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NCOA believes that transportation services provided under the OAA could best be improved by transferring administration of those services to the Department of Transportation.

Alternatively, should such efforts fail, NCOA would support creation of a new title for transportation services to ensure sufficient funding for these services.

Legal Services

The ombudsman, elder abuse prevention, and legal assistance services protect legal rights of older persons. To protect these rights requires, among others, education, advocacy, investigation, and mediation. Eligible persons may need assistance with obtaining benefits, and with housing, consumer, and estate planning problems. Many need help with living wills and durable power of attorney for health care decisions. Others, due to increasing frailty and decreasing ability to act on their own behalf, need elder abuse protection.

NCOA recommends moving the ombudsman and elder abuse prevention subtitles under a new "legal and protective services" title. Legal assistance services-perennially underfunded in spite of Congressional attempts to ensure an "adequate proportion" of Title III-B funds for the service-would be advanced by incorporation into this title. These services are to ensure access; they do not include enforcement of laws protecting rights, that function belongs to other agencies.

PUBLIC-PRIVATE PARTNERSHIPS

The cooperative and contractual arrangements of State and area agencies on aging with the for-profit sector raises several

concerns:

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Is the intent to use private funds to substitute for needed federal funding?

. O Can State and area agencies provide services to employees of a for-profit corporation without neglecting their mission to target services to low-income minority older Americans?

o Do the partnerships establish State and area agencies on aging as direct service providers, contrary to their mandate as advocates and coordinators, not service providers, under the Act?

Area agencies on aging are not to provide services except in those areas where services cannot be provided by others. In those cases, the AAA must obtain a waiver from the State to provide direct services. Area agencies on aging that become service providers compete for funds rather than allocate funds to others.

NCOA believes that public-private partnerships may present a potential for conflict of interest and abuse on the part of State and area agencies on aging and their stated mission of serving those with the greatest social and economic need.

NCOA recommends close scrutiny of such arrangements.

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ADMINISTRATION ON AGING

Previous reauthorizations indicate Congressional intent that the Commissioner on Aging serve at a sufficiently high policy level within the Department of Health and Human Services to assure that the needs of older persons are adequately addressed.

The Commissioner must have the rank and status as head of an operating division in order to have control of AoA operating funds and prevent the use of those funds for other HHS programs.

NCOA recommends that Congress elevate the Commissioner on Aging to the level of Assistant Secretary within the Department of Health and Human Services (HHS) to ensure access to the Secretary and the visibility, status, and fiscal control commensurate with an Assistant Secretary position.

FEDERAL COUNCIL ON THE AGING

Under the OAA amendments of 1973, the Federal Council on the Aging (FCOA) was established to advise the President, Congress, and the public on aging issues.

Although the Council conducts hearings around the country and issues an annual report, it does not actually operate in its designated capacity. The AoA and Congressional committees seek own information through hearings or forums such as those held during the past year soliciting input from the public and experts on aging issues. It appears that the role the FCOA is to serve is largely ignored.

However, the Administration on Aging could benefit from an advisory group, similar in composition to the FCOA, that would advise the Commissioner, the President, and the public, and whose members are appointed in like manner by the White House, the Senate, and the House of Representatives.

NCOA recommends transfer of the Federal Council on the Aging to a new capacity as an advisory council to the Administration on Aging. In its present situation, it is not a viable institution that merits continuance.

PERIOD OF EXTENSION

During its life, the Older Americans Act has been reauthorized for two, three, and four year periods. reauthorization period is sufficient for implementing new provisions and conducting mandated studies.

NCOA recommends a three year extension of the Older Americans

Act.

CONCLUSION

A three year

The Older Americans Act provides not only essential services but also a system to assure that older Americans live in dignity and independence. Yet the Act from its beginning has been inadequately funded. In the course of the next three years, authorizations for the Act should rise to much higher levels to match the significantly larger population of older persons the Act serves. Overall appropriations in FY 1992 should increase by

25 percent; and by FY 1994, they should increase by no less than 50 percent over the FY 1991 levels.

The well-being of America's older population is a concern that bonds one generation to another. Service to older adults represents benefits to the rest of the population on whom caregiving responsibility rests. This deserves our society's attention and action.

The Health Promotion Institute of the National Council on the Aging urges funding of $100 million to the Older Americans Act for the purposes of health promotion and preventive services. In addition, the Health Promotion Institune supports the expansion of the preventive health services program of the Older Americans Act (Title III, Part F) to include disease prevention and health promotion services known to be cost-effective such as medical self-care education.

HEALTH PROMOTION INSTITUTE / NCOA
OLDER AMERICANS ACT REAUTHORIZATION POSITION

THE VISION

The mission of the Health Promotion Institute of the National Council on the Aging is to promote an optimal quality of life including physical, mental and emotional health, and social and spiritual well-being for older adults. The Health Promotion Institute proposes to accomplish its mission by advocating for and empowering older adults to achieve health and well-being through a multi disciplinary approach.

A well conceived and implemented national health promotion strategy for older adults would create a healthier and more empowered elder force in the nation. As a result, older adults would:

a

b.

C.

d

C.

Be more fit (stronger, more flexible).

Be better nourished.

Prevent the onset of some illnesses.

Acquire and maintain improved self-care for health problems.
Reduce their need for and use of medical services.

THE MANDATE

The cost of health care for older Americans is testing the society's willingness to pay the bill. Rationing of health care by age is openly discussed. Even with Medicare coverage, millions of low income elders are unable to access high quality medical care. The cost spiral trends are not encouraging.

The greatest untapped resource for solving this crisis lies in the older adults themselves:

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Seventy-five percent of older adult health problems are the result of lifestyle behavior.

Older adults are more ready than any other age group to accomplish lifestyle changes to improve their health.

Informed and empowered older adults can achieve improved control over many chronic conditions through lifestyle changes and appropriate medical self-care.

THE PLAN

The goals of the Older Americans Act health promotion effort include the following.

Improve the health practices of older adults through support of the "Health Promotion, Health Protection and Preventive Services" objectives included in "Healthy People 2000" (USDHHS).·

1.

2.

3.

Many older adults have been participating in the wellness revolution of the past 25 years. They are capable of being participating partners in any effort to improve their health. Funding of a national health promotion strategy would mean that access to health promotion services would be improved and that health disparities in death, disease and disability rates would be reduced.

Empower older adults to do a better job of taking care of their own health problems and a better job of managing the professional care that they need.

Healthier older adults, especially those educated to be wise medical consumers, would take tremendous pressure off the health care delivery system.

Help older adults to build stronger self-images both of themselves as individuals and of older adults as a population.

We need to equip older Americans to take their rightful place in society, continuing not only to live but to function effectively and contribute richly to our nation.

These objectives would be accomplished through State and Area Agencies on Aging and other organizations working under national guidelines. Five percent of the total allocation would be earmarked for evaluations to document the effectiveness of the efforts.

NCOA/NCRA OLDER AMERICANS ACT REAUTHORIZATION POSITION

April, 1991

Ensure the adequate and equitable targeting of OAA resources to rural elders with the following:

TITLE III:

1.

2.

3.

4.

By guaranteeing that an annual inflationary adjustment is applied to the federal budget allocation which funds the OAA.

By requiring that intrastate funding formulas include a rural factor.

By requiring the restoration of the identical AAA base allocation to ensure the viability of rural AAA's.

By increasing funding for the ombudsman program and Title III-D in-home services and providing new funding for III - F, preventive health services.

TITLE IV:

1.

2.

TITLE VI:

1.

Ensure that 30% of the research and demonstration project funding is targeted to issues of aging in rural America.

Support the continued funding of rural gerontology centers.

Continued expansion of program funding for the identified Native American groups within Title VI

NCOA/NISC OLDER AMERICANS ACT REAUTHORIZATION POSITION
January, 1991

FUNDING/HEALTH PROMOTION - Support the addition of $100,000,000 to Tide III for a National Older Americans Wellness Program for FY 1992 and subsequent years. Dollars spent on wellness programs save in health care costs. In Sec. 361 (a) add the word "primarily" so it reads: "The Commissioner shall carry out a program for making grants to States under State plans approved under section 307 for periodic preventive health services to be provided primarily at senior centers or alternative sites as appropriate."

FUNDING/TITLE III OF OLDER AMERICANS ACT - In addition to the Health Promotion Initiative, funding for Tide III in 1992 should be increased by not less than 10% over current service levels.

AGE ELIGIBILITY - No change from current age 60 and above.

CONTRIBUTIONS - Support voluntary contributions from clients for senior center activities and services.

FOCAL POINT - Support the language of Sec. 306 (a) (3) designating multipurpose senior centers as focal points and add to this language, "and reflect such designation in the provisions of all grants, contracts and agreements implementing the plan.”

OPERATING FUNDS - In Sec. 321 (b) (2) change the word "may" to "shall" so it reads: "Funds made available to a State under this part shall be available for the purpose of assisting in the operation of multipurpose senior centers and meeting all or part of the costs of compensating professional and technical personnel required for the operation of multipurpose senior centers." Add a second sentence to this section to read: "Require a budgetary line item for such purposes in state and area plans."

TRANSFERS BETWEEN PARTS - All parts of the act should be funded adequately thereby minimizing the need for transfers. In the past, transfers have often been from senior centers to other services.

COMMUNICATION - Add language under Sec. 306 (a) (6) (B) that Area Agencies on Aging "furnish appropriate technical assistance, support and timely information to providers of supportive services, nutrition services, and multipurpose senior centers in the planning and service area covered by the area plan."

To Sec. 307, State Plan, add a new subsection, (32), to read: The State Unit on Aging shall establish an appeals procedure for agencies funded under State and area plans."

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