Mrs. SNELL. May I interrupt to say the first two ladies mentioned are home health aides in the county.

Mr. KRICK. Yes.

They came to help me out then in any way, shape, or form.

Then in May I got my heart attack with my diabetes and could not care for my wife. I went to the hospital for 23 days and in the meantime they took Rose, my wife, to the nursing home-Morningside Manor June 7, 1975. She stayed there for 10 months before she died on April 7, 1976. I came home from the hospital after 13 days. In the meantime the flu got bad and took my wife on April 7, 1976. We would have been married 57 years on April 9, 1976. She was buried on the 10th. She was 78 years old and would have been 79 the 15th of October. I am going on 83. I was born January 9, 1894.

I have had this social service ever since my wife died. They have been a wonderful help to me and I cannot praise them enough. I cannot say enough for the care this social service has provided. I cannot thank Mr. Tobin, Phyllis Fick, Larry Bayliss, and Delores Peffer, Joanne Segebart, and Mae Brookbank enough for their wonderful help. I feel I owe something to the social service and these wonderful people who can't do enough for the aged.

I thank Dick Clark and his staff for their help. They have done a good job for the aged. We all get there sooner or later. Phyllis Fick has done a good job for the aged in this social service work. I also want to thank my daughter Barb, her husband, Al, my sister-in-law, and all of my friends.

I thank you all for listening to me.

Senator CLARK. Thank you very much, James, and thank you for your kind comments.

Mr. KRICK. This is my first talk. I don't need to tell you that-you know it. I did the best I could, and I am surely glad to be here and help you out. There are just a few here a little older than I am. My friend over there, John Shultz, is 87. Is that right, John, 87?

Mr. SHULTZ. Eighty-eight.

Senator CLARK. Eighty-eight he said.

Mr. KRICK. I'm just a kid at 83.

If you ask me anything in the transfer business or gray line, I could have done it-most anything of that kind. I had 46 years there. I don't believe there are very many in Ida Grove that I have not been in contact with one way or the other.

I want to thank you for listening. Excuse me for my bad language.

"BEST KIND OF TESTIMONY"

Senator CLARK. I think that was the best kind of testimony that this committee could receive about the value of the chore aides and the value of the homemaker services, because it has made it possible for Mr. Krick to stay in his own home for a very long period. This simply would not have been possible had we not had these programs. I would like to ask Dennis Tobin and Anne Snell a couple of questions before we see if there are any questions or comments from the audience.

First, Mr. Tobin. I recently conducted a survey of the title XX services that are provided to Iowa. We wrote to virtually everyone who was associated with this program and one of the expressed points

of concern was the State matching requirements of 25 percent. In other words, the Federal matching share is 75 percent and the State share is 25 percent in this program.

My question is this. Is 25 percent a reasonable share, in your view, or is it too difficult for a State like Iowa to come up with this amount?

Mr. TOBIN. I don't know what the official opinion is supposed to be, Senator Clark, but we have not found the problem to be getting match money. Our problem has been to run into the federally assigned maximum for the State. We have been able to raise the match money wherever we made people aware of the programs and how they would function. We have a breakdown in Iowa two different ways. Many programs are matched by State dollars, many of them are local dollars and there has been some problem in some areas with the local dollars-but in this area that has not been a big problem. Senator CLARK. Good.

Now the second question. What percentage of your service program participants are elderly? In other words, of the services that you provide, to what degree do you serve the elderly as distinguished from others?

Mr. TOBIN. I don't believe I could tell you the absolute statistics, but I think the statistics that Anne came up with would come awfully close. The vast majority of the services we provide are either to the elderly or from the handicapped.

Senator CLARK. Another question. We just heard from Mr. Krick about the benefits of the chore services and homemaking. Can you be more specific about just what that means? If they go into the home once, twice, or three times a week, what do they do? What does a homemaker do, or what do you do with the chore aides?

Mr. TOBIN. There is a basic difference between the three functions. A chore service person, at least the way we are using it, is generally a neighbor lady or a friend who can come in and do any of the simple daily tasks such as heavy cleaning, helping someone go for the groceries, and that type of thing-the type of task that a neighbor or a friend could do. We do this on a contract basis, and on an individual basis.

The homemakers, when they are functioning as homemakers, do skilled types of functions: Teaching people how to do tasks of daily living, teaching some how to function when they are physically handicapped-for example, helping them prepare special diets-this type of thing.

GRAY AREA IN SUPERVISION

There is a gray area between the homemaker and the health aide, however. When they are doing specifically health aide work they are under the supervision of the public health nurse and she has received orders from a physician. So when they are doing health aide work they are doing the types of things required for health reasons to keep them in their own home.

Senator CLARK. Fine. Thank you very much.

I would like to ask Anne Snell a question. As I understand it, approximately 90 percent of all the persons that you serve as a public health nurse in Ida County are elderly people.

Mrs. SNELL. That is correct.

Senator CLARK. Are you trained to care for the elderly specifically in that kind of program?

Mrs. SNELL. All of the public health nurses have basic nurses training, of course. Our goal is to find nurses who have public health experience or who have public health training in the program, but this is not always possible. So through some of our area technical schools, as well as the State department of health, in-service training is given so that they do learn while they go along. There does not seem to be any problem finding qualified personnel.

Senator CLARK. Suppose someone here at some future time wanted the services of a public health nurse. When you find someone, do you make regular calls or do you simply respond to telephone calls? How

does that work?

Mrs. SNELL. Anyone may be referred to the public health nurse in the county. Many of them are doctor referrals, the patient, the patient's family, or a concerned neighbor.

Senator CLARK. How do they reach you?

Mrs. SNELL. Just simply call the phone number in the phone book. There are many different ways-through newspapers, and so on. They call the office, the public health nurse makes a home visit to assesss the situation and, upon an assessment, if she feels that she can provide a service she then contacts the family physician for orders. The public health nurse only works under direct supervision of the family physician unless it is general health supervision, and then she may function without a physician's orders.

Senator CLARK. Good.

I want to thank this panel very much. Please stay seated because we are going to see if there are any comments or questions from the audience.

I do want to thank you very, very much. I know that it is very warm and we are not going to take more than about 5 minutes or so. There is a microphone up here in the center and anybody that would like to walk to the microphone and make any statement or ask any questions, we welcome you to do so. I will then see if Congressman Bedell has anything to say. I am going to take about 30 seconds and that will complete the program.

Come up to the microphone and identify yourself for the record. STATEMENT OF BOB TORRY, CHAIRMAN, CITIZENS ADVISORY COMMITTEE, CHEROKEE COUNTY HOMEMAKER/HEALTH SERVICE, CHEROKEE, IOWA

Mr. TORRY. Senator Clark, Congressman Bedell, I am Bob Torry, a farmer in Cherokee County. I have been on the health board of Cherokee County since it started. I have been on the homemaker service since that started. I report that both of our organizations in Cherokee County have been very successful.

What we need is a comprehensive program which will meet the social, psychological, and physical needs of the homebound elderly. These people who are testifying are not as concerned with health programs because they are well enough to be here. The ones that I am talking about are the ones that are found in their home.

As chairman of the Citizen's Advisory Committee for the Cherokee County Homemaker/Health Service, I respect fully recommend that Federal assistance is necessary for continuance of this vital service to the elderly and handicapped.

The Cherokee County Homemaker/Health Aide Service is designed to place responsible workers in homes where illness, disability, or other crisis threatens normal family living. Aides are assigned to the home to perform whatever duties are required to meet the needs of each individual situation.

While services are available to all citizens in need, the majority of cases involve the elderly. In the month of June, 50 individuals were provided this service in their homes. Forty-seven of the individuals served were over 60 years of age. Seventeen were unable to pay full cost for services provided. Consequently, funds generated from other sources provided the resource for subsidizing the services for those financially incapable of paying full cost of services provided.

INFLATION CAUSES FUNDING PROBLEMS

We have mobilized funds to subsidize the program for those in need, such as social services, department of health, Commission on Aging, Cherokee Board of Supervisors, Mid-Sioux Community Action Agency, and citizens' contributions. Any decrease in Federal or State funding plans place an added burden on local resources. Local resources are inadequate to sustain the homemaker/health aid service. Ever-increasing costs, because of inflation, complicate the problem. This inflation really cats us up.

The Cherokee County Homemaker/Health Aide Service has citizen support in evidence by financial assistance from the county board of supervisors and concerned citizens.

We feel the program has a twofold benefit. First, many of our senior citizens can remain in their homes living with dignity and respect for an indefinite period when a helping hand is provided by the homemaker/health service. For many, the only other alternative would be institutionalized facilities. Our program is a human approach to satisfying a need for many of our elderly and others plagued with sickness.

Second, we feel it is good economics to provide this service within the home as compared to institutional care. A few hours of aide service in the home each week will satisfy the needs for many of our elderly.

We feel our citizens and county officials have responded to the need by providing financial assistance within their capability. As stated previously, local resources are inadequate to sustain the program. Without continued Federal assistance, the services of the program will have to be curtailed or discontinued.

It is the concern of the advisory group I represent that services should be expanded, but limited funds compel us to do the best we can with what we have.

I thank you.

Senator CLARK. Thank you very much. That was a very good state

ment.

I wonder if there is anyone else in the audience who would care to say anything or ask any questions.

Rick Motz.

Let me say, by the way, that if you want to speak for only a moment or two, if any of you have a longer statement we will put that in the record as if given.

So you go right ahead, Rick.

STATEMENT OF RICK MOTZ, DIRECTOR, AREA AGENCY ON AGING FOR AREA IV

Mr. Morz. The first thing I want to say to you is that now is your chance to speak up. The second thing I want to say, and you already know that, I am Rick Motz. I am the director of the area agency on aging for area IV.

First of all, thank you, Senator Clark, and Congressman Bedell also, for coming to our area to listen to our concerns regarding aging programs. Your efforts at the National and State level on behalf of older Iowans are to be commended.

Aging programs have come a long way during the short time in which Older Americans Act funds have been available to our area. Transportation is evolving from a one-county, one-bus system to a multicounty, tristate system. Senior centers or clubs exist in almost every town of area IV. Other programs, such as meals-on-wheels, homemaker-health, and winterization programs have enjoyed similar

success.

We have been involved with the aging concept for about 3 years now. I have two concerns regarding programs for older persons. First, I would recommend to you the elimination of the 25 percent local public cash match requirement. The rule, in effect, does not recognize cash match from entities other than local taxing bodies. For example, if a program needed a total of $10 match, $5 of it would have to be cash and $2.50 of the $5 would have to be identified as being received from a local taxing body. If a service club would give $5 for match, the program could only use $2.50 of it and hope to get the other $2.50 from local and county governments.

Second, as you are very aware, there is a large river running down the boundary of area IV. This boundary, called the Missouri River, prevents services from being delivered to many counties in Nebraska and South Dakota. The Older Americans Act has fostered a separation of State's policy thus far. I would suggest to you that future legislation encourage interstate agreements. Interstate area agencies on aging would provide the potential to serve many more older persons in the most efficient way possible.

I appreciate this opportunity to express my comments at this time. Thank you, Senator Clark.

Senator CLARK. Thank you very much.

Anyone else who would like to make a statement, comment, or ask a question? Is there anything you would like to say?

STATEMENT OF BERNICE DAHL, WHITING, IOWA

Mrs. DAHL. I am Mrs. Bernice Dahl. My husband, Willard R., and I live in Whiting, in Monona County. Thirteen came in on the mini