In each of the projects that have been initiated and brought to a successful completion, I think that a number of people that did not know anything about the multipurpose center or what a community service agency is supposed to do, except that we existed in what used to be the "old creamery building," now know what we are, what we do, and why we do it. I sincerely hope that such joint efforts will bring many more projects to help our fellow man to successful completions in coming years.

One of the biggest hurdles for any people program, particularly those involving people in rural areas, is reaching those people with accurate, unimbellished information about the program and its aims. I feel that personal eyeball-to-eyeball contact by an adequately trained and informed outreach person is the only answer.

OUTREACH ALLOCATION SHOULD BE UPDATED

Every program written and implemented should allocate enough money for this outreach. CSA centers are operating on the same allocation that they were 10 years ago so therefore cannot provide the outreach personnel necessary to reach the number of people that need to hear the news. Their expertise could be used to train and supervise the people needed to reach the prospective participants in these programs and to assess the value of the programs.

I would like to infringe on, maybe, a little bit of extra time to express my appreciation and thanks to the following people:

Herb Flint, director of the multipurpose center from its beginning in 1966 until January 1975 and under whom I started to work; H. W. Callison, Reese Bridenstine, Harvey Davis, and Joe Pals for their confidence and backing when I became acting director of the center and later as director. I could not have made it without them. To the mayors, past and present, of Winterset; the city council members, past and present; the Madison County Board of Supervisors; the area agency on aging, particularly Kay Samec, Vada Babcock, Glenda Knight, Rhonda Varnum, and Vance Baird: Les Goeldner, chairman of the area agency on aging advisory board; and the Central Iowa Regional Association of Local Governments, that is, Gary Pryor, Jerry Franke, Judy, and Joe. And for the efforts and help above and beyond the call of duty in getting things ready and in shape for this hearing today: Yvette Wilson, transportation secretary and all-round handyperson: Betty Berry, outreach worker; Fred Vierling, Dan Rater, Helen Grandfield, Lillie Moore, Florence McCauley, and Wilma Barker; Roscoe Tyer, general contractor for our kitchen; and his personnel and subcontractors.

Finally, I would like to introduce my mother, Mrs. Neva McKibban, a member of the Hillbilly Band and an active participant in center activities.

Senator CLARK. Yes. Stand up, please. We need the drummer.

Mrs. FORSYTH. And I would like to say a special "thank you" to her and my father, now deceased, for raising me in a home where love, thoughtfulness, and concern for others was a daily part of life.

Senator CLARK. Thank you very much for an excellent statement. We appreciate it very much. We can see why people are doing so many excellent things around here.

Mrs. FORSYTH. Thank you.

[A prepared statement of Mrs. Forsyth follows:]

PREPARED STATEMENT OF LOUISE FORSYTH1

The Madison County Multipurpose Center, located in Winterset, Madison County, Iowa, was opened in 1966, in a building that had been used to house a creamery (some of the vats and other equipment were still there and had to be removed), cream-buying business, and hatchery. There were no ceilings-just unadorned beams and hollow tile walls.

The reason for the opening and continued existence of any CSA (prior to 1974 CAP) Center was, and is, to provide help for people, particularly those with low incomes, the handicapped, blind, disabled, and/or disadvantaged.

We feel that over the past 10 years we have helped to coordinate programs that have provided help in many areas and have generated other needed programs.

From the beginning the center people have worked a great deal with the elderly and the handicapped. The center was instrumental in starting, and continues to work with, seven senior citizens' groups in the county. The center serves as the meeting place for four of these groups.

The center conducts, and has since shortly after opening, a class for adult handicapped people; most of these people reside at Horton's Custodial Home just north of Winterset. This class consists of a craft project and refreshments. The help in teaching the craft lesson and providing refreshments is all volunteers-most of whom are senior citizens.

Two very important things, or benefits, to the participants in this class have been self-discipline (learning to complete a task) and a sense of accomplishment. It was through the center staff's concern and interest in these handicapped people that an effort was launched to start a challenge center as a satellite of the Southwest Iowa Sheltered Workshop, located at Afton, Iowa. This challenge center began operation early in 1975.

A class is still held at the center one afternoon a week for those handicapped people who are unable to attend the challenge center.

In past years the center director and others directly involved with center have worked with the health planning council to encourage doctors to come to our county and in getting new nursing homes (4) and a custodial home in operation. They also have been active on the board of the home-health agency (Earlham CARE program) and in recruiting home-health aides.

Our center has operated a rent-a-kid, or busy kid as it is now known, service for the past 5 or 6 years. We also keep in close touch with the Job Service of Iowa and make referrals to them and to the EDS Manpower Office.

Head Start, Neighborhood Youth Corps, GYOP, and many other self-help agencies received our full support and cooperation.

GED certification classes, classes in sign language for those wishing or needing to communicate to the deaf, classes in needlecraft and ceramics are held regularly at the center.

We maintain a close contact with various health agencies: i.e., the Commission for the Blind, Easter Seal Society, the Cancer Society, Crippled Children of Iowa, and Planned Parenthood.

One of our greatest areas of influence has been in alerting the community to the need for coordinated volunteer activities. Over the years a great number of women (over 200) have been involved in: (1) a clothing room (used clothing donated for use by those who need them); (2) personal shopping service to three nursing homes; (3) library service for nursing home residents; (4) friendly visitors; and (5) handicapped class once a week.

Other activities and services that came from the center's efforts are the hospital guild; Madison County Title VII Nutrition program; a car that provides transportation for people over 60 within the city limits of Winterset; the Madison County Title III Transportation System; a HUD block grant to build a kitchen at the center so that the congregate (Title VII Nutrition) meals could be prepared on site in Winterset; 51 homes weatherized (attic insulation, caulking of windows and cracks, storms and screens put on); a summer recreation (1976) program for youngsters from low-income families, ages 8 through 13— 50 enrolled: approximately 400 homes reached with direct (one-to-one) information on SSI; property tax relief; rent reimbursement; countywide transportation; nutrition meals (since September 1975); and a kitchen.

As the months and years fly past, it is our hope and aim to continue to serve the people in need in our county to the best of our abilities and to continue to

seek and enlist the help of whatever agency or individual that is needed to provide this service.

The real challenge for community centers is to be foresighted enough to recognize the changing needs of the community and be prepared to meet these needs.

Senator CLARK. I would like, Dr. Fickel, to call on Congressman Harkin. I know he has office hours downtown starting about 10 minutes ago.

Representative HARKIN. That is right.

Senator CLARK. We will take your statement now, then we are going to have Dr. Fickel's, and we will be closing.

Go right ahead.

STATEMENT OF HON. THOMAS R. HARKIN, A REPRESENTATIVE IN
CONGRESS FROM THE STATE OF IOWA

Representative HARKIN. Thank you very much, Senator Clark.
Dr. Fickel, I appreciate your indulgence.

I had previously scheduled office hours in a mobile office starting at 11:30. I am a little late.

I deeply appreciate the opportunity to be here. I am no stranger to this place, as you all know. I was just invited to stay for lunch, but I guess I am going to have to miss it.

Senator CLARK. I will eat for both of us.

Representative HARKIN. I appreciate your coming out here and having these hearings. It seems that whenever Congress holds hearings on anything about rural affairs, especially on the elderly, they usually do it in Washington, D.C., where people can't get to the hearings. So I think we ought to be thankful to Senator Clark for bringing his committee out here to where the problems really are. If there is one thing that I discovered in just a year and a half in Congress, it is that you know the answers are not in Washington-the answers are out here where the problems are. So by bringing the committee out here for the hearings, I think they will gain a very good insight into where the problems are that the rural elderly face.

Rural America in the past few years is becoming less visible in terms of priority in our Federal programs. This is so because, let's face it, those of us who represent rural areas are becoming fewer and fewer in Congress. The district that I represent is one of the most rural in America. Out of 435 congressional districts, this is the eighth most rural.

Now if I had been elected to Congress about 25 years ago, there would have been about 125 Members of Congress from areas about like this. Now there are only about 25 of us. As rural America becomes less and less visible in terms of the Federal Government, the elderly who are becoming less visible all around the country have become even less visible in the rural areas.

RURAL ELDERLY SUFFER MORE

As bad as things have been for the elderly in the cities, their problems have doubled and quadrupled in the rural areas because of the low visibility. These older persons become isolated. The poor health standards in the rural areas are something that has recently come to our attention in Washington. Also, problems with housing, and especially transportation.

Recently I just read in the Congressional Record the "Bicentennial Charter for Ŏlder Americans" prepared by the Federal Council on Aging. I don't know if anyone brought it up here yet to see, but it outlines a "bill of rights" for the elderly in our society which I think ought to be adopted by our Government:

(1) The right to freedom, independence, and the free exercise of individual initiative;

(2) The right to an income in retirement which would provide an adequate standard of living;

(3) The right to an opportunity for employment, free from discriminatory practices because of age;

(4) The right to an opportunity to participate in the widest range of meaningful civic, educational, recreational, and cultural activities; (5) The right to suitable housing;

(6) The right to the best level of physical and mental health services needed;

(7) The right to ready access to effective social services;

(8) The right to appropriate institutional care when required; and (9) The right to a life and death with dignity.

While all older Americans have had many of these basic human rights denied to them, those living in rural areas have suffered most of all. For example, in 1973, the Department of Health, Education, and Welfare spent only $7 million out of $175 million on health services delivery in rural areas, although statistics show that approximately 140 rural counties in the Nation do not have a physician and that they have very limited auxiliary health services. In the Congress we have passed legislation designed to encourage health service professionals to practice in rural areas. But it is just a step, and there is much more that needs to be done.

We do have some of the minivans now. They have been very good but, as we all know, there is not enough of them and they only service a very small fraction of the people that really need them. The LaborHEW appropriations bill which Congress has enacted provides more funding for senior citizens and more than requested by the administration. Title III of the Older Americans Act has been increased quite a bit. The nutrition program, which provides for the congregate meals, has also been increased. One provision that I was especially pleased to see finally get funded was title V, the multipurpose senior citizens program, which has not before been funded. I suppose we have just touched on this.

Senator CLARK. This kind of center.

MUCH REMAINS TO BE DONE

Representative HARKIN. Yes. This now is being funded for the first time. Again, while we have made some progress, there is a lot more to be done. I believe that I am well represented on the Committees on Aging by Senator Clark from the Senate and Congressman Blouin from the Second District in the House of Representatives.

I am sure that it comes as no surprise to all of you here that Florida has, as I understand it, the most percentage of its people who are elderly, and second to Florida is Iowa. So I think it is very mandatory that we have someone on the Committees on Aging like Senator Clark

and Mike Blouin.

Let me just wrap up by talking about money. We are all concerned about inflation. We are all concerned about the fact that those of you who are on fixed incomes see a real decline in your purchasing power because of inflation. We want it stopped, and we are trying to do everything we can to bring our Government spending under control. I hope that we can bring our budget into balance in the next few years and bring our inflation down to a reasonable level of maybe 1, 2, or 3 percent per year, but that means we are going to have to change some priorities.

You know we only have so much money and we are going to have to decide where that money is going to be spent and how it is going to be spent that is where we need your input. No longer can we continue to go to the Federal Government to fund this and fund that, no matter how well-meaning a program may sound. So we have got to decide on our priorities.

Just let me mention one thing. The House of Representatives this year lost by 17 votes-17 votes-in an effort to stop funding for the B-1 bomber. Let me just tell you what that B-1 bomber is going to cost. I was a pilot; I flew for 8 years in the Navy, and my brother was an Air Force pilot. I can tell you the B-1 bomber is the biggest boondoggle that has ever been foisted upon us. To build a fleet of B-1 bombers and service them over a lifespan of about 20 years is going to cost this country somewhere in the neighborhood of $60 billion.

Now I just see here from the memorandum from your committee, Dick, that the Senate just approved $480 million for the Older Americans Act for the entire United States. Let's just round it out and say that is $500 million. For the cost of the B-1 bomber, we could fund the Older Americans Act at its present level-actually a little more than its present level-for 120 years. Now you tell me where your priorities are. I know where mine are, and they are with the Older Americans Act.

Thank you very much.

Senator CLARK. Thank you very much, Tom. [Applause.]

Representative HARKIN. I just want to say, again, thank you. I have to go to my office hours.

Senator CLARK. We are going to hear now from Dr. Fickel who, I think, is in a position to talk with you about a program in Red Oak that has been one of the most successful and one of the most exciting programs in terms of rural health care in America, and certainly leading the way in showing the rest of the country how this kind of program can work. So we are very, very pleased. Dr. Fickel, that you are here to talk with us about your program. Please proceed in any way you think appropriate.

STATEMENT OF DR. JACK FICKEL, MEDICAL DIRECTOR, FAMILY CARE CENTER, RED OAK, IOWA

Dr. FICKEL. Thank you, Senator Clark.

I think I will read this in the interest of brevity because I tend to wander if I speak extemporaneously. I tend to get off on another subject.

I would like first to thank you for this opportunity to present testimony to your committee. Any serious effort to consider problems of the rural elderly must, early on, deal with their health and the health care delivery system available to them.