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Before my husband started attending the day health care center in Fairfax, we had tried all sorts of alternatives. We had help from our families, but since my husband needs assistance with every activity and personal hygiene, any outside help had to be considered skilled. We could not hire just regular help.

Since he was declared totally disabled, it was necessary for me to work. By the way, I do not work all week 11:00 to 11:00. That is 4 days a week. And then Friday, Saturday and Sunday, only 4 hours.

When I was at work, my husband spent many hours in bed. His condition deteriorated, and he spent a lot of time, even when he was sitting up, either staring into space or watching the TV.

It was more difficult for me to assist him in transferring from the wheelchair to the bed. He finally fell on me and crushed my hip. During my recuperation, my sister-in-law was investigating possibilities for care for my husband. I would no longer be able to lower him onto the tub bench or exercise him. She was referred to the Annandale Day Health Care Center.

He was accepted and our routine changed drastically. My husband began to feel better and more alert. He looked forward to his days which were filled with his breakfast, lunch and many activities. I was more relaxed about going back to work knowing that he was being well taken care of all day and that a nurse on duty was able to check on his health all the time. A therapist was also made available through their efforts and also a podiatrist. I was unable to cut his toenails because they were toc tough.

At first I had to drop my husband off on my way to work, but eventually transportation was made available through Fast Train.

The financial burden was eased because the charge was based on a sliding scale. We currently pay only $15 a day for this service.

The staff was helpful to me in many other ways also. When I developed carpal tunnel syndrome and was again faced with surgery and not being able to take care of my husband, they furnished me with a list of companions and other help available to me.

Last year George transferred to the Lincolnia Adult Day Health Care Center in Fairfax and has made a very good adjustment. This is a new type of facility being developed in Fairfax that combines an adult day care center, a senior recreation center and senior apartments and assisted living. I recommend that you all come and visit this new facility because it really could serve as a model program for other places in the country which you were mentioning before.

I realize that it is a traumatic experience for a person who has to spend most of their life in a wheelchair, but it is also a major upheaval in the life of the caregiver. The day health care center helps preserve the sanity of both parties. Had we not been able to avail ourselves of this opportunity, I do not know how we would have managed the past few years. I only hope that this type of care is made available to everyone who needs it.

Thank you.

Senator ADAMS. Thank you, Mrs. Glakas.

I understand you contribute money each time you go to the center. Do you have concerns about your ability to make these contributions in the future?

Mrs. GLAKAS. Actually I felt that Senator Rockefeller was talking to me. I will be 65 in October. I have started to worry about what will happen. I am not in the best of health. What would happen if I cannot take care of my husband or take care of myself for that matter? I will work as long as I can and take care of him in the home as long as I can, but we will eventually also need some assistance. And I am thinking of the future also and hoping that some of these bills will pass.

We appeared before a committee Senator Melcher had several years ago, and to my knowledge, nothing has been done yet. I hope that this committee will be able to pass something that will be helpful to people in our position.

Senator ADAMS. Mrs. Glakas, I want you to know it is very difficult. That is why I brought in Senator Rockefeller, and why we ng these hearings. They are directed toward what you are

talking about.

Incidentally, what kind of transportation do you have to get to the center and back?

Mrs. GLAKAS. Fast Train offers assistance for handicapped people. There is a handicapped van that picks my husband up at the door and brings him home. That is also sponsored by Fairfax County. That is an additional charge to the day care. But also in case I am working and I cannot take him to the doctor or for some other appointment, if you make arrangements ahead of time, they will pick him and up and take him. It is a minimal charge. That is also based on a sliding scale.

Senator ADAMS. Thank you all very much for your testimony. I think it is very important that everyone understands.

Mr. GLAKAS. And before I close, Senator, my wife and I can sit here and talk until we are blue in the face about the day care services in Fairfax. We would love to have you and your committee come over and spend the day with us or spend a couple hours with us, especially lunch. They serve good lunches.

Senator ADAMS. Thank you, Mr. Glakas.

Mr. GLAKAS. We would love to have the whole committee and your assistants.

Senator ADAMS. Thank you for the invitation.

Mr. GLAKAS. And no charge. [Laughter.]

Senator ADAMS. Good. Thank you.

The third panel that we have this morning will highlight the Older Americans Act and its efforts to stimulate and expand the long-term care system on the State and local level. We have witnesses from Washington State as well as the State agencies on aging in Michigan and in Mississippi.

Charlie Reed has been working on behalf of Washington State's senior citizens for 25 years. He started off as a consultant to the State Office on Aging and eventually became director of that office, a position he held for 9 years. For the past 5 years, he has held the position of Assistant Secretary for the Aging and Adult Services Administration which is responsible for overseeing aging and adult services and long-term care and nursing home care. Charlie has testified before this committee in the past, and I personally look forward to hearing from you once again, Charlie.

Robert Dolsen is Executive Director of the Region IV Area Agency on Aging which serves southwestern Michigan. He has been in that position since the agency's inception 17 years ago. He is also on the boards of several organizations, including the Michigan Association of Area Agencies on Aging and the National Association of Area Agencies on Aging.

Jane Kennedy comes to us today from the State of Mississippi. Mrs. Kennedy has been Director of the Southern Mississippi Planning and Development District's Aging Division since 1973. She currently serves on the board of directors of the National Association of Area Agencies on Aging, the Southern Association of Area Agencies on Aging, and the Mississippi Gerontology Society.

I am very pleased to welcome this panel. We are looking forward to your testimony. You may either summarize it or put it in in full. Charlie, why don't we start with you. Welcome to the committee, and we are very pleased to see you.


Mr. REED. Thank you, Senator Adams. It is a pleasure to see you again as well.

I appreciate being asked to testify here today. As you know, I am the director of the State Aging Office in Washington State. I also have the responsibility, as you said, for the nursing home program and for the other services, the in-home, and nonmedical residential services in the State of Washington.

I would like to talk about three things here today, Senator: first, to describe briefly how our system works in the State of Washington, summarize what I think is going to be happening with longterm care reform in the country and what I think the goals should be for that reform, then finally, talk about how the Older Americans Act and how the aging networks should be participants in that activity.

In the absence of strong Federal leadership, the States, as you know, have been the laboratories for program development and innovations in long-term care. And while there is a lot of diversity amongst the States in population, geographic size, and administrative organization and so on, the one thing we do seem to have in common is that there is a growing need for long-term care that cannot be ignored. The problems simply are not going to go away.

In the State of Washington, we have been trying to address those for the last several years. We do have 13 area agencies on aging in our State. There has been a very good relationship between the State and the area agencies over the years. We have developed a culture of advocacy in that we feel that it is our role to advocate for older persons and their long-term care needs.

We took very seriously in the State of Washington what is in the Older Americans Act about the role of the aging networks to develop a comprehensive, coordinated system of services for older per

sons, and we have gone about doing that for the last several years in our State.

One of the things that has made a difference in our State is the area agencies from the very beginning took very seriously the idea of developing what we call information and assistance programs, commonly referred as information referral in other States. I think that is the cornerstone of our system in the State of Washington.

We have also gone about targeting our services to those that we think are most in need either because of their disability or because of their income. We have had a cost-sharing program in the State of Washington, and it has been very successful. There simply does not seem to be enough public funds to meet the needs of all the people in the system who have needs. Our service system serves everybody regardless of income, but it does use a sliding scale to decide who is going to receive the public funds. We have found that to be a very good way of sorting out who is going to receive the public funding.

In the early 1980's in our State, we became heavily involved in the Medicaid waiver program in administering the federally funded community care programs.

We also took very seriously the issue of case management, feeling that was a very important element of the system. We were one of the first States to codify our case management standards. We do have standards statewide now that are adhered to by all the area agencies, and it is a very important element of our service system.

In 1986, we merged our community service system under one administration with the nursing home system and decided we were in the long-term care business. We articulated at that time for the first time that people's values do not change when they age or become disabled. They have the same strong feelings that all of us I think in this room have about very simple things, about who they want to share a bedroom with, who they want to share a bathroom with, what they want to eat, when they want to eat it, what they want to watch on TV. All those values that we treasure so much are lost often when people have to use the long-term care system by moving into institutional care.

We have tried to balance out our system in the State of Washington and are struggling to do that. Roughly half the people we serve in our system reside in nursing homes. Roughly one-half reside in the community. We are still spending 80 percent of our money on those in the institutional setting because of the biases in the Medicaid system.

The area agencies in our State have been very strong advocates in helping develop the system. While they do not actually operate all the services or even establish eligibility, they are a very critical part in our system in the State of Washington. State employees establish eligibility for the long-term care system in our State.

Because the long-term care system and the Medicaid funding is fundamentally biased toward nursing home care and because there is such a very strong lobby for nursing homes, we continue to struggle in our State, even though it is a relatively good system, to balance out our services, as I mentioned. There is a great demand on the public funds. As you know, I think, there is a teachers' strike in the State of Washington right now today, and the leg

islative session will probably end on Sunday. I suspect there will be more money going into education. It is hard to quarrel with. There will be less money available for social services. What will be hit probably are community social services for older persons and those needing long-term care. I am sure that is not unusual around the country.

The recommendations that I have for developing a national longterm care policy are much like Senator Rockefeller's. I definitely agree with what the Pepper Commission has been doing. I am convinced that if we are ever going to have a system that serves anybody other than poor and near poor, we will have to focus on a social insurance program. The best we can do in our system now with the money we have available is serve the poor and near poor.

We need to have equitable benefits based on assessment. Case management will be a critical part of that.

We need to focus on the community and home care, but also provide some coverage for nursing home care to protect people's assets for a long enough time that they can go back into the community if that is possible.

I believe the program must be administered by the States. Because of the diversity around the country, the different political structures and administrative structures, it is really important to have State administration.

We do need to have Federal financing, however, and we also need to assure that there is good quality in the system.

The Older Americans Act has provided for a role for the States and area agencies in this whole development of long-term care over the years. I would caution, however, the field of aging is not synonymous with long-term care. I think it is a mistake to put all the eggs in one basket. There are many other important things that older people need that are dealt with in the Older Americans Act. The whole issue of elder rights is extremely important.

I am very pleased with the recent reorganization in the Office of Human Development in giving the Commissioner on Aging the Assistant Secretary status with the rank and status of Assistant Secretary. I think that is a good way to have the Commissioner begin to coordinate at the Federal level as people of my type try to coordinate at the State level.

We do need to have continued long-term care reform. Everybody wants a long-term care benefit. That is not synonymous with a generic long-term care system. It is important to have a generic benefit, but there may be different delivery systems for different types of people.

In conclusion, just let me say that there is definitely a role for the area agencies in the State in long-term care systems. There has to be a lot of flexibility given to the States because there will be a variation in how that happens around the country. In every case I think it is important for States and area agencies to play a strong advocacy role in the development of long-term care.

Just one final point. I would like to also say that it is very important that the administration continue with its long-term care resource centers to give assistance to States and area agencies. We have received a great deal of assistance from the various centers across the States. You are going to hear from a couple of them here

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