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April 26, 1991

Mr. Chairman, I want to congratulate you and your staff for the hard work and effort your committee has done on the reauthorization of the Older Americans Act (OAA). The topic this hearing addresses, long-term care, is one that I have been seriously concerned about and involved with during my years in Congress.

I want to tell you about a constituent I met in Springfield, Illinois a few weeks ago, Naomi Fowler. Ms. Fowler has spent more than ten years taking care of her mother, who has Alzheimer's disease. The long-term caregivers who are here today know what sort of a sacrifice this is.

For ten years, Naomi Fowler has been a mother to her own mother. For ten years she has fed her, bathed her and been on call 24 hours a day. Ten years of being strong and patient and kind, even when her mother did not recognize her. This represents an enormous devotion to a loved one, and an enormous personal burden that many thousands of Naomi Fowlers across Illinois and the nation face today.

On top of the emotional strain, there are financial problems. In today's world, most families depend on two incomes. It is a serious problem if one

breadwinner has to take too much time off to provide long-term care. Many caregivers have to reduce their work hours or even give up jobs to provide

care full-time.

Some families simply can't provide constant care for a loved one at home. Many say that if they could get even a few hours a week of paid home care at a reasonable price, they could cope. But home care costs up to $150 a day. Most families can't afford it.

We have a situation today where Medicare won't pay for long-term care and although Medicaid will pay for institutional care, it won't pay for the home care that can keep people out of institutions. Millions of families are forced to institutionalize loved ones for financial reasons, not medical reasons.

Nursing home care is a growing need among seniors. A recent article in the New England Joumal of Medicine reported that 2.2 million Americans turned 65 in 1990 and an estimated 43% of these individuals will enter a nursing home, for at least some length of time, during their lifetimes. But the average cost of nursing homes, from $25,000 to $30,000 a year in most areas and up to $45,000 in other areas, is out of the range of most Americans' budgets. The only alterative is to apply for Medicaid and try to find a Medicaid space in a nursing home. This means the family has little choice where the patient goes or what quality of care he or she will get. It is devastating emotionally, and it is often devastating financially since the individual must spend himself or herself into poverty to get what help Medicaid can offer.

There is a better way. America needs a comprehensive program for long-term care. We need a program that everyone will contribute to and

everyone can benefit from. Poll after poll shows that nearly 80% of Americans want a federal long-term care program along these lines. And the polls also show they are willing to pay their fair share in taxes if they get such an important benefit in return.

During my recent campaign for reelection to the Senate, I called for a one-half cent increase in Social Security taxes to pay for long-term care. My opponent was quick to criticize me for it - but Illinoisans supported me for it. Old or young, Republican or Democrat, people want protection for the longterm care disaster that hits nearly all American families at one time or another.

Naomi Fowler came to my office to talk about the struggles of families who are silent heroes shouldering the burdens of long-term care. She told me it is time for a comprehensive, national program to help people care properly for their loved ones. I told her she is right. In the Democratic Party response to the State of the Union address, Senate Majority Leader George Mitchell said that long-term care will become the "crisis of the decade' unless we develop a national policy to deal with it.

I am prepared to sponsor legislation to assist families who need home care and residential care services for a loved one. The time is now. Together we can create a program that will protect our families from the emotional and financial burden of the long-term care crisis. For Naomi Fowler and the many thousands like her, we can do better.

The OAA has created a successful aging network, which acts as a lead facilitator, a resource and information center, and an advocate for older

Americans. Its role should be continued and improved upon. We should be working toward helping to keep those older individuals in the community who want to stay in the community. Perhaps we can utilize this network more effectively to serve older individuals in need of long-term care.

Currently, the OAA facilitates the coordination of community-based long-term care services for older individuals who are at risk of institutionalization through Title III. In addition, the OAA is the only federal program providing ombudsman services for institutionalized elderly.

Title Ill services include a variety of home care services and home delivered meals. About 4 to 7 million disabled elderly are staying in the community and are in need of some kind of home and community-based care. The OAA Title III is serving those in our communities who are not eligible for services under other federal programs, such as Medicaid. It is catching many who would have otherwise fallen through the cracks.

Mr. Chairman, as you know the ombudsman is an important part of longterm care. It is estimated that currently 1.3 million older Americans reside in nursing homes. The ombudsman serves as a resource and vital link between institutionalized elderly, their families, and institution staff. They are moderators, educators, and advocates for institutionalized older Americans.

Ombudsmen are mandated to have a regular presence in institutions; however, with limited and scarce resources this is often difficult. For some Illinois Area Agencies on Aging (AAA), that means almost day-to-day contact. and for others only the minimum requirement of one visit every year. Most AAA's use volunteers who act as the eyes and ears of the ombudsman. The

contributions of the volunteers is invaluable, and I commend and encourage

their efforts in helping others.

Mr. Chairman, I would like to share some examples of the type of incredible work the ombudsmen from my state do.

* An elderly women was sexually assaulted in a nursing home. The woman knew the ombudsman and felt comfortable talking to them about the incidence. The ombudsman was then able to talk to the woman's family and direct them to the proper authorities. In addition, they alerted the nursing home staff. The elderly women said that if it weren't for the ombudsman, she never would have reported the incidence.

* An ombudsman was successful in retuming an elderly man to the community. His grandson gained guardianship and inappropriately placed his grandfather in a nursing home. The elderly man read about the ombudsman program on a poster at the nursing home. He called the area agency on aging for assistance. Through the help of the ombudsman, he is now back living in the community.

A former local school teacher with Alzheimer's disease was placed in a nursing home. Those who signed her in were not her guardians. In fact, she had no guardian, living relative, or friends. Her account with the nursing home had been delinquent since 1990, and the institution was about. to be forced to remove her from the institution. The nursing home administrator called the local ombudsman to investigate the situation, as they did not want to put the woman out on the street. The ombudsman discovered that the elderly woman was a victim of gross financial exploitation, and are

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