Veterans of Foreign Wars, Disabled American Veterans. American Red Cross, and AMVETS, who have provided much valuable assistance in providing veterans' benefits information to the aged in these States.

The Veterans Administration has also designated representatives of the Department of Medicine and Surgery and the Division of Veterans Assistance to each of the 10 Administration on Aging Regional Committees. The regional committees serve all States in the task of carrying out the VA's information and referral responsibilities as they have been spelled out in the working agreement between the 14 Federal agencies and the Administration on Aging. Part of the FA's commitment is to acquaint all elderly veterans with the availability of VA information and referral services. Also, to see that each information and referral office has access to VA information and referral service, each VA hospital and/or outpatient clinic and the Department of Veterans Benefits, Division of Veterans Assistance Offices have been designated liaison representatives to each Administration on Aging Area Office to serve the information and referral programs under their jurisdiction. (This provides service at the local level where the "Older American Veteran" is.)

(5) Are any VA day treatment mental health facilities serving elderly rural residents of the hearing States?

Medical District No. 23 includes Iowa, South Dakota, and Nebraska. There is one day treatment center in this medical district located at VA hospital, Des Moines, Iowa. The day treatment center sees approximately 60 people per day. This generates about 15,000 outpatient visits per year. Of the 60 patients seen at the day treatment center, 5 can be considered elderly, 1 in his early 80's, 4 are over 60 years of age. None of these patients are living in rural areas.

(6) What VA social work services, including telecare, are directed toward the elderly rural veteran of the hearing States? What are the names of the affiliated hospitals?

Social work service has a long tradition of providing a wide range of services to the older veteran and to his wife and widow. This is due in part to the fact that the veteran population is essentially an aging population and because medical science and technology have made it possible to live longer than ever before. The challenge to social work has been to help older veterans live meaningful and useful lives within the limits of their health problems and their disabilities. The complicating factor in achieving this goal has been the lack of adequate social services and social supports for older veterans in the community, and the need to locate and develop a variety of reseources including income maintenance, ambulatory health services, housekeeping and other personal services, such as meals on wheels, transportation, recreational opportunities, etc.

Social work service provides a full range of services either directly or through referral to community agencies for veterans requiring discharge planning and followup assistance. Services include evaluation and counselling visits to veterans placed in nursing homes, State homes, personal care homes, their own homes or other special living situations. VA social workers are active in the development of community resources and the coordination of services veterans may require in order to achieve a satisfactory adjustment in the community. All VA hospitals have extensive field visitation programs through which social services are provided directly to the veteran in his own home.

Volunteers are being utilized in 3 hospitals to provide Telecare services to veterans with special needs who live in isolated areas. One additional hospital will have a formal Telecare program operational in 6 weeks. All programs are operating under the auspices of social work service.

The following hospitals are affiliated for graduate training in social work: VAH Des Moines, VAH Iowa City, VAH Knoxville, VAH Omaha, VAH Lincoln, VAH Grand Island, VAH Hot Springs, VAH Ft. Meade.

(7) What, if any, of the following programs are operational and serving elderly rural veterans in the hearing States: rehabilitation medical services; dietetic and nutritional programs; nursing service; or voluntary service programs? All of these programs are operational and serving rural veterans in VA Hospitals and VA Centers in Iowa, Nebraska, and South Dakota.

(8) Have any findings resulted from your GRECC research program which are of significant interest to the rural elderly?

The geriatric research, education, and clinical centers are involved in ongoing research efforts which are of interest to rural elderly. The research is not limited, however, to just elderly people living in rural areas. Some of the early research involvements include:

Three GRECC's are engaged in demographic health needs assessment studies of their surrounding communities. Results from this work enables better longterm planning of health services, particularly for the elderly population.

Controlled research is being conducted comparing the normal and pathological states of the cardiopulmonary system in the elderly.

Research efforts at another GRECC are making possible the early diagnosis of senile dementia.

Research is being conducted in the area of nutritional effects upon development in the aging brain.

Work carried on at another GRECC has resulted in the first successful growth of human arterial smooth muscle cells which revealed significant species differences in lipoprotein uptake between human and rat cells. This finding has implications for future research in cellular aging.

Additional research is being conducted on diseases often associated with the aged: osteoporosis, diabetes, and arthroscerosis.

(9) Can you recommend any alterations in your pension and compensation programs which would enable them to better serve the rural veteran?

We have no specific recommendations on this point. Veterans' benefits are the same for all, regardless of area.

We trust that the above answers are responsive to your inquiries.

Sincerely,

ODELL W. VAUGHN.

Appendix 3

LETTERS FROM INDIVIDUALS AND ORGANIZATIONS

ITEM 1. LETTER AND ENCLOSURE FROM JOYCE LEANSE, DIRECTOR, NATIONAL INSTITUTE OF SENIOR CENTERS; TO SENATOR DICK CLARK, DATED JULY 15, 1976

DEAR SENATOR CLARK: I am pleased to be able to assist the Special Committee on Aging with its preparations for field hearings on older Americans living in rural areas. Not all of the questions you addressed to us could be answered with information from the National Institute of Senior Centers Senior Center Research Project, but I hope the enclosed information will be useful.

The attached summary of data relies on two NCOA publications, the 1974 "Directory of Senior Centers and Clubs" and the "Report of Senior Group Programs in America," and on the in-depth survey questionnaires which were used to prepare the report. Pages from both books have been copied and enclosed for use with the summary. If the committee staff would like an additional copy of the directory or the report, please do not hesitate to ask. I have also enclosed copies of materials which describe some innovative programs designed to serve the rural elderly.1

If you have any questions about the summary or if you need additional information, please call me or Valinda Jones of the Public Policy Department, who prepared our response. I look forward to the results of your upcoming hearings and to working further with the committee.

Sincerely,

[Enclosure]

Mrs. JOYCE LEANSE.

(1) The exact number of senior centers and clubs in the United States or in any particular State cannot be determined from the senior center research project data. Although an extensive effort was made to identify and elicit responses from as many adult group programs as possible (as described on pages 3-6 of the report), 9,448 organizations of the 17,930 on the basic mailing list did not respond to the initial questionnaire. Of the 8,442 responses, only 4,870 of those that wanted to be listed in the directory met the three criteria for inclusion. To be included, an organization had to offer a program directed at older adults, meet on a regular basis at least once a week and provide some form of education, recreation or social activity.

Consequently, the listings in the directory represent the minimum number of senior centers and clubs in a region. The following chart (based on information from the director) shows the total number of listed centers and clubs, the average age membership, the average daily attendance and the range of membership totals for organizations in the three States (see pages 407 and 437 of the directory). Comparable national averages are listed on page ix of the directory.

The directory lists the centers and clubs alphabetically by towns and cities within each State. That information is also attached (pp. 409-415, Iowa; pp. 429-435, Nebraska; pp. 453-459, South Dakota). A summary of the percent of centers in rural and urban areas can be found on pages 13 and 14 of the report.

1 Retained in committee files.

(2) The National Institute of Senior Centers Senior Center Research Project did not attempt to determine funding sources for construction or alteration of facilities because, at the time the surveys were conducted (fall 1973-fall 1974), there were no active Federal programs of assistance for such activities. Title V of the Older Americans Act was not funded until this year when $5 million was appropriated for the Fiscal Year 1976 transitional quarter. Title I of the Housing and Community Development Act of 1974 (enacted August 22, 1974) allows grants for construction and alteration of publicly sponsored senior centers, but it was not an active program when the questionnaires were distributed. Pages 17-19 of the report include a general description of facilities.

The initial surveys and the in-depth questionnaires tried to determine general funding sources and the proportion of Federal, State, and local funds used by centers. Unfortunately, many of the centers did not respond completely to the questionnaires, particularly to the questions concerning financing. The proportion of Federal and other funds on the average in each State is noted on pages 408 and 438 of the directory. Pages 14-17 of the directory summarize the detailed funding information on a national basis. Additional information on funding patterns in Iowa, Nebraska, and South Dakota can be obtained from the indepth questionnaires. The difficulty is that the number of in-depth questionnaires from each of the three States is too small to be statistically reliable (10 from Iowa. 7 from Nebraska, and 11 from South Dakota). However, the data might be useful in making some broad generalizations about funding resources. The combined data show that each program relies on several funding sources-the only exceptions being the smaller clubs that indicated a sole reliance on dues and fees.

According to the ten in-depth questionnaires from programs in Iowa, only three received financial assistance from sources other than dues, fees, or individual contributions (a "kitty" was listed by several). (Most of the respondents to the in-depth questionnaire in that State considered themselves clubs rather than centers which might explain the reliance on membership contributions.) In these three programs, funds from title III of the Older Americans Act (OAA) were listed twice; from the Office of Economic Opportunity (OEO) once; from adult social services, once; and from a city tax levy, once. Local organizations, such as the United Fund, were listed by all three.

In Nebraska, only one program of six responding to that question used Federal funds (OEO) and that also relied on local in-kind support. Of the other five programs, unspecified, state funds were listed as a revenue source once; unspecified local funds, twice; local revenue sharing funds, once; and dues, fees or money-raising projects, such as bake sales, were listed several times.

Five South Dakota programs out of nine responding to the question used Federal money. Four of these used title III OAA funds; one used Department of Labor funds. Local unspecified funds were listed five times and, again, dues, fees, projects and other membership contributions were also listed by most of the respondents.

(3) Pages 25-33 of the report summarize the findings on activities and services nationwide. For each center that provided details, the directory lists types of services and notes how often and when centers meet (see pages 409-415; 429435: 453-459). A comparison of services and frequency of meetings can be made by States and by regions from the information listed on pages ix, 407, and 437 of the directory. Organizations noted whether they held sessions in the morning, afternoon or evening in the initial survey. The frequency of full-day sessions (mornings and afternoons-evenings were infrequent and so not considered here) in centers in Iowa, Nebraska, and South Dakota is noted below.

The report suggests two standards by which multipurpose programing can be determined (see p. 25). The first is to count those groups that offer three or more nonspecific services; the other is to count those that offer the so-called three basic services (recreation, education, information, and referral or counseling). The following chart is based on information obtained from directory listings.

A similar chart, also based on the directory listings, shows the number of centers offering health services and, from these, the number offering health screening.

Information on outreach programs was sought in the in-depth questionnaires, but responses were sporadic and inconclusive. A major difficulty in obtaining information is that two in-depth forms were used-one for organizations that considered themselves clubs and the other for self-designated senior centers. Only centers were asked about outreach efforts in any detail, so the number of responses is negligible. (The small number of in-depth questionnaires from each State must also be kept in mind.)

In Iowa, three outreach programs were identified from six responses to that question; in Nebraska, two outreach programs from five responses; and in South Dakota, five from eight responses. The data on the number of contacts made per month and the number of outreach workers used are too scanty to be useful. Thirty is a rough average of contacts per month through all three States. When compared with the national averages on page 39 of the report, this figure demonstrates the likelihood that the small number of responses has made the information unreliable.

(4) The senior center research project did not attempt to obtain descriptions of innovative programs and, unfortunately, correspondence to the National Institute of senior centers from Iowa, Nebraska, and South Dakota has not included many descriptions of programs which might be useful to your committee. The few that might be of interest have been copied and attached.1

ITEM 2. LETTER AND ENCLOSURE FROM JUDITH ASSMUS RIGGS, DIRECTOR, OFFICE OF GOVERNMENT RELATIONS, LEGAL SERVICES CORP.; TO SENATOR DICK CLARK, DATED JULY 19, 1976 DEAR SENATOR CLARK: This letter is in response to your request for information on legal services for the elderly in the states of Iowa, Nebraska, and South Dakota. It is provided as background for field hearings on the effectiveness of federal programs serving the rural elderly in those three states.

As you know, the Legal Services Corporation is a private nonprofit corporation established by the Legal Services Corporation Act of 1974 (Public Law 93-355) to provide legal assistance in noncriminal matters to persons who cannot afford to employ an attorney. The corporation makes grants to local legal services programs that previously received funds from the Office of Economic Opportunity and its successor agency, the Community Services Administration. From 1971 through 1975, Federal funds for legal services remained at the same level. As a result, there was no expansion of service and, in fact, many programs were forced to cut back services as a result of inflation. Congress has just enacted an appropriations measure for fiscal year 1977 that provides an increase in funding to enable the corporation to begin expansion of services to the vast areas of the country where the poor are still without any legal assistance at all.

Programs in Iowa, Nebraska, and South Dakota that receive grants from the Legal Services Corporation.

The corporation supports four programs serving eight counties in Iowa, three programs serving four counties in Nebraska (and one county in Iowa), and two programs in South Dakota, one that is limited to a single county and one that

1 Retained in committee files.