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And second and simultaneously and maybe even more importantly, we have to develop the infrastructure, Mr. Chairman-we have to develop the infrastructure- to provide these services reliably and effectively. And I think again that the Older Americans Act has a pivotal role to play in exploring the various ways that that can be done.

I have concluded. I would be glad to answer any questions. [The prepared statement of Senator Rockefeller appears in the appendix]

Senator ADAMS. Thank you very much, Senator Rockefeller. I particularly wanted you to be here this morning. Yesterday I placed in the record Senator Pryor's bill. Unfortunately, as you know, he is in the hospital at the present time. Yesterday, I introduced on his behalf his bill with the OAA amendments that he has suggested. I want you to know that the OAA reauthorization bill that will come out of this committee, will reflect the tremendous work that has been done by the Pepper Commission, and by Senator Pryor with the Select Committee on Aging. We are trying to march together on this.

I know your time is limited, so I just have a couple of brief questions for you regarding how we can best coordinate our efforts and put this together.

In your State and in my State, we both have very active senior programs that deal to a degree with the case management question. Do you think we should be looking to the Older Americans Act, which has an aging network in place, to develop this infrastructure that you are speaking of? I agree that we must have a structure to apply to home care if we are going to put money into it, or it will not work. I agree that it has to be done at the local level. And it has to be federally funded.

Would you comment on that? You can use your program as an example or I could use mine, but we have in common, as you know, the aging network. We have senior centers available. And it ap pears to me that we may have an opportunity here to short circuit what you indicated is a long-term problem about developing an infrastructure for the use of Federal money for home care.

Senator ROCKEFELLER. Yes, sir, Mr. Chairman. I think the aging network is crucial because, first of all, it is out there. It is experienced. It is across every single State. As you indicated, the Pepper Commission did leave administration up to the States, and I think that is very important. I think it is equally important that the Feds are saying in most ways we are going to pay the bill.

Senator ADAMS. The bill that I put in yesterday for Senator Pryor for demonstration projects would you give me your thoughts on how many or where we ought to have these? How do we get a really good set of demonstrations and good operations to manage if we are going to put more money into home care?

Senator ROCKEFELLER. Yes. The obvious places to put them are West Virginia, Washington, and Minnesota. [Laughter.]

But in seriousness, the demonstration projects are very, very important, and I say that because States have far more experience in long-term care than does the Federal Government, which is why the Pepper Commission wanted to leave administration to them. Still, we do not really have a long-term care policy. We have a pas

sive, negative long-term care policy which, as I say, is the spousal impoverishment approach or just impoverishment approach. And, therefore, demonstration projects are necessary.

You can talk about rural America. There are all kinds of rural Americas. I can take you into my State and you go to what you call a rural section of the State, which is most of it, but there are fundamental differences between counties and between the populations and oddly so.

Senator ADAMS. You and I are well aware of that from certain trips you and I have taken through there.

Senator ROCKEFELLER. Yes, that is right.

But the demonstration programs are necessary. The case management is an easy word to say, but assessing how do you get at long-term care. Then how do you manage it, how do you tailor it. And then when you have long distances between, let's say, a senior center and a home or between health services that can be brought to the home in home health care, everything is different. And we have to make sure that we do this efficiently and that we do it intelligently.

So, the aging network is important for that. The demonstrations are important for that, and then the aging network across the State and then across the country. We then learn from those demonstrations in some sense how we can learn from each other.

Senator ADAMS. And you are really proposing that the Federal Government start funding some of the people who are taking care of people within their own homes so they do not have to go the nursing home.

Senator ROCKEFELLER. That is the fundamental philosophy of the Pepper Commission.

Senator ADAMS. That is the fundamental philosophy, isn't it? Senator ROCKEFELLER. Yes, of our long-term care policy. That is the fundamental philosophy.

Senator ADAMS. Thank you.
Senator Durenberger?

Senator DURENBERGER. No questions. Thank you.

Senator ADAMS. Thank you, Senator Rockefeller, both for what you have done and what you are doing. We want to work very closely with you. We will be reauthorizing the Older Americans Act, and we want do our part in dealing with the long-term care problem as part of it. We recognize that there is controversy with this. We do not want to bite off something that we shouldn't. So, we will need your help, and I hope that you will give it to us.

Senator ROCKEFELLER. Yes, sir. And we need the help of everybody in the Congress. We need the help of seniors all over America putting pressure on this end of Pennsylvania Avenue and on the other end of Pennsylvania Avenue or else we are going to be right where we are 10 years from now.

Senator ADAMS. I know, and that would be very bad.

Thank you very much, Senator.

Senator ROCKEFELLER. Thank you, Mr. Chairman.

Senator ADAMS. You have been very helpful and we are grateful for your service.

Our second panel consists of three individuals, including one caregiver, who rely on long-term care and other community serv

ices and are funded through the Older Americans Act. This particular panel will demonstrate what we are in the process of doing now so we will know what our takeoff points are.

Mrs. Helen Lee is the first witness. She attends a senior center in Arnold, MD, not far from Annapolis. Mrs. Lee is the caregiver for her 90 year old mother-in-law who lives in her own home nearby. Her mother-in-law has various health problems and receives home care services.

Next on the panel, we will hear from George and Jean Glakas of Falls Church, VA. Mr. Glakas attends Lincolnia Day Health Care Center in Fairfax, VA, three times a week while his wife works in their small family business from 11:00 a.m. to 11:00 p.m. in order to make ends meet.

We are looking forward to your testimony. Mrs. Lee, we will start with you and then we will move to the Glakas family.

Mrs. Lee.


Ms. LEE. Thank you.

Many seniors have expressed their appreciation of the benefits they receive including the many and varied programs provided at the Arnold Senior Center in Anne Arundel County near Annapolis, MD.

There is the companionship and friendliness to be gained in the classes in exercise, dancing, arts and crafts.

There is the daily lunch for which the seniors sign up in advance. This is a well-balanced meal. Enrollment increases as more people become aware of lunch, and we have a waiting list for these services.

Transportation is important to those who do not drive. These people are picked up in the morning and returned to their homes in the afternoon. The van is available for medical appointments as well.

There is a scheduled health check for screening diabetes and blood pressure. I myself find these very important as I am a diabetic and have had a heart attack in the past.

However, there is an undercurrent of worry about possible cuts in health for the elderly, particularly the retiree living on a fixed income in the low to middle income bracket. They feel the pressure of increased living costs, increased tax and medical expenses. This applies to the renter as well as to the home owner.

The most pressing, constant need lies with the elderly who want to stay in their homes, but who need assistance and some personal care, yet they are not totally disabled nor confined to the bed. Often what is needed is part-time services. For instance, my mother-in-law, Lillian Rollins, a 90 year old retiree with a heart condition, gives herself insulin every day for her diabetes and needs a walker to get around because of her arthritis. She has assistance in the home three times a week in the morning for her grooming, some daily meal preparation, shopping and laundry. All of these

are nonmedical needs, but without them she would not be able to manage.

I am a 75 year old retiree and wonder what my future holds for me when I am unable to attend to all of my needs. I also hope and plan to remain at my home in my old age. Now the upkeep is becoming a problem.

Again I would just like to say once more that all of us in the senior center are very concerned that the funds will be cut back this year. We would like to encourage your committee to strongly consider our plea for continued support for the programs funded by the Older Americans Act. They are so very important to all the older people of this country.

[The prepared statement of Ms. Lee appears in the appendix.] Senator ADAMS. Thank you, Mrs. Lee. You said that you were 75 and your mother-in-law was 90, and that you assist her as a caregiver. And you have somebody who comes in 3 days a week?

Ms. LEE. Yes. I assist her whenever she needs the extra care. Once in a while she has become ill, and she needs more care than the person who comes in three times a week can give her. So, I will go in and help her with her meals and whatever else she needs.

Senator ADAMS. Mrs. Lee, you may not be able to answer this, and if you cannot, just don't worry about it. What do you see as the future for your mother-in-law and yourself if she can no longer live in her own home?

Ms. LEE. That is my constant worry because she is so adamant about the fact that she does not want to go into a nursing home. She says she will just give up when she reaches that point. I believe she might because she is a worrier.

So, as for myself, I would like to feel that when the times come that I can no longer drive, no longer take care of myself, that I will have an adequate place to go where I can live with some assistance. But I do not see it right now in the future.

Senator ADAMS. Thank you, Mrs. Lee.

Mr. and Mrs. Glakas, we will be pleased to hear your testimony and we welcome you to the committee.

Mr. GLAKAS. I used to be a very active man with two jobs. When I was 63, I had a stroke that left me paralyzed on my left side. I was in the hospital for 32 months. From there, I went to the Woodrow Wilson Rehabilitation Center in Fisherville, VA for 3 months of therapy. I got to the point where I could take a few sters, but I needed a lot of help and spent most of my time in a wheelchair.

I was glad to get home. My bed was in the kitchen and there was no bathroom on that floor. I was in bed most of the time because I needed so much help to get up and out of bed. It was too much for my wife. I needed to have someone with me to dress me, feed me, do everything. I was a real burden. I was miserable and depressed. I could not go up and down the steps in the house, so we sold the house and bought a condo where everything is on one floor.

We used to hire people to take care of me. It was very hard to get somebody good, and it was expensive. Money was really getting to be a problem with my wife and L

I was still in bed most of the time feeling unhappy and guilty that I had to depend on my wife for so much. Luckily, I had a young wife. That wasn't planned. I had a good family that helped


My sister in Maryland located a day care center here in Virginia. My first reaction was that it was not my bag sitting around with older people, but when I went in 1985, I liked it and still do. I like the staff. They care about me and help me keep my spirits up. I have made a lot of friends there. It has been really important to me to have friends to sit around with and talk about current events and lie about our women. [Laughter.]

I figured that would get a little laugh. (Laughter.]

The center bus picks me up at my home and brings me home at night. We do many different things. We have competitive baseball. That does not mean we go out on the baseball field and play. We play it on the inside. We play box hockey. We even play against the other centers. This year we took first place in the volleyball tournament and second place in the box hockey.

We go to a movie occasionally and then out to lunch. We have trivia games to rack what is left of our brains. We have sing-alongs and dances. Those dances are something. You should see them. I do the wheelchair shuffle. When we have parties, I tell jokes.

We have lunch there. I get only the food on my special diet. There is a nurse to check my pressure and heart and to talk me, and there are other people to help me in whatever way I need.

Being at the center is much better than sitting at home, and I prefer the center. 50 to 1 to a nursing home. I only wish there were more centers for people like myself in all 50 of the States.

Thank you and please support us.

Senator ADAMS. Thank you, Mr. Glakas.

Mrs. Glakas, as the sole caregiver for your husband, what would you and your husband do without these services?

Mrs. GLAKAS. Well, this is my statement.

I do not know what we would have done without the day care service actually. When we first started with the day care center, we had tried other choices, Nurse Finders, comp health care, and other things, paying someone to come in, but I could only afford them 4 hours a day. So, without the day care, I would not have been able to supply any supportive service for him. The adult day care center has saved our lives actually.

I have a statement.

Senator ADAMS. Please go right ahead with it. I just had that question because his statement was so eloquent, and I wanted to get a feeling from you first. But please proceed with your statement.

Mrs. GLAKAS. Well, as you know, I am the caregiver of George Glakas, and I am here today to present the human and the personal side of having long-term care service, particularly adult day care, available, which he just said, from the caregiver's point of


Some people might think of the centers as social clubs or recreation clubs for the elderly. They are much more than that. The service is exactly what the name implies, with the emphasis on


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