not each and every one is an outstanding instrument of Government. But as a group, they have acquired substantive orientation, administrative know-how, and some measure of effectiveness in State politics for having statewide impact in meeting the needs that their older citizens express. There is little reason to waste the investment that has been made in developing these agencies by bypassing them, as the Hartke bill provides.

Senator EAGLETON. Just for clarification, does the Hartke bill permit any latitude of discretion by the State agencies on aging, or is it all so specific as you have indicated?

Dr. BINSTOCK. The amount of funds is unspecified, but if the blanks in this bill are filled in then the funds would be earmarked, as I understand the legislation.

Senator EAGLETON. But it would be channeled through the States, would it not, into these agencies?

Dr. BINSTOCK. Not as I read the legislation. I may be mistaken, but it seems to me the Secretary has discretionary authority to fund directly to local organizations.

Title IV of the Hartke bill calls for a gerontoligical research center to develop a national program on the biological aspects of aging. As implied by my earlier discussion of the state of social and behavioral knowledge, I believe that the emphasis of this proposed program is gravely misdirected. My service as Chairman of the Aging Research and Training Committee at NICHD has deepened by appreciation and respect for the work of my colleagues in the biological sciences. But the primitive state of social knowledge leaves this Nation unable to provide or even to describe an adequate social existence for millions of older Americans who now remain healthy into their seventies and eighties. The basic anatomies of the social and behavioral phenomena of aging have yet to be charted, and few services have been truly evaluated. I respect fully suggest that any new gerontological research center have social and behavioral research, and research on the true impact of services as its primary emphasis. The very important basic research on the biology of aging will be able to continue, in any event, funded through the excellent programs of NIH.

Senator EAGLETON. Would you hold there just a minute? Are you familiar with the bill that the subcommittee reported to the full Committee on Labor and Public Welfare which would create a national institute on aging?

Dr. BINSTOCK. Yes, I am, Senator.

Senator EAGLETON. As you would view such an institute, should it include more than just the biomedical aspect; also some of these behavioral and social aspects you are talking about in terms of research being done by such an institute?

Dr. BINSTOCK. I certainly think that it should if the type of center proposed in the Hartke bill did not exist. However, I do not think that it should include service evaluation research which is really entirely out of keeping with the tone and tenor at NIH. It would be regarded very hostilely there by the administrators who have been associated with NIH for years.

Senator EAGLETON. What do you mean? Spell out what is service evaluation.

Dr. BINSTOCK. This would be research which would be able to tell you, when you intervene with a program in a community: Did it make any difference at all in the lives of people? Is it just chance whether the people benefit or do not benefit? Does it make any difference at all and, if so, how? In contrast, basic research on the dynamics of the family or the psychological behavior of the individual, would be classified as social and behavioral research.

Senator EAGLETON. Yes. On the impact that it might have in a given community, you say NIH would want to keep out of that?

Dr. BINSTOCK. Yes; very much. They are very hostile to that sort of research, by tradition.

Senator EAGLETON. Then are we going to have two separate research agencies: one of the type Senator Hartke calls a gerontological research center as well as maybe a national institute on aging? Is it wise to create two?

Dr. BINSTOCK. I see nothing inherently bad about competition. At the moment one of the problems is that the Administration on Aging research program and NICHD aging research program have staked out domains which they have informally agreed to keep rather separate. They do not compete with each other to stimulate good research. So in that larger sense I do not think it would be bad.

To answer your question in another sense, the Hartke bill now proposes a center focused strictly on the biology of aging. If that bill passes as it is, it is imperative that social research be written in at NIH.

I understand that the NIH bill is very likely to pass. If that can have in it some broad mandate for social and behaviorial research of a basic kind without specific earmarking of funds, then I think it would be a duplication to have social and behavioral basic research in the Administration on Aging or elsewhere. But there needs to be some place that does genuine impact research so that we will know who benefits, for example, from senior centers, why, when, and where. Senator EAGLETON. Very good. That is very helpful to us.

Dr. BINSTOCK. The administration bill, S. 3391, implicitly recognizes that our state of scientific knowledge does not provide a basis for legislating substantive service priorities. It provides a procedural mechanism for determination of priorities that, in theory, will be responsive to the different situations of the 50 States and the needs expressed by older Americans at the community level. Even if social and behavioral knowledge were more fully advanced, the needs expressed by citizens might well be regarded as the desired basis for decisions about the kinds of services to be provided. Given our virtual ignorance about the impact of services, priorities developed through an assessment of available resources and the needs expressed by older persons are to be infinitely preferred.

This is the theory of the administration bill. The realities that must be confronted if this program is to succeed, however, are staggering. First of all, S. 3391 is premised on the assumption that detailed, substantive plans for integrated and coordinated services will be developed in substate areas or communities and at the State level, and will guide the funding and execution of program development. This assumption flies in the face of everything that is known about State and local plans developed in relation to HEW programs. Hardly a State or Fed

eral administrator could be found who could honestly maintain that the substance written into State plans provides a serious frame of reference for the operation of grant-in-aid social service programs. Such plans are, in effect, financial and procedural contracts between the Federal Government and the States. In fact, the Social and Rehabilitation Service of HEW has acknowledged this, de facto, by developing an instrument called a preprint State plan that merely calls for each State to "fill in the blanks" on some standard questions needed to satisfy Federal procedures. If the administration proposal for moving ahead with the Older Americans Act is to have any chance of succeeding, stronger and more specific language must be drafted for section 304, and administration of the program will need active congressional oversight in its early stages.

A second reality that must be confronted if the administration bill is to be effective is the shortage of qualified manpower to execute the proposed programs. After 6 years, the 50 State units on aging are barely staffed with qualified personnel. The new proposal for "substate planning area units" would shortly require professionals for at least 300 new units, qualified for accurately eliciting the needs of local older persons, assessing the configuration of existing community resources, identifying gaps in resources, proposing the specific additional resources needed, and integrating all of these factors into a comprehensive area plan.

There are very few local mechanisms in the Nation that are truly qualified to perform these functions with present staff. If it took 6 years to barely staff the 50 State units with qualified personnel, how long will it take to develop qualified staff for 300 additional units? The answer does not lie in long-term graduate programs; it does not lie in short term "5-day-wonder" training institutes. All I can suggest, out of hand, is that the training faculty in gerontology programs from universities throughout the country be assembled periodically in one central place to provide 6 to 8 weeks of intensive basic training to sizable cohorts of fresh recruits. This suggestion does not wholly satisfy me, and I do not expect that it will satisfy this subcommittee.

Senator EAGLETON. Who would convene this 6- to 8-week training conference? Would this be under the aegis of the Federal Government, or would it be some university that would conceivably do it?

Dr. BINSTOCK. I think it could be done in any one of several alternate ways. Of course it will always come down to dollars whether the Federal Government or universities undertake it. Funds will be needed to bring in the people and develop the curriculum. But I think it could be convened by any one of a number of parties.

Even with the deficiencies I have noted, I believe that the administration bill is to be preferred to the Hartke bill and the current program. It has several notable strengths. First, it leans heavily on the State agencies, which are the best available sources of strength. Second, it provides a means of beginning to develop local service delivery capabilities which the health and welfare systems have not developed; no true measure of older persons' demands for services will emerge until a reasonable supply of accessible services appears on the horizon. If the realities of planning and staffing take time to overcome at the local level, it might be wise to allow for State units on aging to use some title III funds as non-Federal matching funds for local projects

jointly financed with other State agencies. That would have to be written into the legislation and specifically allowed. Third, the administration bill, to its credit, comes as close as possible to enabling that very heterogenous group of citizens we call older Americans to make their varied local choices as to the services they regard as priorities. The Church bill, S. 3181, attempts to deal with the longstanding need for powerful advocacy and coordination of programs for older Americans throughout the Federal Government. It would legislatively establish an Office for the Aging in the Executive Office of the President and, like the Hartke bill, it would elevate the status of the Administration on Aging within HEW.

The potential deficiency of these proposals is that titular changes and administrative location mean absolutely nothing if the executive branch is not willing or not forced to be committed to the success of such advocates. There are dozens of agencies in the Executive Office of the President that have little importance or strength. Conversely, an agency such as the Peace Corps, though structurally buried within the bureaucratic hierarchy of the State Department, had a great deal of power within the Federal Government during President Kennedy's administration.

If these grandly titled advocates that are propsed have no Presidential, secretarial, and congressional commitment behind their advocacy activities, then it would be better if they were not created. Their nominal existence would delude older Americans into believing that they had an effective ally in high places, that they had won an important concession. Perhaps their demands for social and individual justice would be cooled down. This would be another in a series of cruel hoaxes for our Nation's elderly, like the President's Council on Aging which existed for many years and wrote an "annual" report every several years. That was about the extent of its activity.

There is obviously nothing that I can suggest to insure that the President or the Secretary of HEW would be truly committed to be responsive to the needs of the aging. All I can suggest is that the proposed offices for advocacy will be desirable and important structures, Senator Eagleton, if you and your congressional colleagues continue your dedicated and vigorous interest in the well-being of our older fellow Americans.

Senator EAGLETON. Thank you very much, Dr. Binstock.

On page 5 of your prepared statement at the very top paragraph you say as follows:

Third, the Administration bill, to its credit, comes as close as possible to enabling that very heterogeneous group of citizens we call older Americans to make their varied local choices as to the services they regard as priorities.

As I understand the administration bill, it would allow the States a great deal of discretion in allocating their Federal money for various sources. Do you see anything in that bill that would permit the older people in a given State to have a voice or to have a say in deciding what services ought to be provided?

Dr. BINSTOCK. As I read the bill, it needs to be strngthened in that respect by specifically putting in words to that effect. But the spirit of it, and the strategy behind it, as I read the background documents, suggest that the substate area plans be drawn up with full participation of older persons in that area. The older persons, together

with the aid of the professional who would staff that unit, would then submit that plan to the State agency, and thereby the State agency would at least have this expressed need.

Senator EAGLETON. But earlier in your testimony you expressed some doubt as to whether there could be an effective substate area plan because of the lack of qualified personnel, and you pointed out that the State agencies themselves in many instances are just barely staffed. Dr. BINSTOCK. Yes.

Senator EAGLETON. So if the State cannot go to a substate area plan because of lack of personnel or for other reasons, where would be the input of the older Americans on the State level?

Dr. BINSTOCK. As the bill is right now, and without effective provisions for strengthening the planning and the staffing, I do not think there would be much promise for effective input.

I think this would be simply distributing out money to the organizations once again in terms of the weightings State politics. I do not think there is much question of this.

I think definite, active, additional steps need to be taken if the administration bill is to have any chance of succeeding. But its merit is that it could provide the beginnings of a local delivery system which we keep talking about everybody talks about delivery systems, but no one can find one, not in the medical field or the welfare field.

We have been talking about separating services from payments since 1967, and that is fine, but no one has seen the services. The payments are standing out there separately, and alone.

There are just no mechanisms. The aging program, if it can be made effective, could provide a model for service delivery.

Senator EAGLETON. I have to take a call here. We will recess just 1 minute.

(Short recess.)

Senator EAGLETON. Are you suggesting that because of the lack of qualified personnel we should scrap, if we are going to go the administration route, the references in there to substate area planning because it is unrealistic?

Dr. BINSTOCK. If you are going to scrap the substate plans, you might as well just keep the present act because that is about what it would amount to, which is just having State agencies, and having more money for them to dispense without priorities.

The administration does, in theory, have a departure here. If you would change the administration bill, I would change it by working out ways of insuring in the bill that areas of priority need are the first sub-state areas to be developed, by writing into the bill specific provisions to see that training is done in more than a half-baked way, and by writing in provisions that see that planning is a meaningful concept, and is overseen by the Secretary in a way that pays attention to substance.

If you pull out the substate arrangement, then in effect you have the Church bill which is just to extend the act basically as it is, without priorities.

Senator EAGLETON. But in essence is that not what you are saying. That this is about all we can accomplish from a practical point of view in any event?

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