THURSDAY, APRIL 20, 1972. NUTRITION PROGRAM FOR THE ELDERLY WITNESS HON. CLAUDE PEPPER, A REPRESENTATIVE IN CONGRESS FROM THE STATE OF FLORIDA Mr. FLOOD. We will now hear from the Hon. Claude Pepper from the 11th District of Florida. Mr. PEPPER. Thank you, Mr. Chairman and members of the committee. I would like, Mr. Chairman, if I may, to have my statement included in the record and I will briefly summarize. (The statement follows:) STATEMENT FOR SUBCOMMITTEE ON LABOR-HEW APPROPRIATIONS NUTRITION PROGRAM FOR THE ELDERLY Mr. CHAIRMAN. You know I was the author of the nutrition program for the elderly and, since I first introduced the legislation in May of 1970, I have done everything I possibly could to obtain the favorable consideration of both the Congress and the administration for this program. As you know the final support was overwhelming, with the approval of the bill in the Senate 88 to 0 and the passage in the House by a vote of 350 to 23. The President now has sent to you an amendment to his budget request which provides for $100 million for fiscal 1973, authorized in Public Law 92-258. The need for your subcommittee's favorable consideration of the President's request is urgent. You know 25 to 30 percent of aged Americans live in poverty; but, even if we were able to eliminate poverty, the elderly would still face problems that the nutrition program for the elderly will overcome. The elderly suffer not only from lack of adequate income; they also lack physical mobility, adequate transportation, adequate housing with cooking and refrigeration facilities. There are important social and psychological factors too. The elderly who live alone are isolated from family and friends and this isolation results in a lack of incentive to plan and prepare adequate meals. Americans cannot deny, but we must overcome, the ambivalence in our society toward old people. Simone de Beauvoir in “The Coming of Age” frankly describes our brutal attitudes that have condemned so many older people to poverty, decreptiude, wretchedness and despair. Miss de Beauvoir believes we must "recognize ourselves in this old man or in that old woman. It must be done," she says, "if, we are to take upon ourselves the entirety of our human states. And when it is done, we will no longer acquiesce in the misery of the last age; we will no longer be indifferent, because we shall feel concerned, as indeed we are." Delegates to the White House Conference on Aging, held in Washington, last November, were very much aware of our ambivalence which resulted in their very loud plea for less rhetoric and more action on the part of Congress. You know I am pleased the recommendations of the Conference in the field of nutrition needs were thoroughly consistent with the nutrition program for the elderly. They attest to the fact that full funding of this program is absolutely essential to the Federal Government's fulfillment of its obligation to preserve and protect the mental and physical health of older Americans. Mr. Chairman, the administration opposed this legislation initially and the reasons specified are pertinent to considerations this committee may have with regard to full funding. First, the argument was offered in opposition that a categorical program of nutrition services was undesirable because a more comprehensive approach to the provision of social services for the aged is needed. There is certainly a need for a comprehensive program and I hope the administration will carry through on its promise to prepare legislation that would provide for the integrated social services needed by the elderly. A study of the recommendations of the White House Conference on Aging clearly indicates, however, an acute present need for the nutritional services, and the President has acknowledged this priority need. Full funding of the President's request is imperative. We must not delay in our efforts to keep the aged out of institutions and help as many as possible maintain their independence and enable many of them to resume activities that will contribute to community life. The second argument advanced by the administration in opposition was cost of the meals. The Senate committee recognized that cost estimates based on the administration on aging's title IV research and demonstration projects varied considerably; the committee considered, however, that the bill provided for some payment by the recipients of the meals and, moreover, that testimony had been presented that frozen meals designed especially for the elderly can be obtained from commercial sources throughout the country at a cost of about $0.50 each for the meal itself. The Federal Government will surely save money by funding this program which according to abundant geriatric authority will help preserve the health and self-sufficiency of so many Americans. The Federal Government spent approximately $500 million on nursing home care under medicare in 1970 and about $1.3 billion on such care under medicaid. Total medicare outlays are approaching $8 billion a year. The final argument offered in opposition was that the income strategy embodied in H.R. 1 holds the best hope of meeting nutrition problems of the elderly. In its broad concept the nutrition bill clearly is not an income maintenance bill; but is a valid program, which will be needed even if we are able, at some future time, to raise the level of income of older Americans to a decent standard. Moreover, I remind the subcommittee that we have not raised social security benefits to an adequate level and there are millions of Americans who are hungry now and must be fed this year and the next. We must begin to provide much greater Federal support for many needs of older Americans. According to trends indicated in a report available from the Special Committee on Aging, U.S. Senate, entitled "The Economics of Aging." older Americans are twice as likely as younger persons to be poor. The report states: "The number of Americans over the age of 65 who live in poverty increased by 200,000 between 1968 and 1969, and by 12.000 for those aged 60 to 64. A total of 4.8 million people aged 65 and older were living in poverty in 1969. The number of all other age groups living in poverty declined by 1.2 million." The provisions of the nutrition program will in a small way help in providing supplemental employment for some of the elderly because it requires that preference must be given to the elderly themselves for necessary staff positions. The President in his press release announcing his request for $100 million for Public Law 92-726, stated that it was estimated approximately 900.000 elderly would receive one meal a day, 5 days a week. There is the possibility that even a greater number may benefit. There would be a reasonable expectation that if you appropriate $100 million to provide a greatly expanded program over those projects funded at $2,400.000 that a scaling of economies must or should result. You know the title IV projects were designed solely to develop and test techniques and were designed with specific limitations, particularly on the outreach aspects of the program that are required in Public Law 92-726. The subcommittee should not fear that the $100 million will not be utilized fully in fiscal 1973. We should have every expectation that by providing the full appropriation, the States and local communities will for the first time have the stimulus to try to match the Federal 90-percent funding with the 10-percent local funding required under the bill. I am, in fact, confident that the senior citizens themselves will see to it that all the matching requirements are met at the local level for the full sum available. This program has built-in provisions to assure maximum utilization of the Federal funding. Senator Javits, in his testimony before the Senate, noted: "The bill states a fine criteria for a State plan and gives the State the first opportunity to develop a plan and operate it satisfactorily. But if the State does not develop a plan or does not operate it satisfactorily, then the administrator is left free to use other means, others levels of government, even private agencies. for the purpose of seeing that a meaningful plan is developed and administered. "It seems to me that that is really the right way in which to realize the best of federalism and not to incur the worst. I call that particularly to the attention of the Senate because I hope it will be a model for other bills and there are many of them-in which we can solve this particularly serious question." Another factor which assures that the funds will be used for food and necessary related services to the elderly, is the limitation that States may utilize up to 10 percent of their allotment, and no more, for administrative costs. The possibilities of abuse which we unfortunately have experienced in some Federal programs are minimized in the nutrition program. Only nonprofit organizations and governmental bodies may qualify for a grant or contract under Public Law 92-726. The nonprofit sponsors may contract with profitmaking organizations, subject to the approval of the State agency. The experience in certain title IV research and demonstration projects has been that the profits of food suppliers are controlled and kept modest by the process of competitive bidding; the review process of volunteer boards of directors; and the elderly participants themselves. I urge this subcommittee to give the President's request for $100 million favorable consideration, thereby continuing the overwhelming bipartisan support the legislation received in the Congress. Mr. PEPPER. Mr. Chairman, I appear here today in behalf of S. 1163, the nutrition program for the elderly, which passed the Senate by vote of 88 to 0 and the House by vote of 350 to 23. If I may say with a little measure of pride because of the many people benefitted by this program, as brought out by the chairman of the Education and Labor Committee when we considered this matter in the House, I offered this bill in 1970. We had a hearing on it in Miami and some other places and then it didn't pass the House in 1970 and I introduced it again in 1971 in March, and invited Senator Kennedy to join as coauthor. It just happened the Senate passed the bill and sent it over to us, but we in the House can take a measure of pride in the fact this measure was originated in the House of Representatives. I speak of it with pride, as I think all of us may regard it, because I think it will be one of the most meaningful programs for the elderly people in the country ever enacted in the Congress. It provides at least one nutritional meal a day for at least 5 days a week for the citizens of this country who wish to take advantage of it who are 60 years of age or over and the spouse of that individual. It will also provide transportation for the individual to the place where the meals are served and, of course, back to the residence of the persons participating in the program. And then there will be delivery of the meal to the person who is not able to be transported to the place where the group will dine. In addition to providing of meals for the people who are participating in the program, it would also provide social and recreational services to these people. It is a $100 million appropriation which was authorized by the Congress for fiscal 1973 and $150 million for fiscal 1974. As we requested in the House in our statement, the President not only signed the bill but came along recently and requested the full amount authorized, which is a little unusual for the executive to request the full amount authorized for a program, particularly a new program The White House had held off for awhile in giving assent to this program because they took the position that this sort of a program ought to be part of a much larger and more comprehensive program for the elderly. After the Congress had taken the initiative, and I think seeing that this would not only provide meals but recreational and social opportunity for those participating, the administration gave its wholehearted support and requested this $100 million appropriation in a budget amendment. Ninety percent of the funds of this program would be provided by the Federal Government, 10 percent by the States, the local community and nonprofit organizations. The local authority will be obligated to provide the building and they will participate in the 10percent contribution to the cost of the program. I foresee, Mr. Chairman and members of the committee, that this will be, as I said, one of the most meaningful programs to the elderly people of this country, so many of whom are impoverished. Thirty percent of them are below the poverty line. It will some day, and I hope it will not be a distant day, make it possible for these people not only to come together in fellowship and friendship and comradeship, breaking the shackles of the terrible loneliness which so many experience in the places where they live, and enjoy a good meal; but there will be opportunities, I hope to foresee in your lifetime and mine, where they can see a picture show or witness slides, they can hear lectures, can have access to books and magazines and newspapers and of course games and that sort of thing. Eventually I hope it will be a sort of a senior citizen club where comradeship and friendship and recreation and social activities will be made possible for them. This is so important, Mr. Chairman, that these funds be appropriated, I hope, in entirety within the wisdom of your great committee so we can get this program started. I have already had a very encouraging letter from the Governor of my State. The legislature made provisions for our State's participating and the local authorities are anxious to have a part in it. I have no doubt but that the States or local communites and/or both and/or private groups will do their share. I hope we can get ready so that by the first of July we can get this program underway; and it will mean a happy future for some of these people, Mr. Chairman, if you see fit to approve the President's request. Mr. FLOOD. Thank you very much. Mr. MICHEL. Mr. Chairman, I would like to make one very brief observation. Mr. Pepper, in your testimony you said something about hot meals to an individual 5 days a week. I was under the impression, too, that this meant a hot meal 5 days a week to the same individual, building up their nutritional standard over a period of time. But when we had the testimony from the Department witnesses, I found, to my surprise, that the program is not necessarily predicated on that premise, that the same individual may not get five hot meals in a week. The allocation is based on so many people times five for a week; it may be one person getting two meals and another person getting three. I don't know if that is your understanding. Mr. PEPPER. There is no means test specifically provided for those who can participate in this program. It was hoped that it would not be necessary for a means test to be provided or enforced, but the President estimated, I believe it was when he signed the bill, that 900,000 people would participate. We know there are 20 million people in this country over 65 years of age. Of course, among these elderly citizens are many who are amply able to provide the necessary things at their homes or wherever they wish to dine. We will find out, and I would certainly be individually shocked and certainly would individually protest if anybody who came within the range of reasonableness and wanted to participate in this program was turnedaway. You know it is generally supposed these meals will be paid for to a minimum degree by the participants. They generally use the figure of 50 cents or 65 cents. We have had these pilot programs in Miami, and perhaps you have had in your area, with the little money we had. That money has run out and these programs will all be ended before July 1. We have had some local supplement of these funds. In my county 800 to 1,000 people out of a senior population of 200,000 have participated in this program. There will be a very much larger response now that more people will be able to participate. But I can't believe that we would be cruel enough to turn away any people who could reasonably be said to be eligible to participate in this program. I know in my area I have, as you have in yours, a juxtaposition. Take Miami Beach, Fla. Above a certain line you fine elderly people of great wealth and below that line too many elderly people living in poverty where it is a real sacrifice for them even to buy a paper. Those people will look forward to this bill and we will only be able to tell by experience. I would not come in and tell this distinguished committee we are going to find in the future $100 million will be enough. I think we will have to be governed by what the practicalities of the situation are. As I understand it, of the total cost, about a third will be for the food itself in its raw state that goes into the meal, about a third of the expense will be the preparation of the meals, and about a third will be transportation and the social and recreational services and the jobs given to the senior citizens who participate in the program. I think it will be an enormously meaningful program and at least this will give us a good opportunity to determine the response of the people, and the experience that we have will guide us in what we do in the future. Mr. FLOOD. Thank you. Mr. PEPPER. Thank you, Mr. Chairman. THURSDAY, APRIL 20, 1972. HEALTH AND EDUCATION BUDGET WITNESS HON. TENO RONCALIO, A REPRESENTATIVE IN CONGRESS FROM THE STATE OF WYOMING Mr. FLOOD. We will now hear from the Hon. Teno Roncalio, Congressman at Large from Wyoming. Mr. RONCALIO. Thank you, Mr. Chairman. I would like to read a statement. Mr. Chairman and my colleagues, I am not pleased at the administration request to cut funding of Public Laws 874 and 815. If this is |