Senator CLARK. Other comments?

Ms. LLOYD. On the renovation of homes, we find in our area we have labor, but we do not have money for materials. I think that if they could concentrate on the materials we could probably get the work done. It is a very good volunteer kind of activity for numbers of people.

MODEL PROJECT FUNDS

Mr. BYRAN. Our model project funds are used to purchase the materials, and the State community services agency, with which we have worked out a statewide contract, gets the work done. Community action agencies are providing the labor with Department of Labor funds.

Senator CLARK. What kind of money do you think we are talking about?

Mr. BRYAN. I do not have any idea on that, nationwide.

Senator CLARK. I suppose an average of several hundred dollars per home.

Mr. BRYAN. Oh, you mean per home? The particular program that we are involved in, we started out with $100 per home.

Senator CLARK, Amortization?

Mr. BRYAN. Materials. But we cut it to $80 per home, because of limited funds.

Senator CLARK, Are there other titles or other areas that you think we ought to be looking at as this bill comes before us?

Mr. BRYAN, Senator I realize it is primarily the specifics of the bill that you are interested in, but I think basically the area agency concept has worked well. Title VII is working well and title III has also.

In response to my request for suggestions prior to this hearing I have a statement from one of our area directors that I thought was pretty much to the point. She points out that the main deterrent to providing services to the rural elderly is not in the act itself. She said, "The major problem is lack of sufficient funding of the Older Americans Act to deliver services to the rural elderly, especially transportation, which is a very expensive proposition."-everybody says that today-"It requires a lot of money and a lot of time. Current levels of funding have forced projects to choose between serving many elderly living in urban areas or serving a few elderly in rural areas," she wrote.

Dr. MADDEN, Senator, a group of officials from one of our rural counties approached my office recently with a proposal to cut back the congregate meals program from 5 days a week to 1 day a week. Their argument was that they could serve five times as many people. I discussed this concept with others in the State and have received a good deal of discussion on it. I would like to share with you some of these ideas.

FUNDING 2 PERCENT OF ELIGIBLES

It is obvious that the current level of the program funding provides coverage for only about 2 percent of the population coverage-only about 2 percent of the elderly population is now served by the congregate meals program. If the program were to cut down to fewer days per week then more people could be brought into the program. However,

is not quite as simple as that, as I understand it from talking with various program officials.

One of the difficulties is that, in order to establish the kind of rapport and trust that the people must have with the program, it is necessary to meet quite frequently. They admit that it may not necessarily require 5 days a week, but certainly more than one. They do not know what the magic number is between one and five. Perhaps some experimentation could be done on the different levels of the service, different numbers of days, and perhaps this could be facilitated through some flexibility in the legislation.

If a greater number of people could be brought into the program, at least for part of the project activity, this would expand the number of people who would be helped by the program. But at the same time we want to avoid becoming a mile wide and an inch deep, that is, providing very low quality service-a very low outreach and referral service to a large number of people. It is better to have some impact on a few than no impact on a large number.

These are some of the ideas that have come up in my discussions with people around the State.

Senator CLARK. We are trying to calculate about what percentage of the elderly, nationally, are being served. I suppose that would be a fairly difficult figure.

Dr. MORRIS. I would think that the transportation problems. would be greatly increased.

Dr. MADDEN. Yes. There are transportation difficulties in terms of getting the people to the meals, but also you have a limited number of professional personnel to serve these people. These personnel would have to travel to several locations around the county, which would increase the transportation costs. In addition, the cost of rent, setting up, renovating, and so forth, would be increased if you increase the number of sites. There are certainly problems associated with this.

Senator CLARK. It seems to me, if I remember correctly, that Elliot Richardson used this program as an example-along with several others of the kind of priority question that America has to face in the next few years. At that time the appropriation for title VII was $100 million, yet we needed about $3 billion to effectively serve those people who need the congregate meals program.

Of course, if you multiply that in each of the areas where there really is common agreement that we ought to appropriate money, such as this one, you begin to see the nature of the expenditure problem that the Federal Government, or any government, faces.

I suppose before we really accomplish something of that magnitude, we will have to see some very basic changes in priorities in general. It is difficult to imagine that we will begin to meet the needs of Americans in this area and in other areas without some basic changes in our attitude on how to spend the Federal dollar.

Are there other areas that someone would like to address themselves to?

NEW MEAL SITE AREAS

Ms. LLOYD. We have felt that rather than going to the expense of setting up new sites we could reach out beyond our present 5-mile radius to communities 10 to 20 miles away, bringing in people once a

week for a meal, socialization and recreation, and information and referral. Most of our sites could accommodate the additional people along with their regular participants who live closer in, and although we would not be giving them a nutritional meal every day, it would help break the isolation many of them experience, and would certainly be better than nothing. But we would have to have more money to transport these different groups, for minibuses and operation costs. Senator CLARK. If we make our case before the Appropriations Committee, if we can get away from this question of expanding authorization, what do you think we ought to emphasize if we could push one area of elderly services in rural areas? What areas should we talk about-perhaps it should be transportation? Is that the area for which we need additional funds, or is it housing, or nutrition?

Ms. MYERS. I would like to throw in another one just to confuse the issue.

Senator CLARK, Good,

Ms. MYERS. It so happens in our area the people are very interested in the senior companions program, giving low-income people a taxfree stipend, therefore getting more dollars into the area to be spent in the economy in the area, and to help older people-probably as a team, with mental health-who need companionship and to get back into the community from nursing homes.

I was disheartened to see that other programs under the legislation kind of shunted it aside, outside of RSVP and foster grandparents. It is allocated very little money.

The people in our area feel very strongly that this is one of the most valid projects that has come out and should be allocated more money. I know that is not in the Older Americans Act at present.

Senator CLARK. What about other opinions or views. Dr. Madden? Dr. MADDEN, Another problem area which I thought you were going to address is health care. That is another critical area. The others are certainly important the housing, transportation, meals, and so forth. All of these are important. We want to see that the older people get to the health services.

HEALTH, TRANSPORTATION, HOUSING

Mr. SCOTT. In our Governor's testimony this morning we spoke primarily to the three biggest problem areas we saw. That was health, transportation, and housing. I would have to concur with him that really health may be more symptomatic of other problems.

As Dr. Madden addressed, your population density-it is very natural for the doctors to migrate to the more metropolitan urban areas. There are some very fundamental questions I think we, as a State, have to address ourselves to in terms of health care.

We are now involved in various kinds of enticement efforts to try to get physicians into rural areas through regional medical programs and family practice in rural areas, this kind of thing.

We found that the doctors will go there and do their stint and come right back to the urban areas to establish their practice.

Senator CLARK. You may want to look at our Iowa experience in that they have been very effective in that respect.

The question is not whether we are going to set up health care under the Older Americans Act, but whether this committee and others—the rural development committee in agriculture, and many others-are

going to insist that any national health care proposal will adequately provide for rural Americans. We must watch carefully that any national health proposal has adequate provisions, both for rural people and for elderly people, so that they are not left behind. That is the challenge. We ought to be sure that when a national health program is enacted, it includes the kinds of facilities and provisions that we think are important.

Mr. SCOTT. This total concept that you are discussing now, about coordination or interrelationships between various governmental programs, seems to me to be very central to the whole issue here. I am not convinced that more money in the Older Americans Act is always the only answer.

While the efforts in these coordinative agreements to secure some agreement for coordination of the various programs is good, I think the end result of that activity is always the determining factor of success. I think just because we, sometimes, get somebody to agree in writing to do certain things, this does not insure coordination.

Before we convened here this afternoon, Mr. Brotman and I were wondering at what point the Administration on Aging was to assume responsibility for doing what. This is central to the whole issue of housing in title III, or whether that should be a HUD-administered program with AoA as a pass-through. That is a question that is not really resolved.

Our saying in Arkansas is that everybody wants coordination but nobody wants to be coordinated. That is kind of central to the whole issue of the Older Americans Act.

Senator CLARK. It is, indeed.

You mentioned Herman Brotman, who is a statistician in many of the areas that we are talking about. Herman, is there anything you would like to add at this point?

STATEMENT OF HERMAN BROTMAN, CONSULTANT, SENATE

SPECIAL COMMITTEE ON AGING

Mr. BROTMAN. I would like to step back in relation to what this discussion has been pointing out. As one of the authors of the original Older Americans Act, I think there are two basic concepts that we struggled with in the development of the act.

govern

First is the realization that government is organized, primarily, along functional lines. As soon as you get into the advocacy of the program for the kinds of groups you run across in the grain of mental organization, you have two choices. You can try to take over and become an operating agency for your client group, which foresees a kind of a governmental organization like-if I might be extremethe department of prenatal affairs, the department of benefit affairs, and so on. In each of these agencies, duplicating the facilities and sentences of every other, but directed towards their client group. As soon as you analyze that thing, you realize it is kind of silly.

The other thing that we tried to get in writing the act was to have true decentralization, not just lip service. But along with the decentralization of responsibility, having the authority, the funding, and the self-determination; in other words, the flexibility of having a minimum standards and guidelines of the Federal regulations.

It would have been nice, for instance, if we could have had the funding under the Older Americans Act allocated to States in one lump sum, and say: "Here are the minimum guidelines. Here is the purpose of the Older Americans Act. And you decide how you want to organize your area agencies. What are your local priorities? How does it vary within the State? What kinds of programs can best serve the kinds of people you are trying to serve?"

I think that parts of the Older Americans Act maintain that concept and push in that direction; parts of it do not. Within the administration of the act, of course, it gets into a whole additional area.

RURAL AGENCIES NEED FLEXIBITY

Specifically, turning to the rural area agencies, I think we need even more flexibility than you do in the urban areas, because of the difficulty of the resources, the transportation, the costs, and so on, that have to be solved locally.

I would like to add one more word. A lot of people worry about the State allotment formula and the amount of funds that become available to the State. I think that struggle in some ways is a little shortsighted. The way we are going to provide enough money for the planning process in community organization or coordination, and the advocacy efforts of the State on local areas on aging, is by having larger appropriations not by playing around with the allotment formula to take from one State and give it to the other because they have found some factor that is better for their State.

I have prepared a short statement with some basic tables which will be inserted in the record.*

I would like to point out that those tables are matched to others. As I usually indicate with the statistician, you will probably find no community in the United States that has exactly that picture. But this is the total I have mentioned in the rough outline until you get down to your community and find out what the situation there is. Then you do your planning of your program on that basis.

Senator CLARK. Herman, on those statistics, did you point out the factors that strike you as being the most significant?

Mr. BROTMAN. In terms of area planning and programing, I would say that the most significant thing was that the older population is found in the urban areas.

Senator CLARK. The older population is what again?

Mr. BROTMAN. Is 75 and older. It is more prevalent in the urban area than in the rural. You find that the proportion of the foreign born is much higher in the urban than the rural, which means that you have a slightly different approach for outreach and using the media and other ways of reaching your older population.

HEALTH FACTORS IN RURAL AREAS

In terms of one single indicator of health, I took the impact of chronic conditions on the mobility of the older person, in other words, how well is he able to get along on his own, how much aid does he need to get along, and how many are homebound. There the situation

*See p. 56.