PREDOMINANTLY RURAL AREA

South Dakota remains predominantly rural, with 55 percent of the population remaining on farms and in smaller towns, and 45 percent located in communities of 2,500 or more inhabitants. There are only 26 towns with a population of 2,500 or more. There is no major metropolitan area.

Average county population of persons age 60 and over is 1,724 persons. Forty-four of the sixty-seven counties have older populations which fall below that small average. In those counties the average falls to 859 persons. Twenty counties have 700 or fewer persons in that age category.

American Indians comprise 2.3 percent-10 times the national average of the State's population age 60 and over. Approximately 8,400 square miles, or 11 percent, of South Dakota is designated as Indian reservation.

Currently 30,423 persons, or 26 percent, of the State's population age 60 and over have incomes below poverty level. Lack of employment opportunity is a major cause.

"Housing remains the paramount problem of poor and elderly persons," according to a study made by the South Dakota Economic Opportunity Office. "Blighted housing conditions contribute to the physical, mental, and social instability of their occupants."

Unemployment, rising energy and food costs, and inadequate housing all pose serious problems for elderly persons, especially those with fixed incomes-and that tends to be most of them.

Age discrimination and mandatory retirement hold down the income levels of elderly persons. Social security and supplemental security income benefits do not keep pace with inflation and cost-ofliving increases which confront unemployed elderly.

It was the consensus of the 1971 White House Conference on Aging that distance is a major problem in delivery of Older Americans Act programs and services in rural areas. This is true of most social services provided in South Dakota. Even in towns, lack of transportation keeps many elderly, disabled, and poor persons from getting to vital services.

The success of nutrition programs for the elderly is dependent upon efficient provision of supportive services such as transportation, outreach, escort, nutrition education, health and welfare counseling, shopping assistance, information and referral, and recreation services. Provision of these services means that problems of distance unique to each of these services must be dealt with.

Now, Senator, to discuss some aspects of the service delivery system, I wish to introduce the chairman of the South Dakota Advisory Council on Aging. He is Mr. Peter B. Johansen of Yankton. After a long career in business, he served for a time on the staff of the State office on aging where he helped in the establishment of senior citizen centers and retired senior volunteer programs. Still resisting retirement, he has taken time off from his current full-time job to be with us here.

STATEMENT OF PETER B. JOHANSEN, CHAIRMAN, SOUTH DAKOTA ADVISORY COUNCIL ON AGING, YANKTON, S. DAK.

Mr. JOHANSEN. The State's 225 senior citizen service centers and clubs, mostly located in rural communities, are the most significant focal point for delivery of social services to the elderly.

More and more senior centers are becoming multipurpose senior service centers providing a range of service beyond recreation. Such services include information, referral and outreach, nutrition and nutrition education, home-delivered meals, education and life enrichment, health services, volunteer services, counseling and assistance with social security, SSI, sales tax relief, medicaid, medicare, and other problems.

Under Older Americans Act regulations the definition of a multipurpose senior center includes being open to constituents 30 hours per week and having a full-time director. This puts rural areas at a disadvantage. In the smallest communities a center may provide important services though it may not need, nor be able to afford, a full-time director. Regulations presumably intended to encourage good use of resources should recognize sparsely settled areas as well as cities, so that rural elderly will not be ineligible for possible benefits.

In many of South Dakota's communities there is no available facility that is suitable for successful senior center services and activities. Often these small towns have acquired unused, older buildings in need of repair and with architectural barriers. These buildings were not designed for senior center purposes, most having been places of business or large old houses, and are inadequate without repair, alteration, or renovation. Thus the new availability of Older Americans Act title V funds for acquisition, alteration, or renovation of these buildings is a welcome resource.

RESPONSIBILITY FOR ADMINISTRATION

Officially, administration of title V is being carried out directly between prospective applicants and the Administration on Aging in Washington, D.C., but State units on aging have been called upon by the Administration on Aging to disseminate information and application materials. Thus, it is the State agency which is seen by the applicants as the responsible contact and from whom adequate and timely assistance is expected. However, too little time was allowed, the materials are partly new and complex to this program, and not all materials were sent out by the Administration on Aging when promised.

Some of the application materials to be used had not arrived even 2 weeks before applications were due at the Administration on Aging. There could not then be adequate preparation by the applicant, nor technical assistance and prioritization by the State agency. A 12-day extension which has now been announced will help only a little. The result has been frustration for the applicants, a poor image for the Administration on Aging and the State Office on Aging, and unnecessary difficulty in providing technical assistance, coordination, and manpower for this purpose.

Transportation poses a problem for all elderly, particularly rural elderly, and consistently ranks as a primary concern. Federal and State departments of transportation should continue their priorities for stronger emphasis on rural transportation with consideration for disadvantaged persons such as elderly, handicapped, low and middle income.

Basic needs of older citizens are not unlike those of the general population, but assessing appropriate services to meet those needs is much more difficult for them, particularly the disadvantaged, lowincome, or infirm elderly. We make extensive use of the personal, oneto-one contact of outreach workers to help older persons receive services for which they are eligible.

Related to outreach is information and referral. In July 1975 a statewide service called TIE-LINE was implemented to provide tollfree access for all citizens to more than 6,500 public, private, local, State, and Federal agencies that can help them. The office on aging supports, through funding and technical assistance, the special efforts of TIE-LINE to serve more older persons.

Important to service delivery is training. Through Older Americans Act and other funding, experts in the field of aging have conducted sessions on a wide variety of topics geared to increasing the expertise of service providers and the capacity of older persons to serve themselves.

The office on aging annually develops and administers a State plan on aging and awards grants serving older persons in all counties. Efforts continue to build the capacity of comprehensive and coordinated programs for older persons throughout the statewide planning and service area. Together with the office, the advisory council on aging has helped secure legislation for senior citizens' use of school buses, school lunch facilities, county and city mill levies, and increased awareness of needed legislation benefiting elderly citizens.

The office on aging has field coordinators who promote coordinated planning and development of services and resources among senior organizations, agencies, and State and local governments. Also facilitated by the office on aging has been establishment of a statewide consortium of public and private colleges and interested organizations in the Gerontology Association for Training and Education-GATE.

ELDERLY INDIAN NEEDS

As already noted, the 2,600 older Indians comprise 2.3 percent of the State's population age 60 and over. The office on aging has made a major effort to develop services for older Indians, working with tribal organizations and providing technical assistance and Federal funds. On the reservations, unemployment is high, averaging 47 percent. Transportation is scarce and distances are measured in hours of travel rather than blocks or miles.

At the Bicentennial Governor's Conference on Aging, May 1976, a task force on Indian affairs was convened to discuss needs of older Indians. Recommendations of this group reaffirmed the continuing need for transportation services and other supportive services. There is a desire for location of nursing care facilities on reservations; there

are none now.

A person who cannot communicate with others may mistakenly be thought to be mentally deficient or at least uncooperative. The cause may be loss of hearing, or a speech impediment, but the resulting frustration, misunderstandings, and rejection can lead to withdrawal and inability to function adequately even for self-care.

In South Dakota, mobile equipment and traveling educational and therapy teams have proved the feasibility of communication disorder screening and education in rural areas. The results of such screening and education have significant impact upon the lives of older persons. Hearing and speech often mean the difference between independence and dependence.

With advanced age may come some changes in a person's lifestyle that are desirable and freely chosen and other changes that are unwelcome. Nearly all South Dakotans live in private homes or apartments where they have convenience, comfort, and security. In time, with changes in family composition, reduced income, and loss of some physical abilities, the older couple or single person often finds the familiar surroundings becoming less convenient and secure.

All have an economic concern; a balance between income and the costs of utilities, maintenance, taxes, and insurance. Other needs from time to time may be home health care or homemaker service, chore service, transportation, hot meals, telephone reassurance, friendly visits, spiritual ministry, counseling, or legal service. If the supportive service can be supplied, the older person continues to function well at a relatively low cost.

When a person needs additional or more concentrated assistance, a foster home, group home, long-term care facility, or hospital may be needed. Some older or handicapped persons have moved to these facilities when they could have continned at home if support services were available. Surveys indicate that this occurs in South Dakota at a rate higher than the national average. For both humanitarian and fiscal reasons the State is working to increase its home support resources. Isolation, physical problems, death of loved ones, family problems, economic worries, psychosomatic illnesses, and other problems confront the older person. Ways in which mental health services can be provided to older persons are greatly needed.

Despite efforts, little progress has been made to link mental health clinic services to the needs of older citizens, especially rural South Dakotans. Nursing homes, for the most part, are not yet equipped to deal with older people with emotional problems.

These are some aspects of the needs of older persons and resources serving them in South Dakota. It is all too briefly and incompletely described, but the office on aging will submit a written statement which will add detail and will include some other materials of concern or interest.

Thank you for your interest and for this opportunity to contribute to your studies.

Senator CLARK. Thank you very much for a very comprehensive

statement.

We will hear next from Vada Thomas, advocate of the poor, Catholic Social Services, Sioux Falls, S. Dak.

STATEMENT OF VADA D. THOMAS, ADVOCATE OF THE POOR,
CATHOLIC SOCIAL SERVICES, SIOUX FALLS, S. DAK.

Mrs. THOMAS. Good morning, Senator Clark and Representative Pressler.

I want to thank you for the opportunity to appear here this morning to speak on behalf of the 23,000-plus elderly in South Dakota who live below the poverty level. I want to direct particular attention to those 5,500 who must rely on SSI to supplement their income.

It seems unjust to me that a nation which has established a poverty level of $2,800 a year as being the minimum needed to provide the basics of life to a single adult, $3,700 for a couple, can then proceed to assure them income of $2,013 to meet these needs. Now $2,013 is only 73 percent of the poverty level.

South Dakota did not accept the responsibility of supplementing SSI. Of the 5,547 aged people in South Dakota receiving SSI benefits in April 1976, only 266 persons were being supplemented by South Dakota to their own payment level in December of 1973, which was a maximum payment of $193 per month.

Recent increases in social security and SSI payments has decreased this number to 169 persons as of August 1, 1976.

At the last legislative session, Senator Michael O'Connor introduced a bill for State supplement to SSI to bring all individual recipients in South Dakota up to the State level of $193 per month with a passthrough for future SSI increases at the request of the State advisory council. But as often happens to legislation that benefits the poor, it got caught in the game of political football and went down to defeat in the closing hours of the session by partisan political maneuvering. My recommendation to this committee is that the Federal Government assume the responsibility they accepted with the passage of SSI and raise the Federal SSI payment to at least the official poverty level. If this level is not appropriate for all areas of the United States, which I am sure that it is not, a regional approach could be used.

TRANSPORTATION FIRST PRIORITY

I would strongly oppose the urban rural system of payments for several reasons. First, the increased cost of transportation in extreme rural settings such as we have in South Dakota would more than equal the added cost of housing in an urban area. Transportation is a must for South Dakota's rural elderly, as many of them have to travel long distances to obtain medical services to purchase food stamps and even to purchase food. In small communities the food prices are much higher than they are in the supermarket in a larger city. Rural homes rely on fuel oil or bottled propane for their heat, which costs much more than natural gas.

Another area of concern to South Dakota's older population is housing. South Dakota has a severe shortage of low-cost rental units. South Dakota relies on property taxes for the support of their school districts. Many older people are finding this tax burden too much for their limited income and are being forced out of their own homes into rental units.