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Rockefeller, Hon. Jay, a US. Senator from the State of West Virginia

Lee, Helen, caregiver and recipient, Arnold Senior Center, Arnold, MD;

George and Jean Glakas, recipient and caregiver, Lincolnia Day Health

Care Center, Fairfax, VA

Reed, Charles E., assistant secretary, Aging and Adult Services Administra-
tion, Seattle, WA; Robert Dolsen, executive director, Region IV, Area Agen-
cy on Aging, St. Joseph, MI; and Jane Kennedy, director, AAA of Southern
Mississippi, Planning and Development District, Gulfport, MS

Kane, Rosalie A., DSW, director, Long-Term Care Decisions Resource Center,

Minneapolis, MN; and John A. Capitman, Ph.D., director, National Aging

Resource Center, Waltham, MA

Jones, Mary Gardiner, chair, public policy committee, Older Women's League,
Washington, DC; and Dr. Linda Redford, National Council on Aging, Wash-
ington, DC .............................

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Adams, Hon. Brock, a U.S. Senator from the State of Washington, from
Charles E. Reed, assistant secretary, Aging and Adult Services Admin-
istration, WA, dated May 15, 1991

Adams, Hon. Brock, a US. Senator from the State of Washington, from

Robert Dolsen, executive director, Area Agency on Aging, Inc., MI,

dated May 3, 1991 (with attachments)

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FRIDAY, APRIL 26, 1991


The subcommittee met, pursuant to notice, at 10:08 a.m., in room SD 430, Dirksen Senate Office Building, Senator Brock Adams (chairman of the subcommittee) presiding.

Present: Senators Adams, Cochran, and Durenberger.


Senator ADAMS. Good morning. I am pleased to convene today a hearing of the Aging Subcommittee of the Senate Committee on Labor and Human Resources. This is the fourth in a series of hearings which we are holding on the reauthorization of the Older Americans Act, commonly referred to as the OAA.

Today's hearing will show the significant and diverse roles the OAA and the aging network have played in long-term care.

Debate over developing a comprehensive long-term care system for our Nation is well underway. One part of this debate concerns the extent and appropriateness of the Older Americans Act in longterm care.

The fact is that in many States and local communities across the country, the Older Americans Act is having a significant impact in long-term care as we speak here today. Many States and communities already have in place innovative long-term care efforts. And at the heart of many of these programs is the aging network, that is, the State and area agencies on aging and the local OAA-funded service providers.

The aging network, in the absence of a national long-term care program, has become the principal source of key home and community-based services in many parts of America. Moreover, the aging network is serving a crucial role as a catalyst for planning, coordination and development of long-term care.

I have placed some charts before the committee.

[The charts referred to appear in the appendix.]

Senator ADAMS. It is clear just from looking at these charts that a great many of our senior citizens are at home and are being taken care of on a long-term care basis with help from services that are similar to those provided under the Older Americans Act. Yet,


the amount of funds being devoted to long-term care at home is almost directly opposite to the amount of long-term care that is being provided in nursing homes. We have to examine this to determine where this Nation wants its priorities set and how we are going to deal with this problem.

Surprisingly, however, the contributions made by the OAA and the aging network in this area often go unnoticed. People do not realize that most people cared for on a long-term care basis are cared for at home. Today's hearing will help correct that oversight. We will not only hear about the act's current roles, but consider potential future roles for the act and the aging network in long-term


Most of the public funds, excluding the OAA, spent on long-term care are spent for institutional care, for nursing home care. By contrast, the overwhelming majority of those needing long-term care live at home, and that is where the OAA often comes in.

As I indicated previously, as you can see, the chart shows that 84 percent of those needing long-term care live at home. Yet, our expenditures are in inverse proportion. Out of nearly $53 billion spent on long-term care in 1988, 82 percent was for nursing home care, not home-based care.

The other chart to my right shows expenditures on long-term care for the elderly by five States that have similar sized aged 60 and over populations. This chart shows the OAA-the red columnis but one component of the home and community-based care system. And the total dollars spent on noninstitutional long-term care are small. Today's witnesses, including Charles Reed, a leader in long-term care from the State of Washington, will show that OAA funds, however, provide an important foundation for home and community-based long-term care.

The OAA dollars are not large, but their impact is. With OAA dollars, homemakers and chore workers can cook meals, grocery shop, and do difficult household chores for those who are unable to do these tasks. The OAA also provides congregate and home-delivered meals, case management, adult day care, and respite care, and other needed services. The best part is that the recipients of these services can stay in their homes rather than a nursing home. We ill hear from several brave older Americans about how these services have helped them maintain their autonomy in the community.

The need for long-term care is clearly on many people's minds. National polls repeatedly show the great concern that Americans have about long-term care. The recent Pepper Commission report provides us with a thoughtful and important starting point. That is why we are so very pleased this morning that Senator Rockefeller, who chaired the Pepper Commission, will be with us and will tell us about the Pepper Commission's recommendations and discuss its relevancy to the Older Americans Act.

I hope we can make real progress toward a national long-term care program. Regardless of what form a future long-term care system takes, this hearing will show today that OAA has helped to lay the groundwork and its experience should be carefully taken into account in the future.

I have a statement for the record, and also a statement by Senator Simon, and both will be made a part of the record.

[The prepared statements of Senator Adams and Senator Simon appear in the appendix.]

Senator ADAMS. I want to have an opening statement from Senator Durenberger, if he wishes one, but before doing that, I would like to welcome my colleague, friend, and the head of the Pepper Commission, the Honorable Senator Jay Rockefeller from West Virginia. Jay, it is wonderful to have you with us. As soon as Senator Durenberger finishes his opening statement, we will turn immediately to you.


Senator DURENBERGER. Mr. Chairman, thank you. The opportunity not just to say something appropriate about Jay Rockefeller, but something important I cannot pass up. We all went to the Pepper Commission thinking it was sort of a political compromise between catastrophic-a mandated acute care program and then the long-term care that became a big political issue in 1988. And I remember the early struggles to determine whether or not we were going to be doing Claude Pepper's agenda or we were going to be doing a national agenda or whether they coincided or what the case may be. And then just as we were resolving those incredibly important issues, as it turns out, we lost Claude Pepper. You can imagine a commission that may have looked to many people either the commission looked like a political compromise, or the issues looked like a political compromise, leaderless at that particular point in time. There just were not a lot of people that held out a lot of expectation that we were going to accomplish anything.

But we elected Jay Rockefeller, who was then the brand new ranking member succeeding George Mitchell on the Medicare Subcommittee of the Finance Committee, as our leader. And I must say that when it came to the universal access issues, we ended up at least with a divided vote, but not a divided committee. And I think that everybody on that committee came so much closer to agreement than they would have under any other set of circumstances. Since there were only a few of us there and many of you who were not, I wanted to tell you that because there was an 8 to 7 vote on the acute care side of that committee, that should not lead you to believe that this was a committee divided down the middle. We are much closer because of Jay's leadership.

On the long-term care side, which is the subject of consideration today, he forced us first to define what it is we were talking about. Nursing home care, home support services, assistance with essential ADL's, assistance with instrumental ADL's, physical therapy, rehabilitative services, housing assistance, you know, just whole variety of things. Then he forced us to deal with the current policy responses, Medicaid, Medicare, the Older Americans Act, Title III in particular, the social service block grants, the VA programs, the income tax provisions that we labor with over in Finance, this new market for private long-term care insurance. All of these things he forced us to examine and to deal with, and the end result was a set of recommendations, which I think we ended voting 11 to 4.

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