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working with the proper authorities to solve the problem. Furthermore, because the area agency is involved the nursing home will continue to care for the woman in the facility.

• An elderly couple were placed in separate institutions by their son, who became their legal guardian. The wife needed to be placed in a special institution because of mental illness. Needless to say, the couple would like to stay together. The ombudsman is working toward moving the husband into his wife's facility. Compounding the problem, the bills for the two have not been paid. Their son has taken his parents assets, and although the husband's joint health insurance policy covers nursing home stay, the


company has not paid yet.

The OAA and the aging network can and does play an important role in the comprehensive solution of providing long-term care; however, without adequate funding the program cannot be effective. I look forward to exploring the ways in which it can best be utilized. The elderly in our nation

deserve no less.

Senator Jay Rockefeller

Testimony before the Senate Subcommittee on Aging
on the Older Americans Act and Long-Term Care
April 26, 1991

Mr. Chairman, I want to commend you for holding this hearing today on long-term care. As Chairman of the Senate Subcommittee on Aging, you are one of the leaders in this body for senior citizens and I deeply appreciate and welcome your invitation to testify this morning on the Pepper Commission recommendations on long-term care.

I support your legislation reauthorizing the Older Americans Act and want to work with you on its enactment.

Lack of coverage for long term care services is a major source of fear and anxiety among older Americans. It is most appropriate to look to the Older Americans Act as a way to aggressivel promote long-term care services needed by seniors citizens.

For the last 25 years, the Older Americans Act has been a major force in promoting desperately needed services for the elderly. Through its support for vital services ranging from nutrition, to transportation to legal advocacy, this historic legislation, along with Social Security and Medicare, has helped to raise the overall quality of life for many seniors. We should be proud of our achievements on behalf of seniors, but we must also look ahead to tackle new challenges and one of the most pressing is the need for long-term care.


Between 9 and 11 million Americans must depend on others for help with the basic tasks of daily living. Millions more know the physical, emotional, and financial burden of caring for family members or friends who need care. These are tragic, but, I know, all too familiar statistics for the members of this Subcommittee. Even so, statistics and numbers don't fully convey the story and consequences of not having a national policy on long-term care. As just one example, let me tell you about the Keeney family in West Virginia.

Mr. Keeney lives in Charleston, West Virginia. Recently, Mr. Keeney had to purchase the house next door for his elderly parents. His father suffers from Alzheimer's Disease, and his 77-year old mother could not care for her husband alone so she must depend on her son. Medical expenses have eroded all family savings. Mr. Keeney has taken out four mortgages on his home to care for his father. He has been forced to use the savings intended for his son's college education to provide for his elderly parents. This is a tragic situation.

We must respond to the plight of the Keeney family and millions of other American families.

The Pepper Commission does respond. As Chairman of the Pepper Commission, I am very proud of our final report that we submitted to Congress last September. It lays out a bold blueprint for both universal access to health care coverage and And I will long-term care for every American who needs it. briefly summarize the Pepper Commission's long-term care proposal, which passed the Commission with solid, bipartisan support:

** Our plan recommends social insurance for home and community-based care and for the first three months of nursing home care, for all Americans regardless of income.

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** For Americans and families facing long nursing home stays, key protections are provided to prevent family impoverishment.

** To ensure quality care and keep a lid on excess costs, the Commission recommends relying on case managers to develop and oversee individual care plans that are tailored to individual needs. Our report envisions benefits that include personal care, homemaker services, respite care and training for family caregivers, as well as more skilled nursing care and rehabilitative care.

The Pepper Commission has laid out a blueprint that I urge the members of this subcommittee and all of our colleagues to support. We should enact the legislation needed to provide the protection that the Commission believes every American deserves.

Just as importantly, we must strengthen the infrastructure to provide the long-term care services that ultimately would be covered under the Pepper Commission's bold plan.

Pilot projects and state and local programs are underway across our country, providing long-term care services to older Americans and developing a basic level of knowledge that will guide us in forming a national, more comprehensive long-term care policy. We must build on these efforts and do much more.

And I am proud to report on my recent initiative to expand services for some of the most deserving older Americans. Just last year, in spite of intense budget negotiations, Congress passed legislation that I authored, which now allows Medicaid to be the source of home and community services for frail elderly.

We still have a long way to go. There is a great deal to learn about case assessment, case management, and cost containment, and how they interact with each other, if we hope to reach our goal of quality long-term care, not just for seniors, but for every American who needs it. And it's in these areas that I see a valuable and important role for the Older Americans Act.

In the Pepper Commission blueprint, we accepted federal responsibility for financing some key aspects of the program. But we also sought to give the states flexibility in the development and implementation of home and community-based services. Therefore, in my view, a logical next step is for the federal government to play a more supportive role in helping states explore ways to administer and manage the provision of long-term care services.

I would like to work closely with you, Senator Adams, as you work on the reauthorization of Older Americans Act to explore such ways to promote long-term care.

To turn to one example, I am an original cosponsor of Senator Pryor's proposed amendments to the Older Americans Act to establish a $5 million demonstration program to promote and evaluate the role our aging network could play in providing longter care services. This proposal would compare eight different models in order to identify the best, most efficient way to provide long-term care services.

Such a demonstration could provide valuable, in-depth information for the aging network, and other health agencies struggling to balance the questions of cost containment, case management, and quality assurance.

I also believe that it will be vital to ensure that the lessons learned through long-term care programs in the aging network are widely distributed. New efforts must be made to disseminate useful information and ideas among all the key federal health agencies and state organizations that are working on answering the tough questions of cost and administration associated with long-term care coverage.

Continued experimentation will be necessary. West Virginia's Community Care Program is a prime example. Since 1987, my state has been working to provide community care by trying various approaches.

The state ultimately decided to reorganize all its long-tem care services under a single office for Geriatrics and Long-Ter Care. This office works closely with the Commission on Aging and used the state's network of senior centers to provide home and community care in every county in my state. Over 5500 West Virginians are served through this innovative program via a single point of entry for home care - their local senior center.


This is a strong start, but much fine tuning still remains to ensure quality care and cost containment in the West Virginia program.

In summary, I believe we must push forward on two tracks to promote long-tem care.

First, we must fight to expand direct services and ultimately build a comprehensive long term care protection program as envisioned by the Pepper Commission.

Secondly and simultaneously, we must develop the infrastructure to provide these services reliably and effectively. The Older Americans Act can play an important role in exploring effective, efficient ways to build that infrastructure.

Mr. Chairman, thank you again for the opportunity to testify before your committee this morning. I am eager to work with you to achieve our objective of long-term care protection for all Americans.

Prepared Statement of Helen Lee

The Older Americans Act and the Aging Network: the Importance of Home and Community-based Services"

Many seniors have expressed their appreciation of the benefits they receive including:

1. The many and varied programs provided at the Arnold
Senior Center in Anne Arundel County near Annapolis,

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


3. 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.

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

5. 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 help 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 cost, increased tax, and medical expenses. This applies to the renter as well as 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 retire with a heart condition, gives herself insulin everyday 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 non-medical 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 my needs. I also hope and plan to remain at 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.

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