At the very least, that balance ought to be shifted and more, twothirds of the funds, should get out to the people and one-third, I think, would even be a high figure for administration and planning. Both of us are not against planning. You said you weren't, and I am not either. There may need to be some proper planning, but you can't use it as a convenient crutch time and time again not to act. We are still planning, we are still thinking, we are still drawing blueprints, we are still designing programs. It is a convenient escape clause as I take it from hearing the thrust of your testimony. All the book shelves have been filled. We have our plans and lots of things we could do but we have to start bringing some bucks to these programs that get out to the people.

Do you share that with me?

Mr. WELTY. Yes, sir, I do.

Senator EAGLETON. We will now hear from Mr. Ron Jensen, the executive director of the Nebraska Office of Aging.

Mr. Jensen.

STATEMENT OF RON JENSEN, EXECUTIVE DIRECTOR, NEBRASKA OFFICE OF AGING

Mr. JENSEN. Let me begin by saying I did not vote for you, Senator. [Laughter.]

Senator EAGLETON. Well, if you did, you would be in jail, you would not be here.

Mr. JENSEN. The point I wanted to make is I didn't vote for your opponent either.

I am very pleased to be here and to have the opportunity to testify and to visit with you and to bring you greetings from Nebraska's Governor, Governor Exon.

I think Earl pretty well covered many of my own misgivings about the implementation strategy, as it is called, of the AOA or what they hoped will be an amended version of the Older Americans Act at this current session of Congress. As he said, the $18 million additional appropriation of Kennedy money for the title III program, the hope there, I guess, is to carry it over into next year and to expend it for planning. And, frankly, a little quick work of the pencil seems to indicate that that would be more money than we could possibly spend on planning in the State of Nebraska, so I, too, question the wisdom of cutting the pie up in that manner.

There is one thing that Earl did not touch on that I think deserves perhaps more attention than this other issue, and that is that it is proposed to, through regulation, Senator, time limit the period that grant moneys would be available for services, including the nutritional bill, on the local level to a maximum of 3 years. You know as well as anyone in this room what the revenue picture is at the local and county level these days. We go out and talk to local officials about the initiation of new federally assisted programs these days and the first question we are asked is what is the matching, and the next one is how long will it be available to us and what happens then.

Quite frankly, if we are talking about starting programs at a $100,000 or $200,000 level, and a municipality or county is then going to have to pick up total funding at the end of a 3-year period, I am fearful

that it will stop the program before it ever gets off the bat. I don't see how we can sell that in my own State, and I don't think the picture is much different anywhere else in the United States.

There has been no absence of testimony or opinon on the administratrative placement of AOA and I would just second my colleague's comments here that the original intent of Congress, which is clear in the preamble of the Older Americans Act, for a strong agency that can provide coordinating leadership, has deteriorated through the years to where the administrative unit for that program is in a position where I doubt that it can coordinate anything. And it does need to be upgraded; it needs to be moved up the administrative ladder to where it is visible, and to where it has some clout, and to where its administrative writ might be increased.

To sound a positive note, there is one aspect of the administration proposal that I endorse and most heartedly so, and that is the proposal that the various local programs or projects of services under the Older Americans Act be developed around a theme or goal of preventing institutionalization of the elderly. It may be kind of a parochial view, but in my State of Nebraska we have close to 15,000 persons who are over the age of 65 who are residing in a nursing home or some other type of institutional setting. We believe, and, in fact, I think I can say that many of those people, some presently undefined portion, really don't need that kind of placement, if some in-home or supporting services and activities were available for them. We have twice the national proportion, 8 percent, of our elderly population in institutional settings. The national average is 4 percent.

In one area of England through providing outpatient and in-home services they found it possible to meet the needs of elderly population of 50,000 people with 50 long-term beds.

I don't have to tell you, Senator, that institutional placement is disruptive. It is socially and personally disruptive, and besides that it is costly. The past fiscal year in Nebraska we spent some $19 million through the public welfare department to purchase nursing home care for public assistance recipients, and that is more than double the total of $9 million 2 years ago, in fiscal year 1969. So I do welcome that kind of emphasis on both the personal and professional level.

I share Earl's concern about the manner of implementation, particularly about the time limitation. Those needs are there today; they are needs that go beyond the financial and perhaps the administrative resources of local government. They are still going to be around here years from now. It seems to me to be a folly to start what appears to be a worthwhile program or service and to shut it off at the end of 3 years. That is another broken promise, and we have had enough of those.

That would conclude what I have to say, Senator. Of course if you have any questions, I would be glad to try to answer them.

Senator EAGLETON. My thanks to you, Mr. Jensen, for being with us today, and thanks to Mr. Welty.

Let me perhaps clarify one point, Mr. Jensen. I fully agree with you when the Federal Government initiates a program and then says, well, now, 2 or 3 years from now we are going to turn all of this over to you, State of Nebraska or State of Missouri, that with the firmness of taxation on the local level of the respective States you are asking

the impossible. I realize that because fortunately I have served in both State and Federal Government. The States are more broke than the feds.

But on this nutritional program it is 90 percent Federal and 10 percent local. This is what I talked about before, the bill S. 1163, one hot nutritional meal a day. This is a 2-year bill, it doesn't go on for perpetuity, but it is fully expected that we would continue the same 90-10 funding. This is not our sneaky way of enticing you into the business and then cutting it off and slamming the door on you 2 years later. This bill will go on. If the programs are as successful as I think they are going to be, this will be an expanded program and one that would remain on the 90 fed. and 10 percent local basis. I hope you won't be reluctant to go into this nutritional program for fear of being left holding the bag 2 years later.

Mr. JENSEN. Let me say I understand that legislation, Senator, and the hope for renewal. However, I think you should know the administration's proposal is to by regulation limit the local availability of that program for a period of 3 years, and that is what I find unacceptable.

Senator EAGLETON. I didn't know that. Did this come out of that same meeting?

Mr. JENSEN. Yes.

Senator EAGLETON. That is why hearings like this are valuable because I hadn't heard that. I thought this was going to be an on-going, continuing 90-10 basis. We are certainly going to inquire into that.

Mr. JENSEN, That has been our understanding. We have been quite excited about the program.

Senator EAGLETON. By the end of this month the White House is expected to send up their recommendations on what items the White House finds should be pursued. Once we get those recommendations, we will have the White House officials in for testimony and we will specifically ask them about this regulation with respect to the nutritional program.

I wouldn't blame you one bit, if that is what they told you, that in 2 or 3 years from now you guys will have to take up the whole burden. I doubt if that would please Governor Hearnes or Governor Exon very

much.

Thank you, gentlemen.

Mr. JENSEN. Thank you, Senator.

The prepared statement of Mr. Jensen is as follows:)

PREPARD STATEMENT OF RON JENSEN, EXECUTIVE DIRECTOR, NEBRASKA OFFICE OF AGING

Senator Eagleton, it is a great privilege to have the opportunity to offer testimony to this special hearing of the Subcommittee on Aging of the Senate Labor and Public Welfare Committee. All of us in this field know of the Subcommittee's interest and leadership in building a better life for all older Americans, and most especially of your own contributions to that effort. I feel that the interest which you demonstrate by conducting this hearing here today speaks most eloquently of your personal commitment to assuring a meaningful and decent existence for our nation's elderly.

Recognizing that there are many here wanting to testify, I will be brief and will coLine my remarks to what I believe to be two critically important areasthe administrative role and organization of the Administration on Aging, and the matter of providing alternatives to the unnecessary institutionalization of the elderly.

To -2 0-72-7

It seems that there is certainly no absence of opinion as to what should be the nature and function of the Administration on Aging. I note that earlier this month your distinguished colleague, Senator Church of Idaho, addressed the Senate at some length on what he termed the “continuing decline of the Administration on Aging." Senator Church pointed out that in the past two years the program authority of A.O.A. has been cut by two-thirds.

I note also that during the past two years no less than four separate task forces or study groups have been commissioned, either by the executive or legislation branch, to study and report on the future of A.O.A. Each of these groups has recommended either independent status for A.O.A. within H.E.W., or a cabinet-level entity reporting directly to the President, or some combination of the two.

Additionally, it is my personal estimation that there was very significant sentiment among the delegates to the recent White House Conference on Aging for a visible and viable federal agency on aging. I recall vividly a member of the subsection on planning, in which I participated, standing to address the group on this subject. He stated, Mr. Chairman, that he had participated in the 1961 White House Conference on Aging, and that a recommendation of that meeting had been for an agency on aging to serve as a strong coordinating focal point for all of the efforts of the federal establishment in behalf of the elderly. In his estimation, the Administration on Aging, as we find it today, buried within the federal bureaucracy, stripped of most of its program authority, constitutes a poor excuse for the type of agency which is truly needed. He urged the members of our subsection to support such a recommendation at the 1971 Conference, and we did.

My conversations with other delegates would indicate that the matter was favorably expressed or voted upon in many of the sections, and yet I was quite disappointed that the preliminary report distributed at the closing session of the Conference contained no recommendation of this type. Quite frankly, Mr. Chairman, and with no recrimination intended, I feel I must question whether the Conference process allowed the true sentiments of the delegates in attendance to be expressed on this issue.

The fact is, as you well know, Senator, that the national Administration is opposed either to placing A.O.A. higher on the administrative ladder, or to the establishment of an independent agency on aging within the Executive Office of the President. Rather than ponder the rationale for that opposition, it might be more instructive to consider today the importance of a strong, vocal, and visible federal office or agency on aging.

While many in the field would speak to you of coordination, I believe that the most important factor to be considered is that of visibility. Let's be honest enough to admit that we have a federal program on aging in the first place, that we have state commissions on aging, that we have congressional committees devoted to the problems and needs of the aging, because our existing agencies and institutions, indeed, our society as a whole, has tended to neglect those needs and problems. Our whole reason for being, it seems to me, is to serve as what Sargent Shriver once termed "the point of the lance". That is to say that it is for us to serve as the voice for millions of isolated and impaired older persons who, in effect, have no voice. To advocate the programs and services they need. To demonstrate the viability of new activities and new approaches. To be the "hair shirt" on the back of existing agencies and programs to bring them to serve the elderly more effectively.

You can call this process "coordination" if you wish, but whatever it is called, it cannot be effectively carried out in a darkened closet. If this type of organization, and those responsible for its direction are to speak out effectively on behalf of the elderly, they must do so from a position from which they can be seen and heard, not from beneath several layers of bureaucracy.

If an organization of this type is to resist future downgrading or dismantling by an unsympathetic Congress or Administration, it must at least be highly placed enough so that the process can be observed by those who would contest it. I do not believe that this is possible with the present administrative alinement and placement of the Administration on Aging, no matter how great the talents or sincerity of those who lead it.

Shortly your Subcommittee will be considering legislation to extend and revise the Older Americans Act. There are many important issues to be considered in this process, Mr. Chairman, but I would submit that none can be more important than this matter of the administrative organization of the federal agency charged with the implementation of that far-reaching legislation.

Turning to the matter of providing alternatives to the institutionalization of the elderly, I believe that there is perhaps no more important focus for our efforts in the field of aging than a national commitment to enabling older persons to continue to live independently in their own homes.

I welcome the commitment of the national Administration to this goal. I be lieve it can bring needed unanimity and singleness of purpose to the programs of the Older Americans Act, programs which in the past have made a great contribution to the lives of many older Americans, but which have perhaps not had the impact which could come from having all such efforts developed around a common theme or goal.

We in Nebraska most especially are concerned with this problem of unnecessary institutionalization of older persons because we have exactly twice the national proportion of our elderly population residing in institutional settings. We have recently given some serious attention to the effort led by Dr. Lionel Cosin the Oxford Health Care District in England. Through the provision of a complete range of in-home and out-patient services, Dr. Cosin has found it possible to meet the needs of an elderly population of 50,000 persons with 50 longterm-care beds. In our nation as a whole, we would expect such a population to require 2,000 such beds, and in my State of Nebraska, 4,000 beds.

As you know, senator, long-term care is as costly as it is disruptive, and it is seldom the living pattern of choice. Recently, Nebraska Governor Exon stated that it will be the ongoing policy of Nebraska state government, coordinated by the State Commission on Aging, to attempt to reverse this trend toward increasing institutionalization, and to do everything feasible to assist our communities in making it possible for our older citizens to continue to maintain their independence.

We hope and expect that a revised and expanded Older Americans Act can be the prime vehicle for mobilizing local services and activities designed to meet that goal. We believe that the provision of services such as homemaker assistance, specialized transportation, home-delivered and drop in meals, as well as in-home health care, can make a significant impact on the rate and manner in which older Nebraskans are forced to give up independent living in order to remove to an institutional setting.

We are pleased to have one of the first nine area wide model Projects on Aging at work in Lincoln and Lancaster County to provide a complete range of those services in a coordinated and meaningful framework. The program has completed its planning period and is just now becoming fully operational. And yet we already believe, and hope to document, that it is bringing about a significant revision, not just in the manner in which services are delivered to the elderly, but the total way in which a given community views and reacts to its older population.

This program is a hopeful beginning, the most hopeful development I have seen in close to five years with the Commission on Aging. We can only hope that a strengthened federal program and agency on aging might one day make it possible for all older Nebraskans, indeed, for all older Americans, to have the same opportunity to live in the brighter and more hopeful universe which can be provided by programs of this type.

If I might close with a personal reference, I would like to tell you of the situation of my own grandmother. It's becoming a well-known story in Nebraska, because I tell it often, as it illustrates so perfectly the crying need for the kinds of efforts which we are trying to develop.

My grandmother lived in a small Nebraska community, alone and independent, until she was well into her 80's. She might still be there, but she suffered a coronary some two years ago. She was hospitalized and spent some time in the local nursing home before returning to her own home to resume her normal activities. She could have managed this with some minimal assistance, but she had trouble remembering to take her medicine. The result was that she suffered another, fairly mild coronary, and this time her physician absolutely forbade her going anywhere but back to the nursing home.

I used to stop and see her on my trips into that part of the state, and although she was in a pretty nice facility, I have to say she wasn't happy there. For any number of reasons, it just wasn't like being at home in her own house.

We hoped that she would adjust to the new situation, but before she really had the opportunity there was an accident at the nursing home which resulted in her death.

Now, it would be too much to maintain that my grandmother would still be alive if so simple a thing as a daily visitor could have stopped in to see that