbers of clients needing such service to make a public service agency economically feasible, this can mean that the welfare agency must face the dilemma of either refusing to provide the service or providing it at an exorbitant cost. In addition, serious problems of public administration can be encountered in organizing a public agency to render the service. One of these is whether to give those rendering the service civil service status, with all its technical requirements and fringe benefits which were intended for an entirely different type of personnel.

If this inflexible requirement is eliminated, as the subcommittee recommends, the State or local welfare agency will be free to choose whether to organize its own service agency to render the service, to purchase it from another Government agency, or to purchase the service from a private organization, whichever, in its own locality, offers the best hope of success, is most economical, and is easiest to administer.

This improvement has been recommended by the American Public Welfare Association, as reflected in the testimony of Mr. Lourie, its witness at our hearings.20

The need for this improvement was also indicated by several of the replies of State welfare commissioners to the subcommittee's questionnaire, reported beginning on p. 128 of the appendix. One respondent, Director Leo T. Murphy of the New Mexico Department of Public Welfare, commented:

I would like to see more flexibility in administration of public assistance, such as extension of vendor payments for purchase of services such as homemaker services.

Another, Director Raleigh C. Hobson of the Maryland State Department of Public Welfare, expressed himself in favor of repealing the present provision, in these words:

It not only implies a mistrust of private sources but also deprives persons least able to pay of taking full advantage of all that a community is offering.

The Commissioners stated that the repeal of this provision would enable their States to provide a number of services which they do not now provide, including homemaker services, legal services, educational services, recreational services, foster care, and psychological and counseling services.

20 Hearings p. 48.

The desirability of encouraging the purchase of nonmedical services for public welfare clients from private nonprofit organizations already had impressive support when the Public Welfare Amendments of 1962 were enacted. It had been recommended by the Advisory Council on Public Assistance, the Advisory Council on Child Welfare Services, and the ad hoc committee on public welfare of 1961. In its recommendation, the Advisory Council on Public Assistance stated:

The Federal Government should encourage each State to

(c) utilize services of voluntary agencies, when available and qualified, to serve recipients of public assistance;

Private as well as public organizations should be, we feel, an integral part of a comprehensive plan for helping the needy. From the beginning of settlement in this country, relatives, friends, neighbors, religious groups, and privately organized agencies have voluntarily helped the needy and otherwise unfortunate.

The number of voluntary agencies in large urban centers increased during the 20th century. However, since they were overwhelmed by the financial demands of the needy during the depression of the thirties, and since the provision of taxsupported financial assistance by the 1935 Social Security Act, their primary function has not been to give money. It is, rather to render a wide variety of services.

A few examples are counseling on personal problems and family situations; vocational guidance; foster home care for children or old people; group living facilities for those who cannot live alone; adoption services; day care centers for children of working mothers; and homemaker services that help children or old people remain in their own homes instead of going to institutions.

We are aware that voluntary groups and agencies often work together now. The more systematic and consistent this involvement becomes, we believe, the broader and deeper, in human terms, the public assistance programs deal with people whose problem is not poverty alone. They have a complex of problems, aggravated in each instance by poverty.

*** almost nowhere are there public assistance agencies with sufficient staff adequately trained to deal with the really difficult problems that recipients face.

Voluntary agencies also have their limitations of staff and financing. Thus, the job to be done is greater than the resources of both combined.

Coordinate planning of both agencies in a community is essential if their limited resources are to be most effectively used. In some instances the needs of people can best be met by referral of the individual to an appropriate agency-voluntary or public.

The wholehearted partnership of public and private agencies is the best assurance of a job well done.

When Ways and Means Committee Chairman Mills introduced H.R. 10032, the administration bill to initiate consideration of the administration proposals upon which the Public Welfare Amendments of 1962 were based, it contained a provision which would have accomplished the objective we favor. It would have permitted Federal matching for services which:

*** in the judgment of the State agency cannot be as economically or as effectively provided by the staff of such State or local agency and are not otherwise reasonably available to individuals in need of them, and which are provided by the State agency by contract with nonprofit private agencies * * *.

The Committee on Ways and Means, in reporting out a clean bill, H.R. 10606, deleted this section without comment (H. Rept. 1414, 87th Cong.). The Senate Finance Committee concurred in the House

committee decision, likewise without comment (S. Rept. 1589, 87th Cong.).

The subcommittee recognizes that there are respectable fears regarding the enactment of this proposal but feels that the adoption of appropriate safeguards can allay such misgivings. The first safeguard that should be adopted is a requirement that the services be purchased and paid for on a 100-percent basis of cost to the service agency, carefully determined through cost accounting. As another desirable safeguard, it should be required that purchase of services be on a case-by-case basis and not through a contract or other mass purchase arrangement. Third, there should be a limit upon the amount of service that can be purchased from any one private agency. These safeguards would prevent subsidies and dominance by public welfare agencies of private service organizations, and vice versa.

When the 1962 act was enacted, there were fears of purchase of nonmedical services from private agencies which subsequent experience has shown to have been exaggerated. Since then, purchase of medical services has operated smoothly without substantial difficulties of the type feared for purchase of nonmedical services. With all due respect for these fears, the subcommittee considers the basic proposal of Federal matching on a 75-25 basis for purchase of nonmedical services from private nonprofit agencies a sound improvement for which there is an urgent need if a full range of services to the elderly on public assistance is to be provided.

Recommendation No. 3: The subcommittee recommends that the Social Security Administration study the various proposals that would authorize contributions from Federal general revenues to the OASI program, and that it report to Congress its conclusions and recommendations resulting from the study of this issue.

The subcommittee is impressed with the testimony it has received from witnesses favoring this proposal.21 It offers a possibility for financing more adequate old-age insurance benefits, and for preventing more recipients of such benefits from falling within the definitions of poverty established for purposes of the "war on poverty" and other great national objectives.

While this is an attractive possibility, the subcommittee recognizes that it is a complicated proposal, and that no specific recommendation should be made with respect to it by this subcommittee, limited as we are in our jurisdiction. Instead, we solicit thorough consideration of it by the Social Security Administration, whose officials are skilled and experienced in the complications of social security financing. If they find it is sound, the groundwork may have been laid for making the social security system much more responsive to the economic needs of the Nation's elderly than it now is. This might also usher in a new era of services to the elderly.

There is nothing new about this proposal. In 1935 it was suggested as a possibility in the report of the President's Committee on Economic Security, which laid the framework for the Social Security Act enacted that year. The following statement appears in that report:

22

We suggest that the Federal Government make no contribution from general tax revenues to the fund during the years in which income exceeds payment from * Quoted in our finding No. 4, above.

22 Report of the Committee on Economic Security, H. Doc. No. 81, 74th Cong., 1st sess., p. 25.