POSITION STATEMENT of the THE NATIONAL COUNCIL ON THE AGING, INC. on the OLDER AMERICANS ACT 1991 REAUTHORIZATION INTRODUCTION The National Council on the Aging, Inc. (NCOA) is pleased to. present its views on the 1991 reauthorization of the Older Americans Act. NCOA helped develop legislation for the Act in 1965 and has continued to provide policy and program considerations with each extension. In the early years of the Older Americans Act, many believed it would not survive its first reauthorization. Yet last year, . we celebrated the 25th anniversary of the Act. The Act's endurance is a tribute to a program that has not deviated from its mission of providing important services as an entitlement based solely on age to millions of older Americans, allowing them to maintain their independence in home and community settings. NCOA, founded in 1950, advocates for improvements in public and private policies that affect the aging, conducts research and demonstration projects, provides training and technical asssistance, develops program standards, and disseminates information. NCOA encompasses nine national constituent units and member organizations that provide services to millions of Americans: o The National Institute on Community-based Long-term Care o The National Institute of Senior Centers o The National Institute of Senior Housing o The National Voluntary Organizations for Independent o The Health Promotion Institute o The National Interfaith Coalition on Aging NCOA is also one of ten national sponsors of the Title V Senior Community Service Employment Program under the Older Americans Act. NCOA's principal concerns with regard to the OAA over the years are the erosion of funding levels, the tendency to "medicalize" Title III of the Act, clarification of community focal points as providers of service, and development and dissemination of standards for OAA services. NCOA and its member units make the following recommendations regarding the 1991 reauthorization of the Older Americans Act: WELLNESS For more than two decades, Title III under the Older Americans Act has provided an array of nutrition and social services such as congregate and home-delivered meals, transportation, information and referral, advocacy assistance, visiting and telephone reassurance, homemaker, chore, and legal services. The Older Americans Act created a "network" or system for the provision of social services that are both comprehensive and coordinated. The network's services promote independent living for older Americans and play a role in preventing unnecessary or premature institutionalization. Many older persons who are in good health today could very likely become frail or at-risk without OAA supportive and nutrition services. Senior centers, in particular, have played a significant role in health promotion activities. NCOA believes that the major focus of the OAA is to promote and maintain health and foster independence through the delineated social and nutrition services of Title III of the Act. To further that objective, NCOA recommends a substantial investment of funds in the health promotion program, Title III-F of the Act. FRAILTY The Older Americans Act has become all things to all older people--for frail and well alike--but without adequate funding. In recent years, the Act has expanded to include the following long-term care services among others: in-home services for frail elderly; additional assistance to those with special needs; outreach to those eligible for Medicaid, SSI, food stamps; supportive services for families of Alzheimer's Disease coordination of services for those with disabilities and NCOA urges the development of services to meet the needs of both frail and well older persons. However, the purpose of OAA is to assist in the promotion of wellness with special attention to serving low-income minority older persons. NCOA believes that state and area agencies on aging, and service providers, should provide leadership and advocacy for the development of a spectrum of services for older persons. However, NCOA holds that long-term care services addressing chronic health problems should not be provided under the Older Americans Act. NCOA maintains that the focus of the OAA is to promote and maintain health, and foster independence, not provide long-term care programs and services. NCOA does recommend continuing those programs that have already been initiated under the Act, such as in-home services for frail older individuals. NCOA recognizes that chronic illness requires both medical and social interventions. While standards for in-home, case management, and other long-term care services may appropriately be developed under the OAA, implementation of such standards and provision of such services must be part of a national health or long-term care program. Such a program based on health care needs, not age, should have adequate appropriations and be located in agencies that can effectively carry out the administration of such services. COST-SEARING Even in the years of debate that preceded the enactment of the OAA legislation, it was clear that the purpose of the Act was to improve the lives of all older Americans. The Act's Declaration of Objectives says "it is the joint duty and responsibility of the government of the United States and of the several states...to assist our older people to secure equal opportunity to the full and free enjoyment" of such basic its as suitable housing, adequate income, employment opportunities, community services, and the best physical and mental health "without regard to economic status. Senator Pat McNamara and Representative John E. Fogarty; sponsors of the original OAA legislation, were emphatic, at hearings and in floor discussion, that they expected the AoA to be a strong agency, totally independent of agencies which provide welfare assistance or services. : A Department of Health, Education and Welfare reorganization in 1963 that moved the then program on aging, the forerunner of the Administration on Aging, out of the Office of the Secretary and under the jurisdiction of the Commissioner of Welfare was met with opposition from Congress and national organizations. Representative Fogarty, at a hearing on bills creating OAA programs and AoA, spoke on the reorganization as follows: "I believe every one of America's 18 million persons over age 65 has a right to resent this official action by the Federal Government announcing to the nation that--the independence, dignity and usefulness of our older Americans will hereinafter be regarded as welfare programs. This is contrary to everything that has been researched and recommended to change the image of aging from a sickly, indigent individual to a dignified, responsible person. welfare setting has wiped out most of the social progress that was made over the last 15 years in the field of aging." The Mandatory cost-sharing and means-testing requires an estimation of income. Whether the determination is based on an individual's word or documented, the end result is the same: some individuals are excluded from the programs; others, facing the demeaning effects of the means-test, are reluctant to admit their marginal economic status. NCOA supports voluntary contributions for services under the Older Americans Act. NCOA rejects the concepts of means-testing and mandatory costsharing for OAA services. NCOA believes that the real issue hidden behind cost sharing is the fact that federal funding has not kept pace with need. Congress must authorize and appropriate an adequate budget for an Act that enhances the quality of life of millions of older people. NCOA recommends an increase in authorizations for existing Title III programs that by fiscal year 1994 will be double the fiscal year 1991 levels. NCOA urges an appropriations increase for fiscal year 1992 for Title III of not less than 25 percent over current service levels. TITLE At its beginning, the Senior Community Service Employmer.t Program (SCSEP) was more of an income-maintenance program than a training program. However, over the years, the focus of SCSEP has shifted from income-maintenance to training older individuals for new employment opportunities in private industry. It is not a welfare program; it keeps people off welfare. SCSEP not only enables older low-income workers to improve their job skills and employability, it also provides the community with essential staff for community services. Nearly 40 percent of NCOA enrollees provide services to senior centers, nutrition sites, and deliver meals or other in-home services. Sixty percent of enrollees provide services that benefit the general community. The population over age 55 increased by 11.3 percent between 1980 and 1989, indicating that many more older individuals are in need of the SCSEP programs. Yet funding has not increased with the population. NCOA recommends the SCSEP program be increased by at least 113 percent in order to continue to provide for the expanding population group of individuals over age 55. NCOA believes that the Title V program needs only fine tuning during this reathorization. To that end, we recommend: o retaining the eligibility age at 55; retaining the income eligibility at 125 percent of poverty, dual eligibility for the Title V and Job Training and Partnership Act (JTPA) programs to promote coordination and expand training and employment opportunities for enrollees, o increasing the cap on administrative costs from 13.5 percent to 15 percent, and allowing the Secretary of the Department of Labor the discretion to grant waivers for a higher cap, o a provision allowing a 90 day period following the end of the annual grant period for obligation of carry over funds, and o allowing legalized aliens to enroll without a five-year waiting period. This would make SCSEP consistent with the eligibility criteria of the JTPA and Foster Grandparents programs. CHANGES IN OAA TITLES Transportation Services Today, public transportation is provided primarily for the urban, suburban, young, and able-bodied. Those who are underserved by public transportation include persons with disabilities, with limited incomes, older persons, and rural residents. Together, they represent one-third of the total population. Although the Americans with Disabilities Act will improve access to public transportation, nevertheless, transportation for many of these 84 million Americans is obtained only through an inefficient, underdeveloped, and underfunded patchwork of human service agencies and paratransit systems. is must change. Funding formulas of many government programs--formulas based on numbers or percentages favoring non-rural areas--do not recognize the higher costs in rural areas. Public transportation, almost non-existent in rural areas, is costly to provide where it does exist. Deregulation of the transportation systems has permitted airlines, buses, and taxis to withdraw service from rural areas. Studies have documented the necessity for rural agencies such as rural hospitals, rural mental health centers, and others, to spend a large portion of their limited service dollars on transportation. Transportation costs need to be built into funding formulas. Across the country, service providers in the aging network spend more on transportation that any other Title III service, except congregate and home-delivered meals. area agencies on aging allocate upwards of 50 percent of their Title III-B dollars on transportation. The result is a drastic reduction in funding for other desperately needed services. Some Congress will reauthorize the Urban Mass Transportation Act (UMTA) in 1991. Of particular value to older people and rural residents are: Section 16 (b) (2) which provides grants for buses, vans, and lifts to nonprofit agencies for transporting older persons and individuals with disabilities; and the UMTA Section 18 program which provides capital and operating grants for public transportation in communities under 50,000 population. Other pertinent UMTA programs are the Section 3 discretionary grants, and Section 9 formula grants for urban areas. The reauthorizations of OAA and UMTA present an opportunity to expand services to unserved and underserved groups including older persons. |