Mr. KURZMAN. Of course, the principal source of funds for construction and maintenance for community centers is the Department of Housing and Urban Development. What we do with regard to these community centers through the Administration on Aging, is to seek to make sure that HUD policy incorporates some provision for the elderly in Hud-supported centers. Senator PERCY. I would like, as you look down the path and develop a comprehensive program and I trust that we will come up with oneI would like to offer the services of any of the people on my staff that have been working on this problem. We did the best we could, in the package of 12 bills I put in, but we realize they are far from perfect, and I would be happy to provide any assistance or help I can. So far as feeding and nutrition, I think even though we have needled and pushed the administration a great deal from three or four different directions, I can only quote the chairman of the committee of which I am the ranking Republican, the Committee on Nutrition and Human Needs, Senator McGovern. He has said that no administration in the history of this country has ever done more in feeding people than this administration has. I think this has been given a high priority. It would be disappointing if we were ever satisfied. Senator Eagleton has been a tenacious fighter and advocate for the elderly and for their needs. The elderly have not had effective lobbyists or spokesmen in the past, but they are betting better at it. I certainly want to commend Senator Eagleton for what he has done, and at the same time commend the administration for what it has done. I look ahead to the White House Conference as pulling a lot of things together, and I hope to work with the administration in the development of an outstanding program. In our working experience, if we can close this hunger gap, I think for all citizens, I think it would be a magnificent contribution. Mr. Chairman, I would like to thank you and members of the staff very much for your indulgence this morning. Senator EAGLETON. Thank you, Senator Percy. You always make a valuable contribution in this area because it is one in which you have a distinct interest and expertise. We appreciate your participation. (The prepared statement of Senator Percy follows:) PREPARED STATEMENT OF HON. CHARLES H. PERCY, A U.S. SENATOR FROM THE STATE OF ILLINOIS Mr. Chairman, in 1970, the Federal Government spent approximately $500 million on nursing home care for the elderly under the Medicare program. It spent about $1.3 billion for such care under Medicaid. Total Medicare outlays are fast approaching $8 billion a year. We are asking a great deal of the American taxpayer, and he is unhappy about it. He is unhappy not so much because he minds paying taxes to help the sick, the poor, and the aged, but because he sees little or no return on his tax dollar. With the figures cited above in mind, the taxpayer becomes upset-and understandably so-when he picks up a newspaper and reads that Medicare covers less than one-half of the health-related expenses of the elderly, or that large numbers of federally funded nursing homes are so squalid and depressing that they are known as "pre-funeral homes". To those who have delved into the problem of expensive but inadequate health care, it is clearly that the taxpayer is paying not only for widespread abuse and waste in the Medicare and Medicaid programs, but also for our inefficient and inadequate use of appropriate, but less expensive alternatives to these programs. In my opinion, S. 1163 offers us a less expensive, but appropriate alternative to some of the more expensive federal programs. S. 1163 builds upon and expands a highly successful research and demonstration program funded since 1968 under Title IV of the Older Americans Act. Under this program, hot, nutritious meals are served to elderly citizens in communal dining facilities-generally located in a school, church, or other public and nonprofit setting. The elderly participants pay for their meals, and even though the amount paid may only be nominal, it allows the participants to maintain a sense of dignity and independence. Nutrition education is offered, as many elderly people have only a limited knowledge of what foods are best for their health and how to prepare them. Several of the ongoing demonstration projects deliver hot meals to homebound, isolated senior citizens, and most of the projects also offer help or advice with such matters as transportation, employment, Social Security and Medicare. The basic premise underlying this program is that nutritious meals provided in a social setting lead not only to improved health, but also to better spirits and a more positive outlook on life. Arthritis and other chronic ailments combine with inadequate public transportation to force many elderly people to subsist on foods most easily procured and prepared, rather than on those foods that are best for them. As a result, their health suffers. Immobility, vulnerability to crime and unscrupulous enterpreneurs, poor health and a deteriorating physical appearance, loss of family and friends who have either moved or passed away, loss of one's role in society and the accompanying sense of uselessness-all of these factors can add up to an overwhelmingly depressing existence for the isolated elderly individual. These factors aggravate one's sense of loneliness and isolation, and lead to poorer appetites, which in turn lead to poorer health. The need for a program like that envisioned in S. 1163 is best illustrated by quoting directly from some of the elderly people now participating in the demonstration project. One participant says: "It is hard for us as Seniors to put into words just how we feel about our Senior Citizens program. It has enriched our lives to the extent that we now have a real zest for living. The meals program has been a tremendous tool to get us together around a table twice a week. Besides the good we get from the nutritious meals, we also have such a grand time socially." Another participant comments: "I have become a different person altogether. This program is my best medicine. If it were not for this program, I'd be in the hospital. Now I save on doctor bills". A project director writes me: "The true measure of the program is extremely difficult to define. We can only tell you that we have observed attitude changes in our Seniors toward themselves and toward others. Feelings of dignity and self-worth and a friendly rapport with other members of the group are now evident. Their interest in community affairs is renewed. They eagerly seek information on shopping trips, menu planning and consumer news”. There is an immediate and crying need for a broad scale, nationwide nuitrition program for the elderly. A full one quarter of the 20 million older Americans live at or near the poverty level, and these people comprise the most uniformly malnourished segment of our population. In testimony on this legislation, the Administration has expressed its opposition on the grounds that S. 1163, a categorical grant program focusing on nutrition alone, will not meet the needs of the elderly. It has indicated further that we should endeavor to meet the full array of the needs of the elderly for social services, including nutrition services, through a broader, more comprehensive program. I would agree that we should be working toward a broader, more comprehensive program to meet the needs of the elderly, but it will take time to develop such a program. The need for a more basic nutrition program is immediate. Although the current ongoing nutrition demonstration projects were designed to focus on the problem of malnutrition and undernutrition, they have also come to provide various social services. There is no reason that S. 1163 could not provide the basis for a broader, more comprehensive program. Indeed, by starting out on a smaller, more limited basis, the prospects for success of the broadertype program should increase, as mistakes or shortcomings could be identified and corrected. It is noteworthy that S. 1163 specifically calls for the delivery of meals in a setting conducive to expansion of the nutrition program to include information, recreation, health and welfare counselling, and referral services. S. 1163 is the natural culmination of the current nutrition demonstration project which has proved so successful. It is, in a sense, a "known quantity", as opposed to an intriguing, but untested government program which we sometimes pursue. To provide the type of program considered more desirable by the Administration, I have already introduced a bill, S. 1588, known as the Senior Citizens Community Centers and Services Act. S. 1588 would provide a focal point in a community for all senior citizen activities and social services. The elderly would be able to go to a single center and obtain information or help with such matters as low-cost meals, transportation, legal and employment counseling, and recreational, social, educational, and cultural programs. This measure would very easily- and logically-absorb and expand the basic nutrition programs, and in so doing, provide the type of broader, more comprehensive program called for by the Administration. S. 1588 is a more complicated piece of legislation, however, and I do not believe we should delay enactment of S. 1163 while are are working toward the broader program. As a cosponsor of S. 1163, I urge its enactment on the grounds that it offers us an alternative to expensive, institutionalized care for many senior citizens. It is a good bill. In addition to the fact that it is moral and right that we act to alleviate the problem of malnutrition among the elderly, this measure may very well save the taxpayers money. Senator EAGLETON. One further question and then we will conclude in the area of nutrition, and discuss some other problems with Dr. Marston. I have difficulty in translating the testimony of Mr. Martin as to the need for further research, further gathering of cost figures, further analysis, and thus the further postponement for an indefinite period; we have tried on more than one occasion to get a rough estimate, and have not succeeded I have difficulty relating that testimony to the budgetary recommendations of the administration on title IV of the Older Americans Act, which is the section of the act dealing with research and demonstration projects. I will read into the record the figures. For fiscal 1969, $4.155 million. For fiscal 1970, $3,250 million, a decline of about a million dollars. For fiscal 1971, $2.8 million, a decline $400,000 from the previous year. For fiscal 1972, the original budget request was $1.8 million, which is another decline, but it was later amended in testimony by Secretary Richardson on April 27, back up to $2.8 million. So let me ask you, Commissioner, if you feel that we need more time, more demonstration programs, if you need more cost figures, or more research so as to better prepare the Administration for an ultimate recommendation in this area, how is it that the Administration's request for title IV research and demonstration funds is each year a lesser one? This year it was down to $1.8 million, but was amended back up to $2.8 million, which is again progress by standing still. How does that gibe? Commissioner MARTIN. One reason for the decline is, as you complete projects, there is a drop in continuation costs. Senator EAGLETON. As you complete projects that means you gather information. Commissioner MARTIN. Yes, that is correct. Senator EAGLETON. And if you don't start new projects, that means you have gathered enough information, I guess. Commissioner MARTIN. The $1.8 million figure reflected a very broad cut in research funds which applied not only to aging but applied to various other parts of the Social and Rehabilitation Service appropriation. We think $2.8 million will give us the funds we need to do the research we want to do. Senator EAGLETON. Do you think the 21 demonstration projects will come out of that $2.8 million? Mr. MARTIN. They will not necessarily come out of that, Senator, no. Senator EAGLETON. A final question, then, Mr. Commissioner. In September of 1970, about 9 months ago, roughly, during hearings before Congressman Brademas, and those hearings related to Congress man Pepper's nutrition bill, you said that these would be an amendment to the social service amendments to include nutrition for the elderly in that package and that a major test would be conducted into the delivery of nutrition services as a part of the total social service delivery system. My question to you is, has that test been conducted or started? Commissioner MARTIN. As we testified, it is being started now. Senator EAGLETON. Have the amendments that you described as forthcoming in September of 1970 been submitted? Commissioner MARTIN. The test is the one to which we referred in or testimony. It will be funded before the end of the fiscal year, by June 30, at a cost of 2.4 million dollars. It has taken us some little time to get that on track because we were holding rather lengthly discussions with OEO as to just what sort of demonstration we should develop. That is in motion and will be funded by the 30th of June. To answer your other question, the title XX proposal was withdrawn after some study. It was felt that a better proposal could be made. As Mr. Kurzman testified, it will be resubmitted in the form of an integrated services bill. That bill will pick up elements of the title XX proposal. We expect that bill to be submitted during this session. Senator EAGLETON. Do you think that bill will be sent up before the end of this calendar year? Commissioner MARTIN. Yes. Mr. KURZMAN. That is our goal, Mr. Chairman; yes, sir. Senator EAGLETON. Continuing in the area of the discussion relating to nutrition, we have a series of questions from Senator Kennedy on this subject which we will submit to you in writing and request that you answer in writing, and both the questions and the answers will be made part of the record. Now if we may, let's move to the question of the proposed Institute of Gerontology. At the outset, let me make part of the record a letter dated April 8, 1971, from Dr. Gerald F. La Veck, Director, National Institute of Child Health and Development, addressed to Dr. Denham Harman of the University of Nebraska, at Omaha. It is a one-page letter. I will read a portion of the letter: And the appropriations request for the Institute in the President's budget for the fiscal year 1972 is $132 million, of which $7.2 million is allocated for our aging program. So that is about 5 percent. This represents a $1.4 million reduction compared to funds spent in fiscal year 1971 for this program. This will mean, for example, that no new aging research grant awards can be made in fiscal year 1972. The table that follows provides a more detailed analysis. The entire one-page letter will be made part of the record along with Senator Kennedy's questions and the responses thereto. (The information and letter referred to follows:) This is to respond to the questions of Senator Kennedy which you The Administration opposes S. 1163 because: 1. We do not believe that a categorical feeding program for the 2. We believe that the costs of a national nutrition program 3. As you know, the meal cost is only part of the expense 4. Although we are actively engaged in trying to discover 68-179 O 71 19 |