duplication of services," "better administration of money that's already available, "a rational services delivery system, "coordination of total services-prioritysetting in local jurisdiction. The desired service structure, however, varied considerably. Some groups wanted "a unified aging structure"; others called for "commingling of aging programs with other organizations and agencies (youth, schools) and transfer of resources among all these programs." Some called for comprehensive services-"a continuum of care" -but more officials wanted to make existing services more effective through various procedures-"single entry point for all programs, "coordination of services through information and referral services, "coordination of all funding," "service site consolidation,' "multi-county administration,' "a common intake system, reporting system, and planning council."
Other priorities looked beyond county borders to solve administrative problems: "state plan consolidation,' defined role for each county within its area agency on aging to avoid overlap," "grantsmen at county, state or regional level," and "cabinet-level representation for aging programs at federal, state and local levels."
Overly restrictive or complex federal and state laws and regulations were the most commonly cited obstacle to efficient delivery of services. Priorities that were con- stantly repeated included:
⚫"removal of barriers in federal programs that prohibit integration of services,"
•"elimination of stumbling blocks in Titles XIX
(Medicaid) and XX (Social Services) of the Social Security Act."
elimination of legislative and regulatory barriers that prohibit transportation consortia of providers of services to the elderly.
•“elimination of federal priorities tied to funding,' •"consolidation of multiple aging programs-federal, state and local,'
•"elimination of income restrictions for Social Security benefits,"
⚫"elimination of means test for services to the elderly," ⚫"increasing all types of block grants directed toward the elderly.'
Federal and state funding procedures evidently also create problems for efficient management. County of ficials' priorities on this subject include:
•"simplified funding procedures,'
•"coordinated state and federal finances," "consolidation of funding sources,'
"elimination of state and federal mandated programs that are without funding,' •"assistance to counties in changing financial bud- geting according to cost increases,'
"state and federal funding for all counties," •"reducing red tape of state agencies by directly funding local offices of aging to operate federally funded programs,"
"state legislation recognizing revenue ceilings placed on county boards,'
⚫"adequate sustained funding,"
services and cycles, "flexibility on state and federal levels for funding
•"open-ended funding to meet locally identified tance. needs rather than needs identified from a dis-
Local barriers to good management also were addressed. Priorities directed toward county-level problems included calls for: "a mechanism for coordination of services at county level," "interagency coordinating council," "city and county cooperation,' "increased linkages between aging programs and other social, alcoholism, mental health, and employment programs,' "establishment of conversation between medical and human service per- sonnel," "establishment of interagency client advocacy."
Increasing local resources for aging services was a priority among slightly less than half the groups. Most such priorities called for using revenue sharing funds to support services for the elderly. Other priorities were:
•"increased county general fund dollars for admin- istration and planning,"
⚫"counties that assure input of cities,"
"increased religious and industrial sector support," ⚫"community responsibility for fiscal operation and monitoring of existing programs.'
Only two groups-both in the midwest-advocated a special mill tax levy to support services to the elderly.
In addition to coordinating the efforts of various local service agencies, county officials expressed a keen desire and delivery: to involve the elderly in all phases of services' planning
"let seniors decide what's important,'
⚫involve the elderly in planning,'
"the community should identify the expectations
⚫"learn who elderly are and where they are,' •"formal linkages between service and client,' ⚫"involvement of elderly in program delivery,' •"input from consumers,'
⚫"create county policy requiring that at least half of members of council on aging be elderly,"
•"utilize the individual in assessment of his or her needs when planning for long-term care.
Finally, one group mentioned a need which bureau- cratic requirements may often thwart: "allow the elderly to obtain a single unit of a service." Whether one visit by a nurse, one home delivered meal, or one trip to a doctor's office-county officials say the elderly are entitled to it without difficulty.
Although administration was the subject that received the most attention at the three conferences, most of the groups' priorities concerned services that directly benefit the elderly. Ranked in order of the number of times they were listed as priorities, they are:
The top five categories were mentioned by every group at all three conferences. The last five were mentioned, on the average, by about a third of all the groups. Mental health services were cited by only one group in the east, two groups in the midwest, but by six groups in California.
caring.' ity may be the hardest of all to achieve: "more one-to-one
medical services. Health Care. This broad category includes all health and
Hospitals, nursing homes, in-home and neighborhood services are represented-but very unequally. Hospitals and acute care were mentioned only two or three times. One group expressed a need for "pre-discharge programs for elderly patients in acute care hospitals." Another mentioned the need to assure ambulance and emergency medical services to the county's elderly. On the other hand, every group mentioned the need for clinics, preven- tive health screening, and in-home health services. About two-thirds of the groups mentioned nursing homes. the major problem of the elderly. Clearly, county officials see long-term chronic illness as
Several services were mentioned only once or twice, but should be noted. Among these: eliminating language barriers for non-English speaking senior citizens; respite centers*; disaster preparedness programs; library ser- vices; better research and evaluation methods (including better collection and recording of data); accessibility to buildings, especially public buildings; and "death and dignity options" including hospices.** One group's prior- family relet- •Respite centers board elderly people for a day or two They allow a or respite from the often arduous task of caring for an
aged relative. **Hospices first appeared in England about 1967. In a hospice, spe- cially trained staff administer to the needs of people with terminal New Haven, Connecticut illnesses The best known hospice in this country in Hospice, Inc in Luke Hospital Center in New York
City began a pilest tomgital tinsel honger program in 1976
Some representative health care priorities are: •"affordable and accessible primary health services,' "comprehensive health assessments,' "preventive medical and dental services,' "alcoholism and drug services,'
"prosthetics assistance,'
•"provision of items not covered by Medicaredentures, eyeglasses, hearing aids,'
"better trained doctors,'
"a doctor and dentist in each county." "coordinated home care services," certified home nursing services,"
•more in-home supportive services,''
expanded health insurance for home care,** •"homemaker and chore services,"
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