THE QUESTION OF EXTENDING FEDERAL SERVICES Consideration of a further development of programs and activities by the Federal Government in the aging field presents a number of questions of broad social, economic, fiscal, and administrative policy, with numerous political implications. For example: In what fields is the Federal responsibility fully discharged and to what extent is more Federal action needed in others? How much revenue should the Federal Government allocate for aging needs? Through what organizational channels should Congressionally-appropriated funds be expended? Why Federal Action? No one is "against the old folks." Nearly everyone has some friend or relative, and often a member of his immediate family, who is facing old age. Some take the position that it is up to each individual to work out his own problems or for his family and relatives to assume the responsibility if he cannot. Others insist this matter is the responsibility of State and local government. Still others ask: "Why doesn't the Federal Government do something?" Much of the pressure on members of Congress to "do something" (and they are considerable) comes from old folks themselves. Many of them feel that the extensive Federal programs already operating in their behalf are not adequate. Their criterion for evaluation is the extent to which these programs meet their own personal and immediate needs. For instance, many older people who are in serious need of jobs are convinced that in some way it is a Federal responsibility to make jobs available. Some of this same attitude exists with respect to housing, medical care, hospitalization, and other needs. These pressures do not come merely from older persons or from children and other relatives who must shoulder a burden of care and support of elderly family members. They come from the great number of individuals and groups who are aware of the scope of the aging problem and who genuinely believe that the Federal Government must play a larger role in this field. Providing Federal Aid Whether the States, local communities and voluntary service groups have the means to provide the necessary services and facilities is surely debatable. It obviously bears heavily on the question of expanded Federal responsibilities. The legislation setting up the White House Conference on Aging reflects the desire of some Members of Congress to see the question of Federal responsibility explored further. Some of the pressures we have described have been reflected in a large and growing number of bills introduced in the Congress by members of both parties. These bills have as their purpose a broader commitment than exists now on the part of the Federal Government in the aging field and sometimes the appropriation of considerable sums to underwrite this commitment. A Bureau of Aging? In recent years, under both Republican and Democratic sponsorship, a number of bills have been introduced in the Congress to help the States initiate or expand State and community programs for older people. To administer these grants, the proposed legislation would generally establish a Bureau of Aging (or some equivalent) in the Department of Health, Education, and Welfare, though bills have also been introduced to establish a separate agency apart from the jurisdiction of any single Department, and some bills of both types would establish a new agency but without authority to make grants-in-aid. Whatever the auspices, these proposals would set up a new operational agency in the HEW Department-somewhat comparable to the Children's Bureau of the Social Security Administration-to deal directly and exclusively with the many and various problems arising out of the increase in the number of older people in our population. It would not, of course, take over any of the present functions of OASDI or public assistance or of the Public Health Service, nor would it encroach on the programs operated by the Department of Labor, the Housing and Home Finance Agency, or other agencies of the Federal Government. It would, however, presumably have authority to develop programs which are not included in present Government operations or to meet needs which cannot be adequately dealt with in existing programs. It would have the responsibility of working more closely with States and local communities and for providing a measure of specialized and coordinated technical and consultative assistance which, generally speaking, is not now available or is available only in piecemeal fashion. And it might have authority and funds to support research, training or demonstration programs, as well as ongoing State and local operations if Congress and the States were so disposed. For example, recreational activities are at present somewhat of a no-man's-land in the Federal Government and in most State Governments. State commissions with funds at their command could share with municipalities the cost of setting up well-equipped and well-staffed recreational centers of the type now found only in a few of the larger cities. The commissions would also be able to hire trained staff in order to provide consultation service and other help to communities setting up specialized programs in aging. The State Commission would also assure some measure of coordination of community services. Federal grants-in-aid administered by the existing Federal agencies are usually channelled to the counterpart departments of the State, thereby by-passing these State commissions or committees. Despite the "coordination" of the State commission or committees, these counterpart departments are chiefly concerned with developing their own programs. It is contended that Federal grants-in-aid administered by a separate Bureau of Aging would be channelled directly to the State commissions or committees. These groups would then be in a better position to attack the problem as a whole. Assistance could be given to those programs in the various departments which could be developed more fully; new programs of their own could be developed to meet needs not being met through the regular State departments; or subsidization could be given to programs of private agencies. Recommendations by the States What are the wishes of the States themselves? Do they want Federal grants-in-aid specifically keyed to aging? Are they prepared to provide matching funds should these be required? If so, through what channels would States prefer to receive these grants? Do they see their own commissions or committees on aging as groups whose functions should be confined largely to making studies and engaging in informational activities, leaving the main responsibilities for dealing with the aging problem to established departments of the State Government? Or should these commissions or committees be given the opportunity and encouragement to develop into serviceoperational branches of the State Government? The recommendations from the States can be divided into two categories: 1. Those related to organizations and coordination of general functions and services to be performed within the Federal Government; 2. Those related to specific program areas, such as health and housing, but containing significant implications for the Federal Government. Twenty-two States transmitted recommendations in the first category, covering a wide range of items. The subjects appearing most often were the establishment of a bureau or office of aging; increasing present informational and advisory services and adding new services; providing grants to States for post-Conference activity; and urging Congressional review of Conference recommendations. A national Office or Bureau of Aging or similar organization was recommended by seven States and specifically opposed by one. Federal grants to States for post-conference activity were recommended by three States and suggested indirectly in the recommendations of two other States. A number of States made recommendations about activities and services to be handled at the Federal level. These ranged from consultation and information services to State agencies for aging to conducting research on current problems. Four States recommended Congressional review of Conference recommendations. One of these States recommended that no specific legislation should be enacted until the Conference results have been evaluated. Most of the recommendations in the second category dealt with subject-matter related to the various Conference Sections, e.g., housing, health, etc. The Section on Federal Organizations and Programs, however, considered these recommendations in terms of their implications for Federal action. Population: Three States recommended action by the Bureau of the Census. This included expansion of data-collecting activity regarding the older population and special publications of such data. Income Maintenance: Of eight general recommendations, seven dealt with the Social Security program and the other called for clarification of Federal policy on distribution of surplus foods. Other recommendations in this area included: Establishment of a non-Federal study commission to scrutinize any proposed change in the Social Security Act; Changes in the fund-matching formula more favorable to lowincome States in Old-Age Assistance programs; Increase in earnings level in Old-Age, Survivors, and Disability Insurance programs; More social and economic research to be conducted by the Social Security Administration; Elimination of the residence requirement in the Old-Age Assistance program; Extension of present public assistance financial arrangements with nursing homes to include county homes; Establishment of a Social Security Administration office in the Virgin Islands. Employment and Retirement: Collectively, the recommendations suggested public educational activities and elimination of age requirements in Government employment. Health and Rehabilitation: A large number of recommendations concerned Federal action for better health through increased research, construction of facilities, and specific programs. Recommendations included: Research and public education on nutrition; Increase of funds for nursing home construction and other expansion of the Hill-Burton program; Development of national standards for nursing homes and other facilities; Development of standards by inter-state commissions for institutional facilities; Federal research on biological and medical aspects of aging; Utilization of existing health organizations rather than establishment of separate geriatric agencies; Attention to dental health programs. Social Services: All recommendations relating to social services suggested increased Federal activity: Provision of matching funds for general assistance and for all public social services; Federal leadership in development of services directed toward self-care; Provision of counseling and referral services in Old-Age, Survivors, and Disability Insurance programs; Federal development of standards for domiciliary homes, family care homes, day centers, and homemaker services. Housing: Housing recommendations with Federal significance suggested liberalization, extension, and expansion of existing programs: Provision in FHA home mortgage insurance program for additions to or remodeling of family residences so that an older person could live with a younger family and have separate space and facilities; Planning and consultative services to local communities; Re-evaluation and relaxation of limitations and requirements to achieve greater flexibility; Federal research relating housing needs to ability to pay, to guide policy on private versus public financing of housing. Education: All recommendations concerning education indicated that increased activity is called for in several areas: All governmental organizations should work on pre-retirement planning; |