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THE NATION'S RURAL ELDERLY

TUESDAY, AUGUST 17, 1976

U.S. SENATE,
SPECIAL COMMITTEE ON AGING,
Ida Grove, Iowa.

The committee met at 2:40 p.m., pursuant to notice, in the community hall, Third and Main Streets, Ida Grove, Iowa, Hon. Dick Clark presiding.

Present: Senator Clark and Representative Bedell.

Also present: Deborah K. Kilmer, professional staff member; David Harf, legislative assistant to Senator Clark; Margaret S. Fayé, minority professional staff member; and Donna Gluck, resource assistant.

OPENING STATEMENT BY SENATOR DICK CLARK, PRESIDING

Senator CLARK. If I may have your attention, we are delighted that so many of you came out on such a warm day. We are very happy to be here in Ida Grove.

This is an official hearing of the Special Committee on Aging. We have several scheduled witnesses and then we are going to try to have some time at the end for people in the audience to make statements or ask questions that they may have.

On my left is a stenographer who will record what is being said and we will then issue a printed transcript of these proceedings. If any of you are interested in getting a copy, it probably will be about a month or two before it is printed. I hope you will write to me or leave your name and address here and we will be very happy to mail

you one.

I might also say that we have a form for people who do not get the opportunity to testify here but who may have something they would like to say. It simply says: "If there had been time to testify, we would like to have said the following." That will be made a part of the official record of this hearing as well, so anyone and everyone who wishes to participate in that way, may.

1

Our subject at this and five other hearings that we are holding this week in Iowa, Nebraska, and South Dakota is "The Nation's Rural Elderly." and I emphasize the word "rural." I suggested that such hearings be held about a year ago since, as I said at our opening hearing yesterday in Winterset, we can't hope to know what is happening in rural America if we simply stav in Washington, D.C.; that is not rural America. Our chairman, Senator Frank Church,

1 See appendix 3, p. 243.

of Idaho, agreed with this suggestion. The committee will visit many different States of the Union and talk to people in rural areas.

We are starting here in Iowa. As I said, we were in Nebraska this morning and we are going to be going to South Dakota later tonight for hearings tomorrow, and then back in Iowa again.

I want to make my statement very brief because we have a number of witnesses. We also want to hear from Congressman Berkley Bedell. So let me just try very briefly to make three or four points.

ARE THE PROGRAMS WORKING?

One of the prime objectives of these hearings is to determine the responsiveness and the practical help provided to the rural elderly by programs such as the Older Americans Act, medicare, housing programs, transportation programs, nutrition programs-all of these programs that have been set up. We would like to know whether they are working, whether you think they ought to be kept, whether you think they ought to have less funding or more funding, whether there is too much redtape-anything that you feel you want to say about it by way of trying to improve these programs.

There is a real need for this kind of evaluation because, in our view, we failed to do what we said we were going to do at the 1971 White House Conference on Aging. We really stopped at the beginning of this decade and said, "What is it we want to accomplish in the area of aging?" We have not yet arrived at a national policy on aging, particularly on rural issues. Part of the lag has been caused by lack of leadership in the executive branch. Another part has been caused by economic uncertainties that have been related to such things as inflation and unemployment.

Nationally, about 8 million people-that is, about 28 percentof all the people in this country over the age of 60 live in rural areas like Ida Grove, but in some States that percentage actually rises to as high as 50 percent. In fact, here in Iowa about 45 percent of all people over 60 live in small towns in the countryside. So there are major differences among the States. Even though each of our hearings has a rural theme, we find that there are special circumstances in each locality that call for close inspection. That is why we are here in Ida Grove.

DELIVERY OF HEALTH SERVICES

We will be especially concerned here about the lack of health services and the problems with delivery of services of this kind into rural areas. Shortage of health services in this country has reached a point, in my judgment, of extreme concern. In 138 rural counties nationwide residents do not have a single resident doctor. Now that figure is up about 37 percent-over a third from what it was in 1963. Unfortunately, it is getting worse, not better. In Iowa, the rate has dropped well below the national average.

Here in Ida County the shortage of medical care is particularly acute. The county has been designated as a medical shortage area by the Department of Health, Education, and Welfare, and today we are going to hear from health professionals of this area who will describe the barriers for the elderly persons to obtain adequate health care.

We also hope to hear from some successful programs to try to combat these barriers. The other panel of witnesses will detail the difficulties in providing any service to a rural area: The geographical obstacles, the low density of population, and the cost factors involved in providing services to the rural residents. This is what we will be discussing.

In a hearing last spring in Washington, D.C., on this very subject, I heard a great number of recommendations for removing obstacles of delivery service under the Older Americans Act. I hope that our witnesses today will have additional suggestions for improving the Older Americans Act and other Federal statutes.

Lastly, I would like to say that with the Older Americans Act programs, and in all of the others, the rural elderly must feel that no one is dictating to them. The progress that we are making in aging is due in no small part to the initiatives and the determination of older persons who are making things happen. The Federal share of their effort, if one is needed, ought to be part of the solution and not part of the problem. I think we have made much progress in the area of assisting elderly people, primarily because older people have organized themselves. Government responds to that kind of organization, whether it is at a local level, a State level, or a national level, and I congratulate you for that.

Now I would like to ask Congressman Berkley Bedell of this congressional district if he would like to make some comments before we start with the panel.

STATEMENT OF HON. BERKLEY BEDELL, A REPRESENTATIVE IN CONGRESS FROM THE STATE OF IOWA

Representative BEDELL. Thank you, Senator Clark.

On behalf of the people of northwest Iowa in this sixth district and, more particularly, on behalf of the people that are here and our senior citizens all across the area, I want to tell you how appreciative we are of the fact that you would take your time and the committee's time to come out here, as you state, to try to learn firsthand about the problems that exist in the field.

I would like to echo what you said. I think so frequently we find people who think they know what the problems are in their organization or out in the field. I can tell you from having been in management myself that the only way you find out what the problems are anywhere is to get out there among the problems, and we certainly are grateful that you would take the time to do this.

I would like to say that I think it is important that we concern ourselves with the lives of all of our people in America, and some of those people are indeed senior citizens. So frequently I fear that they tend to be forgotten as we look at some of the issues that may be somewhat more exciting.

As we look at our senior citizens, I think we have two important things that we need to do. First, we need to help so that they can live meaningful lives. Second, I think we need to tap the assets and the capabilities that they have or that they can contribute. If any of you question that at all, you should have been here a little earlier to see the band that we had up here. Somebody mentioned to me, "Well,

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