Senator Thomas F. Eagleton 2 5. We believe that additional research is necessary in order to test and validate the proposition that not only are nutrition services effective, but that they are more cost effective than other means for reducing isolation and hunger among the elderly. Even though we do not support S. 1163, we do intend, as was stated before your Subcommittee, to continue to experiment with twenty-one AoA demonstration nutrition projects, which will be restructured to include a heavy research component, and to test a comprehensive social services program for the aged with nutrition as one of the central elements on a major scale. Against the background of our position on the proposal, stated above, our answers to Senator Kennedy's questions follow. QUESTION: Have you made any estimate of the number of single elderly persons who have need of the services provided by this Legislation? the number of elderly couples? ANSWERS: We understand that the elderly who were primarily sought to be benefitted by the bill's sponsors are the poor and near-poor. In 1970, there were 2,735,000 unrelated elderly individuals who fell below the officially-established poverty line, and 752,000 unrelated elderly individuals who can be considered near-poor, since their incomes were only slightly above the line. In 1970, there were 1,166,000 families with heads age 65 or over who fell below the poverty line, and 597,000 of such families who were near-poor. QUESTION 2: Have you made any estimates of the number of elderly persons who would be benefited under the nutrition bill before the Committee? Of ANSWER: We have made no estimate, and it would be extremely difficult to come up with any reliable figures, because of the uncertainties with which we are confronted in contemplating the program. First, we cannot know at this point how much Congress will be willing to appropriate each year. Second, we cannot predict what percentage of those served will be rural or urban. ENKI Research Institute studied the Title IV nutrition demonstration projects with a Title IV grant from the Administration on Aging. It found that the costs for all activities and services per participant per day were $4.40 in rural areas and $2.32 in urban areas, a ratio of approximately two to one. Third, we cannot foretell the percentage of the cost of the projects which will be borne with the Federal funds appropriated. The bill would provide that "up to 90%" of the costs would come from the Federal share. Fourth, we do not know the extent to which charges to participating individuals will reduce the amount of Federal funds used in each project. Fifth, we cannot predict the extent to which economies of scale will result from an extensive, Senator Thomas F. Eagleton 3 nationwide program, as contrasted with the relatively few, scattered demonstration projects upon which most of our present knowledge is based. Finally, it is difficult to foresee the extent to which additional experience might reveal ways of effecting economies without substantially reducing the quality of the programs. Additional research and demonstration activity, which we strongly recommend, would probably answer some of these questions for us and enable Congress to legislate more knowledgeably. QUESTION 3: I believe HEW should be commended for finally agreeing to release the $1.7 million to permit the demonstration programs to continue but if you are going to oppose this program, what do you expect to put in its place and when do you expect those services to be available to the elderly who are not now served by the pilot programs? ANSWER: We attempted to give this information during the hearing. To recapitulate, we pointed out that various features of H. R. 1 would provide better incomes for the elderly, thus making it possible for them to afford better food. Second, we referred to the comprehensive social services bill which the Administration hopes to complete and send to Congress soon. It is expected to authorize nutrition services as part of the comprehensive approach toward meeting services needs. Third, we discussed various research and demonstration efforts which are being carried on, including the joint efforts of the Social and Rehabilitation Service and the Office of Economic Opportunity and the continuation of the research and demonstration projects under Title IV of the Older Americans Act of 1965. we expressed our hope that the Areawide Model Projects which are just now being launched will help meet the need for nutrition services for the elderly as part of their approach toward meeting the need for comprehensive, coordinated services to the elderly. Fourth, QUESTION 4: Do you agree that in addition to the nutritional services, such services as transportation to and from the site, information and referral services, and nutritional education services are vital to meet the needs of the elderly? Do you have objections to the manthat these services are included in the bill? ner ANSWER: We do agree that the provision of these additional services is vital to the success of a nutrition program, and that it enhances the value of a program out of proportion to any additional cost which may be incurred thereby. While the provisions in the bill regarding these services might be improved, we have no objection to them at this time. QUESTION 5: Stephen Simonds, last year testified as Commissioner of Senator Thomas F. Eagleton the Community Services Administration, Social and Rehabilitation Service, HEW, that the Administration on Aging should become"the primary advocate in government for the needs of the aging". How can the Administration on Aging become the primary advocate when you cut off programs like RSVP and Foster Grandparents from the Administration on Aging and when you oppose their directing an obviously needed program such as the Nutrition for the Elderly Program? ANSWER: As you know, the Administration on Aging designed, and, for almost six years, administered the Foster Grandparent Program. It also, as you know, designed and launched the Retired Senior Volunteer Program. Because both programs had their origins in the Administration on Aging, the AoA stamp will remain on them in the future, wherever they may be administered. In addition, AoA will maintain close cooperative relations with these programs, as it does with Aging programs which did not originate with it, and, as advocate, will have a voice in their future. We do not oppose AoA's administering the nutrition programs. We have opposed S. 1163 because of its narrow categorical approach and because we believe patience in awaiting the needed additional information will be rewarded with a much better program. AOA would be well suited to administer the right program, with the right approach, at the right time. QUESTION 6: Dr. Donald M. Watkins, the chairman of the Technical Committee on Nutrition, for the upcoming White House Conference on Aging stated the problem of nutrition for the elderly is "of such magnitude that it can be mounted only by a dedicated Federal government using its powers to invoke equally concerted action by state, county and municipal authorities." Do you agree that the Federal government must be the focus of a national program of nutritional aid to the elderly? ANSWER: We believe that the Federal Government should provide incentives and financial and technical assistance to States and localities to establish nutrition programs for the elderly, but that the focus should be in the States and localities. They know the needs of their older citizens and are better able to set up and administer such programs. Playing its proper role in the programs, the Federal government could provide the needed financial assistance through H. R. 1, revenue sharing, and the forthcoming social services proposals. The technical asistance would come from the Administration on Aging, based upon what it will have learned from the nutrition programs it has conducted and will continue to conduct. Senator Thomas F. Eagleton QUESTION 7: The evaluations of the pilot projects have been positive. This program seeks to take those results and devise a permanent program based on them. Wasn't that the original function of the pilot programs? ANSWER: Although the evaluations of the AoA Nutrition demonstrations have been positive, they have also pointed up the lack of data on cost control in these projects plus the need for additional services. The original purpose of the AOA Nutrition demonstration projects was to explore alternative means of coping with the nutritional needs of older people, with the possibility that States and/or localities would pick up these services if the projects proved successful. This has not occurred and one reason may be the expense involved in delivering nutrition and related services to the elderly. Another reason may be that States do not know how to deliver such services on a Statewide basis. Since all the projects were relatively small local efforts, we have inadequate knowledge with which to assist the States. Hopefully, the OEO/SRS test will provide us with much-needed additional knowledge. QUESTION 8: The President's Task Force on Aging recommended in April 1970: "1 '...that the President direct the Administration on Aging and the Department of Agriculture to develop a program of technical assistance and, when necessary, financial assistance, to local groups so that such groups can provide daily meals to ambulatory older persons in group settings and to shut-ins at home." Doesn't this program represent an adequate Federal response to that recommendation? ANSWER: While it may be an adequate response, it is our view, expressed in our testimony, that it is not the wisest and best response. As we have testified, nutrition programs for the elderly would be most beneficial to them if conducted as part of comprehensive, coordinated programs of services to the elderly, not as a narrow, categorical program, and if designed and planned often adequate research and demonstration projects have been completed. QUESTION 9: Have you received any opposition from any representatives of the elderly to this proposal? ANSWER: No such opposition has been brought to our attention. I trust that you will call on us should you desire amplification of any of these answers. Sincerely yours, John B. Martin John B. Martin Thank you for your letter of March 31. I was most interested to read about the American Aging Association at the time of its establishment last fall, and I am happy to have the additional information which you sent to me about your new organization. The appropriation requested for the National Institute of Child Health I hope this information is helpful to you. Thank you for sending me the newsletter, and please feel free to contact me again if we can be of any assistance to you. Sincerely yours, Gerald DLa Veek Gerald D. LaVeck, M.D. National Institute of Child Health and Human Development |