THE OLDER AMERICANS ACT AND THE RURAL ELDERLY MONDAY, APRIL 28, 1975 U.S. SENATE, SPECIAL COMMITTEE ON AGING, The committee met, pursuant to notice, at 10:10 a.m., in room 5302, Dirksen Senate Office Building, Hon. Dick Clark presiding. Present: Senators Clark, Chiles, and Domenici. Also present: David A. Affeldt, chief counsel; Deborah K. Kilmer, professional staff member; John Guy Miller, minority staff director; Patricia G. Oriol, chief clerk; Gerald Strickler, printing assistant; and Joan Merrigan, assistant clerk. OPENING STATEMENT BY SENATOR DICK CLARK, PRESIDING Senator CLARK. The hearing will come to order. Two weeks ago, over 1,100 people from all across the country gathered here in Washington, D.C., to attend the first National Conference on Rural America. That conference was designed to help bring the problems of rural people to the attention of the public, the Congress, and the executive branch of the Government. It gave all of us the opportunity to find out from rural America's delegates what living in a rural area really means. At the conference, there were many accounts of how this Nation's resources and technology have ignored the problems of rural citizens who have been left behind, in terms of goods and services, health care and decent housing, jobs and educational opportunities, public transportation, and public assistance. The conference emphasized the need for our Government to pay more attention to rural America, and that is one reason for this hearing. We want to listen to the concerns of one very special group of rural Americans those over 65. We want to find out how well the Federal Government is working with State and local governments to provide these people with the services they need and how we can improve our efforts. At present, there are 5.4 million people 65 and older who live in rural America, and predominantly they live in nonfarm localities. These older Americans often are totally ignored by service programs, not by design, but simply because of their place of residence, the additional costs involved in bringing services to them, and the limited funds for rural services. DECLINE IN RURAL SERVICES The last two decades have brought about a dramatic decline in services to rural areas. Right now, 138 rural counties do not have a resident doctor; 146 bus companies have gone out of business in small cities and rural areas in the past 15 years; and, rural residents do not have employment and manpower services available to them, even though they are more likely to be unemployed or underemployed than their urban counterparts. All of these problems have serious ramifications for every rural resident, but they have placed an especially heavy burden on rural elderly. The neglect and the deterioration of rural services may mean that older people become housebound for months, that they cannot get to the doctor or to the hospital to take care of their health needs, that older workers cannot find a job, or that older people cannot get together with their neighbors and friends. The consequences of being rural and elderly too often are tragic at best, and, as a Nation, we have not done a good job of providing them with much help. In 1965, Congress adopted the Older Americans Act to provide the limited funds to help all of America's needy elderly, including the rural elderly. That legislation was amended in 1973, and it now provides for a number of services, including nutrition, health, transportation, information, and referral, through area agencies on aging, coordinated by State units. Unfortunately, these programs have not given enough attention to rural areas. But, in the next few weeks we will have the opportunity to help change this as the Senate considers legislation to extend the Older Americans Act programs. We can evaluate the effect of the Act's provisions on rural areas, putting into action one of the themes of the current conference on rural America: the right to be free from discrimination not only of class and race, but also of place. As the Older Americans Act now is written, there is emphasis on low-income and minority elderly, but there is no special focus on the needs of the rural elderly. Senator Frank Church, chairman of the Special Committee on Aging, has introduced legislation that would begin to recognize the special needs of rural elderly by including, under title III of the Older Americans Act, support for demonstration programs to assist older rural people and to improve the delivery systems of rural America. I am a cosponsor of this legislation and I know that it would be very helpful to many rural elderly people. Much more needs to be done as well, and I hope that the witnesses today will give the Congress their recommendations. Today's hearing starts off with one of this Nation's leading advocates for the elderly. He certainly is one of their best friends, and he is an old friend of the Congress as well. Governor David Pryor of Arkansas served as a member of the U.S. House of Representatives for three terms, and during those years he devoted much of his time to helping our older citizens. In fact, the Governor was so concerned about this Nation's older citizens that he set up an unofficial House committee on the aging in a trailer. Governor, we welcome you and your State director of aging, Ray Scott, before this committee and invite you to begin your testimony. We will follow with a discussion after that. STATEMENT OF HON. DAVID H. PRYOR, GOVERNOR OF ARKANSAS; ACCOMPANIED BY RAYMOND L. SCOTT, DIRECTOR, ARKANSAS STATE OFFICE ON AGING AND ADULT SERVICES Governor PRYOR. Thank you very much for the opportunity to appear before the U.S. Senate Special Committee on Aging. I would, if I could at this time, like to introduce Ray Scott, who is the director of the office on aging in the State of Arkansas. I would first like to basically state some of the characteristics of the State of Arkansas. I will try to proceed with this testimony as quickly as possible. The 1970 census showed the total population of Arkansas was 1,923,295, or approximately 2 million people. This population is distributed throughout our State on approximately a 50 percent urban and 50 percent rural basis. Only 17 of 75 counties are considered urban. The 1970 census also noted that 335,156 persons, or 17.4 percent of that total population, were age 60 or older. This fact, according to the Administration on Aging, ranked Arkansas second in the Nation as to the percent of the total population who are 60 years of age or older. According to the latest unpublished estimates from the Bureau of the Census, that figure now stands at 366,000 persons. RURAL ELDERLY-77 PERCENT In terms of geographical distribution, Mr. Chairman, the 1970 census showed that only 23 percent of the elderly lived in urban areas and 77 percent lived in rural areas. Obviously then, we are faced with meeting the needs of a predominantly rural elderly population. In order to meet the needs of this population under the authority of the Older Americans Act, specifically the 1973 amendments, we currently have six area agencies on aging funded and operating. These agencies cover six of our eight planning and service areas with the two remaining areas to be funded as area agencies on aging by June 30, 1975. These agencies, for the most part, are doing an excellent job developing transportation, information, and referral, outreach, and nutrition services. Our reporting system for title III is not as well developed as that for title VII; we can, therefore, only estimate that at least 60,000 elderly persons received some type of service from July 1, 1974, through February 28, 1975. In our title VII effort we have funded 17 of 75 counties which have established 58 feeding sites. These sites served approximately 5,800 different elderly individuals and a total of 331,000 meals from July 1, 1974, through February 28, 1975. Like many States, we have experienced some difficulty establishing the area agencies on aging, but we feel they have been an asset in further developing the program and are striving to strengthen their role as the comprehensive aging agency in our State regions. ARKANSAS' NEW ELDERLY-AID BILLS Our 70th general assembly, which has just concluded, Mr. Chairman, in the State of Arkansas, recently passed several of my administration's bills which will have a direct impact on the elderly. As a brief summary, the major items were as follows: 1. A measure allowing pharmacists to substitute a generic drug for a brand-name drug, and allowing the posting of competitive drug prices. 2. An appropriation of $750,000 to be used as a 12.5-percent State share of the 25 percent necessary to match $4.5 million of title XX funds. These funds will go to develop aging and adult services programs such as homemaker/home health, foster care, day care, and protective services. 3. An appropriation of $35,000 to assist local communities in developing the matching funds necessary for the Urban Mass Transit Act funds for transportation of the elderly and the handicapped. 4. An appropriation of $100,000 as a State supplement to the title III funds available for establishing the area agencies of aging. 5. A revised property tax relief measure to increase the benefits available to the eligible elderly. 6. A measure providing for tuition-free admission to any public educational institution-a university, college, vocational school or community college-for any citizen of our State 60 years of age or older. We may be the first in the Nation to take this step, but I am not certain. 7. We have doubled our commitment and our appropriation for our green thumb program, which has served our State and our elderly citizens so well. But despite these very significant steps taken by the recent legislature and the progress made by the area agencies on aging, much remains to be done. As was pointed out earlier, approximately 77 percent of the elderly live in rural counties which encompass 70 percent of our State's land area. These counties represent sparsely populated areas where services are simply not available. The following areas of need are highlighted merely to dramatize the problems facing our rural elderly. Health Care.-The latest figures available from health planning sources show that approximately 65 percent of all licensed physicians in Arkansas reside in eight urban counties. That leaves 35 percent of the State's physicians to service the remaining 67 counties. This has some obvious impact on the aging population's ability to utilize the available health delivery system. This distribution of health care services may force the individual to delay routine health maintenance functions until a catastrophic illness or other severe problem necessitates the seeking out of assistance. This distribution perpetuates a system which promotes an all or no care proposition, either total care such as in an institution, or little or no care such as in rural, sparsely populated areas. Transportation. There are many obstacles to providing transportation services to the rural elderly who comprise 77 percent of our aging population. The sheer geographical barriers such as unpaved, and in some areas, extremely rough, roads, and the basic cost per passenger mile or cost per unit of service are some factors bearing on transportation services in rural areas. URBAN VERSUS RURAL TRANSPORTATION COSTS In regard to the expense of transportation services, we have compared the cost of operating a vehicle in an urban area with the cost for a similar vehicle in a rural area. This comparison is based upon figures of the 3-month period from January through March 1975. The urban program provided 3,600 rides at a total cost of $6,200, or at an average cost of $1.72 per ride. By contrast, the rural program provided 480 rides at a total cost of $2,900 for an average cost per ride of $6.04. This cost differential is obviously a product of fewer rides being provided in the rural area which inflates the cost per ride. It is inevitable that any discussion of program costs will eventually lead to the questions of efficiency versus effectiveness. In the simple example just presented it is obvious that in terms of cost/efficiency, the urban program takes the honors. However, when we begin to discuss cost effectiveness, who is to say that the 480 persons served by the rural program did not derive as great or greater benefits from the service than did the 3,600 urban elderly, even though the cost was considerably higher in the rural program? Therein, Mr. Chairman, lies the dilemma. The urban programs can show greater numbers being served and at a lower cost, but the rural programs are attempting to reach those in areas where services are simply not accessible. This is not to say that the urban elderly are without problems and that all the services they need are at their doorstep, for we all know this is not the case. But it does show that special service-delivery strategies are essential in meeting the transportation needs of the rural elderly. Housing. A third specific area of need for the rural elderly of Arkansas is that of housing. This problem is basic to the whole concept of promoting independent living and maintaining environments that will allow the elderly to remain in the community as long as possible. In fact, in all of the programs to date in the State of Arkansas, the basic thrust of those programs would be to prevent institutionalization of our elderly citizens. According to figures available from the 1970 census, 27 percent of all housing units in the State were classified as having inadequate living conditions. Of these 182,093 inadequate households, 41.5 percent or 75,677 were occupied by the elderly. Further analysis shows that 68,076 or 90 percent of these households were occupied by elderly with incomes of less than $5,000 per year. These 68,076 households were occupied 51 percent by elderly renters and 49 percent by elderly owners. These brief statistics should certainly document the need for programs which can address the housing needs of the elderly in a variety of ways. I feel at this point it is appropriate to relate to you an actual case which dramatically illustrates the three problem areas which we have just discussed. This case is not meant to represent the majority of Arkansas elderly, but it is most assuredly a case that could be repeated in our State and I am certain in many other predominantly rural States. |