In all, Green Thumb will receive an additional 2 million dollars to support these programs and to extend our current contract for an additional two months. At the moment, we are waiting for the Department of Labor to finish processing our contract modification.

Senator EAGLETON. Have you seen any evidence, hard cash to Green Thumb, green cash evidence that the program has been doubled from $13 million to $26 million?

Mr. BARTON. We have not.

Senator EAGLETON. Thank you very much.

Mr. BARTON. Thank you.

Senator EAGLETON. Our next witness is Mr. Dan MacDonald, executive director, Health & Welfare Council, Metropolitan St. Louis, Inc. We welcome you, Mr. MacDonald.

STATEMENT OF DAN MacDONALD, EXECUTIVE DIRECTOR, HEALTH AND WELFARE COUNCIL OF METROPOLITAN ST. LOUIS, INC.

Mr. MACDONALD. I do not have a written statement, so I will be informal, if it is all right with you.

The purpose of my appearance today is to discuss a possible project which may have some implications for development of the Older Americans Act and its programs, but which will essentially get at some of the problems of fragmentation of services; when we get down to executing programs for the older adults at the local level.

Briefly, let me first say this: we have a variety of different kinds of programs and projects serving older adults all the way from housing to income maintenance or old-age assistance, if you will, to meals on wheels-nibble and chat-a feeding program, nutrition. All of these are pretty well separate agency functions.

They are operated by different agencies, but for the most part, we have no situation in which all of these services are together.

I represent a group of agencies, largely voluntary agencies, the major voluntary agencies in the city of St. Louis, which have been discussing and are in the process of developing a proposal for a comprehensive package of services for older adults.

If I could just refer to some of the elements of this particular plan: First, we intend to use existing agencies in the community rather than establishing or creating new organizations or new operational agencies of either public, quasi-public or voluntary nature.

Second, we intend the use of voluntary agencies via a coalition approach under which they will have a single management of program. Third, we would be using existing facilities, including those agencies with facilities, including schools and churches and other organizations, rather than again creating a capital need for new facilities.

The essential element is a comprehensive package of basic services which would cover these areas: nutrition, health, protective services, transportation, leisure time services, housing, and specialized personal services of a varied nature.

We are talking about an areawide approach, corresponding with what in Missouri is the regional planning area for older adults through the department of community affairs.

Senator EAGLETON. Including traversing State lines?
Mr. MACDONALD. If possible.

If, for example, it can be worked out with the State of Illinois, the

same

Senator EAGLETON. An area wide approach?

Mr. MACDONALD. Right.

You are well aware there is much in the way of obstacles due to traditional factors, but this could very well be part of the whole project. We would attempt to define within the total area districts in which areas of concentration of older adults would be analyzed.

The areas would be tailored to high-density population for adults, peculiar kinds of factors such as high-rise public housing, and also taking into account the unique needs of the elderly in each of these areas. By no means do they all correspond or are they uniform.

We would be planning for overall management and contracting for services with existing agencies under a franchise arrangement whereby carefully selected agencies would provide the full range of services or would be tied in with others that would cooperate with them.

Another element is the employment of older adults themselves to the maximum extent possible in all aspects of service programs. This includes a variety of different kinds of positions in the nutritional area, leisure time area, and others that would be-the source of, we think, both manpower and older adult involvement which is important.

The eighth point, I think, probably the most unique aspect; we are proposing a membership enrollment plan which would be entirely voluntary, but individuals could sign up, be entitled to a range of services which would be specified, but only to those members who wish to participate in the plan.

Senator EAGLETON. Is the latter somewhat analogous to the concept envisioned by HMO's?

Mr. MACDONALD. This is the closest thing we can compare to, the health maintenance organization concept of prepayment, enrollment, and coverage by a variety of different insurors.

Senator EAGLETON. Would that prepayment be in part based on financial ability to pay?

Mr. MACDONALD. Right.

Let me give an example.

A person who is an old-age assistance recipient would be in a category in which he could pay none of the cost. We would ask the division of welfare to pick up the full membership cost for the membership in the plan.

Senator EAGLETON. Do you have a ball park figure of what that membership cost might be?

Mr. MACDONALD. I would hesitate to do so at this time. There are a number of sizable factors, such as the nutrition program that is coming along and some of the other services.

We are in the process now of trying to do a delineation of this, and also some actuarial work. As an example, if you have a thousand members in the plan, and you provide casework counseling services, you may end up with 25 percent of those people needing casework counseling service in a given year.

You have to take this into account in figuring costs, and all these services are segmented and part of the total cost.

Persons who are not on old-age assistance, but in poverty up to a given level would pay according to ability, and we would seek the difference in their cost of membership from other sources.

Conceivably anyone who has the wherewithal to pay for these services would pay the full cost; they would be entitled to membership. I think one other factor is important. By using existing voluntary agencies, particularly those serving the wide segment of the community of all age groups, we will attempt to involve older groups with other age groups in programing, rather than continue to isolate them or attempt to isolate them from the mainstream of the community. Also, we are talking about multisource financing in this total program including, HEW in terms of purchase of service, the Administration on Aging in terms of nutrition programs and other special programs, and there is a variety of other Federal programs in which funding could be available for specific purposes; and of course, membership income is also a sizable part of it; and, local funds, which would be a variety of sources, including the agencies themselves.

While there is some element of demonstration to be considered, we do not propose this as a research or demonstration project. We intend to work toward development of this plan in four-level

Senator EAGLETON. You do not consider research in demonstration, but nevertheless at the outset of it you would not expect that every recipient of old-age assistance in the St. Louis metropolitan area would immediately join it?

Mr. MACDONALD. No; it is a building block approach.

After definition of areas and franchisement of centers, we would be talking about two or three areas to begin with, a limited number of services.

As we go along, we would add new centers and, secondly, develop and expand services within those centers.

That concludes my remarks, Mr. Chairman.

Senator EAGLETON. Thank you very much, Mr. MacDonald.

In terms of definition, I am very much enchanted by your, shall I call it. eight-point planning-God had 10 commandments and Wilson had 14 points; so you are at least entitled to eight. Whether all eight can be achieved, of course, no one knows.

I guess the second point in your program is the most overused and abused word in the bureaucracy, the word "coordinate"-"coordinated" management, "consolidated" management. That is the goal toward which we always work; but we seldom, if ever, achieve; in all fields of government there is much diffusion, overlapping, and duplication. That is true in the field of social services relating to the aging and middle-aged and younger Americans as well; so I for one wish you well and hope you do succeed in trying to formulate a clearly coordinated approach so that you do not have to build a whole new bureaucracy.

Point 1 was you are going to use existing agencies, and point 3, you were going to try to use as best you could existing capital facilities. Point 4 was you were going to try to do it on an area wide basis, et cetera.

You would be the first to recognize you are biting off a big hunk, but I think it is the necessary approach to make.

Mr. MACDONALD. We are going to deal first with the State of Missouri and the west side of the region, of course, in terms of developing this program in which most of these agencies are involved.

I would say now that for any given service-you can go to one or a dozen agencies and there has been no attempt to provide one place and one system. Again, it is not an entitlement basis when we are talking about a membership plan.

Senator EAGLETON. În my conversation with you yesterday, I think you mentioned and I may have overlooked it in your presentationthat in certain areas such as public housing units, where there are substantial populations of low-income people, you would try to have an individual or group of individuals there to serve as sort of social service ombudsmen. They would try to guide and direct people who are in need of either nutritional service or health service or transportation service to where that individual could get some relief. That is almost desperately needed in this field, in which there is so much duplication and overlapping and general lack of knowledge on the part of the beneficiaries of such services as to where to turn.

Mr. MACDONALD. I did mention to your staff yesterday that we are already involved with a contract between HUD and HEW, financed entirely by the two Departments, in public housing. On May 15 we open, operationally, nine stations for information and referral, in all projects of public housing, plus additional floating staff.

These people will cover the 11 turnkey projects plus the nine major areas. One element is that, of the 19 people we have employed to operate this information and referral program, about 15 are residents of public housing who are currently engaged in a 3-week intensive training program. We are concentrating a good deal in terms of provision of direct services.

Senator EAGLETON. Is one of your nine stations going to be the infamous Pruitt-Igoe?

Mr. MACDONALD. Yes, sir.

Senator EAGLETON. What is the tentative population there?

Mr. MACDONALD. It has now been reduced. Three years ago, in the rent strike, it was about 40 percent occupied of the total. It is down to less than 10,000-8,000 or 9,000, I believe.

Senator ÉAGLETON. That is not families; that is people?

Mr. MACDONALD. People.

Senator EAGLETON. As you view this plan that you are going to attempt to undertake, what do you think of the Federal Government putting in some startup money, some on-top-of-the-table money, but with the idea that after the 2 years initial startup period it would then be turned over for funding to either the State or county or city or all three?

Mr. MACDONALD. You mean how do I view the State or local government operating or funding it?

Senator EAGLETON. Funding it. And with funding obviously sometimes follows operation; but if the Federal Government were to fund it initially, and for 1 or 2 years, but at the end of that period, the money to keep it going, if it is worthy of continuation, will have to emanate from Jefferson City or the city hall or 12th and Market

Mr. MACDONALD. Living in Missouri and working closely with both the Division of Welfare and the State legislature, I am skeptical whether or not the State can come up with the necessary funds.

For example, a fact is that to live in the city of St. Louis, the State Division of Welfare says it costs $300 monthly for a family of four.

In our AFDC program we provide less than $135. This then is the level we are at now; I do not see a change, or at least until there is federalization of the entire income-maintenance program, that the State would be willing to move back into funding of the service

area.

Senator EAGLETON. Do you know of any extra surplus funds kicking around in city hall, St. Louis

Mr. MACDONALD. No; I do not.

Senator EAGLETON. We are only deluding ourselves in this area if we commence a program with initial Federal moneys then anticipate that either the State or city will be able to pick those up in future years?

Mr. MACDONALD. Until we have a form of revenue sharing or some federalization of income maintenance and at least get that on a sound basis, I see no disposition, at least on the part of the State of Missouri, to move to this. I think, until there are substantial revenues coming in the other direction, you will find no interest in support of this.

Senator EAGLETON. Thank you very much, Mr. MacDod. We appreciate your most helpful presentation.

Our third and final witness is Stanley Brody, Ph. D., Department of Community Medicine, University of Pennsylvania, for the National Association of Social Workers.

STATEMENT OF STANLEY BRODY, PH. D., DEPARTMENT OF COMMUNITY MEDICINE, UNIVERSITY OF PENNSYLVANIA, FOR THE NATIONAL ASSOCIATION OF SOCIAL WORKERS

Mr. BRODY. Thank you, Mr. Chairman.

Senator EAGLETON. You have supplied to the committee a very excellent eight-phase statement, which will appear in the record in full at the conclusion of your testimony. If you can, we would appreciate it if you would give us the principal highlights of that presentation. Mr. BRODY. For the record, my name is Stanley J. Brody. I represent the National Association of Social Workers, an organization of 55,000 social workers.

I am associate professor for social planning in the Departments of Community Medicine and Psychiatry and associate chief of the regional medical program at the medical school of the University of Pennsylvania.

We are addressing ourselves today to the three bills which presumably these hearings are concerned with.

Senator EAGLETON. You are not an M.D., you are a Ph. D.

How did the medical fraternity permit you to have anything to do with the RMP program, since you do not have an M.D. degree? I am pleased that you are; but I find it unusual.

Mr. BRODY. It is unusual, generally speaking. I have a long history in health planning. I had a major role in running the Department of Public Welfare in the State of Pennsylvania. It really is the health and mental health agency for the State; and I was engaged for a long time with the State hospital planning commission.

I think with those kinds of credentials it perhaps got me some foot in the door and I managed to keep it in.

I might say that while the University of Pennsylvania Department of Community Medicine is primarily made up of clinical men in medicine, nevertheless, I have associates in a variety of fields.

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