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Aging - Special Committee on Aging
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The original documents are located in Box 4, folder "Aging - Special Committee on Aging"
of the Sarah C. Massengale Files at the Gerald R. Ford Presidential Library.
Copyright Notice
The copyright law of the United States (Title 17, United States Code) governs the making of
photocopies or other reproductions of copyrighted material. Gerald R. Ford donated to the
United States of America her copyrights in all of her husband's unpublished writings in National
Archives collections. Works prepared by U.S. Government employees as part of their official
duties are in the public domain. The copyrights to materials written by other individuals or
organizations are presumed to remain with them. If you think any of the information displayed
in the PDF is subject to a valid copyright claim, please contact the Gerald R. Ford Presidential
Library.
12:30
I
THE WHITE HOUSE
WASHINGTON
Sarah,
FORD i LIBRARY GERALD
gim Cananaugh
drapped this
by + would to like
for him you call
Blah!
Special Committee n aging
Now embargred-
Time untimen
(Partial)
CAN - LINO - 15
CHAPTER I
ADMINISTRATION RELUCTANCE AND
CONGRESSIONAL RESPONSE
1 Additional details on many of the matters described in this chapter may be found later in
this report.
Very few, if any, initiatives on aging originated from the executive
branch during 1975. Instead, the administration's strategy on aging
seemed to be expressed in vetoes, funding eutbacks, and overall relue-
tance either to accept new programs or to implement several already
on the books.
Nevertheless, several important advances were made on behalf of
aged and aging Americans, including:
-An 8-percent social security cost-of-living adjustment for nearly
32 million persons, instead of the 5-percent celling recommended
by the Administration."
# For more detailed information about the 8-percent Social Security cost-of-living adjust.
ment. see chapter IV.
one-shot $50 payment ($100 for couples) for 34 million Social
Security, Railroad Retiree, and Supplemental Security Income
beneficiaries.
GERALD FORD LIBRARY
Public Law 04-12. approved March 29, 1975.
-Enactment of the Older Americans Amendments of 1975, which
extended and expanded the Older Americans Act, the Older
American Community Service Employment Act, and other legis-
lation for the elderly.
Public Law 94-135, approved November 28, 1975.
-Approval of tax relief measures to help stimulate our sagging
economy.⁵
8 Tax Reduction Act of 1975, Public Law cited in footnote 3.
I. THE VETOES
Bv the end of 1975. President Ford had vetoed 45 bills, since becom-
ing President in August 1974. The Congress had overridden eight of
his vetoes, including several measures of direct importance to older
Americans.
Emergency Employment Appropriations.-Ir May 1975. the House
and Senate reached final agreement on an emergency employment
appropriations bill (H.R. 4481). Of special significance, the bill in-
cluded an additional $30 million appropriation for the title IX Older
American Community Service Employment Act-above the $12 mil-
lion already provided in the fiscal 1975 Labor-HEW Appropriations
Act.
President Ford. however, considered the bill to be inflationary and
vetoed it on May 28. In his veto message, he said:
Further stimulus would hurt more than it would help our
economy in the long run. H.R. 4481 provides too much stimu-
lus. too late, and I must therefore veto the bill."
"Congressional Record. June 2. 1975. p. H4706.
The President's veto was later sustained by the House.' However,
By a vote of 277 yeas to 143 DAYS (two-thirds not voting In the aftirmative). the House
sustained the veto of H.R. 4481, Congressional Record. June 4, 1975.) 114573-74.
the Congress provide an additional $30 million for the senior com-
munity service employment program in the first continuing resolu-
CAN-LINO-16
tion.⁸ This amount was extended through March 31, 1976, under the
8 Public Law 94-41, approved June 27, 1975.
second continuing resolution.
9 Public Law 94-159, approved December 20. 1975.
The effect of this action was to enable 12,400 low-income older per-
sons to obtain community service employment under title II. compared
with 3,000 previously. But, this did not result in an overall increase in
the total number of older workers because nearly 9,000 Mainstream
participants from the title III Comprehensive Employment and Train-
ing Act were transferred to title IX when Mainstream was phased out
on July 1.
Special Health Revenue Sharing Act.-In December 1974. the Con-
gress sent to the President a special health revenue sharing package,
which the President pocket vetoed on December 23. 1974. Senator
Kennedy reintroduced this bill (S. 66) in 1975. Again, the Congress
approved this package. despite the administration's opposition. In
its final form. S. 66 included several provisions of direct importance
to older Americans. Among the key provisions:
1. An $8 million authorization to establish new home health agencies
and to expand services of existing units. S. 66 further authorized $2
million to train professional and paraprofessional personnel.
2. Creation of a nine-member Committee on Mental Health and
Illness of the Elderly to conduct a study and make recommendations
concerning the future needs of mental health facilities, manpower,
research, and training.
3. A funding authorization to nursing schools to provide in-service
training programs for nursing home aides and orderlies.
"4. A funding authorization to nursing schools to provide training
for nurse practitioners in geriatrics to enable them to provide primary
care in nursing homes.
President Ford vetoed the bill on July 26 because he considered the
authorization levels excessive. He also opposed the bill because "it
would authorize several new narrow categorical. and potentially costly
programs which duplicate existing authorities. including
$10
million for home health service demonstration agencies." 10
10 Congressional Record, July 26, p. S13889.
The Congress decisively overrode the veto (by,a vote of 67 to 15 in.
the Senate on July 26 and by a vote of 384 to 43 in the House on July
29, and S. 66 became law on July 29¹¹).
11 Public Law 94-63.
Educational Appropriations.-The Congress and administration
had another confrontation on the fiscal 1976 Education Appropriations
bill. For older Americans. $3.53 million was at stake for launching the
community schools program authored by Senator Church.15
President Ford again opposed the bill because the Congress ap-
proved funding levels in excess of his budget requests. In his veto
message, President Ford said, "Taken as a whole, this appropriation
bill is too much to ask the taxpayers-and our economy-to bear." 13
The Congress insisted on its appropriation level, and passed the bill
over the President's veto.¹⁴
Labor-HEW Appropriations.-Congress and the administration
clashed once more in 1975 on the Fiscal 1976 Labor-HEW Appropria-
tions Act. which included several measures of direct importance to
older Americans:
1. A $125 million appropriation for the title VII nutrition program
for the elderly. $25.4 million above the administration's budget re-
quest. More importantly. committee report language directed that the
title VII level of operations should be $187.5 million. This new spend-
CAN-LINO-17
ing level would enable nearly 350,000 older Americans to obtain low-
cost nutritious meals at prices within their reach.
"The Church amendment to the 1974 Elementary and Secondary Education Act would
provide the framework for the establishment of a nationwide community education program.
The Community Schools Act (section 405) authorizes the Commissioner of Education to
make grants to local and State educational agencies to plan, establish. expand, and operate
community education programs.
13 Congressional Record. July 25. 1975, p. H7543.
14 The House overrode the President's veto of H.R. 5901 by a vote of 379 to 41. Congres-
sional Record. September 9. 1975. p. H8498. The Senate overrode the President's veto by a
vote of 88 to 12. Congressional Record, p. S15785.
2. A $17.5 million funding level for the National Institute on
Aging-nearly $3.1 million above the administration's request-to sup-
port biomedical, social, and behavioral research and training relating
to the aging process.
3. A $31.9 million appropriation for Foster Grandparents and Sen-
ior Companions-almost $4.4 million above the budget recommenda-
tion-to provide increased service opportunities for older Americans.
4. Funding to continue the Senior Opportunities and Services
(SOS), Emergency Energy Services Conservation, and Community
Food and Nutrition programs. The administration had proposed to
phase out these programs.
President Ford vetoed H.R. 8069 on December 19. H.R. 8069 became
law when the House and Senate mustered the required two-thirds
majority to override the President's veto. The House passed over the
Presidential veto on January 27, 1976, and the Senate overrode the veto
1 day later.¹
15 The House overrode the President's veto of H.R. 8069 by a vote of 310 to 113. The
Senate overrode the President's veto by a vote of 70 to 24, Congressional Record, Janu-
ary 28, 1976, p. S733.
II. CUTBACKS IN MANY FORMS
Throughout 1975 and in early 1976, the administration proposed
cutbacks in aging programs in many forms: recissions,¹⁶ reductions in
A rescission occurs when the President proposes that funds already appropriated
either not be spent or not be totally obligated. Under the Congressional Budget and Im-
poundment Control Act. both the House and Senate must pass a rescission bill within 45
days of the President's proposal. Otherwise. the funds must be spent by the administration.
Usually. rescission proposals are made near the start of the calendar year. They should not
be confused with budget requests for the following fiscal year.
17 See chapter IV for more detailed discussion.
18 This legislative package was later incorporated in the fiscal 1977 budget. See p. - for
more detailed description.
budget requests, increasing the elderly's out-of-pocket payments under
FORD
Medicare, and others.
In early 1975. the administration called for a 5-percent ceiling for
the July 1975 Social Security cost-of-living increase, although this
measure would have undermined the basic purpose of the automatic
GERALD
LIBRARY
adjustment mechanism. Senator Frank Church. chairman of the com-
mittee, led a bipartisan drive to reject this measure and to insist that
Social Security beneficiaries receive the full 8-percent increase author-
ized by law. Nearly 32 million Social Security beneficiaries will re-
ceive, on the average. an additional $70 this year to pay for food. fuel,
medicines, utilities. and other necessities because of this action.¹
President Ford called for the enactment of an earlier Nixon admin-
istration proposal to impose new and onerous costs on Medicare bene-
ficiaries. All in all, the administration's new "cost-sharing" proposals
would have reduced Medicare outlays by $1.3 billion.¹⁸
The Ford administration attempted to increase food stamp
charges-to the point that most elderly recipients would find it uneco-
nomical to participate in the program. Under proposed regulations
announced on December 6, 1974. practically all food stamp households
would pay 30 percent of their income to purchase food stamps, despite
near record breaking increases in food costs. Once again, the Congress
balked and blocked the administration's proposal by passing legisla-
tion 19 to prohibit an increase in food stamp charges for 1975. Presi-
10 H.R. 1589, 94th Cong., 1st Sess.
dent Ford allowed the bill to become law.20
20 Public Law 94-4 became law without Presidential approval on February 20, 1975.
CAN - LINO - 18
But still another effort was then made to make drastic reductions
`in the food stamp program.
In September 1975, the Department of Agrículture proposed regu-
lations in response to a court order directing the Department to up-
grade food stamp benefits SO that recipients could obtain the "nutri-
tionally adequate diet" guaranteed by the Food Stamp Act. The pro-
posed regulations applied three formulas for determining food stamp
allotments. Two of the proposals would have seríously cut back bene-
fits for more than 60 percent of the recipients, particularly the elderly.
The proposed regulations would have reduced assistance for approxi-
mately 11 million of the country's 18.8 million food stamp recipients.
Negative comments from recipients, consumer organizations. State
administrative agencies-as well as a hearing by the Senate Commit-
tee on Aging-agreed to block implementation of the regulations.
On other fronts, the administration recommended rescissions as a
means to reduce or terminate programs. A $25 million cutback in
funding was proposed for the title VII nutrition program for the
elderly. If the Congress had adopted this recommendation. participa-
tion in the food stamp program would have been slashed by nearly
35,000. However, the Congress rejected this proposal.
A $9 million cutback was recommended for the title III State and
community programs on aging. Yet, title III services-homemaker,
home health, telephone reassurance calls, friendly visitor, and others—
help older Americans to live independently in their own homes, in-
stead of being unnessarily or perhaps prematurely institutionalized at
a much higher public cost. An estimated 85,000 elderly persons would
be denied services if the Congress had acquiesced.
The Congress also rejected the administration's proposed $12 mil-
lion rescission for the title IX Older American Community Service
Employment Act. The effect of this proposal was to phase out the
senior community service employment program, although unemploy-
ment for persons in the 55-plus age category increased by 52 percent
from January 1974 to January 1975.
III. THE FISCAL 1977 BUDGET 21
President Ford submitted his fiscal 1977 budget to the Congress on
January 21, 1976. The new budget offered practically no new initiatives
in the field of aging, and called for cutbacks in several areas.
21 For a detailed analysis. see "The Proposed Fiscal 1977 Budget What It Means for
Older Americans," U.S. Senate Special Committee on Aging, February 1976.
A $52 million reduction in funding is recommended for Older Amer-
icans Act programs, from a $245 million appropriation in fiscal 1975
to $192 million proposed for fiscal 1977. AoA programs-with the ex-
ception of the title VII nutrition program-are now operating under
a continuing resolution because the authorization legislation had not
been enacted when the House and Senate considered the fiscal 1976
Labor-HEW Appropriations bill.
Major proposed cutbacks in the Older Americans Act include:
-An $8 million reduction in the title III State and Community
Programs on aging, from $105 million in fiscal 1975 to $97 million
for fiscal 1977.
-No funding for the section 308 model projects program and title
IV training.
-A $37 million reduction for the title VII nutrition program.
No funding was requested again for multidisciplinary centers of
gerontology and multipurpose senior centers.
Moreover, the fiscal 1977 budget called for the termination of the
title IX Older American Community Service Employment Act. Sen-
ator Church expressed opposition to this recommendation, saying:
This is penny wise and dollar foolish because title IX
enables low-income elderly persons to work their way out of
poverty by helping others in their communities, instead of be-
ing forced onto the welfare rolls.
Unemployment has nearly doubled during the past 2 years
for person 55 and above. I strongly believe that we should
CAN - LINO - 19
make every effort to maximize job opportunities for older
Americans, as well as youngerAmericans."
Major entbacks in Medicare coverage were again proposed in the
fiscal 1977 budget. In his state of the Union message, President Ford
referred to these recommendations as a catastrophic health insurance
package. But in reality these proposals would reduce Medicare out-
lays substantially for aged and disabled beneficiaries.
The administration's catastrophic health care package would:
22 Congressional Record, January 21, 1976, p. S236.
1. Require Medicare beneficiaries to pay a coinsurance charge equal
to 10 percent of all hospital charges above the $104 inpatient deductible
payment. Now Medicare patients pay the first $104 of their qualifying
hospital bills. and nothing thereafter until the 61st day.
2. Raise the part B Supplementary Medical Insurance deductible
from $60 to $77. Afterwards, the deductible would rise proportionately
with percentage increases in Social Security benefits.
3. Impose a new 10-percent coinsurance charge on hospital-based
physician and home health services under part B.
4. Limit a patient's liability to $500 per benefit period for qualifying
hospital services. This ceiling, though, would rise proportionately with
Social Security benefit increases.
5. Place a $250 limitation per calendar year on part B covered serv-
ices. Here again, this amount would rise proportionately with Social
Security increases.
Senator Church introduced legislation (S. Con. Res. 86) on Janu-
ary 22, 1976, to express congressional opposition to proposals to in-
crease out-of-pocket payments for Medicare beneficiaries." In his in-
troductory statement, Senator Church said:
23 Cosponsors of S. Con. Res. 86 include
The Ford plan would only intensify the costs for the over-
whelming proportion of Medicare beneficiaries. In fact. only a
tiny fraction of Medicare patients with costly and cata-
strophic illnesses would benefit under the administration pro-
posal. but at the expense of the vast majority of Medicare
beneficiaries.
The higher charges may also cause large numbers of aged
persons to delay seeking necessary medical services-or per-
haps wait until treatment is no longer effective.
It is time to put a lid on rising medical expenditures which
hit those hardest who can least afford these costs.
Despite the many negative features in the fiscal 1977 budget, there
are a few encouraging developments for the field of aging. In certain
cases these policy changes were the direct result of earlier adminis-
tration defeats to terminate or reduce programs for older Americans.
Among the encouraging developments:
-A $375 request in new loan authority for section 202 housing for
the elderly and handicapped. This funding level would finance
nearlyl 16,000 units.
-A $55.3 million request for ACTION's old American volunteer
programs (Foster Grandparents, $34 million: Retired Senior
Volunteer Program. $17.5 million: and Senior Companions, $3.8
million). nearly $6 million above the fiscal 1976 appropriation.
-A $26.22 million recommendation for the National Institute on
Aging, almost $8.7 million above the fiscal 1976 appropriation.
-A recommendation to continue the Senior Opportunities and Serv-
ices program.
-A decision not to place an arbitrary ceiling on the July 1976 Social
Security cost-of-living increase (now projected at 6.7 percent),
as had been the case in 1975.
24 Congressional Record. January 22, 1976. p. S312.
25 Congressional Record, February 7. 1975. p. S610.
IV. THE OLDER AMERICANS ACT: A CASE STUDY
The Older Americans Amendment of 1975-perhaps more SO than
any other proposal-symbolized administration reluctance on aging.
CAN - LINO - 20
On January 30, 1975, sent to the Congress a draft bill for extending
the Older Americans Act.25 This proposal would have extended the
Older Americans Act for 2 years. In addition, the bill would have
authorized-for cash of the fiscal years 1976 and 1977:
-$91 million for title III area planning and social services and
State agency operations. $39 million below the fiscal 1975 author-
ization of $130 million and $6 million below the fiscal 1975 ap-
propriation of $97 million.
-$5 million for section 308 model projects, $3 million under the
fiscal 1975 appropriation of $8 million.
-$7 million for title IV research.
-$200,000 for the National Information and Resource Clearing
House for the Aging.
The administration further called for the termination of the train-
ing, multidisciplinary centers of gerontology, and multipurpose senior
centers programs.
When it became evident that the Congress would reject these recom-
mendations, the administration launched a frontal attack to block con-
gressional efforts to provide more substantive and far-reaching
changes to the Older Americans Act and other legislation affecting the
elderly. Secretary of HEW Weinberger and Under Secretary of Labor
Schubert sent letters on March 20 26 to House Minority leader Rhodes,
26 Congressional Record, March 20, 1975. pp. H1303-4.
expressing opposition to the House Education and Labor Committee
proposal."
27 "Older Americans Amendments of 1975," H.R. 3922, 94th Cong., 1st Sess.
Secretary Weinberger strongly opposed provisions to designate four
priority services (transportation, legal counseling. residential repairs,
and in-home services) for funding by local agencies on aging. He
urged that the measure to authorize direct funding of Indian tribes be
deleted. Instead. he called upon Congress to rely upon existing en-
forcement authority to insure that Indians receive their proper share
of services under the act.
As for the proposed new Age Discrimination Act, Secretary Wein-
berger recommended that the Congress ask the Federal Council on the
Aging to study the matter.
In addition. the administration opposed the new authority to train
lawyers and paraprofessionals to provide legal counseling services,
giving this rationale:
This proposal, if enacted, would run directly counter to
our goal to end the proliferation of programs designed to
grant institutions specific funds to train specific types of per-
sonnel.*8
28 Congressional Record, March 20, 1975, p. E1304.
Under Secretary of Labor Schubert objected to the extension of the
title IX Older American Community Service Employment Act. He
contended: "Authority and adequate funding for this type of activity
are available under the Comprehensive Employment and Training
Act (CETA). 29
29 Page E1304 of Congressional Record cited in footnote 28.
The House rejected these arguments and approved the Education
and Labor Committee bill by a vote of 377 to 19 on April 8. The Senate
approved a similar measure by voice vote on June 26. House and
Senate conferees then resolved the differences in the two bills. Final
approval of the conference bill came on November 17 in the House
and November 19 in the Senate.
The overwhelming bipartisan support for the conference bill-404
to 6 in the House and 89 to 0 in the Senate-clearly demonstrated that
a veto would be overridden. On November 28, President Ford signed
the Older Americans Amendments of 1975 into law, although he ex-
pressed disagreement with key features in the act. He objected to the
new Age Discrimination Act, in particular:
CAN - LINO - 21
The delineation of what constitutes unreasonable age dis-
crimination is SO imprecise that it gives little guidance in the
development of regulations to prohibit such discrimination.
Also, the provisions raise a question on the extent to which the
Federal Government should seek to regulate private activity,
particularly without holding hearings to permit affected
persons and institutions to be heard."
30 Public Law cited in footnote 3.
31 "Weekly Compilation of Presidential Documents." December 1. 1975. pp. 1326-7.
President Ford also was "not pleased" with the authorization levels
included in the Act: "The authorization for social service programs
for fiscal year 1976, for example, is almost twice that of my budget
request. 32
33 Page 1327 of document cited infootnote 31.
IV. THE PRESIDENT'S MESSAGE ON OLDER AMERICANS
President Ford submitted his message on older Americans on
February 9, 1976. To a very large degree, his recommendations were
based upon earlier proposals advanced in his state of the Union and
budget messages.
The President again called for the enactment of his catastrophic
health care proposal. He made one modification, however, in his aging
message. He urged that Medicare be expanded to provide unlimited
rhospital and skilled nursing home care coverage. Senate Church
expressed support for this provision. as well as the recommendations
to place a limit on hospital and physician charges for Medicare bene-
ficiaries (see page - for further discussion). However, he pointed
out:
But the benefits from these proposals are greatly outdis-
tanced by the "cost sharing" arrangements which would sub-
stantially increase the elderly's out-of-pocket payments. The
new 10-percent coinsurance charge for part A services would
reduce medicare benefits by more than $1.7 billion.33
33 Congressional Record, February 25, 1976, pp. S2293-4.
Nearly 5.9 million Medicare beneficiáries are expected to receive re-
imbursable hospital services in fiscal 1977. Of this total. only 150,000-
or less than 3 percent-would pay less under the administration's
catatrophic health care package. Independent analyses reveal that an
elderly patient must ordinarily be hospitalized about 75 days to bene-
fit from the administration's $500 ceiling for qualifying hospital
charges.
Approximately 14.2 million persons are projected to receive reim-
bursable service under the Supplementary Medical Insurance program
in fiscal 1977. But only 1.8 million-or about one out of seven of those
receiving reimbursable services-would pay less under the administra-
tion's proposal.
President Ford also proposed to limit increases in Medicare daily
payment rates in 1977 and 1978 to 7 percent for hospitals and 4 percent
for physicians. The purpose of these provisions is to reduce Medicare
expenditures. However, Senator Church warned that these measures
may shift the cost to aged and disabled and Medicare beneficiaries. He
noted that the 4-percent ceiling on physician charges may cause doctors
not to accept Medicare reimbursement in full. Elderly patients may
then be forced to pay more for physician services, since Medicare pays
80 percent of "reasonable charges" after the deductible payment is
met.
President Ford recommended major changes in Social Security
benefits, including:
-Phasing out over a 4-year period Social Security benefits for full-
time students.
-Eliminating the retroactive payment of actuarially reduced pay-
ments when a beneficiary would have a permanent reduction in
monthly benefits. A retired worker may now receive up to 12
months retroactive payments, provided all factors of entitlement
are fulfilled during the retroactive period.
CAN - LINO - 22
-Removing the monthly test of the Social Security earnings limita-
tion, except for the first year a beneficiary receives a cash benefit.
Now a beneficiary under age 72 may earn $2,760 a year before $1 in
benefits is withheld for each $2 of earnings above the earnings
ceiling. However, a person may receíve benefits during any month
that earnings do not exceed $230.
President Ford urged two major propoșals to insure the financial
integrity of the Social Security trust funds. He called for a 0.3 per-
cent increase in the Social Security contribution rate, from 5.85 to 6.15
percent effective in 1977 (for further discussion on financing pro-
posals, see p. -). In addition, he urged that the Social Security sys-
tem be "decoupled" (for further discussion of "decoupling," see p.-).
FINDINGS AND RECOMMENDATIONS
The administration's fiscal 1977 budget falls far short of re-
sponding to many key problems of older Americans. If allowed
to stand, it will intensify the difficulties of large numbers of
elderly persons.
Major changes are needed in several areas. The committee
recommends that:
-Funding levels for the Older Americans Act should be raised
to more realistic levels.
-The Title IV training program should be continued and
expanded.
-The Title V Multipurpose Senior Center program should
be funded.
-The Title IX Older American Community Service Employ
ment Act should be continued and expanded.
-Legislation 34 should be enacted into law to express congres-
34 On January 22, 1976. Senator Church introduced S. Con. Res. 86 to express congres-
sional opposition to proposals to increase out-of-pocket payments by medicare beneficiaries.
sional opposition to proposals to increase out-of-pocket pay-
ments for Medicare beneficiaries.
The committee on Aging renews its pledge to cooperate with
the administration to improve the budget for older Americans.
The committee strongly believes there is genuine bypartisan
interest in such an objective.
CAN-LINO-61
Appendix -
REPORTS FROM FEDERAL DEPARTMENTS
AND AGENCIES
ITEM 1. DEPARTMENT OF AGRICULTURE
DEAR MR. CHAIRMAN In response to your letter of December 30, 1975, to Secre-
tary Earl Butz, enclosed is a summary of major activities on aging by the Depart-
ment during 1975. Plans for activities in 1976 are stated in the summary.
If we can assist you further, please let us know.
Sincerely,
JOSEPH R. WRIGHT, Jr.
Assistant Secretary for Administration.
[Enclosure]
ACTIVITIES OF THE U.S. DEPARTMENT OF AGRICULTURE TO HELP
OLDER AMERICANS
ECONOMIC RESEARCH SERVICE
The Economic Research Service is engaged in studies designed to gain insight
into the needs and problems of elderly people living in nonmetropolitan areas.
Over 36 percent of our Nation's 20.6 million older citizens lived outside standard
metropolitan statistical areas in 1974. About two-thirds who reside in nonmetro
areas live in counties with a town or city of 2,500 to 25,000 people. In addition,
many mid-American farm belt States have a relatively high concentration of
people 65-plus years old. The following studies were completed or underway dur-
ing the calendar year 1975.
THE AGED BENEFIT FROM NUTRITION PROGRAM
This study examined the possible benefits associated with participation by older
people in a nutrition program funded under title VII of the Older Americans Act
of 1965. The selected nutrition program was at a rural site in Scott County, Ark.,
and had been in operation 1.5 years as of July 1, 1975. While the results are based
on a small sample, the researchers feel that. due to direct corroborating evidence
in their experiences. the findings are relevant elsewhere in the State.
Fifty participants in the nutrition program and an equal number of non-
participants were interviewed. The major finding was that hospitalized partici-
pants averaged 10 nights of hospitalization during the year ending July 1. 1975.
compared with an average of 28 nights for hospitalized nonparticipants. At $130
per night (average cost for medicare patients). the difference in hospitalization
costs for the two groups amounted to $40.300. The estimated annual cost of the
title VII nutrition program in Scott County was $39,000. Thus, participation in
the nutrition program was associated with reductions in hospital expenses
sufficient to offset the cost of the program. This result suggests that the nutrition
program may substitute, in the long run. for higher cost hospital care thereby
improving well-being and reducing the demand for hospitalization.
THE EFFECTS OF WIDOWHOOD
Loss of a spouse has a substantial social and economic impact upon the
survivor according to 100 Arkansans that had been widowed between ? and 36
months. All were 60 years of age or over, and half were males. Although the
inferences from this study reflect the views of the sample population. these
feelings are experienced generally.
"Loneliness" at meal time was a major problem for most (67 percent) of the
widowed respondents. Only 41 of the 100 felt they had made the necessary
adjustment regarding meal planning and preparation. Others were having
difficulty cooking for "just one person." Females tended to adjust by sharing
the cooking with relatives. while men tended to ent in restaurants. Over half
of the respondents were experiencing chronic health problems 85 percent had
consulted a physician during the past year. and 21 percent had been hospitalized.
partly because of inadequate diets.
Nearly one-third of the respondents had an annual income under $2,400. Over
half (24 men and 29 women) had experienced income decreases with loss of
spouse. In addition. loss of spouse placed a heavy financial burden on the
survivor. Twenty-seven percent of the respondents indicated that the deceased
spouse required between 1 and 4 months of hospitalization prior to death. Among
those requiring hospitalization. 10 percent required over 2 years care.
In adjusting to loss of spouse, the men felt (69 percent) that community-
sponsored services, such as meals-on-wheels, were most useful. Whereas. women
(69 percent) considered emotional support as being quite useful in making
necessary adjustments. Among other community services. financial aid was
listed as being useful by 41 percent of the women and 27 percent of the men.
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A major implication from this study is that elderly persons who lose a
spouse need economic and social assistance in making necessary adjustments.
This also suggests the kinds of services that are needed in meeting emotional,
nutritional, social, and economic needs for adjustment.
PILOT STUDY OF NONMETRO ELDERLY
A pilot survey of elderly persons in Powell County, Ky., was completed during
August 1975. Powell is a nonmetropolitan county located in the Appalachian
Area of eastern Kentucky. Data were collected from 398 households containing
one or more persons 60 years of age and over. Inferences that result from this
study will reflect the situation of the sample population and will not necessarily
represent situations elsewhere in the State or Nation.
Information collected includes basic demographic data on household-person
characteristics and data regarding housing. health conditions. activities, work
experience, transportation problems, community service needs. income. and
assets. Researchers will explore how problems differ among older people. analyze
factors contributing to problems, and examine how well available services
alleviate identified basic needs. In addition. researchers will evaluate how effec-
tive the survey technique was for analyzing problems associated with aging and
whether this procedure provides sufficient basic information necessary for policy
formation and program management.
NORTHERN NEW ENGLAND NONMETRO ELDERLY
Data from a regional project, "Community Services for Nonmetropolitan
People in the Northeast." will be used to develop a report on elderly households
in northern New England. This study will focus on that segment of the northern
New England nonmetro population 60 years of age and over with independent
living arrangements including persons living alone, couple living alone. and
elderly individuals and couples who have someone else living with them. In all
cases, an elderly person was reported as head of household. Excluded are the
institutionalized elderly and elderly persons living in a household in which the
head was under 60 years of age. The initial phase of the analysis will examine
household composition, economic and labor force status. housing characteristics.
and use of and satisfaction with selected community facilities and services.
IMPROVED HOUSING FOR THE RURAL AGED
The quality of housing occupied by the aged has not improved as rapidly as
that occupied by the younger households. For example. 32 percent of the sub-
standard housing in the United States was occupied by households whose heads
were over 65 years of age in 1970 as compared with 24 percent in 1960. About
half of the poorly housed aged are located in rural areas. Lack of progress in
improving housing for the aged may be due to a variety of factors such as
location, tenure, household composition. and income distribution. An ERS study
is underway to determine what factors are affecting the quality of housing
occupied by the aged in rural areas and the types of programs which may be
most effective in helping the aged improve their housing conditions.
RESEARCH PLANS, 1976
In addition to completing the above reports. new studies will be undertaken
to determine alternative structures for providing services to meet the needs
of the nonmetro aged.
EXTENSION SERVICE
Extension State specialists. State program leaders. county home economists,
and 4-H agents are continuing to provide educational programs for older
Americans. They are continuing to interpret the needs of this segment of the
population to the volunteer community. As a result volunteers are providing
services that are helping the elderly remain in their own homes. Educational
programs in 1975 emphasized consumer information. energy conservation.
nutrition and community services available. A random sample of programs and
results are given below.
A. HOME ECONOMICS
Texas reports the following accomplishments:
-18 counties, in cooperation with area agencies on aging have set up infor-
mation and referral centers for the elderly
senior centers opened with local volunteer support
-12 counties provide volunteer telephone reassurance and/or visiting to 340
seniors;
-28 counties sponsored fairs or bazaars at which 2,500 seniors exhibited and
received awards ribbons and $11,275 from sales:
-1,150 seniors received arts and craft instructions for pleasure. hobby develop-
ment and source of income;
-158 seniors gained skills. consumer information and saved money through
clothing construction workshops and fashion shows:
-5,380 seniors benefited from foods and nutrition information including use
of food stamps, buying, energy-saving preparation and food preservation
-3,162 seniors received free blood pressure checks at a saving of an estimated
$15,810;
-500 seniors received educational information on arthritis:
-731 seniors received diabetes planning assistance and/or tests;
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-350 seniors tested for glaucoma at savings of $4,024 with 35 referrals made
in one county:
-600 seniors received health information on exercise. respiratory diseases.
heart and vascular diseases, cancer. eye diseases, food quackery
-1,500 seniors assisted with resource management information. i.e., wills,
consumer information. insurance. estate planning:
-235 seniors provided mini-garden and lawn care information:
-350 seniors provided vegetable gardening information
-16 committees have assisted in developing bus transportation routes to best
serve the elderly population:
-10 counties sponsored local and long distance tours for seniors
-258 seniors honored for civic contributions in 57 connties with an attendance
of 13.279:
-these accomplishments were supported by 51 television programs. 921 news
releases. 461 radio programs plus numerous recreational activities at many
retirement centers and nursing homes.
South Carolina Extension Service. State Commission on Aging and the De-
partment of Recreation and Park Administration. Clemson University spon-
sored the fifth annual "college week for senior citizens" at Clemson. A pre-
registered attendance of 600 people made it necessary to offer the program for
2 weeks. Numerous educational and cultural experiences were included in
curricu'um.
North Carolina Extension Service and several other agencies sponsored the
sixth annual "senior citizens week" at Lake Junaluska. During the week. 1.497
older Americans participated in the education and crafts classes. Home econo-
mists in 100 counties and on the Cherokee Indian Reservation are focusing on
older Americans as a target audience in 1976. State staff members have conducted
inservice training and have developed appropriate publications for this emphasis.
Virginia's Bland County Extension homemaker clubs studied "Methods To
Cheer Shnt-ins." with primary emphasis devoted to the elderly shut-ins. Leaders
in groups conducted the programs in respective areas. As a result of the program
four groups have initiated service projects such as a cheer basket for a shut-in
and biweekly services to a Wytheville nursing home where patient visiting.
letter writing. or reading to patients takes place. Another group is getting books
from the bookmobile for community shut-ins.
Extension agents in Bedford provided organizational assistance to a group
of older people to form a senior citizen group. This group has grown to 40 per-
sons. meets monthly, and is involved in special interest and other activities.
Thirty-nine leaders in Amherst County representing all geographic areas and
socio-economic levels-young adults and older citizens-were trained in problems
of the aging and programs that might offer possible solutions. A skit on
"choices to make" conducted by Family Service of Central Virginia presented
misconceptions of the aging. Programs such as telephone contact. RSVP. Green
Thumb. meals-on-wheels, and others were discussed.
Cards which had been developed by Extension agent for community groups to
develop a file of aging persons in the community who might participate in a
telephone contact program were distributed among with information about
social security and other related materials. Leaders were encouraged to identify
senior citizens in their community and in SO far as possible plan an event for
their enjoyment and inclusion in group activity.
Seventeen Extension homemaker clubs conducted some type of community
recognition of the elderly. inviting them to a special event or program planned
just for them. They were invited to participate in ongoing educational programs.
Perhaps the most outstanding program in the community involved 42 senior
citizens who gathered to recognize one of their members who has been singled
out as an artist of some importance. The artist herself is in her 80's and is be-
coming famous for paintings of real life activities in her rural community in
the recent past. such as baptizing in streams. hog killings. molasses making, etc.
Missouri Extension staff members have met with staff members of the area
agencies on aging in an effort to improve communications and plan for coordi-
nated activities of the two staffs. In several counties programs have included
conducting training sessions for volunteers manning telephones in the informa-
tion and referral on aging programs. Five thousand East-West Gateway area
senior citizens receive a monthly "interest and concern" newsletter which in-
cludes foods/nutrition and clothing/textiles information.
Indiana's educational programs were designed to add "life" to the years of
senior citizens. Some examples are by improving the home environment. orga-
nizing Extension clubs in nursing homes, providing nutrition education in
congregate feeding centers and meals-on-wheels program. Forty home economists
have assisted with the organization of county councils on aging.
The Vinnesota Extension Service cosponsored a conference on aging for 172
professionals and volunteers who work with the senior citizen programs.
Forty-tiro States and Puerto Rico hare Extension homemaker clubs that are
affiliated with the National Extension Homemakers Conncil. Extension works
with these 600,000 volunteer leaders many of whom are providing programs
and services for the elderly.
New Merico initiated a program called "telephone friends" at four district
meetings. Through this program they are trying to reach isolated and elderly
people. They are also finding a way through individual clubs to help with trans-
portation problems such as for shipping and keeping doctor's annointments.
In O'loboma. 2.194 EHC's spent 22,883 hours helping in nursing homes. Pro-
grams included sing-a-longs, birthday parties. crafts and bingo, writing letters.
etc.
In Morris County. Kansas. EHC conducted a survey of all citizens 60 years
of age or older. The survey revealed the need for some social organizations in
the communities. The club family life chairman conducted an information and
CAN-LINO-64
organizational meeting for the elderly in three communities that wanted a senior
citizens club. The chairman explained the purpose of the group, led some dis-
cussion and helped with the election of officers. The three senior citizen groups
are enjoying pot luck suppers. special entertainment and game afternoons.
Missouri had 30 counties who reported having been sponsors or assistants in
the meals-on-wheels program. In three countles. NEHC members have helped
at the congregate feeding centers. 68 counties reported that 1,360 days of
volunteer time had been devoted to residents in nursing homes. Some senior
centers were established and furnished. Three counties conducted safety pro-
grams for senior citizens.
In Kentucky. many homemakers are giving their services as volunteers to
work in the local feeding centers. They help service the tables, work with crafts
and assist in taking the meals to the home-bound senior citizens.
B. 4-H PROGRAMS
Pilot program involving several States.-Over the past year. 4-H has been
involved in a pilot effort with the American Association of Retired Persons in
the "generation alliance program" (GAP). The pilot area is Illinois. Wisconsin,
Indiana. Michigan. and Ohio. The basis of GAP is dialog--communications and
sharing between senior citizens and 4-H youth. As a result. friendships are
developed. stereotypes destroyed and the lives of all who participate enriched.
Moreover, many have chosen to further develop their relationships by working
together on community service projects. Bicentennial programs. and other social
and/or cultural events. The program is being expanded to other regions of the
United States.
Special proiect in Teras.-The Extension Service is piloting a special project
in Texas to identify some of the needs of senior citizens. After needs are iden-
tified. a team of consultants will see which of these needs might be met by
working with 4-H youth. Some may be with senior citizens teaching youth, some
by youth helping senior citizens. and some just by sharing with each other.
Models will be suggested for testing in the Extension program.
4-11 cooperation with labor union.-Contact has been made with the Inter-
national Brotherhood of Painters and Allied Trades. AFL-CIO Golden Years
Senior Citizens' Club to have their membership serve as volunteers to teach
teenage youth the basic skills for entering into the world of work. Their member-
ship has completed successful careers in such areas as painting. decorating.
hardwood finishing. paperhanging. glasswork paintmaking. decorative covering
and operational care of tools of these trades. They are interested in sharing
these experiences with teens.
North Carolina.-A "youth looks at aging" program which had its beginnings
in 1974 is showing some significant results for 4-H. Purpose of the program
is to develop a closer relationship between youth and senior citizens in the
community. help youth increase their understanding and respect for older
adults. and in return. help senior citizens develop a better understanding of
today's youth. As a part of this program. senior citizens are attending 4-H Club
meetings. often giving the program and assisting with projects. In return. 4-H'ers
offer free plowing of gardens, provide hospital sitters. provide transportation for
shopping trins and provide educational programs on nutrition. safety and health
to the elderly. Since its beginning in 1974. 44 North Carolina counties have con-
ducted "youth looks at aging programs." involving 1,575 youth and leaders and
2,673 senior citizens. In 1975, 17 of the 44 counties conducted these programs
and involved 865 youth and leaders and 998 senior citizens.
Also in North Carolina. some 300 elderly residents participated in a 4-H
day camp for senior citizens in Caldwell County. The day camp featured social.
recreational and educational activities. The North Catawba 4-H Club coordi-
nated the event. involving numerous agencies including health and social services
departments and social security officials.
Utah.-4-H and other youth in five southwestern Utah counties this past
summer were involved in a community garden project with and for senior
citizens. A total of 37 gardens were planted in 17 different communities. They
were cared for by 247 4-Hers and other young people with assistance from 101
volunteer leaders and other service and civic minded adults. From these gardens,
fresh vegetables were provided to the senior citizens residing in nearly 400 homes
in these rural communities. The aim of the project was to help increase the
nutritional level of these older rural folks and in addition. the project instilled
into the youth community pride and a genuine concern for others. In 12 4-H foods
clubs, youth each adopted an older person as a "grandmother" or "grandfather"
and visited them regularly. They also invited the older folks to have dinner
with their 4-H foods clubs.
In one county. a leader reported a vacant lot was donated to 4-H'ers for
the garden. a senior citizen gave his water rights. another senior citizen plowed
the ground. Several times during the summer. the young people met to weed the
garden. Fresh vegetables were delivered to over 40 people. In another county.
one of the gardens became a real demonstration garden. with 17 different kinds
of produce-several of them new vegetable varieties. This "community garden"
generated enthusiasm for a number of other gardeners and became a standard
for comparing gardening skills and vegetable varieties.
This multi-benefit. youth involving community garden project was the out-
come of two ACTION-funded programs being tied in with the 4-H community
pride effort. The two ACTION programs were a senior nutrition aide program
designed to improve the senior citizens' nutritional level. and a mini-grant
gardening program to involve youth in growing vegetables as a part of nutrition
:.
improving efforts. All participating in this project agree it has been a successful,
satisfying program for all concerned.
CAN - LINO - 65
Georgia.-As a result of interest shown by 4-H members in Oconee County.
Ga., county leaders formed a "council on aging." 4-H'ers cooperated with the
council by providing financial assistance and distributing literature.
Kansas.-Kansas 4-H'ers have discovered that the community's senior citizens
make excellent project leaders. A few clubs even hold their meetings in nursing
homes. One 4-H group regularly holds classes in dog obedience on the front
yard of the town's nursing home.
An "adopt a grandparent" program is being conducted in several communities
where 4-H'ers are matched with "grandparents" in the community. They visit
their "grandparents," do crafts together, play games. and share in other activities
to help the elderly.
4-H members in Thomas County. Kans.. are involved in projects to help resi-
dents in a senior citizens center. Latest projects included making a sign and
a bookcase for the center. An earlier project was making 42 planter boxes for
each apartment's porch and painting them.
South Carolina.-In a recent State 4-H teen leader retreat in South Carolina,
special emphasis and training was given on "working with senior citizens." As an
outgrowth of this retreat. several programs for the elderly were begun. In Ker-
shaw County, all members of the 4-H Junior Leadership Club have committed
themselves to "adopt a senior citizen." Service activities include telephoning,
reading to. personal visiting. yard work. running errands and providing trans-
portation for the elderly. The junior leaders are also cooperating with the Greater
Camden Area Senior Citizens Service-Auxiliary including assisting at the Cam-
den Senior Citizens Center. The teen leader's "adopt a grandparent" project in
Berkeley County has also been very successful.
At the teen leader retreat. senior citizens were involved as guests and instruc-
tors in rap sessions. recreation. discussing "working with the elderly," teaching
crafts and "survival during hard times."
Arkansas.-Two 4-H members in White County. Ark., as a result of their club's
visit to a nursing home became interested in starting an "adopt a grandparent"
program. The girls took the idea to their 4-H Club as a new community service
project and soon the program became a county-wide effort. In starting the pro-
gram, members of the club worked with three nursing homes in the county to get
names of patients who had no family or regular visitors. They also received a
list of patients that had regular visitors but wanted to participate in the pro-
gram. Rap sessions were set up at the three nursing homes SO that 4-H'ers and
patients could learn to know and understand each other. The patients were also
asked to share their knowledge and skills in helping the 4-H'ers with their projects.
The 4-H "adopt a grandparent" has now been organized as a Statewide program
and was conducted last year by over 300 4-H Clubs in the State. Commercial TV
ran special features and the Governor of Arkansas signed an Arkansas proclama-
tion declaring "adopt a grandprent month."
Many States.-As a part of community service projects. 4-H'ers in many
States are involved in helping individual senior citizens and elderly families in
such activities as lawn. garden and livestock chores: household tasks: visiting
nursing homes. In one county in Arkansas, a 4-H Club recently winterized two
homes of elderly people.
National scholarship winners' work with olderly.-Many teenage 4-Hers have
built relationships by working with the elderly in their communities. Several of
these were recognized for their work by receiving national scholarships at the
4-H Congress in Chicago in December. The Alabama home management winner
did extensive work with the local Golden Age Clubs. She found that some of the
members were neglecting their diets because it was "just too much trouble" to
prepare a balanced meal. The 4-H'er came up with easy recipes that could be pre-
pared in a short time and demonstrated them to the group. They all asked her to
come back on her school break.
The North Carolina food preservation winner worked as a volunteer last sum-
mer at a local housing project for the elderly. She helped them preserve food that
they grew in a garden project.
Several of the national 4-H citizenship winners have worked with the elderly.
One Alabama winner served as a volunteer at the county nursing home. Another
took 18 of his best plants to the local nursing home where they were distributed to
the patients that could care for them. He took Polaroid photos of each of the
ladies with their new plants. He also brought a card to each patient on Valen-
tine's Day and a rose corsage he'd made from his garden on Mother's Day. The
Colorado winner has planned and directed monthly entertainment programs at
the county nursing home and put together a statewide program in which 4-H'ers
in every county presented programs in nursing homes on special holidays.
Similar kinds of programs will be continued in 1976 with adjustments to meet
the changing needs of the clientele.
FARMERS HOME ADMINISTRATION
The Farmers Home Administration is the rural credit agency of the Depart-
ment of Agriculture. This agency administers a varied number of loan and grant
programs. Eligible persons. including the aging, participate equally in FmHA as-
sistance.
Authority for the Government to make housing loans to rural residents is con-
tained in title V of the Housing Act of 1949. as amended. This net authorizes the
Secretary of Agriculture to make and insure loans to owners of farms, to owners
of other real estate in rural areas, and to elderly persons who are. or will be,
owners of land in rural areas for the purchase, construction. improvement. altera-
tion. and repair of dwellings. related facilities, and farm buildings.
The FmHA has the major responsibility to administer Federal housing pro-
grams directed toward improving housing conditons in rural areas. One program
of special Interest to the elderly is the 504 loan program which provides low inter-
CAN - LIN 0- 66
est rates for repair of homes they own. Increased emphasis on servicing the elderly
with this loan is receiving special effort.
Through the community facilities loan program of FmHA. loans are made to
-public bodies and nonprofit corporations in rural communities and places of not
more than 10,000 population to provide health care. fire rescue and safety. cultural
and education, transportation. recreation and other essential community facili-
ties. These afford beneficial services and assistance to all rural citizens, includ-
-ing the elderly. These include hospitals. clinics, nursing thomes. fire ions, am-
bulance, and community buildings for public service and recreational activities.
Water and waste disposal loan programs include older people in the clientele
they serve.
This agency will continue to provide its services to eligible persons. Eligible
persons, including the aging, participate equally in FmHA assistance.
FOOD AND NUTRITION SERVICE
FOOD STAMP PROGRAM
Legislation enacted in 1975 concerning the food stamp program included
changes that benefited the elderly and other participants. Public Law 91-1
froze purchase requirements for calendar year 1976 at the level in effect on
January 1, 1975. Public Law 91-41 permits persons receiving payments under
the supplemental security income (SSI) program to continue participating in
the food stamp program until June 30. 1976. unless they live in one of the
States that is providing the bonus value of food coupons in cash. The States
providing the bonus value in cash are New York, California, Massachusetts,
and Nevada (aged and blind only).
Beginning September 1. 1975, SSI recipients in Wisconsin were determined
to be eligible for food stamps because Wisconsin no longer elects to cash-out
food stamps. Further, in accordance with a court order in the case of Elliott et
al. V. Weinberger, et al., SSI recipients in Wisconsin who choose to participate
in the food stamp program after September 1. 1975. will receive credits against
food stamps purchase requirements if they received SSI benefits in July or
August 1975. These credits shall be in the amount of $10 per person for each
of those 2 months during which SSI benefits were received.
Two of the amendments to the food stamp program regulations during 1975
have a special effect on the elderly. First, the amendment to the food stamp out-
reach provision. made in compliance with the court order in the case of Bennett
V. Butz, specially requires that the special needs of the elderly and several other
groups be considered as a part of a State's outreach activities. Second. the food
stamp regulations were amended to incorporate the extension of SSI eligibility
for food stamps through June 30. 1976; the change in Wisconsin's status as a
cash-out State: and the court order entitling SSI recipients in Wisconsin to
credits for lost benefits in July and August 1975.
As has been mentioned in previous reports, under current program pro-
visions certain elderly recipients may use food coupons to pay for home delivered
meals or meals served at a communal dining facility. At the end of calendar year
1975 there were 1,819 nonprofit meal delivery services and 3.656 communal
dining facilities authorized to accept coupons in exchange for meals served or
delivered to elderly persons. There are two other current program provisions
which are of particular benefit to elderly persons. Namely, the provision for the
use of an authorized representative when a recipient is unable to apply for or
purchase and use coupons in person and the provision for mail issuance of
coupons.
Lastly. in regard to plans for 1976. the administration's proposed National
Food Stamp Reform Act of 1975 (S. 2537) contains several provisions which
will affect the elderly. Careful consideration was given to the situation of senior
citizens when the administration's legislative proposal was developed. The
proposal provides for a $100 standard deduction per month for all households
and another $25 when the household includes a member age 60 or over. This
would result in about four out of five elderly participants paying the same
amount or less for their food stamps than they do currently. and these are
the poorest participants. In addition. many elderly-about 200,000-who cannot
currently qualify for food stamps or who do not participate because their
purchase price is too high may. for the first time. receive the benefits of the
program. S. 2537 also includes a provision to lower the age limit for work
registration to 60 years rather than 65 as required by the current Food Stamp
Act.
FOOD DISTRIBUTION PROGRAM
An amendment to title VII of the Older Americans Act of 1965. Public Law
93-351, enacted July 12, 1974. had a significant impact on USDA food donations
to nutrition programs for the elderly funded under the Act by the Department
of Health, Education. and Welfare. This legislation set the minimum level of
donated food assistance to these programs at 10 cents per meal (subject to annual
adjustments for increased food service costs) and required USDA to give
emphasis to purchasing high protein foods. meat and meat alternates.
The Department of Agriculture and the Commission on Aging Department
of Health, Education. and Welfare, finalized arrangements for serving title VIII
elderly feeding projects in January 1975.
Because of the limited time available during the balance of fiscal year 1975.
it was determined to supply these projects with canned beef in natural juices and
process cheese only. at the rate of 10 cents per meal served.
During fiscal year 1975, some 685 title VII feeding projects covering approxi-
mately 4,490 feeding sites, served more than 52.2 million meals. It is estimated
that approximately 1.5 million persons benefited from Federal food donations.
In addition, selected foods were made available by USDA to public and private
CAN-LINO-67
nonprofit institutions, including nursing homes, senior citizens' centers, meals-
on-wheels programs and other charitable organizations which provide food
services for needy persons. Some 9.000 institutions served approximately 1 million
needy persons who benefited from Federal food donations in fiscal year 1975.
Of these, approximately 25 percent were institutions that have been identified
as serving predominately elderly persons over age 65.
All but two States were actively participating in fiscal year 1975. Kansas,
which selected cash in lieu of commodities for their child feeding programs,
declined to designate a distributing agency for programing commodities to their
title VII feeding projects, and therefore. received no USDA-donated foods.
Georgia accepted offered foods: however. distribution was not made to title VII
feeding projects pending the resolution of internal administrative problems.
Legislation enacted November 27. 1975, Public Law 94-135. amending the
Older Americans Act of 1965. further broadened the food donation authority
to require the Secretary of Agriculture to maintain an annually programed
level of assistance to title VII projects of not less than 15 cents per meal during
the fiscal year ending September 30, 1976. Applying the annual adjustment for
increased food service costs, this results in 16½ cents per meal for fiscal year
1976. This legislation further provided, in any case in which a State has
phased out its commodity distribution facilities before June 30. 1974, such State
may, for purposes of the program authorized by this act, elect to receive cash
payments in lieu of donated foods This "hold harmless" clause is applicable
only to the State of Kansas which had phased out its commodity distribution
system prior to June 30. 1974.
In fiscal year 1976 (excluding Kansas), Georgia is the only State which
has not acepted any offered USDA foods. as a result of the aforementioned
Internal administrative problems. However. it is estimated that approximately
800 title VII projects, comprised of some 5.400 sites, will provide approximately
270,000 meals per day for elderly citizens.
ITEM 2. DEPARTMENT OF COMMERCE
FEBRUARY 17, 1976.
DEAR MR. CHAIRMAN I am pleased to submit a report summarizing Depart-
ment of Commerce activities during 1975 which affect the aging. Including in the
narrative are statements regarding the continuation of certain projects in 1976.
Sincerely,
ELLIOT L. RICHARDSON.
[Enclosure]
PROGRAMS FOR THE AGING-1975
STATISTICAL RESEARCH, DATA. AND PUBLICATIONS
The Bureau of the Census issued the following reports containing statistical
data on the demographic, social, and economic characteristics of older Americans.
Many of these reports are issued annually and new ones will be issued during
1976.
CURRENT POPULATION REPORTS
Series P-20
Title
No.
275
Voter Participation in November 1974 (Advance).
276
Household and Family Characteristics: March 1974.
279
Population Profile of the United States 1974.
280
Persons of Spanish Origin in the United States: March 1974.
282
Households and Families by Type: March 1975 (Advance).
283
Persons of Spanish Origin in the United States: March 1975. (Ad-
vance).
285
Mobility of the Population of the United States, March 1970 to March
1975.
287
Marital Status and Living Arrangements March 1975.
Series P-23
52
Some Recent Changes in American Families.
54
The Social and Economic Status of the Black Population in the United
States 1974.
56
Social and Economic Characteristics of the Metropolitan and Nonmetro-
politan Population 1974 and 1970.
57
Social and Economic Characteristics of the Older Population 1974.
Series P-25
539
Estimates of the Population of States. by Age. July 1. 1973 and 1974.
541
Projections of the Population of the United States. by Age and Sex. 1975
to 2000 with Extensions of the Total Population to 2025 (Advance).
601
Projections of the Population of the United States: 1975 to 2050 (an-
nually by race, age, and sex 1975 to 2000).
614
Estimates of the Population of the United States, by Age, Sex, and Race:
1970 to 1975.
Series P-28
1513
Special Census of Waukegan, III. January 9. 1975.
1514
Special Census of Little Rock, Ark. August 16, 1974.
1515
Special Census of Madison, Wis.: October 22, 1974.
1516
Special Census of Fargo, N. Dak. January 9. 1975.
1518
Special Census of Eau Claire County and that part of Eau Claire City
in Chippewa County, Wis. March 31, 1975.
CAN - LINO - 68
1518
Special Census of Wayne County, N.Y.: April 22, 1975.
1519
Special Census of Longview. Tex. : May 19, 1975.
1520
Special Census of Putnam County, N.Y. April 14, 1975.
1521
Special Census of Davenport, Iowa February 14, 1975.
Series P-60
97
Money Income in 1973 of Families and Persons in the United States,
98
Characteristics of the Low-Income Population 1973.
99
Money Income and Poverty Status of Families and Persons in the United
States: 1974 (Advance).
100
Household Money Income in 1974 and Selected Social and Economic
Characteristics of Households.
Mr. Jacob S. Siegel, demographic statistician. Population Division, Bureau of
the Census, attended the 10th International Congress of Gerontology held in
Jerusalem. Israel. in June. Mr. Siegel was a principal speaker in a "Symposium on
the Demography of Aging."
During 1976, the Bureau of the Census will publish two significant special
reports:
1. Demographic Aspects of Aging and the Older Population in the United
States. This report will present and analyze data on selected topics pertinent
to an understanding of the demographic aspects of aging. The topics relate to
age, sex, and race composition: geographic distribution and internal migration;
mortality and survival and certain other social and economic indicators.
2. The Bureau's Population Division is compiling a report which will describe
the socio-economic characteristics of women. The report will also contain data on
older women.
The Department's National Technical Information Service (NTIS) continues
to sell the technical report Community Planning for the Elderly and to provide
two bibliographies with abstracts. One bibliography. The Elderly (Com-74-
11393). contains 139 selected abstracts of research reports submitted to NTIS by
both Federal agencies and private organizations or individuals with Federal
grants and contracts. The reports primarily treat topics on transportation. health
care. social services, housing. and welfare.
The second bibliography. Transportation for the Elderly or Physically
Handicapped (Comm-74-10887). contains 25 abstracts of reports on transporta-
tion difficulties and design as they relate to the aged and handicapped populations.
The source documents were submitted to NTIS from both Federal and non-Fed-
eral organizations.
HEALTH-RELATED RESEARCH
The National Bureau of Standards (NBS) has conducted a number of health-
related studies with application to people of all ages but which have special
impact on older persons.
One is a joint project with the Bureau of Radiological Health (BRH) of the
Food and Drug Administration. Department of Health. Education. and Welfare.
The project involves a nationwide voluntary study of the dose calibration of
Cobalt-60 teletherapy units and has two purposes. One is to assist an NBS study
of the adequacy of methods for making national dosimetry standards available to
the public. The other will assist BRH in its program to improve medical care and
reduce unnecessary radiation exposure.
The NBS Dental and Medical Section. working with the George Washington
University Medical Center. investigated poly(methyl methacrylate) cement in
laboratory tests. The findings are now available to surgeons who replace dis-
eased or damaged hip joints with artificial parts. The NBS study of the charac-
teristies of the cement used to stabilize these parts will help surgeons better con-
trol the surgery and assure permanent replacement of bones and joints that have
failed. The information obtained through the study has been used to develop
American Society for Testing and Materials voluntary consensus standards for
both orthopedic and neurosurgical applications.
To address the technical questions involved with assuring cardiac pacemaker
reliability NBS brought together for the first time experts from the pacemaker.
electronics and related communities in a workshop jointly sponsored by the Food
and Drug Administration. The workshop was attended by representatives of the
ten known domestic manufacturers of pacemakers and two of the five known dis-
tributors of foreign-made pacemakers.
Although this workship was intended to be a single event. the attendees rec-
ommended that it become an annual 3-day meeting devoted to specific problems
in their field. The attendees also concurred that NBS should be the focal point
and several industry representatives agreed to assist NBS in the development of
such a meeting. The Electronic Technology Division is involved in making prepa-
rations for the next workshop which is expected to be held during the summer of
1976.
Another NBS program relates to the development and use of ultrasound as a
diagnostic technique. Applications of ultrasound to the diseases of old age include
screening for circulatory diseases such as arteriosclerosis. one of the most preva-
lent diseases: the measurement of blood flow rate using donnler techniques:
eaneer detection: and diagnosis of diseases of the eye. Basic standards for the
measurement of radiated ultrasonic power. intensity. and heam pattern have been
developed and are in use. NBS is now developing a computerized scanning system
for intensity and beam pattern. There are also plans for the development of a pro-
totype. low-cost. reliable transfer standard instrument for nower measurement
which can be used by nontechnical personnel. Manufacture of the device by pri-
vate industry will be strongly encouraged.
CAN - LINO - 69
Another NBS program with special implications for elderly people the Non-
Ionizing Radiation Safety Program. The intent of this program is to protect the
populace from the effects of exposure to ever increasing levels of electromagnetic
(EM) radiation. Elderly people may be more susceptible to high-intensity fields
for the following reasons: (a) their overall physical condition is probably
inferior to that of the general population: (b) more elderly people wear
pacemakers. which can he adversely affected by (EM) radiation: and (c) more
elderly people may be treated by diathermy machines. etc., which have strong EM
fields associated with them. Consequently. this NBS program. which will result
in more reliable measurements and control of hazardous EM fields. will have a
direct impact on the health of older people.
There is a great prevalence of hearing loss among elderly individuals. NBS is
working to improve the techniques of measuring hearing loss. At the present
time the uncertainties in hearing measurement are such that some degree of
hearing impairment can be concealed in the uncertainties. With more precise
knowledge of the degree of hearing loss, it should be possible to diagnose the
onset of hearing loss before significant hearing impairment is suffered. For the
elderly person suffering hearing loss. NBS is working on techniques for evaluat-
ing the degree of impairment suffered in terms of a loss of "channel capacity."
from which it is hoped to derive a better method of ascertaining the fit of hear-
ing aids by measuring the enhancement of "channel capacity" that is produced
in the wearer.
NBS furnishes technical data and test results on hearing aids to the Veterans
Administration for use in selecting hearing aids for their clientele. of which a
substantial fraction may be assumed to be elderly. The VA makes the test results
available through the Government Printing Office SO other Federal and State
agencies may make use of the data in selecting hearing aids.
Among the National Bureau of Standards publications on hearing is a 32-page
Consumer's Guide. Facts About Hearing and Hearing Aids. which should be of
use to the elderly and their families in answering questions on this subject.
SAFETY
The National Fire Prevention and Control Administration (NFPCA). working
with the Center for Fire Research of the National Bureau of Standards. is con-
ducting technical research in fire prevention methods and life safety systems
for hospitals, nursing homes. and other institutional facilities. The research is
focusing on six elements of life safety: (1) decision analysis: (2) behavior in
fire emergencies: (3) alarm and communication systems: (4) smoke control
systems: (5) fire and smoke detectors: and (6) automatic extinguishment. The
research began in 1975 and will continue in 1976.
NFPCA has planned a major public education project for 1976. using written
materials. and radio and TV spots/programs. The project is directed toward fire
prevention among the elderly. who suffer the highest rate of death and injuries
from fires.
The elderly suffer a disproportionate number of home accidents. and two NBS
research projects are intended to reduce the number of such accidents. In one,
a behavioral model was developed for accidents due to stairs and doors. Tech-
niques were then developed for investigating these accidents through analysis
of accident data. surveys of stair and door usage. and analysis of video tapes
of such usage. Draft performance standards for selected door assemblies and
door components were developed and safety performance criteria of stairs were
set.
The other project relates to floor slipperiness. A portable tester to measure
slipperiness has been developed and continuing research includes the develop-
ment of a test to measure the fundamental problem that denotes slipperiness.
The test will be used to establish standards for floor material to control slip-
periness.
BUSINESS ASSISTANCE
District offices of the Domestic and International Business Administration
work actively with the Service Corps of Retired Executives (SCORE). The
SCORE group has assisted in such activities as presenting seminars on inter-
national export promotion. The district offices provide detailed business informa-
tion to SCORE personnel. and SCORE in turn has provided the in-denth tech-
nical assistance to private companies which the district offices could not under-
take because of limited resources.
PATENTS
The Patent and Trademark Office ordinarily takes nn new patent applications
for examination in the order of their effective United States filing dates. Certain
exceptions are made by wav of petitions to "make special." One exception can
be made if the applicant is 65 years of age or older. A birth certificate, affidavit.
or declaration of age is required.
The following patents are examples of those granted during 1975 which di-
rectly affect the aging:
Patent No. 3,909,853
Artificial joints. These are usually replacement
Patent No. 3,848,272
joints for the fingers. knees. and hips to re-
lieve problems caused by arthritis.
Patent No. 3,673,616
Intraccular lens.
Patent No. 3,577,981
Contains diagnostic devices. some of which are
used to predict the probability of a stroke or
to indicate accumulated deposits such as cho-
lesterol or blood clots in blood vessels.
CAN - LINO - 70
Patent No. 3,736,925
Patent No. 3,776,244
Wrinkle eradicators.
Patent No. 3.815,611
Patent No. 3,918,459
Electrical systems. This area deals with pace-
makers and stimulators, usually to treat prob-
lems of the elderly.
Patent No. 3,928,602
Lowering lipid levels. The lowering of serum
lipid concentration is important during the
treatment of such diseases as diabetes mellitus.
and certain vascular diseases which affect the
aged.
Patent No. 3.920.817
Composition for treatment of arthritis.
Patent No. 3,917,829
Inhibits the activity of testosterone. One of the
undesirable manifestations is the excessive en-
largement of the prostate gland. which is quite
common in males aged 60 or over.
Patent No. 3.917,840
Method for treating Parkinsonism.
Patent No. 3,928,598
Antianxiety drug.
ITEM 3. DEPARTMENT OF DEFENSE
FEBRUARY 6, 1976.
[Enclosure]
DEAR MR. CHAIRMAN This is in reply to your letter of December 30. 1975.
requesting information summarizing the Defense Department's major activities
on aging during 1975 and plans for continuing efforts in 1976.
The Department of Defense continues to operate one of the most comprehen-
sive retirement planning programs for civilian employees in the Federal Gov-
ernment. The program has been integrated into the overall personnel manage-
ment process and is designed primarily to assist employees in their adjustment
to retirement and to assist management in planning for replacement manpower
needs. It encompasses extensive preretirement counseling for employees and
includes both trial retirement and gradual retirement options for employees
where feasible. This program serves to alleviate some of the problems that
employees have encountered in the past when approaching retirement age. This
program is expected to continue through 1976.
We have continued to make effective use of the early optional retirement pro-
visions of Public Law 93-39 [5 USC 8336(d) (2)] to help reduce the adverse
impact of major reductions in force on our career employees. Under this legisla-
tion Federal agencies or parts of agencies undergoing a major reduction in force
as determined by the U.S. Civil Service Commission can be authorized to permit
the immediate voluntary retirement of employees who have completed 25 years
of service or who are at least 50 years of age and have completed 20 years of
service. During 1975 the Defense Department has been authorized to apply these
major reduction-in-force retirement provisions for specific areas on 20 separate
occasions. The effect of these authorizations enabled many employees to volun-
tarily retire and permitted other employees who would have lost their jobs to
be offered continuing employment. We will continue to request the use of this
authority in future major reduction-in-force situations where it will serve to
minimize the adverse impact of necessary reductions on our career employees.
The Defense components provided a variety of multiphasic occupational health
programs and services to employees during 1975. many of which are designed
FORD
to address problems generally associated with increasing age. Included were
health guidance and counseling. periodic examinations. testing and screening
for diseases and disorders. immunizations and treatments. These programs and
services will be continued during 1976 to the maximum extent possible.
Internal programs to assure nondiscrimination on the basis of age were ex-
GERALD
LIBRARY
panded during 1975. Some of the affirmative steps taken in this regard include
dissemination of policy statements to managers and employees. actions to elim-
inate specific age restrictions applicable to employees. supervisory training and
employee orientation on the prohibitions against age discrimination. and actions
to eliminate age guidelines and implications in selection criteria. These are con-
tinuing programs which will extend into 1976.
We appreciate the efforts of the Senate Special Committee on Aging. and we
hope that the above information will be helpful to you.
Sincerely,
CARL W. CLEWLOW.
Deputy Assistant Secretary of Defense
(Civilian Personnel Policy).
ITEM 5. DEPARTMENT OF HOUSING AND URBAN DEVELOPMENT
MARCH 19. 1976.
Dear Mr. CHAIRMAN: I am pleased to provide a statement summarizing major
activities relating to older Americans carried out by the Department of Housing
and Urban Development during 1975 as well as some followup efforts in 1976.
It should be noted that the Department has now established an Office of Con-
sumer Affairs and Regulatory Functions headed by an Assistant Secretary.
Although the precise structuring of this new office has not evolved, when finalized,
its organization will be concerned with furthering consumer interests, including
those of the elderly and handicapped.
CAN - LINO - 71
I would like to assure the committee that this Department will remain firm
in its commitment to respond to the needs of our older Americans, and I look
forward to working with you and your colleagues in the Congress in this regard.
Sincerely,
CARLA A. HILLS, Secretary.
[Enclosure]
INTRODUCTION
The Federal role in housing the elderly continues to be a prominent one. Par-
ticipants in the Community Development Block Grant Program. which requires
that communities develop a housing assistance plan identifying the condition of
the housing stock and the housing assistance needs of lower-income persons. have
reported that 3S percent of their housing assistance funds are allocated to meet
the needs of Iderly and handicapped persons.
The Housing and Community Development Act of 1974 has provided two new
major thru ts for community improvement and increased housing for needy
persons. including the elderly.
Community 'evelopment programs in the past were funded through individual
categorical grants. requiring involved and complicated applications and long
periods of procesing time. Often the grants were made to communities on the
basis of their "grautsmanship" ability-the skill in presenting a good applica-
tion-rather than on the basis of the need for the funds.
Under the new act. the community development funds have been combined into
block grants based on a needs formula, whereby most American communities
receive funds for Ineal improvement. The formula takes into account the popula-
tion. the amount of substandard housing. and poverty (counted twice). Applied
against previous funding Ievels. the formula assures communities of annual
funds to carry out programs developed and implemented locally.
The other major new thrust is in the field of housing. A principal new program
for providing needed housing is in the form of leased housing made available to
persons most in need of decent housing. including the elderly. Low rent public
housing continues to be a major source of housing for needy elderly people.
Other major HUD programs have been continued and improved-Housing
Production and Mortgage Credit. including the Federal Housing Administra-
tion. is pro ided with more realistic limits of mortgage insurance: Housing
Management has developed improved management systems to carry out the
supervision of HUD assisted housing: Policy Development and Research. with
its many studies and the experimental Housing Allowance Program: the Office
of Interstate and Sales Registration: the New Communities Program: and the
Federal Disaster Assistance Administration.
ASSISTANT TO THE SECRETARY FOR THE ELDERLY
The Department of Housing and Urban Development. which first established
the position of Assistant to the Secretary for Elderly and Handicapped in the
immediate office of the Secretary in 1972. has continued to demonstrate its
special concern for the needs of the olde" Americans by undertaking a number
of significant initiatives to strenghen and expand the scope of the activities of
the Office of the Assistant to the Secretary. Programs for the Elderly and
Handicapped.
Secretary Hills has maintained as her Assistant for Elderly and Handicapped
Mrs. Helen Holt a long time FHA employee. Her office fully staffed. is the focal
point within HUD for all matters pertaining to housing and related facilities
and services for the elderly and handicapped. and advises the Secretary on such
matters.
Responsibilities specifically assigned hr the Secretary include: reviewing the
adequacy of pertinent HUD policies and procedures and participating in their
development (1" revision. participating in planning for the inspection and evalua-
tion of HUD assisted housing for the elderly. coordinating activities within HTD
affecting the olderly and handicapued. and representing HUD in meetings with
other Federal State. and municipal or private organizations on matters affecting
the elderly.
In order to help the Assistant to the Secretary for the Flderly and Handi-
capped carry out he" responsibilities. an Intradepartmental Task Force on the
Elderly has been provided The merrbers of this task force represent each of the
operating divisions of the Department. and they meet at least once a month to
discuss major issues relating to the elderly.
In addition. in order to insure that the now emphasis to housing programs for
the elderly and handicanned provided for in the Housing and Community De-
velopment Act of 1971 is given the attention it needs in all HUD field offices. and
to provide a visible contact point for the public Flderly and Handicapped Hous-
ing Coordinat have this year. hoen designated in 80 HUD offices throughout
the country. The individual so designated:
-Disseminates educational and informational material to individuals and
organizations and acts as primary point of contact on all aspects of HUD
elderly and handicapped programs:
-Provides assistance to interested sponsors and developers by directing them
to appropriate technical personnel:
-Insures that annlications for elderly and handicapped housing are being
processed expediti netr and reports problem areas to appropriate program
officials and for office directors for resolution and
-Maintains Maison with Regional and Headquarters offices to insure that
élderly and handicapped housing program objectives are being met.
CAN - LINO - 72
HOUSING PRODUCTION AND MORTGAGE CREDIT
SECTION 8 IMPLEMENTATION
The problems of aging and particularly the housing needs of the elderly are
continual concerns of the Department. The implementation of the new section
:8 Housing Assistance Payments Program will assist both the construction of
<elderly housing projects and will also provide an alternative for those who
prefer to avoid living in projects housing only elderly persons.
The section 8 of Lower-Income Housing Assistance, authorized in title II
of the Housing and Community Development Act of 1974, replaces and consider-
ably expands and improves upon section 23 leasing program which enabled low-
income families to rent privately owned housing. Section 8 will provide the
flexibility necessary to allow lower-income families including elderly families
to occupy existing standard rental units, as well as to permit a family to shop
for and choose its own dwelling. rather than leaving selection to HUD or the
local housing authority.
The new section 8 program provides assistance to encourage the construction
of new units, the substantial rehabilitation of substandard housing and the
use of standard existing units. It encourages the participation of both private
developers, and housing agencies. And importantly, section 8 is designed to
maximize the use of the existing housing stock. while inducing production of
additional units in markets where the supply of existing units is inadequate
to meet all bousing needs. including those of the elderly.
The new legislation requires that section 8 projects serve a range of income
groups. In any given section 8 project. therefore. residents may be drawn from
three different income groups: the unsubsidized, the minimally subsidized, and
those needing deep subsidies.
In addition. the act recognizes that the elderly have special housing needs.
Accordingly. the section 8 statute requires that a project specifically intended
to house the elderly. and in which 100 percent of the tenants may be subsidized.
be given coual priority with partially subsidized projects. In other words. the
preference for section 8 projects with 20 percent or less of the units subsidized
does not apply in cases of the elderly.
No family assisted under section 8 may pay more than 25 percent of its gross
income for rent. but the rental payment may be as low as 15 percent, depending
on family income. size. and medical or other unusual expenses.
Over 46 percent of the applications for new section 8 units received to date
have been for the elderly or handicapped. Assuming this 46 percent ratio is
reflected in all final approvals whether new. existing or rebabilitated housing,
we can expect to have section 8 commitments for over 140.000 units for the
elderly in 1976. This would be the highest number of units for the elderly ever
assisted b⁻· HUD in any one year.
Several other features of the section 8 program should be of special advan-
tage to older Americans:
-Eligibility for section 8 assistance has been expanded to include two or more
unrelated eiderly. disabled. or handicapped persons. who are living together.
or one O" more such individuals living with another person who is essential
to their care or well being.
-The 1974 act (title TI. section 209) requires that section 8 projects designed
especially for the elderly or handicapped be consistent with. and supportive
of. State or area plans for comprehensive services and that project design
accommodate the special environmental needs of the occupants. This provi-
sion also requires cooperation between agencies at the Federal level. Specifi-
cally. it stipulates that the Secretary of HUD must consult with the Secre-
tary of Health. Education. and Welfare to assure that public housing for
the e'derly or bandicapped meets acceptable standards of design. manage-
men+ and services.
-FHA multifamily mortgage insurance programs will be made available to
both section 8 developers and nonprofit sponsors to provide the project
financing they need for new construction or substantial rehabilitation.
Public housing agencies also mav use FHA's section 221 (3) market rate
multifamily insurance program to finance construction or rehabilitation
of section S-assisted units (Develonment for profit-motivated mortgagors
will generally use the section 221(d) (4) program or conventional financing.)
HUD will a'so continue to provide mortgage insurance for nursing homes and
intermediate care facilities under section 232 of the National Housing Act.
The recent addition of subsection (i) to this program provides for FHA-insured
supplemental loans to finance installation of fire safety equipment in these
facilities. These loans are not limited to section 232 facilities and may prove
useful in enabling conventionally financed nursing homes to comply with HEW
and State requirements concerning fire safety.
Another program feature of particular relevance to elderly citizens is the
provision of congregate facilities. The term "congregate housing" generally
refers to projects in which some or all of the dwelling units do not have full
kitchens. where the residents are served by a central kitchen and dining facility.
This arrangement permits some of the conveniences and economics of communal
living to be built into rental projects. Assistance for such housing will be avail-
able under the section 8 program, within the 10 percent statutory limit on such
use of section contract authority.
The 1974 HCD Act also amended FHA's multifamily housing programs to add
a general provision authorizing mortgage insurance for housing project which
include units "which are not self contained." or in other words. congregate
housing. While HUD/FHA has previously provided mortgage insurance for
projects with congregate facilities only under the section 231 elderly housing
mortgage insurance programs, the section 236 lower income rental housing
program, and the section 232 program, we now have authority to include such
CAN - LINO - 73
housing under all FHA multifamily project insurance programs, including sec-
tions 207, 213, and 221.
SECTION 202-DIRECT LOANS FOR HOUSING FOR THE ELDERLY OR HANDICAPPED
The section 202 program was first introduced as a part of the Housing Act
of 1959 to provide direct Federal long terms for the construction of housing
for the elderly or handicapped. The program intended to serve elderly persons
whose income was above public housing levels but still insufficient to secure
adequate private housing. The section 202 program was amended by the 1974
HCD Act to provide, among others, for the use of section 8 housing assistance
payments for projects constructed or substantially rehabilitated under the
program.
HUD is authorized to lend $375 million in fiscal year 1976 for the construction
or substantial rehabilitation of projects which meet the requirements of, and
which will receive the benefit of housing assistance payments under the section
8 Housing Assistance Payments Program-New Construction (24 CFR part
880) or the section 8 Housing Assistance Payments Program, Substantial Reha-
bilitation (24 CFR part 880). Under the new program the Department is au-
thorized to make loans with a maturity of 40 years at an interest rate related
to the long term borrowing cost of the U.S. Treasury. (HUD may add a per-
centage to cover administrative cost or losses.)
The housing projects are to be designed to provide, or management plans
shall include, an assured range of necessary services for the occupants, which
services may include, among others, health. continuing education, welfare,
homemaker, counseling, and referral services. as well as transportation when
necessary to facilitate access to social services, and services designed to en-
courage and assist occupants to use the services and facilities made available.
An invitation to apply for these loans was published in the Federal Register on
September 24, 1975. By the closing date of December 15, 1975. applications
for over 1,500 projects had been received requesting financing for over 230,000
units.
Allocations to applicants are expected to be announced on or about April 15,
1976. Allocations will follow a regional pattern reflecting a fair share distribu-
tion among HUD's 10 regions with attention to income levels, housing condi-
tions, and the number of elderly households.
OTHER SUBSIDIZED HOUSING PROGRAMS FOR THE ELDERLY
Rental Assistance-Section 236(f) (2) and Rent Supplement
Section 236(f) (2) also was added to the National Housing Act by the Housing
and Community Development Act of 1974. It is designed to assist tenants in
section 236 projects who cannot afford to pay basic rents within 25 percent
of their income. It provides that HUD will make rental assistance payments
to project owners on behalf of such tenants. The program has been structured
along lines similar to those for the rent supplement program.
Generally, rental assistance payments are not made with regard to more than
20 percent of the units in a project. However, in the case of projects for the
elderly, this may be increased to 40 percent, and in some cases to even higher
levels.
During 1975, over 1,150 section 236 units occupied by the elderly were made
eligible either for rent supplements or for the new rental assistance payments.
Section 236 Project Applications
Eighteen projects either wholly or partially intended for elderly occupancy
were in process during 1975. These projects represent some 4.200 units of which
3,600 are designed specifically for elderly occupancy. Over 55,000 units for the
elderly have been developed under section 236 during its program life.
FORD VIBRARY
Section 231-Mortgage Insurance for Elderly Housing
Under section 231 of the National Housing Act, as amended, the Department is
authorized to insure lenders against losses on mortgages used for construction or
rehabilitation of rental accommodations for older persons (aged 62 years of age
or more, married or single).
Section 231 is HUD's principal program for unsubsidized rental housing for
the elderly. Nonprofit as well as profit-motivated sponsors are eligible under the
program, and section 8 housing assistance payments can be made available in
connection with it. During 1975. activity levels were modest. Firm commitments
were issued for seven projects consisting of 867 units. Construction wasstarted on
three projects, bringing the total number of units under section 231 mortgage in-)
surance to slightly more than 43,000 units. With section 8 assistance available, a
higher volume of activity under section 231 can be expected in the future.
Sections 221(d) (3) Market Rate and 221(d) (4) of the National Housing Act-
Mortgage Insurance Programs for Multifamily Housing
While these programs are not specifically geared to the elderly, they also are
available to sponsors as alternatives to the section 231 program.
Section 221(d) (3) authorizes the Department to provide insurance to finance
the construction or rehabilitation of rental or cooperative structures for housing
low and moderate income families or elderly or handicapped persons. Up to 10
percent of the units may be occupied by low or moderate income single persons
under 62 years of age. Priority in occupancy is given to those displaced by urban
renewal or other governmental action. (Because they tend to be residental oc-
CAN-LINO-74
cupants of old and deteriorating urban neighborhoods. a greater proportion of
older persons than younger persons are affected in these areas.)
The above features are present in the section 221(d)'(4) program except that
this program is available to public and private profit motivated sponsors as op-
posed to nonprofit sponsors under section 221 (d) (3).
Section 223(f) Mortgage Insurance for the Purchase or Refinancing of Existing
Multifamily Housing Projects
This program offers mortgage insurance for existing facilities. including hous-
ing for the elderly, where repair costs do not exceed 15 percent of project value.
The program can be used either in connection with the purchase of a project. or
for refinancing only. To the extent that real estate liquidity is enhanced. the
availability of section 223(f) encourages investment in residential real estate of
all kinds. Prior to its being added to the National Housing Act in August 1974,
project mortgage insurance could be provided only for substantial rehabilitation
or new construction.
Section 232-Mortgage Insurance for Nursing Homes/Intermediate Care
Facilities
The primary objective of the section 232 program is to assist and promote
the construction and rehabilitation of long-term care facilities. Since 1959, when
the program was enacted, the Department has insured mortgages for 1,040 facili-
ties providing over 115,000 beds.
Approximately 90 percent of the residents of nursing homes are elderly. HEW's
medicare and medicaid programs have made it possible for many, who would not
otherwise have been able to do so, to benefit from the services provided under
this program.
During 1975, firm commitments for insurance covering 44 section 232 proj-
eots were issued representing over 6,500 beds. Construction starts were achieved
for projects representing some 4,700 beds.
PUBLIC HOUSING FOR THE ELDERLY
The low-rent public housing program was authorized by the Congress in the
Housing Act of 1937 as a local-Federal aid to communities through which they
may provide safe, decent, and sanitary housing for families who cannot afford
standard private housing. Over the years, the public housing program has been
and continues to be a principal alternative for the elderly. As of July, 1975, of the
total number of Annual Contribution Contracts (an agreement between HUD
and the LHA to guarantee the debt service on bonds issued by the authority to
finance the housing project) executed between 1968 and 1975, 39.6 percent or
195,608 were elderly units.
HOUSING MANAGEMENT
The Special Concerns staff continues in its range of interests of the manage-
ment needs of the elderly, handicapped, congregate, nursing home and transient
residents, and security in HUD-assisted housing. In addition, it has been assigned
the responsibility of assisting in contract supervision of housing management
training for elderly housing management, as well as developing standards for
the certification of housing managers.
TRAINING
During 1975, Temple University continued its development of elderly housing
management materials that can form the basis for curriculum development in
schools and universities throughout the country. The first phase of its contract
was completed on December 31, 1975, and additional funds are being granted by
HUD to continue to perfect the materials, and begin the transfer process to other
educational institutions.
ELDERLY HOUSING DIRECTORIES
During 1975, the Special Concerns staff prepared and distributed two director-
ies of interest to the elderly. The first item U.S. Housing Developments for the
Elderly which has been printed up in several thousand copies. and distributed
to those who request the listing. A second is Federally Assisted Congregate Hous-
ing Developments for the Elderly, just completed, and about to be distributed.
HUD CHALLENGE REPRINTS
'A series of articles dealing with security for the older person was printed in
the HUD magazine, Challenge, and since they were SO popular, they were grouped
and reprinted as a separate issue entitled Residential Security. whose articles
include, among others, "Crime Prevention for the Elderly." "Self-Help Crime
Prevention Program," and "Residential Crime and the Elderly Victim." This
special issue is being distributed by the National Criminal Justice Reference Serv-
ice on a National basis.
IMPLEMENTATION OF INTERAGENCY AGREEMENTS
Current agreements between HUD and AoA, HUD and DOT, and HUD and
HEW continue to produce programs and services. Another HUD/AoA agree-
ment for services under section 8/202 housing for the elderly is currently being
completed. A member of the Housing Consumer Division staff serves on the
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Administration on Aging Task Force on Nutrition. as well as on its Task Force
on Information and Referral. Some 400 local housing authorities have provided
facilities for the meal program over the past year, with some housing agencies
providing additional service as grantees. In several instances, the nutrition pro-
gram has added other programs in recreation, health education, referral and
transportation. Nearby elderly residents of housing projects are thereby bene-
fitted.
An unusual multiple purpose project has arisen out of this kind of interagency
cooperation in Little Rock, Ark., where the local area agency on aging has worked
with HUD and the Veterans Administration, along with a number of related agen-
cies that can provide service to the elderly. They have created a significant food
and service program, named The Central Services for the Elderly, in a hospital.
Many related agencies are beginning to provide service, or even to move into
the facility, which of course, makes it easier to provide additional adjacent service
for the older person. Services under way or planned included recreation, case-
work counseling, physical therapy, food stamps, Medicaid and Medicare, Social
Security, and day care.
POLICY DEVELOPMENT AND RESEARCH
Title V of the Housing and Urban Development Act of 1970 authorizes and
directs the Secretary to undertake programs of research, studies, testing, and
demonstrations relating to the mission and programs of the Department. Section
815 of the Housing and Community Development Act of 1974 strengthened the
role of HUD research in the areas of elderly and handicapped by specifically
encouraging demonstrations into the problems of members of special user groups,
including the elderly and handicapped.
The HUD research program serves as a stimulus for positive change by con-
ducting technological and managerial research, and by demonstrating new meth-
ods for application of government and private enterprise. The program serves
as a national focal point for housing and community development research, and
as a central point for research. analysis, data collection and dissemination.
The focus on research related to the problems of the elderly and handicapped
is in our program of Special User Research, although other program areas such
as Community Design Research and Economic Affairs also support research
which impacts on the elderly and handicapped.
The mission of the Special User Group Research Program is to design, conduct
and support research and demonstration projects whose results will improve hous-
ing conditions and related housing and community services for the elderly, the
handicapped, and other members of identifiable special user groups. The focus of
the Special User Group Research Program is on five areas: (1) Improved design
and technology, (2) financing mechanisms, (3) service delivery, (4) housing man-
agement, and (5) integration of past findings into current operating programs.
The Special User Research Program is conducted in the Office of the Deputy
Assistant Secretary for Research and Demonstration.
CURRENT SPECIAL USER RESEARCH
The Office of Policy Development and Research is currently sponsoring seve-
ral projects related to the housing problems of the elderly and handicapped, and
additional projects will be undertaken during 1976. The following list demon-
strates the scope of these ongoing projects:
--An evaluation of the effectiveness of existing elderly property tax relief
measures nationwide, and the development of model improvements in ad-
ministration, incidence, eligibility, and cost;
-A guidebook for the conversion of family housing or other facilities to hous-
ing for the elderly, concentrating on the needs for public and service space.
-A cost study, based on classifications of disabilities, will determine the ex-
pense for making existing housing accessible, to include design services and
management adaptations. Information drawn from this study will be used
in determining Departmental policy and standards for planning, manage-
ment, and delivery services.
-The development of a program of maintenance and repair assistance tailored
for elderly homeowners, which also includes a study of sources of appropriate
financing and means to educate the elderly to assess their own maintenance
and repair needs and to more effectively plan for their accomplishment.
-The revision, broadening and extension of the existing American National
Standard for Accessible and Usable Buildings to include dwellings and their
related exterior spaces. This report with its recommended revisions will
reflect the state of the art in standards for barrier-free design to make the
built environment accessible to people with various disabilities.
-An evaluation and demonstration of mobile homes specially adapted for use
by the severely handicapped. This project will adapt standard mobile home
units to meet the needs of physically handicapped persons thereby facilitating
independent living in low cost housing for this group with special housing
needs.
-Further research in the use of a sheltered housing environment for the
in severely handicapped to determine whether persons with different types
and degrees of disabilities benefit differently from residence there, and if so,
what this would suggest in determining target populations for operating
programs.
-An evaluation of the effectiveness of existing congregate housing in meet-
ing the needs of elderly persons no longer able to live independently, but not
yet in need of medical supervision.
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FUTURE RESEARCH
The great majority of the research sponsored by the Office of Policy Develop-
ment and Research is done through competitively awarded contracts. It is custom-
ary to prepare and release requests for proposals and then to select a contractor
from among the proposals received in response to the RFP. During this fiscal
year the Department will be releasing the following RFP's which relate to the
needs of the elderly and handicapped:
-A study and demonstration of community based small group homes as a hous-
ing alternative for handicapped persons. This type of alternative would al-
low for release from unnecessary and costly institutionalization. Group homes
could provide closely integrated service, management and housing packages
to meet varying levels of services and needs, depending on the special group
served.
-A study that combines costing out the adaptation elements to existing hous-
ing and housing-related services for elderly occupants. These services in-
clude facility usage to provide day care for the elderly in need of daytime
supervision or assistance and availability of a senior center and its activi-
ties. It would concentrate on housing services in order to improve a hous-
ing model design, as well as salient service programs.
HOUSING ALLOWANCE EXPERIMENT
The Department of Housing and Urban Development is conducting a major
research effort, the Experimental Housing Allowance Program, to evaluate the
concept of channeling Federal assistance directly to families in need of housing
instead of through organizations in the business of providing housing. The pro-
gram, authorized by the Housing Act of 1970, is being conducted as a part of the
Housing Assistance Research Program under the direction of the Assistant
Secretary for Policy Development and Research.
The experimental program will produce information upon which to base key
decisions: The decision as to whether the direct assistance approach is in fact
a tenable one; and decisions as to how and in what form the direct assistance
can best be administered.
Three elements, which form the basis for a full analysis of an operating hous-
ing allowance program, make up HUD's Experimental Housing Allowance Pro-
gram. Although these elements were not designed to focus specifically on the
problems of the elderly in the housing market, some information will be gained
in the context of the analyses that were planned. The three elements are briefly
described below:
A Supply Experiment will provide information on the market effects of a full-
scale, operating housing allowance program. About one-fourth of participating
households are expected to be elderly. The plan calls for assistance to be given
to both renters and homeowners.
The Demand Experiment completed its enrollment at the end of February
1974. About 20 percent of the participants are elderly households. The focus of
the experiment is the participant family and its experiences under carefully
controlled variations, and a wide variety of interviews and survey data is being
collected, including information on the quality of housing and neighborhoods,
participant initiative, locational choices, maintenance and rehabiltation and cost
factors. In some of the analyses planned, elderly parteipants will be compared
with other age groups on such questions as quality of housing. satisfaction with
their homes and neighborhoods, and the degree to which they move. They will
be consistently observed as a relevant subgroup throughout the experiment.
Reports from the Demand Experiment are scheduled for 1976 through early
1978.
The Administrative Agency Experiment (AAE) was designed to determine
experimentally the most satisfactory and cost-effective management procedures
that may be used under varying conditions in the delivery of a housing allow-
ance program. Since one measure of a successful administrative process or fune-
tion is the effect on the participant, data regarding participating attitudes,
responses and experiences are being gathered in several different contexts, in-
cluding from agency record keeping, from surveys, and from in-depth participant
case studies.
The final enrollment period was completed in May 1974, and the final number
of recipients was 5,512 with approximately 17 percent (950) being elderly
households.
Several of the reports concerning the administrative functions of outreach,
screening. certification and enrollment will have information on the extent to
which elderly participants attended counseling sessions and some descriptive
data on the extent to which they required special counseling services. Reports on
the other administrative processes contain similar findings by age group where
relevant results are found.
Special Study of the Elderly (under the AAE).-Since there are considerable
data available in the AAE of particular relevance to the elderly, the evaluation
contractor was asked to conduct a special study, including a special survey, to
gain certain additional information from the AAE elderly subsample. This study
focuses on such questions as how the elderly recipients use their housing allow-
ance, the ability of elderly households to shop for housing, the relationship of
the housing allowance to the special needs of the elderly, and the delineation of
an appropriate outreach, application and enrollment system for the elderly.
COMMUNITY PLANNING AND DEVELOPMENT
The two programs presently administered by Community Planning and De-
velopment impacting on the elderly and the handicapped are Community Develop-
ment Block Grants (CDBG) which became effective January 1. 1975, under the
Housing and Community Development Act of 1974, and the "701" Comprehensive
Planning and Management Assistance Program. Neither program is specifically
CAN - LINO - 77
directed to the elderly and handicapped. but activities benefiting these persons
are eligible under the act and may be carried out at the discretion of communi-
ties receiving community development funds.
COMMUNITY DEVELOPMENT BLOCK GRANTS
The primary objective of the CDBG program is the development of viable
urban communities including decent housing and a suitable living environment
and expanding economic opportunities principally for persons of low and mod-
erate income. Many of the Nation's elderly persons live on fixed incomes and a
majority of these people fall within that income. Since it is the intent of the
act that a Community Development Program assisted under title I be directed
principally at this low and moderate income group, it is expected that communi-
ties will set their priorities in accordance with those statutory requirements.
At this point, most recipients have had very little time for actual implementa-
tion of the Community Development Programs. The following figures are based
on the recipient's planned program objectives and use of funds which will most
benefit low and moderate income groups of which the elderly are a significant
part:
Percentage of CDBG funds programed for objectives
Objectives:
1. Elimination of slums and blight
49
2. Elimination of conditions detrimental to health, welfare and safety_
4
3. Housing stock conservation and expansion
17
4. Improvement of community services
13
In addition to the above distribution of CDBG funds, communities plan to
coordinate their housing and community development activities. Presently their
plans call for 38 percent of housing assistance to be distributed among the elderly
and handicapped. The proportion of total housing assistance being planned for
the elderly and handicapped corresponds closely to proportion of the total needs
population. Elderly and handicapped households, representing approximately
one-third of the need, are to receive slightly more than one-third of the total
assistance.
More than half of the new construction planned by communities is targeted
for elderly and handicapped households. This would meet nearly 60 percent of
the housing assistance goals for the elderly and handicapped in the first year.
Twenty-five percent of their housing assistance goals would be met by existing
housing and seventeen percent by rehabilitated units.
The heavy reliance on new construction as a type of assistance for the elderly
and handicapped may be related to the need for special services or facilities.
Existing housing may have architectural barriers restricting mobility of these
household types. Rehabilitation of housing for this target group may be re-
stricted by those units which can be altered to add conveniences or remove bar-
riers. The fact that almost half of the new construction areas and one-third of
the rehabilitation areas are in upper income areas suggests that dispersed
housing is being planned for the elderly and nonelderly.
In addition to the activities listed above, localities plan on using a part of their
funds for service programs and facilities benefiting the elderly.
701 PLANNING AND MANAGEMENT ASSISTANCE
Planning for the elderly has been an eligible activity under "701" Planning
and Management Assistance Program and agencies funded through this program
have the latitude to include efforts to assist the elderly. Not only are these
funded recipients the key decision makers for any such efforts, but many of the
activities they are now carrying on with grant assistance from this program
are directly relevant to, and provide a solid foundation for. specific planning for
the elderly such as housing, and community and service facilities.
NEW COMMUNITIES ADMINISTRATION
Through legislation passed in 1970. the Federal Government can guarantee
mortgages for developers of large scale new communities which meet certain
requirements, including provision of an economic base, provision of substantial
amounts of low and moderate income housing. good physical and social planning,
and provision of adequate community amenities and facilities including educa-
tion. health, culture, and recreation.
All of the 16 new community projects approved for Federal assistance by the
end of 1975 will provide housing. community facilities and amenities which will
have special value to the elderly and handicapped. These include barrier-free
access to public buildings. pathway systems separated from vehicular traffic,
and ready access from homes to shopping, recreational facilities, and neighbor-
hood facilities.
BARRIER FREE DESIGN REGULATIONS
Draft regulations for the new communities program contain the following
paragraphs:
The new community must be planned to accommodate the "current and
projected need for housing by age, household size and income. particularly
for the elderly and low and moderate income households for the region and
market area."
"Buildings, outdoor areas and facilities must be designed to satisfy the
needs of the physically handicapped and elderly who need a barrier-free
environment to facilitate their movement and self-sufficiency."
CAN-LINO-78
In addition, design standards for new community projects include the De-
partment's standards for public housing (40-FR 24). the FHA Minimum Prop-
erty Standards. the General Services Administration standards for public build-
ings (101-17-FR-41), and standards published in 1964 by the American National
Standards Institute.
The regulations further permit incorporation of non-profit community associa-
tions which will own and manage facilities and provide services to residents.
Generally, the regulations state that these community associations will charge
dues which are available to, and affordable by, all residents including the el-
derly. persons from low income families, the handicapped, and renters. These
may include such facilities as certain parks and playgrounds, walkways, lakes,
tennis courts, swim clubs, community centers. and services as community recrea-
tion programs, community information services, broad appeal training, cultural
and counseling services, and community center operation.
NEW COMMUNITY PROJECTS
Two of the fifteen active title VII new community projects have completed
housing projects for the elderly. On Roosevelt Island. N.Y., 284 units for the
elderly and handicapped have been completed. and are to be opened for oc-
cupancy March 1. 1976. The ground floor contains an 8,000 square foot activity
center with offices. meeting rooms, and fully equipped kitchen and dining fa-
cilities. Roosevelt Island residents have ready access to health services offered
by existing hospitals on the island. Barrier-free access to buildings and facili-
ties is provided in the new community design. and apartment structures are
multi-use, some containing schools and social services. Private auto are banned
from the island's streets and mini-bus transportation will provide ready access
throughout the island. A rapid transit station to provide transportation to jobs
in downtown Manhattan and the New Jersey communities is under construction.
In Park Forest South. III.. the 186 unit Thornwood House for the elderly is
over half occupied. The local town government is actively working with NCA
to find means to provide additional programs and opportunities for the elderly
in Park Forest South.
Two others projects, St. Charles, Md. and Harbison, S.C. have made applica-
tion to HUD to build rental housing for the elderly.
PROGRAM ADMINISTRATION
The recent HUD research report, Barrier Free Site Design, will shortly be
distributed to the title VII developers. NCA is building on this existing research
by sponsoring a followup project to design whole villages in new communities
to be barrier free and thereby accessible to the elderly and the handicapped. The
purpose of this particular study is to determine the additional increment of cost
required to build barrier free. The new communities participating in this study
will be selected on the basis of their willingness and ability to capitalize on this
barrier free planning in terms of providing housing, services and other oppor-
tunities for the elderly and handicapped.
INTERSTATE LAND SALES
Congress passed the Interstate Land Sales Full Disclosure Act in 1968, to give
the public a measure of protection against fraudulent and deceptive land sales
operations. The act is administered through HUD's Office of Interstate Land
Sales Registration. Although the act is intended to provide protection for all
consumers, it is evident that the greatest number of potential victims of fraud-
ulent land sales could be the elderly.
The property report is the key to the protection available to consumers under
the act, since developers are required by law to give the prospective purchaser
a property report before or at the time of signing a contract. The disclosure
contained in a property report covers such items as: (1) existence of mortgages,
liens and other encumbrances; (2) whether contract payments are set aside in
a special (escrow) fund (3) availability of recreational facilities, where and
when; and (4) availability of water and sewer facilities or of wells and septic
tanks.
In 1974, The Interstate Land Sales Full Discloure Act was amended to give
purchasers the option to void their contract or agreement by notice to the seller
if they did not receive a property report prepared pursuant to the rules and
regulations of the Office of Interstate Land Sales Registration. in advance of
or at the time of their signing the contract or agreement. If they received the
property report less than 48 hours prior to signing the contract or agreement
they have the right to revoke the contract or agreement by notice to the seller
until midnight of the third business day following the consummation of the
transaction.
In addition. the statutory provision with respect to waiver by a purchaser of
his revocation rights because he made an onsite inspection and received, read
and understood the property report has been repealed.
These amendments to the act give the general public and elderly greater pro-
tection against fraudulent and deceptive land sales practices.
FEDERAL DISASTER ASSISTANCE ADMINISTRATION
Following the devastating tornado of May 6, 1975. in Omaha, Neb., the local
office of aging, under the coordination of FDAA. made available several services
to elderly disaster victims. These services included:
CAN-LINO-79
-Operation of a mini-transporation system for the elderly;
--Counseling the elderly on types of disaster assistance available to them,
FDAA trained the counselors who performed this function;
-Provision of legal advice to the elderly;
-Expansion of the "meals on wheels" program to feed elderly disaster vic-
tims and
-Provision of "handyman services" to the elderly.
Similarly, following summer flooding in North Dakota, the State division of
aging (partially funded by HEW), working through the county offices of social
services in the northeastern counties of the State, made available to elderly
disaster victims transportation services to disaster assistance centers. The
county offices also provided outreach services for the elderly. A statistical analy-
sis of grants made in North Dakota under the Individual and Family Grant
Program revealed the average age of grant recipients was over 50.
Based on observation of these activities and subsequent meetings with the
office of aging, FDAA finds that it can make greater use of the Federal and
State personnel who normally work with the elderly. FDAA also can use sta-
tisties available in Federal and State agencies which show, by locality, the
population by age group and the location of nursing homes with space for dis-
aster victims.
FDAA continues to provide disaster assistance without regard to race, color,
religion. nationality, age. sex, or economic status in each disaster or emergency
declared by the President. In the past year, FDAA expanded its Disaster Re-
serve Program in which augmentation personnel are trained to render disaster
assistance. Many of these reservists have been recruited from the ranks of the
elderly. In 1976, the reserve organization will be expanded nationwide, with a
substantial number of key positions filled by older citizens.
INTER-AGENCY Co-operation
HUD-HEW COOPERATION
HUD, through the Office of the Assistant to the Secretary for Elderly and
Handicapped. is working in close coordination with the Department of Health,
Education and Welfare pursuant to Section 209 of the 1974 Housing and Commu-
nity Development Act.
Thus, an HEW/HUD review group has been established to identify and work
toward the resolution of differences in the minimum property standards now
used by the two Departments for housing for the elderly and the handicapped.
This includes the related facilities of cafeterias or dining halls, community
rooms or buildings, workshops. infirmaries or other inpatient or outpatient health
facilities, and other essential service facilities.
A total of 22 members from both Departments participate on one of the
three subgroups: steering, design/construction standards, or policy, management
and operations. Farmers Home Administration and the National Bureau of
Standards have participated in the subgroup deliberations.
INTERDEPARTMENTAL AGREEMENTS
The Office of the Assistant to the Secretary for Elderly and Handicapped has
been an active participant in the work of the Interdepartmental Working Group
of the Domestic Council Committee on Aging. Through this group, the Depart-
ment has been able to enter into a number of working agreements with other
Federal agencies. These agreements cover such subjects as nutrition, transporta-
tion, energy and information and referral. A summary description of actions
undertaken by HUD pursuant to each of these agreements follows:
Nutrition
HUD recognizes that it and the Administration on Aging (AoA) share a com-
mon interest in serving residents of elderly housing through the Nutrition Pro-
gram for older Americans and that a number of HUD housing developments for
the elderly can offer facilities in their community space to serve as sites for the
AoA Nutrition Projects, serving one hot meal a day not only to residents of the
development but also to other elderly of the community.
Therefore, in each State, local, housing authorities and the management of
other HUD assisted housing for the elderly will be alerted through HUD field
offices to make contact with the State agency on aging. They also identify the
number of elderly residents reachable through the housing development inform
the State agency on aging about community space and facilities that can be made
available: ascertain from the State agency on aging how and when participation
may be brought about; and are instructed by HUD that modernization program
funds can be utilized to accomplish alterations necessary in community space to
accommodate meal preparation and service.
Transportation
Management of HUD-insured housing for the elderly, section 202 direct loan
projects, and local housing authorities have been urged to establish and maintain
relations with their local transit authority and to explore: working with the
local government to implement reduced rates for the elderly and handicapped: re-
routing of transit lines to serve housing projects for the elderly and handicapped;
adjusting schedules to accommodate the special transportation needs of the
elderly and handicapped and obtaining from the local transit authorities special
services or facilities.
The management of HUD assisted housing for the elderly and handicapped and
local housing authorities also post the transit maps and transit schedules of local
transit authorities.
CAN - LINO - 80
Energy
The Department advises its field offices about elderly related energy conserva-
tion efforts and suggest that these offices provide state and area offices on aging
with information concerning HUD Home Repair Programs. In addition, the
Department will suggest to its field offices that they initiate discussions with
state and area agencies on aging concerning the use of community space in HUD
assisted elderly projects for energy conservation related activities.
Information and Referral
The Department is providing to the National Clearinghouse on Aging, on a con-
tinuing basis, directories of HUD assisted housing for the elderly and HUD
issuances pertaining to the elderly, and has reaffirmed the fact that HUD Area
and Insuring Offices can answer general questions on elderly housing availability,
eligibility for occupancy and questions of this nature. In addition, the Depart-
ment has agreed that HUD assisted projects can provide a conduit for appropri-
ate aging information and materials, and that these elderly projects may, in
some instances, be able to provide information and referral sites in community
space.
The Department expects to participate in additional interagency agreements
pertaining to the elderly, to be developed during 1976. These include an agreement
covering social services for elderly residents of Section 8/202 projects and a
multiagency agreement concerning elderly Indian Americans.
ITEM 6. DEPARTMENT OF THE INTERIOR
FEBRUARY 12, 1976.
DEAR SENATOR CHURCH This is in reply to your letter of December 30, 1975,
requesting a summary of our major activities on aging during 1975.
The Department, for the fourth consecutive year. participated in the program
conducted by Retirement Advisors of New York. Under this program, a series of
informational booklets is distributed to employees who are within 5 years of
optional retirement and a postretirement newsletter is distributed to all retired
employees. Copies of the booklet and the newsletter are enclosed.
The National Park Service has expended considerable effort in making im-
provements in the national parks SO that the handicapped can better use these
facilities and enjoy the national park areas. Much of this work also benefits
the aged in using these parks. Changes, such as installing ramps in lieu of steps
and improving trails to facilitate the use of wheelchairs have been made.
The Golden Age Passport is issued free to citizens or permanent residents
of the United States who are 62 years of age or older. The passport admits the
permit holder and other occupants of the car to designated national parks and
recreation areas where entrance fees are charged.
In addition to these programs. preretirement counseling is conducted in the
regional and field offices of our bureaus on an individual case basis.
We have no specific plans for activities for the aging in 1976, other than the
continuation of these programs.
Sincerely yours,
JOHN F. McKUNE,
Director, Organization and Personnel Management.
ITEM 7. DEPARTMENT OF LABOR
FEBRUARY 26, 1976.
DEAR MR. CHAIRMAN: Enclosed are papers summarizing and describing the
Department of Labor's major activities on aging which you requested in your
letter of December 30, 1976. I trust this will meet your needs.
Sincerely,
JAMES H. HOGUE,
Deputy Under Secretary for Legislative Affairs.
[Enclosure]
NATIONALLY ADMINISTERED OLDER WORKER EMPLOYMENT
PROGRAMS
PERFORMANCE REPORT FOR FISCAL YEAR 1975 AND PROJECTIONS FOR FISCAL YEAR 1976
In fiscal year 1975, the U.S. Department of Labor administered two special
employment programs for the elderly: The National Older Workers Program-
Operation Mainstream (NOWP-OM) and the Senior Community Service Em-
ployment Program (SCSEP). The NOWP-OM was funded under title III of
the Comprehensive Employment and Training Act, and the SCSEP was funded
under title IX of the Older Americans Act. Differing only in size and legislative
funding authority, these two programs provided part-time jobs for elderly
poor persons and provided the communities in which they operated with a
federally subsidized pool of manpower which was drawn upon to upgrade
existing human services or to establish new ones.
Activity under both programs was sponsored almost entirely by a group of
five national-level organizations, most of which have participated in projects
of this type since 1968. The five organizations are: (1) Green Thumb. Inc., an
arm of the National Farmers Union. (2) the National Council on the Aging,
(3) the National Council of Senior Citizens, (4) the National Retired Teachers
Association-American Association of Retired Persons, and (5) the U.S. Depart-
CAN-LINO-81
ment of Agriculture Forest Service. In total, they operate local projects in 47
States, Washington, D.C., and Puerto Rico. Local projects were administered
by the staff of the national organization or were, in some cases, administered
by locally based service agencies under subcontractual arrangement with the
national organizations. In addition, regionally administered SCSEP grants
were awarded directly by the Department of Labor to the governments of the
three States and four territories not covered by the national organizations
Alaska, Delaware, Hawaii, American Samoa, Guam, the Trust Territories of
the Pacific Islands, and the Virgin Islands.
Local projects under the NOWP-OM and the SCSEP hired economically dis-
advantaged persons, 55 years old or older, to work in part-time community
service jobs. With their wages fully subsidized by the Federal Government,
project participants worked in a wide variety of activities. such as day care
centers, senior citizen centers, schools, hospitals ,and beautification, conserva-
tion, and restoration projects. In addition to subsidized job opportunities, the
projects also provided participants with physical examinations, personal and
job-related counseling, job training, and in some cases referral and placement
into regular unsu.bsidized jobs.
The chart below summarizes (1) costs, enrollment levels, and turnover experi-
enced by both programs during fiscal year 1975; and (2) the aggregate charac-
teristics of persons actually enrolled in both programs at the close of the fiscal
year (i.e., June 30, 1975).
On July 1, 1975, all NOWP-OM projects were merged into the SCSEP. The
consolidated program is currently financed under title IX of the Older Ameri-
cans Act through June 30, 1976. The output and resource plan for the consolidated
SCSEP is also attached.
NATIONAL ADMINISTERED OLDER WORKER PROGRAMS
1. Cost and Output Table for Fiscal Year 1975
Program factors
NOWP-OM
SCSEP
Composite
Obligations (thousands)
$20,042
$12,000
$32,042
Expenditures (thousands)
$26,190
$7,738
$33,928
Man-years (estimated)
8,855
2,554
11,409
Enrollees carried over from fiscal year 1974
9,342
9,342
New enrollees
5,485
6,975
12,460
Unsubsidized placements
1,511
344
1,855
Dropouts
4,588
1,635
6,223
Current enrollment (June 30, 1975)
8,728
4,996
13,724
II. SUMMARY OF CHARACTERISTICS-PERSONS ACTUALLY ENROLLED AS OF JUNE 30, 1975
[In percent]
NOWP-OM
SCSEP
Composite
(8,728
(4,996
(13,724
Characteristic
persons)
persons)
persons)
Sex
Male
53.4
47.3
51.2
Female
45.6
52.7
48.8
Age
54 and younger
1.6
1.0
55 to 59
15.8
24.1
18.8
60 to 64
24.3
25.9
24.9
65 to 69
28.4
26.3
27.6
70 to 74
19.3
15.9
18.1
75 and older
10.6
7.8
9.6
Education
8 and under
52.7
46.3
50.3
9 to 11
18.8
19.7
19.2
12
19.1
22.3
20.3
1 to 3 years college
6.4
8.3
7.1
4 years college and above
3.0
3.4
3.1
Ethnic group
White
69.8
78.4
72.9
Black
22.8
18.2
21.1
American Indian
3.3
2.0
2.8
Other
4.1
1.4
3.2
Spanish American
7.0
3.3
5.6
Economically disadvantaged
100.0
100.0
100.0
SENIOR COMMUNITY SERVICE EMPLOYMENT PROGRAM: PROGRAM OUTPUT AND RESOURCE PLAN FOR FISCAL
YEAR 1976
[Does not include estimates for regionally administered projects in Alaska, Delaware Hawaii, Samoa, Guam, TTPI, and
Virgin Islands.]
Fiscal year Fiscal year 1976 quarterly plans (cumulative)
Fiscal year
1976 annual
Performance measures
1975 actual
plan
1st
2d
3d
Obligations (in thousands)
$32,042
$29,780
$29,780
$29,780
$29,780
Costs (in thousands)
$33,928
$43,705
$8,857
$20,473
$32,089
Enrollees carried over from fiscal year
year 1975 (actual)
13,675
13,675
13,675
13,675
New enrollees
12,460
8,000
1,647
4,000
6,000
Unsubsidized placements
1,855
1,860
570
930
1,395
Dropouts
6,223
7,415
1,666
3,045
4,580
Current Enrollment (EOP)
12,400
13,086
13,700
13,700
1 Includes combined figures for the senior community service employment program and the national older workers
program-operation mainstream. The 2 programs were merged at the outset of fiscal year 1976.
CAN LINO - 82
COMPREHENSIVE EMPLOYMENT AND TRAINING PROGRAMS AND PUBLIC SERVICE
EMPI OYMENT PROGRAMS
Older workers benefit from ograms and services esetablished with special
revenue sharing grants provided to State and local:governments under titles I,
II, and VI of the Comprehensive Employment and Training Act (CETA) of
1973. Attached are progress repor'ts covering fiscal year 1975 and 1976. These
reports indicate the participation rates of persons in the upper age groups
under comprehensly programs (CETA title 1) and under public service employ-
ment programs (CETA titles II and VI).
In the near future, the Employment and Training Administration will pub-
lish a technical guide for CETA prime sponsors which will assist them in
recognizing the employment needs of the elderly and in planning services to
meet those needs. This technical assistance guide will be the first published by
the Employment and Training Administration directed toward the provision of
services to a specific target group.
CETA ACTIVITY IN FISCAL YEAR 1975, AS OF JUNE 30, 1975
Total
Title I
Title =
Title VI
Total individuals served
1,510,100
1,126,000
227,100
157,000
Total terminations
658,000
553,300
70,900
33,800
Direct placements
64,200
62,900
1,000
300
Indirect placements
98,400
84,500
9,700
4,200
Self placements
39,700
28,600
5,900
5,300
Other positive terminations
198,300
170,800
21,900
5,600
Nonpositive terminations
257,400
206,600
32,400
18,400
Current enrollment, as of June 30, 1975
852,000
572,700
156,200
123,100
Emulative enrollment by program activity:
Classroom training.
297,900
292,000
5,100
800
On-the-job training
76,500
73,800
2,400
300
Public service employment
361,200
29,800
211,500
119,900
Work experience
609,700
562,200
10,700
36,800
Other activities
88,000
86,900
1,100
Current enrollment by program activity, June 30, 1975:
Classroom training
127,200
124,200
2,700
300
On-the-job training
41,100
39,400
1,400
300
Public service employment
261,100
20,700
149,000
94,500
Work experience
331,100
297,200
4,600
29,300
Other activity
36,700
36,200
500
TABLE 1.-CETA ACTIVITY IN FISCAL YEAR 1976 AS OF SEPT. 30, 1975
Total
Title I
Title =
Title VI
Total individuals served
1,308,400
886,500
166,900
255,000
New enrollees fiscal year 1976
561,800
403,100
31,500
127,200
Cumulative enrollment by selected program activity
1,210,600
791,200
164,500
254,900
Classroom training
208,700
205,900
800
2,000
On-the-job training
78,000
61,000
400
16,600
Public service employment
384,700
36,100
159,400
189,200
Work experience
484,600
434,200
3,500
46,900
Other activities
54,600
54,000
400
200
Current enrollment, as of Sept. 30, 1975
735,800
438,800
86,000
211,100
Current enrollment by selected program activity
665,100
368,500
87,000
209,600
Classroom training
127,900
126,200
400
1,300
On-the-job training
51,100
36,000
300
14,800
Public service employment
263,300
21,800
84,300
157,200
Work experience
191,200
153,400
1,700
36,100
Other activity
31,600
31,100
300
200
Total terminations
572,500
447,700
80,900
43,900
Direct placements
29,100
27,500
700
900
Indirect placements
61,600
48,300
6,600
6,700
Self placements
24,000
15,800
3,100
5,100
Other positive terminations
322,200
259,100
51,900
11,200
Nonpositive terminations
135,600
97,000
18,600
20,000
CETA CHARACTERISTICS, FISCAL YEAR 1975
Data for fiscal year 1975 on the characterstics of participants during the first
year of operation under CETA (Comprehensive Employment and Training Act)
show that generally a similar type clientele is being served as under the earlier
categorical programs. Table 1 displays the percentage distribution of partici-
pants enrolled in titles I, II and VI. Table 2 arrays the characteristics of enrollees
during fiscal year 1974 in categorical programs (for comparison with the CETA
title I program) and presents the fiscal year 1974 characteristics of the en-
rollees under the Public Employment Program (for comparison with CETA
titles II and VI).
The typical title I enrollee was young (62 percent under age 22), economically
disadvantaged (77 percent), unemployed or not in the labor force (93 percent)
and with less than 12 years of education (66 percent) Well over one-half of
the enrollees-54 percent-were male. and 55 percent were white. Some of the
major differences in the enrollment pattern under CETA title I as contrasted
with the categorical programs are a higher education level (39 percent having
a high school education), fewer (77 percent VS 87 percent) economically dis-
advantaged, fewer veterans (9.6 percent VS 15.3 percent), and a great many more
not in the labor force (31.6 percent VS 8.1 percent). These presumably were
full-time students.
The typical title II enrollee was white (65 percent), male (66 percent), be-
tween the ages of 22 and 44 (63 percent), a high school graduate (72 percent)
and from the ranks of the unemployed (84 percent). Nearly half (48 percent)
were economically disadvantaged.
CAN - LINO - 83
The typical title VI enrollee was white (71 percent), a high school graduate
(73 percent) and unemployed or not in the labor force (92 percent). Some of
the major differences in the characteristics of title II and title VI Public Service
Employment enrollees from enrollees in the PEP program during fiscal year
1974 are: a greater percentage of the CETA participants were on public assist-
ance: a larger proportion were economically disadvantaged: fewer veterans,
and an increased number had been receiving unemployment insurance.
TABLE1.-CHARACTERISTICS OF NEW PARTICIPANTS IN CETA TITLE I, TITLE II, AND TITLE VI, PROJECTS THROUGH
JUNE 30, 1975
[Percentage clistribution; preliminary data]
Title
Title
Title
I
=
VI
U.S. total (cumulative enrollment)
1,126,000
227,100
Percent
157,000
100.0
100.0
100.0
Male
54.4
65.8
70.2
Female
45.6
34.2
29.8
Age:
Under 22
61.7
23.7
21.4
22 to 44
32.1
62.9
64.8
45 to 54
3.5
8.4
9.1
55 and over
2.6
5.0
4.7
Education:
8 grades or less
13.3
9.4
8.4
9 to 11
47.6
18.3
18.2
12 and over
39.1
72.3
73.3
On public assistance:
AFDC
15.5
6.6
5.6
Other
11.3
9.2
8.1
Economically disadvantaged
77.3
48.3
43.6
Ethnic group:
White
54.6
65.1
71.1
Black
38.5
21.8
22.9
American Indian
1.3
1.0
1.1
Other
5.6
12.1
4.9
Spanish American
12.5
16.1
12.9
Limited English-speaking ability
4.1
8.0
4.6
Migrants or seasonal farmworkers
1.6
1.0
1.0
Veteran:
Special Vietnam
5.2
11.3
12.5
Other
4.4
12.6
14.6
Handicapped
3.8
3.2
2.9
Full-time student
32.8
3.0
2.8
Offender
5.7
2.9
2.6
Labor force status:
Employed
2.3
3.9
2.0
Underemployed
4.5
8.4
6.4
Unemployed
61.6
83.6
88.4
Not in labor force
31.6
4.1
3.1
Receiving unemployment insurance
3.9
12.0
14.6
Median hourly wage:
Preenrollment
$2.60
$2.87
$3.02
Poster:rollment
$2.76
$3.36
$3.57
1 A large portion of participants falling in this group reflect the nonclassification in Puerto Rico by ethnic categories.
TABLE 2.-CHARACTERISTICS OF NEW PARTICIPANTS OF CETA TITLE I, TITLE II, AND TITLE VI, PROJECTS
THROUGH SEPT. 30, 1975
[Percentage distribution]
Title I
Title II
Title VI
U.S. total (cumulative enrollment)
886,500
166,900
255,000
Percent
100.0
100.0
100.0
Male
53.8
64.0
66.8
Female
46.2
36.0
33.2
Age:
Under 22
61.3
22.5
21.7
22 to 44
32.4
64.0
64.5
45 to 54
3.7
8.7
8.8
55 and over
2.6
4.8
5.0
Education:
8 grades or less
12.4
8.0
8.3
9 to 11
45.0
17.8
18.0
12 and over
42.6
74.2
73.7
On public assistance:
AFDC
14.7
6.1
5.3
Other
11.5
10.3
7.8
Economically disadvantaged
77.0
44.3
42.9
Ethnic group:
White
55.2
63.4
66.4
Black
37.4
25.4
22.6
American Indian
1.2
1.8
1.3
Other
6.2
9.4
9.7
Spanish-American
13.0
11.7
11.6
Limited English-speaking ability
4.8
3.9
5.2
Migrants or seasonal farmworkers
1.8
1.4
1.4
Veteran:
Recently separated
1.2
2.9
3.8
Vietnam
4.1
10.7
10.3
Other
4.2
11.4
11.9
Disabled
.2
.3
Handicapped
5.7
2.7
2.4
Full-time student
34.7
2.5
1.3
Offender
4.2
2.5
2:3
Labor force status:
Underemployed
4.6
7.8
5.5
Unemployed
65.0
80.8
79.4
Other
30.4
11.4
15.1
Receiving unemployment insurance
5.2
11.5
12.5
1 A large portion in this group reflect the nonclassification in Puerto Rico by ethnic categories.
CAN - LINO - 84
TABLE 2.-CHARACTERISTICE OF ENROLLEES IN CATEGORICAL PROGRAMS AND PUBLIC EMPLOYMENT PROGRAMS
[Percentage distribution: fiscal year 1974]
Categorical
programs
PEP
Total:
Number
549,700
26,200
Percent
100.0
100.0
Male
57.7
56.1
Female
42.3
33.9
Age:
Under 22
63.1
22.8
22 to 44
30.5
66.5
45 55
55 and over
6.2
10.7
Education:
8 grades or less
15.1
9 11
51.1
22.8
12 and over
33.6
77.2
On public assistance:
AFDC
Other
23.4
10.1
Economically disadvantaged
86.7
34.1
Ethnic group:
White
54.9
68.8
Black
37.0
22.9
American Indian
3.5
3.8
Other
4.6
5.0
Spanish-American
15.4
13.2
Limited English-speaking ability
1NA
INA
Migrants or seasonal farm workers
INA
INA
Veteran:
Special Vietnam
Other
15.3
39.2
Handicapped
6.3
4.2
Full-time student
INA
INA
Offender.
INA
INA
Labor force status:
Employed
$7.6
INA
Underemployed
38.7
9.7
Unemployed
$75.6
90.3
Not in labor force
38.1
INA
Receiving unemployment insurance
4.6
7.4
Median hourly wage of employed terminees:
Pre-enrollment.
$2.30
$2.78
Post-enrollment
1$2.86
$2.94
1
Includes MDTA-Institutional, JOP/OJT, NYC in-school, NYC Out-of school, Operation Mainstream, CEP, and JOBS.
3 Excludes enrollees in PEP summer youth program for whom data was not available.
3 Excludes NYC In-school and JOBS enrollees for whom data was not available.
4 Includes MDTA-Institutional, OJT, CEP, JOP.
5 Median wage is for the PEP job; median wage for post-PEP employment is not available.
INA Information not available.
CETA PROGRESS REPORT, FISCAL YEAR 1975
During fiscal year 1975, its first year of operation, CETA served over 1,510,000
individuals. Three-fourths of total enrollment was in CETA title I which pro-
vides manpower training and work experience.
Over 678,000 enrollees terminated from the program during the year. leaving
852,000 still on board on June 30. 1975. Of those on board, the vast majority
572,700 were in title I. Title II had 156,200 enrolled and title VI had 123,000
at the end of the fiscal year.
Of the terminees in all programs, 30 percent left for employment, another 30
percent left for entry into the armed forces or to return to school, and the
balance left for a variety of reasons.
About 21 percent of the total individuals served were provided with class-
room training, 5 percent with on-the-job training, 25 precent were in public
service employment (largely under titles II and VI) and 43 percent were pro-
vided with work experience (92 percent under title I). The remaining 6 percent
were provided with a variety of services designed to improve their employability.
CETA PROGRESS REPORT, FIRST QUARTER FISCAL YEAR 1976
During the first quarter of fiscal year 1976. CETA served 1,308,400 individuals,
of whom 561,000 were new enrollees and 746,000 were on-board at the beginning
of the quarter.
About 40 percent of those served were provided with work experience (see
table 1), mostly under title I and 32 percent were in public service employment
largely under titles II and VI. About 17 percent received classroom training
and 6 percent received on-the-job training almost exclusively under title I. The
declining number enrolled in on-the-job training under CETA (only 9 percent
during fiscal year 1975 contrasted with 22 percent in fiscal year 1974, the last
year of the categorical programs) suggests that prime sponsors may be sub-
stituting work experience programs (up 10 percent) for the OJT programs.
Under titles II and VI. the emphasis is on enrollment in public service employ-
ment and reports for the first quarter show 83 percent thus classified.
Of the terminees in all programs during the quarter, 20 percent left for em-
ployment and an additional 57 percent were "positive terminations". i.e., those
who entered the armed forces, or more likely, those students who returned to
school. The balance (23 percent) left for a variety of reasons.
CAN - LINO - 85
The social-economic characteristics of CETA participants during the first
quarter (see table 2) show very few changes from the pattern reported for fiscal
year 1975. There were a few more women enrolled under each title a slightly
greater participation by minorities. In title I, the characteries pattern is sig-
nificantly influenced by the fact that one-third of all enrollees are full time stu-
dents (also reflected in 60 percent under age 22 and the 31 percent reported
'not in the labor force"). In titles II and VI, the public service employment pro-
grams, the characteristics are similar to each other and are relatively unchanged
from those reported in fiscal year 1975.
UNITED STATES EMPLOYMENT SERVICE PROGRAM FOR OLDER WORKERS
A. NATIONAL EMPLOY THE OLDER WORKER WEEK
In fiscal 1976, the United Sttes Employment Service is playing a major role in
the observance of National Employ the Older Worker Week, a nationwide cam-.
paign which promotes the employment of older workers. In addition to the issu-
ance of guidelines, the national office supervised the preparation of pamphlets,
brochures, films and public service announcements to assist the States in the
observance of this "week."-Materials prepared reflect a Bicentennial theme.
B. TRAINING AND TECHNICAL ASSISTANCE CONTRACT WITH THE NATIONAL COUNCIL
ON THE AGING
For the first six months of fiscal 1976. the Manpower Administration has
awarded a contract to the National Council on the Aging to provide technical
assistance and training in an effort to increase the knowledge and skills of
employment service staff involved in interviewing. counseling and placing mid-
dle-aged and older workers. In addition. the contract provides for preparation
and distribution of a Journal of Industrial Gerontology for each quarter of FY
1976 and the preparation of a kit of materials to be used during National Employ
the Older Worker Week observed in March each year.
ADEA ENFORCEMENT IN FISCAL YEAR 1975 AND THE FIRST 6 MONTHS OF
FISCAL YEAR 1976
As in the previous fiscal year, substantial age discrimination violations were
disclosed in fiscal year 1975. particularly with respect to hiring practices and lay-
offs. During the past 2 fiscal years, monetary damages found due have amounted
to almost $13 million dollars. During the first 6 months of fiscal year 1976,
monetary damages found due have amounted to $4.6 million. Income restored to
employees during the past 2 years exceeded $4 million. while income restored
to employees during the first 6 months of fiscal year 1976 have exceeded $2.2
million. This continual rise in damages and income restored represents a sub-
stantial increase over previous fiscal years.
Complaints reached 4,717 in fiscal year 1975, a 55 percent increase over fiscal
year 1974. There have been 2,571 complaints received in the first 6 months of
fiscal year 1976, a rate of inflow approximately 10 percent above the previous
year.
1975 ACTIVITIES
A number of significant litigation cases were filed during 1975. One of the
largest of these was against Sandia Corporation. It is important both in the
amount of money sought to be recovered (several million dollars) and in the
number of employees affected (several hundred). It is also important in the
sense of the precedent that may be established as to the evidence required to
demonstrate prevasive age discrimination by pattern and statistical evidence.
Another very significant case was filed against Pan American Airlines. As in
Sandia, it involves primarily a layoff and its effect on older workers. Again, the
case potentially involves hundreds of individuals and millions of dollars in back
wages. Two other multimillion dollar cases were filed in 1975, one against the
Crown Cork and Seal Co., and the other against Goodyear Tire and Rubber Co.
Some 32 suits were filed in calendar year 1975. Since the effective date of the
act on June 12, 1968, over 261 actions have been instituted by the Department
of Labor; 195 have been resolved in the Department's favor and 49 are still
pending. The other 17 cases were resolved adversely to the Department.
The thrust of ADEA enforcement in recent years has been toward more full
fact-finding investigations, because they tend to disclose patterns of age discrim-
ination affecting large numbers of older workers. Such investigations continue
to have the highest priority. However, the ever-increasing volume of complaints,
including notices of intent to sue, and the need to service such complaints with-
in the time limits spelled out in the statute have necessitated greater use of con-
ciliation and limited investigations. Full fact-finding investigations continue to
be utilized, but on a more selective basis.
Conciliation or mediation, which in its initial stages, is a less formal, time-
saving compliance action. accounted for 30 percent of the compliance actions
during fiscal year 1975. Section 7 of the ADEA specifically provides that con-
ciliation be attempted before legal proceedings are initiated. Full and limited
investigations accounted for virtually all of the remaining 70 percent of com-
pliance actions.
During fiscal year 1975, a total of 6,555 establishments were investigated under
the act. Approximately two-thirds of the establishments investigated were found
to be in compliance with all of the ADEA provisions; the other one-third were
in violation of one or more of the provisions of the act. Monetary violations
amounting to $6.6 million were disclosed in 451 establishments involving 2,350
individuals. Income was restored to 728 employees and job applicants in the
amount of $1.7 million in 249 establishments.
CAN - LINO evidence 86
Nonmonetary discriminatory practices were found in 1,642 establishments;
3,376 individuals were aided and 27,217 job opportunities made available by the
removal of discriminatory age barriers.
Illegal advertising was the most prevalent discriminatory practice disclosed.
871 instances, followed by refusals to hire, 434 instances, and illegal discharges,
354 instances.
SUMMARY OF PENSION PLAN TERMINATION INSURANCE PROTECTIONS UNDER THE
EMPLOYEE RETIREMENT INCOME SECURITY ACT OF 1974
PENSION BENEFIT GUARANTY CORPORATION
On September 2, 1974, the President signed into law the Employee Retirement
Income Security Act of 1974 (ERISA), which provides many new protections and
guarantees for employees covered by private pension plans.
One of the key sections of ERISA. title IV, established the Pension Benefit
Guaranty Corporation (PBGC), a self-financed, Government corporation. The
Secretary of Labor is the Chairman of the Corporation's Board of Directors; the
Secretaries of the Treasury and Commerce are the other Board members.
Upon termination of a covered pension plan (most defined benefit plans are
covered), the PBGC guarantees the payment of basic benefits vested under the
terms of the plan, within limits specified in the act and PBGC regulations. In
the event a plan terminates wih insufficient assets, PBGC assures payment of
the guaranteed benefits. However. the employer sponsoring the plan is liable to
the PBGC for the shortfall in plan funds, up to 30 percent of the employer's
net worth.
For individuals who are not already covered by a pension plan. or for those
who are leaving employment under a plan. ERISA permits establishment of tax-
qualified individual retirement accounts. PBGC furnishes advice and assistance
on the economic desirability of establishing such a program.
In its first 17 months of existence, PBGC collected about $60.7 million in
premiums. The annual premium. which is paid to the Corporation by each covered
plan, is now 50 cents for each participant in a multiemployer plan, and $1 for
each participant in a single employer plan.
Over 6,700 termination cases have been opened since enactment. Careful review
of each termination notice led to the administrative closing of 807 cases because
they did not meet the statutory requirements for coverage. For cases where it
seems clear that the plans have sufficient assets to cover benefit obligations,
PBGC has developed a procedure for plan administrators to certify to that asset
sufficiency and receive from PBGC a notice of sufficiency that permits them to
distribute assets and close out the plans. Such notices of sufficiency have been
issued in 1,519 cases as of February 18, 1976.
PBGC has authorized terminating plans to continue benefit payments to re-
tirees pending final termination of the plans even where plan assets are insuffi-
cient. In those instances where benefit payments were in jeopardy, PBGC has
taken steps to resume and continue payments, including action to have itself
appointed trustee where necessary. Through February 18, 1976, PBGC has been
appointed trustee for 15 plans, involving almost 1,700 participants in pay status.
Monthly benefits paid total approximately $235,000.
Through the pension benefit guaranty program, an estimated 33 million workers
and retirees have the security of knowing their retirement benefits are guaranteed
by a U.S. Government agency.
PRIVATE EMPLOYEE BENEFIT PLANS
Private employee benefit plans affect the welfare of millions of Americans.
Retirement plans help to provide income in the later years. Welfare plans help
to give economic security to workers and their families in such events as sick-
ness, disability, death, unemployment, etc. The interests of Americans in these
retirement and welfare plans received new protections in the Employee Retire-
ment Income Security Act of 1974 (ERISA), signed into law on Labor Day,
September 2, 1974.
Generally, the purposes of ERISA are to see that:
-Retirement and welfare plans are managed prudently and exclusively for
the benefit of participants and beneficiaries (fiduciary standards).
-participants in plans know their rights and obligations, and the government
has the information it needs for regulation and enforcement (reporting and
disclosure provisions).
-Workers are not required to satisfy unreasonable age and service require-
ments before joining a retirement plan (participation provisions).
-After working for a reasonable period under a retirement plan, a person
has a right to the retirement benefits he has earned (vesting provisions).
-Retirement plans accumulate money to pay promised benefits (funding
provisions).
-Benefits under certain "defined benefit" retirement plans are protected in the
event of plan Termination (plan termination insurance).
-Tax advantages relating to various types of retirement savings are more
equitable.
Responsibilities for carrying out the law's provisions are assigned to the U.S.
Department of Labor, the Internal Revenue Service of the U.S. Treasury De-
partment, and a new government corporation named the Pension Benefit Guar-
anty Corporation, which was created to administer the plan termination insur-
ance provisions of the law.
During 1975 the fiduciary responsibility and reporting and disclosure provisions
of ERISA became effective. The Department of Labor took steps in both areas to
implement these far-reaching reforms in a reasonable manner that would not
CAN - LINO - 87
disrupt the operations of employee benefit plans. The initial reporting and dis-
closure deadlines were deferred to allow time for plans to receive adequate
guidance as to their responsibilities and to make changes required under other
provisions of the act, SO that employees would receive meaningful information
about their rights and benefits under ERISA. The Labor Department published
regulations detailing reporting and disclosure rules, exercised its statutory dis-
cretion to permit certain exemptions and variances, and also developed reporting
forms with full participation and comment from the public. In anticipation of
the effectiveness of minimum standards provisions for most plans in 1976, the
Department published regulations governing important standards for vesting,
participation and benefit accrual.
The Department of Labor issued a number of interpretive bulletins to provide
guidance on matters covered by the fiduciary responsibility provisions of ERISA.
Temporary regulations were issued to govern bonding, and to allow deferral of
certain rules until 1976. In conjunction with the Internal Revenue Service, the
Department of Labor established a procedure to handle applications for exemption
for certain transactions or type of transactions from the ERISA prohibited trans-
actions rules. One major class exemption was made final, others were published
for comment, and action on a number of exemptions for individual transactions
was begun.
While much more remains to be done in implementing ERISA, the bicentennial
year will be especially significant to many thousands of Americans in private
retirement plans, as the vesting and related minimum standards provisions of the
law become effective and create new rights to retirement income. The Department
of Labor will continue to issue regulations and interpretations during 1976, and
will also accelerate its enforcement efforts.
ITEM 8. DEPARTMENT OF TRANSPORTATION
FEBRUARY 27, 1976.
DEAR MR. CHAIRMAN In response to your letter of December 30, 1975, I am
pleased to send to you the enclosed report which summarizes the major activities
of this Department in assisting older Americans during 1975, and which projects
our plans for 1976.
I trust you will find this information helpful.
Sincerely,
WILLIAM T. COLEMAN, Secretary.
[Enclosure]
SUMMARY OF ACTIVITIES TO IMPROVE TRANSPORTATION SERVICES
FOR THE ELDERLY
I. INTRODUCTION
Improving transportation services for the elderly continues to be an important
element in the Department of Transportation's program. The following is a sum-
mary of relevant 1975 (1) legislative and regulatory activities: and (2) program
activities, including research. demonstrations, capital assistance, technology
sharing, and interagency cooperation. Included in this report are both ongoing
programs and projected initiatives, on the behalf of the elderly.¹
1 Many of the activities described in this report are directed toward the handicapped
however, more than one-third of the elderly are handicapped and they will also benefit from
these initiatives.
II. LEGISLATION AND REGULATIONS
A. LEGISLATION
No new relevant transportation legislation has been passed since the National
Mass Transportation Assistance Act of 1974 (NMTA). This act established an
$11.8 billion, 6-year mass transportation program, for both capital and operating
assistance. In addition, the act contained the following provisions which are
relevant to the elderly and handicapped population.
1. Reduced Fare Provision for the Elderly
Section 5(m) of the act requires that rates charged elderly and handicapped
persons during nonpeak hours for transportation utilizing equipment and facilities
of DOT-funded projects, will not exceed one-half the rate applied to general
transit users during peak hours.
2. Planning and Design Provisions for the Elderly
NMTA amended section 16 of the Urban Mass Transportation Assistance Act.
Section 16(a) of the act. as amended by NMTA, declares as national policy that
elderly and handicapped persons have the same right as other persons to utilize
mass transportation facilities and services. Section 16(a) also directs that special
efforts be made in the planning and design of mass transportation facilities and
services SO that the availability to elderly and handicapped persons of mass
transportation which they can effectively utilize will be assured.
Section 16(b) provides that grants be made to State and local agencies to
provide for mass transportation to meet the special needs of the elderly and
handicapped. It also provides that grants may be made to private nonprofit
organizations if public or private agencies do not provide adequate service.
B. MASS TRANSIT REGULATIONS AND GUIDELINES
Five Urban Mass Transportation Administration (UMTA) issuances pertaining
to the mobility of elderly persons were published in the Federal Register in 1975.
CAN - LINO - 88
1. Reduce Fare Programs for Elderly and Handicapped Persons
Interim guidelines to implement the nonpeak, reduced fare section 5(m) pro-
visions of NMTA appeared in the 1975 issuance "Capital and Operating Assistance
Formula Grants" (generally referred to as UMTA's "section 5 guidelines").
Elderly citizens in over 100 metropolitan areas have already received assistance.
Several dozen more areas will also be instituting reduced fare programs in 1976.
2. Elderly and Handicapped Transportation Services
UMTA has issued a notice of proposed rulemaking establishing new require-
ments for the provision of transportation services to meet the special needs of
elderly and handicapped persons. Six regional hearings were held by UMTA to
encourage public comment. The proposed rule would have required that (1) all
areas undertake special planning efforts to identify the transportation needs of
the elderly population and address these needs as part of the transportation im-
provement program for the urban area: (2) all transit-related buildings and
facilities planned or constructed after the effective date of the final rule be
accessible to the elderly and handicapped and (3) all new transit rolling stock
purchased with capital grants awarded after the effective date of the final rule
incorporate interior design features that will increase the comfort and conven-
ience of transit vehicles for the elderly. The requirements will take advantage of
available technology and hardware to provide handicapped and elderly persons to
the maximum extent possible with transportation services they can effectively
utilize.
UMTA is completing its analysis of the public and transit industry comments
and plans to issue the final regulations in the spring of 1976.
3. Rural Highway Public Transportation Demonstration Program
UMTA and the Federal Highway Administration (FHWA) jointly issued
regulations on administering the Rural Highway Public Transportation Demon-
stration program. Project selection criteria developed for this program were
defined to encourage applicants to recognize the disproportionately high percent-
age of elderly people living in rural areas. Selection and evaluation criteria
specifically required consideration of the "adaptability of systems to the needs
of the elderly and handicapped." "Needs" included both the travel demands of the
elderly (trips to employment, medical centers, shopping) and hardware considera-
tions (hand grips, low steps, signs).
4. Major Urban Mass Transportation Investments
UMTA has issued a notice of proposed policy on Federal decisions with respect
to major mass transportation investments. Included in the suggested criteria for
local decisionmaking are economic and social impacts of alternative systems on
traveler subgroups, including the elderly and handicapped. The policy also en-
courages near-term solutions to current travel problems which will have im-
mediate impact on the transportation disadvantaged. Public comments are being
reviewed and a revised policy statement and supplemental guidelines will be
issued in 1976.
5. Planning for the Elderly in Urban Areas
UMTA and FHWA have issued joint planning regulations for metropolitan
planning organizations in urbanized areas, within a document entitled "Trans-
portation Improvement Program." Section 450.120 of these regulations require
that the urban transportation planning process ensure involvement of the public
and include special efforts to plan public mass transportation facilities and
services that can be utilized by elderly and handicapped persons. Projects to meet
their needs are considered as important transportation improvements and must
be addressed in annual planning and budgeting activities.
C. AIR TRANSIT REGULATIONS
The Federal Aviation Administration (FAA) received over 1,500 comments
in 1975 on its notice of proposed rulemaking, "Air Transportation of Handicapped
Persons." FAA indicates that it expects to publish a final rule in the first half of
1976.
III. PROGRAM ACTIVITIES
A. RESEARCH AND EVALUATION
1. Air Transportation
In conjunction with the Federal Aviation Administration's notice of proposed
rulemaking (NPRM) on "Air Transportation of Handicapped Persons." the
agency in 1975 conducted evaluation tests at its medical research facility in
Oklahoma City in order to study the evacuation of handicapped persons under
simulated emergency conditions. The evaluation tests, along with comments
received in response to the NPRM, are being used to develop an advisory circular
to be issued in conjunction with the amendments to the Federal Aviation regula-
tions. The advisory circular will be used to help train air carrier personnel to be
aware of the problems of handicapped persons and to learn to help solve their
transportation problems.
2. Rural Transportation
(a) The Office of R&D Policy, in the Office of the Assistant Secretary for
Systems Development and Technology, is revising two technology sharing reports
on rural transit.
(b) A national conference on rural transportation is schdeuled for June 1976,
under a University Research contract with North Carolina A. & T. University.
A technical overview of rural transportation will be edited from video taped
recordings of these sessions and a summary video tape will be available from
CAN - LINO - 89
the Department's Transportation Systems Center (TSC) in late 1976. The
conference is expected to include consideration of the transit needs of the rural
elderly.
3. Urban Transportation
The Office of University Research, in the Office of the Assistant Secretary for
Systems Development and Technology, has funded the following active research
contracts addressing problems of elderly and handicapped persons:
(a) The University of California at Los Angeles is conducting research to
determine spatial and social characteristics of various lifestyle groups to estimate
future transportation demand patterns and needs. The methodology developed
will be capable of estimating the elderly's future locational patterns and travel
needs and will be structured in such a way as to be easily utilized by transporta-
tion planners.
(b) The Polytechnic Institute of New York is conducting a Manhattan based
study of the mobility of aged and handicapped persons in order to determine
a balanced transportation system for them. An analysis of the present system
will be conducted in conjunction with research into needs of affected persons in
an attempt to determine a solution that is financially viable, responsive to
change, elicits cooperation among transportation modes, and ensures maximum
mobility.
(c) A study of problems of the carless is being conducted at the State Univer-
sity of New York at Buffalo. The nature, extent, and consequences of carlessness
and the means of improving mobility for this diverse group is to be identified
and analyzed. Trip purposes, priority, opportunity. and accessibility will be
identified and the disadvantages to the carless quantified. Results of research
and solutions to decrease existing disparities will be presented to State and
local authorities. Conclusions and recommendations for changes in Federal, State,
and local policies, programs. and operations will be made.
The Urban Mass Transportation Administration's Office of University Re-
search is sponsoring three university training programs the research components
of which will address "The Cost Functions of Public Transportation Systems
for the Elderly and Handicapped" (North Carolina A. & T. State University)
"Transportation Services for Special Social Groups with Mobility Limitations"
(Carnegie Mellon University) ; and "Transportation Problems of the Aged and
Handicapped: The Baton Rouge Experience" (Southern University).
UMTA's Office of Transit Planning is sponsoring a major national study entitled
"Research on the Transportation Problems of the Transportation Handicapped."
The objective of this study is to determine the travel requirements of various
classifications of handicapped persons of all ages and to develop and evaluate
transportation service alternatives for satisfying those requirements. The plan-
ning phase of study has been completed and the data collection and analysis
activities will be started in 1976.
UMTA's Office of Research and Development sponsors several projects that
pertain to the elderly and handicapped. The research is oriented towards identify-
ing the physical demands that use of public transportation makes upon the elderly
and handicapped and devising ways of ameliorating those physical demands.
In particular, the difficulties of changing from one level to another in a terminal
will have a high priority. Three specific programs merit special attention:
The UMTA Transbus program has progressed to the stage that three prototype
40-foot vehicles, which are specially equipped with experimental hardware to
board and unboard elderly and persons in wheelchairs, have been tested by users
in selected metropolitan areas throughout the country. The prototype testing is
expected to end in early 1976. and a performance specification for a level change
device (e.g., lift, ramp) will be developed if no unforeseen problems arise during
the testing period. The development of this performance specification will ac-
celerate the availability of a new generation of vehicles that are accessible to
elderly and handicapped persons. It is hoped that these vehicles will be available
in production quantities by 1979. Pending the development of workable per-
formance specifications and a substantial post-production performance period,
UMTA will determine whether to require that all buses purchased with UMTA
funds should conform to the specifications for a level-change device and a low
floor.
The objectives of the project entitled "Low Pollution Paratransit Vehicle." is
to develop a vehicle well-suited for use in paratransit. particularly in taxi
service. Two contracts provides for design and fabrication of one prototype
vehicle each that can transport up to five ambulatory passengers and that can
be modified easily to carry one wheelchair and two ambulatory passengers. These
vehicles are tentatively scheduled for limited public display in the summer of
1976.
A contract has been awarded for the "Small Bus Requirements. Concepts. and
Specifications" program. The purpose of the Small Bus Project is to: (1) examine
small bus operations and projected desired operations in the United States: (2)
establish needed and desired operating features for small buses: (3) determine
desirable features for accommodating the special needs of the elderly and
handicapped. including wheelchair travelers: (4) produce conceptual small bus
designs to meet the operating features: and (5) establish a performance standard
for a small bus suitable for mass transit service in the United States.
Other UMTA R&D Office activities involve: wheelchair access in current
bus design, impacts of fare collection methods on bus design, future paratransit
service requirements for wheelchair users and the elderly, subway station de-
sign and construction, wheelchair lifts for a modernized trolley (which UMTA
refers to as a Standard Light Rail Vehicle (SLRV)). and designs for an ad-
vanced concept train. The R&D Office's prototype transit system at Morgantown,
W. Va., will also Increase its accessibility to elderly and handicapped persons.
CAN - LINO PASSPORT 90
-4 Transportation Safety
Using a new vision tester previously built under a contract let by the National
Highway Traffic Safety Administration (NHTSA). researchers working under a
new contract in 1975 developed diagnostic procedures for detecting vision
problems of the elderly. They also identified treatment requirements for correct-
ing the vision problems.
In 1975, NHTSA distributed to driver licensing agencies of all the States
samples of a manual supplement on older drivers. This manual supplement is
specifically being tested in Virginia.
In 1976, NHTSA expects to support research (1) to develop licensing system
for older drivers, which will include an on-the-road performance test and
(2) to look at vehicle design factors which may not be compatible with the
capabilities of older drivers.
B. DEMONSTRATIONS
Under UMTA's Office of Transit Planning, Service and Methods Demonstra-
tions Division, approximately $1.6 million has been programmed to improve
transit service for the elderly and handicapped in fiscal years 1975 and 1976.
UMTA continues to support West Virginia's Transportation Remuneration
Incentive Program (TRIP) to improve transport services to the transit depend-
ent; principal UMTA program elements include detailed system design activities,
new service development, prototype demonstration designs, and TRIP evaluation.
Three new 1975 demonstration projects for the elderly and handicapped
have been initiated: (1) to test the viability and effectiveness of user subsidies
for the elderly and handicapped; (2) to start a large city transport service
that is coordinated with health and social service agencies: and (3) to conduct
a demonstration of a comprehensive transit-company operated, demand-responsive
special transport system for the elderly and handicapped in an urban area of
400,000 people. These demonstration projects will be conducted in Danville, Ill.;
Chicago, Ill.: and Portland. Oreg., respectively.
Over 300 applications requesting over $100 million in program funds were
submitted for the first round of project selection under the Rural Highway
Public Transportation Demonstration program established by section 147 of the
Federal-Aid Highway Act of 1973. Congress established the program as a 2-year
demonstration effort and appropriated $9.65 million for the first year and
recently appropriated $15 million for the second year.
In September 1975, the Department announced the preliminary selection of
45 projects in 31 States. These applicants are now complying with the public
hearing requirement and making project revisions, as appropriate. Flve of these
projects have received final approval from FHWA and UMTA, which are jointly
administering the program. The projects represent a variety of service strategies
including "dial-a-ride" systems, alternative vehicle types such as taxicabs,
small buses, school buses, and automobiles. Most projects will pool existing fund-
ing sources from various levels of government.
While this program is not designed to serve only the elderly, project selection
criteria are broadly defined to encourage a comprehensive, coordinated program
for all who have Inadequate transportation in the project area, including the
disproportionately high percentage of elderly people living in rural areas.
Projects must be designed and operated to allow use by the elderly and handi-
capped and, except for compelling reasons, projects purchasing rolling stock
must include at least one vehicle which can accommodate wheelchair-users.
Program regulations were reissued on January 21, 1976. to begin the second
round of project selection. We expect that almost twice as many projects will
be selected this year.
In developing this program, the Department has coordinated closely with
other Federal agencies, particularly the Administration on Aging in the De-
partment of Health, Education, and Welfare.
C. PLANNING
1. Urban Transportation
Under section 9 of the Urban Mass Transportation Act of 1964, as amended.
UMTA has provided financial and technical assistance to 258 metropolitan and
50 State agencies. A recent survey of the agencies revealed that approximately
85 percent have planning efforts underway for transportation improvements for
the elderly and handicapped.
2. Transportation Safety
Under the State and Community Highway Safety Program of the National
Highway Traffic Safety Administration, States are encouraged to plan and
execute their own projects to benefit the elderly using Federal, State, and local
funds. Broad Federal guidelines are provided to the States in the areas of
instructional programs, pedestrian safety programs, special course materials
FORD
for driver education instructors about the elderly, and driver simulators and
audiovisual aid infomation for the elderly.
1. Urban Transportation
GERALD
LIBRARY
D. CAPITAL ASSISTANCE
UMTA's primary funding sources for meeting the needs of elderly and handi-
capped persons are section 3 and 5 of the Urban Mass Transportation Act of
1964, as amended. Grants under this activity fund 80 percent of the cost of
buses and other capital equipment. The applicant for these grants is generally
a State or local body such as a city, county, or regional transit authority.
However, the public agency may. by lease or other arrangement, furnish a pri-
vate operator with Federal financial assistance.
CAN - LINO - 91
Grants are also made under section 16(b) (2), a supplement program which
assists private nonprofit organizations in the acquisition of capital equipment
for the provision of transportation service to the elderly and handicapped. Forty-
seven States, the District of Columbia, and Puerto Rico have availed themselves
in 1975 of more than $20 million in Federal funds on behalf of more than 1,000
private nonprofit organizations. The purchase of more than 2.300 special vehicles
for use by private nonprofit organizations has been approved under this pro-
gram. These vehicles have been or soon will be placed into service.
$22 million will be provided for the program in 1976. Revised procedures have
been developed to improve the quality of the applications and the efficiency of
program administration. Emphasis will be placed on State and local coordination
among transit and paratransit providers. Governors will continue to be asked
to designate a State agency, preferably a multimodal transportation agency,
to help UMTA manage the program at the State level.
UMTA expects to revise its procedures during 1976 for planning and capital
grant programs for nonurbanized areas. Elderly and handicapped residents in
small towns and rural areas are anticipated to be among the principal benefici-
aries of any resulting new services.
E. INTERAGENCY COOPERATION
The Department of Transportation (DOT) and the Administration on Aging
(AOA) have worked closely in the development of the report to Congress on the
state-of-the-art of transportation for the elderly. This report is required under
title IV, section 12, of the Older Americans Act.
DOT and AOA signed an expended working agreement in 1975 aimed at assur-
ing maximum coordination and mutual support for their programs. The agree-
ment sets forth the UMTA objective of providing capital grants and loans to
private nonprofit corporations and associations to assist them in meeting the
special transportation needs of the elderly and handicapped for whom mass
transportation services are otherwise unavailable, insufficient, or inappropriate.
From the standpoint of AOA, the agreement facilitates the implementation of
its programs by helping to provide transportation services for the elderly as part
of a coordinated comprehensive delivery system.
Regional offices of AOA, UMTA, and FHWA are working together on the
implementation of the Rural Highway Public Transportation Demonstration
program in order to improve the mobility of rural elderly persons. FHWA and
UMTA are providing AOA with a listing of all Rural Highway Public Transporta-
tion Demonstration projects funded for fiscal year 1975, in order that AOA might
inform regional, State, and area agencies on aging.
DOT has contributed staff and financial support to several conferences spon-
sored by the Transportation Research Board, the Florida State Department of
Human Resources, the Florida State University. and the Administration on
Aging, dealing with conventional and paratransit systems for elderly and
handicapped travelers.
DOT and AOA expect to sponsor one or more regional conferences in 1976, to
familiarize regional, State, and local agency personnel with the availability
and requirements of Federal grant programs providing transportation assist-
ance to elderly persons.
The Federal Railroad Administration is continuing to cooperate with Amtrak
in its efforts to upgrade its equipment and facilities to accommodate the
handicapped and elderly. Amtrak is utilizing handicapped and elderly persons
as advisors in the upgrading of its facilities and equipment.
ITEM 9. DEPARTMENT OF THE TREASURY
FEBRUABY 12. 1976.
DEAR MR. CHAIRMAN On behalf of the Secretary of the Treasury and myself,
I am furnishing you with a summary of Treasury activities benefiting the elderly
during 1975. Our efforts during 1976 will be largely along the same lines, although
we hope and expect to improve our programs. We are also continuing to make a
major effort to inform elderly taxpayers, and others, of their tax rights
and responsibilities, and to simplify our forms and instructions where possible.
If we can provide additional assistance to the committee, please call upon us.
With kind regards,
Sincerly,
DONALD C. ALEXANDER, Commissioner.
[Enclosure]
INTERNAL REVENUE SERVICE ACTIVITIES AFFECTING THE AGED
As in past years, the Internal Revenue Service was active during 1975 in
numerous activities directly associated with providing tax assistance for the
elderly. These activities inclued:
-Issued guidelines in our Taxpayer Service Division which included a re-
quirement for out-reach special emphasis programs for low-income and elderly
taxpayers.
-Visited senior citizen centers, nursing homes and other sites convenient to
elderly taxpayers in order to assist in tax return preparation.
-Emphasized tax problems of the elderly by providing special lessons in our
volunteer training program geared to the tax situations of older citizens
as a part of the Voluntary Income Tax Assistance (VITA) portion of our
Taxpayer Education program.
CAN-LINO-92
-Conducted a workshop, in conjunction with National Retired Teachers
Association and the American Association of Retired Persons, for senior
citizen instructors who, in turn. recruited and trained other volunteers in
the tax aid program for the elderly.
-Developed a system in cooperation with the Social Security Administration
(SSA) whereby publications describing tax benefits for the elderly are dis-
tributed through SSA local offices.
-Continued emphasis on securing first floor space or. alternatively, easy access
to elevators as an aid to handicapped and elderly citizens.
-Conducted "Retiree Income Tax Seminars" as part of our Overseas Tax-
payers Assistance Program designed to assist retirees and senior citizens
residing abroad with their U.S. tax obligations. The seminars consist of dis-
cussions of tax laws and forms applicable to this specific taxpaying group.
The discussions are followed by an exercise in the preparation of a return
under the guidance and assistance of a Tax Assistor.
-Worked through our Revenue Ruling projects to ensure that groups claim-
ing nonprofit status to qualify as charitable organizations and offering serv-
ices to the elderly (e.g., counseling services. specialized recreation for the
elderly. rest homes, etc.) were indeed qualified under the law.
-Administration of the provisions of the Internal Revenue Code of 1954
relating to the qualification and operation of retirement plans. The emphasis
has been squarely on the protection of retirement benefits for both rank-
and-file employees and retirees.
-Establishment of a procedure to permit the participation of "former" em.
ployees," as interested parties, in the determination as to whether certain
retirement plan amendments or retirement plan terminations affect the con-
tinuing qualification of the plan.
-Assistance by Employee Plans Specialists in answering questions relating
to retirement programs and the tax benefits available.
-Assistance in the publication of two Internal Revenue Service publications,
"Tax Information on Pension and Annuity Income" and "Tax Information on
Individual Retirement Savings Programs."
-Prepared and issued a Technical Information Release (TIR) containing a
series of questions and answers to provide guidelines for applying the newly
amended sick-pay regulations. This TIR would be of interest to disability
retirees, both before and after their mandatory retirement ages.
-Directed informational materials via our Public Affairs Office to older Amer-
icans with the following as major points of emphasis:
A. Special tax advantages available to taxpayers over age 65; for example,
the additional personal exemptions the tax break in the sale of a residence,
and the availability of a retirement income credit for those qualifying;
B. A 1974 IRS ruling permitting disability retirees to exclude up to $100
a
week of income as sick pay until reaching mandatory retirement age;
C. The availability of special Form W-4P for use by retirees having in-
come tax withheld from their pensions;
D. The necessity for many part-time workers. including retirees, who
have taxes withheld during the year but had no tax liability, to file a tax
return to obtain a refund:
E. The services provided by the IRS-sanctioned Voluntary Income Tax
Assistance Program (VITA), a tax aide volunteer program focusing on the
elderly and retired.
In 1976 our plans will cover the following activities:
-Continue Retiree Seminars (eight are currently scheduled) to assist senior
citizens residing abroad with their U.S. tax obligations.
-Scheduled a workshop similar to that held in 1975 for National Retired
Teachers Association and the American Association of Retired Persons
volunteers.
-Require that all employees who will be performing tax assistance work
during the 1976 filing period complete a lesson during Refresher Training
on tax issues for the elderly.
-Continue to direct information to the elderly via our Public Affairs Office
including appropriate messages or themes from last year as well as some
newer ones. For example:
A. Special tax advantages available to taxpayers over age 65 (additional
personal exemption, tax break in the sale of a residence, and availability
of retirement income credit for those qualifying) use of Form W-4P. tax
assistance, necessity for many part-time workers to file to obtain a refund,
and sick pay exclusion available to ceratin retirees;
B. Computation by the IRS of the retirement income credit;
C. Special $50 payment made to Social Security beneficiaries in 1975 is
non-taxable
D. Individuals claiming extra exemption because of blindness or age
may claim only one special $30 personal exemption;
E. Availability of tax help through the VITA program;
F. Availability of several free IRS publications geared to the tax rights
and responsibilities of Older Americans; especially the comprehensive IRS
Publication 554, "Tax Benefits for Older Americans."
G. Handling of Medicare premiums and payments as they relate to medical
deductions;
H. Liberal filing requirements as they relate to persons age 65 or older.
CAN - LINO - 93
BUREAU OF GOVERNMENT FINANCIAL OPERATIONS
ACTIVITIES AFFECTING THE AGED
Treasury's Direct Deposit Program for social security payments was imple-
mented nationwide during 1975. Social security beneficiaries may receive their
monthly payments by automatic credit to their accounts in financial institutions.
This new system virtually eliminates loss, theft. forgery, and delays in receiving
credit when the beneficiary is away from home. This same service will be made
available to recipients of civil service retirement payments during 1976, and
subsequently to other categories of elderly payees.
ITEM 10. ACTION
FEBRUARY 24, 1976.
DEAR MR. CHAIRMAN: In response to your request of December 30, 1975, I
am enclosing a report summarizing ACTION's activities for Older Americans
during 1975.
As you know, the SCORE/ACE programs have been transferred to the Small
Business Administration, and thus are omitted from the enclosed report.
Please let me know if additional information is needed on any of our volunteer
programs.
Sincerely,
WILLIAM B. PRENDERGAST.
Assistant Director for Congressional Affairs.
[Enclosure]
DOMESTIC VOLUNTEER PROGRAMS
FOSTER GRANDPARENT PROGRAM (FGP)
The foster grandparent program (FGP) provides opportunities for low-income
persons, age 60 and over, to offer supportive person-to-person volunteer services
in health, education, welfare. and related settings to children with special needs.
The program was originally developed as a cooperative effort between the
Office of Economic Opportunity and the Department of Health, Education, and
Welfare (Administration on Aging). It was given a legislative basis in 1969
under title VI, part B, of the Older Americans Act of 1965, as amended. In
July 1971, the program was transferred to ACTION in accordance with Executive
Reorganization Plan No. 1. Current authorizing legislation is title II, part B
of Public Law 93-113, the Domestic Volunteer Service Act of 1973, as amended.
The foster grandparent program is designed to meet the needs of two groups:
low-income older Americans and children with physical, mental, social. or emo-
tional health needs. This activity is intended to enable older persons to main-
tain a sense of personal growth and self-growth, to enrich social contacts and
retain physical and mental alertness. Foster grandparents do not displace salaried
staff, but complement staff care to special children with the love and personal
concern essential to their well-being.
ACTION grants to support the operation of foster grandparent programs are
awarded to public or private nonprofit agencies and organizations other than
progam settings in which foster grandparents serve. These settings where foster
grandparents serve include correctional facilities, pediatric wards of general
hospitals, schools. day care centers. private homes. and institutions for mentally
retarded, physically handicapped, emotionally disturbed, and dependent and
neglected children. Foster grandparents serve 4 hours a day, 5 days a week, and
receive a small stipend for their service. They are also reimbursed for. or
provided with, transportation and, where possible, a nutritious meal daily. They
are covered by accident insurance and receive annual physical examinations.
An orientation and in-service training program is provided. and through the
professional staff of each project. foster grandparents receive counseling on
personal matters and information and referral services.
In fiscal year 1975, with an appropriation slightly over $28 million, the foster
grandparent program grew to a strength of 13.627 volunteers serving approxi-
mately 34,000 children daily. During fiscal year 1976 ACTION expects the program
to experience further growth at a modest rate.
Washington, D.C., was selected as the site for the 10th anniversary celebration
of FGP in September 1975. Several hundred foster grandparents and most of
the 156 project directors gathered on September 10. 11, and 12 for this purpose.
Highlighting the celebration was a White House presentation by the President
to 20 10-year foster grandparents representing the first 20 projects funded in
1965. These 20 foster grandparents represented the 178 foster grandparents
who have served since the beginning of the program. The President presented
a plaque to each of the 20, telling them that the foster grandparent program
"is one program that I am familiar with that everybody is for and, as far as I
know, no one is against."
The essence of the President's remark is depicted by the foster grandparents
themselves. More than 90 percent of the foster grandparents surveyed recently
(1972) expressed improved satisfaction with life, improved feeling of useful-
ness to others, improved happiness and less financial worry. Three-quarters
of those surveyed stated that their affiliation with the program is one of the
most important events to occur within the past 5 years of their lives. A 1975
survey by ACTION corroborates these happy findings.
In many instances the foster grandparent program offers to the children
served an opportunity to participate more fully in the activities and joys of
life. In one case a foster grandparent was assigned to a child suffering from
CAN-LINO-94
near deafness and blindness who was classified as mentally retarded. Through
the efforts of the foster grandparent and a psychologist at the State hospital
where the child resided, it was determined that the child was not a retardate.
He is now in a regular school and is studying Braille. Another foster grand-
parent was assigned to a child who had never spoken. The grandparent sang
to the child and encouraged her to sing, eventually getting her to articulate
single words. Today the girl can talk and sing simple lullabies. Still another.
foster grandparent, assigned to a male child suffering from starvation due to
his refusal to eat, brought fruit to the boy daily and spoke to him in his native
tongue (Spanish). The boy responded and gained 14 pounds after a few months
with his "grandpa." Doctors in the pediatric ward of a large hospital report
that the foster grandparents assigned to babies diagnosed as failure-to-thrive,
through the grandparents love and tender handling. have helped the babies to
eat and thus increased their chances of survival. Numerous other examples
attest to the ability of the foster grandparents to train the "untrainable" and
give reason for hope to the "hopeless."
The foster grandparent program has provided many insights into the potential
utilization of the elderly in community settings by demonstrating that older
persons have the talent. skills, experience, and desire to serve their commu-
nities. This desire to serve was expressed repeatedly by older persons at the
1971 White House Conference on Aging. The conference section on Retirement
Roles and Activities established this need as a national priority.
SENIOR COMPANION PROGRAM (SCP)
The purpose of the senior companion program is to provide meaningful oppor-
tunities for low-income persons, age 60 and over, to offer person-to-person sup-
portive vices to adults, especially older persons. living in their own homes
and in residential and nonresidential group care facilities.
The senior companion program, an Older American Community Services Pro-
gram, was originally authorized under title VI, part V, of the Older Americans
Comprehensive Services Amendments of 1973. Current authorizing legislation
is title II, part B. of Public Law 93-113, the Domestic Volunteer Service Act
of 1973. as amended.
The senior companion program became operational in fiscal year 1974 and
there are now 18 projects established nationwide with 1,026 federally funded
senior companions as of December 31, 1975.
The senior companion program. like the foster grandparent program. primarily
benefits low-income older persons. It provides them with opportunities through
volunteer service to maintain a sense of self-worth. retain physical and mental
alertness. and enrich social contacts. Additionally, the program's provision of a
stipend and other direct benefits enable them to partially overcome the combined
hardships of poverty and old age.
ACTION grants to support the operation of senior companion projects are
awarded to public and private nonprofit agencies and organizations. Volunteer-
stations where senior companions serve include hospitals, nursing homes, in-
termediate care facilities or homes for the aged, and various health, welfare or
related settings in a community through which senior companions are assigned
to assist other persons, especially older persons, to remain in their own home
or familiar surroundings.
Senior companions serve 4 hours a day, 5 days a week, and receive a small
stipend for their service. They are also reimbursed for, or provided with, trans-
portation and, where possible, a nutritious meal daily. They are covered by acci-
dent insurance and receive annual physical examinations. An orientation and
inservice training program is provided; and through the professional staff of each
project, senior companions receive counseling on personal matters and infor-
mation and referral services.
In fiscal year 1975 ACTION awarded continuation grants totalling $1.6 million
to maintain the 18 pilot projects to support the services of approximately 1,000
senior companions who, in turn. are serving approximately 3,000 to 4,000 adults.
The persons served are primarily older persons with special needs with a focus
on providing services to them in their own homes in an effort to delay or prevent
institutionalization. By the end of the fiscal year 1976, including the transition
quarter, ACTION expects the senior companion program to reach a strength of
approximately 1,500 volunteers serving in 35 or more local projects.
RETIRED SENIOR VOLUNTEER PROGRAM (RSVP)
The purpose of the retired senior volunteer program is to develop a recognized
role in the community and a meaningful life in retirement for older adults
through significant volunteer service.
Originally authorized under the Older Americans Act Amendments of 1969,
RSVP became operational in 1971 when the Department of Health, Education,
and Welfare (Administration on Aging) funded 11 pilot projects. In July 1971
the program was transferred to ACTION in accordance with Executive Reorgan-
ization Plan No. 1. Current authorizing legislation is title II, part A of Public
Law 93-113. the Domestic Volunteer Service Act of 1973, as amended.
ACTION grants are awarded to local public agencies and nonprofit private
organizations to support the development and operation of RSVP's, providing
volunteer opportunities for persons 60 years of age and over. Either transporta-
tion, or assistance with the costs of transportation, is provided between the homes
of senior volunteers and their volunteer stations. Accident and public liability
insurance are provided for all RSVP volunteers.
As an inherently local program, each RSVP is locally planned, operated, con-
trolled. and supported. Federal funding is provided on an annually decreasing
basis for the first 5 years of a local project's operation. According to legislation
CAN - LINO - 95
enacted July 12, 1974 (Public Law 93-351 amending section 201 of Public Law
93-113), sponsors are generally expected to provide 10 percent of the cost of
the project in the first year of operation, 20 percent in the second. 30 percent in
the third, 40 percent in the fourth, and 50 percent in the fifth and subsequent
years. Exceptions to this requirement may be granted by ACTION in individual
cases of demonstrated need.
Retired senior volunteer programs encourage organizations and agencies to
develop a wide variety of volunteer opportunities for retired persons. The focal
point of RSVP activity is the needs and interests of the senior volunteer, and vol-
unteer opportunities are arranged to match his interests, abilities and physical
capacities. Orientation or instruction for volunteer assignments may be pro-
vided. Older adults, including the isolated elderly, are sought out and actively
encouraged to contribute their time and experience in service to their communi-
ties. Handicapped older persons are included in the ranks of senior volunteers:
special arrangements to facilitate their service are made when necessary. There
are no income. education, or experience requirements for a retired person to be-
come a senior volunteer.
Special assignments arranged for senior volunteers offered varied opportuni-
ties to serve people of all ages. Assignments are made to publicly owned and op-
erated facilities or projects, and to local programs sponsored by private nonprofit
organizations. Examples are schools. courts, libraries. museums, hospitals,
nursing homes, day care centers, institutions, and programs for shut-ins.
In the last 4 years the retired senior volunteer program has experienced truly
dramatic growth. In the latter 6 months of fiscal year 1973 alone, the program
more than doubled in size to total 590 local RSVP's. These programs are located
in all 50 States, Puerto Rico, the Virgin Islands, and the District of Columbia. Al-
most 65,000 senior volunteers were in service by the close of fiscal year 1974 at
which time project strength had increased to 666. That approximate number of
projects was maintained during fiscal year 1975, while the number of volun-
teers continued to increase to 149,602 by June 30. The latest count available, as
of September 30. 1975, showed over 162,000 RSVP volunteers in service.
In December 1973, E. F. Shelly and Co., Inc., completed a study of the retired
senior volunteer program. The study identified benefits derived from participation
in RSVP by both senior volunteers and volunteer stations. Nearly three-fourths
of volunteer stations included in the study indicated that senior volunteers pro-
vided a valuable supplement to their staff, and nearly two-thirds stated that
they would be forced to cut services or activities in the absence of senior
volunteers.
More than half of the senior volunteers included in the study indicated that
they felt better physically, and nearly four-fifths stated they felt better mentally,
due to their volunteer experience. In addition, study data indicated that a ma-
jority of senior volunteers live alone and had little or no previous volunteer
experience. They therefore experience an increase in community involvement and
a reduction in isolation as a result of RSVP.
Numerous examples illustrate the value of the contributions of senior volun-
teers to their communities. A nurse writes: "All of the senior volunteers' achieve-
ments and contributions aid us in promoting the effectiveness and operation of
our hospital in a more advantageous manner." The director of education at a
State correctional school writes: "Three of our former students were all
tutored by RSVP volunteers and the three all said they would not have finished
high school or passed the high school equivalency test without this help." The
director of two day care centers writes: "Because of the senior citizens, we have
been able to provide an additional area of enrichment for our children in the
centers." And the managing attorney of a legal services program writes: "Be-
cause of the RSVP volunteers
and the competent and gracious assistance
they are giving to us, we are able to serve a much larger number of clients in a
much more professional atmosphere than would ever be possible in their absence."
Countless other examples affirm that senior volunteers are serving their com-
munities, and serving them well. in a variety of volunteer activities.
A major thrust of the program in fiscal year 1976 is to place many additional
senior volunteers in public schools, in connection with the Nation's Bicentennial
observance, to pass on to the youth in the schools the volunteers' personal experi-
ences in the development of our national heritage.
VOLUNTEERS IN SERVICE TO AMERICA (VISTA)
Volunteers in service to America (VISTA) was originally authorized under
title VIII, section 801, of the Economic Opportunity Act of 1964. as amended.
The program was transferred to ACTION in July 1971. It is now authorized
under title I, part A, section 101 of the Domestic Volunteer Service Act of
1973.
In fiscal year 1975 approximately 19 percent of all VISTA volunteers worked
on projects geared specifically toward services to older people, according to a
January 1976 survey of volunteer activities. Many other VISTA projects, though
not directed solely toward the elderly, impact significantly on the problems of
the aged.
Other arts programs for senior citizens supported by the Endowment in fiscal
receiving benefits include health-related services such as food and nutrition.
housing. legal services, welfare assistance and referral services.
Approximately 10 percent of the VISTA volunteers as of January 1, 1976 are
55 years of age and older. The breakdown is as follows:
55 to 59
102
60 to 64
94
65 to 69
119
70
45
Over 70
64
Total
424
CAN - LINO - 96
These older volunteers work in a variety of programs across the VISTA spec-
trum. We anticipate approximately the same effort for fiscal year 1976.
INTERNATIONAL OPERATIONS
While the Peace Corps is not designed to impact upon the aging in the United
States, its mission overseas provides some unique opportunities for the older
American. During its recent past, there have been changes in the degree of skill
required for overseas service. The older person in our society is more likely to
have the type and level of skill needed by many of the countries in which we op-
erate, and therefore, we pay particular attention to that group in our recruiting
efforts.
Our most recent figures as of December 1. 1975 indicate that almost 4 percent of
our volunteers and trainees are over age 50. The specific figures follow:
50 to 59
143
,60 to 69
113
70 to 80
5
Total
261
ITEM 12. CIVIL SERVICE COMMISSION
FEBRUARY 27, 1976.
DEAR MR. CHAIRMAN This is in response to your letter of December 30, 1975,
requesting a paper summarizing our major 1975 activities on aging.
Our report on these activities is enclosed under the title "Major 1975 Activities
of the Civil Service Commission Affecting Rights and Benefits of Older Ameri-
cans." Related efforts in 1976 will continue to focus on assuring nondiscrimina-
tion on account of age in Federal employment and providing the services and as-
sistance related to administration of the Civil Service Retirement System and
the Retired Federal Employees Health Benefits Program.
We are happy to provide this report and hope it will be useful to the Special
Committee. Please let us know if any other information is needed.
Sincerely yours,
RAYMOND Jacobson, Executive Director.
[Enclosure]
MAJOR 1975 ACTIVITIES OF THE CIVIL SERVICE COMMISSION
AFFECTING RIGHTS AND BENEFITS OF OLDER AMERICANS
AGE DISCRIMINATION IN EMPLOYMENT ACT (ADEA) PROGRAM
Section 15 of the Age Discrimination in Employment Act of 1967, as amended in
1974. is. entitled "Nondiscrimination on Account of Age in Federal Government
Employment." It authorities the Civil Service Commission to administer and en-
force Age Discrimination in Employment Act (ADEA) provisions applicable to
the Federal employment sector. Our activities to implement the ADEA as a new
regulatory program area, administered primarily in conjunction with equal em-
ployment opportunity (EEO) activities, were covered in our report to the Com-
mittee last year. Now, we have also received and reviewed reports from most of
the Federal agencies covered by ADEA section 15, indicating the steps they have
taken to provide for a continuing program to assure nondiscrimination on account
of age under the law and implementing Civil Service Commission regulations.
In our last report to the committee, we indicated that a major change instituted
under the ADEA was the extension to Federal employees and applicants who are
age 40 to less than 65 of the full benefits of administrative procedures in the dis-
crimination complaints system which had already been established under the
Commission's EEO regulations to process complaints of discrimination based on
other prohibited factors. During fiscal year 1975, 10.4 percent of all discrimina-
tion complaints filed Governmentwide were age discrimination complaints.
Our data program for regular provision of age-related statistics on Federal
employment is still in development stages. However, we now have some data for
initial analysis and reporting purposes, and we are beginning to develop a data
base (with 1974 as the starting year) which should become more useful and
meaningful in subsequent years. Attached are tables reflecting basic information
on the (1) age distribution of the Federal "white collar" work force and (2) com-
parative age breakdowns for the Federal work force and the total civilian work
force of the Nation.
CIVIL SERVICE ANNUITANTS
Pursuant to 5 USC 8340(b), annuities payable under the Civil Service Retire-
ment Act were increased twice, by 7.3 percent effective January 1, 1975. and by
5.1 percent effective August 1, 1975. This section of the retirement law serves to
maintain the purchasing power of civil service annuitants by authorizing the auto-
matic adjustment of civil service annuities when the cost of living nationwide
rises at least 3 percent and remains up for three consecutive months.
Implementation of Public Law 93-647 (enacted January 4, 1975) resulted in
the provision for garnishment of civil service annuities when a court-ordered
garnishment is based upon an obligation to pay child support, alimony, or sepa-
rate maintenance.
CAN INSURANCE LINO - 97
Public Law 94-126 (enacted November 12, 1975) retroactively grants full re-
tirement credit to National Guard Technicians for pre-1969 technician service.
This law applies to any technician serving as such on or after January 1, 1960 in
a position covered by civil service retirement. The original National Guard Tech-
nicians Act of 1968. (Public Law 90-486) granted Federal employee status as of
January 1, 1969. to individuals serving as technicians on or after that date: credit
for annuity computation purposes for pre-1969 technician service was limited to 55
percent. The new law retroactively removes the 55 percent limit on credit for
pre-1969 technician service.
Public Law 94-166 (enacted December 23. 1975) will permit allotment or assign-
ment of payments from annuities for such things as savings bonds, union dues,
etc.
As a result of Public Law 94-170 (enacted December 23, 1975) the Civil Service
Commission has increased the monthly annuity of widows of deceased employees
of the Lighthouse Service. Prior to enactment of the law, widows received $174;
the monthly annuity is now increased to $200. The increase is effective January 1,
1976.
LIBERALIZED RETIREMENT OPPORTUNITY
Utilizing the flexibility of current regulations, the Commission has made known
to agency heads the possibility of providing trial and/or gradual retirement op-
tions for retiring employees. (Trial retirement is a period of separation by op-
tional retirement with guaranteed reemployment rights. generally within one
year, for those employees who wish to test the adjustment to retirement. Gradual
retirement refers to a reduction in the number of hours worked or in the more
demanding duties of the job in order to provide an on-the-job adjustment for em-
ployees six months to two years preceding retirement.)
While the Commission neither advocates nor opposes these programs, it is mak-
ing efforts to see that agencies which wish to consider them are familiar with
these programs. Data from our most recent study of agency use of these two op-
tions show that eleven agencies had active trial retirement programs and seven
offered gradual retirement to their employees. Agencies report that these options
have served as a means of relieving some of the tension experienced by those fac-
ing the uncertainties of retirement.
HEALTH BENEFIT IMPROVEMENTS
Iniplementation of a portion of Public Law 93-246 (enacted January 31. 1974)
dealt with review of disputed health benefit claims under the Federal Employees
Health Benefits Program. The Commission issued regulations and began accept-
ing appeals from Federal employees and annuitants who have contested the car-
rier's settlement of a health benefits claim, effective January 1, 1975.
Public Law 94-182 (enacted December 31. 1975) repeals a section of the Social
Security Act pertaining to the relationship between Medicare and the Federal
Employees Health Benefits Program. The section which was repealed required a
change in coordination between Medicare and FEHBP which would have signi-
ficantly raised the rates which most Federal retirees and employees would be re-
quired to pay for their health benefits.
COMMISSION PARTICIPATION WITH GROUPS ON AGING
The Commission continued to participate in activities dealing with problems of
older Americans. In cooperation with the Administration on Aging. for instance,
the Commission signed an agreement to make available certain information and
referral services in the Commission's nationwide Job Information Center network
primarily for the use of older Americans.
AGE DISTRIBUTION WITHIN GRADE GROUP FOR GENERAL SCHEDULE EMPLOYEES, 19741
Percent
Percent
Percent
under 40
40 64
65 plus
Total
GS 1-4
62.4
36.6
1.0
100
Number
(173,741)
(101,696)
(2,764)
(278,201)
GS
47.3
51.7
1.0
100
Number
(194,172)
(212,601)
(4,223)
(410,996)
GS 9-11
40.3
58.7
1.0
100
Number
(118,718)
(173,019)
(2,974)
(294,711)
GS 12-13
35.1
62.8
1.1
100
Number
(86,075)
(149,601)
(2,581)
(238,257)
GS 14-15
19.3
79.1
1.6
100
Number
(14,197)
(58,017)
(1,175)
(73,389)
GS 16-18
10.7
86.8
2.5
100
Number
(531)
(4,300)
(121)
(4,952)
I Data are from the central personnel data fb (CPDF) for December 1974. Percentages were forced to add to 100.
The general schedule pay plan covers professional, administrative, technical, clerical, and other "white collar" occupa-
tions in the Federal Government, and accounts for over 70 percent of all nonpostal Federal employment,
CAN LINO - 98
AGE DISTRIBUTION OF FEDERAL EMPLOYEES, ALL EMPLOYED PERSONS, AND U.S. CIVILIAN LABOR FORCE 197 4
Federal employees
Employed persons 2
Civilian labor force
Age
Percent
Number
Percent
Number
Percent
Number
Under 40
40.0
948,113
55.3
47,493,000
56.5
51,394,000
40 to 64
58.8
1,392,787
41.4
35,622,000
40.3
36,696.000
65 plus
1.2
29,067
3.3
2,821,000
3.2
2,921,000
Total
100.0
2,369,967
100.0
85,936,000
100.0
91,011,000
1 Data are from the central personnel data file (December 1974) and include all Federal civilian employees.
2 Data are from "Employment and Earnings" (published by the Bureau of Labor Statistics, January 1975) and include a II
civilians in the employed U.S. labor force, 16 yr of age and older.
3 Data are from "Employment and Earnings' (published by the Bureau of Labor Statistics, January 1975) and include
all civilians in the U.S. labor force, 16 yr of age and older.
ITEM 14. COMPTROLLER GENERAL OF THE UNITED STATES
FEBRUARY 23, 1976.
DEAR MR. CHAIRMAN This is in response to your December 30, 1975, request
for information on our major activities concerned in one way or another with
aging. We are enclosing a listing of reports issued since January 1, 1975, on
reviews of Federal programs which either directly or indirectly impact on the
elderly population (enclosure I). We have also included a listing of jobs in
process which concern the elderly (enclosure II). Copies of the issued reports
are being provided to your office separately. A summary of the major findings
and conclusions for each report is included either in a digest bound in the report
or in the letter transmitting it. We are also enclosing a statement on the Gen-
eral Accounting Office's "in-house" activities for the elderly (enclosure III).
In addition. the General Accounting Office testified before the Select Com-
mittee on Aging, House of Representatives, in December 1975, on problems asso-
ciated with the identification of Federal outlays affecting the elderly. A copy
of the hearing will be included with the issued reports being provided to your
office separately.
Sincerely yours,
R. F. KELLER,
Deputy Comptroller General of the United States.
[Enclosures]
Enclosure I.-General Accounting Office issued reports which directly or
indirectly impact on the elderly population
Title
Date
Report to the Congress on National Rural Development Efforts
and the Impact of Federal Programs on a 12-County Rural
Area in South Dakota (RED-75-288)
Jan. 8, 1975,
Report to the Congress on Housing for the Elderly-Factors
Which Should Be Evaluated Before Deciding on Low- or
High-Rise Construction (RED-75-308)
Jan. 9, 1975.
Letter to the Chairman, Civil Service Commission. on Use of
Extended Sick Leave in Conjunction with Optional Retire-
ment (B-152073)
Feb. 3, 1975,
Letter to the Commissioner, Administration on Aging, on Re-
view of Certain Provisions of Title III of the Older Ameri-
cans Act of 1965, as Amended (MWD-75-57)
Feb. 4, 1975,
Report to the Congress on Local Housing Authorities Can
Improve Their Operations and Reduce Dependence on Oper-
ating Subsidies (RED-75-321)
Feb. 11, 1975.
Report to the Congress on Observations on the Food Stamp
Program (RED-75-342)
Feb. 28, 1975.
Report to the Congress on Many Medicare and Medicaid Nurs-
ing Homes Do Not Meet Federal Fire Safety Requirements
(MWD-75-46)
Mar. 18, 1975.
Report to the Secretary, HEW, on Lengthy Delays in Proc-
essing of Overpayments Under Part A of the Medicare Pro-
gram May Result in Losses of Millions of Dollars (TCD-
75-4)
Apr. 4, 1975.
Report to the Subcommittee on Health, Committee on Finance,
United States Senate. on Improvements Needed in Medicaid
Program Management Including Investigations of Suspected
Fraud and Abuse (MWD-75-74)
Apr. 14, 1975.
Report to the Congress on a Proposal for Disclosure of Con-
tractual and Financial Arrangements Between Hospitals and
Members of Their Governing Boards and Hospitals and Their
Medical Specialists (MWD-75-73)
Apr. 30, 1975.
Letter to the Secretary. HEW, on Need for Closer Monitoring
by the Social and Rehabilitation Service of State Reim-
bursements of Hospitals for Inpatient Services Furnished
Under Medicaid (MWD-75-78)
May 9, 1975.
Letter to a Regional SRS Commissioner on Medicaid Overbill-
ings by Health Centers (No report number)
June 4, 1975.
Report to the Congress on Outpatient Health Care in Inner
Cities: Its Users, Services, and Problems (MWD-75-81)
June 6, 1975.
Letter to Special Committee on Aging. United States Senate,
on an Interim Report on Study of Area Agencies on Aging
CAN - LINO - 99
(MWD-75-95)
June 18, 1975.
Letter to a Regional SRS Commissioner on Delays in Trans-
ferring Medicare and Medicaid Patients (No report num-
ber)
July 3, 1975.
Report to the Congress on Further Action Needed to Make All
Public Buildings Accessible to the Physically Handicapped
(FPCD-75-166)
July 15, 1975.
Report to Representative Lester L. Wolff on Financial Prob-
lems Confronting the Federal Old-Age and Survivors Insur-
ance and Disability Insurance Trust Funds (MWD-75-105)
July 25, 1975.
Report to Representative Elizabeth Holtzman on Effect of Cer-
tain Policies and Procedures of Blue Cross and Blue Shield
of Greater New York on Reasonable Charge Reductions
Under Part B of Medicare (MWD-76-12)
Aug. 1, 1975.
Report to the Committee on Post Office and Civil Service, House
of Representatives, on Proposed Coordination Between the
Medicare and the Federal Employees Health Benefits Pro-
grams (MWD-75-99)
Aug. 4, 1975.
Letter to the Speaker of the House and President of the
Senate, on Information on an Unreported Impoundment of
Budget Authority for the Housing for the Elderly or Hand-
icapped Program (ACG-76-4)
Aug. 6, 1975.
Report to the Secretary, HEW, on Increased Compliance
Needed With Nursing Home Health and Safety Standards
(MWD-76-8)
Aug. 18, 1975.
Report to Representative Donald M. Frazer on Certain Disa-
bility Provisions of Federal Programs (FPCD-76-13)
Aug. 19, 1975.
Report to the Senate Committee on Finance on Deficiencies in
Determining Payments to Prepaid Health Plans Under Cali-
fornia's Medicaid Program (MWD-76-15)
Aug. 29, 1975.
Letter to Representative Edward I. Koch on The National
Home Health Care Act of 1975 (MWD-76-30)
Sept. 17, 1975.
Letter to Representative Edward I. Koch on Comments on H.R.
4772-The National Home Health Care Act of 1975 (B-164031
(3))
Sept. 19, 1975.
Report to the House Committee on Ways and Means on Per-
formance of the Social Security Administration Compared
With That of Private Fiscal Intermediaries in Dealing With
Institutional Providers of Medicare Services (MWD-76-7).
Sept. 30, 1975.
Report to Representative Cardiss Collins on Need for More
Uniform Application of the Presumptive Disability Provi-
sion of the Supplemental Security Income Program (MWD-
76-2)
Oct. 16, 1975.
Letter to the Secretary. HEW. on Selective Tests of the Eligi-
bility of Medically Needy People for Whom Payments Were
Made Under Medicaid (MWD-76-45)
Oct. 17, 1975.
Letter to the Administrator of Veterans Affairs on Need for
Action to Prevent Potential Overpayments of More Than
$90,000 to Community Nursing Homes in Pennsylvania
(MWD-76-50)
Oct. 24, 1975.
Letter to Senators Adlai E. Stevenson and Charles H. Percy on
Response to Allegations of Efforts By State Officials to With-
hold Information and Generally Impede GAO's Review of
the Illinois Medicaid Program (B-164031(3))
Dec. 8, 1975.
Letter to the Secretary, HEW, on Review of the Desirability
and Feasibility of a Disability Recall and Reassessment Pro-
gram (MWD-76-S2)
Jan. 22, 1976.
Enclosure II.-General Accounting Office jobs in process
which concern the elderly
Class History of the Medicare and Medicaid Programs and Efforts to Control
These Costs; 1966-1975.*
:
*Being performed at the request of committees or individual Members of Congress.
Improvements Needed in the Management of Patient Funds Maintained by
Skilled Nursing Homes and Intermediate Care Facilities.*
review of Skilled Nursing Facilities Costs.
Review of Deinstitutionalization of the Mentally Disabled.
Review of ACTION's Progress Toward Meeting the Goals of Its Establishment.
Impact of Hospital Insurance Benefit Structure on Medicare Operations and
Costs.
Review of the Way That Independent Laboratories Are Regulated and Reim-
bursed Under Four Federally Funded Health Programs.
Review of Eligibility of Persons Converted From State Disability Roles to the
Supplemental Security Income Program.
Survey of Administration of Income and Resource Criteria.
Survey of the Complexities in Administering and Financing Supplemental
Security Income Benefits.
Survey of Supplemental Security Income Client Contact Problems.
Survey of Erroneous Payments to Supplemental Security Income Beneficiaries.
Survey of Problems Resulting From Interface Between Supplemental Security
Income and Other Benefit Programs.
Survey of the Implementation of the 1972 Medicare Amendments.
Review of the Veterans Administration Contract Nursing Home Program on
CAN INVOICE LINO - 100
Limiting the Length of Stay for Non-Service Veterans to Six Months.
Survey of the Impact of Federal Programs on the Elderly.
Study of Area Agencies on Aging.*
*Being performed at the request of committees or individual Members of Congress.
Review of Civil Service Disability Retirements.
Review of Project to Return Unclaimed Retirement Benefits to Former Federal
Employees.
Review of Cost-of-Living Adjustments for Retired Federal Employees.
Follow-up Review of Military Retirement and Related Pay and Other Benefits.
Enclosure III.-General Accounting Office's internal activities for the elderly
The increased emphasis placed on equal opportunity principles regardless of
age, as exemplified by the Age Discrimination In Employment Act, is reflected
in GAO's personnel policies. A GAO order on merit promotion was recently pub-
lished and requires that all staff selections be determined strictly on the basis
of merit principles without discriminatory consideration of age and other non-
merit factors. Our recruiting staff informs applicants for employment of the
prohibition against age discrimination and provides literature on the subject.
The topic is covered in our orientation and other training activities.
GAO actively recruits qualified personnel, regardless of age. This is especially
true in hiring for upper-level positions.
Our policy also provides that training not be restricted to the younger employee.
This policy has resulted in many of our older employees receiving training to
increase their effectiveness and opportunities for further advancement. Addi-
tionally, the Office recognizes the importance of dealing with the older employee
and includes this topic in its "in-house" courses on supervision.
The Employees Health Maintenance Examination. a comprehensive and pro-
fessional medical examination. has been available for several years at no charge
to GAO employees who are 40 years and older and who are in grades GS-11 and
above. Beginning in March or April 1976, coverage of this benefit will be extended
to all employees 40 years of age and older, regardless of grade level.
Individual preretirement counseling is available to all employees of the Office
who are approaching retirement age. A daylong preretirement conference is held
periodically. dealing with topics of annuities, life insurance, medicare and other
health benefits, social security, etc. Announcements of the availability of the
conference, counseling. and other topics of special interest to the older employee
are regularly published through memorandums and in the GAO Employees Asso-
esiation monthly newspaper, "The Watchdog" which is available to retirees at
reduced rates.
The employees of GAO are aware of the Equal Employment Opportunity chan-
nels for filing complaints of alleged discrimination because of age provided by
law and implementing Civil Service Commission regulations since July 1974. Our
Equal Employment Opportunity Office has been providing counseling in the area
of age discrimination for approximately 30 months.
ITEM 15. CONSUMER PRODUCT SAFETY COMMISSION
FEBRUARY 25, 1976.
DEAR MR. CHAIRMAN This is in response to your request of December 30, 1975
for a statement summarizing the Consumer Product Safety Commission's activi-
ties on aging for 1975 and our continuing plans and activities in this area for 1976.
We are pleased to enclose the statement that you have requested. Since the
Nation's elderly population is especially prone to injuries associated with a wide
number of consumer products, they should derive important benefits from our
product safety activities. Because of this, we constantly consider this age group
and its special problems in our work.
I hope that the enclosed statement will be useful. Please let me know if I can
be of any further assistance.
Sincerely,
RICHARD O. SIMPSON, Chairman.
[Enclosure]
PROGRAMS RELATING TO THE AGING
Improving product safty for the elderly is an important continuing objective
of the Consumer Product Safety Commission (CPSC). Our 1975 activities, includ-
ing injury-data collection, research studies, standards-development and informa-
tion-education programs were not directed solely to programs for the benefit of our
20 million older Americans. However, it is estimated that some 20 million Ameri-
cans of all ages each year are injured by products used in and around the house-
hold, 110.000 are permanently injured and 30,000 are killed in product-related
injuries. The Consumer Product Safety Act (Public Law 92-573) was passed by
Congress in 1972 in recognition of the need for Federal regulations to ensure safer
consumer products. That Act called for the creation of the Consumer Product
Safety Commission and charged it with the mission of reducing the number and
severity of product-related consumer injuries, illnesses and deaths. While none of
the laws administered by CPSC is applicable solely to older Americans, the Com-
mission recognizes that they are particularly vulnerable to risks of injuyr
associated with consumer products and, therefore, considers this factor in its
activities.
INJURY DATA COLLECTION
The Commission's primary source of its information concerning product-
related injuries is the National Electronic Injury Surviellance System (NEISS).
CAN - LINO - 101
The NEISS is composed of a statistically selected set of 119 hospital emergency
rooms located throughout the country which report to the Commission, on a daily
basis, data on product-related injuries treated in those emergency rooms. In 1975
an estimated 252,000 persons of 65 years or older were treated in hospital emer-
gency rooms in the continental United States. For injuries to persons in all age
groups, only four percent of the victims were hospitalized, and for the 65 years and
older group, 13 percent were hospitalized. Injuries associated with stars, ramps
and landings which are suffered by the elderly, are the most prevalent. Other
major product categories associated with injuries and which affect the elderly are
floors and flooring materials, chairs. doors, beds, and bathtub and shower struc-
tures. The Commission also obtains informations from its Death Certificate Pro-
gram. Copies of death certificates relating to all external causes of death presumed
to be product-related (i.e., burns and falls) are received monthly from participat-
ing health jurisdictions. It is anticipated that additional health jurisdictions will
be participating in this program by the end of Fiscal Year 1976. At that time more
specific information will be available regarding fatalities resulting from product-
related injuries suffered by persons of all age groups. Death certificates are a
particularly valuable source for data information since not all accident victims
are taken to emergency treatment rooms.
INFORMATION AND EDUCATION ACTIVITIES
The Commission's Bureau of Information and Education is involved in several
programs relating to the elderly. A variety of prepared materials has been
distributed widely, including fact sheets on "The Elderly and Stairway Acci-
dents," "Upholstered Furniture," "Stairs, Ramps, Handrails and Landings,"
"Bathtubs and Shower Injuries," "Kitchen Ranges," and "Flammable Fabrics."
The Burn Injury Education Demonstration Project is a controlled three-year
experiment to measure the effectiveness of various burn-injury education tech-
niques and strategies. The elderly. as well as four other population-group targets,
will receive special attention in the development of the education program. The
results of this three-year experiment, it is hoped, will provide the basis for a
nationwide burn injury education program.
Since many elderly persons may not be aware of the exemption available to
them from the regulations requiring child-resistant packaging issued under the
Poison Prevention Packaging Act, CPSC is preparing an information campaign
to explain the exemption which was provided in that Act especially for the
elderly and the handicapped who experience difficulty in opening child-resistant
closures.
OTHER MAJOR ACTIVITIES RELATING TO THE AGING
The CPSC actively considers older citizens in its programs dealing with
product hazards and safety standards. For products normally used by large
segments of the population, safety devices and operational procedures requiring
manual and mental dexterity by users are examined carefully with an awareness
of the fact that those faculties may diminish in the older population. Where
applicable. potential offerors for standard-development are required to consider
the problems of the aging.
The CPSC notice requesting offers to develop a standard for bookmatches
under the procedures of Section 7 of the Consumer Product Safety Act, pointed
out that the potential hazards of the aging, as well as to children. were to be
considered. A recommended product safety standard for matchbooks being con-
sidered by the Commission for publication during the third quarter of fiscal
year 1976 contains a provision which should contribute to reducing injuries
associated with matches to the aged. One provision relates to burn-control to
help reduce burns and fires started by the "dropped" match. The burning time
for matches will be reduced from about 25 seconds to 15 seconds and the match's
burn-distance will be limited to ½ inch from the top of the bookmatch splint.
In addition, we expect that a similar standard development activity for gas space
heaters will result in a product safer for use by all persons including the elderly.
This standard will address fabric-ignition and burn hazards, among others, to
which the elderly are especially vulnerable.
Regarding hazards to be found in residence areas, special studies are being
conducted by CPSC and are designed to address unsafe conditions, among other
parameters, according to the age of the injured. Those studies which address
structural and architectural hazards use injury data for developing models of
typical accidents. Research into stair accidents has revealed a number of factors,
especially critical for the elderly. It has been shown that the elderly are
especially dependent on handrails for stability, on even distributed lighting, and
on uniformity in tread conditions. An effort is being directed for incorporation of
these requirements into building codes and standards pertaining to unit occupancy
by the elderly.
Other studies contracted for by the Commission give consideration to safety
problems encountered by the elderly with bathroom hazards and doors. Possible
solutions being considered are design guides to be developed for architects and
engineers, proposals for mandatory product standards. assistance to the develop-
ers of voluntary standards and general information and educational campaigns.
The Commission is working with the American Society for Testing and Ma-
terials' F15.03 Committee on Safety Standards for bathtubs and showers to
develop standards for slip-resistant bath surfaces, anti-seald systems and for
grab bars.
For the past few years a considerable amount of injury data relating to the
ignition of clothing and of interior household furnishings has been collected.
One study addressed such problems specifically selected for adult sleepwear, with
emphasis on sleepwear for the elderly. As a result CPSC recommendations are
being formulated to help solve serious problems that have been identified
involving clothing ignitions and burn injuries to the elderly. Another study is
CAN - LINO - 102
being conducted to develop new test concepts that may predict more accurately
the flammability hazards associated with all wearing apparel and interior furn-
ishings. The feasibility of extending existing Strict Children's Sleepwear Stand-
ards to certain other specified items of wear apparel is under study.
A TV receiver safety standards being prepared will address hazards such as
those of fire, shock, implosion and mechanical failure, asosciated with TV
receivers. When finalized, this standard would be beneficial to the elderly since
they are important users of television receivers.
Before a standard or a safety activity is begun by the Commission, it attempts
to examine carefully and estimate predicted benefits and costs which might accrue
from such activities. The Commission has presently prepared some working drafts
of impact analyses on several products which present special hazards to the
aged. Product categories analyzed include such articles as smoke detectors, hair
dryers, small electrical appliances, and ranges and ovens.
ITEM 16. ENERGY RESEARCH AND DEVELOPMENT ADMINISTRATION
FEBRUARY 17, 1976.
DEAR SENATOR CHURCH I am pleased to submit the enclosed report in response
to your letter of December 30, 1975, to Dr. Seamans. requesting information on
Energy Research and Development Administration (ERDA) activities in the field
of aging for inclusion in the forthcoming annual report of the Senate Special
Committee on Aging.
ERDA, formerly the Atomic Energy Commission, has for many years sponsored
large-scale research efforts aimed at evaluating the environmental and health
risks associated with the use of nuclear energy. With the advent of ERDA. this
mission has been expanded to include the effects upon environment and health
of a broad spectrum of energy-related physical and chemical hazards. These
efforts range from basic studies of biological mechanisms at the molecular levels
to more sweeping studies of human. animal, and plant populations and their
responses to energy-related environmental stresses. Since age is an important
factor in biological responses to environmental stress, certain of these studies
touch directly or indirectly upon the phenomenon of aging.
Thus, while ERDA has no specific mission in aging or geriatric research, it is
clear that the ongoing and planned research activities listed herein contribute
in a real way to understanding the relationships of disease states and environ-
mental stresses to reduction of lifespan.
I hope the information provided in the enclosed report will be helpful and that
you will call on me if further assistance is required.
Sincerely,
JAMES L. LIVERMAN,
Director, Division of Biomedical and
Environmental Research.
[Enclosure]
ERDA PROGRAMS RELATED TO AGING
INTRODUCTION
The great majority of Energy Research and Development Administration
(ERDA) programs related to aging are carried out within the Agencys' Division
of Biomedical and Environmental Research. The primary objectives of this Divi-
sion's program are: (1) To ensure that the national goal of increasing domestic
energy production is achieved with a minimal impact on man and his environ-
ment: (2) to provide information for the establishment of a workable set of re-
lease and exposure standards for energy-related hazardous agents; and (3) to
provide a basis for informed public judgment of the cost, risk, and benefit trade-
offs involved in the development of energy resources and production technologies.
With respect to man, it is essential to evaluate the latent somatic, genetic,
developmental, and pathophysiological effects that may result from continuous
low-level exposure to energy-related agents. In order to extrapolate experi-
mental results obtained from model animal populations to man. it is necessary
to use both short- and long-lived animal species and to understand age-related
differences in the production or development of these effects. Thus. certain
ERDA biological research programs deal with an evaluation of life-shortening
diseases and their increased frequency of occurrence under stress. Efforts are
made to identify the cause of death in stressed and unstressed model animal
populations, and a large amount of supporting research is conducted to facilitate
understanding the sequence of events and the mechanisms involved in the indue-
tion of life-shortening in stressed populations. This supporting research is per-
formed at the whole-animal, tissue, cellular, and molecular levels of biological
organization. These studies also contribute indirectly to the body of informa-
tion needed to develop realistic approaches to the prevention or reduction of
age-related degenerative processes that contribute to normal senescence or spe-
cific malignancies.
LONG-TERM HUMAN STUDIES
Since the late-effects research program is aimed at prediction of damage to
the human population, long-term followup of four major human populations
with radiation exposure histories is being continued. As the responsibilities of
this Agency increase in terms of other energy-related pollutants, new human
epidemiological studies may be initiated. At present, human population studies
are of major interest to all agencies concerned with human health.
CAN-LINO-103
A new Radiation Effects Research Foundation sponsored jointly by the United
States and Japan has been created to replace the Atomic Bomb Casualty Com-
mission and continue lifetime followup of a sample of survivors of the atomic
bombings of Hiroshima and Nagasaki in 1915. Detailed clinical and laboratory
examinations of exposed and control groups will be performed on a continuing
basis to obtain evidence of disease states that contribute to morbidity and mor-
tality. To date, no significant radiation-induced life shortening other than that
due to malignant neoplasms has been noted.
A group of about 200 inhabitants of the Marshall Islands, who were exposed
accidentally to fallout from a thermonuclear weapon test, has been followed
for the past 20 years by medical investigators of the Brookhaven National Lab-
oratory. The Marshallese were exposed to substantial quantities of radioiodine,
which concentrated in their thyroid glands and caused many cases of thyroid
adenomas and a few cases of carcinoma or hypothyroidism.
Over 1,500 persons who have been exposed to radium, many of whom have
demonstrable radium burdens. have been studied at the Center for Human Radio-
biology (CHR) of Argonne National Laboratory. In most cases, the exposure
occurred occupationally during watch dial painting or chemical laboratory ac-
tivities or medically by injection as a method of treatment. Many individuals in
this study receive medical and radiologic (dosimetric) examinations periodically
at the CHR.
A large epidemiological cohort study of 170,000 employess of ERDA produc-
tion and laboratory facilities is in progress as a cooperative effort between mem-
bers of the Graduate School of Public Health of the University of Pittsburgh
and data collection and analysis groups at the Hanford and Oak Ridge plants.
The Social Security Administration assists materially in ascertaining the OC-
currence of deaths in the population and providing the location of a person at the
time of death. Various levels and modalities of radiation exposure as well as
exposure to other toxic agents may be encountered in this group of employees.
However, most radiation exposures are at a low level. In-plant and sibling con-
trols are studied for comparison with the exposed employees.
LIFETIME STUDIES OF LONG-LIVED MAMMALS
Although the aforementioned human studies are valuable for supplying direct
estimates of adverse effects of radiation on man, they are inadequate to provide
the detailed, quantitative data necessary for the estimation of health risks that
form the basis for exposure guidelines and standards. Information of this type
will have to be derived from comparative studies on long- and short-lived animal
species. The beagle dog, whose life expectancy is about one-fifth that of man, has
been the major long-lived mammal utilized in the ERDA radiation effects re-
search for more than 20 years. At the University of Utah, the University of Cali-
fornia at Davis, the Battelle-Pacific Northwest Laboratories, the Argonne Na-
tional Laboratory, and the Inhalation Toxicology Research Institute more than
5,000 beagles have lived out their lifetime under careful experimental observation.
Periodic clinical examination has revealed a wealth of information about the
pattern of diseases throughout the lifespan of normal animals and alterations
in the pattern caused by superimposed stress of radiation exposure. Every effort
should be made to capitalize on the geriatric information evolving from this
animal resource. Only minor efforts have been made to date in this regard.
LONG-TERM RESEARCH WITH OTHER SPECIES
Small rodents with lifespans of 2 to 6 years have been used primarily for large-
scale radiation studies to evaluate late somatic and genetic risks involved in low-
dose lifetime exposure. Moreover .small laboratory and wild rodent populations
have been used at the Argonne National Laboratory to specifically understand
the genetic and physiological factors involved in aging per se. At the Argonne
National Laboratory and the Oak Ridge National Laboratory combined, more
than 50,000 mice have been exposed to various doses of ionizing radiation at dif-
ferent daily exposure rates to characterize the various radiation-accelerated dis-
ease states that contribute to lifespan reduction. The unexposed, control popu-
lations are characterized, as well as the irridated groups, in terms of the diseases
that cause death.
It is anticipated that similar studies will be conducted to evaluate the late
somatic effects produced by other potentially hazardous chemical pollutants in-
troduced into man's environment from a variety of energy-producing technologies.
Since man is constantly exposed to a number of such environmental pollutants,
it is suspected that they contribute to reduction of his lifespan. Although radia-
tion does not seem to contribute to nonspecific lifespan reduction, it is likely
that other environmental pollutants do. The anticipated studies should produce
a large pool of information for understanding the development of latent somatic
damage which contributes to morbidity and mortality under conditions of en-
vironmental stress.
RESEARCH MORE SPECIFICALLY CONCERNED WITH AGING
Two programs, one at the Argonne National Laboratory and one at the Oak
Ridge National Laboratory, funded by ERDA at about $1 million, are concerned
with the theoretical, genetic, and physiological aspects of aging. including changes
in the microvasculature as they relate to imposed stress. The program at Oak
Ridge is aimed at gaining an understanding of how normal body defense mecha-
nisms, primarily immune surveillance against disease, are reduced in aging mice
and, hence, make the old individual more prone to certain diseases that can in-
capacitate or kill. A part of the research is aimed at developing immune therapy
to counteract reductions in body defense mechanisms by cell transplantation. This
latter study is done in collaboration with investigators at the National Insti-
CAN - LINO 104
tutes of Health's Gerontology Research Center in Baltimore. Since immune sur-
veillance may play an important role in prevention of malignant diseases, in-
cluding those induced by environmental agents, these studies are of interest to a
number of agencies concerned with human health. At the Argonne National Lab-
oratory research has emphasized homeostatic control. localized in the brain, as a
regulator of aging or lifespan. In this regard, studies at the Brookhaven National
Laboratory suggest that certain monoamines, fed to rodents, can increase their
lifespan.
Parts of several research efforts at the Oak Ridge National Laboratory, the
University of California at San Francisco, and the Brookhaven National Labora-
tory involve studies to test the cellular hypothesis of aging using either in vivo
or in vitro cell systems.
In addition to these studies, ERDA has always sponsored small efforts in
aging-related research in various university departments.
CLINICAL ASPECTS OF AGE-RELATED DISEASES
In addition to the aforementioned research areas, the ERDA biomedical pro-
gram expends more than $10 million per year for research and development aimed
at developing improved methods for the early diagnosis and treatment of dis-
eases that contribute to morbidity or mortality of human populations, including
the aging or aged. For example, at the Brookhaven National Laboratory a seg-
ment of the 1975 nuclear medicine program has included clinical and experimental
research on hypertension and senile osteoporosis as well as Parkinson's disease.
ENVIRONMENTAL STUDIES OF THE RESPONSE OF AGED MEMBERS OF POPULATIONS TO
EXTERNAL STRESS
Finally, the ERDA environmental program has a large number of controlled
environment resident species under observation for their ability to withstand
applied stresses. The age span of these populations are normal for such circum-
stances. and data on correlations between age and stress resistance either are
available or could be made.
BREAKDOWN BY RESEARCH SUBJECT AREA OF ERDA BIOMEDICAL RESEARCH
RELATED TO AGING
Table 1 provides a dollar breakdown of ERDA research activities related to
aging according to research subject area. This table is patterned after a recent
response by ERDA to a canvass of Federal research on aging conducted by the
National Institute on Aging. Projects are further categorized according to their
focus on aging. A program with a "primary focus" on aging is one in which aging
is the main focus of the research activity. A "secondary focus" indicates that
aging is not the main focus, but an important accompanying factor in the re-
search. Projects listed under "applicable" are those in which aging is not an
explicit focus of the research activity. but in which research findings could
be applicable to the field of aging. All ERDA biological research related to aging
falls into either the "secondary" or "applicable" categories.
The ERDA Division of Biomedical and Environmental Research is currently
undergoing an examination and remodeling of research and development activi-
ties to increase programmatic relevance to ERDA's primary mission. While it
is not certain, at this time, what the final program structure will be. it is prob-
able that the aging-related research activities described herein will continue at a
slightly reduced level during fiscal year 1976.
CAN - LINO - 105
TABLE 1.-ERDA RESEARCH RELATED TO AGING
Number of projects
Amount of funds (in thousands)*
Aging is-
Aging is--
Second-
Second-
Primary
ary
Appli-
Primary
ary
Appli-
Research subject area
Total
focus
focus b
cable 0
Total
focus
focus
cable
1. Biomedical, total.
44
0
14
30 18,244
0
2,539
15,705
A. Intrinsic aging proc-
ess, total
12
0
11
1 2,302
0
1,635
667
1. Cellular and
molecular
8
0
8
0
797
0
797
0
2. Organ and Lis-
sue system.
3
0
2
1
1,149
0
482
667
3. Organisms
1
0
1
0
356
0
356
0
B. Diseases, total
0
0
i. Diseases with
a strong se-
nescence
component
(specify m-
portant dis-
eases):
2. Other
dis-
eases
of
importance
to the elder-
ly (specify
important
diseases):
C. Interaction of exter-
ternal influences
and aging, total
26
0
2
24 12.083
0
274
11,809
1. Nutrition and
aging
0
0
0
0
0
0
0
0
2. Drug metab-
olism and
aging
0
0
0
0
0
0
0
0
3. Physical
a-
gents
and
aging
13
0
2
11
4,873
0
274
4,599
4. Other environ-
mental fac-
tors
and
aging
13
0
0
13
7,210
0
0
7,210
D. Demography/epide-
miology, total
6
0
1
5 3,859
0
630
3,229
1. Human popu-
lation study_
6
0
1
5 3,859
0
630
3,229
2. Model systems
for study of
the aging
0
0
0
0
0
0
0
0
E. Other (specify subject
area)
II. Behavioral and society, total
0
0
111. Human services and delivery
systems, total
0
0
ITEM 17. FEDERAL ENERGY ADMINISTRATION
FEBRUARY 5, 1976.
DEAR MR. CHAIRMAN I am pleased to provide a summary of FEA activities
during the past year affecting the aging. I have included actions directed spe-
cifically at resolving the energy-related problems of the elderly, as well as activi-
ties of special importance to those on fixed incomes.
1. FEA's Office of Consumer Affairs/Special Impact funded a study on the ef-
fect of rising energy costs on low-income and elderly consumers. The purpose of
the study was to assess the primary impacts of rising energy costs on the individ-
ual elderly consumer, and the institutions and Federal programs which serve the
elderly. To the extent that available data permitted. these effects were assessed
on a regional basis. The study was published in March. 1975.
2. During 1975, the Office of Consumer Affairs/Special Impact conducted
seven regional Consumer Energy Workshops which provided a forum for ex-
change of information among Federal, State, and local organizations, as well as
discussion of proposed energy policies and programs by audience participants.
One of the six seminars at the workshops, energy programs for the poor and
aged, focused on current funding sources available for energy programs, infor-
mation on successful local energy programs, problems of the poor and aged, and
energy policies of Federal and State governments. A summary of major recom-
mendations made at the workshops will be submitted to you when it is completed.
3. Through the Interagency Task Force on Energy and Human Resources,
established in 1974 by FEA's Office of Consumer Affairs/Special Impact, FEA con-
tinues to utilize other Federal resources at the Washington level in the develop-
ment of energy programs, particularly in assessing the impact of various pro-
grams on the low-income and elderly.
4. FEA has entered into two interagency working agreements with the Admin-
istration on Aging and several other Federal agencies. To implement these agree-
CAN LINO - 106
ments, FEA has established regional interagency task forces on Energy and
Human Resources to coordinate existing Federal programs at the regional level.
The task forces (which include regional staffs of the Administration on Aging
and Community Services Administration) have begun statewide meetings with
various human services departments. Through these meetings. the task forces
will catalog all energy programs and services (including existing funding sources
and local programs) on a State-by-State basis and will develop new programs re-
quired to assist the aged.
5. FEA developed legislation. submitted by the President to the Congress last
year, which provides for grants to State governments for materials to winterize
units occupied by low-income persons, with emphasis on elderly and handicapped
persons. Pending passage of the legislation. FEA is assisting the Community
Services Administration in operating a limited version of the program.
6. FEA is currently involved in several activities directed toward improving
the operational efficiency and restructuring the rate bases of electric utilities.
These programs are especially important for the elderly and poor since sharply
rising electric utility bills have a particularly harsh impact upon those with
fixed incomes. Greater utility efficiency minimizes the need for construction of
new capacity and thereby reduces the pressure for rate increases. Rate structure
reforms designed to price electricity differentially, based unon time-of-day or
amount of use, provide consumers a means of reducing their electric bills through
off-peak usage and conservation. FEA activities include the following
-FEA's Office of Energy Conservation and Environment, in cooperation with
local regulatory commissions, is funding nine demonstrations of innovative
electric rate structures and load management techniques.
-FEA's Office of Utilities Programs is participating in State regulatory hear-
ings (at the invitation of the State regulatory commissions) to help analyse
structural rate revisions, implementation of load management techniques,
and end-use conservation practices.
-FEA's Office of Consumer Affairs/Special Impact studying the concept of
"lifeline rates"-a utility rate structure which offers necessity level power
to individual consumers at a low rate and permits the price above that level
to be set to recoup the subsidy and to encourage conservation by large volume
users.
7. FEA assisted the Department of Health. Education. and Welfare in a feas-
ibility study of a fuel stamp program and an analysis of various options under
current income maintenance programs for responding to energy price increases.
8. FEA funded a study of the most significant energy problems experienced
by low income consumers during the 1973/74 embargo period. The study docu-
ments many of the problems experienced by the elderly. including energy supply
and payment problems and aid that State energy offices and local community
agencies provided the elderly during that period. Based on information gathered
in the study, a handbook is being published to assist State energy office in deal-
ing with consumer energy problems.
I hope this information will be of assistance in drafting the annual report
for the Senate Special Committee on Aging.
Sincerely,
FRANK G. ZARB, Administrator.
ITEM 18. NATIONAL ENDOWMENT FOR THE ARTS
MARCH 16, 1976.
DEAR SENATOR CHURCH This is in response to your request for a report on
the major activities of the National Endowment for the Arts in 1975 and 1976
which were of benefit to older Americans.
We welcome this opportunity to bring to the attention of the Special Committee
on Aging the Endowment's interest in making the arts more widely available to
the elderly and the scope of the programs we have supported in this effort.
If the Committee would like further information, we would be happy to be of
assistance in any way possible.
Best wishes.
Sincerely,
NANCY HANKS, Chairman.
[Enclosure]
REPORT TO THE SENATE SPECIAL SUBCOMMITTEE ON THE AGING
SUMMARIZING THE MAJOR ACTIVITIES IN THIS AREA BY THE
NATIONAL ENDOWMENT FOR THE ARTS DURING FISCAL YEAR 1975
AND CONTINUING IN FISCAL YEAR 1976
The National Endowment for the Arts has become increasingly involved in
arts programs aimed at reaching the elderly and other special groups. One of
the major thrusts of the National Endowment for the Arts is to make the arts
accessible to Americans of all ages, economic levels and backgrounds.
The elderly are an important constituency for the arts community. More than
any other Americans, they have a great deal of leisure time and often draw on
many years of appreciation and involvement in the arts.
Access to cultural opportunities is often denied the aged because of psycholog-
ical. architectural, financial and logistical barriers. On each front, the Arts En-
dowment, through its grant programs, has sought to remove these barriers and
bring the arts to people and people to the arts.
ARCHITECTURAL BARRIERS
Architectural barriers to cultural opportunities have received special atten-
tion by the Endowment, particularly since September, 1973, when the organiza-
tion's advisory body, the National Council on the Arts. passed a resolution urging
CAN-LINO-107 -
the Endowment to help make the arts more accessible to the physically handi-
capped, including the elderly.
The problem of architectural barriers to cultural institutions has been ex-
plored in a recent publication by the Educational Facilities Laboratories (EFL)
for the Arts Endowment. The booklet, titled "Arts and the Handicapped," details
numerous examples of ways in which cultural institutions have overcome
physical barriers which deny many, including the elderly. access to our cultural
wealth. At the same time, the Endowment has sponsored a series of television
film spots produced by the Public Advertising Council of Los Angeles which make
the public aware of the numbers of Americans who are impeded by physical
handicaps and architectural barriers. The spots highlight several important
design solutions and the state of the law regarding access to public buildings.
On a smaller but equally important scale, a fellowship in the Architectural
and Environmental Arts Program went to an individual for research to develop
design parameters to enhance the use of products by the aging and the
handicapped.
BUILDING UNDERSTANDING
There is another unspoken barrier which must be broken for the elderly-
one of public understanding of the special needs of older Americans. For the
past several years, the Arts Endowment has supported the National Council on
the Aging's Center for Older Americans and the Arts. This center does a great
deal to stimulate arts programing for the elderly and to broaden public under-
standing of the needs of the elderly. The center provides assistance to arts
organizations in developing new programs at the local level to involve the elderly
and works with them to elevate the quality of their participation in the arts. It
serves as a clearinghouse for information and ideas relevant to the arts and
older Americans.
This year's grant to the Center for Older Americans and the Arts is for tech-
nical assistance and consultation to a number of cities around the country. The
center is working with people in New Orleans. Cleveland and Winston-Salem,
helping them bring together local arts agencies and agencies working with the
aging.
In New Orleans, the two agencies are trying to develop an action plan for the
area's cultural resources to get in touch with the elderly.
In Winston-Salem. the city of Old Salem and the North Carolina School of the
Arts are building a 200-unit highrise for the elderly with facilities designed for
the entire community. They are in the process of planning studios and common
rooms for the building which will foster activities between the elderly and the
rest of the community.
In Cleveland, the local arts agency and the agency on the aging are planning
a series of meetings to develop better relationships between the community, the
Cleveland Settlement School of Music and the elderly.
FINANCIAL BARRIERS
The participation by the elderly in cultural events is often colored by the lack
of sufficient funds to meet the price of a concert ticket or museum admission. In
a public opinion survey conducted by the National Research Center for the Arts
funded in part by the Arts Endowment, it was noted that there has been a dra-
matic drop in attendance at cultural events by older ricans. The survey
found that 56 percent of those 65 and over were nonattenders at cultural events.
Cost is clearly a factor in the low attendance rates. Of those surveyed with in-
comes under $5,000, a level not uncommon for older Americans, 11 percent said
that they attend less due to the high cost. The survey found that 23 percent of
the elderly said that decreased attendance was due to bad health, 12 percent
said transportation difficulties prevented their attendance and 7 percent of the
elderly claimed they attended less frequently because they had "no one to go
with" and didn't like to alone.
The Arts Exposure grant category of the Endowment's Expansion Arts pro-
gram was designed in part to assist community organizations in providing tickets
and transportation to major cultural events for low income young and elderly
and others not in the cultural mainstream. Last year (fiscal year 1975) grants
totaling $1,289,452 were awarded for Arts Exposure efforts. Two other grant
categories, Community Cultural Centers and Neighborhood Arts Services, also
assist programs which involves the elderly. In fiscal year 1975, a total of $552,500
in grants was awarded by the Endowment for Community Cultural Centers and
$491.959 for Neighborhood Arts Services.
Other Arts Endowment programs support efforts to provide low cost or free
programs for the elderly, particularly the Museum, Music and Special Projects
Programs. Some of the efforts these divisions have supported include:
-In Chicago, several city museums have joined together to offer free admis-
sion to the elderly.
-In Cincinnati, the city ballet offers discount tickets to senior citizens.
-In Rochester, N.Y., the Civie-Music Association received a major grant to
provide afternoon concerts for senior citizens on their spring tour.
--In Toledo, the Orchestra Association received a grant to present Sunday
afternoon concerts for senior citizens and their families who were unable
to attend evening concerts.
-In western New York State, the Arts Development Services has a voucher
system in operation which offers vouchers for 32 different performing arts
groups for discounts to the elderly and other special groups.
-In Rochester, N.Y., the International Museum of Photography offers free
films to senior citizens once a week at George Eastman House. The Museum
shows films of the 30's, 40's and 50's S and plays to packed audiences each
week.
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The Arts Endowment also supports touring performing arts groups, partic-
ularly in the areas of dance and theatre. This assistance has helped to bring
the arts to people in smaller communities who otherwise might not have been
able to afford a trip to a large city to take advantage of the cultural resources
it might offer. In the area of dance, in fiscal year 1975, more than 60 different
professional dance companies took up short residencies in all 51 States. The
total amount expended by the Endowment for dance touring in fiscal year 1975
was $3,603,801.
Arts groups around the country have applied to the Endowment for grants
for special performances for senior citizens.
-In Dayton, Ohio, the Philharmonic received a grant to expand the or-
chestra's exposure to hospitals and senior citizen centers.
-In New York City, special concerts supported by the Endowment and the
city are being given in senior citizen centers.
--In Santa Barbara, Calif., the symphony brings a series of concert pre-
views to people in senior citizen centers using small groups of musicians.
-In Puerto Rico. the Orquesta Sinfonica presents Puerto Rican ethnic music
in senior citizen centers and other institutions.
-In Madison, Wisc., the Memorial Union Building Association received a
grant to support staff and artist fees for concerts in senior citizen centers,
hospitals and other social centers.
-In Minneapolis, Minn., the Guthrie Theater received a grant to run an out-
reach program in hospitals and in prisons.
-In Ft. Lauderdale, Fla., the Tamarac Civic Association received a grant to
perform for senior citizens.
-In New York City, the Off Center Theatre toured nursing homes with a
grant from the Arts Endowment.
Each year the Endowment's Museum Program devotes a substantial share of
its budget ($563,677 in fiscal year 1975) to help museums become more accessible
to a wide range of community groups, including the elderly. In addition to the
free films offered by the International Museum of Photography, the Museum
Program has supported two other efforts aimed specifically at the elderly and
other special groups. The Antique Auto Museum in Massachusetts has ex-
panded its program of community service for the elderly and physically and
emotionally handicapped with an Endowment grant. The Museum of Science
and Industry in Chicago has also received a grant to develop special exhibits,
theater. scientific exhibits, educational film and workshops for senior citizens
and other neglected groups.
The Endowment has done a great deal to foster participation in the arts by
the elderly. For example. the Visual Arts Program has a special fellowship cate-
gory for artists age 50 and over.
Two Endowment supported projects offer statewide programs for the elderly.
In Iowa, the State Arts Council. with partial assistance from the Arts Endow-
ment. offers a grant program to local groups for programs geared to the elderly.
All the programs must be participatory in nature and involve a minimum of 10
people for at least 2 hours every week in a location available to senior citizens.
All programs must be directed by a reçognized professional artist in either the
performing, visual or literary arts.
Programs now underway through the Endowment/Towa Arts Council program
include a poetry program for senior citizens in an Iowa City group lunch facility,
a musical program in Cedar Falls, and a visual arts project in Des Moines.
In Iowa City, 75 senior citizens meet with a poet and write between 13-14
pages of poetry twice a week. The group has created a poetry mobile with one-
line poems which they contributed to the children's section of the local library
and a poetry robot covered with poems which now stands in an Iowa City bank.
In Cedar Falls. a music program has brought two musicians into two nursing
homes to hep residents write their own music and make their own instruments.
The residents now tour the area, playing their music on instruments of their own
creation.
In Des Moines. a group of 30 elderly people began working with a visual
artist on individual paintings. The group has now progressed to the creation of
a joint mural for the Bicentennial which is now on tour in area nursing homes.
Other participatory programs supported by the Endowment include a state-
wide series of workshops sponsored by the Rhode Island States Arts Council.
The Rhode Island Arts Aging Program has brought professional artists to senior
citizens in nursing homes. state mental hospitals and senior citizen centers to
teach body movement. weaving. puppetry. writing and other art forms. The
program also helps senior citizens with transportation problems to attend major
musical and theatrical events.
Other arts programs for senior citizens supported by the Endowment in fiscal
year 1975 include:
-Opportunity House, a community arts center in Hendersonville, N.C., offer-
ing a wide range of arts classes to a largely elderly population. Many stu-
dents at Opportunity House volunteer and become teachers, sharing their
knowledge of an art form with others.
-Learning Guild of Boston. offered workshops and presentations to more
than 100 nursing homes in and around Boston. Each learning guild activity
is based on an 8-10 week program. In the course of the past year, the
organization has worked directly with more than 2.000 residents.
-COMPAS (Community Programs in the Arts and Sciences) of St. Paul
Minn., in conjunction with the St. Paul-Ramsey Arts and Science Council,
the Arts Endowment and the Wilder Foundation, has run a series of work-
shops in theater. music. writing. photography. painting. and ethnic crafts
in addition to offering tickets and transportation to local performing arts
events.
CAN - LINO - 109
-The Links, Inc., a Baton Rouge, La. cooperative gallery offered training in
the visual arts to senior citizens and young people.
-The Bronx Council on the Arts, in conjunction with the area's community
college, offered a series of cultural, recreational and educational programs in
the arts for the elderly.
Several artists-in-residence in senior citizen homes have been supported by
Endowment grants. Every borough in New York City had an artists in resi-
dence in a senior citizen center a printmaker was in residence in Arlington
County, Virginia in association with the Recreation Division to work with senior
citizens; a poet was in residence in a cancer out-patient hospital in San Fran-
cisco; and a poet was in residence in several Montana senior citizen centers and
community centers.
Finally, service to senior citizens has been explored by several grantees. In
Chautanqua, N.Y., the Chautauqua Society is trying to identify numbers of in-
dividuals over 55 within a 50 mile radius of the organization to plan special
year-round programs. The Iowa State University Center is working to develop
senior citizen audiences and programs.
The Endowment continues to be concerned that the arts reach all Americans.
Through its programs, it is hoped that senior citizens will be able to participate
in the vast cultural resources of our country. The National Endowment for the
Arts and its grantees are continually working on new means to bring the arts
to the elderly and the elderly to the arts.
ITEM 19. NATIONAL ENDOWMENT FOR THE HUMANITIES
FEBRUARY 18, 1976.
DEAR SENATOR CHURCH: In response to your request, I am pleased to enclose
a statement summarizing major activities for the aging supported by the Na-
tional Endowment for the Humanities in 1975.
I hope that you and your committee will find this brief report of our activities
useful. I also hope that the readers of your report will find the examples cited
here suggestive of the varied ways in which humanities projects can be de-
signed to benefit the public, and in particular, those presently experiencing the
process of aging in our society.
Sincerely yours,
RONALD S. BERMAN, Chairman.
[Enclosure]
REPORT TO THE SENATE SPECIAL COMMITTEE ON AGING ON
ACTIVITIES AFFECTING OLDER AMERICANS IN 1975
INTRODUCTION
In carrying out its congressional mandate to encourage the understanding and
use of humanistic knowledge in the United States, NEH responds to the needs
and interests in the humanities, principally as they are expressed in applications
for specific projects. The agency does not designate fixed amounts of money for
work in any particular subject area or in general for particular groups of in-
dividuals. Consequently, NEH does not have a special program for older citizens
in which money is allocated specifically for the use of that group; nor does
it have a formal program to support study of the processes and problems asso-
ciated with aging.
; However, through its regular procedures for selection and support, NEH has
funded projects specifically designed to increase understanding of attitudes to-
ward aging, and to provide learning experiences in the humanities for the
elderly. In addition, all of the many activities supported by this agency to in-
crease understanding and use of the humanities among the general public
reach large numbers of older Americans. Only those general programs which in-
clude special planning for the elderly. which are particularly relevant to this
group, or which could be much more fully used to benefit this group are described
in this report.
The Endowment recognizes the important contributions older Americans can
and do make to this society it also recognizes the need of older citizens to have
access to information and perspectives that can aid them in making informed
FORD
decisions as they confront personal and public problems and choices. Therefore,
NEH is making an active effort to promote increased utilization by the elderly
of project results, such as media productions, and to promote the active partici-
pation of older Americans in a wide variety to NEH supported activities, rang-
ing from contributions to scholarship, to the pursuit of additional knowledge
GERALD
through formal and informal educational programs, to discussions of vital pub-
lic policy questions in communities across the Nation.
I. SPECIFIC NEH GRANTS SERVING THE ELDERLY
In response to applications received from individuals and organizations, the
Endowment has made several grants specifically for the purpose of increasing
knowledge about aging, or providing special information or special activities
for the elderly.
In 1975, a grant was awarded to the National Council on the Aging to produce
10 articles for distribution to weekly newspapers across the country. These ar-
tieles provide background materials and information on the contributions of the
elderly to our society, on their problems, and on the critical issues affecting the
aged. Dissemination of these articles, which were prepared to coincide with the
various topics of the American Issues Forum, is described below.
CAN-LINO- 110
Through the Endowment's Science, Technology and Human Values Program,
an award was made in 1974 to Case Western Reserve University in Cleveland,
Ohio, to enable the detailed planning and preparation necessary for a sympo-
sium which would introduce younger humanities scholars to research needs and
opportunities on the subject of aging and the aged. As the result of this plan-
ning grant, NEH began in 1975 to support a 2½ year research-design project
to elicit humanistic research on this important subject.
Early in the project there will be a symposium for 30 postdoctoral humanists
with interest in this subject, at which several scientists and social scientists
will discuss the biomedical and socio-psychological aspects of aging, and several
humanists will discuss potentials for research in humanities disciplines (e.g.,
history, literature) which could provide broader perspectives and insights on
the characteristics of aging, how the process has been viewed by the aged and
by younger people. Research papers will be prepared by the participants during
the ensuing year who will then reconvene for review of their work. The results
of their work will be edited and organized for dissemination.
The youth grants program (which supports humanities projects initiated and
conducted by students and out-of-school youth) last year awarded a grant to the
Learning Guild in Boston. With this grant the Guild traveled to 30 nursing
homes in the greater Boston area offering two workshops, "Jazz: An American
Heritage" and "200 Years of American Arts Forms." The Guild is a nonprofit,
mobile, educational group staffed by young persons from the city's many colleges
and arts organizations. These young people are working to provide for nursing
home residents mental and physical stimulation, productive occupation of time
and the resulting rise in self-esteem, recreation and activity for therapeutic pur-
poses and re-education. or the learning of new skills. A poll of the nursing home
residents indicated that jazz and American art were subjects of special interest
to the participants. The Guild then designed the workshops, not to serve as
temporary time fillers, but to provide a learning experience that would estab.
lish motivation for further study. The Guild also is training the director of the
homes to motivate this interest in the humanities SO that when the project is
completed there will be lasting benefits.
Another grant was recently made to enable the National Council on the
Aging to plan and develop a reading unit in the humanities, to be disseminated
widely among senior citizens, and to be used in discussions led by trained people.
The discussions are intended to generate intellectual discourse among the par-
ticipants, while providing a structured opportunity for the participants to be in
touch with other older people. The grant will also enable the National Council
to work out the details of how such a project can be established on a continuing
basis, using the established network of over 5,000 senior centers associated with
the National Institute of Senior Centers.
II. STATE-BASED HUMANITIES PROGRAMS
A major activity of the Division of Public Programs is the State-based humani-
ties program which is now operating in all 50 States. In each States, volunteer
committees of citizens representnig business, labor, cultural, educational and
community groups regrant funds from NEH for projects developed and imple-
mented in the States which focus on humanistic understanding of public policy
issues. In the 4 years since the program was launched, over 3,500 locally initiated
projects sponsored by a wide variety of organizations have been supported, bring-
ing together through the efforts of over 30,000 volunteers, more than 10,000 pro-
fessional humanists and approximately 20 million citizens as participants or
audiences.
Types of States-based projects directly affecting older citizens
In 1975, as in previous years, regrants made by the States supported projects
varied in their format but similar in their focus on issues of importance to the
people in each State. A study of the State-based program is in progress which will
provide more detailed information than we presently have on these projects and
their participants. We do know that there is a high rate of participation in all
of these community projects by older citizens, and that many are on subjects
specifically related to aging. Although the variety of these projects can only be
suggested here. they generally include one or more of the following features:
projects exploring the values and assumptions implicit in our behavior toward
the elderly at present; exploring attitudes toward aging in other cultures or in
other times in our history considering future alternatives to our present be-
havior and attitudes: exploring major public issues with audiences limited to
the elderly; and programs on the topics of death and dying.
Examples of State-based projects directly affecting older citizens
Of the hundreds of State-based regrant projects undertaken in 1975, the
following few sugge : the nature of the program, and, it is hoped, prove sug-
estive of content and concepts that can be duplicated elsewhere.
1. Wisconsin. Senior citizen "cracker barrel" discussions on taxation, expendi-
tures and aging-This project was funded by the Wisconsin Humanities Com-
mittee which had chosen the theme "Human Values at Stake in Public Taxing
and Spending" for discussions in the State. Over 600 senior citizens in 18 south-
western Wisconsin cities participated in "cracker barrel" discussions led by two-
person teams of retired lay and academic humanists. Discussions were held in
churches, schools, senior citizen centers, and nursing homes, and the "summer
school for seniors" sponsored by the University of Wisconsin-Extension.
2. North Carolina. Independence for older adults: Individual rights and liber-
ties.-Traditions in Transition: Private Rights and the Public Good" was the
theme chosen by the North Carolina Committee for Continuping Education in
the Humanities sponsored by Sandhill Regional Library System and the steering
committee of Richmond Country Organizations for Services to Older Persons,
CAN - LINO - 111
Inc. A series of four discussions were held in Hamlet, N.C., "to identify present
problems and explore possible solutions with members of the community." As
th series were designed for an audience interested in the problems of the elderly.
the four discussions focused on the following topics: Historical perspectives on
independence for older adults; independent living-rights and liberties: financ-
ing the rights and liberties of older adults: and health for independent living.
3. Massachusetts. Alliance-young and old-via the movies.-This project, still
ongoing, is sponsored by the Amherst Film Cooperative and the Amherst Senior
Center, Council on Aging through a grant from the Massachusetts Committee to
bring together senior citizens and young people (ages 12-18) in the community.
In order to provide a common focus for discussion between such diverse groups,
early movies are being shown followed by discussions led by professional hu-
manists. The project is intended to create an understanding of the "like atti-
tudes and justified differences" of the young and old participants.
4. South Dakota. Human values in education and the older American.-This
project enabled over 50 humanists to travel to 19 rural towns in South Dakota
where, using materials from their disciplines of literature, history, philosophy,
religion. and foreign languages, they spoke with more than 800 persons about
values learned from educational experiences, myths about senior citizens, and
public policies regarding educational opportunities for older South Dakotans.
While the program did not have such action as a goal, one institution waived
all tuition for persons over 65 and sharply reduced it for persons 35 to 65 when
the college's administration, as a result of the programs, reconsidered its respon-
sibilities to all age groups and the value of higher education for older Americans.
As these examples show, through the cooperation of local organizations, schools,
and various groups of concerned people, humanities programs of interest and
benefit to oldre Americans can be locally designed and successfully implemented
providing a service not only to the elderly. but to the entire community. The sig-
nificant level of participation of older citizens in the many other projects on a
wide variety of topics which are conducted through the State-based committees,
is evidence of the value placed on serious discussion of the public policy questions
facing them as individuals and citizens in this society.
III. AMERICAN ISSUES FORUM
The American Issues Forum, a nationwide program developed by NEH, in-
vites citizens to engage in a serious exploration of some of the issues that are
fundamental to our society. Calendars identifying major issues for discussion each
month have been widely distributed, as have other materials designed to assist
discussion leaders, and to enable people to study the questions objectively and
in depth. This program has received active support from a wide variety of na-
tional and local organizations, groups and individuals.
As part of the NEH effort to reach and involve all citizens in this serious
Bicentennial celebration, special efforts have been made on behalf of older Ameri-
cans. These efforts and indications of participation by senior citizens are sum-
marized below.
Efforts to Reach the Elderly
1. The AIF calendar of topics: Natitonal distribution.-In April 1975, the AIF
calendar along with an invitation to participate, was mailed to 250,000 national,
regional, and State leaders. Included in this mailing was:
-Leadership of national organizations whose missions relate to the aging, i.e.,
National Council of Senior Citizens, ACTION, Administration on the Aging.
-Leadership of American Association of Retired Persons/National Retired
Teachers Association, State and local chapters (5,000 copies).
-Leadership of all community centers.
2. The AIF calendar of topics: Local distribution.-Many local institutions
such as libraries, community colleges, and community centers have distributed
versions of the Forum Calendar to senior citizens in their areas to stimulate dis-
cussion groups. For example:
-Montcalm Community College, Sidney, Mich., collected the names of 10,000
senior citizens in the Sidney area and sent each an AIF calendar along with an
invitation to participate.
Special AIF Materials
NEH provided the National Council on the Aging with a grant of $14,974 to
develop a series of articles related to the nine monthly AIF calendar topics from
the perspective of older Americans. The series was distributed to 2,000 news-
papers. Editors were asked to reprint the articles to facilities their readers par-
ticipation in the forum. The articles are now appearing in papers across the
country.
At this time, the National Council on the Aging has distributed an additional
400 sets of the series in response to individual requests and is planning to print
additional sets.
Participation of Older Citizens
Hundreds of senior citizens groups across the country are holding weekly and/
or monthly discussions on the forum topics. Some examples are:
1. Dade County, Fla.-Florida International University, Division of Continu-
ing Education, has developed a series of forum programs for senior citizens at
community centers throughout the city of Miami.
2. Haskell, Okla.-Monthly discussion programs on the Forum topics are being
led by retired members of the community.
3. Deerfield Beach, Fla.-A series of nine monthly dialog programs is taking
place the retirement community, Century Village.
4. Placerville, Calif.-The senior nutrition program is sponsoring forum discus-
sions, and to encourage participation offers a "dial-a-ride" service for those who
need transportation.
CAN LINO - 112
IV. HUMANITIES PROJECTS FQR THE GENERAL PUBLIC
The following examples of projects designed to serve the general adult public-
that is, adults not formally affiliated with educational institutions-are described
because they involve special planning, or are particularly relevant or useful to
older citizens.
Media Programs
Within the Division of Public Programs, a major activity is the development of
television and radio programming in the humanities:
-The "Adams Chronicles," a 13-week series of 1-hour long programs currently
being shown on public television is an excellent example of NEH-supported
humanities programing. Current indiactions are that this series is the object
of wide interest by viewers and of acclaim by critics and historians. While
we have no statistics on the ages of viewers, among the millions of viewers
of the program to date, many are, of course, older citizens. Because many
people in the general audience have impaired hearing, the "Adams Chroni-
cles" is available in a captioned version (shown locally by WETA).
-As for all media programs, specific information on the "Adams Chronicles"
program and on any adjunct material is provided to all organizations work-
ing for special interest groups, including the elderly. Without using addi-
tional money, NEH is attempting to extend the results of its awards to older
Americans, by encouraging grantees to promote the use of media produc-
tions among senior citizens. Many institutions of higher education including
community colleges are offering courses for credit using NEH-supported
television programs and accompanying written material. These courses, some
of which do not require attendance on campus, are good opportunities for
continuing education, particularly for those elderly whose mobility may be
limited by health or transportation problems.
-Humanities radio programing serves a wide audience, including the visually
handicapped, who might have limited access to the humanities in other media.
For many elderly people confronting problems such as impaired vision and
reduced mobility, such projects provide access to information as well as a
mechanism for communicating with others. One example is the "American
Issues Radio Forum" developed by National Public Radio. Information about
this program was distributed to all major senior citizens groups. A mechan-
ism for national call-in and discussion of issues with prominent humanists
has enabled many senior citizens to participate in the program without leav-
ing their places of residence. A listener's guide prepared to enhance the inter-
est and usefulness of the Forum has been distributed to many senior citizens.
Museum Programs
Several major exhibitions supported by NEH funds have been widely viewed.
in 1975. For example, "Archaeological Finds of the People's Republic of China"
was seen by 835,000 persons from throughout the western United States during
its 2-month stay in San Francisco, and in Kansas City drew 285,000 visitors.
Equally large crowds on the East and West coasts saw the "Seythian Gold" exhi-
bit from the Soviet Union.
A recent survey of museum attendees conducted by NEH indicated that 14
percent of the persons attending were between the ages of 51 and 64. This would
suggest that a large number of older persons have benefited from exhibitions such
as those described above. However, our sample also indicated that only 4 percent
of the viewers were 65 and over, a finding which corroborates the results of the
study of attendance at cultural events reported in "Americans and the Arts." We
are concerned that our exhibitions for the general public do not reach more people
in this age group, and hope through the initiatives of our grantees and communi-
ty service organizations for the elderly to resolve some of the problems which
presently make participation of the elderly in this activity difficult.
(Courses by Newspaper)
"Courses by Newspaper" is another NEH project designed to serve the general
adult public. Administered by University of California at San Diego Extension,
"Courses by Newspaper" consists of a series of 18 articles prepared by eminent
thinkers, and published in newspapers across the country. In September 1975,
450 newspapers with a total circulation of 45 million people began publishing
the third course by newspaper.
According to a recent survey of subscribers of newspapers carrying the course,
the percentage of those over 65 who read the articles was relatively high-20
percent or over in several communities, and as high as 43 percent in one. Reader-
ship among subscribers between 51 and 64 years of age was slightly higher in
all communities surveyed. As these figures indicate, many elderly adults want
to gain humanistic perspectives on issues of current interest in our society and
are being served in that effort by this project.
Use of the course can vary from reading the articles only, to independent
study of additional print material, to enrollment in the courses for college
credit offered by over 200 institutions in all parts of the Nation. Recently a
guide for discussion leaders has been developed which will be particularly use-
ful in those people, many of them elderly, who wish to discuss the articles with
others. but who are not interested in acquiring credit for formal course work.
We anticipate even wider distribution of the two courses now being developed
for 1976-77; one one the oceans and one on contemporary ethical choices. We
hope that wider knowledge about the courses, and recognition of their potential
as a focus for discussion and learning will result in even greater active partici-
pation by the elderly. The project director is making a special effort to provide
CAN - LINO - 113
information on the course to organizations such as the American Association of
Retired Persons to encourage increased participation by this group. This effort,
which does not involve the expenditure of extra tax dollars. is another expression
of the agency's commitment to reach people not traditionally identified with the
humanities. That commitment is based on the conviction that humanistic under-
standing of important social Issues is important to help citizens of all ages,
V. NEH PLANS FOR 1976
NEH cannot estimate what support will be in future years for activities
related to the aged because the Endowment responds to, rather than solicits, in-
quiries and proposals initiated by individuals and organizations from all over
the Nation. NEH makes awards based upon first, specialist peer review, and,
then, recommendations of the National Council on the Humanities, which, by
law, must advise the Chairman regarding action to be taken on all applications
submitted to the Endowment.
However, NEH will make increasing efforts to encourage applicants and
grantees to consider this age group in their project designs. For example, a grant
was recently made for fiscal year 1976 for the production of a major television
series on the "search for liberty." The content is of importance to the elderly,
as it will be to other citizens. But. in addition, the program producers are
seriously considering a radio version which will make the program available
to the visually handicapped, and will increase access to the program among those
who cannot or prefer not to leave their residences. In 1976. the Endowment has
also made several grants for production of local and regional radio programs
in several parts of the country (i.e., northeastern Pennsylvania, northern New
York, and in the Southwest) which are specifically designed to draw upon the
special knowledge of senior citizens about the history of their regions,
ITEM 20. NATIONAL SCIENCE FOUNDATION
FEBRUARY 13, 1976.
DEAR SENATOR CHURCH: The National Science Foundation (NSF) is pleased
to respond further to your request of December 20, 1975, for a summary of the
Foundation's activities in aging research during 1975 and plans for 1976-77.
The attachment summarizes research on human aging that is supported by the
research applied to national needs (RANN) program. Although some basic
research projects have implications for aging they are not primarily concerned
with the aged or aging.
We would be happy to supply any other information you may wish.
Sincerely yours,
H. GUYFORD STEVER, Director.
[Enclosure]
ACTIVITIES IN AGING RESEARCH
The National Science Foundation has no legislative mandate for research in
aging, however, the research applied to national needs (RANN) program has a
responsibility to support social policy research. In fulfilling this responsibility,
the Division of Advanced Productivity Research and Technology (APRT) has
developed a program subelement concerned with aging and public policy. The
magnitude of this program subelement has been approximately $500,000/year
but expands to approximately 1 million in fiscal year 1976 and will probably
continue at that level in fiscal year 1977.
The NSF program has identified aspects of social gerontology that are not
duplicated by other agencies and that are supportive and complementary to the
programs of these agencies. The projects supported emphasize the strengths
of NSF; strong performers. a broad approach to research questions and an
emphasis on a multidisciplinary approach to problem solving. The focus of NSF
projects is on the social aspect of aging and on emerging rather than immediate
problems. This gives future orientation to the program. The intent is to provide
data bases and policy analysis before problems become crises. A second emphasis
is on problem definition and assessment of research needs.
There are four active projects in the program, of which one was a new start
in fiscal year 1975. Fiscal year 1976 project applications are still being reviewed
and it is anticipated that two to four new projects will be funded in fiscal year
1976 and a similar number in fiscal year 1977.
The active projects are:
(1) The Cultural Contexts of Aging, Andrus Gerontology Center, University
of Southern California.
A coordinated combination of community survey, decisionmakers attitude
survey and cross cultural, anthropological studies. The emphasis is on aging
and ethnicity. The project is in the fourth year of 5 years. Policy related
reports on transportation health, income, preparation for retirement and
social services will be released at intervals beginning in summer 1976. A
unique feature of the project is the involvement of the subject community
in study design and analysis.
(2) Aging in the year 2000: Research Needs, Committee on Human Develop-
ment, University of Chicago.
This 2-year assessment is nearing completion. This has been a multi-
disciplinary attempt to develop a conceptual framework for viewing the
needs of the elderly in the near future. The first report on the ethical aspects
of aging will be distributed in the summer of 1976.
(3) Economics of a Stationary Population: Implications for the Elderly, Cen-
Center. ter for the Study of Aging and Human Development, Duke University Medical
CAN - LINO Amount 114
This assessment has been completed and a final report is now in prepara-
tion. The questions posed have to do with the ways in which the movement
toward zero population growth will affect the ratio of workers to retirees,
and the impact of these changes in age,composition on productive capacity
and the distributive patterns in the economy. The Nation can anticipate
problems caused by an eventual decline in the proportion of the population
of working age and the consequent necessity to make larger income transfers
from workers to retirees. These problems are intensified as the retirement
period is extended or the age of entry into the workforce is raised. This
means that there is a low probability of any substantial improvement in
real income during retirement unless strong countermeasures are taken.
(4) Alternative Community Support Options for the Differentially Impaired
Elderly: Institute on Aging, Portland State University.
This project is attempting to define and assess the various options to
support the elderly as they age and decline in the ability to maintain them-
selves. The report should permit better informed choices among available
or new options in order to maximize the efficient use of scarce resources.
New projects in fiscal year 1976 are expected to deal with private pensions,
intergenerational funds transfer, the older consumer. work related cognitive
decline in old age, and further studies on the future of aging.
In fiscal year 1977, while retaining the overall emphasis on the future and a
broad approach to social problems, the program is expected to give some em-
phasis to the economic and social issues associated with retirement. The main
thrust is likely to be on economic and demographic projections, problem defini-
tion. and social impact studies of various retirement policy options. These
issues are perceived to be among the most important emerging issues and likely
to have a major impact in the next 10-20 years.
ITEM 21. THE POST OFFICE DEPARTMENT
FEBRUARY 20, 1976.
DEAR MR. CHAIRMAN: In further response to your December 30 letter. we are
pleased to furnish for your consideration the following information relative
to Postal Inspection Service activities of special interest to our elderly customers.
Confidence in business transacted by mail is vital to the national welfare. It
is the principal artery of commerce and communication in this country. No
element of our society is immune to loss through mail fraud, depredations on
the mails, and other activities involving misuse of the postal system. We recog-
nize the special vulnerability of senior citizens to this sort of criminal victimi-
zation.
MAIL FRAUD
Mail fraud is characterized by guile, deceit, and concealment. Its success does
not depend upon the use of physical force, violence or threats. Structured on
man's natural tendency to trust his fellowman, frauds are often designed to be
perpetrated on particular segments of society such as the elderly. the unem-
ployed and the poor. Through vigorous enforcement of postal statutes, the
Postal-Inspection Service seeks to protect the public from fraudulent promoters
who would use the mails to further their schemes.
The Mail Fraud Statute, section 1341, title 18, U.S. Code, is the oldest "con-
sumer protection law" enacted by Congress. It provides for 5 years imprison-
ment, $1,000 fines, or both, for any use of the mails in furtherance of a scheme
to obtain money, or property, on the basis of fraudulent representations.
During fiscal year 1975, the Inspection Service received 127,044 complaints of
alleged mail fraud. Arrests by Postal Inspectors for mail fraud totaled 1,618 and
1.260 convictions were obtained. Some 4,133 questionable promotions were dis-
continued in fiscal year 1975 through investigations. Although the Mail Fraud
Statute makes no specific provisions for restitution, approximately $8 million
were returned to victims.
Working with the Law Department of the U.S. Postal Service, the Inspection
Service utilizes two administrative-civil actions as provided by sections 3005
and 3007 of title 39, U.S. Code. Section 3005 permits the Postmaster General to
withhold and return to senders mail addressed to anyone whose advertisements
soliciting remittances are shown to contain false representations. The com-
panion statute, section 3007, makes it possible to obtain an order from a U.S.
District Court which permits the withholding from delivery of mail addresed
to such a firm or person, pending conclusion of section 3005 proceedings. During
fiscal year 1975, 170 cases were presented by Postal Inspectors to the U.S. Postal
Service Law Department for consideration of action under these statutes.
Consumer Protection Program.-Because of the convenience, many elderly
persons transact business and handle personal affairs by mail. The consumer
protection program of the Postal Inspection Service is designed to asssist postal
customers who complain of unsatisfactory mail-order transactions. Complaints
received are reviewed to determine if a full investigation is warranted, or if
action can be taken to resolve the customer complaint through direct contact
with the mail-order houses. In either case. the customer is notified of the action
taken. Direct contacts with mailers have been very successful. Many complaints
resulting from poor business practices. overlooked orders, and similar errors,
have been promptly resolved. Postal customers have expressed their apprecia-
tion for the attention given. During fiscal year 1975, the Inspection Service
received 34,900 mail-order complaints from postal customers, which were han-
dled under this program. Of those complaints, 27,000 were resolved.
CAN - LINO - 115
All consumers, regardless of age, are adversely affected when a fraudulent
scheme is perpetrated upon the community. While the variety of mail fraud pro-
motions is virtually limitless and persons from all walks of life are potential
victims, experience has shown that elderly consumers are particularly vulnerable
to certain schemes. The following brief résumé of some of these schemes, to-
gether with related statisties, may be of interest to your committee.
Business Opportunitics.-Four separate but closely related promotions fall
within this category. Distributorships, franschises. vending machines, and other
job opportunity frauds lure investors with promises of high returns and guar-
antees of success which later prove, for the most part, worthless. These schemes
frequently victimize older people who hope to put their resources to profitable
use. In fiscal year 1975, investigations were completed in 158 cases, resulting
in the discontinuance of 85 questionable operations. A public loss of $11,202,409
was cushioned somewhat by the 28 convictions which were obtained, and an
estimated public savings of $3,630,786 were effected.
While many elderly investors may find it desirable to invest in or purchase
franchise operations, there are dangers in such ventures. Recently, the operator
of a travel oriented business promised investors a yearly income of up to $25,000.
The investors received very little, if anything, in return, and the operator was
convicted of mail fraud.
Chain Referral Schemes.-These schemes are aimed directly at low-income
consumers. The elderly are particularly susceptible. Fast talking salesmen pass
off desirable, but grossly overpriced, appliances and home improvement items
under the misrepresentation that the products will actually cost nothing. The
victim is requested to supply names of friends and associates as potential pur-
chasers and thereby earn commissions. Not until they have signed conditional
sales contracts and other documents, do the victims realize they have actually
obligated themselves to pay for a product which they often neither want nor
can afford. During fiscal year 1975, 101 investigations resulted in the termina-
tion of 76 chain referral schemes.
Home Improvement.--This type of fraud is generally directed at the unin-
formed owners of modestly priced homes. Elderly citizens are often physically
unable to make repairs themselves. and can be convinced that their property
is badly in need of expensive renovation. Likewise, such items as aluminum sid-
ing. porches, patios, and garages are attractive to retired or seimretired in-
dividuals who desire to make their homes as comfortable as possible.
Land Sale Swindles.-The purchase of land for a retirement homesite is an
attractive investment for senior citizens. Unfortunately, some promoters mis-
represent the property they have for sale. Unfinished developments, swamp lands
and barren desert plots, may be foisted on an unsuspecting purchaser. In fiscal
year 1975, the Inspection Service investigated 51 cases involving alleged fraud
in land sales. totaling almost $11 million in public loss.
Matrimonial Schemes.-Lonely people, including the elderly, are often swin-
dled by dishonest persons. Men and women seeking pen pals, with a view toward
finding suitable mates, frequently join lonely hearts clubs. Few, if any, of these
clubs have facilities to determine the integrity of the persons who apply for
membership. It is said that a list of members can be purchased with little or no
difficulty. Club membership lists are. therefore, sometimes obtained by unscrupu-
lous persons who use them to carry on extensive correspondence with pros-
pective victims. The correspondence is usually started by the promoter mis-
representing himself to be exactly what the club member desires in a mate. As
the correspondence continues, endearing terms are used, and when the pros-
pective victim mentions matrimony. his or her pen pal responds with talk of
current financial problems. There will generally follow a request for money to
carry the loved one over the temporary crisis. Once the money is received, the
pomoter ignores additional correspondence. or returns the letters marked as
undeliverable. Obviously. many victims are hesitant to report the matter because
of embarrassment.
Medical Frauds.-By nature, medical frauds probably affect the elderly more
than any other segment of our society. Today. despite up-to-date medical facili-
ties and widely published warnings. elderly people fall prey to medical quacks.
These charlatans depict. by means of cleverly designed advertisements. cures for
a long list of geriatric problems, including arthritis. cancer. obesity, impotency,
and headaches. Rapidly rising medical costs and lack of sufficient insurance
coverage, among other circumstances, influence the elderly to try these alleged
quick cures.
In addition to prosecution. many medically related schemes are thwarted by
timely action by the U.S. Postal Service. This action, under 39 U.S. Code 3005,
may result in orders being returned to the senders. effectively stopping the
promotion. In establishing the fraudulent nature of the representations made,
the Inspection Service obtains expert medical testimony to the effect that the
product or treatment would do no good whatsoever.
Some medical fraud schemes include representations that are not only false
and misleading. but may also be considered dangerous. One company. in business
for many years. until the principals were indicted for mail fraud, had victimized
an estimated 6½ million people, through the sale of worthless dietetic, aphro-
disiac and muscle developing products. In another case. a pair were charged
with fraud for failing to provide goods and services which allegedly concealed
baldness.
Solicitation of Funds.-Thousands of organizations solicit funds from the
public, and appeals for contributions extend to many causes and include an
endless variety of charities and betterment organizations. Elderly people who
have experienced life's problems are often anxious to assist those less fortunate
than themselves. In some instances. this involves reducing an already meager
income by that much more. Unfortunately, funds solicited by unprincipled
CAN - LINO - 116
promoters funnel into the hands of swindlers. Schemes of this type vary, but
all have the following characteristic: they prey on the sympathy and the desire
of many to help the unfortunate. Unauthorized assumption of the names of
legitimate charitable organizations, as well as the use of bogus and official
sounding titles. are two of the ploys used by the con man. A fraud operator
business. needs little more than a solicitation letter and a mailing address to set up his
There were 210 cases issued for investigation by the Postal Inspection Service
in the area of solicitations during fiscal year 1975. Of this number, 104 promo-
tions were discontinued.
Work-At-Home Schemes.-Retirees. invalids, housewives. and others, par-
ticularly in the poor and lower middle-class income levels. frequently desire to
supplement whatever income they have. Age. health and family responsibilities
may make it impossible for these persons to hold even a part-time job. Naturally,
the prospect of employment at home is attractive to them.
A mail-order promotion in New Jersey was recently stopped when both opera-
tors pleaded guilty to mail fraud. They had advertised nationwide and offered
steady income through work-at-home employment stuffing and addressing en-
velopes. Investigations of 151 such promotions resulted in 112 work-at-home
schemes being discontinued during fiscal year 1975.
Merchandise Schemes.-In addition to the Inspection Service efforts under
the consumer protection program in resolving customer complaints against non-
fraudulent mail order firms. criminal investigations also are conducted when
fraudulent intent is indicated by the failure of a merchant to furnish ordered
merchandise or make refunds. Many of the investigations involved complaints
made by elderly citizens who are victimized. There were 546 criminal investiga-
tions of this type conducted in fiscal year 1975 involving losses to the public
of over $5 million. There were 263 questionable promotions discontinued.
SEXUALLY ORIENTED ADVERTISEMENTS
Often, elderly people are subjected to unsolicited receipt of objectionable or
sexually oriented advertisements. The Postal Service has two methods available
by which they can be protected from receiving such unwanted mail. One of these
methods is the Pandering Advertisements Statute (title 39, U.S. Code, section
3008). Under the provisions of this statute, a customer who receives an adver-
tisement which he considers to be "erotically arousing or sexually provocative,"
may sign a request for a Prohibitory Order Form 2150. or Publication 123
(available at all post offices) against the mailer. The Postal Service would, in
turn, issue an order to that mailer instructing him to cease further mailings to
the customer, effective on the thirtieth calendar day after the date of the order.
If the mailer makes a subsequent mailing to the customer after the 30-day grace
period. the mailing should be referred to the Postal Service. The matter will then
be brought to the attention of the Justice Department for consideration of
civil action.
The Sexually-Oriented Advertisements Statute (title 39, U.S. Code. section
3010) is the second method made available by law. This statute is intended to
afford protection from receiving unsolicited advertisements from any source,
rather than from one particular mailer. However, the advertising material must
be sent unsolicited and must depict material specifically defined by the statute
as being sexually oriented.
THEFT OF MAIL
Investigation of the theft of mail after delivery to houses, apartments and
rural mail boxes is one of the major criminal investigative functions of the
Inspection Service. Approximately 66 million American families are served by
city and rural routes. An estimated 750 million Federal, State, and local checks
are delivered through the mails annually. Checks are most vulnerable to theft
when they reach the addressees' mail box.
U.S. Treasury Checks and State welfare checks are the most common targets
of letter-box thieves. A disproportionate number of their victims are the poor
and the elderly who suffer most when their checks are stolen and replacement
checks must be issued. The check theft problem is most severe in the low-income
areas of the larger cities where millions of welfare and social security checks
are distributed by mail. Contributing to the problem has been the ease with
which thieves have been able to cash stolen checks. False identification is easily
obtained.
Inspectors work with Secret Service Agents, State and local law enforcement
officers, and with officials of check issuing agencies to insure the prompt ex-
change of information and the efficient coordination of investigative efforts. The
Inspection Service has encouraged State and local efforts to develop better photo
and signature identification cards. The aid of public housing authorities at local
levels has been enlisted to install and maintain secure mail receptacles, mail
rooms and guard forces. Inspectors participate in local programs to educate
merchants in check cashing procedures. Liaison is maintained on a continuing
basis with banking institutions to exchange information on check-fencing opera-
tions and split-deposit schemes.
SECURITY
The U.S. Postal Service is vitally concerned with the secure handling of all
mails, as well as providing a safe environment for postal customers. This is of
particular importance to older Americans who lack mobility through physical
infirmity, who rely on benefit checks received by mail. or whose separation from
family makes them heavily dependent on prompt and reliable mail service. The
task of providing for the security of the Postal Service has been assigned to the
Postal Inspection Service. In fulfilling its mission, a variety of steps are taken
CAN-LINO-117
by the Service to provide for the safe delivery of all mail. Recognizing the im-
portance of millions of social security. veterans. and other retirement checks
handled by the Postal Service each month. the Inspection Service insures that
extra protection is afforded them. Specially designed. lockable containers as
well as unique handling and transportation methods are used to protect the
checks from loss or damage. The Inspection Service is also constantly studying
new techniques to improve service and protect the mail.
Providing a safe environment for postal customers is one of the primary
missions of the U.S. Postal Service Security Force. Stationed in and around
designated postal facilities, these specially trained officers, under the direction
of the Postal Inspection Service, provide perimeter security for postal buildings
to insure ready and safe access by the public. Frequent use of postal services
by the elderly makes them a prime beneficiary of this added level of protection.
PUBLIC EDUCATION
The Postal Inspection Service maintains close liaison with other Federal,
State, and local agencies having a concern for consumer protection. In addition,
Postal Inspectors make numerous speaking appearances each year before various
law enforcement. civic, education. and consumer groups. The Inspection Service
was represented at the National Conference on Crime Against the Elderly held
at Washington. D.C. between June 5 and 7, 1975. The conference, sponsored by
The American University. brought together concerned practitioners and planners
in the fields of aging services and criminal justice, in the hope of gaining better
understanding of the needs of older people and to study the problems confronting
them.
Although many postal investigations are "after the fact situations," our pro-
grams are also directed at prevention and increasing the public awareness of
potential problem areas. I hope this summary will be helpful to you and your
committee.
Sincerely,
BENJAMIN F. BAILAR.
ITEM 22. RAILROAD RETIREMENT BOARD
JANUARY 29, 1976.
Dear MR. CHAIRMAN With reference to your letter of December 30, 1975, I am
pleased ot enclose a statement summarizing major activities of the U.S. Railroad
Retirement Board on aging during 1975. It is anticipated that payments under
the Railroad Retirement and Railroad Unemployment Insurance Acts will be
somewhat higher during 1976 than in 1975.
We look forward to your committee's 1975 report on developments in aging.
Sincerely yours,
[Enclosure]
R. F. BUTLER, Secretary.
The U.S. Railroad Retirement Board is the Federal agency that administers a
comprehensive social insurance and staff retirement system for railroad workers
and their families, separate from but coordinated in several ways with social
security. Programs of the system include the following: (1) Old-age, survivor
and disability benefits under the Railroad Retirement Act: and (2) unemploy-
ment and sickness insurance benefits under the Railroad Unemployment Insur-
ance Act. In addition, certain administrative services under the Federal health
insurance (medicare) program are performed with respect to aged and disabled
railroad workers and eligible members of their families.
BENEFITS AND BENEFICIARIES
During fiscal year 1975, benefit payments under the railroad retirement and
railroad unemployment insurance programs totaled $3,127 million, an increase
of $407 million from fiscal year 1974. Retirement and survivor benefit payments
amounted to $3,060 million. an increase of $390 million over the preceding fiscal
year. Unemployment and sickness benefit payments during fiscal year 1975
totaled $67 million, almost $17 million more than in the preceding fiscal year.
The number of beneficiaries on the retirement-survivor rolls on June 30. 1975,
totaled 1,013,000. The vast majority (over 82 percent) were aged 65 and older.
At the end of the fiscal year. nearly 462,000 retired employees were being paid a
regular annuity averaging $324, about $28 higher than a year earlier. In addition,
142,000 of these employees were being paid supplemental annuities averaging
almost $62.
Almost 220.000 wives of retired employees were receiving an average annuity
of $153. Of the 338,000 survivors on the rolls as of June 30. 1975, 291,000 were
aged widows receiving an average annuity of $233. About 875,000 individuals
who were receiving or were eligible to receive monthly benefits under the Rail-
road Retirement Act were covered by hospital insurance under the medicare
program at the end of fiscal year 1975. Of these, 851,000 (97 percent) were also
enrolled for supplemental medical insurance.
Unemployment and sickness benefits under the Railroad Unemployment In-
surance Act were paid to over 137,000 railroad employees during fiscal year 1975.
However, only about $350.000 (less than 1 percent) of the benefits went to in-
dividuals aged 65 and older.
DEVELOPMENTS IN 1975
LEGISLATION
The Railroad Retirement Act of 1974, enacted on October 16, 1974, as Public
Law 93-445, became effective January 1, 1975. The 1974 act. which was described
in last year's report, comprehensively restructured the railroad retirement sys-
CAN - LINO - 118
tem. This legislation was developed by a joint committee of railroad management
and labor representatives and was intended to put the railroad retirement system
on a relatively sound financial basis, make certain improvements and preserve
the existing equities of career railroad employees. It is anticipated that the 1974
act's provisions for changes in the annuity formulas, a reduction in dual railroad
retirement-social security benefit payments, plus the additional funds provided
by the Federal Government to pay the phase-out costs of dual benefits, and higher
investment earnings, together, will place the railroad retirement system in a
much improved financial condition.
Other than technical amendments to the Railroad Retirement Act of 1974, and
provisions of the Tax Reduction Act of 1975 extending one-time $50 payments to
railroad retirement annuitants as well as social security beneficiaries. 1975
legislation affecting the railroad refirement system was confined to the Railroad
Unemployment Insurance Act administered by the Board, and to the Railroad
Retirement Tax Act. The 1975 amendments to the Railroad Unemployment In-
surance Act which were effective July 1. 1975. increased unemployment and sick-
ness benefits, provided extended unemployment benefits during periods of high
unemployment such as the present for employees not previously eligible, and
otherwise liberalized this benefit program for nonretired employees. The 1975
amendments to the Railroad Retirement Tax Act concerned the periods of time
to which certain payments to employees are to be taxed.
ITEM 23. VETERANS' ADMINISTRATION
FEBRUARY 5. 1976.
Dear MR. CHAIRMAN: In response to your request of December 30, 1975, I am
pleased to forward the enclosed report on Veterans Administration activities
relating to developments in aging for the year 1975.
This agency has a special interest in the increasing proportion of aging persons
in the national population. The average of the ages of the more than 29 million
veterans in this country is slightly more than 46 years; however, the average
age of all patients in VA hospitals presently is 9 years greater.
Since the number of veterans who are age 65 or older is growing rapidly and
this class of veterans is a heavy user of VA medical care. the average age of
inpatient groups will advance steadily in years immediately ahead. When ex-
tended care types of patients (domiciliaries and nursing homes) are included,
about one-third of all VA inpatients are age 65 or older.
The magnitude of our activity is more fully realized when to this is added
the fact that the VA provides all or part of the income of more than 1.6 million
persons over the age of 65.
The development of new thrusts in geriatric programing. exemplified by the
establishment of an Office of Assistant Chief Medical Director for Extended
Care and further development of geriatric research, education and clinical cen-
ters in seven locations, attests to the increasing leadership of the VA in this
important area.
I hope the enclosed information will be helpful to the committee. Please let
us know if we can provide any further assistance.
Sincerely,
RICHARD L. ROUDEBUSH, Administrator.
[Enclosure]
VA ACTIVITIES AFFECTING OLDER VETERANS IN 1975
DEPARTMENT OF MEDICINE AND SURGERY
1. INTRODUCTION
During the past year the Veterans Administration has taken two steps which
are expected to have significant impact upon health care delivery to older veter-
ans. First, all tended care facilities existing within the VA system were re-
organized into one medical service. headed by one Assistant Chief Medical Di-
rector for Extended Care. Ths move brought together several diverse long-term
care programs. including: domiciliaries, VA affiliated State domiciliaries, VA
nursing homes. community nursing homes, VA affiliated State nursing homes
and hospital based home care.
These programs have a strong bond and mutual concern, however, because the
populations which they serve are comprised primarily of older veterans. Bring-
ing together under one organizational roof those facilities which are concerned
primarily with the extended care of older veterans was seen as a first step in
providing more comprehensive and better geriatric care.
In our long-term care programs, the number of veterans on a typical day were:
6,933 in VA nursing homes: 6,571 in community contract nursing homes: 9,222
in VA domiciliaries; 1,062 in State hospitals (VA supported) 4,268 in State
nursing homes (VA supported) ; and 5,754 in State domiciliaries (VA sup-
ported).
The number of inpatients 65 years of age or older in VA facilities or in other
facilities under VA auspices has increased 5.4 percent since 1970, while the total
number of all inpatients has remained about the same. Significant increases in
the number of inpatients 65 years of age or older occurred in four extended care
programs: Community Nursing Home Care (97.6 percent), State Home Nursing
Care (47.8 percent), VA Nursing Home Care (46.8 percent), and State Home
Hospitals (44.8 percent). These increases are commensurate with the increased
availability of beds for these programs.
CAN-LINO-119
Of all VA inpatients under care on October 1, 1975, approximately 33 percent
(36,700) were 65 years of age or older. Compared to the census day in 1970, this
represents a 7.2 percent increase in the proportion of older patients receiving
health care by the VA. About 47 percent of these older veterans are receiving
extended care.
To provide for and ensure that geriatric care in extended care facilities is up-
graded, the Veterans Administration took a second significant step. The newly
formed VA Geriatric Research, Education and Clinical Centers (GRECC's) were
made the management and planning arm for the Extended Care service. These
Centers had already been singled out by the Veterans Administration because of
their staff's interest and expertise in approaching the medical and psychological
problems associated with the aged.
The Geriatric Research, Education and Clinical Center (GRECC) is designed
to be a collaborative effort among basic researchers and clinicians on the prob-
lems associated with aging. Researchers and clinicians, both with diverse back-
grounds and with similar expertise, are expected to exchange views and to utilize
each others' experiences to identify important areas and approaches in geriatric
research. An important component of each GRECC is its clinical demonstration
ward where applied studies can be conducted and clinical care models can be
demonstrated. It is expected that the GRECC's will play a major role in the
education of staff throughout the Extended Care service. The Centers will re-
search particularly acute problem areas in aging, develop treatment and clinical
care programs, and educate staff across the VA system to implement similar
programs in their care facilities.
Currently, there are seven Geriatric Research, Education and Clinical Centers
and one additional Center is expected to be designated within the next 2 years.
GRECC's have been organized at the VA Center, Bay Pines, Fla.; VA Hospital,
Little Rock, Ark.; Palo Alto/Menlo Park, VA Hospital, Palo Alto, Calif.: VA Hos-
pital, Sepulveda, Calif.; VA Center, Wadsworth Hospital, Los Angeles, Calif.;
and two joint Centers were established involving Boston Outpatient Clinic/Bed-
ford VA Hospital, Mass. and American Lake/Seattle VA Hospitals, Wash. These
Centers are expected to provide leadership and direction in geriatric research
within the VA. The GRECC's have the needed expertise: many of the outstand-
ing researchers in the field of aging are associated with the Centers. The GRECC's
have also been given resources in terms of facilities, equipment, and moneys to
recruit additional personnel to enable them to accomplish their program goals.
The Administrator of Veterans Affairs through his designee, the ACMD for Ex-
tended Care, has continued to cooperate fully and actively with the Interdepart-
mental Working Group on research, nutrition, energy, and information and re-
ferral.
In working with other governmental agencies on the problems of the aging
citizen, the Geriatric Centers have been the logical VA representative. When the
Commissioner on Aging requested that the VA appoint AoA regional representa-
tives, the Geriatric Center Directors agreed to assume the liaison information role
where needed. The Geriatric Centers have actively supported the efforts of the
AoA nutritional program and four Centers are originating projects in conjunc-
tion with AoA to identify and meet the nutritional needs of older veterans.
The VA is actively working with the Administration on Aging Federal Inter-
agency Task Force on Information and Referral Services for Older People. This
is an effort among Federal agencies to coordinate their information and re-
ferral services to elderly citizens. The VA has been particularly concerned with
discovering ways in which cooperative efforts initiated at the top agency levels
can be filtered down meaningfully to "grassroots" agency workers.
Since their organization in 1974, the GRECC's have been involved in developing
and conducting educational conferences. These conferences disseminate current,
up-to-the-minute knowledge about important issues in the field of aging. The con-
ferences are aimed not only at GRECC and other extended care services staff, but
álso are made available to community professionals, paraprofessionals, and in-
terested university members. In the first year of GRECC operation, Seattle pre-
pared a program on "Aging and the Caring Environment" while the Sepulveda
GRECC sponsored a second conference dealing primarily with the physical and
design aspects of long-term care facilities for older persons.
During the present fiscal year 1976, three conferences will be sponsored by the
Geriatric Centers: "Dermatosis and Aging," held at the Albuquerque, N. Mex.,
VA Hospital; "Caring Environment," sponsored by the Boston/Bedford GRECC;
and "Cardiopathy of the Aging III," sponsored and organized by the Little Rock
Geriatric Center.
A brochure is being prepared which will describe the function of the Geriatric
Research, Education and Clinical Centers within the VA. This pamphlet will be
available for dissemination to professionals in the aging field and interested
citizens. A Bicentennial exhibit explaining extended care services within the VA,
including the Geriatric Research Centers, is scheduled to be displayed at a profes-
sional conference in Washington next summer.
Finally, in addition to its educational conferences, the Geriatric Research, Edu-
cation and Clinical Centers are committed to organizing professional symposia
dealing with specific issues in aging. A series of monographs are planned which
would summarize the symposia's proceedings and enable even wider dissemi-
nation of expert opinions on vital, current topics. The first such symposium was
held in February 1975, and the proceedings have been published in a monograph
entitled "Procaine and Related Geropharmacologic Agents-The Current State
of the Art."
Further significant efforts in the Department of Medicine and Surgery and
the Department of Veterans Benefits to meet the needs of aging veterans are
described in the following sections.
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2. MEDICAL SERVICE
Medical Services in VA hospitals are responsible for approximately one-third
of the total number of operational beds in the system. One-fourth of all patients
in VA hospitals on a given day are aged 65 or older. Patients over 65 show a pro-
gressively increasing length of stay, illustrating two principal points: aging
patients tend to manifest chronic diseases requiring longer periods of hospitaliza-
tion and many of these patients are to be found on Medical Services, frequently
in what is termed intermediate sections, which are staffed and equipped for the
needs of longer-term patients, especially for those with need for hospitalization
in excess of 30 days. Moreover, as the largest group of American veterans from
Wold War II become older (now 53.5 years on the average), VA can expect even
a greater incidence of long-term illness arising from this group.
Heart, stroke, cancer and renal diseases continue to be the principal causes of
death among adults in this country. VA is making significant effort to improve
care of all veterans with these conditions, which per se affect a large propor-
tion of aging patients. VA is in process of completing programs for installing
specialized intensive care, coronary care and respiratory care diagnostic and
treatment capability in all its hospitals. The VA dialysis program for end-stage
kidney disease continues to grow and more aging patients are being accepted for
long-term dialysis treatment. Hypertension, one of the principal underlying causes
of heart disease, stroke and kidney failure, is the target of a major VA detection
and treatment program. Implementation of the hypertension screening and treat-
ment program should do much to ameliorate major causes of disability and death
in the aging veterans.
Several programs which should have further impact on care of the aging
veterans are continuing to develop in VA. Examples are improved methods of
diagnosing and treating infectious diseases (pneumonia and kidney infections
continue to be major problems in the older age groups) rheumatology, which is
concerned with arthritis and related bone and joint conditions, major causes of
discomfort and disability among the elderly and a planned program of rehabilita-
tion for major heart and lung disabilities.
Medical Services in the VA are committed to and involved in major emphasis on
ambulatory care as a significant element of a comprehensive care program for
veterans. In addition to broader services. greater use of ambulatory care as an
alternate to hospitalization may yield significant cost avoidances.
3. MENTAL HEALTH AND BEHAVIORAL SCIENCE SERVICE
The Mentl Health and Behavioral Sciences Service has continued and expanded
its services to the elderly patients in our Veterans Administration health care
facilities. In addition to the provision of psychiatric and psychological consulta-
tion and services to the patients in our Intermediary Medical Services and Nurs-
ing Home Care Units, there has been an expansion of needed services to our
domiciliary population, for instance. in psychiatry in our single domiciliary at
White City, Oreg., where they have had none prior to 1975.
In keeping with the expansion of geriatric services, the Mental Health and
Behavioral Sciences Service has joined with the newly formed Extended Care
Service to conduct special seminars, the last held in Bedford, Mass., on "Aging
and the Caring Environment." This was fourth in a series in which the concerns
of developing a psychological environment conducive to the most effective care
and treatment of the medical and psychological condition which affect the aged
was presented. These services were attended by practitioners both within and
outside of the Veterans Administration.
Special attention must be accorded to our psychiatric hospital in St. Cloud,
Minn., which pioneered a special program in which sixth grade students as part
of their school work established friendships with a group of aged veterans in the
hospital. What started as an experiment, to teach younger people the habits
and mannerisms of older adults and to motivate older patients to become more
interested in living, developed into mutual friendships among the generations.
The parients, many of them grandfathers who may be long distances from their
families and grandchildren, took much more interest in themselves and the world
around them as a result of their interaction with the children. The original class
was so enthusiastic over the experience that other classes are continuing the pro-
gram with obvious benefit to both generations. The psychiatric hospital at St.
Cloud was awarded a gold award at the 24th Institute on Hospital and Com-
munity Psychiatry for this program of using sixth graders as remotivation
therapists for geriatric patients.
Work is continuing in the area of drug prescription practices in order that,
particularly in regard to psychotropic medication, benefits which these wonder
drugs have produced can be maximally applied to patients who manifest psychic
disturbances in addition to the physical infirmities accompanying advancing age.
FORD
In most of our psychiatric hospitals, and in wards which treat a significant
number of geriatric psychiatric patients, programs of reality orientation are
almost routine SO that the ward and hospital environments are actively working
to reduce the experience of confusion and disorientation which often result from
LIBRARY
the institutionalization of elderly people.
93
As one of the major outpatient mental health programs our Day Treatment
Centers which have been functioning since 1957 are allowing many of our World
War I and II veterans to remain in the community while providing a stimulating
and therapeutic experience and environment without which hospitalization would
be required for many of them. There are currently 52 Day Treatment programs
treating over 5,000 patients.
During 1976. it is anticipated that there will be increasing efforts in the
treatment, research and educational activities of the Mental Health and Be-
havioral Sciences Service to direct its attention even more to the aged veteran
who is becoming such a major consumer of our health care services. It is pro-
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jected that the close alignment which now exists will be further fostered between
this Service and the new Extended Care Service and thus bring about even
more direct involvement of Mental Health personnel and programs with the
veteran patients who fall in our senior citizens category.
4. SOCIAL WORK SERVICE
Social Work Service has a long tradition of providing a wide range of services
to the older veteran and to his wife and widow. This is due in part to the fact
that the veteran population is esentially an aging population and because medical
science and technology have made it possible to live longer than ever before.
The challenge to social work has been to help older veterans live meaningful
and useful lives within the limits of their health problems and their disabilities.
The complicating factor in achieving this goal has been the lack of adequate social
services and social supports for older veterans in the community, and the need to
locate and develop a variety of resources including income maintenance, ambula-
tory health services, housekeeping and other personal services, such as meals-
on-wheels, transportation, recreational opportunities, etc.
For those veterans requiring long-term care, there has been a need to humanize
our nursing homes and other special institutions, to create more caring environ-
ments which are responsive to individual's needs and problems and to encourage
social interaction and independent decisionmaking.
In addition to helping older veterans with practical difficulties, Social Work
Service offers counseling programs in such areas as retirement planning, loss of
a loved one. developing avocation interests, coping with feelings of discourage-
ment, building a new life. and accepting the need for supervised living arrange-
ment when independent living is no longer medically or socially feasible or
desirable.
During fiscal year 1975, Social Work Service assisted 26,096 veterans from
general medical and surgical hospitals in finding community alternatives to
hospitalization. This was accomplished by placing veterans in such placements
as personal care homes, nursing homes, state soldiers' homes, boarding homes and
other special placements. Twenty two percent of these veterans were 70 years of
age or older. The combined totals of those veterans already in placement and
those placed during the fiscal year totals 37,513.
Special attention is given to ensure that all community homes used by the
VA meet quality standards and to this end, Social Work Service along with other
involved disciplines regularly inspect each home being utilized. In addition,
Social Work Service carries major responsibility for providing continuing sup-
portive service to these veterans after they have been placed in community care
homes. Ongoing guidance, consultation, and training is also provided for the
sponsors of homes to ensure that they are able to meet the needs of these veterans.
Several new programs have been developed recently to serve veterans return-
ing to their own homes. Veterans who live in isolated areas or who live alone are
being contacted by telephone at specified times by volunteers to ensure their
well being. This program is known as telecare. Social workers in over 100 hospi-
tals are supervising such programs or referring appropriate veterans to similar
programs operated by other community agencies. A friendly visiting program of
volunteers seeing aged veterans who are homebound or residing in community
nursing homes is another service offered by many of our VA hospitals.
Counseling programs on death and dying have been expanded this year and
there has been an increased emphasis on improving the quality of terminal care.
Special attention is being given to helping hospital and nursing home staff,
along with patients and relatives, understand and deal with their anxieties, fears
and frustrations in dealing with death.
Social Work Service plans to increase its involvement with university geron-
tological centers, schools of social work and community agencies concerned with
the aged in the areas of service delivery, training and research. Continuing
emphasis is being placed on regionalized approaches to the care of the aged
while upgrading social support systems which will assist the aged in maintaining
appropriate living situations in the veteran's own communty.
5. REHABILITATION MEDICINE SERVICE
Rehabilitation Medicine Service (RMS) continues to place emphasis on the
treatment and rehabilitation of the elderly. In most all conferences, workshops
and teaching seminars. a part of the program focuses on the aging veterans and
his needs with which RMS should be concerned.
Current programs in RMS range from the treatment of the older individual's
dysfunction problems to socialization programs. They include such programs as
community orientation, compensated work therapy, nursing home care units,
half-way houses and community foster homes, reality orientation, behavior
modification, and many others.
Rehabilitation Medicine Service is currently providing assistance in develop-
ing a multidisciplinary rehabilitation concept in the Extended Care faclity at
St. Albans, N.Y. Current plans include having an initail reality orientation work-
shop in early 1976. After the staff has had an opportunity to practice and per-
fect its reality orientation techniques, training programs will then be estab-
lished to provide ongoing educational programs for both VA and non-VA per-
sonnel.
In VA. Recreation Therapy has placed emphasis on using community facilities
to involve patients in community activities as a part of the treatment. Senior
citizen groups, special geriatric calisthenic programs, adult educational programs,
and social and pienie outings are accomplished on a cooperative basis with the
community. RMS considers the problems of chronicity as one of its major con-
cerns and is. therefore, moving toward providing continuous education in geria-
trics for its therapists.
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The older veteran is a chronic user of bed space within the VA. These patients
in our medical facilities are spending an inordinate amount of time in the casto-
dial sense, rather than being responsible for themselves. RMS is stressing the
rehabilitation of the elderly in hopes of giving them back their sense of diguity
and self-determination. Rehabilitation rather than custodial care is the major
consideration in providing care for these veterans.
6. DIETETIC SERVICE
Comprehensive nutritional care is provided for aged veteran beneficiaries.
This care addresses itself to the physiological, sociological, and psychological
aspects of aging. Assessment of the aged veteran's nutritional status looks into
the underlying causes of an inadequate food intake. A common cause is the
aging veteran's diminished appetite: another is swallowing or chewing problems
from a disability such as stroke or the absence of teeth or dentures. Also con-
sidered is inadequate food intake resulting from the reduced buying power of
retirement and/or fixed incomes and failure to eat at regular hours due to
loneliness and depression. The dietitian works closely with all members of the
health care team in integrating appropriate nutritional care with the aged
veteran's total treatment regime. In response to the diet prescription the dietitian
modifies the veteran's food intake to meet the physiological requirements of his
condition. Menus and mealtimes are adjusted to increase patient satisfaction.
Food acceptance studies conducted regularly document the aged veteran's food
preferences. Whenever possible the veteran is encouraged to make his choice of
food from a cafeteria counter or from a printed selective menu. Selecting his own
food is one of the few opportunities the aged hospitalized veteran has to exercise
his independent judgment. Taking meals in the atmosphere of a dining room
as opposed to three meals from a bedside tray fosters resocialization in an in-
stitutional setting. Leaving the bedside three times a day for meals in a cheerful
dining area stimulates an improved food intake as well as a more positive at-
titude toward the total treatment program. New food products are evaluated
continually for their merit in meeting the veteran's specific nutritional needs.
Supplemental foods containing concentrated nutrients are made available to the
aged veteran whose poor appetite or limited capacity curtails the required food
intake for normal nutrition.
Since the benefits of good nutrition manifest themselves slowly, nutrition edu-
cation must be a continuous process to assure proper eating habits throughout
hospitalization and after the veteran's return to his community home. Veterans
are instructed individually as well as in groups. Effort is made to assist the
aged vetrean on a modified diet to integrate the restrictions of his prescribed diet
with the foods he usually eats and his usual mealtime pattern. Particular em-
phasis is given to instructing the aged veteran to avoid being victimized by food
faddists selling SO called "health" foods which are costly and unnecessary for his
health. The use of food stamps for aged veterans with reduced incomes and in-
structions on reading food labels for maximum nutritional and economic value
are typical of the nutrition education classes provided. The aged veteran's wife
or other family member is encouraged to attend nutrition classes with the vet-
eran to increase the support he will receive in obtaining proper nutritional care
following medical discharge. A large segment of alcohol dependent veterans is
elderly. The ravages of alcoholism frequently result in severe malnutrition.
Dietitians, in collaboration with the health care team, work closely with these
patients to restore them to normal nutritional status when physically possible and
to teach them improved eating habits to maintain their health while overcoming
alcohol dependency.
The need to research the relationship of nutrients with disease conditions of
the aged is of ever-increasing importance, from the standpoint of improved
quality of life old age as well as from a purely economic basis. Since the aged
have the highest incidence and prevalence rates for illness and disability, the
cost of medical care and maintenance of the disabled will increase proportion-
ately to the increasing aging population. The seven Geriatric Research. Educa-
tion and Clinical Centers address themselves to the specific problems of the aged.
Nutrition research, basic, metabolic and clinical has been encouraged since the
inception of these centers. Dietitians in these locations have demonstrated their
interest in nutrition research and have developed research proposals.
The dietitian has participated in the followup care of aged veterans through
such programs as hospital based home care, foster homes, personal care homes,
and community nursing homes. The expansion of ambulatory care has afforded
the aged veteran the opportunity to receive nutrition counseling in coordination
with his total treatment program. Followup nutritional care is particularly es-
sential for the growing number of aged veterans who live alone. Teaching these
veterans to care for their own nutritional needs within a reduced income and
with limited cooking skills and equipment is a mounting responsibility of dieti-
tians today.
7. NURSING SERVICE
Nursing Service utilizes a multidisciplinary approach to planning and provid-
ing individualized care for each veteran patient. This approach has proved suc-
cessful and is in keeping with current care concepts. By collaboration and
coordination with other disciplines on the treatment team, all therapeutic activ-
ities are directed toward the same goals for the specific veteran. Nurse admin-
istered units are established in selected long-term care settings. in which nurses
practice in an expanded role and assume primary responsibility for the con-
tinuum of care in health maintenance, management of symptoms and referral to
alternate care settings.
CAN - LINO - 123
A. written patient care plan is made for each veteran. and includes an assess-
ment of nursing needs and a plan of action. The plan assures maximum attention
not only to needs related to care during the illness, but also to health teaching
and supportive assistance needed by the veteran and family. Focus is toward the
individual veteran's potential for independent functioning and the maintenance
of health. A plan is developed for each patient in all VA care settings.
Reality orientation. remotivation. resocialization and therapeutic recreation
are integrated into daily programs involved with care for the aged veteran.
Reality orientation in some long-term care settings has been adapted to include
reorientation to functioning in the contemporary social and physical environ-
ment. Trips to laundromats. drycleaning establishments. department stores. pub-
lic libraries. entertainment areas. restaurants, railroad stations and airports
are diversional activities which also motivate improvements in personal hygiene
and grooming. bridge gaps between institutional and community living and add
to quality of life.
The patient and family participate in planning care in many settings. Nurs-
ing Service. in discharge planning, teaches the patient, family, or other health
workers including community health workers. to care for the patient in non-
hospital settings. When medically indicated. Nursing Service provides for fol-
lowup visits to the home through referral to community nursing agencies and
orients community health agency workers or the community nursing home staff
to the care of a specific patient. VA nurses also participate in surveys of nursing
homes and make followup visits to these homes to assure satisfactory adjust-
ment of the veteran to the specific facility.
Nursing Service feels a professional commitment to establish and maintain an
environment which permits the individual to maintain a satisfying self-image
and attain the optimum level of independent functioning. Activities which
encourage feelings of accomplishment, and assuming of responsibility are utilized.
Nursing Service continues to: (1) Demonstrate that through expanded roles
nurses are improving care for the aged in a variety of settings. and (2) explore
the influence of environment on therapeutic outcomes, and (3) seek improved
methods of care for aged veteran patients.
8. VOLUNTARY SERVICE
Through the Voluntary Service program volunteers participate in a wide
variety of VA medical care services to the aging. beginning with the admissions
process and carrying through into the community at nursing homes and satellite
clinics. Their ability to concentrate substantial amounts of time on companion-
ship with individual patients and their capability of bringing the community
and its resources into the institution gives these volunteers their own particular
value as members of the total treatment team for the long-term patient.
Older patients in nursing home care and domiciliary units respond well to
the vitality and enthusasium of youth volunteers and to the shared interests of
older volunteers. In other areas of VA health care facilities as well. qualified
volunteers of all ages help the staff to meet a variety of patient needs. Among
their activities are: performing personal services such as letter wrting and
shopping: counseling with the terminally or chronically ill: taking books and
talking books to patients on the wards or assisting them in the library escort-
ing wheelchair and litter patients to clinics and chapel services: assisting with
menu selection and food service: participating in psychological testing and group
therapy teaching music, manual arts. crafts, sports and games. and gardening:
helping with speech therapy. and counseling stroke victims and laryngectomy
patients. There are, in addition, many other direct and indirect services involving
older patients where volunteers effectively supplement the work of the staff.
The fact that older volunteers are encouraged to participate in the VA health
care program provides for many of them a sense of being needed and of belonging.
The value they place upon this involvement may be judged by two current
examples: A 92-year-old woman commutes by bus. with two transfers each
way. to mount electrocardiograph strips 4 days a week in the EKG laboratory
at the Kansas City, Mo. VA Hospital: an octogenarian member of the American
War Mothers travels 100 miles round trip to represent her organization on the
Voluntary Service Advisory Committee at the Boise, Idaho VA Hospital, never
missing a meeting.
To encourage the enrollment of even more older Americans in the VA volun-
teer program. Voluntary Service seeks active relationships with such agencies
as ACTION, with its older American volunteer program. and the American Asso-
ciation of Retired Persons/National Retired Teachers Association.
9. EDUCATION
The Office of Academic Affairs with the Office of the ACMD for Extended Care
has been actively involved in planning a comprehensive educational program for
health care workers involved in the treatment of geriatric patients. The approach
that has evolved is multifaceted. involving training of students and the continuing
and in-service education of VA health professionals.
Under the auspices of Extended Care and Academic Affairs, the Geriatric
Research, Education and Clinical Centers (GRECC's) have been involved in
developing and conducting educational conferences. These conferences disseminate
current, up-to-the-minute knowledge about important issues in the field of aging.
The conferences bring together national and local experts engaged in long-term
care of the elderly and are aimed not only at the Geriatric Centers and other
Extended Care Services staff, but also are made available to community profes-
sionals and paraprofessionals. During May of 1975, the Seattle/American Lake
GRECC sponsored the 3rd annual conference on "Aging and the Caring Environ-
ment." in which more than 50 VA staff and 200 community nursing home adminis-
trators participated. The Sepulveda GRECC sponsored the conference on "Impact
CAN enterned LINO - 124
of Physical Environment on Patient Care in VA Nursing Homes," dealing pri-
marily with the physical and design aspects of long-term care facilities for older
persons. The Geriatric Centers actively participated in the symposium on educa-
tional development in aging sponsored by Academic Affairs and held in Washing-
ton during May of 1975. The VA-GRECC program in conjunction with the
University of New Mexico School of Medicine sponsored the Symposium on
Geriatric Dermatology held at the VAH Albuquerque in October of 1975. The
Bedford Geriatric Center sponsored a most successful symposium on "Caring
Environment for the Aging" during November of 1975. Several other conferences
are planned for this year including cardiopathy of the aging. nursing home design,
hospital based home care, neurobiology and behavioral sciences symposia relative
to aging.
The Geriatric Centers are actively involved in developing training programs in
various specialties with prominent universities and gerontology institutes, as well
as community colleges.
A brochure is being prepared describing the function of the Geriatric Centers
within the Veterans Administration and will be disseminated throughout the VA
as well as to professionals in the aging field and interested citizens.
In addition the Geriatric Centers are committed to organizing professional
symposia dealing with specific issues in aging. The first such symposium was held
in February of 1975 and the proceedings have been published by the Sepulveda
GRECC entitled "Procaine anh Related Geropharmacologie Agents-The Current
State-of-the-Art," VA-GRECO Monograph No. 1.
10. RESEARCH
The Veterans Administration broadly defines its older population as including
those veterans who are 55 years and older. The VA has long recognized that aging
is not an invariate process. An individual's personal health and social-psychologi-
cal history affect his aging process. Chronological age is seldom an adequate
criterion for determining "aged" persons. Some veterans are in need of medical
care for arthritic and cardiovascular conditions at relatively young ages while
other veterans are in fine physical health through their seventies.
Research priorities within the VA reflect the dual aspects of aging. It is impor-
tant to distinguish between true age change and those physiological changes which
are related to age but which are the direct result of disease and other external
agents. Treatment. and ultimately prevention efforts, can be better conceived and
executed if the aging process is clearly delineated.
Intensive biological, perceptual and cognitive studies are being carried out in
an attempt to identify universal physiological changes with age. Functional
changes with age both on the cellular level and the human performance level are
being studied. The VA is conducting longitudinal studies of normative aging
processes and metabolic changes with aging in order to distinguish between disease
consequences and normal aging.
In keeping with its mission to provide quality health and medical care to
veterans of all ages, the Veterans Administration is also researching and develop-
ing diagnostic and treatment techniques for age-related diseases. Problems of the
respiratory and circulatory systems and the skeletal structure seem to culminate
and become prevalent with age. Biomedical researchers within the VA are involved
in determining the causes for these degenerative diseases and in alleviating the
symptoms in older individuals. Psychiatrists and psychologists are working to
relieve some of the environmental and mental health stress often experienced by
older citizens.
The aged individual, as identified by the VA operation, reflects in his physical
or mental health those changes which are the result of true biological aging or
which result from the cumulative effects with age of external stresses. Aging is
viewed as a continuous process reflecting each individual's developmental history
Since it is expected that the developing Geriatric Research, Education and
Clinical Centers (GRECC) will be in the forefront of aging research within the
VA, a short description is given of the areas of research concentration with each
center.
Bay Pines GRECC
Bay Pines VAC has a long history of biochemical and behavioral research in
the field of geriatrics. Under the GRECC. research is continuing on the metabolic
changes during aging and the effects of stress and maternal nutrition on animal
metabolism and aging. The future thrust of research at the biomedical level at
Bay Pines will be in the "hormonal aspects in circadian rhythms" and in "trace
metals and aminoacids." In the area of psychosocial research. two demographic/
health needs assessment studies will be continued and expanded one study is
reviewing the needs of World War I veterans both in and out of institutions: and
a second study involves a determination of the personality type of veterans who
utilize outpatient services. Bay Pines is also engaging in evaluation research of a
reality orientation clinical program and prosthetic devices designed for the care
of elderly patients.
Little Rock GRECC
As a Geriatric Research Center. Little Rock has had a strong emphasis upon
medical education in geriatric problems, particularly in the area of cardiopathy
and aging. Therefore. the research at this center is strongly biomedical. Experi-
mental work is being conducted on the metabolic defects of acute ischemia in an
effort to determine the appropriate therapy for acutely ischemic myocardium in
the elderly. Research is just starting at the Center on normal and pathological
states of the cardiopulmonary system in the elderly. The use of a mild stimulant
in combating the symptoms of depression in elderly patients is also being studied.
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Palo Alto/Menlo Park GRECC
The Palo Alto GRECC has a number of strong, but diverse, research thrusts.
On-going work at the station has been in cellular aging: the study of non-
adrenalene nerve cells involved in Parkinson's disease and molecular protein
studies of fibrous neuroglia. As the Center develops, however, new biomedical
interests have emerged; in diabetes, insulin and the implications of aging for
receptor sites. Research efforts in the early diagnosis of senile dementia appear
to be promising. A health needs assessment survey of the Palo Alto community is
also planned. In the area of psychosocial research, a major study has been pro-
posed to analyze geriatric institutional living environments. The impact of the
environment both upon the olderly residents and upon the personnel who work in
the environments will be detailed.
Sepulveda GRECC
The GRECC at Sepulveda has a strong potential in the psychological/behavioral
area of aging. A set of quantitative tests has been developed to measure memory
function in normal and amnesiac patients. Test results indicated that age affected
performance but not necessarily memory. Further work is planned to test out
additional age effects. A life-span approach to memory and aging which uses
animal models is also being initiated at the Sepulveda GRE CC. Other patient care
research programs organized at the Center involve geriatric sexuality, sleep and
geriatric psycho-pharmaceuticals. In the area of biomedical aging, Sepulveda
GRECC has proposed a special diagnostic unit for metabolic conditions like bone
disease, obesity and arthrosclerosis. It is also hoped that a Hypertension Screen-
ing Sub-Center will eventually be developed at Sepulveda GRECC.
Wadsworth GRECC
The GRECC at the Wadsworth VAC has shown interest in a program of clinical
and physiological exploration of the aging process as reflected in endocrine and
metabolic disease, particularly diabetes in the aged. Research in the areas of
obesity and aging, protein requirements and the elderly, and the relation of
aging to the development of diabetes is seen as vitally important and the pos-
sibility of the Wadsworth GRECC engaging in such work is being explored.
Boston/Bedford GRECC
The development of this joint GRECC brought together two equally established,
though uniquely different. settings for aging research. The Boston VA Outpatient
Clinic has a strong emphasis upon patient service and a long history of longi-.
tudinal studies on the medical, social, and psychological aspects of community
veterans. The Bedford VAH had a long history of basic biological research in
aging. In wedding the two Centers. it was hoped that each would continue to
expand its individual expertise while developing collaborative efforts across
disciplines.
The Boston/Bedford GRECC has initiated an evaluation of the economic aspects
of medical care. A research program is being conducted in the area of nutritional
effects upon development in the aging brain. A behavioral neurologist has been
recruited to develop a program in applied clinical research. Physiological and
psychosocial data continue to be collected in the normative aging study. Likewise,
work in cellular aging continues under the Center, specifically in the area of
extracellular space and its impact upon collagen synthesis in old cells: the
effect of age and antibiotics upon protein synthesis: and DNA changes in aging.
An exciting new area of biomedical research being conducted at Boston/Bedford
involves circulating antibodies specific to the central nervous system. It is
believed that the long-term effects of this circulating antibody upon disease states
in the elderly may have imporant implications.
Seattle/American Lake GRECC
This joint-hospital GRECC is similar to the Little Rock GRECC; it has a heavy
emphasis upon disease processes and aging and it is anxious to establish itself
as a training facility in geriatric medicine. Research programs are already under-
way in osteoporosis and metabolic bone processes. Continuing emphases in
biomedical research include: the evolution of capillary basal lamina thickening
as it occurs in aging and various disease states, such as diabetes mellitus; the
study of diabetic fibroblasts to determine their replicative capacity. Work carried
on at the Seattle VAH has resulted in the first successful growth of human
arterial smooth muscle cells which revealed significant species differences in
lipoprotein uptake between human and rat cells.
Longitudinal Studies
In the area of geriatric research, the longitudinal research of longest duration
is the normative aging study which continues to be conducted by the Boston
Outpatient Clinic. This study has taken periodic physiological, psychological
and sociological assessments of a large number of veterans living in the Boston
area. Repeated measurements of a more recent vintage have been made of two
interesting populations found within the Bay Pines. Fla. area. One study involves
World War I veterans living in Pinellas County. The second research study
involves repeated physiological measurements which have been made on an aged
athletic group whose members, age 75 and older, play baseball on a regular basis.
During fiscal year 1975, biomedical research received the greatest proportion
of VA funds awarded to aging research. Of the 57 biomedical studies funded. 22
projects were in cellular and molecular biology, and 8 projects were funded for
organ and tissue system research. The second largest biomedical category to
receive funds was external influences in aging with 13 projects funded. The
remainder of the biomedical projects were found to fall primarily in the category
of disease processes; however, five demography studies were funded in fiscal
year 1975.
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Behavioral and social research in aging received approximately one-third the
amount of funding designated for biomedical studies in aging. Thirty-two be-
havioral projects were funded primarily in the area of behavioral-psychological
research
Sixty-five projects in the area of human services and delivery systems were
funded in aging research in fiscal year 1975. One-third of these projects were in
the area of health care services. Less than one-third were funded in the area of
physical living environments. Approximately 21 projects were funded in the area
of social services. The remaining project was funded in the area of education.
Research in aging has made a number of major shifts in the last four years.
During fiscal year 1973, 141 projects in aging received funding. Of these, the
largest number (60 projects) were in the area of basic behavioral science research.
By fiscal year 1975, the number of aging studies funded totals 154 projects. The
number of biomedical projects which received funding increased by 39 percent
(35 biomedical projects in fiscal year 1973 and 57 biomedical projects in fiscal
year 1975).
As a result of the reorganization of the extended care facilities under one
service during fiscal year 1975 and its incorporation of the Geriatric Research,
Education and Clinical Centers, it is expected that research in aging will continue
to increase during the upcoming years. It is likely that support of biomedical
research will remain high in the future. Considering the emphasis in a number
of the Centers upon disease processes related to aging, it is probable that future
biomedical funding will reflect that concern.
The GRECO's are also likely to provide needed support and expertise to develop
neglected areas of behavioral research. The collaborative projects currently being
organized at Palo Alto and Sepulveda can more comprehensively approach
complex human behavior. Multidisciplinary expertise can be utilized to analyze
difficult psychological and environmental problems.
Finally, Geriatric Research Centers are ideal settings for the development of
human service delivery programs for the elderly. Increasingly, human service
providers are concentrating upon rehabilitation and pevention programs. The
extended care facilities will be looking to the Geriatric Research, Education and
Clinical Centers to utilize their research and clinical expertise to update and
create better service approaches. A number of Centers are evidencing their
preparation to move in this direction with their plans to study the health needs
of community veterans.
DEPARTMENT OF VETERANS BENEFITS
1. COMPENSATION AND PENSION PROGRAMS
The Veterans Administration, through the various programs administered by
the Department of Veterans Benefits (compensation, pension and dependency and
indemnity compensation) provides all or part of the income for 1,641,015 persons
age 65 or older. This total is broken down to 789,884 veterans, 698,490 widows,
118,569 mothers and 34,072 fathers of veterans.
2. VETERANS ASSISTANCE SERVICE
In 1975, the Veterans Assistance Service-Guardianship activity completed its
third full year of application of supervised direct payment procedures whereby
marginally functioning VA beneficiaries, persons classified as imcompetent but
deemed borderline between competency and incompetency, are paid direct with
supervision. When payments are made directly to such imcompetent beneficiaries,
frequent personal contacts are made to evaluate their status. If a beneficiary
deteriorates to the point where a fiduciary is necessary, one is obtained. On the
other hand, if a beneficiary improves to the point where a competency classifica-
tion seems in order, effort is made to have him SO declared. Supervised direct
payment procedures are providing the degree of assistance the individual bene-
ficiary requires and still leave him a free and unencumbered member of society.
The toll-free telephone system (FX (foreign exchange) and WATS (wide area
telephone service) has made it easier for the aged to receive VA assistance
regarding benefits to which they may be entitled. Approximately 90 percent of
the population can now talk toll-free to a Veterans Benefits Counselor in our
regional offices. This means that it no longer is necessary for veterans or mem-
bers of their families to travel to one of our offices or pay for a long distance call
in order to obtain information or help on VA benefits.
The VA mobile van program was initiated to aid in implementing the out-
reach program by going to those persons located in rural areas. The Veterans
Benefits Counselors, who man the mobile vans, are aware of the special economic
and health needs of the aged and where claims for benefits have not been made,
assist in initiating claims for veterans' benefits.
Veterans Benefits Counselors stationed all across the Nation are aware of the
special application of VA monetary and service programs to the problems of the
aging. These VA representatives not only counsel the potential beneficiaries on
the availability of the service but assist them in applying for the benefits.
3. EDUCATIONAL ASSISTANCE
There are about 1.498 people age 65 or over receiving Veterans Administration
educational benefits. Eleven hundred and forty-nine persons are attending train-
ing under chapter 34, title 38. U.S. Code. receiving benefits designated by the
Veterans Readjustment Act of 1966 as amended. In addition. 149 widows of
veterans who died of service-connected causes and wives of veterans who are
permanently and totally disabled from service-connected disabilities are enrolled
in the education program under chapter 35. About 200 are recipients of voca-
tional rehabilitation benefits under chapter 31.
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ITEM 4. DEPARTMENT OF HEALTH, EDUCATION, AND WELFARE
MARCH 29, 1976.
DEAR MR. CHAIRMAN As you requested for the Special Committee on Aging
annual report, "Developments in Aging," enclosed are reports of calendar year
1975 activities to benefit older Americans which have been carried out by vari-
ons agencies and components of this Department.
Please let me know if I can provide you with any additional information.
Sincerely,
MARJORIE LYNCH, Acting Secretary.
[Enclosures]
OFFICE OF HUMAN DEVELOPMENT
ADMINISTRATION ON AGING
CALENDAR YEAR REPORT FOR 1975
A. INTRODUCTION
The year 1975 marked the second full operational calendar year after enact-
ment, on May 3, 1973, of the Older Americans Comprehensive Services Amend-
ments of 1973 (Public Law 93-29). In fulfillment of this new mandate, the
Administration on Aging (AoA) identified two major goals toward which its
immediate and long-range efforts are being directed, and its work during the
year emphasized these goals.
The first goal is to increase State and area agency on aging capacity to:
-develop and implement annual operation plans to enable older persons to
remain in their own homes or other places of residence;
-identify available resources
-set priorities for action programs;
-coordinate existing services for older persons and pool available but untapped
public and private resources for the support of services:
-promote the development of supporting services, such as information and
referral and transportation: and
-promote the development of other social services for older persons as defined
in the Older Americans Act.
The second major goal is to increase the capacity of the Federal sector to
promote comprehensive coordinated services for older persons through coordina-
tion of plans and programs which affect older persons. AoA's interagency efforts
are being directed at influencing these Federal resources SO that they can be
brought to bear in developing and strengthening at the sub-State level a com-
prehensive-system of coordinated services for older people.
Under its current organizational structure, which became effective in 1974,
the Administration on Aging is composed of the following constituent units:
(1) The Office of the Commissioner on Aging: (2) The Office of Planning and
Evaluation: (3) The Office of State and Community Programs; (4) The Office
of Research, Demonstrations, and Manpower Resources: (5) The National Clear-
inghouse on Aging: (6) The Field Liaison Staff: and (7) The Nursing Home
Interests Staff. An organizational chart for the Administration on Aging as of
May, 1975 is presented on the next page.
The Office of Planning and Evaluation (OPE) carries out 5-year forward
planning activities, various evaluation activities, and legislative and policy anal-
ysis functions. OPE's legislative analyses make it possible for AoA to keep ad-
vised of bills, hearings, and other phases of the work of Congress, and their effect
or potential effect on older persons. In this connection, AoA's legislative staff
keeps an up-to-date compilation and analysis of all proposals pertinent to older
persons which are introduced in the Congress.
Examples of OPE's policy analysis activities in fiscal year 1975 included an
on-going. in-house analysis of major issues related to the conduct of programs
under titles II, III. IV, and VII of the Older Americans Act, as amended: an
ongoing analysis of the effects of the energy shorage on older persons; an anal-
ysis of food stamp policies; continued attention to the transportation needs of
older persons; continuing analysis of issues relative to the Supplemental Security
Income program (title XVI of the Social Security Act) analysis of health care
services provided under the Public Health Service and such services provided
under Medicare and Medicaid; and thorough analysis and review of the recently-
enacted title XX social services program of the Social Security Act. Analyses in
these and other areas have facilitated the development by AoA of formal working
agreements with appropriate Federal agencies.
The Office of State and Community Programs (OSCP) serves as the focal point
for development and assessment of the State and Community Programs on Aging
:
(title III) and the Nutrition Program for the Elderly (title VII). It maintains
information on programs of other Federal agencies and national voluntary agen-
cies which have potential for relating to State and area agency on aging planning
and implementation of services for older people. In addition, OSCP develops regu-
lations, policies, and guidelines for use by State and area agencies on aging: devel-
ops optional models and disseminates "best practice" suggestions for use by the re-
gional offices, State agencies on aging and area agencies on aging: develops and
monitors, in cooperation with other AoA units, management information and
reporting systems which provide updated information to facilitate planning and
program adjustment for management efficiency at all organizational levels; and
carries out other related functions.
AoA's Office of Research, Demonstrations. and Manpower Resources serves
as a focal point for coordination of research on aging by Federal agencies: pro-
CAN - LINO - 128
vides the chairman and secretariat services to the Interagency Task Force on Ag-
Ang Research, under the Interdepartmental Working Group of the Cabinet-level
Domestic Council Committee on Aging: develops policy. supports projects and
monitors progress related to research. demonstration, and manpower resources
programs under title IV of the Older Americans Act and carries out other fune-
tions supportive to AoA's mandate to provide national leadership and expertise
in encouraaging new knowledge and upgrading competencies in the field of aging.
AoA's National Clearinghouse on Aging serves as the focal point within the
Federal Government for the collection. analysis, and dissemination of informa-
tion related to the needs and problems of older persons, and, wherever possible,
develops and coordinates programs with other offices and agencies to fill gaps in
information in the field of aging; develops policy for information and referral
services: provides technical assistance to State Agencies on Aging in the develop-
ment of information and referral services: provides the chairman and secretariat
services to the Interagency Task Force on Information and Referral, and to the
Federal Task Force on Statistics: produces a variety of professional and lay
publications and audiovisual material on aging; publishes Aging magazine; de-
velops special information campaigns: responds to numerous letters and tele-
phone inquiries; and performs other related functions in the area of public
informati m.
AoA's field liaison staff assists regional offices in keeping informed of continu-
ing developments relative to the objectives and programs of the Administration
on Aging: identifies difficulties being encountered by regional offices in carrying
out their duties and responsibilities; ascertains the degree of further assistance
required from AoA headquarters to insure that regional offices achieve national
and operational planning objectives; and provides other related assistance to
regional office staff.
The nursing home interests staff serves as project officer for the nationwide
Nursing Home Ombudsman program, which was initiated in July of 1975: pro-
vides technical assistance to community and advocacy groups which are work-
ing for the improvement of long-term care and for alternatives to institutionali-
zation: and collaborates with other agencies on activities related to improvement
of long-term care and relocation of patients from nursing homes which are closed
due to failure to meet Federal certification standards.
In addition to completing its second operational year under new legislative
initiatives and internal organizational arrangements, AoA also completed its
second operational year as a component of the Office of Human Development
(OHD) within the Office of the Secretary of Health, Education, and Welfare. As
a part of this office. AoA has the advantage of working in close association with
other OHD components which have responsibilities for the planning and delivery
of services for special populations which overlap with AoA target groups, such as
rural Americans, the handicapped, and Native Americans, including those of
low income and racial minority status.
The remainder of this report provides detailed information relating to activi-
ties carried out during calendar year 1975 by the Administration on Aging under
the Older Americans Act Amendments of 1973, including major program initia-
tives and grants and contracts awards.
B. STATE AND COMMUNITY PROGRAMS ON AGING
By the end of calendar year 1975, the title III program created by the Older
Americans Comprehensive Services Amendments of 1973 had been in operation
for just more than 2 years. The overall objective of the title III program is to
strengthen or to develop at the sub-State or area level a system of coordinated
and comprehensive services which will enable older persons to live in their own
homes or communities as long as possible.
During 1975, the Administration on Aging's activities were focused primarily
toward providing developmental assistance to State Agencies on Aging through
a program of assessing and strengthening the management capabilities of the
State agencies on Aging and through them. those of the area agencies on aging
and nutrition projects established under title VII. Emphasis was also placed on
expanding the quantity and quality of nutrition services to older persons. In
addition, activities were focused upon increasing the capacity building efforts
in particular areas, to assist State and area agencies and nutrition projects.
In November 1975, the President signed into law the Older Americans Amend-
ments to continue and expand programs under the Older Americans Act, the
Older American Community Service Employment Act, the Domestic Volunteer
Service Act, and other legislation affecting older persons. Among some of the
major provisions of the Older Americans Act amendments are:
-Three years extension of the Older Americans Act;
-Requirements for the establishment or maintenance of programs for the
provision of transportation services: home services; legal and other coun-
seling services: and residential repair and renovation programs:
-Direct funding of Indian tribes under title III, under certain circumstances;
-Expansion of the title V training program to include lawyers and parapro-
fessionals to provide legal counseling for older persons; and
-Increases in State administrative costs.
A detailed discussion of State and community program activities and accom-
plishments is presented below:
I. State Planning, Coordination, Administration, and Evaluation
The title III program has as one purpose the strengthening of State agencies on
Aging to discharge, among others, the following responsibilities:
-to become a focal point in the State on behalf of older persons;
CAN - LINO - 129
-to carry out those activities necessary for effective planning on behalf of
older persons, including the establishment of measurable objectives for aging
programs;
-to establish such procedures and mechanisms as are necessary to assure the
effective coordination of all State planning and service activities related to
the field of aging:
-to provide ongoing monitoring and assessment and to conduct periodic evalua-
tions of activities and projects in the field of aging, with special emphasis on
the work of area agencies on aging; and
-to assure, in cooperation with area agencies on aging, the availability of
information and referral sources in sufficient numbers SO that all older
persons will have reasonably convenient access to such sources.
To be eligible for grants under title III. States are required to submit annual
State plans on aging to the Commissioner on Aging for approval. These plans are
developed by the designated State agency on aging and submitted to the Com-
missioner by the Governor of each State. Each State plan must identify the
objectives which the State proposes to achieve during the year, and the plans of
action which the State will implement for such activities as provision of
technical assistance, monitoring of programs, conduct of coordination and pooling
activities. provision of manpower development and training. and establishment of
information and referral resources. The State plan must also identify the manner
in which the State has been divided into planning and service areas, the deter-
mination of which of these areas will have designated area agencies, and the
manner in which resources will be allocated under the program.
By the end of 1975, State agencies on aging designated 596 planning and service
areas (PSA's) and 462 area agencies on aging had been established within
PSA's of highest priority to administer area plans for comprehensive and co-
ordinated services for older persons.
The State agencies' resources in 1975 were directed toward the implementation
of the approved State plans on aging for fiscal year 1975 and the development
and implementation of State plans for fiscal year 1976. The fiscal year 1975 State
plans included objectives related to the development of State level capabilities
for providing policy direction and technical assistance to area agencies on aging
and title VII nutrition projects in the areas of information and referral, data
analysis, operational planning and assesment and self-assessment; the negotia-
tion of formal interagency agreements with the social services agency in each
State: the establishment of additional area agencies on aging: the development
of other resources to increase the number of meals served in congregate settings;
and the development of information and referral sources which were to meet
minimum standards established by the Administration on Aging. The State
planning activities also included action programs for the involvement of minority
agencies and organizations in the delivery of services under title III and title
VII; actions to assure equal employment opportunities for minorities, older
persons, and women at the State and area levels; and actions designed to assist
older persons who face problems during the energy crisis.
The State plans on aging for fiscal year 1976 were approved in December 1975.
Although no operational objectives were prescribed for fiscal year 1976, the
States were expected to develop their State plans in keeping with the national
directions and strategies established by the Administration on Aging, emphasized
the development and provision of policy guidance and technical assistance in
selected subject areas. intended to contribute toward building the capacity of
State agencies, area agencies, and nutrition projects to carry out their responsi-
bilities more effectively. The subject areas were as follows:
-Capacity to Advocate.-Emphasis on expanding the opportunity for con-
sumers to be involved in the State and area planning and decisionmaking
processes;
-Capacity to Serve Priority Groups of Older Persons.-Emphasis on expand-
ing the participation of low income and minority older persons in Older
Americans Act programs:
-Capacity for Assessment.-Emphasis on capacity at the regional and State
levels to assess program operations of State agencies and area agencies,
respectively;
Capacity to Develop Participation of Minority Organizations.-Emphasis on
developing and assisting minority organizations to become involved in the
title III and title VII programs:
-Capacity for Equal Employment Opportunity.-Emphasis on assuring equal
employment opportunities for minorities, women and older persons;
-Financial and Grants Management Capacity.-Emphasis on developing sim-
plified fiscal and grants management policies and procedures governing ad-
ministration of title III and title VII and
-Capacity for Policy Guidance.-Emphasis on developing or revising policy
manuals to conform with current Federal policies and procedures governing
the title III and title VII programs.
Accordingly. States reflected this focus on capacity building in these areas in
their State plans by incorporating into their objectives and action plans those
activities which result in building the capacity of area agencies and nutrition
projects.
Fiscal year 1976 marked the first year of implementation of title XX of the
Social Security Act. a major piece of legislation which has great significance
for older persons. The fiscal year 1976 State plans, therefore, included as an
objective the execution of written joint agreements between the State Agency
on Aging and the State Agency designated to administer the title XX program.
There were also continuing priority program efforts carried out by the Ad-
ministration on Aging relative to information and referral services, and the
development of interagency agreements in the following areas with agencies
CAN-LINO- 130
whose programs impact on older persons. State and area agencies have been
successful in developing agreements with State and local counterpart agencies.
-Information and Referral.-(a) With the Soical Security Administration
and the Social Rehabilitation Services; and (b) with 14 other departments
and agencies:
-Medicaid.-With the Medical Services Administration, Social and Rehabilita-
tion Service:
--Rchabilitation Services.-With the Rehabilitation Service Administration,
Office of Human Development:
-Public Health Services.-With the Public Health Service:
-Social Scrvices.-With the Public Services Administration, Social and Re-
habilitation Service. regarding the provisions of title XX of the Social Secu-
rity Act. to insure that the needs of older persons are addressed;
-Transportation.-With the Department of Transportation:
-Use of School Buses for Older Persons.-With the Department of Transpor-
tation and the Office of Education:
-School Lunch Program and Facilities.-With the Office of Education;
-Volunteer Programs.-With ACTION:
-Food Stamp Program.-With the Department of Agriculture;
-Community Development Program (Housing).-With the Department of
Housing and Urban Development;
-Head Start Program.-Joint collaboration between the Office of Human
Development (Office of Child Development and Administration on Aging)
and ACTION:
-Nutrition Project Sites.-With the Department of Housing and Urban De-
velopment
-Energy Crisis.-With the Federal Energy Administration and other de-
partments;
the Civil Service Commission:
-Health and Social Services.-With the Community Services Administra-
tion (formerly Office of Economic Opportunity).
Of the fiscal year 1975 funds appropriated for the title III program, $15 million
was allotted to the States to pay not more than 75 percent of the cost of admin-
istration of the State plans including planning, coordination, administration,
and evaluation at the State level.
II. Area Planning and Social Services
As previously stated, the overall objective of the title III program is to
strengthen or to develop at the sub-State or area level a system of coordinated
and comprehensive services which will enable older persons to live in their own
homes or communities as long as possible. A comprehensive and coordinated
service delivery system, as defined in regulations, is one which provides necessary
social services in a manner designed to:
-facilitate accessibility to and utilization of all social services within the
geographic area served by a public or private agency or organization,
-initiate. develop, and make the most effective use of social services in meet-
ing the needs of older persons, and
-use available resources efficiently and with a minimum of unnecessary du-
plication.
The vehicle for realizing this objective is the establishment by State agencies
on aging of a network of area agencies on aging in State defind planning and
service areas. The designated area agencies on aging are charged with the
following major responsibilities:
-To become a focal point for leadership in the field of aging for its planning
and service area;
-To engage in a continuous process of planning in order to define or redefine
objectives and to establish priorities and to develop a system designed to
improve the delivery of services;
-To make provision for an action program designed to coordinate the delivery
of existing services for older persons;
-To make provision for an action. program designed to pool available but
untapped resources from both the public and private sectors in order to
strengthen existing or to inaugurate new services;
-To take steps, in cooperation with State agencies on aging, designed to
achieve the establishment or maintenance of information and referral
sources in suffiicent numbers to assure that all older persons within the area
will have reasonably convenient access to such sources:
-To enter into contracts or to make grants for inangurating or strengthening
supporting and gap-filling services for older persons;
-To monitor and assess and conduct periodic evaluation of activities carried
out under its auspices: and
-To develop comprehensive and coordinated programs for older persons
throughout the planning and service area.
In order to qualify for title III funds, the area agency must develop and submit
to the State agency for approval an area plan for activities on behalf of the
older persons in the planning and service area encompassed by the area agency.
After the State agency approves an area plan, it awards funds to the area agency
to support area agency activities and to enable the area agency to enter into
grants with local service providers to carry out services programs set forth in
the approved area plan.
Title III funds may be used by area agencies to support a broad range of social
services. The types of services provided under area plans will be largely deter-
mined by the priorities established by the area agency based upon assessment of
the status and needs of older persons within the planning and service area. Com-
CAN - LINO - 131
monly supported services include transportation, outreach, escort, home-health
and homemaker services, and legal services.
Generally, an area agency is prohibited from providing social services directly.
Exceptions occur in the case of information and referral service and coordination
activities. Other social services may be provided directly only if specific State
agency approval is granted. No such approval may be given unless it can be
clearly shown in the area plan that the direct delivery of a service is necessary
to assure an adequate supply of such service, and that no other agency in the
planning and service area can and will effectively deliver such service.
During fiscal year 1976 area agencies on aging will submit their required annual
area plans on aging to the State agencies for approval. Included in the plans will
be action programs for the following activities:
-Coordinating the delivery of existing services for older persons and pooling
untapped resources to strengthen existing services or inaugurate new
services;
-Giving priority to those services and activities to assist and benefit low-
income and minority older persons throughout the planning and service
area;
-Bringing about maximum possible coordination between the resources avail-
able under title III and those available under the adult services and medical
care titles of the Social Security Act;
-Strengthening information and referral sources;
-Endeavoring to work out arrangements under which recipients of grants or
contracts for nutrition projects under title VII mutually agree with the area
agency that such nutrition projects shall be made a part of the areas coor-
dinated and comprehensive service system for older persons.
Of the fiscal year 1975 appropriation for the title III program, $82 million was
allotted to State agencies for area planning and social services programs. Not
more than 15 percent of these funds could be used for planning and administration
at the area level. The balance of the allotment was available for social services.
including the coordination of existing services and the pooling of untapped
resources.
III. Nutrition Program for the Elderly (Title VII)
The nutrition program authorized by title VII of the Older Americans Act, as
amended. began operations early in fiscal year 1974. Under the provisions of title
VII, the Commissioner on Aging is authorized to make formula grants to States
to establish and maintain community-based nutrition program project sites for
the delivery of low-cost, nutritious meals, served primarily in congregate settings
and with supportive services to persons 60 years of age and over and their
spouses. Each nutrition program project must provide each participant at least
one hot meal per day, 5 or more days a week. 52 weeks a year. The project must
also provide to the extent that they are needed and not already readily available
and accessible to participants those supportive services necessary to facilitate
participation of eligible individuals in the meals program. Such services include
outreach, transportation, and escort services. In addition. projects are encouraged
to assure as needed the provision of other supportive services, including education
and counselling in health and welfare, information and referral services, shop-
ping assistance and recreational services.
The program is designed to assist communities to meet the nutritional and
social needs of older persons who do not eat adequately because: (1) They can-
not afford to do SO: (2) they lack the skills to select and prepare nourishing and
well-balanced meals: (3) they have limited mobility which may impair their
capacity to shop and cook for themselves: (4) they have feelings of rejection
and loneliness which obliterate the incentive necessary to prepare and eat a meal
alone.
The nutrition program operates within the same conceptual framework as title
III, since the delivery of low-cost meals and related services is one component
of a comprehensive coordinated services system. State and area agencies on
aging are urged to work out mutually satisfactory agreements with grantees
under title VII designed to integrate the nutrition projects into area service
systems, and to bring about meaningful coordination between them and the pro-
viders of services under title III.
With funding authority for the title VII nutrition program expiring in fiscal
year 1974, the Congress enacted extension legislation which the President signed
into law (Public Law 93-351) on July 12. 1974, providing for a 3-year extension
of the program through fiscal year 1977. The authorization of appropriations are
as follows: $150 million. fiscal year 1975; $200 million, fiscal year 1976; and $250
million, fiscal year 1977. This legislation also mandated support for the title VII
program by the USDA donated food program. A description of how this was im-
plemented during fiscal year 1975 is found in section C of this report. The Older
Americans Amendments of 1975 (Public Law 94-135) further added authoriza-
tion for title VII in the amounts of $62.5 million for the period beginning July 1,
1976, and ending September 30, 1976, and $275 million for the fiscal year ending
September 30, 1978.
On February 13. 1975, $98.6 million was allotted to the States for the nutrition
program. A supplemental appropriation bill enacted by the Congress for fiscal
year 1975 expanded appropriations for the nutrition program to $125 million. On
March 17, 1975, an additional $25.4 million was allotted to the States for the
program.
Consistent with the intent of Congress, the Secretary of Health, Education. and
Welfare on May 2, 1975, authorized the States to utilize the $25 million released
on March 17 to build the operating level for the program to $150 million by the
end of fiscal year 1975.
During fiscal year 1975, AoA concentrated on assisting State agencies in their
efforts to expand and strengthen the nutrition program.
CAN-LINO-132
In order to facilitate greater utilization of public resources other than title
VII by nutrition projects, AoA successfully negotiated interagency agreements at
the Federal level as follows:
-Use of school Tunch program and facilities.-With the Office of Education.
---Derelopment of nutrition program project sites in federully-sponsored or
subsidized housing.-With the Department of Housing and Urban Develop-
ment.
-Use of school buses in transportation of participants to and from nutrition
program project sites.-With the Department of Transportation and the
Office of Education.
-Development of transportation systems for carrying the elderly to and from
nutrition program project sites.-With the Department of Transportation.
-Federal subsidy for volunteers serving at nutrition program project sites.-
With ACTION.
In addition. although no formal agreements have been signed, the nutrition
program initiated during fiscal year 1975 the following actions with other'
department and agencies:
--A joint program to evaluate the feasibility of veteran participation at nutri-
tion program project sites as a means of reducing the rate of institutionaliza-
tion and the duration of necessary institutionalization in Veterans' Adminis-
tration facilities: With the Veterans' Administration.
-Authorization of nutrition program project sites to receive food stamps from
eligible and certified elderly as their contribution toward meal costs: With
the Department of Agriculture.
-Development of a system for utilization at nutrition program project sites
of the high protein foods, meat and meat alternates provided by the Depart-
ment of Agriculture's donated food program: With the Department of Agri-
culture at the Federal and regional levels and the distribution agencies at
the State level.
One AoA agreement has been SO very successful that it merits further
discussion.
This agreement was signed in January 1975 between the Commissioner on
Aging and the Commissioner of Education, which encourages the expanded use
of public school facilities for serving meals to older people. Included in this
agreement is provision for a variety of educational, recreational, cultural, and
other community services and volunteer opportunities for older people. The AoA
network is making every possible effort to utilize school meal facilities to serve
older persons. There are 12 States that have signed a formal agreement to serve
older Americans in their public schools. Also, there are 11 States negotiating
an agreement which will be signed at a later date. There are approximately 175
public schools that have opened their school lunch facilities to serve meals to
older persons since the signing of the agreement.
In addition, AoA began planning for the development of technical assistance
to nutrition projects, through the State agencies, designed to assist them in
progressing toward the following objectives:
-Introduction of the nutrient standard method of menu planning and
monitoring:
-Use of the 1974 recommended dietary allowances as standards in place of
those promulgated in 1968;
-Use of greater quantities and varieties of USDA-donated foods;
-Reduction in the salt content of USDA-procured meat products;
-Emphasis on more project-controlled meal service:
-More intensive education efforts in nutrition, health and aging with empha-
sis on educational spin-off effects to younger age cohorts;
-Greater numbers of effectively trained personnel to increase the outreach,
escort, transportation, and health services;
-Enhancement of mutual understandings between area agencies on aging and
nutrition program projects;
-Emphasis on giving top rank order priority to serving those in greatest need.
particularly those elderly with low incomes and who belong to minority
groups.
By the end of fiscal year 1975 approximately 240,000 meals were being served
daily at 685 projects with over 4,400 sites. According to periodic reports from the
States, 64 percent of the meals were being served to older persons below the
poverty threshold, and 25 percent were served to older persons in minority
groups.
The title VII nutrition program staff has earned a commendation for the rapid
implementation of the meal service and the substantial increase of services to
older Americans as the year has progressed.
C. FEDERAL COORDINATION ACTIVITIES
The Older Americans Act, as amended, assigns responsibilities to the Adminis-
tration on Aging to serve as a focal point within the Federal Government in
matters pertaining to problems of the aged and aging. In pursuing its broad
legislated responsibilities as the Federal focal point for aging matters, AoA
seeks:
(1) To improve interagency coordination of plans and programs which affect
older persons.
(2) To serve as a clearinghouse for information pertinent to the problems
of the aged and aging and to generate and analyze such information.
(3) To assess the progress and problems of programs which affect older per-
sons with a view toward designing new strategies for improved program effect.
(4) To direct initiatives in aging programming and supporting research to
meet demonstrated neds of the elderly.
CAN - LINO INSURED 133
The current long-range strategy of the Administration on Aging is to direct
its limited resources primarily in support of its program management roles under
titles III and VII. Consequently, in regard to its research, information, evalua-
tion, training. and technical assistance functions, as well as in its implementa-
tion of the title III and VII programs, AoA attaches high priority to identifying
and pursuing those interagency activities which will contribute toward coordinat-
ing existing resources of other programs in order to develop and expand compre-
hensive services for older people at the local level.
Principal emphasis is being placed upon a national knowledge base on aging
and coordination of those resources which currently or potentially impact on AoA
target group populations. Priority attention has been directed at improving the
delivery and utilization of specific services for the elderly, in particular, the low-
income impaired and minority elderly. through joint agreements and program-
ming with SRS. SSA, PHS, and DOT, in such areas as I. & R., adult social
services including transportation, medicaid, rehabilitation services, community
health and mental health services. and comprehensive health planning. With
additional program experiences and continuing analysis, AoA will be in a posi-
tion to identify other specific services needed by the elderly which cannot be
developed through the State and area agency structure alone and which require
new Federal initiatives. Barriers to increased cooperative programming will be
identified, as well as infrastructural changes and interagency mechanisms and
authorities which are necessary to facilitate AoA's full assumption of its broader
Federal focal point role.
In carrying out its focal point activities during 1975, AoA has sought to uti-
lize the potential for coordinated plannig and programing inherent within the
Committee on Aging of the cabinet-level domestic council, the Federal regional
councils, and the Federal executive boards. In addition, AoA has built upon
previously existing interagency agreements and authorities, negotiated and de-
veloped new agreements, and has moved to implement its responsibility within
the Department for improving Departmental coordination and effectiveness on
behalf of the aged.
AoA believes that significant contributions toward insuring appropriate at-
tention to the interests of the aged have also been secured through review of
major issues and proposed legislation and regulations related to Federal activ-
ities in such areas as the supplemental security income program, food stamps,
skilled nursing homes and intermediate care facilities, transportation, Federal
energy policies, adult education, medicare, medicaid adult social services, re-
habilitation services. adult education, social security, retirement and employment
policies for older workers, including the senior community service employment
program authorized under title IX of the Older Americans Act. as amended and
the Comprehensive Employment and Training Act programs, both of which are
administered by the Department of Labor.
I. Interdepartmental Committees
(a) Domestic Council Committee on Aging.-The cabinet-level Domestic Coun-
cil Committee on Aging. established in 1971, is chaired by the Secretary of Health,
Education. and Welfare. The committee is charged with, among other duties, the
responsibility for developing governmentwide aging policy. An interdepartmental
working group, chaired by the Commissioner on Aging, has been established in
order to assist the cabinet committee with its work.
During 1974 and 1975, the working group of the domestic council committee
established interdepartmental task forces to develop and implement plans for
coordinated action programs in the four needs areas of nutrition, research, I. & R.,
and statistics. To develop and implement these plans, the task forces were con-
vened with representatives from AoA, the Departments of Agriculture. Labor,
Housing and Urban Development, Transportation, and Commerce, the Veterans'
Administration, and ACTION, as well as the Office of Education. Social and
Rehabilitation Service, Social Security Administration, and the Public Health
Service and the Office of Consumer Affairs within the Department of Health,
Education, and Welfare. Other agencies which have been involved in coordination
activities with AoA are the General Services Administration. the Community
Services Administration (formerly the Office of Economic Opportunity) and the
Federal Energy Administration.
It is expected that additional task forces will be convened in response to areas
of need for interagency collaborative efforts as identified in on-going program
analysis and State and area agency experiences.
Task Force on Nutrition.-The Task Force on Nutrition during the first half
of fiscal year 1975 identified and planned for ways in which existing Federal re-
sources can be pooled to (1) increase the number of meals provided to older per-
sons through Federal sources other than title VII of the Older Americans Act,
and (2) provide necessary supportive services to the older persons participating
in nutrition programs.
Collaborative agreements in support of these objectives have been completed
with HUD, DOT, OE, ACTION, the Department of Agriculture, and the Veterans'
Administration.
Task Force on Research.-The Task Force on Research in Aging has been en-
gaged in a joint effort to develop ways of effectively coordinating Federal re-
search and related activities which concern the older population. As a first step
in that direction, member agencies of the task force were requested to consider
a number of proposed research question areas in terms of their relevance to
the research program. interests, and resources of the respective agencies. These
research questions share a common focus in that they bear closely on the de-
velopment of community service networks.
Once member agencies identified those questions which were consistent with
their own research program directions, these interests were shared with the
CAN - LINO - 134
educational community and other interested groups and individuals and iden-
tified as an initial step in the development of a coordinated, Federal research pro-
gram in aging.
In a concerted attempt to avoid duplication of research activities members of
the task force have agreed to support a comprehensive inventory and analysis
of past and current federally supported research in the field of aging. A joint re-
quest for proposals was issued for a contractor to assume this task. Bilaterally,
AoA has been working closely with the newly organized National Institute on
Aging (NIA) to minimize problems of duplication and overlap in NIA and AoA
aging research areas. These joint activities will be discussed further in this sec-
tion under the subheading of intradepartmental coordination.
Task Force on Information and Referral.-AoA has entered into an arrange-
ment with 14 Federal agencies to work in concert toward the objective of making
I. & R. activities at the State and local levels more responsive to the needs of
older persons. These Federal agencies have also agreed to monitor and evalu-
ate their progress toward this objective.
As an outgrowth of task force activities, an indepartmental working group
on information and referral was organized. In May 1975 this group effected an
interagency working agreement among AoA, the Social Security Administration,
and the Social and Rehabilitation Service for mutual support in the development
of information and referral services for the elderly.
Other interagency activties in the area of I. & R. are included in section G of
this report.
Task Force on Statistics.-Preparatory work to the establishment of a Federal
Task Force on Statistics within the interdepartmental working group on aging
has begun. An initial task force meeting is scheduled early in fiscal year 1976
and is expected to consider plans for conducting an inventory of all Federal sta-
tistical data relating to the older population.
(b) Federal Regional Councils.-Federal regional councils (FRC) have com-
mittees on aging in order to accelerate the development of coordinated programs
for the delivery of services to older persons. The committees have sought to re-
spond to State and local program development within each region.
The committees on aging generally involve representatives of the various de-
partments and agencies with programs serving older persons directly or in-
directly. Some of the committees also include national voluntary agencies with
regional offices such as the American National Red Cross. One or two also include
the directors of the State agencies on aging in either the full committee or in
special subcommittees.
Examples of objectives which the regions are focusing on include the follow-
ing: (a) Providing a retirement planning program for all Federal employees;
(b) reduction of the incidence of crime against the elderly with support from
the Law Enforcement Assistance Administration, the Federal Bureau of Inves-
tigation and local police: (c) implementation of CETA program: (d) printing
resource directories of Federal resources available to older people: (e) concentra-
tion of Federal assistance in selected sites within the region where services to
the elderly are deficient: (f) developing with the States alternatives to institu-
tional care: (g) assisting in the implementation of interagency agreements: and
(h) working with "natural communities" otherwise divided by political bound-
aries like State and county lines to plan more effectively and coordinate emer-
gency efforts. Several regional committees are also using the FRC mechanism
to increase Federal agency cooperation to State and area agency programs.
(c) Federal Executive Boards.-In order to foster Federal-wide involvement in
the development of information and referral services available to all older persons
the Federal executive boards (FRC) have identified the development and im-
provement of such sources as a priority assignment. Accordingly, in 25 of the
major metropolitan areas of the country, there is a Federal executive board, com-
prised of the highest ranking officials of each Federal agency in the area. assist-
ing State and area agencies on aging to carry out their I. & R. responsibilities.
FEB involvement has grown out of earlier cooperative activities undertaken
among AoA, the Office of Consumer Affairs, and the Office of Management and
Budget.
Most FEB task forces during 1975 produced or up-dated community directories
of services to older persons. Others began an effort to coordinate information and
referral services. Several have instituted training programs for employees in the
FEB member agencies to improve the handling of problems of older persons who
asked the agencies for assistance. Some FEB task forces also instituted com-
munitywide publicity campaigus to inform older persons about the information
and referral services.
The Federal executive boards develop programs which assess past accomplish-
ments: improve the responsiveness of Federal offices to older persons: and help
older persons and institutions serving older persons to conserve energy with
FORD
the assistance of the Federal Energy Administration. Also, during 1975, the Fed-
eral executive boards were furnished materials by AoA as background for any
participation they might have in celebration of the International Women's Year.
The AoA materials were aimed specifically at pointing up the special problems
LIBRARY
of older women. Statistical material on older women. developed by the National
Clearinghouse for the Federal executive boards, was widely used in other pro-
GERALD
grams celebrating International Women's Year.
The Federal executive boards are also now developing workplans for fiscal
year 1976, which will assess fiscal year 1975 accomplishments, improve the respon-
siveness of Federal offices to older persons with questions, and assist the Federal
Energy Administration with programs that will help older persons, and institu-
tions serving older persons, conserve energy.
CAN - LINO - 135
II. Other Interdepartmental Coordination
In addition to the multilateral cooperative activities pursued through the
interdepartmental working group, during 1975 AoA built upon existing bilateral
agreements and cooperative arrangements with other departments and agencies.
Department of Transportation.-DOT and AoA effected a joint working agree-
ment in June 1974 which pledged mutual cooperation and coordination in ac-
tions designed to achieve increased mobility of older persons by improving their
access to public and specialized transportation systems in urban areas. The
agreement took note of the fact that DOT set aside $20 million in fiscal year 1975
funds from the capital assistance program to implement section 16(b) (2) of
the Urban Mass Transportation Act of 1964, which provided for capital grants
and loans to private, nonprofit corporations, and associations for transportation
of the elderly and handicapped. Twenty-two million dollars for such grants and
loans will be allotted during fiscal year 1976.
A revised agreement was developed and signed in September 1975. The cur-
rent agreement is broader in scope than the 1974 agreement, and covers the
range of Department of Transportation programs that could impact on the im-
provement of transportation for older persons, as well as those DHEW programs
that have resources which could be pooled with title III and title VII of the
Older Americans Act and the programs of the Department of Transportation to
develop and maintain comprehensive, coordinated transportation systems for the
elderly.
Department of Transportation/Office of Education.-In May of 1975, the Ad-
ministration on Aging, the Department of Transportation, and the Office of Edu-
cation. DHEW, signed a statement of understanding related to the use of school
buses for older persons. The three agencies pledged to explore methods for in-
creasing the mobility of older persons through the use of school buses, with spe-
cial attention devoted to those older persons residing in rural areas.
Department of Housing and Urban Development.-HUD and AoA have jointly
supported a program within the National Center for Housing Management to
develop a short-term training program and appropriate materials for managers
of housing for the elderly. Also involved in this program are trainers from a
variety of organizations specializing in housing management. These individuals
will then be expected to develop additional training under the sponsorship of their
respective organizations and thereby establish a national delivery capability for
the program.
Efforts were also continued by A0A, HUD. and the Law Enforcement Assist-
ance Administration, in regard to security for the elderly in housing projects.
This topic was also chosen as one of the priorities of the region III, Mid-Atlantic
Federal Regional Council Human Resources Committee's Task Force on Problems
of the Elderly.
In June 1975. AoA and HUD transmitted a joint issuance to their respective
counterparts at the State and local levels. on the community development pro-
gram, under title I of the Housing and Community Development Act of 1974.
The joint issuance includes a description of the community development program
and accompanying guidance to State and area agencies on aging on ways in
which community development can be most effective for older persons, with spe-
cial emphasis on how these funds can be used for the development of senior
centers.
Additionally, in early 1975 a statement of understanding was signed by the
Commissioner of AoA and the Assistant Secretary for Housing Management,
HUD, for the purpose of encouraging States and communities to explore the
possibilities of locating new nutrition sites in public housing facilities thereby en-
abling these projects to make maximum use of resources available through HUD
local housing authorities.
Department of Commerce.-An interagency agreement was made with the
Bureau of the Census for their Census Use Study group to develop a social sta-
tisties system for use by State and area agencies on aging.
Current plans call for the completion of a prototype State system in 1974. A
manual and instructions for duplication in other States will be completed some-
time in 1976.
ACTION.-AoA and ACTION developed joint program objectives during fiscal
year 1974, under which maximum coordination and mutual support between the
two programs was pledged. The ACTION objective included the designation of
at least one ACTION program designed to provide volunteer opportunities for
older persons in each planning and service area in which an area agency is desig-
nated and an area plan is approved. In addition. AoA and ACTION agreed to
cooperate in the placement of volunteers in nutrition projects supported under
title VII. Under the terms of the joint objective, State agencies on aging were
also to provide for maximum utilization of senior volunteers and to support and
enhance the objectives of the senior volunteer programs.
States reported a total of 66.372 of older volunteers participating in title III
and title VII programs throughout the country.
Federal Energy Administration.-AoA has attempted to insure that the special
problems of older people are granted appropriate attention in all activities of
the Federal Energy Administration (FEA) and its predecessor agency, the
Federal Energy Office.
The Administration on Aging and several Federal departments and agencies
entered into an interagency agreement in January 1975 designed to: (1) Promote
coordination of existing resources and programs to assist in winterization of
older person's homes; (2) adopt strong advocacy roles at the State and local
levels related to energy-related needs of older persons; and (3) provide older
persons with clear and accurate information about fuel allocations and energy
conservation.
CAN - LINO - 136
The interdepartmental working agreement on energy was signed by the follow-
ing departments and agencies: Administration on Aging: Department of Agri-
culture Extension Service and Farmer's Home Administration: Department of
Housing and Urban Development; ACTION; Federal Energy Administration:
and the Community Services Administration (formerly OEO).
Since the signing of this agreement, the Administration on Aging has on an
ongoing basis, alerted the national aging network about legislative and fiscal
developmets that could assist in the implementation of the goals of the agree-
ment. To obtain further feedback on the subject of energy issue, the Commis-
sioner conducted two filed hearings on the subject of energy conservation and
winterization during the month of September 1975, in Lewiston, Maine, and Mil-
waukee. Wis. Subsequent to the hearings, several technical assistance papers
were transmitted to the aging network to apprise them of additional actions that
could be taken to tap the various Federal resources available for energy-con-
servation-winterization activities.
Department of Agriculture.-AoA and the Department of Agriculture devel-
oped an agreement whereby the Department of Agriculture will promptly certify
nutrition projects as eligible to accept food stamps toward the purchase of
congregate meals in title VII nutrition for the elderly meal sites.
In addition, AoA worked with USDA Federal and regional staff and State
distributing agencies in the development of a system for utilization at nutrition
program project sites of the high protein foods, meat and meat alternates pro-
vided by the U.S. Department of Agriculture's donated food program. (With the
U.S. Department of Agriculture at the Federal and regional levels and the dis-
tributing agencies at the State level.)
The 1974 Amendments to the Older Americans Act of 1965 (Public Law 93-
351) (section 707(d)) require the Secretary of Agriculture to maintain an
annually programed level of assistance for the title VII nutrition program of
not less than 10 cents per meal adjusted on an annual basis each fiscal year
after June 30, 1975, to reflect changes in the series for food away from home
of the Consumer Price Index published by the Bureau of Labor Statistics of the
Department of Labor.
The Department of Agriculture, working closely with the Administration on
Aging, issued regulations implementing this section of the 1974 Amendments.
Subsequently. both the Department of Agriculture and the Administration on
Aging issued instructions and technical assistance memoranda advising the
regional offices, State distributing agencies, and State aging agencies on the
details of the donated food program. In addition. regional meetings were held
at which representatives of State distributing agencies and State agencies on
aging were briefed by Washington-based Department of Agriculture and Ad-
ministration on Aging staff in regard to the management of the program.
In fiscal year 1975, because the program started late in the year. the donated
food distributed consisted only of beef packed in its own juice and processed
cheese. The actual value of these two foods distributed during fiscal year 1975
(based on $0.10 per meal served from mid-October to the end of the fiscal year)
approximated $3,263,000.
Together, the U.S. Department of Agriculture and the Administration on
Aging plan to expand the variety of foods available to nutrition program projects.
Details of this expansion and the management changes it entails were topics
of instructions and technical assistance memoranda transmitted to State agen-
cies on aging.
Department of Labor.-The Administration on Aging has worked closely with
the Department of Labor in its development of regulations for implementation
and operation of the Comprehensive Employment and Training Act of 1973
(CETA) and for the senior community service employment program authorized
by title IX of the Older Americans Comprehensive Services Amendments of
1973. The State and area agencies on aging have also been encouraged to take
an active role in the implementation of these programs. Technical assistance
material has been developed and transmitted to the State and area agencies
on aging on the possible actions that can be taken to insure that the employ-
ment-related activities of the Department of Labor and the State and area
agencies on aging are coordinated, and the older persons needs are considered
in the development by manpower prime sponsors of comprehensive manpower
plans.
Also, information has been provided on the availability of funds under the
emergency job program under the Comprehensive Employment and Training Act
program. and State and area agencies on aging have been urged to work wtih
manpower prime sponsors to ensure that older persons are included among the
persons hired under the program.
In addition. the Department of Labor under an agreement with AoA is cur-
rently working on a study to enable the Administration on Aging to carry out
its responsibility for appraising existing and future personnel needs in the field
of aging. Details of this study are presented in section E.
Civil Service Commission.-In 1975, AoA and CSC signed an agreement
designed to help insure that State agencies on aging are engaged in meaningful
affirmative action activities. AoA and CSC made joint visits to State agencies
on aging for the purpose of assessing State agency progress in this regard dur-
ing the year. Based on these assessments, findings and recommendation were
developed and transmitted to State agencies on aging, who are currently
assessing the affirmative action activities of area agencies on aging and title
VII nutrition projects.
III. Intradeportmental Coordination
The Administration on Aging has been intensively involved in the development
of a series of formal agreements with various agencies within the Department
of Health, Education, and Welfare, especially, SRS. PHS, and SSA. These efforts
CAN - LINO - 137
are designed to improve coordi nation of State and community activities in the
areas of information and referr.al, adult social services, rehabilitation services,
community health and mental health services, and comprehensive heatlh plan-
ning. Building upon cooperative arrangements pursued during 1974 these formal
agreements reflect AoA's commitment to identify and plan for ways in which
departmental resources can be brought to effectively focus upon the needs and
interests of older persons. In addition, AoA has been engaged in collaborative
activities with the National Institute on Aging (NIA), to ensure coordination
of NIA's research objectives with those of AoA.
Social Security Administration.-AoA has continued to work with SSA on
the establishment of information and referral services for older people and on
the dissemination of information concerning the supplemental security income
program. A comprehensive discussion of I. & R. activities is presented in section
G. AoA has reviewed and commented on virtually all regulations pertaining to
the SSI program.
Public Health Service-AoA has been working to update a joint agreement
with the PHS under which joint efforts have been focused on cooperative funding
of research and demonstration grants, health technical assistance to areawide
model projects formerly funded by AoA. planning for long-term care and alterna-
tives to institutionalization, and development of objectives for joint action in
health planning. AoA has also consulted with PHS components, namely the
Health Services Adminstration, Health Resources Administration, and the
Alcoholism, Drug Abuse, and Mental Health Administration, relative to the
cosponsorship of selected evaluation projects.
A joint working agreement was signed and distributed by the Administration
on Aging and the Public Health Service in 1974, which had as its objective the
improved delivery of coordinated health and social services to older persons.
Liaison between AoA and PHS will continue to provide a mechanism for joint
efforts at the Federal level. Joint technical assistance memorauda will be issued
on home health and options in long-term care.
AoA has also worked with PHS components and the HEW Office for the Handi-
capped, formerly the Office of Mental Retardation Coordination, to identify prob-
lems of mentally retarded patients in nursing homes. AoA and PHS staff also
worked with the Division on Aging of the National Association of State Mental
Health directors to try to effect cooperation with State agencies on aging.
AoA serves on the Interagency Advisory Group on Long-Term Care and Health
of the Aging, the Interagency Task Force on Home Health Services and the
Interagency Home Health Work Group.
Office of Nursing Home Affairs.-Staff of the Office of Nursing Home Affairs
and staff of the regional offices of Long-Term Care Standards Enforcement par-
ticipated in training sessions for personnel of the nursing home ombudsman
program and continue to work with AoA personnel at both the Federal and
regional levels to promote the nursing home ombudsman program.
The AoA Nursing Home Interests staff continues to serve on the interagency
advisory group, which was established to coordinate policy and programs related
to nursing home care.
Office of Education.-AoA has cooperated with the OE Bureau of Libraries
and Learning Resources on a demonstration project utilizing libraries as infor-
mation and referral centers. In cooperation with the Bureau of Adult, Voca-
tional, and Technical Education. AoA has also fostered the cooperation of state
supervisors of home economics education as a resource in the nutrition education
program mandated under title VII of the Older Americans Act.
An agreement signed in January 1975 between the Commissioner on Aging
and the Commissioner of Education encourages the expanded use of public school
facilities for serving meals to older people. Included in this agreement is provi-
sion for a variety of educational, recreational, cultural, and other community
services and volunteer opportunities for older people.
AoA has also worked with the Bureau of Adult Education to insure that the
educational needs of older adults are more adequately considered in special
projects funded under the Adult Education Act.
Social and Rehabilitation Service.-AoA and SRS have agreed to cosponsor
selected program evaluation studies directed at assessing long-term care alterna-
tives and the development of nonvocational rehabilitation goals for older people.
Agreements have been developed with the Community Services Administration
(CSA) called the Public Services Administration-Medical Services Ad-
ministration (MSA), and the Rehabilitation Services Administration (RSA)-
before it was transferred from the Social and Rehabilitation Service to the Office
of Human Development.
The agreement with CSA signed in July 1975 is designed to promote efforts at
the Federal, State, and local levels to coordinate planning, service development
and delivery, and manpower development activities of the aging and nutrition
programs under title III and title VII of the Older Americans Act and the social
service program under title XX of the Social Security Act.
The agreement, delineates the steps that will be taken at the Federal level to
achieve coordination, including:
-establishment at the central office and regional office levels of mechanisms for
joint identification and resolution of policy and administrative barriers to
coordinated planning and integrated provision of services to older persons;
-preparation of joint policy issuances and technical assistance material, and
joint provision of technical assistance and consultation to the State staff of
the title III and title VII and title XX programs;
-sharing. and coordinating where feasible, annual forward plans and opera-
tional plans;
-sharing the findings of research and demonstration projects on planning and
services delivery;
-sharing materials that have been developed for the States on planning and
needs assessment activities;
CAN - LINO - 138
-joint funding of an evaluation of the title XX program. a portion of which
will address how effectively title XX serves older persons; and
-encouraging the respective State aging and social services agencies to take
steps to maximize coordination between the two programs at that level,
including the development of written joint agreements.
An agreement with MSA has been signed and transmitted to the field which has
as its objective the improved delivery of coordinated health and social services
for older persons. The agreement is designed to bring about greater coordination
of resources available under the medical assistance program and title III and
title VII of the Older Americans Act.
In May 1975 RSA and AoA signed a joint working agreement to improve
delivery of coordinated health and social services for impaired older persons.
The agreement is intended to provide a framework within which to structure
joint efforts on consultation and sharing of expertise, planning and implementa-
tion of coordinated service delivery programs and recommendations for future
program directions.
Several agreements have been signed by State vocational rehabilitation agen-
cies and the State aging agencies. As an outgrowth of this agreement, in one
region, RSA and AoA, in conjunction with one of the voluntary agencies serving
the blind, are planning a regional conference on services to the elderly blind.
Joint AoA-NIA Research Activities
AoA is represented on the National Advisory Council on Aging of the National
Institute on Aging NIA by the Director of the Office of Research, Demonstra-
tions, and Manpower Resources (ORDMR). In that capacity, AoA has been
directly involved over the past year in the formative stages of NIA's program
decisions. This has helped to minimize problems of duplication and problems of
overlap in NIA and AoA aging research areas, with NIA emphasizing support
of biomedical and behavioral research and AoA focusing on the social aspects of
aging. Other cooperative arrangements between NIA and AoA in the field of
research include:
-Joint AoA-NIA Evaluation Activities.-AoA provided the chairmanship for
the subcommittee on evaluation of the task force to establish NIA. Through
its membership with NIA on the ad hoc Intra-HEW Committee on Evaluation
in Aging, which evolved from this subcommittee, AoA continues its par-
ticipation in the development and coordination of evaluation in aging actvi-
ties within HEW.
D. RESEARCH AND DEMONSTRATIONS
I. Research and Demonstraton
The Administration on Aging's research and demonstration program supports
projects which add to existing knowledge in a variety of areas which may be
useful in the development and improvement of aging programs. The primary
source of funding for R. & D. projects in aging is title IV, part B of the Older
Americans Act of 1965. as amended by the Older Americans Comprehensive
Services Amendments of 1973. During fiscal year 1975, 113 new and continuing
projects received financial assistance.
The new projects (a total of 72) continued to be developed in response to a
research and development strategy which focuses on directing research toward
knowledge useful to effective conduct of new programs mandated by title II,
III, and VII of the Older Americans Comprehensive Services Amendment of 1973
and knowledge necessary to progress toward fulfilling the national objectives for
older persons outlined in title I of the Older Americans Act of 1965.
A dissertation research program was initiated by the Administration on Aging
in fiscal year 1975 under title IV, part B to provide support for doctoral research
in the several research areas addressed by the new projects. Of the 72 new poject
awards made in fiscal year 1975, 45 were dissertation research grants.
Continuation projects (41) are those which were initiated prior to July 1974
and received additional title IV, part B support in fiscal year 1975. These com-
plement the new emphasis on planning and coordination by continuing the search
for new knowledge on approaches to developing and organizing services designed
to enhance potential for independent living and reduce the need for institutionali-
zation among the elderly.
(a) New Awards
The following summary of the new start research projects is organized under
the four research issues of the 1975 research and development document: Aging
Processes (Exclusive of Biological Processes) Descriptions of the Older Amer-
ican Population: Social and Environmental Conditions Affecting the Elderly;
and Intervention Mechanisms.
Aging Processes (Exclusive of Biological Processes) Research funded under
this area is expected to permit identification and understanding of variables
and processes that contribute to the aging phenomenon. Such knowledge will
assist in the development and implementation of programs responsive to the
capabilities and functionings of the elderly. More specifically the following will
be investigated:
-information and knowledge about the strengths and weaknesses of the elderly
to compete for a fair share of goods and services
-knowledge to develop responsive service systems directed toward the prob-
lems of old age:
-basis for assisting service providers to understand the special problems of
the elderly.
Ten new grants bear directly on research in this area
CAN - LINO - 139
-Grants to study the changes of and problems associated with coping ability
among older persons were awarded to: Community Research Application
($50,769), New York, N.Y.; University of Maryland ($66,899), College Park,
Md.
-Grants to conduct research on the problems of decision-making of older per-
sons and its associated processes were made to: University of Chicago
($76,144) University of Missouri-Columbia ($115,934) ; Catholic Univer-
sity ($118,013).
-The University of Southern California will examine the policy and program
implications of investigating different nonchronological approaches to de-
fining the aging process. ($45,565).
-The American Institute for Research will be investigating the identification
of opportunities for improving the quality of life of older age groups
($85,967).
-Bowling Green State University will conduct research to assess the differen-
tial levels of communication competence in older people ($16,769).
-The University of Florida will investigate the nature of changes in cognitive
factor structure concomitant with age in order to gain a clearer theoretical
understanding of the kind of qualitative differences which may be occurring
($23, 90).
-A grant was awarded to the University of Chicago to analyze the relevant
informal and formal institutions that provide resources for coping, and to
study the relationship between a person and such resources that lead to
effective coping behavior ($131,211).
In addition, 17 dissertation research grants pertinent to this subject area were
awarded ($5,000 per grant).
Descriptions of the Older American Population.-Research funded under this
area is expected to provide knowledge about the characteristics, attitudes, be-
haviors, and distributions of older persons. Such knowledge will permit formula-
tion of policies and programs which will facilitate the achievement of equal op-
portunity and access to the objectives specified in title I of the Older Americans
Act (1965) as amended.
More specifically, the following will be investigated
-The characteristics, attitudes, behaviors. or distributions of older persons
(either current or future) which require consideration relative to existing
and future policies and program designs;
-Unanticipated or undesired changes or trends which have been fostered by
policies or programs affecting the elderly;
-Changes or trends which affect the application of intervention mechanisms;
-Subpopulations of olderly, how they differ, and the implications of these
differences for policy, planning, and the application of intervention mecha-
nisms.
Two grants bear directly on research in this urea
-The Research Foundation of the State University of New York will in-
vestigate distinctive patterns of influencing variables on the differential
perception and objective definition of elderly subpopulation ($27,463).
-The University of Georgia received a grant to identify and analyze the char-
acteristics of rural elderly populations and their differential life styles
($49,750).
In addition, 14 dissertation research grants pertinent to this area were
awarded ($5,000 per grant).
Social and environmental conditions affecting the elderly.-Research funded
under this area is expected to provide knowledge of social, economic, and en-
vironmental forces which impinge on the ability of the elderly to secure and
maintain "freedom, independence and free exercise of individual initiative in
planning and managing their own lives" (title I, section 101 of the Older Amer-
icans Act).
Specific research issues to be investigated include:
-national policies which create unique crisis situations for the elderly;
-economic and social forces which enhance or diminish the social or economic
capital of the elderly;
-values, mores, stereotypes, and social conditions in the population at large
which inhibit or facilitate the achievement of freedom and independence of
the elderly
-responses of the elderly to social and environmental conditions which im-
pact negatively on their freedom and independence;
-types of intervention at the national. State, and local levels which can re-
:
duce negative impact of undesirable conditions which affect the elderly.
Six grants were awarded which bear directly on research in this area:
-The University of Missouri will analyze the factors related to residential
segregation of the aged in American cities ($28,597).
-The National Opinion Research Center of Chicago will study the psycho-
logical determinants of public support for five social welfare groups ($49,-
799).
-The University of Florida will investigate ways of improving the older per-
son's purchase decisions ($39,784).
-The University of Michigan will conduct research on the factors influencing
the abandonment of private homes by the elderly ($137,473).
-The Philadelphia Geriatric Center will study the factors related to the
changing housing needs of urban and rural elderly ($55,706).
-The University of California at Davis will analyze life styles of the elderly
as they relate to consumer behavior ($20,955).
In addition, four dissertation research grants pertinent to this subject area
were awarded ($5,000 per grant)
Intervention mechanisms.-Research funded under this area is expected to
provide knowledge descriptive of intervention mechanisms and the responses of
CAN LINO - 140
the elderly to those interventions. Such knowledge will provide the under-
2standing necessary for the development, organization and delivery of service,
as well as the coordination of delivery systems as supported under titles 1, III,
and VII of the Older Americans Act, 1965, as amended.
More specifically, the following will be investigated:
-What intervention mechanisms exist or are possible and how they differ-
entially affect the well being of Older Americans:
-What tools and techniques are required for different intervention mecha-
nisms: how these may differ by application to subpopulation groups of
elderly;
-What resources are required for different intervention mechanisms; how
resources can be uniquely identified as critical to certain subpopulations of
the elderly.
Eight grants bear directly on research in this area
-The Institute for Economics and Social Measurements received a grant to
develop and analyze techniques for translating units of need into units of
service ($91,642).
-The Urban Institute received a grant to increase the information about fac-
tors on which institutional placements are based, and to improve the
quality of care which is provided ($161,760).
-The State Communities Aid Association of New York will study the first
year's operation of title XX of the Social Security Act ($154,218).
-Columbia University received a grant to develop information on the uses
and gratifications of the mass media for aged persons, and to determine
whether a weekly newspaper produced by aged persons can help satisfy in-
dividual needs and raise morale ($67,063).
-A grant was awarded to the University of Massachusetts to examine the
methodological problems of accurately measuring and forecasting the need
for long-term health care services for the elderly ($168,566).
-The School of Medicine of the University of Pennsylvania received a grant
to develop models for analysis depicting strategies of decision-making within'
the context of nursing home closings, focusing on inter-organizational rela-
tionships within long-term care/nursing home facilities ($80,786).
-The Governor's Citizens Council on Aging of Minnesota will conduct re-
search on a comparison of in-home and nursing home care for older persons
($183.154).
-The Curative Workshop of Milwaukee received a grant to demonstrate the
effectiveness of an avocational counseling program for older persons ($74,-
201).
In addition, 10 dissertation research grants pertinent to this subject area were
awarded ($5,000 per grant).
(b) Continuation Projects
The continuation projects largely focus on better ways to develop and or-
ganize services to help the vulnerable elderly return to or remain in their own
homes or other appropriate settings. A number of these projects are described
below in order to illustrate the wide variety of areas within which investiga-
tions and new knowledge on behalf of older persons are being undertaken. A
number of these projects receive support from other Federal agencies, in addi-
tion to the title IV funds provided by AoA.
-The University of Southern California Gerontology Center has organized,
evaluated, and analyzed research data, concepts, theories and issues on the
biological, psychological and social aspects of aging for publication in three
Handbooks in Gerontology.
-The School of Social Service Administration, University of Chicago, has
initiated research on a series of models that show the effects on older
persons of a wide range of service delivery methods ($42,214).
-The Colorado Department of Institutions, Denver, is testing the feasibility
of specialized boarding homes for elderly persons who have had or con-
tinue to have mental problems ($75,347).
-A grant to the International Center for Social Gerontology, Washington,
D.C., will provide a comprehensive literature review on congregate housing
for the elderly, placing special emphasis on European experience in this
field. The grant also aims at a systematic analysis of the environmental,
economic, cultural and other factors that favor success of such programs,
with implications for legislative and administrative action concerning con-
gregate housing programs in the United States ($87,990).
-Grant research by the Center of Demographic Studies, Duke University,
Durham, N.C., will indicate what combinations of factors cause older persons
to adopt independent, congregate, or institutional patterns of living arrange-
ment ($94,391).
-A grant to the Wilmington Housing Authority, Del., will support a literature
search of current knowledge about the causes and effects of social isolation
among the elderly. An analysis of community programs focused on combating
social isolation will also be undertaken ($92,427).
-Catholic University of America, Washington, D.C., has been awarded a
grant to develop models depicting decisionmaking patterns of older persons
in their use of available resources and show the effects of ecological,
psychological, and biological factors on these patterns of decisionmaking
($232,848).
-The University of Illinois at Chicago Circle will conduct a national survey
to provide detailed information on the needs of older people, particularly
as these relate to social integration, community services and health and
specialized housing ($112,246).
CAN - LINO - 141
-The Institute for Research on Poverty, University of Wisconsin, will develop
definitions of "adequate income level" for categorie groups of elderly, and
descriptions of multiple factors, besides lack of income, which contribute
to poverty in old age ($19,926).
-San Diego State University will identify special characteristics of different
aged minority groups which call for special types and methods of service
programs ($153,463).
-Case Western Reserve University, Cleveland, Ohio, will determine whether
and to what extent certain economic and service incentives can induce and
equip family units to provide home care for elderly members ($78,838).
Current and Anticipated Fiscal Year 1976 Funding.-The Administration on
Aging awarded contracts during the first quarter of fiscal year 1976, as follows:
-Roy Littlejohn Associates, Inc., will develop and test conceptual models
and various methodological approaches for identifying and projecting the
future needs and problems of preelderly cohorts.
-Logical Technical Services, Inc., will develop a state of the art paper or
technology transfer to the problems of the elderly.
-Human Resources Corporation will develop a state of the art paper on
theoretical developments in social gerontology and implications for Govern-
ment service programs.
-Roy Littlejohn Associates will develop a state of the art paper on problems
of defining and classifying aged population groups.
-Yale University will study the effects of jurisdictional conflicts on areawide
coordination of service planning and delivery to older persons.
-Documentation Associates will develop a comprehensive inventory and
analysis of past and current federally supported research in aging.
-The Orkand Corporation will develop an inventory of federal outlays for the
elderly.
-Kappa Systems will study the utilization of general and specialized revenue
sharing funds for the elderly.
-Sam Harris Associates will develop a state of the art paper on alternatives
to institutionalization of the elderly.
-Homitz, Allen, and Associates will study educational institutions as resources
for planning, coordinating and delivery of community based services to older
persons.
-Boone, Young, and Associates will study consumer participation in the plan-
ning processes of State and area agencies on aging.
Fiscal year 1976 new starts will respond to a research strategy based on the
four categories of research issues of the 1975 research and development plan.
AoA will fund research and demonstrations projects which will
-Assist in identifying and understanding those processes of aging uniquely
associated with or inherent in the make up of the elderly. Such knowledge
will permit the development and implementation of programs responsive
to the capabilities and functionings of the elderly.
-Provide knowledge of characteristics, attitudes, behaviors, and distributions
of older persons. Such knowledge will permit formulation of policies and
programs which will facilitate the achievement of equal opportunity and
access to the objectives in title I of the Older Americans Act of 1965 as
amended.
-Provide knowledge and understandings of social, economic, and environ-
mental forces which impinge on the ability of the elderly to secure and
maintain "freedom, independence and free exercise of individual initiative
in planning and managing their own lives."
-Provide knowledge descriptive of intervention mechanisms and the responses
of the elderly to those interventions. Such knowledge will provide the
understanding necessary for the development, organization and delivery of
service, as well as the coordination of delivery systems as supported under
titles III and VII of the Older Americans Act of 1965 as amended.
Dissertation Fellowship Programs.-AoA will continue a dissertation research
fellowship program which will seek to encourage research in the field of social
gerontology and related areas. The program's goal is to gain new insights into
the needs, circumstances, resources, expectations and roles of the nation's
older population, including the following research activities:
-Identifying and assessing patterns. conditions, and new approaches which
contribute to a wholesome and meaningful life for older people.
-Developing and evaluating new approaches, methods and techniques for
improving coordination of community services for older persons.
-Collecting and disseminating information concerning research findings and
other materials developed in connection with activities under the Older
Americans Act.
II. Model Projects in Aging
The model projects in aging program, initiated in fiscal year 1974 under the
authority of section 308 of the Older Americans Act of 1965. as amended, was
continued as a result of Congressional appropriations which the administration
earmarked for that purpose. The activity and level of funding rose from 40
projects supported by $3.7 million in fiscal year 1974 to 113 projects receiving
grants totaling $7.3 million in fiscal year 1975.
Four categories of service to Older Americans continued to be given priority
for funding. They are housing and residential arangements, with 11 projects
funded at $721,860: continuing education. with 11 projects funded at $971,026;
retirement preparation. adjustment. and opportunities for new roles, five proj-
ects funded at $507,252; and services for the physically and mentally impaired,
seven projects funded at $1,065,154. Nineteen additional projects, with goals
addressed to several priorities, were funded in the amount of $1,803,489.
The latter adds impetus to comprehensiveness of service which also character-
izes the program development thrust of State and area agency planning and
CAN-LINO-142
coordination underscored in section 303 of the same title of the Older Americans
Act.
In addition. the model projects in aging program provided support for 11 legal
services projects for older persons, totaling $1,193,259.
A nursing home ombudsman program was initiated nationwide with projects
in 49 State agencies on aging. totaling $1,112,604.
Examples of model projects are as follows:
In the area of housing. the New England Nonprofit Housing Development
Corp. is conducting a project to demonstrate improved ways of assisting
public officials and community leaders in implementing a range of alterna-
tives in the provision of improved housing for older persons. The project
is based upon previous research and demonstration activities, and emphasizes
the use of regional resources to accomplish objectives. In another housing
project in Dade County. Fla., the United Home Care Services is conducting
the project "Share-A-Home," to assess the benefits of a shared home arrange-
ment in meeting both housing and social needs.
The National Association for Human Development will conduct a model
project for physical fitness for older persons as one of the activities funded
under the priority of continuing education.
In the area of retirement preparation and adjustment, the San Diego
Ecology Center. Calif., is turning the resourcefulness of older persons into
an interesting and profitable venture. Seniors will collect scrap materials
from industry, et cetera, and sell them to art schools, artists. or businesses
that produce craft products, thus recycling valuable materials that would
have gone to waste. In the same priority category, Handicraft Marketing
Sales, Washington, D.C., will supply both supplemental income and psycholog-
ical reward by developing a model and vehice to market handicrafts
produced by the elderly handicapped.
In San Francisco, the Chinatown-North Beach Health Care Planning and
Development Corp. has developed the ON-LOK Senior Health Services model
project to assure medical and mental health services for older persons in
need of such srevices. Another project to assist older persons is a model
dental program operated by the University of Oregon model dental program
in Portland, Oreg.
Many model projects address multiple priorities. One such project is the
Minnesota Consortium, sponsored by the College of St. Thomas in St. Paul,
which is developing new roles and improving on existing roles for educa-
tional institutions in the field of aging. The project involves a vocational
school, an elementary and secondary public school system, the State uni-
versity, a State college. a community college. and two private colleges. A
broad range of activities is spanned, including curriculum development,
training of paraprofessionals, community organization and technical assist-
ance.
Grant support is also being provided to projects which address the need
for improved approaches to the needs of minority group elderly. Projects
concerned with the needs of older Indians are to be conducted by the Mon-
tana United Indian Association, the Gila River Indians in Arizona, the
Inter-Tribal Council of Nevada and the Papago Council in Arizona. The
Association National Pro Personas Mayores is conducting a project nation-
wide to improve service to older persons of Hispanic heritage, and the
National Urban League is providing technical assistance to State and area
agencies to improve the service delivery systems for minorities.
The State agency on aging in Colorado is implementing a statewide nurs-
ing home ombudsman program by utilizing the State, regional, and local
service and regulatory agency network that has been planned and developed
over the last few years to deal with the complaints and problems of nursing
home residents. Within this present network is the Senior Citizens Law
Center, which, since October, 1974, has operated a nursing home advocacy
project for more than 50 percent of the nursing home residents in the metro-
politan Denver region. The statewide project builds on the existing project
with the intent to expand its services to all of Colorado's 16,000 nursing
home residents by further coordination and integration of its operations
with the entire governmental agency network mentioned above.
In Tennessee, the State agency on aging is establishing the Tennessee
Commission on Aging as the focal point for the promotion and development
of statewide nursing home ombudsman activities. The program seeks to place
a local representative in each nursing home within the program area for
weekly visits to nursing home residents, to establish a local unit within
each participating area agency on aging with the capability to maintain a
visitation network and to effectively handle complaints. and to gather in-
formation relative to the general nursing home situation within the pro-
gram area which will be utilized by those interested in nursing home care in
Tennessee.
The National Senior Citizens Law Center is conducting a project to pro-
vide legal service technical assistance to State and area agencies on aging
throughout the central and western portions of the Nation. The Center is
playing a major role in assisting these agencies to establish. develop. and
expand an evolving network of legal service activities to serve the needs of
older persons. Emphasis is being placed on assisting these agency staff to
understand substantive aspects of the law in helping legal service providers
to provide quality legal services to the elderly.
The University of Michigan Law School is conducting a project to pro-
vide technical assistance to State and area agencies on aging for the provi-
sion of legal services to the elderly through identification of potential legal
resources and the development of various training materials and methodolo-
CAN - LINO means 143
gies. These materials will heighten these agencies' ability to expand the
involvement of the private bar. legal services, law schools, and continuing
legal education organizations in the provision of legal services to older per-
sons. While these materials are primarily designed for application in Mich-
igan, the potential exists for their national application.
Progress has been made in the past year in developing national policy
related to the needs of older people in natural disasters. The impetus for
such national planning is an outgrowth of the experience of the four proj-
ects supported during the previous year. Grant support was provided the
State agency on aging in Nebraska in fiscal year 1975 following the tor-
nadoes which affected many older persons in Omaha.
In fiscal year 1976 plans are underway to implement the recent amendments
to section 308. These include developments in day care, ombudsman activities,
and improved approaches to meeting the needs of older persons of low income,
minority, Indian, limited English-speaking individuals and rural elderly.
E. TRAINING
Under title IV, part A of the Older Americans Act, as amended, AoA is au-
thorized to help meet critical shortages of adequately trained personnel for
programs in aging by (1) Developing information on the actual needs for per-
sonnel to work in the field of aging, both present and long range; (2) providing
a broad range of quality training and retraining opportunities, responsive to
changing needs of programs in the field of aging; (3) attracting a greater num-
ber of qualified persons into the field of aging; and (4) helping make personnel
training programs more responsive to the need for trained personnel in the field
of aging.
The fiscal year 1975 appropriation for title IV, part A, was $8 million. The
following manpower and training activities were in progress in 1975.
I. Career Education in Aging
The Administration on Aging supports training programs at institutions of
higher education that will provide students with the necessary gerontological
knowledge and skills to enable them to serve the Nation's elderly in their chosen
career or profession. It is the intention of this program to stimulate the develop-
ment of gerontological interest and expertise among the faculty and student
body of these educational institutions, to assist in supporting the development
of gerontological teaching capability, and to promote the development of an
institutional commitment to gerontology and the field of aging. Through this
career development program, at baccalaureate, masters, and doctorate levels,
students are prepared for employment in State and Federal program planning
and administration, community development and coordination, administration of
retirement homes and homes for the aged. senior center direction, teaching and
research, and for serving older people through adult education, architectural
design, counseling, law, library service. recreation, and other relevant fields.
For the 1974-75 academic year $4 million supported 35 educational institutions
under 1-year title IV, part A continuation grants. The funds were used pri-
marily to support existing programs in gerontology, including student support
based on need as determined by the university. Approximately 4,600 were en-
rolled in aging courses and programs at these AoA-supported training institu-
tions: 625 of these students received financial assistance as part of the fiscal
year 1974 career training grant awards to the universities.
At the close of fiscal year 1975, approximately $3.5 million was awarded on a
national competitive basis to education institutions to support new or continuing
career training programs. As a result of the national competition, 50 awards
were made to 47 colleges and universities in 34 States for the conduct of career
training activities during fiscal year 1976. These 50 institutions reported that
approximately 16,000 students are enrolled in aging courses and programs; 523
of these students received financial assistance under the provisions of the AoA
fiscal year 1975 awards.
II. In-Service Training
AoA has supported a number of short-term intensive training programs which
have provided skills to several thousand persons recruited from all parts of the
country. With the implementation of titles III and VII a great many newcomers,
requiring such training programs, have been attracted to the field of gerontology.
Moreover, upgrading of competencies has been required for many persons who
were already in the field of aging prior to the passage of the 1973 Amendments
to the Older Americans Act. During fiscal year 1975 support for in-service train-
ing was expanded to meet these needs. Examples of these training activities
include the following:
Syracuse University developed a series of State leadership conferences
and trained approximately 125 State agency executives and key staff in
leadership roles and responsibilities deriving from the broad mandate of
the title III legislation.
The Assistance Group. Inc., of Silver Spring, Md., trained. during fiscal
year 1975, approximately 75 State agency personnel in techniques of pro-
viding technical assistance to persons at State and local agencies who are
responsible for meeting the Administration on Aging's requirements for in-
formation and referral programs.
Under title IV, part A grant support, nutrition training conducted by five
training organizations was provided for approximately 2,620 persons. In
addition, resource publications were developed specifically for use in the
title VII program, as well as for all nutrition and consumer education
activities for older persons.
CAN - LINO - 144
Ten colleges and universities conducted symposia for faculty members and
others offering courses related to the needs of older persons. The Symposia
presented current information on training materials and methods as well
as information related to programs under the Older Americans Act.
To supplement the short-term training activities undertaken to upgrade the
competencies of State and area agency personnel and nutrition project staft, $4
million of fiscal year 1974 funds were awarded in June 1974 to State agencies
on aging to be used by them in meeting fiscal year 1975 State and local training
and manpower development needs not addressed by the national training efforts,
but necessary for effective implementation of the 1973 Amendments. Approxi-
mately 12,000 persons were trained as a result of these awards. Late in fiscal
year 1975, $3.5 million was awarded to State agencies on aging to continue dur-
ing fiscal year 1976 the support of training which meets the priority in-service
needs identified for State and area agency personnel. State agencies were en-
couraged to work with post secondary educational institutions serving planning
and service areas with established area agencies on aging in the development
and delivery of training courses.
III. Manpower Development
As part of the plans for implementing its responsibilities under section 402
of the Act, the Administration on Aging in fiscal year 1974 entered into a joint
agreement with the Bureau of Labor Statistics, Department of Labor to assist
in developing information on manpower needs in the field of aging.
During fiscal year 1975 the Bureau of Labor Statistics completed a study en-
titled "Manpower Needs in the Field of Aging: The Nursing Home Industry."
This study presents an analysis of the manpower needs of nursing homes as well
as an analysis of future supply-demand conditions for several key occupations
in the nursing home industry. This document has been printed and is available
for distribution from the Administration on Aging.
Future studies are being planned that will be devoted to the occupational out-
look of a specific industry or occupational field of high priority concern to older
persons. As these studies are completed they will be disseminated as part of a
series of technical papers that will be available to researchers, educators, practi-
tioners and students in gerontology and related fields.
In further support of its responsibilities under section 402 of the Older Amer-
icans Act, AoA has begun planning for public hearings, to be held during the
spring of 1976, which are designed to generate informtion on manpower needs
in the field of aging.
The Older Americans Comprehensive Services Amendments of 1973 direct the
Commissioner on Aging to support activities designed to attract a greater num-
ber of qualified persons into the field of aging. Young people enrolled in high
schools, vocational and technical schools, colleges, and universities are more
likely to plan and prepare for careers in the field of aging if they are aware
of the career opportunities available. Recognizing the absence of vocational
guidance materials that provide information on current and projected future job
opportunities in the field of aging and related guidance information, the Ad-
ministration on Aging has asked the Bureau of Labor Statistics to develop and
disseminate vocational guidance materials that discuss careers in the field of
aging. The information developed will be presented in format consistent with vo-
cational guidance materials currently published by the BLS and will be published
in the fall of 1976 with a special issue of the Occupational Outlook Quarterly that
will be devoted exclusively to the field of aging.
Other AoA activities during 1975 conducted in response to the legislative man-
date for manpower development included the following:
A project for identifying. classifying, and evaluating training materials
in gerontology. This project provides a clearinghouse capability relative to
resources developed for training personnel in the field of aging.
A project to prepare videotapes illustrating basic aging concepts for use
in training at many different levels and in many settings-for example, para-
professional courses in junior colleges, baccalaureate and masters level
courses in universities, and in-service training sessions for human services
staff at State and area agency levels. Supportive materials adapted to the
learning audience are also being developed.
A project to introduce information on design for the elderly into architech-
tural design education and continuing education programs. Teaching aids
and design guides are being developed and tested in architectural school
settings.
Three project grants designed to identify the informational materials and
training needs of area agencies on aging in their work with service providers.
Continuation support for a project to train American Indian paraprofes-
sionals working with elderly American Indians.
IV. Conferences
Support for national conferences was provided by AoA to initiate new de-
velopments in the field of aging, and to share nationally the knowledge gained
from research, demonstrations, and significant experience. The following awards
were made in fiscal year 1975 for conferences:
1441/2-CAN-LINO
U.S. Project on the Elderly, U.S. Conference of Mayors.
Gerontology as a New Frontier in Higher Education, Association for
Gerontology in Higher Education.
Seminar on the Care and Needs of Elderly Mentally Ill in Nursing Homes
and Board and Care Homes, American Psychiatric Association.
Central Conference of American Rabbis Conference on Aging and Plan-
ning for Retirement, Central conference of American Rabbis.
Youth Conferences on New Charter for Older Americans, National Retired
Teachers Association/American Association of Retired Persons.
F, EVALUATION
The fiscal year 1976 evaluation plan will continue to stress the evaluation of
the major A0A program activities: the area planning and services program, nutri-
tion program for the elderly, interagency agreements, and participation in title
III programs. Contracts for the fiscal year 1975 evaluations of title III, title VII,
and information and referral were let in the first quarter of fiscal year 1976.
(Contract awards were delayed due to limitations on contracts included in the
fiscal year 1975 DHEW/DoL Appropriations Act.)
The following new projects began in early fiscal year 1976:
(1) Longitudinal Evaluation of the Nutriation Program
AoA published a request for proposals for this evaluation based on a methodol-
ogy previously pilot-tested under contract by AoA. The contract was awarded to
Opinion Research Corp. of Princeton, N.J., and Kirschner Associates, Inc. of
Albuquerque, N. Mex. The evaluation study will attempt to measure the impact
of the program in terms of its effect on the health status, nutritional status, iso-
lation, life satisfaction, longevity, and institutionalization of the participants.
It will also determine the relationship of these impacts in nutrition project char-
acteristics and policies in order to recommend improvements.
(2) Area Planning and Services Program Evaluation
Based upon in-house research and information collected by the National Bu-
reau of Standards, AoA developed a methodology for the evaluation of the orga-
nizational effects of area agencies on aging. A request for proposals was published
and Westat, Inc., of Rockville, Md., was selected to perform this evaluation.
Ecosometrics, Inc., of Bethesda, Md., and Robert Walker and Associates of
Minneapolis, Minn., will serve as subcontractors. This study will attempt to
measure changes in organizations included in the services delivery systems for
in developing the elements and components of I. & R. services delivery systems for
older persons resulting from the efforts of area agencies on aging.
(3) 1. & R. Evaluation
The Older Americans Act required that I. & R. services be available and ac-
cessible to every older person. AoA signed a contract with Mark Battle Associates
of Washington, D.C., to measure the progress of State and area agencies on aging
in developing the elements and components of I. & R. services consistent with
A0A guidelines for such services.
(4) Title XX Evaluation
Title XX is a major potential source of funds for services to older persons.
AoA is cofunding with SRS the first major evaluation of this new program. The
evaluation will study both the effect of the program on older persons and the in-
volvement of State and area agencies on aging in the title XX planning process.
The following projects were completed in 1975:
(1) Older Americans Status and Needs Assessment Survey System.-The
Older Americans Status and Needs Assessment Survey for use by State and area
agencies has been completed and distributed. The package included a pretested
survey form, survey manual. interviewer training manual and a utilization man-
ual. The utilization manual discusses use of the data collected for public relations,
legislative relations, planning, evaluation, and coordination.
(2) Secondary Data Manual.-A manual describing sources and uses of
secondary data, such as census reports, for use in planning by State and area
agencies was developed and will be distributed with the State and Needs
Assessment Survey.
(3) Evaluation and Monitoring Tools for Area Agencies on Aging.-Three
self-evaluation and monitoring tools were disseminated to State ad area agencies
on aging. The tools with the following areas:
a. Self-assessment of basic functions and preparation for the State assess-
ments:
b. Evaluation of existing service providers capacity
C. Evaluation and monitoring of service providers with whom the area agen-
cies have agreements or contracts;
Each of these tools was pretested in five area agencies on aging in order to
determine its applicability and ease of performance. State Agency and Regional
Office staffs were trained in their use. These tools provide optional technical
assistance.
The following studies were completed in 1975:
CAN - LINO - 145
(1) Nutrition Outreach Evaluation.-This evaluation measured the effective-
ness of the nutrition projects in reaching and serving those most in need of nutri-
tional services. It found that the minority and low-income elderly were reached
by most sites in as great or greater percentages than are available in their areas,
(2) Strategy Evaluation for the National Clearinghouse on Aging.-This proj-
ect produced a strategy for establishing the Information Resources Center in
Aging within the National Clearinghouse on Aging. It surveyed potential Clear-
inghouse users and sources of information as a basis for that strategy. (See
National Clearinghouse on Aging section for more information.)
(3) R. of D. Utilization Evaluation.-This project collected information on
highly utilized and poorly utilized R. & D. (mainly demonstrations) projects and
determined that potential users. primarily practitioners, want copies of final
reports rather than brief articles and also the opportunity to discuss the results
with the project director on other users. Both project directors and potential users
of project findings were surveyed.
(4) State Agency Evaluation.-This project used the structured case study
approach to evaluate the effectiveness of State agencies on aging in terms of their
planning, coordination. assessmet, advocacy and technical assistance functions.
The results showed that different States have developed at different rates. It
is also studying SSI alert. Fifteen State agencies were studied and both qualita-
tive and quantitative information collected.
(5) Evaluation and Monitoring Tools for the Nutrition Projects.-This project
produced several tools which may be used by nutrition project directors includ-
ing a combined guide for a site assessment and preparation for State assessments,
a former participant questionnaire, a food service contract monitoring tool, and
a community food preparation costs comparison tool.
(6) AoA Data Base-Documentation Associates of Los Angeles, Calif., under
AoA contract. collected documents containing data on the minority elderly and
services to older persons for the AoA Data Base. This data will complement the
existing collection of statistical data on two of AoA's priority target groups; the
low-income elderly and the impaired. noninstitutionalized elderly. The documents
will be indexed and a retrieval system developed to allow the user to locate
relevant references. Also developed under this contract is a thesaurus of terms
covering the field of gerontology. This thesaurus will be of use to all professionals
in the field of gerontology. Further information on the Data Base is contained
in section G of this report.
(7) Social Statistics System for the Elderly.-The Census Use Study Group
of the Bureau of the Census is developing a social statistics system for use by
State agencies on aging. The system will utilize existing data from various
sources, organize the data and allow analysis of the data in order to determine
the status and needs of the elderly. A prototype system is being developed for
Nebraska. A handbook including complete instructions will be provided to allow
duplication of the prototype system by other State agencies who elect to do SO.
A report discussing the Nebraska experience will also be published.
A feasibility study for a similar system for use by Area Agencies on Aging
was performed. The study report was reviewed and it was determined not to
develop the system.
The following studies are in progress:
(8) Evaluation of Aging Magazine.-An in-house evaluation is being conducted
to assess Aging. a magazine published by AoA's National Clearinghouse on Aging.
(9) Evaluation of Alternatives to Institutional Care (Cosponsored with
SRS).-Work is underway to develop a study methodology through the use of
sample surveys to determine costs and impact of various forms of long-term
care in both community and institutional settings. The methodological approach
is being developed as part of the Older Americans Resources and Services
(OARS) study at Duke University in North Carolina.
G. NATIONAL CLEARINGHOUSE ON AGING
The National Clearinghouse on Aging was created by the Administration on
Aging in response to the authorization contained in title II of the Older Ameri-
cans Act Amendments of 1973. The Clearinghouse is charged with: (a) Collect-
FORD
ing, analyzing, and disseminating information about older people and their needs;
(b) providing information to people. agencies. and organizations with respect to
programs for older persons; (c) encouraging the establishment of State and area
information centers and referral services; (d) carrying out a program of con-
sumer education for older people: and (e) stimulating other agencies to prepare
GERALD
LIBRARY
and disseminate information for the field of aging.
The national network on againg-AoA. the State, and area agencies on aging,
the nutrition projects, and cooperating public and private agencies and organiza-
tions-requiries a wide spectrum of information in order to serve effectively as
advocate and program facilitator toward realization of the national goals for
older persons. and to meet its own program objectives. The range of informa-
tion needs includes: General information about the problems and conditions of
the elderly necessary to raise the level of awareness, concern, and sensitivity of
the public-at-large to the situation of the aged and aging: information intended
for older persons to increase their awareness and familiarity with social and
health services available for their use; information regarding the results of
research in the field of aging for the use of professional practitioners: informa-
tion on the planning, programing and administration of services for the use of
public and private agencies; comparative statistics and related data on the
aged and aging to assist decision-makers at all levels in policy formulation, goal
specification and resource allocation.
The 1975 report describes Clearinghouse activities in five functional areas:
CAN - LINO - 146
i. Information and Referral
The Older Americans Act Amendments of 1973 and related regulations require
that State and area agencies on aging must insure that all older peple have
reasonably convenient access to information and referral services. These informa-
tion and referral efforts will help link older persons with opportunities, resources,
and services that enable them to meet their needs and enhance the meaning of
their later years. Information and referral services also aid in collecting and
reporting information about the needs of older people and the adequacy of re-
sources available to them. Viewed in these terms, an information and referral
service becomes a cornerstone for building comprehensive coordinated service
systems for older people.
The primary responsibility for developing information and referral policy,
procedures, guidelines, and information is lodged in the National Clearinghouse
on Aging. which works closely with the Office of State and Community programs
to implement the statutory requirements. Thus, NCA participated in the review
of fiscal year 1976 State plans to determine how States are meeting the statutory
information and referral requirement.
(a) Technical Assistance and Guidelines to State and Area Agencies.-The
number of agencies providing information and referral services continued to
grow throughout 1975. This is due to AoA's advocacy for the provision of these
services and growing awareness among older people and others that the elderly
require help in locating opportunities and services that will help improve their
circumstances of living.
With increased financial support for I. & R. set forth in the new Social Security
Act title XX comprehensive State plans beginning in October. 1975. the need to
coordinate information and referral services at the State and area levels becomes
more compelling. Coordination of information and referral activities is under-
way through agreements established among departments and agencies at the
Federal, State and local levels. See the following section on Interagency Cooper-
ation.
During 1975, technical assistance was provided to State and area agencies in
concern with regional office staff to encourage the establishment of State in-
formation and referral networks. The purpose of establishing such networks is
to assure effective statewide services coverage for older persons through access
to information and referral services. Other network activities include the develop-
ment of statewide resource files and Statewide uniform reporting and service
classification systems.
Additional technical assistance to the field was provided through the develop-
ment of State and area agency assessment guide tools, in cooperation with AoA's
Office of State and Community programs. A section in each of these guides is de-
voted to assessing the adequacy of information and referral services. The re-
sults of these assessments will be forthcoming during calendar year 1976.
A product of research in information and referral services resulted in the pub-
lication and dissemination of the document, I. di R. Program Configuration: A
Guide for Statewide Planning. This guide was prepared to assist States and other
jurisdictions in determining the nature, location, staffing requirements, and other
elements of information and referral services that will best meet the needs of their
older populations.
(b) Interagency Cooperation.-During fiscal year 1975, the Administration
on Aging, working with an Interdepartmental Task Force on Aging, negotiated a
joint working agreement among 15 departments and agencies having respon-
sibility in the I. & R. field and an intradepartmental agreement involving the
Social Security Administration, the Social and Rehabilitation Service, and the
Administration on Aging.
The task force worked under the aegis of the interdepartmental working group
on aging created by the Committee on Aging of the Domestic Council. The work-
ing agreement objectives are: (1) To extend and coordinate efforts of participat-
ing departments and agencies in I. & R. and (2) to encourage their counter-
parts in State and communities to cooperate in making I. & R. services immedi-
ately available to older people.
In May of 1975. the agreements were transmitted to the regional offices of all
participating agencies. AoA program directors in the regions were asked to set up
interagency task forces to foster appropriate activities of regional, State and
area levels, and to monitor and evaluate progress in achieving the stated objec-
tives. In the 10 regional office cities, the AoA program directors are assisted by
members of the Federal regional councils and the Federal executive boards. In
27 additional cities, Federal executive boards assist area agency on aging exe-
cutives in extending and improving I. & R. services.
Task force members currently are assessing their agency for programs in carry-
ing out the specific I. & R. objectives as identified in the interdepartmental agree-
ment. The interdepartmental I. & R. task force also is identifying task force
priorities which will further accelerate the delivery of coordinated I. & R. serv-
ices at the local level.
The Clearinghouse is also coordinating its I. & R. activities with the work of the
Human Services Information Systems program of the Office of Intergovernmental
Systems. Office of the Secretary, HEW.
(o) Grants and Contracts of National Scope.-The Administration on Aging
awarded a national contract to evaluate information and referral services desig-
nated by the State and area agencies on aging to meet AoA's minimum require-
ments. A total of 66 randomly selected I. & R. services will be visited. The results of
this evaluation will be available during 1976.
Reaching older people residing in rural areas is the focus of an Administration
on Aging model project grant, "A mobile I. & R. program in southwest Missouri".
A travel van will wind its way through 20 rural counties in an effort to reach
isolated older persons and connect them with services. Information concerning
this demonstration will be available during 1976.
CAN LINO - 147
Findings and documentation from other national scope efforts to be made
available during 1976 include a regional I. & R. Support System, United Way,
Pinelias County, Fla. and Hampton Roads Information Center Documentation,
Norfolk, Va.
2. The Information Resource Center
The National Clearinghouse on Aging Information Resource Center was opened
to AoA staff and the network during 1975. The existing data base was extended
and indexed and a strategy for further development was approved.
(a) Extending and Assessing the Data Base.-The data base was broadened by
the addition of two new target subjects: Minority elderly and provision of services
to the elderly. Information on low-income and the impaired noninstitutionalized
elderly was updated. At the end of the calendar year, the data base had 2,600
documents.
Work is in progress to gather AoA research grants and to index the grants
for inclusion in the information center. A contract which is being carried out
under the interdepartmental task force on research in aging will provide indexing
and abstracts for a total inventory of research in aging carried out during the
past 10 years.
Indexing and retrieving data base materials is facilitated by the completion of
a Thesaurus. The Thesaurus will also provide a standardized vocabulary for the
field of aging. It will be updated with new terms on a continuing basis to pro-
vide for growth and change in the gerontological vocabulary.
(b) Development of A Strategy.-The year 1975 marked the completion of a
survey of needs of potential users of a gerontological information system and
a survey of existing information resources. Results of these surveys formed, in
turn, the basis for completion of a strategy for future development of the Informa-
tion Resource Center. The study, prepared under contract. recommended the es-
tablishment of a decentralized national network of gerontological information.
The information network will be modeled after ERIC (Educational Resource
Information Center) system. A summary of findings for the study is available
from the Clearinghouse in the publication Summary of Findings and Recom-
mendations, Strategy for the Development of The National Clearinghouse on
Aging.
III. Statistical Analyses
The statistical staff of the Clearinghouse produced a number of documents and
sets of statistical data during 1975 and initiated an interagency coordination
project.
(a) Provision of Statistical Data-A statistical brochure. Facts About Older
Americans: 1975. presenting a quantitative profile of the older population was
published early in the year Multiple eopies were distributed throughout the net-
work on aging and eisewhere.
A trend analysis projecting the size and composition of the older population to
the year 2,000 was published as a statistical memo and in the June-July issue of
Aging magazine.
The November issue of Aging magazine, which was devoted to the elderly
woman. included an article entitled "A Profile of the Elderly Woman."
A contract was executed with the Census Bureau to provide AoA with a count
of persons 65 years of age and older by county. Besides these estimates the staff
developed estimates of persons 60 years and over for counties. planning service
areas and States. These estimates were sent to the State and area agencies on
aging to assist them in formulating their plans and evaluating programs. A notice
of the availability of these estimates in the November issue of Aging magazine
has resulted in numerous requests for them from Federal agencies, universities,
private organizations. and individuals.
Two tabulations on the presence of complete kitchen facilities one by State
and the other by county groupings. were produced from the 1970 Census Public
Use Sample. Each tabulation shows the number of households containing per-
sons 60 years old and over with and without complete kitchen facilities. The
number of persons 60 years old and over is also shown and all data are cross-
classified by urban-rural residence. The purpose of the tabulations is to provide
estimates of the number of elderly persons whose lifestyle. including their
nutritional status, may be affected by lack of complete kitchen facilities.
Based on the State tabulation. an analysis on households and elderly persons
without complete kitchen facilities was published in Statistical Memo. No. 32.
As a result of an interagency agreement with the Office of Native American
programs within HEW's Office of Human Development, the staff is developing-
with the assistance of the Bureau of the Census-a statistical study of the
American Indian population 55 years of age and older.
(b) Development of Additional Data.-An interdepartmental task force on sta-
tisties has been formed from among 19 Federal agencies to determine what gaps
in the statistics on the elderly exist. A first task of the members was to prepare
an inventory of data collection programs within their respective agencies to help
fill the gaps and improve the statistics on the elderly. The objective of the task
force is to construct an interagency agreement which is to bring about better
cooperation between agencies and coordination of information. In addition AoA
will be able to tap into the data resources of member agencies and thus develop
and produce special tabulations as well as obtain selected data on the elderly
not now available.
(c) Response to Specific Requests.-AoA responded to numerous requests for
demographic, financial, and other data about the older population. Requests came
from public agencies at Federal, State, and local levels and from nonprofit and
profit organizations. Data were sought for purposes of research, planning, pro-
gram administration, evaluation and education. Several requests came from
the Senate Special Committee on Aging, the House Ways and Means Committee,
and other legislative committees.
CAN - LINO - 148
IV. Public Inquiries and Publications Distribution
The numbers of written and telephone inquiries and visitors to the Public In-
quiries and Publications Distribution division continued to increase during 1975.
Inquiries concerned the impact of current economic and energy problems on older
people, transportation needs, housing, employment, medical care, legal services,
nutrition, volunteer opportunities, senior centers, and consumer protection. Re-
quests for information and publications came from older people, their families
and friends, organizations, professional personnel. and congressional offices.
Many of the inquiries were forwarded from the White House, members of the
Congress. and other Federal agencies.
Responding to the inquiries and requests required the preparation of 2,671
letter:: and the handling of 11,400 telephone calls during 1975, representing sig-
nificant increases over the preceding year.
During the year AoA distributed 559,000 copies of publications addressed to
older people and to personnel of agencies serving the older population. Many of
these go out with letters in response to inquiries: the majority are distributed
in response to direct requests from individuals or from organizations for distribu-
tion at meetings and conferences. Bulk orders are filled by the Office of Human
Development's Publication Distribution Center. Most of AoA's publications are
sold by the Superintendent of Documents.
V. Public Information Activities
Public information activities of the clearinghouse continued to focus on pro-
viding support for the expanding network of public and private agencies working
for and with older Americans and to assist in spreading general awareness of
the circumstances, needs. and contributions of the older population.
(a) Support for the Field.-The newsmagazine, Aging, entered its 26th year
of publication with a reaffirmed dedication to assisting agencies and organiza-
tions responsible for planning. initiating, conducting. and evaluating programs
and services for older persons in all States and hundreds of communities through-
out the country. The magazine publishes news of innovative developments here
and abroad in the field of gerontology. as well as programs proposed by the
President and the executive branch. legislation on the subject acted upon by the
Congress, and reports by many public and private organizations.
The May. 1975 Older Americans month issue of Aging contained a 15-page
section, describing programs and activities of the AoA, for which there is a
continuing demand.
The Public Information unit produced and distributed to State and area agen-
cies and nutrition projects a manual entitled Public Information Activities For
State and Area Agencies on Aging. The manual has been useful to these agencies
in spreading information about programs and older people in cooperation with
the newspapers, periodicals, radio, and television.
A series of four 15-minute sound/slide shows, produced through a university,
was distributed to all States and territories and the 10 HEW regional offices.
These shows deal with the four major categories of information and referral,
telephone reassurance, volunteers, and the use of school lunch facilities for the
elderly.
The Public Information staff, with the aid of regional office personnel in aging,
launched a survey of newsletters produced by the State and area network. It is
expected that study of these publications will enable the Clearinghouse to im-
prove its communication services to network agencies.
(b) Creating Public and Older Person Awarencss.-The several activities in
this area included the construction and opening of a Bicentennial exhibit in the
display area of the new HEW South Portal Building in Washington. Opened
in January 1976, the exhibit will probably be viewed by thousands of visitors
during the Bicentennial Year. The subject of the exhibit is the State and com-
munity grants programs, funded under titles III and VII of the Older Ameri-
cans Act, and administered by AoA. It explains how area agencies on aging
throughout the United States and its territories are encouraging the establish-
ment of comprehensive coordinated systems of services to help older Americans
maintain their independence through their later years.
The exhibit includes a large wall plaque reproducing the "Declaration of Ob-
jectives for Older Americans" from the Older Americans Act, a slide-sound show
explaining the exhibit and the purpose of the area agencies, a map showing
all planning and service areas, and bins keyed to the map providing Area
Agency address cards. A number of AoA publications are also provided as pickups
for visitors.
In 1975, the film Don't Stop the Music, showing older people engaged in a wide
range of activities, was shown 2,571 times to a total viewing audience of 88,712.
The film also was shown 199 times over cable television to an estimated 367,400
persons.
A 10-part television series on Aging produced by AoA in association with
WRC-TV, Washington, D.C., for showing on NBC-owned stations continues to
be shown. It is aimed at examining attitudes toward aging and problems faced
by older Americans and indicates services designed to help older people live
independent and rewarding lives.
Television and radio spots directing older people to information and referral
services were distributed to State and area agencies on aging for use with local
stations.
Also to aid older people in discovering sources of assistance to them, the
booklet. To find the Way to Services in Your Community. was rewritten with up-
dated material and renamed To Find the Way to Opportunities and Services for
Older Americans. A Spanish translation of it also has been published.
CAN - LINO - 149
A section on publications for Older Americans was included in the 1975 Con-
sumer Information Center Index of Selected Federal Publications of Consumer
Interest. Copies of the index are distributed to the field for their use.
Other consumer activities included working with the Office of Consumer
Affairs within the Office of the Secretary to assist in producing scripts for radio
shows on consumer affairs involving the elderly, produced by that unit.
(c) Publications.-The Clearinghouse issued several publications produced
by its own staff, by other AoA offices, and by outside organizations through grant
or contract. Especially significant among these were:
Older Americans Act of 1965 as Amended. a compilation of provisions of
the original Act and subsequent amendments, as of December, 1974. In
January, 1976, a new compilation, incorporating the 1975 amendments (Public
Law 94-135) was being printed.
Facts About Older Americans 1975-a statistical profile of older Americans
and their geographic distribution.
The first of a series of AoA Occasional Papers in Gerontology covering
Manpower Needs in the Field of Aging: The Nursing Home Industry.
Homes for the Aged: Supervision and Standards, A report on the legal
situation in European Countries, by Ernest Noam and issued in English
translation.
I. di R. Program Configuration: A Guide For Statewide Planning. the latest
in a series of publications dealing with Information and Referral Services.
Transportation for the Elderly: The State of the Art, the report to Con-
gress on transportation required by section 412(a) of the Older Americans
Act of 1965, as amended in 1973.
In addition, several fact sheets describing Federal resources in such areas as
transportation. nutrition, employment and voluntary services were prepared and
distributed to program personnel and to older persons throughout the country.
Public Information staff dealt with requests for assistance from both gen-
eral and special interest reporters covering the field. Increasing interest in the
field of aging by the general public is reflected by increasing calls for background
information and explanation of policy by the general press, radio, and TV
especially.
(d) Freedom of Information.-The Freedom of Information function, added
as an additional function for the Public Information Division in 1975, resulted
in several major tasks.
Besides several requests for advice on handling FOI requests, maintenance of
file material under FOI, and an average of four to six requests a week for assist-
ance on interpretation of regulations, there were several major requests for
information under FOI.
All FOI requests have been answered well within the required 10-day working
period.
H. SPECIAL PROJECTS
I. AoA Role in Disaster Planning Program
During the year the Administration on Aging continued to be involved in
disaster preparedness planning and disaster followup activities, utilizing the
Regional Offices of Aging, State and area agencies on aging and title VII nutri-
tion projects. Much of this effort was based on the experiences of AoA following
Hurricane Agnes and the tornadoes which swept across the midwest and south-
east in 1972 and 1974 respectively, and on the recommendations and framework
established by the AoA disaster preparedness planning conference held in
December. 1974.
Following up on the recommendations of the conference, AoA pursued the
possibility of a mission assignment from the Federal Disaster Assistance Ad-
ministration (FDAA) SO that the national aging network could quickly respond
with an assurace of financial reimbursement in disaster situations. FDAA for
various reasons deemed this request inadvisable on a national basis and as an
alternative AoA is currently pursuing joint agreements/working arrangements
with FDAA, the American National Red Cross, the National Institute of Mental
Health, American Bar Association. and other disaster relief agencies to insure
that the special needs of old disaster victims are addressed.
The Administration on Aging has continued to respond to disasters affecting
older persons, whether Presidentially declared emergencies or not. The AoA
efforts in establishment of the disaster assistance network to assist older victims
have resulted in "hot-line" communications between central and regional offices
as soon as word has been received of a disaster. Prompt alerting of State and area
agencies has become nearly automatic in order to determine the extent to which
older persons are affected, the magnitude of their short and long range needs,
and to see that linkages are immediately affected with available disaster assist-
ance.
During the year, AoA has worked with nine regional offices of aging and
through them 25 State agencies on aging on disaster relief activities caused by
floods, fires, tornadoes, a hurricane, and a volcano. The most extensive damage
and effect on older persons was experienced in Omaha, Nebr., which was struck
by a tornado in May. The region VII office of aging. The Nebraska State Com-
mission on Aging, and the Omaha area agency on aging, immediately responded
with an extensive outreach program which identified several hundred older
persons who were affected by the tornado.
AoA funded a model project to assist the Omaha area agency on aging in
responding to needs and documenting the steps followed in providing disaster
relief assistance. Chore services. nutrition services, transportation services and
legal aid were made available within five days after the tornado struck. The
services to the elderly were immediately incorporated into the official disaster
assistance operation with long range followup built into the program.
CAN - LINO - 150
Under the model project, the region VII office of aging has continued to work
with the Nebraska State Commission. the University of Nebraska at Omaha,
and the regional FDAA office. This has resulted in a working agreement between
the regional aging and FDAA offices involving the States and area agencies in
region VII: a draft "what-to-do" pamphlet based on the Omaha documentation;
a draft preliminary report of research efforts on natural disasters and the
elderly; and a proposal for a conference on preparedness planning for post-
disaster services to older persons to be held early in 1976.
II. SSI-Alert Activities
Although the Administration on Aging did not fund any additional SSI-alert
projects during 1975. the impetus and some funding during the latter part of
1974 carried into 1975. Consequently a number of area agencies on aging included
in their outreach efforts the locating of potential SSI recipients and made refer-
rals to the Social Security Administration.
Carry-over funds in three States served by region VII were used specifically
for outreach on Indian Reservations. In North Dakota the SSI-alert efforts on
reservations produced 89 applications with 34 found eligible and all applications
pending at the end of the year. In addition, 10 claims for social security benefits
were filed. In South Dakota 41 applications were taken for SSI, 10 were found
eligible and 23 were pending in December. In addition, 29 claims for social secu-
rity benefits had been filed. The SSI-alert in Wyoming, which was partially
funded by the Tribal Council, produced 118 claims for SSI of which 26 were
approved.
The Administration on Aging has also continued to work with the Social Secu-
rity Administration in the latter's efforts to develop additional outreach activities
to find potentially eligible SSI recipients.
III. Older Victnamese Refugees
The Administration on Aging became involved in the Department of Health,
Education, and Welfare effort to relocate Vietnamese refugees through the assign-
ment of office of aging staff from some regions to relocation centers and through
followup on the relocation of elderly refugees. The national network on aging
was alerted to the possible needs of elderly Vietnamese for sponsors and assist-
ance due to language barriers. Reports were received from directors of offices of
aging in the four regions where the relocation centers were located. In addition,
reports were provided by both State and area agencies on aging in which the
relocation centers were operating.
Because the numbers of elderly refugees not connected with extended families
proved to be few, it was not necessary for the Administration on Aging to launch
a concerted program. Reports from the regions indicated that senior citizen
groups in communities, where elderly Vietnamese were relocated, were attentive
to their needs.
IV. Bicentennial Program in Aging
The Commissioner suggested during the spring that consideration be given by
older Americans to an updating of the declaration of rights and obligations set
forth in the senior citizens' charter written during the 1961 White House Con-
ference on Aging. The suggested process was that advisory committees to State
agencies on aging and advisory committees to area agencies on aging conduct
Older American Bicentennial Forums beginning in May, Older Americans Month.
The President in proclaiming Older Americans Month supported the Bicenten-
nial effort. He wrote-"I urge everyone to participate in the efforts to achieve
the goal of proclaiming a new Declaration of Rights and Obligations for Older
Persons, which can become a rallying point for our Nation during the Bicenten-
nial year of 1976 and a guide to action during the Bicentennial year of 1976 and
a guide to action during the years ahead."
The Commissioner and the Chairman of the Federal Council on the Aging also
agreed that the Council would develop a revision of the 1961 Senior Citizens'
Charter for consideration during the Bicentennial year. Some of the State agen-
ies on Aging and area agencies on aging advisory committees chose to submit
suggested revisions for consideration by the Council. The December report of
the Council stated that the members endorsed a revision to be called the "Bicen-
tennial Charter for Older Americans." The Council plan also called for trans-
mittal of the Charter to the President SO it could be incorporated in a Presiden-
tial proclamation during the Bicentennial year.
THE OFFICE OF CONSUMER AFFAIRS
Mrs. Virginia H. Knauer serves as the Special Assistant to the President for
Consumer Affairs and as Director, Office of Consumer Affairs, Department of
Health, Education, and Welfare.
The Office of Consumer Affairs (OCA) assures that the consumer's interest is
reflected in Federal policies and programs, cooperates with State agencies and
voluntary organizations in advancing the interests of consumers, promotes im-
proved consumer education, recommends legislation of benefit to consumers,
encourages productive dialog and interaction between industry, government and
the consumer, and provides continuing policy guidance to the Consumer Product
Information Coordinating Center.
Its major activities, however. fall within five primary categories: (1) Con-
sumer advocacy, (2) consumer education, (3) consumer redress, (4) planning
and analysis, and (5) the low income consumer. While these activities in general
are initiated on behalf of all consumers, it should be noted that the elderly con-
sumer shares fully in the benefits of OCA programs.
Highlighted below are major activities in each of these categories with special
emphasis on those having the greatest impact on older Americans.
CAN-LINO-151
I. CONSUMER ADVOCACY
INTERAGENCY COMMITTEES
Mrs. Knauer is a member of the Domestic Council Committee on Aging which
has been charged with responsibility for developing, coordinating and presenting
both short-term and long-range policy issues in this area. Through a task force
of the Committee's Interdepartmental Working Group, OCA participated in the
development and signing of an interdepartmental working agreement on infor-
mation and referral services for the elderly and has continued to work toward
its implementation.
Mrs. Knauer also serves as a member of the Council on Wage and Price Sta-
bility and the Domestic Council's Committee on the Right of Privacy. Consumer
input at these levels is essential to broad policy development and has a special
significance for the elderly consumer.
The inflationary impact of the energy crisis on the elderly in particular has
been consistently taken into consideration in OCA's ongoing active participation
in such top level interagency task forces as the Energy Resources Council (and
its predecessor, the Committee on Energy) the National Power Survey, and the
Federal Power Commission's Task Force on Natural Gas curtailment.
Because of the public hearings co-sponsored by OCA and the Council on Wage
and Price Stability on repricing of existing supermarket shelf inventory, con-
sumers have realized tremendous savings. The hearings put significant pressure
on the retail food industry and shortly afterwards numerous supermarkets an-
nounced that they were abolishing repricing and/or adopting other related
marketing strategies or delays in posting increased prices. Based on data pro-
vided during the hearings, the abolition of supermarket shelf inventory repricing
would carry with it about $325 million in annual savings to consumers in the
form of lower prices. These savings have been particularly significant for the
elderly consumer. especially those on low, fixed incomes.
LEGISLATIVE COMMENTS AND CONGRESSIONAL SUPPORT
OCA has continued to support legislation pending before Congress in behalf
of the consumer as well as proposing and commenting on proposed changes in
Federal regulations. Among the topics covered were such critical issues to the
elderly as credit discrimination, energy. food advertising, unfair trade practices
and consumer redress. For example, OCA submitted comments on the proposed
regulations of the Social and Rehabilitation Service implementing the provision
of the Social Security Act mandating upper limits of reimbursement for pre-
scription drugs. OCA also submitted comments to the Federal Trade Commission
urging the lifting of prohibitions on the posting of prescription drug prices. This
would particularly assist elderly consumers to stretch their medical dollars by
allowing them to comparison shop.
VOLUNTARY CONSUMER ORGANIZATIONS
The Office of Consumer Affairs has continued to maintain close liaison with
national associations having special interests in problems of the elderly and has
also continually worked to assure that spokesmen for the elderly be included in
consultations seeking consumer leader advice on national policy issues. In this
connection, OCA assured that representatives of the elderly participated in the
administration's meetings and briefings on consumer issues and programs. These
included the March 4, 1975 meeting of the Vice President with consumer leaders,
the Whip Inflation Now (WIN) Task Force on Consumer education and the pre-
conference planning sessions for the regional public hearings held on the Con-
sumer Representation Plans.
FEDERAL CONSUMER REPRESENTATION
The Office of Consumer Affairs at the direction of the President, joined with
the Office of Management and Budget to coordinate a major effort to increase
consumer representation in the Federal Government. With OCA's guidance,
each of the 17 agencies under the executive branch development a proposed
consumer representation plan individually tailored to its own circumstances, but
in each instance providing measures whereby consumers could be effectively
represented and participate in consumer related policies and action.
OCA made special mailings of the Consumer Representation Plans to organi-
zations representing the low income and elderly consumers in order to get their
input and written comments on the plans. Representatives of low income and
elderly consumer organizations were also invited to participate in the regional
public meetings held in ten cities.
Noteworthy among individual agency proposed plans is the one from the Social
Security Administration which would be especially significant for senior citizens
living on social security. The Social Security Administration is developing a
pilot project to test the desirability of establishing a social security ombudsman.
The ombudsman would be available to persons experiencing problems in social
security matters. They are also considering the establishment of a toll-free in-
formation service. Consumer News will continue to keep its readers abreast of the
developments in this area.
STATE AND LOCAL CONSUMER PROGRAMS
The Office of Consumer Affairs in 1975 through day-to-day liaison continued to
encourage and assist State and local governments in their responsiveness to con-
sumer problems, including those of the elderly. By December 31, 1975, these
totaled 135 State consumer offices, 158 county offices, and 69 city consumer offices,
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and a growing number of these offices now have, or are considering, special infor-
mation and education programs for the aging and/or concentrated enforcement
efforts against frauds and deceptive practices which are directed toward the
elderly.
For the past 4 years. the Office of Consumer Affairs has compiled and distrib-
uted State Consumer Action. which provides summaries of consumer laws and ad-
ministrative programs adopted during the year by State, county. and city govern-
ments. The 1975 edition has a special section devoted to programs for the elderly
consumer.
OCA's directory of State, county and city government consumer offices includes
a listing of toll-free telephone lines in operation to help facilitate consumer con-
tacts with those offices. The 1976 directory which will be available soon also in-
cludes a listing of Federal information centers. Federal consumer information
centers, and State public utilities commissions. These listings were included to
insure that the directory be of special assistance to the homebound and/or
handicapped consumer. Both State Consumer Action and the directory are avail-
able to the general public through the Superintendent of Documents. Government
Printing Office. Washington. D.C. 20402.
OCA's Guide to Federal Consumer Services has a listing for older Americans
which will be expanded in the next revision. The guide is free from the Consumer
Information Center, Pueblo, Colo. 81009.
VOLUNTARY CONSUMER DIRECTORY
OCA is currently preparing a directory of established nongovernmental con-
sumer groups. Those listed would be groups which derive funding support from
voluntary memberships or are special interest agencies whose primary activities
are one of consumer advocacy and/or providing service to individuals as con-
sumers. We expect to include many organizations serving the elderly consumer.
Like the directory of Federal, State. county and city government consumer offices,
we expect this directory to be of special assistance to the homebound and/or hand-
icapped consumer. This directory will also be available to the general public
through the Government Printing Office.
TELEPHONE HEARING AID COMPATIBILITY
For the past 3 years, OCA has sought to focus public attention on and seek reso-
lution to the incompatibility problems associated with hearing aid devices and cer-
tain telephones. Following many meetings with the hearing aid and telephone
industries, groups representing the hearing aid users. congressional leaders
and regulatory agencies, OCA has obtained commitments from phone manu-
facturers and phone systems to introduce and reintroduce phone equipment that
is newly compatible with hearing aids of those with severe hearing loss. This
represents upwards of 1 million users. The fruits of this effort are now being
announced to groups representing the senior citizen and the hearing impaired. In
addition, following the urging of OCA, several operating telephone companies
have agreed to the disclosure in written advertising of noncompatibility be-
tween hearing aids and certain telephone models. This action should help to
avoid future frustration and misunderstandings. OCA is currently working to
stimulate other companies to adopt a similar policy in the future.
IMPROVED BANKING SERVICES FOR THE ELDERLY
Recognizing the potential benefits to older persons of free checking accounts
and other services which banks are in a position to offer, OCA undertook a series
of individual meetings with representatives of national senior citizen organiza-
tions, officials of Federal agencies, and the banking community to explore op-
portunities for the banking industry to provide expanded banking services for
the elderly.
These initial activities culminated in a meeting of all concerned parties in
August 1975. The purpose of the meeting was to identify the special needs of
older persons and to examine a wide range of improved banking services which
could be useful to them, such as estate planning, trust and will review, com-
munity financial seminars, and direct deposit of benefit checks.
OCA anticipates that on-going efforts with the banking community will result
in the development of viable alternatives for the older American consumer in the
financial market, and represents a continuing opportunity which, when combined
with the activities of senior citizen organizations and other agencies, could
result in significant financial benefit to these citizens.
II. CONSUMER EDUCATION AND INFORMATION
PUEBLO INDIAN CONSUMER EDUCATION AND ADVOCACY PROGRAM
OCA developed, coordinates, promotes and continues to monitor an inter-
agency demonstration project operated by an all Indian staff from the All
Indian Pueblo Council. This program has trained Indian consumer officers from
the 19 pueblos who, backed by a small central staff in Albuquerque, work out of
individual offices on their pueblos. They conduct consumer education classes
which many elderly Indians actively attend. and because the consumer officers
all speak their native pueblo language. they are able to communicate with the
elderly citizens. In fact, the link between the young consumer officers and the
elderly Indians has generally been a very beneficial and mutually supportive one.
CONSUMER NEWS
Im addition to carrying articles in every issue of general interest to older
Americans-as to all consumers-Consumer News focuses on specific news of
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Federal activities of special concern to the elderly. A few examples: Nutrition
programs for the elderly transportation programs for the elderly; prescription
drugs; hearing aids: condominiums: high blood pressure and funeral homes.
In addition Consumer Register, which carries summaries of regulations of
Federal agencies, includes material of special interest to older Americans, such
as those dealing with social security, nursing homes, and prescription drugs.
"DEAR CONSUMER" AND "HELP"
"Dear Consumer" columns, which art provided as a public service to more
than 7,000 weekly newspapers, occasionally deal with topics that primarily
concern older Americans. Mrs. Knauer's 4-minute Public Service Radio program,
"HELP," which is sent to over 1,200 radio stations, frequently has programs de-
signed for the elderly. A recent broadcast featured information about the Federal
Council on Aging.
CONSUMER INFORMATION CATALOG
OCA provides policy coordination to the Consumer Information Center which
has the responsibility to identify areas of needed consumer information. en-
courage Federal agencies having the appropriate expertise to publish such in-
formation in a manner useful to the public, make the public aware that the in-
formation exists and finally. distribute millions of copies of such information
to the requesting members of the public.
At the suggestion of OCA. the Consumer Information Catalog carries a special
section for older Americans, listing selected publications of interest to senior
citizens.
CONSUMERS AND INFLATION
OCA gave publicity to voluntary programs in communities throughout the
country which were designed to help consumers cope with the problems of
inflation and recession. Called the "People Helping People" campaign. the program
publicized through press releases and other media presentations many projects
benefiting the elderly consumer. OCA was assisted by members of Congress and
other Federal officials in locating the programs. Through the "People Helping
People" program. consumers and communities are made aware of what can be
done at the grassroots level to resolve consumer problems.
NUTRITION
HEW-through OCA-the Grocery Manufacturers of America, and USDA
sponsor the Advertising Council's Food. Nutrition, and Health Campaign to
focus public attention on the importance of proper nutrition. Distribution of
the publication Food Is More Than Just Something To Eat, prepared for the
campaign. is near the million Published in a large type face and featuring
basic information on nutrients and their sources as well as sections on changes in
nutrient requirements as individuals grow older, the booklet has proven popular
with older Americans. In the past year, in fact, the Administration on Aging
purchased 85,000 copies for use in conjunction with its 800 nutrition program
projects. The support of the advertising media for this campaign has been
extremely gratifying. In calendar year 1974. the first year of the campaign, almost
$19 million worth of free time on TV and radio and free space in newspapers and
magazines was devoted to the campaign's advertising which was created volun-
tarily by the Young & Rubicam agency.
INFORMATION ON CONSUMER SERVICES
OCA. in conjunction with Consumers Union and the Washington Center for
the Study of Services. is demonstrating the feasibility of developing and dis-
seminating cost and quality comparison information on selected consumer services
in the Washington area. A major result of this effort is the development of a
manual for such evaluation and dissemination for use by consumer groups in any
area of the country which will be available from the OCA. The dissemination
vehicle for this demonstration is a quarterly magazine called, Washington
Consumers' Checkbook. The first issue of Checkbook, just off press, is devoted to
health services. Its coverage of cost and quality of services from significant
Washington area providers of emergency health care, health insurance, prescrip-
tion drugs, and nursing home and alternative services should be of exceptional
value to older residents of the area. Through distribution of the "how-to" manual
produced by the project, OCA hopes to stimulate consumer groups in other
areas to develop and disseminate such information.
III. CONSUMER REDRESS
INDIVIDUAL COMPLAINT HANDLING
OCA handles more than 2,500 individual consumer complaints each month,
many from senior citizens. About 20 percent of the complaints are referrals from
the President, members of Congress, or other Federal agencies. Each complaint
is carefully evaluated and brought to the attention of the appropriate Federal,
State, or city government agency, trade association. or business firm for review
and assistance to the consumer with response to our office and the consumer or
congressional office. Senior citizens' complaints are even more critical because
many of them live on limited incomes.
NURSING HOME CONSUMER ADVISORY PANEL
OCA has been working with the National Council of Health Care Services
(NCHCS), an association of proprietary nursing home operators, to establish
a consumer advisory panel (CAP). This CAP is patterned to a large extent
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after complaint resolution and advisory groups OCA has helped to establish
in several industries, including major appliances (MACAP) and furniture
(FICAP). with positive results. Among the objectives of the new CAP are the
following: (1) Provide a mechanism for prompt, fair and equitable resolution
of consumer complaints concerning the services of the members of the NCHCS;
(2) identify problems with the care and services of facilities that are annoying
patients and families; and (3) review annually the state of the nursing home
industry and identify generic problems from the perspective of the patient.
OCA is aware that NCHCS represents only. a segment of the'nursing home
industry. If the NCHCP CAP is effective, however, it will serve as a model for
other segments of the industry. It is worth noting that this CAP conforms to
the complaint resolution regulations recently established by the Federal Trade
Commission in implementation of the Magnuson-Moss Warranty Act, even though
the act does not apply to nursing home services.
IV. PLANNING AND ANALYSIS
The planning and analysis unit has provided and continues to provide analytic
support in several areas. Among these are energy. inflation, productivity. credit,
supply allocation, and food price problems-all of which greatly affect the
elderly consumer.
In the year ahead, OCA will continue to promote the consumer's understand-
ing of the lifetime or true costs of appliance ownership by pressing for Govern-
ment and industry action: developing a publication that will provide consumers
with evaluative information on local consumer services, such as nursing homes,
health insurance. banking. credit, and auto service: encouraging the supermarket
industry to eliminate sources of consumer irritation in the marketplace, such as
upward repricing of shelf items, elimination of price markings on individual items
when automated checkout systems (UPC) are installed by major food chains,
and the improved quality and availability of unit pricing and open-dating pro-
grams; creating complaint-handling mechanisms within the household moving
and hearing aid industries: and developing a standard system for gathering
consumer complaint data. designed to improve the Federal Government's ability
to respond to consumer complaints and conducting a nationwide, demographically
stratified survey of consumer satisfaction and dissatisfaction with product and
service purchases that will give for the first time a complete statistically reliable
profile of the consumer problems most significant to the elderly.
V. THE LOW-INCOME CONSUMER
SPECIAL CONCERNS UNIT
During the past year OCA instituted a separate special concerns unit to work
directly with civic, educational, social and community organizations providing
services to low income, elderly and minority consumers. Besides providing in-
formation on an individual basis. OCA participates in workshops, conferences,
and conventions providing information on possible funding sources and technical
assistance for low income and elderly consumer projects.
THE NATIONAL CENTER FOR APPROPRIATE TECHNOLOGY
OCA is working with the planning committee to set up a National Center for
Appropriate Technology whose primary purpose would be to develop and imple-
ment innovative energy technology and energy systems that meet the needs of
the elderly, the poor and near poor. The center, to be funded by the Community
Services Administration. would work with community action agencies and other
local community groups. OCA expects this new technology to be especially bene-
ficial for the elderly consumer.
SOCIAL SECURITY ADMINISTRATION
The Social Security Administration (SSA) administers the Federal old-age,
survivors, disability, and health insurance (OASDHI) program (titles II, VII,
XI, and XVIII of the Social Security Act as amended). and, for a specified period,
the black-lung benefit provisions of the Federal Coal Mine Health and Safety
Act of 1969. Since January 1974, SSA has also been administering the Federal
Supplemental Security Income (SSI) program for the aged, blind, and disabled
(title XVI).
Social security coverage is the Nation's basic method of assuring income to a
worker and his family when he retires, becomes disabled, or dies and of assuring
hospital and medical benefits to persons aged 65 and over and to certain dis-
abled persons. As of December 1975, 124.4 million workers were insured for
retirement and/or survivor benefits, a figure which includes 14.9 million aged
65 and over and 1.7 million aged 62-64 receiving benefits. Nearly 60 percent of
persons now filing for retired worker benefits are under 65.
LEGISLATION
Two laws amending the social security program were passed in 1975. On
December 31, 1975, Public Law 94-182 was signed, removing a technical defect
in the social security law that would have prevented future increases in the
monthly premium for medicare part B coverage. The law also (1) provides that
the prevailing charge for any physician's service in fiscal year 1976 is not to
be lower than the prevailing charge for that service in fiscal year 1975: (2) re-
peals a provision that medicare will not pay for covered services also covered
under a Federal employees' health benefits plan unless certain conditions are
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met; (3) authorizes rimbursement for hospitalization utilization review activi-
ties performed by professional standards review organizations (PSRO's) and
establishes the means for designating PSRO areas; (4) removes the require-
ment for total review or screening of hospital admissions under medicaid;
(5) directs the Secretary of Health, Education, and Welfare to conduct a study
of certain diagnostle services by optometrists: and (6) extends the Secretary's
authority to waive medicare's requirement concerning 24-hour nursing service
in participating rural hospitals.
Public Law 94-202, passed on December 19, 1975, was signed on January 2,
1976. It permits existing SSI hearing examiners to hear social security and
medicare cases for a specified time and changes the time limit for requesting a
hearing after a disallowed claim to 60 days (an increase from 30 days for SSI
claims and a decrease from 6 months for social security claims). Other provisions
of Public Law 94-202 include (1) a stipulation that certain State payments
made on residency status are to be excluded in determining a person's SSI
payment; (2) a requirement of advance notice to the States before a change in
deposit procedures for social security contributions; and (3) a change in the
system for annual reporting of wages.
BENEFITS AND BENEFICIARIES
At the end of October 1975, 31.8 million people were receiving monthly social
security cash benefits. Twenty million of them were retired workers and their
dependents. The remaining beneficiaries were 4.3 million disabled workers and
their dependents (a large increase over the 3.8 million recorded a year earlier),
7.3 million survivors of deceased workers, and 230,000 uninsured persons aged
72 and over.
The monthly rate of benefits for October 1975 was $5.7 billion. Retired workers
received an average monthly benefit of $206; disabled workers, $225. For persons
coming on the rolls for the first time in that month, the average awards were
higher-$213 for retired workers and $246 for disabled workers. The higher
increase in the amount of disability insurance benefit awards is also reflected
in the fact that from September 1974 to September 1975, new disabled worker
beneficiaries were responsible for 59 percent of the rise in the number of bene-
ficiaries but 83 percent of the increase in the amount of monthly benefits paid
under the disability insurance program.
Retirement. survivors, and disability insurance benefits paid during fiscal year
1975 amounted to $62.5 billion. Of that total, retired workers and their depend-
ents received $39.7 billion in monthly benefits: disabled workers and their
dependents, $7.6 billion: survivors of deceased workers, $14.6 billion; and special
age-72 beneficiaries, $217 million. Lump-sum death payments accounted for $343
million of the total.
For beneficiaries under the black-lung program, the monthly rate of benefits
in September 1975 was $72 million; per family, the average benefit was $235.
Over 484,000 persons were receiving monthly benefits-166,000 miners and
318,000 dependents and survivors.
MEDICARE OPERATIONS
In January 1975 over 22.2 million aged and 2 million disabled persons were
enrolled for hospital insurance benefits under medicare: 21.6 million and 1.9
million respectively were enrolled for supplementary medical insurance. Under
hospital insurance, approved claims for all of fiscal year 1975 totaled 9.5 million,
an increase of 7 percent over the 1974 figure. Reimbursements reached $9.0 billion,
a 22-percent increase over the amount reimbursed under hospital insurance in
fiscal year 1974. Short-stay hospital claims accounted for 85 percent of all bills
approved and 95 percent of the total reimbursements in fiscal 1975. The average
reimbursement per inpatient claim was $1,062; but each home health agency
claim averaged only $123 and each skilled nursing facility claim, $470. The
average number of covered days of care per inpatient short-stay claim was 10.7.
The hospital insurance program is financed from part of the total social security
contribution. Persons aged 65 and over who are not eligible for medicare hospi-
tal benefits may voluntarily enroll and pay a monthly premium which was raised
from $36 to $40 on July 1, 1975; It will be increased to $45 in July 1976. During
fiscal year 1975. intermediaries and carriers withdrew $10.4 billion from the
hospital insurance trust fund for services under this program.
Under medicare's supplementary medical insurance program, 74.8 million
bills were recorded for fiscal year 1975; 78 percent of them were for physicians'
'services. Reimbursements under supplementary medical insurance totaled $3.6
billion: the average reimbursement per bill was $48. The supplementary medical
insurance program is financed by monthly premiums paid by those who elect
to enroll for coverage and matched by the Federal Government. The medical
insurance premium has been $6.70 since July 1974; it will be increased to $7.20
in July 1976. During fiscal year 1975, intermediaries and carriers withdrew $3.8
billion from the medical insurance fund for services under the program.
SUPPLEMENTAL SECURITY INCOME
The SSI program is financed from Federal general revenues and replaces
Federal grants to the State-administered programs of old-age assistance (OAA),
aid to the blind (AB), and aid to the permanently and totally disabled (APTD).
The new program became effective in January 1974 and establishes a Federal
income floor as a base. States that paid amounts higher than this Federal base
to recipients under OAA, AB, and APTD must supplement the Federal payments
to maintain the higher income levels of these recipients. States can also provide
optional State supplementation. As of July 1975, 39 States had established such
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optional programs. All States have the choice of administering their own
supplemental programs or of having the Social Security Administration adminis-
ter the programs for them. States choosing the latter are protected against
increases over the 1972 costs for welfare payments to the aged, blind. and dis-
abled because of increases in the numbers of eligible persons. By the end of
fiscal year 1975, SSA was administering all State supplementary payments
for 26 States and mandatory payments (with the State administering its own
optional payments) for four States. In July 1975 an automatic 8-percent increase
in Federal SSI payments became effective. Maximum monthly payment levels in-
creased from $146 to $157.70 for an eligible individual and from $219 to $236.60
for an eligible couple. The monthly rate of benefits for federally administered
SSI payments reached $500.7 million in October 1975 when 4.3 million persons
were receiving monthly benefits-2.3 million aged persons were receiving $214.3
million; 1.9 million disabled persons were receiving $257.3 million; and 74,000
blind persons were receiving $11 million in benefits. During all of calendar year
1975, over $5.7 billion, most of it federally administered, was paid under the
Supplemental Security Income program.
SOCIAL AND REHABILITATION SERVICE
1. RESEARCH AND EVALUATION
No SRS programs are targeted on the aged population per se, but elderly per-
sons make up a large percentage of the client population in the medicaid and
social services programs, particularly in the long-term care area. The evaluation
and research activities of SRS, therefore, consider the aged as a significant sub-
group of the client population.
During fiscal years 1975 and 1976, evaluation activity most significant for the
elderly is a project funded jointly with the Administration on Aging and the
Health Resources Administration. This project focuses on deinstitutionalization
and the question of what is appropriate care for impaired persons. Emphasis is
on the testing of a methodology to classify functionally the impairment of adult
persons requiring long-term care. A major field test of the functional classifi-
cation system and survey instrument is scheduled to begin shortly in four States.
Another evaluation effort initiated in fiscal 1975 is examining Federal and
State standards for nursing home care and their associated costs to the homes.
An additional project is analyzing existing accounting systems in the long-term
care industry as a guide to States considering the adoption of a uniform chart-
of-accounts for long-term care. Uniformity of accounting systems could assist
States in comparing facilities to encourage the most effective spending of the
medicaid dollar on long-term care patients.
A nearly completed study of the "spend-down" provision of the medical pro-
gram has obtained data on the socio-demographic and economic characteristics of
persons who entered the program through the spend-down mechanism, including
the effects of the spend-down on their income and assets, and the health service
requirements which caused them to enter the program. Among the study findings
were the determinations that a high proportion of individuals who entered
medicaid via spend-down were aged and that the average spend-down individual
spent over $1,000 in medical expenses in the year preceding his/her medicaid
application. Spend-down is definitely a provision that helps the aged who are poor
and have unusual medical expenses.
The Office of Research and Demonstrations within SRS has created a separate
identifiable unit in the Health Services Division to focus on long-term care.
Analysis of long-term care financing, developing alternatives to institutionaliza-
tion, and studying the impact upon health delivery systems of a series of alterna-
tives, including non-medical services. is being emphasized.
Although the long-term care R&D program is primarily concerned with the
delivery of health care and other appropriate services to the chronically ill and
disabled of all age groups, the elderly comprise the highest proportion of the
population in need of these services. Promoting community care alternatives to
institutionalization for the chronically ill and disabled who want and are able to
function outside of institutions can have an important effect upon the lives of the
elderly.
During fiscal 1975, two demonstrations and analyses of community-wide CO-
ordinated health and social service delivery programs were initiated. The major
thrust of this effort is to determine whether integrating services on a community-
wide base can improve the quality of care and reduce costs for delivering long-
term care to the chronically ill and disabled. The projects are in early planning
stages. One, in the State of New York. entitled "Demonstration of Community-
Wide Alternative Long-Term Care Models," is testing the feasibility of develop-
ing community-wide, population-based models for the organization, delivery, and
financing of care within Monroe County, N.Y. The second project, in the State of
Washington, "Community-Based Care Systems for the Functionally Disabled-A
Project in Independent Living." is an effort to examine the effects of focusing
State social services on coordinating health and social service delivery in order
to prevent unnecessary institutionalization and improve the quality of care for
high-risk populations. Each of these projects is an attempt to provide care plans
for the populations-at-risk which contribute to the maintenance of integrity and
self-sufficiency through appropriate services and placements fitting the functional
capacity of the long-term care population. Each will attempt to develop a link
to the continuum of care important for this population as well as links with
service providers for care delivery. In each of the projects, costs will be tracked
and evaluation of effectiveness undertaken through comparison with a control
community.
A research project primarily concerned with exploring the viability and cost-
effectiveness of delivering services to the chronically ill and disabled in settings
other than day care centers, nursing homes, and long-term care hospitals is ex-
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pected to have several additional products. The project, "The Feasibility and Cost-
Effectiveness of Alternative Long-Term Care Settings," is being undertaken by the
Stanford Research Institute. Its products, when completed, should provide a num-
ber of case studies on long-term care programs outside of nursing homes and
long-term care hospitals. (A companion investigation of day care centers has
been undertaken by the Health Resources Administration.) A comparison of costs
for participants of like functional capacity in nursing homes and the studied set-
tings within the same geographic area will provide insights into the relative costs
for different service packages for such groups. These case studies may provide
guidelines on intiating similar programs useful to innovators developing com-
munity care projects. In addition, a bibliography on studies of long-term care pro-
viding systematic information on developments in this field and a report on the
effects of legislative, regulatory and/or administrative programs on the feasibility
of establishing alternative long-term care programs are being prepared.
The Utah long-term care payments system project is a statewide experiment
designed to link reasonable cost reimbursement with the quality of care within
skilled nursing facilities. It is not only designed to respond to the requirements
of section 249 of Public Law 92-603 but to add to the system a structure which
will increase nursing home accountability for appropriate services to the patients
as well as provide an opportunity for the type and level of care extended to in-
dividual patients to be a component in the cost-reimbursement system.
The demonstration projects program in public assistance under section 1115 of
the Social Security Act has provided grants to State public welfare agencies for
several additional projects during fiscal 1975 which are totally or partially con-
cerned with providing a variety of services to elderly recipients in public welfare.
A project in Pennsylvania on health services is demonstrating how such services
should be administered to persons 65 years or older who were victims of a flood
disaster.
In Connecticut, California, Texas, and Wisconsin, projects are demonstrating
the effect of social services including day care and homemaker services in keep-
ing the elderly in their own homes instead of in intermediate care facilities and
nursing homes.
Housing allowances are being made to the elderly in eight experiments which
are being carried out by the Department of Housing and Urban Development.
Waiver of plan requirements has been granted by the Secretary to enable SSI
recipients to participate in the experiments without having their grant entitle-
ment reduced.
A project in Alaska permits the exclusion from income for the purpose of deter-
mining Supplemental Security Income (SSI) eligibility of monthly benefits
which are paid by the State of Alaska to elderly people who have lived there
more than 25 years.
Current plans for research and evaluation projects for fiscal 1976 include two
evaluation projects which will study means to improve the mechanism for becom-
ing eligible for medicaid. One project will examine the administrative link be-
tween the Supplemental Security Income program and medicaid eligibility, while
the other project will determine means to facilitate the implementation of new
medicaid policies.
Exploration of community-wide coordinated health and social service delivery
programs will be augmented by an additional project which will attempt to
demonstrate that more appropriate care may be delivered to recipients of long-
term care services at equal or lesser cost through the organization of a centrally
managed system of integrated health and social services operated through a
client-oriented case management process. In addition. a fiscal 1976 contract with
Abt Associates, entitled. "Methodology for Finding. Classifying. and Comparing
Costs for Services in Long-Term Care Settings" has been undertaken. This is an
effort to develop a structure useful for (1) comparing costs and services by
patient characteristics and (2) comparing these costs and services across the
spectrum of long-term care alternatives. The methodology, if refined. should be
applicable for use by local communities or public interest groups, regional health
planning centers, and State agencies in examining current services and planning
services appropriate to community needs.
2. SOCIAL SERVICES PROGRAM
During fiscal 1975 social services programs for the aging were funded under
provisions of title VI of the Social Security Act for the 50 States and the Dis-
trict of Columbia, and under provisions of titles I, X, XIV, and XVI for Puerto
Rico, the Virgin Islands, and Guam. Under Federal legislation. funding of the
social services for aging under title VI were included in the $2.5 billion ceiling
on Federal financial participation for public assistance social services.
It has been estimated that for the fiscal year 1975 approximately 1.45 million
of the aged received social services and it has been estimated that $248 million
was expended for this group of eligibles.¹ It has also been estimated that the
1 Source SRS annual report, fiscal year 1975 (CSA).
most frequently provided service was related to the health needs of these per-
sons and that the next most frequently provided was that of homemaker and
home health aide service. Other major services provided were family counseling,
chore services. and protective services.
Continued efforts to upgrade services to the elderly at the Federal level in-
cluded working with the following: The Domestic Council Task Force on Drug
Abuse; the Interagency Task Force on Home Health Services (a national effort
to increase the use of home health services as an alternative to inappropriate
institutional care) the President's Committee on Mental Retardation and
the National Council on Homemaker-Home Health Aides. Inc. This latter in-
cludes a project funded by the Edna McCornell Clark Foundation to extend
homemaker-home health aide services by utilizing older persons for provision
of these services.
A joint agreement was developed between Administration on Aging, Office
of Human Development, and Community Services Administration (presently
CAN - LINO - 158
Public Services Administration Social and Rehabilitation Service) to promote
joint efforts at the Federal, State, and local levels to develop comprehensive,
coordinated social service systems for older persons served by these two admin-
istrations of HEW.
Negotiations are under way between HUD and HEW to coordinate the pro-
visions of Public Law 93-383, the Housing and Development Act of 1974, with
Public Law 93-647, which added title XX to the Social Security Act. The two
departments are cooperating to establish and expand key efforts to create more
effective environments, services, and opportunities for persons residing in fed-
erally assisted housing.
FISCAL 1796
Public Law 93647 established title XX-grants to States for social services
under the Social Security Act. Title XX became effective on October 1, 1975 re-
placing the social services provisions of title IV-A and VI for the 50 States and
the District of Columbia. Title XX may serve not only persons who receive
Aid to Families with Dependent Children and Supplemental Security Income
payments but also, at State option, intact families and individuals with gross
monthly income not exceeding a level set by the State which must be within
limitations established by the Federal legislation.
Objectives of Public Services Administration for fiscal year 1976 include,
through cooperative Federal and State efforts. the following:
1. Establish in each State a title XX social services program as of October 1,
1975.
2. Assure that the title XX statutory and regulatory provisions are met for the
first program year, including the initiation of corrective action program where
necessary.
3. Develop the designated State agencies' capacity for effective services deliv-
ery, either directly or through agreements with providers.
4. Initiate any regulatory changes for the second program year found nec-
essary or desirable out of the first program year experience.
5. Strengthen each State's social service public planning process for the sec-
ond title XX program year, which for most States, will begin on either July 1,
1976 or October 1, 1976.
6. Provide for continuing evaluation of States' service programs.
In fiscal year 1976, it is estimated that 299 million Federal dollars will
2 Based on data extrapolated from various sources.
be spent by the States on social services programs for the aged." Below are
3 Based on budget requests submitted by SRS for fiscal year 1976.
charts of some of the services from a sampling of States. The services, the num-
ber of clients, and estimated total expenditures were taken from the final com-
prehensive annual services program plan for each State in the sample.
It should be noted that in most cases States have not separated the aging
from other clientele who are also expected to receive the services listed. There-
fore, dollar amounts include expenditures for eligible persons in addition to
the aging, unless specified.
For these reasons and for the reason that one person could be eligible for
and receive more than one service, no totals have been shown on these charts
since to do SO could be misleading.
More precise data and information regarding social services to the aging
under title XX will not be available until reports are received from States, at the
end of the fourth quarter of fiscal year 1976.
Total
Number of
estimated
Service
clients
expenditures
COMPREHENSIVE ANNUAL SERVICES PROGRAM PLAN FOR THE PERIOD OCT. 1, 1975 TO JUNE 30, 1976
Total
Number of
estimated
Service
clients
expenditures
CALIFORNIA
Information and referral
1,952,350
11,221,390
Protective services for adults
43,060
6,794,730
Out-of-home services for adults
28,570
3,452,050
Health related
148,580
7,224,180
Housing services
14,840
545,170
Special services for the aged
403
134,500
Special services for the blind
767
287,540
Special services for adults
15,750
$732,230
Homemaker, adult
24,376
14,212,020
Chore, adult
78,590
45,422,480
Day care, adult
5,970
1,006,180
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FLORIDA
Adult day care
2,400
575,000
Chore services
960
61,000
Companionship
700
17,400
Consumer education
900
48,600
Counseling
65,600
4,300,000
Employment services
1,000
400,000
Escort services
7,000
167,000
Foster care
2,000
133,000
Health education
12,500
303,000
Health related services
68,400
2,700,000
Home delivered meals
700
250,000
Homemaker
6,400
1,102,000
Home management
-3,400
291,000
Housing improvement
800
29,000
Legal services
370
22,000
Nutrition services
20,000
71,000
Protective placement for adults
2,000
341,000
Protective supervision
5,000
348,000
Respite care
350
98,000
Social group
services
7,600
1,134,000
Transportation
20,000
601,000
IDAHO
Chore
1,000
319,130
Health related
8,410
250,910
Adult protection
1,810
311,500
Homemaker
690
170,020
Diagnostic testing
350
44,800
Home-delivered meals
1,980
127,05
0
MASSACHUSETTS (SSI-0AA)
Case management
16,000
$26,600
Chore
1,370
330,790
Community residential
3,330
313,750
Emergency services
2,290
351,560
Counseling
3,121
1,050,000
Homemaker
13,800
8,000,000
Housing
1,500
256,200
Legal
300
270,000
Rehabilit
100
12,000
Talking books
475
15,200
Transportation
3,320
985,870
MINNESOTA
Chore
2,790
631,980
Counseling
6,800
739,000
Day care, adults
3,327
3,052,600
Educational assistance
658
61,980
Foster care, adults
1,770
607,100
Health
7,870
1,420,180
Home delivered and congregate meals
1,070
97,390
Homemaking
10,370
2,552,920
Housing
662
117,290
Information and referral
56,550
763,060
Legal
689
65,150
Money management
1,300
184,250
Protective service, adults
6,010
1,243,040
Social and recreational
3,670
198,780
Transportation
3,680
220,100
UTAH
Adult protective
230
58,020
Counsel, drug and alcohol
2,620
214,700
Counseling, personal
9,260
2,105,000
Day care, adult
250
187,920
Health services
2,510
280,800
Home management
1,320
193,596
Homemaker and chore
1,820
930,930
Housing
101,900
1,082,190
Information, referral and follow-up
190
18,130
Legal services
2,650
247,800
Protective, financial
150
45,550
Reassurance
2,140
420,570
Substitute, adult
880
258,030
Recreation and socialization
1,880
134,410
Transportation
6,540
220,460
11 county.
22 counties.
33 counties.
3. MEDICAL ASSISTANCE PROGRAM
The medical assistance program under title XIX of the Social Security Act
is a Federal-State partnership through which Federal matching grants help
States provide medical services to aged. blind. and disabled individuals and to
families with dependent children who meet stringent financial standards. The
program is administered by the Medical Service Administration in HEW's
Social and Rehabilitation Service. Total expenditures for the program in fiscal
year 1975 were $12.6 billion of which the Federal share was approximately 55
percent.
Forty-nine States (Arizona plans to initiate a program in July 1976) and the
District of Columbia, Guam, Puerto Rico, and the Virgin Islands operate med-
icaid programs. In each State, a single State agency is responsible for admin-
istering the medical assistance program in accordance with a State plan that has
been approved by the Social and Rehabilitation Service. The State plan enu-
merates the services to be covered by the program and must conform to the
statute (title XIX of the Social Security Act as amended) and the regulations
issued by the Department of HEW.
Required services commonly used by the elderly include the following:
-physician services
CAN - LINO - 160
-inpatient hospital services (except in institutions for tuberculosis or mental
diseases)
--outpatient hospital services
-other laboratory and X-ray services
-care in a skilled nursing facility
-home health services
-family planning services
The statute gives States the option of providing some or all of a list of
optional services. In that list, the following are of interest to the elderly:
-clinic services
-prescribed drugs
-dental services
-prosthetic devices
-eyeglasses
-private duty nursing
-physical therapy and related services
-other diagnostic, screening and preventive and rehabilitative services
-emergency hospital services
-podiatrists' services
-optometrists' services
--chiropractic services
-care in institutions for mental diseases
-care in institutions for tuberculosis
-care in an intermediate care facility
About 19 percent of medicaid's nearly 23 million patients are 65 or older.
About 40 percent of medicaid's funds are spend of this group. Individuals over 65
are the principal users of skilled nursing and intermediate care facility services
and services in institutions for mental diseases.
Eligibility for medicaid is related to eligibility for the Supplemental Security
Income (SSI) program, a Federal income maintenance program for the aged,
blind and disabled (title XVI of the Social Security Act) that became effective
January 1, 1974. Title XIX gives each State the choice of using the SSI defini-
tion of "aged, blind. and disabled" in determining medicaid eligibility or of
establishing a more restrictive definition of its own. States also have options
in regard to determining financial eligibility for medicaid. A State may use the
Federal SSI payment as the income level, the SSI payment plus its own sup-
plement (if any), the income level of the "medically needy" (if it offers medicaid
to the medically needy), or an income level more stringent than any of these.
It is thus important for aged persons to realize that eligibility for a cash SSI
payment does not automatically make them eligible for medicaid.
Because States do not follow the same procedures, aged individuals who want
to find out whether they are eligible for medicaid should first call their local
welfare or social services offices to find out what rules the State is following
and which office is making medicaid eligibility determinations. The local wel-
fare/social services office will be the right place to apply in some States and
the local Social Security office in others.
Aged persons who are covered by medicaid usually have to find their own
physicians and other health care providers, and should make sure that the health
care providers they want to use will accept medicaid patients. Medicaid patients
should not accept bills for services covered by the medicaid program. The pro-
viders should send bills to the State medicaid agency or its designated fiscal
agent. If a patient finds it difficult to find a provider willing to accept a medicaid
patient, his local welfare or social services office will often be able to help him
find one. Medicaid is also required to assure that eligible individuals have trans-
portation to and from providers of medical service.
SPECIAL PROGRAM ACTIVITIES SERVING THE ELDERLY
Recognizing the heavy emphasis on institutional care which has developed in
the medicaid program and in keeping with the Department's objective of encour-
aging alternatives to institutionalization. MSA has developed and funded (in
some instances in cooperation with the Administration on Aging) several projects
designed to provide a complex of services to the aging. The following are programs
underway at the present time.
On Lock Center
This center was established in 1972 to provide much needed geriatric services
to elderly Chinese, Italian, Filipino persons living in the Chinatown-North
Beach section of San Francisco. It was funded as an R & D project by SRS.
There is a strong health component, with an occupational therapist in charge
FORD
of the program. Other primary staff includes a full time Public Health nurse, a
part-time physician (internist). a physical therapist. nutritionist. speech thera-
pist, and reality-recreation therapist. The program emphasizes rehabilitation but
LIBRARY
also provides much needed maintenance services. Eighty percent of the partici-
GERALD R.
pants are over 70 years old. Most of the participants have medical problems that
require supervision on a sustained basis.
Mosholu-Montefiore Day Care for Elderly
This program is located in Bronx, N.Y., on the grounds of the Montefiore Hos-
pital and Medical Center. This program was funded by SRS in 1972 as an R. &D.
project. The staff is composed of one director (MSW), three aides, one social
worker, one counseling specialist, one RN, one LPN, one OT, and one secretary,
all full time. The physician is part time. The program uses the facilities of an
existing institution (the Montefiore Center) for the meals and social programs.
The daily health care of the participants is supervised by the RN and LPN.
Procedures for special care, such as physical therapy or emergency treatment,
are provided by staff of the Montefiore Hospital or Community Center. Recrea-
tional activities based on a participant's medical needs and interests are pro-
vided as a part of the daily schedule.
CAN - LINO investion 161
St. Camillus
This facility, located in Syracuse, N.Y. is a 130-bed skilled nursing facility
which also offers a wide range of outpatient services such as occupational therapy,
physical therapy, pulmonary care, diabetic care, and arthritic care. The day
care program is operated as an independent program; however, patients admitted
to the day care program receive most of their services from the St. Camillus out-
patient department. The primary staff is composed of a registered nurse, social
worker, and administrative and clerical personnel. Other staff are shared by
St. Camillus SNF and the day treatment program.
Patients must have their own physicians. Day center personnel work coopera-
tively with each patient's physician to develop a care plan and obtain written
orders. Care plans and physicians' orders are reviewed by day center staff with
the private physician at least every 30 days. The medicaid rate is $12.60 per
day, excluding transportation. Transportation costs vary with arrangements.
Currently, taxi rates are about $5 per patient per day. There are approximately
45 persons in this program.
Burke Day Hospital
This program operates like a subsidiary of the Burke Rehabilitation Hospital
of White Plains, N.Y. Although the day hospital is an independent program, the
administrative staff has contracted with the Burke Hospital to utilize many of
its services.
The day hospital is distinguished from the programs described above in two
ways.
(a) The patients served generally have more chronic medical problems.
(b) Diagnostic and treatment services are more sophisticated. Convenient
access to the Burke Hospital treatment facilities permits employment of these
sophisticated diagnostic and treatment services such as radiological therapy,
hydro therapy or electroencephalography for the day hospital patients.
The physician for the day hospital is a member of the Burke Hospital medical
staff and is part time for the day hospital. Other primary staff includes a primary
nurse practitioner, registered nurse, licensed practical nurse, physical therapist,
occupational therapist, speech therapist and recreation therapist. The program
emphasizes rehabilitation and is vitally concerned with patients who have chronic
medical conditions and require an intensive maintenance program to keep them
from being hospitalized for long periods of time.
Wisconsin Community Care Organization
This program's overall objective is to demonstrate that a substantial segment
of the elderly and functionally disabled population may be maintained in their
own homes at a cost lower than that of the present pattern of institutionalization
through the provision of a package continuum of health and health related social
services, such as meals-on-wheels.' An inherent premise of this objective is the
1 Housekeeping aid and transportation.
belief that this population would prefer to continue to live at home if possible.
This premise as well as the overall objective will be tested as a part of the project
evaluation.
The CCO seeks to demonstrate that quality of care can be improved over that
which is the experience in the current medical assistance program by introduc-
tion of interventionary health related social services and limited health services
as offered by the CCO. This objective is based in part on data cited on accelerated
rates of debilitation following institutionalization, studies on debilitation as a
result of inappropriate placement and the experience of health maintenance or-
ganizations in reducing the demand for acute care services by early provision of
lower level health services. Again, this premise will be tested as part of the
evaluation design. Specific indices will be examined in the CCO population in
contrast to a control population in the current system to test achievement of this
objective.
FISCAL 1976
To implement the mandate of Public Law 92-603, section 222, titles XVIII and
XIX awarded the following contracts:
Prospective Reimbursement
During a 3-year period 16 hospitals in South Carolina will participate in a
prospective rate reimbursement experiment through a contract awarded to the
University of South Carolina. There are three major aspects of the experiment
(1) Budget review guidelines, (2) cost savings measures and measurements,
(3) rating criteria for new ventures capital expenditure programs. In general,
the evaluation will examine and analyze the strengths and weaknesses of this
approach to cost containment. It will also examine the efficiency and effectiveness
of the total program as well as the three program components mentioned above.
The program components will be studied in terms of their effects on hospital
budget preparation processes, hospital budgets, hospital decisionmakers motiva-
tional changes and changes in new ventures projects funded.
Homemaker and Day Care Experiments
Section 222 authorizes experimentation to establish an experimental program
to provide day care services under title XIX and part B of title XVIII; and to
determine whether coverage of homemaker services would provide suitable alter-
ations to posthospital benefits presently provided under title XVIII.
In June 1975, contracts were awarded to the following agencies:
Combined Homemaker and Day Care Services.-Lexington-Fayette County
Health Department, Lexington Ky.; San Francisco Home Health Agency, San
Francisco, Calif.
Day Care Services.-Burke Rehabilitation Center, White Plains, N.Y.; St.
Camillus Nursing Home, Syracuse, N.Y.
CAN - LINO excess 162
Homemaker Services.--Homemaker-Home Health Aid Services, Providence,
R.I.; Los Angeles Intercity Home Health Agency, Los Angeles, Calif.
Day Hospital and Rehabilitation Medicine
A proposal has been developed with the Albert Einstein College of Medicine
(Bronx, N.Y.) because of concern over the high cost of inpatient rehabilitation
care.
The Einstein experiment will test the assumption that day hospital services
can result in a substantial reduction in medical care costs for the seriously
disabled, compared to conventional inpatient hospital treatment, without redue-
ing the quality of care. If the experience is clinically successful, it must be deter-
mined if the reduction in cost is sufficient to warrant Medicare and Medicaid
covering the cost of transportation for day hospital services under the program.
The program will evaluate the effectiveness of a day hospital service as a sub-
stitute for the conventional inpatient hospital for the treatment of the seriously
disabled. The project would also include an intensive family training program
as a part of effective day hospital care,
OFFICE OF EDUCATION
Office of Education major activities for the older American are concentrated in
three areas Adult education ,community services and continuing education, and
library services.
ADULT EDUCATION
The adult education program authorized under the "Adult Education Act
of 1966," as amended. provides undereducated adults (persons 16 years of age
and older) an opportunity to continue their education to at least the level of
completion of secondary school and makes available the means to secure train-
ing that will enable them to become more employable, productive, and respon-
sible citizens.
The program is a State grant operation administered by State education agen-
cies according to State plans submitted to the U. S. Office of Education and ap-
proved by the U. S. Commissioner of Education. States are allowed grants to pay
the Federal share of the cost of establishing or expanding adult education pro-
grams in local educational agencies and private non-profit agencies. The matching
requirement for the State grant program is 90 percent Federal funds and 10 per-
cent State and/or local funds.
Initial feedback indicated the following age distribution of participants in the
adult education program during 1975. The number of participants is expected
to remain stable through 1976.
Age group
Estimate
16 to 24
$262, 500
25 to 34
202, 500
35 to 44
135,000
45 to 54
90,000
55 to 64
37, 500
65 to over
22, 500
Total
750, 000
Public Law 93-29 amended the Adult Education Act by authorizing the Com-
missioner to make grants to State and local educational agencies or other public
or private nonprofit agencies for programs to further the purpose of this act by
providing educational programs for elderly persons whose ability to speak and
read the English language is limited and who live in an area with a culture dif-
ferent than their own. Such programs shall be designed to equip such elderly per-
sons to deal successfully with the practical problems in their everyday life, in-
cluding the making of purchases. meeting their transportation and housing needs,
and complying with governmental requirements such as those for obtaining citi-
zenship, public assistance and social security benefits, and housing. However, to
date no appropriations have been requested or made to implement this section,
COMMUNITY SERVICE AND CONTINUING EDUCATION
Title I of the "Higher Education Act of 1965" (Public Law 89-329, as amended)
authorizes grants to the 50 States. the District of Columbia, Guam, American
Samoa, the Commonwealth of Puerto Rico. and the Virgin Islands. The intent
of these grants is to strengthen the community service programs of colleges and
universities for the purpose of assisting in the solution of community problems.
The program is administered in each State by an agency designated by the Gov-
ernor, under a State plan approved by the U. S. Commissioner of Education. The
State agency establishes program priorities and approves and funds institutional
proposals. Funds are provided on a 66% Federal and 33½ non-Federal basis.
A community services project under this act means an educational program,
activity or service. including research programs and university extension or con-
tinuing education offerings.
The State-Grant Program has supported a number of projects designed to assist
the older American. During 1975, more than 150,000 individual participants were
involved in 75 projects (including multi-problem areas) in 32 States at a cost of
approximately $1,160,000 in Federal funds. Activities supported by these funds
included special programs to meet educational needs of the aging: legal aid and
housing assistance: professional and paraprofessional gerontological human re-
lations training for those providing care and services to the elderly.
CAN - LINO - 163
Special projects, authorized by section 100. permits the Commissioner to re-
serve 10 percent of the funds appropriated in order to support special projects
which are designed to seek solutions to regional and national problems brought
about by technological change. Such special projects are limited to demonstration
or experimental efforts. Projects must be based on a design for and the imple-
mentation of organized continuing education activity for adults. In 1975, two
projects for the aging received support at a total cost of $166,352.
An award of $114,852 was made to the Maricopa County Community College
District in Arizona for the project, "Six Dimensions for People Over Sixty."
This statewide project involving six community colleges will target services to
senior adults. Each college will develop and operate separate programs focusing
on a different part of the senior adult population and its continuing education
needs. Individual projects will use the mass media and direct instructional
approaches.
In addition, $51.500 was directed to the University of Tennessee (Nashville)
for Development of an Institutional Model for Community Service and Continu-
ing Education for the Elderly in which ways to increase higher education access
for the elderly will be developed and tested. A consortium of four institutions in
Tennessee (Dyersburg State Community College, East Tennessee State Univer-
sity. Tennessee Technical University, and the University of Tennessee) will con-
duct the project.
Special Projects for the Elderly.-Title VIII of the "Older Americans Com-
prehensive Services Amendments of 1973" further amended title I, HEA to au-
thorize the Commissioner to make grants to institutions of higher education to
assist them in carrying out programs specifically designed to apply the resources
of higher education to the problems of the elderly, particularly with regard to
transportation and housing problems of elderly persons living in rural and isolated
areas. For the purpose of making these grants, the Act authorized to be appro-
priated "such sums as may be necessary." No funds have been requested or ap-
propriated for this section.
Funding.-Congress determines the appropriations annually. Of the sums ap-
propriated. the Commissioner may reserve 10 percent for special project discre-
tionary grants and allot $25,000 each to Guam, American Samoa, Puerto Rico, and
the Virgin Islands and $100,000 to each of the States and the District of Columbia.
The remainder is distributed on a population ratio basis. Total appropriations
for fiscal year 1975, $14.25 million.
PUBLIC LIBRARY SERVICES
Office of Education support for library and information services for the aging
during fiscal year 1975 included a variety of activities ranging from talking book-
mobile services to development and implementation of services to the institu-
tionalized and handicapped. The projects have been funded primarily by the
"Library Services and Construction Act" (LSCA).
Emphasis on the concern for the older American has been shown by the efforts
to study the information needs of the aging, identify those persons who constitute
the population segment for which these services may be appropriate, and the
design of programs which will be effective and useful to this target group. In a
national study, conducted in 1973 and supported by LSCA, it was learned that the
elderly reader represents one of the highest user groups of public library services.
The 1973 study also indicated the older patron's concern for improvement of 11-
brary and information services. These suggestions were made: (1) The service
should be made more accessible; (2) transportation should be provided for
older patrons; and (3) books and materials should be delivered to the neighbor-
hood.
In 1975, isolated and rural as well as immobilized elderly persons benefitted
from the increase of books-by-mail programs, provided by libraries at no cost
to the users who select their reading from mailed book catalogs.
Approximately 43,000 (LSCA programs only) older Americans are participat-
ing in programs specifically designed for the physically handicapped. Both the
LSCA and the Library of Congress programs for the physically handicapped
include large numbers of older handicapped persons: they account for a major
portion of readers of talking books. braille and other special reading materials
available on loan through a network of 52 regional and subregional libraries for
the blind and physically handicapped throughout the country.
Libraries seek to involve persons by direct visits to shut-ins; books by mail
telephone information services; free telephone services to Regional Libraries
for the handicapped; group programs (films on travel, consumer education, and
other subjects, lectures. demonstrations, discussions, concerts, art exhibits, crafts,
hobby shows. etc.) employment programs: and free transportation to the li-
braries. In addition to the number of libraries that are offering free transporta-
tion for elderly residents, more are experimenting with this service and provid-
ing with it special group programs to give impetus to participation. The growth
or library-based independent learning programs begun in 1974 continue to open
up opportunities for purposeful guided study at the senior citizens' individual
pace, education level and convenience.
To cite an example: In North Dakota, where a larger percentage of citizens
fall into the over-65 age category than is the national average, the Fargo Public
Library brought together LSCA funds and OEO funds in order to bring local 11-
brary services directly to the elderly in 15 rural senior citizen centers. The cen-
ters are located in six counties in the southeast corner of the State where lack
of public transportation, severe winters, great distances, and other reasons, deter
senior citizens from using public libraries, if they have them. Books, film-show-
ings, recordings and fellowship are provided by this unique, shared library
program for at least 1,500 persons.
The North Dakota State Library Agency has also with LSCA support gen-
erated a books-by-mail program that reaches isolated elderly persons in low
CAN - LINO - 164
Income areas, and developed a larger print book collection that is widely pub-
licized and heavily used by senior citizens with failing sight. Library service
to the elderly in North Dakota is a targeted. on-going program priority.
LSCA funds are used to develop programs to identify eligible readers and
acquaint them with available services: to buy large print materials. commercially
recorded materials and reading aids: conduct programs for recording materials
in Indian, Spanish, Canadian-French, Polynesian and other native languages;
and for example, the Easter Seal Society and the Desert Regional Library
jointly operate a talking bookmobile throughout the State to promote talking
books and enroll new borrowers-elderly readers are the principal patrons.
Future plans for library and information services for the aging include the
refinement and implementation of model programs developed during the year
and the continuation of established services and programs. The 1973 amend-
ments to the Older Americans Act included opportunities for strengthening
Hbrary services to older adults through a new LSCA title IV, "Older Reader
Services." With no funds for the new title, special services for the aging con-
tinue to be provided from funding available from the Library Services and Con-
struction Act, title I.
OTHER PROGRAMS
Right-to-Read.-The Right to Read Reading Academy program currently im-
pacts youth and adults ages 16 and up. The primary emphasis of the Reading
Academy is to provide for the development of literacy skills for those citizens
whose current skills are at a very low level. In fiscal year 1976. approximately
6,000 adults including older Americans. are participants in these academies located
in 20 sites throughout the United States. The Reading Academy program will be
continued under title VII, Public Law 93-380, as amended authorization and the
number of academies is expected to increase approximately four times under
fiscal year 1976 funding. This has been the initial emphasis of the right to read
effort in providing services to the adult population.
Consumers' Education.-The consumers' education program authorized by title
IV, section 407, of the "Education Amendments of 1974," (Public Law 93-380)
provides funds to stimulate in both school environments and community settings
new approaches to consumers' education efforts through competitive contracts
and grants. These awards will be used for research. demonstration. pilot projects,
training, and the development and dissemination of information on curricula.
In addition, funds may be used to demonstrate, test, and evaluate these and
other consumers' education activities as well.
Fiscal year 1976 will be the initial funding year for this program and the Office
of Education has placed one of its priorities for funding on projects addressing
the consumer education needs of the elderly.
Community Schools.-The community schools program. authorized by title
IV, section 405, of Public Law 93-380 provides grants to States and local educa-
tional agencies for programs to stimulate further community education through
awards for educational. cultural. recreational and other related community needs.
Additional awards are made to institutions of higher education to encourage the
training' of persons to plan and operate community education programs.
Fiscal year 1976 will be the initial funding year for this program and in order
for any community to receive Federal funding. its program must have several
minimum elements, including the potential to serve all age groups in the com-
munity, including the elderly.
Women's Educational Equity.-The women's educational equity program, an-
thorized by title IV. section 408. of Public Law 93-380 provides funds for public
agencies, private nonprofit organizations, and individuals to carry out such ac-
tivities as the development of materials, preservice and inservice training, re-
search and development, guidance and counseling, etc., which will further educa-
tional equity for women.
Fiscal year 1976 will be the initial funding year for this program and adult
women including the elderly, will be amongst the beneficiaries of the authorized
activities.
Indian Education.-The Office of Indian Education is cooperating with the
Office of Human Development. the Office of Native American Programs, and the
Administration on Aging in increasing the base of knowledge about educational
opportunities for elderly American Indians and to focus the involvement of
Indian tribes and Indian organizations in the decision making processes on
problems of elderly Indians.
NATIONAL INSTITUTE OF EDUCATION
In 1975 the National Institute of Education released a publication on the
response of community colleges to educational needs of the elderly. This pub-
lication, available from the dissemination and resources group of the National
Institute of Education, was written by Lillian L. Glickman and Benjamin S.
Hersey, of the Massachusetts Association of Older Americans, and by I. Ira
Goldenberg, of Harvard University.
Entitled "Community Colleges Respond to Elders-A Source Book for Pro-
gram Development." the publication describes the educational needs of older
adults and surveys some of the programs carried out in response to those needs
by community colleges. Using this information as a base, it outlines appropriate
core curriculums and presents a model for program development built on the
characteristics that appear to make the programs successful. Also listed are some
Federal, State. and other resources on which community colleges can draw for
assistance in developing programs.
The publication is designed to be used as a planning guide and working tool.
It sets forth an inclusive model of educational program development for elders
CAN - LINO 165
through community colleges. The source book is predicated on a view that the
challenge coufronting community colleges is twofold
(1) To recognize the emergence of a healthy, active, capable generation of
elders who presently face many years of inactivity and leisure and
(2) To develop an alliance with elders to explore and develop a range of life
styles for this period of life.
The NIE anticipates that the source book will encourage community col-
leges to provide effective education programs for elders, and that it will pro-
vide assistance for those who undertake this task,
PUBLIC HEALTH SERVICE
PREFACE
The Public Health Service (PHS) is the health component of the Department
of Health, Education, and Welfare. The following report on the PHS activities
in aging presents the major accomplishments for 1975 and some anticipated
program directions for 1976. The report includes pertinent information from
five PHS agencies and from the Office of the Assistant Secretary for Health.
A. ALCOHOL, DRUG ABUSE, AND MENTAL HEALTH ADMINISTRATION
FEBRUARY 2, 1976.
Dear Mr. CHAIRMAN Thank you for your letter of December 30 requesting
a report of the National Institute of Mental Health's activities in the area of
aging.
The attached report details our activities in fiscal year 1975. Currently, we
are working towards plans for implementing the Committee on the Mental
Health of the Elderly as mandated by Public Law 94-63. As soon as these plans
are finalized, Institute staff will be pleased to provide your staff with an update.
We appreciate your continued interest in the field of mental health and aging,
and if I may be of further assistance, please let me know.
Sincerely,
BERTRAM S. BROWN, M.D., Director.
[Enclosure]
NATIONAL INSTITUTE OF MENTAL HEALTH
The mandate given the NIMH by the Congress is to conduct a program of
research, training, and services for the prevention and treatment of mental ill-
ness and for the maintenance and improvement of the mental health of the Na-
tion. Since persons of 65 years of age and older now constitute approximately
10 percent of the population. or 21.8 million citizens. it follows that a significant
portion of the NIMH effort should be directed toward the mental health problems
and needs of this group. The fact that the aging constitute a population group de-
fined only by chronological age provides some indication of the size and variety
of problems that are encountered. Included in this group are persons from all
social and economic levels, all racial and ethnic groups, from every region of the
country, representing every occupational and education background, and dis-
playing the widest possible range of mental health problems and needs. The
high incidence of poverty, increased susceptibility to debilitating physical dis-
ease, the loss of status in a youth-oriented society. and personal losses, such as
death of spouse. that increase with advancing age, are all factors that contribute
to the vulnerability of this age group and to the pressing mental health prob-
lems that they experience.
The enormous implications for mental health posed by this segment of the
population are reflected by the fact that psychopathology in general and depression
in particular rise with age to the point that the highest incidence of new cases
of psychopathology of all types is found in the population 65 years of age or
older, as reported by the World Health Organization.
Their survey found that in the 65-plus group there occurred 236.1 new cases
per 100,000 population, or 2½ times the rate found in the next highest age
group. Suicide also increases with age and attains its zenith in elderly white
males. Of the 1 million persons 65-and-over who live in nursing and personal care
homes, it is estimated that between 65 and 75 percent display a significant
degree of mental impairment and that over 50 percent evidence symptoms of
depression severe enough to justify psychiatric intervention. Though it is more
difficult to obtain precise data for community residents. it is estimated that
from 10 to 25 percent of the elderly in the community are suffering from signifi-
cant mental impairment and that the incidence of depression is almost as high
as that found in the residents of institutions for the aging. Some measure of
the lack of attention given the aging by mental health professionals is reflected
in a recent NIMH conducted study which showed that more than 60 percent of
the elderly admitted to State mental hospitals have received no previous psy-
chiatric care: that is, the State hospital is the first mode of mental health inter-
vention for them.
Faced with a public mental health problem of this magnitude, the NIMH
has attempted to mobilize its resources to maintain, and, if possible, to improve
the mental health of this segment of the population. By the active support of
research. the development of innovative and more effective methods of deliver-
ing mental health services, and the education and training of appropriate man-
power, the NIMH is seeking to provide increased and precise knowledge of the
factors associated with mental health and mental disorder in later life. to
devise means for preventing mental disorder and maintaining the psychosocial
functioning of older persons, and to stimulate greater interest and more ade-
quate programs for the elderly on the part of various public and private
agencies and institutions responsible for the mental health and welfare of the
American public.
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Until recently the NIMH program in aging was carried out primarily by the
section on Mental Health of the Aging. In recognition of the importance of the
problem and of the need for a greater concentration of NIMH resources to meet
it, the Director of NIMH during the past year announced the formation of a
Center for Studies of the Mental Health of the Aging. This brings together in
one organizational structure the various elements of the NIMH program having
to do with the aging and provides the program with greater visibility, emphasiz-
ing its priority status. At present the center is a coordinating unit and serves
as the focal point for all NIMH activities relating to the aging. Rather than
be budgeted for direct extramural support activities, it is designed to stimulate
and act as advocate for the aging and to keep abreast of national needs and
developments in the field. The major activities for the first year will include
collaborative efforts in the professional community in addressing research priority
issues: attention to models for service delivery, and training issues and multi-
disciplinary concerns along the entire continuum from the university classroom
to the community.
To accomplish this, the center is planning to convene a series of three planning
conferences devoted to research, mental health services. and mental health train-
ing. Each conference will be made up of a small group of recognized experts
in the field who will come together to discuss with the staff the most important
issues in relation to these topics and to formulate plans by which the problems
can be met. The first of these conferences, the one devoted to research. has
already been held, and it is anticipated that the training and services conferences
will be held in the near future. Reports of these conferences will be published
and made generally available.
To assist him in administering the research program of the NIMH, the Director
has in the recent past convened an NIMH Research Task Force to review the
research program of the Institute and to make recommendations for future
directions. The final report of the Research Task Force recommended that the
Director establish a research advisory group to assist him in the setting of
the Institute's research policies. This group devoted several of its first weekly
meetings to consideration of the NIMH research program of the aging, with
the aim of defining the areas of research most appropriate to the Institute.
The subsequent recommendation fits neatly into three broad categories:
1. Etiology. diagnosis, and treatment of mental disorders.
2. Development and delivery of mental health services.
3. The prevention of mental disease.
In each category. there are a number of more specific areas designated as
proper responsibilities of NIMH. This report has been widely circulated, both
as a means of public information and to stimulate research interest and studies
appropriate to the mission of the NIMH.
Examination of the research projects supported by the NIMH during the
past fiscal year. as well as in previous years, reveals that the research previously
supported also fits quite well into these three categories. During the past fiscal
year, 55 research projects were funded by NIMH, which are of relevance through
the mental health of the aging and which can be placed into the three categories
mentioned above.
THE ETHIOLOGY, DIAGNOSIS, AND TREATMENT OF MENTAL DISORDERS
This category contains the largest number of projects supported during the
past year. Included in it are a wide range of studies dealing with bio-medical
and psycho-social processes with important mental health implications, a number
of studies having to do with the effect and appropriate use of the various
psychoactive drugs. clinical studies of mental diseases. particularly chronic
brain syndrome and depression. and studies into the epidemiology and demog-
raphy of mental illness in the elderly. The need for further and more precise
knowledge of the nature of mental illness in the elderly is emphasized by a study
conducted at the Research Foundation for Mental Hygiene in Albany, N.Y.
This studv, which has been going on for several years, is now focusing on
geriatric patients with special reference to distinction between and prognosis
for organic disorders.
The study is of a cross-national character. in which the same diagnostic pro-
cedures are applied to populations of older people in the United States and the
United Kingdom. It is of interest that nearly 80 percent of the first admissions
to mental hospitals of persons 65 years of age and over in the United States are
diagnosed as organic disorder. while the United Kingdom only 46 percent were
admitted in this age group are SO diagnosed. Such a dramatic difference demands
further investigation and study since it has important implications for the treat-
ment of mentally ill older people.
DEVELOPMENT AND DELIVER OF MENTAL HEALTH SERVICES
A number of innovative experiments in this area have been supported during
fiscal year 1975. They have ranged from studies of the effect of various architec-
tural arrangements on mentally impaired older persons in institutions. through
the study of a new and more effective program for persons resident in nursing
homes and retirement homes to the need of providing mental health support and
treatment for older persons living in very deprived circumstances in welfare
hotels in large cities. Typical of these projects is the one being conducted by the
Ebenezer Society in Minneapolis. Minn. In this project. a home for the aging
serves as the focal point for a wide range of institutional and community activi-
ties designed to maintain the current level of functioning of older persons, slow
down deterioration, and reduce and possibly halt deterioration often associated
CAN - LINO - 167
with chronic brain syndrome. The program has been quite successful, not only
in the treatment of the subjects included in it, but in mobilizing a variety of
community resources and focusing their efforts upon providing more appropriate
therapeutic and supportive services for older persons who are at high risk of
being permanently institutionalized.
PREVENTION OF MENTAL DISEASE
This category contains the second largest number of research projects recently
funded by NIMH. Since projects in this area are concerned with the wide variety
of psychiatric. psychological, and sociological aspects of the older persons life, the
studies contained in it similarly reflect a wide range of interesting and important
research projects. Studies aimed at developing understanding of the meaning
of forced retirement from employment and the value of assisting the older worker
to prepare for it, the effects in housing and various living arrangements on the
adjustments and satisfaction of older persons. the role that remarriage plays in
later life. and the importance of social integration on successful aging have all
been topics addressed by these studies.
The need to provide more appropriate and effective mental health services to
persons in the community has long been recognized by the NIMH and is reflected
by the importance assigned by the Institute to the community mental health cen-
ters scattered throughout the country. It has become apparent that the elderly
have not been receiving a proportionate share of these services and that effort
must be undertaken to remedy this neglect. This deficiency has been recognized by
the Congress as reflected in recent legislation requiring federally supported mental
health centers to provide identifiable programs for older persons in their eatch-
ment areas.
Staff of the Center for Mental Health of the Aging have been activel yinvolved
in this effort. both in the development of guidelines and regulations for such pro-
grams and in providing consultation and technical assistance to directors and
staff of community mental health centers in various parts of the country. During
the past year staff of the Center have participated in conferences and workshops
for groups of mental health center personnel, and it is anticipated that this
effort will receive even more attention during the coming year.
The NIMH has long regarded one of its most important functions as being that
of recognizing gaps in knowledge and of attempting to remedy such gaps by pro-
ducing documents providing information for students and practitioners to assist
them in understanding means by which appropriate programs can be implemented.
The NIMH program in aging has long been concerned with producing documents
designed to provide technical assistance to organizations and individuals inter-
ested in developing such programs. Over the years. publications have been de-
veloped by the center by contract. including a guide for program development for
aged persons for the use of the community mental health centers staff. a guide
for long-term care facilities staff of how to care for the mentally impaired aged
patient, a social work guide for long-term care facilities. results of a study of
retirement and its predictive variables, summaries of NIMH supported research
into the mental health of the aging, and the results of a longitudinal study of
human aging. During the past year, a guide for staff of long-term care facilities
on the maintenance of familial relationships of patients has been developed and
will be published during the coming fiscal year. Other publications are being
planned for the immediate future. including summaries of NIMH research rele-
vant to aging persons updated to cover the years 1961 to 1975: a primer on
psychotherapy with the aged: proceedings of the center's three planning confer-
ences on research. training. and services; and a comprehensive clinical textbook
on aging and mental health.
The center staff has collaborated with a variety of Federal and private agen-
cies with programs dealing with the elderly. Staff of the center serve on a num-
her of committees and task forces and have been closely involved in the efforts
of various national professional organizations. It is anticipated that such activi-
ties will continue and expand in the future.
B. FOOD AND DRUG ADMINISTRATION
Laws enforced by the Food and Drug Administration (FDA) are designed to
protect the health, safety, and pocketbooks of all consumers regardless of age.
But this protection is particularly important to the elderly consumer. who has
interests and special problems peculiar to this age group. During 1975 there were
many events and actions which illustrate the significance of FDA's protection
of the elderly.
BI0AVAILABILITY/BIOEQUIVALENCE
"Bioavailability" and "bioequivalence" are important terms in the FDA drug
lexicon.
It has been found that some chemically identical drugs-drugs meeting identical
official standards and Labeled for the same medical indications-were not bio-
equivalent and in some instances resulted in therapeutic failures. Digoxin is an
important example-peak blood concentrations after a single dose varied among
products of four manufacturers as much as sevenfold and nonuniformity was
demonstrated even within the same brand. In consequence, medication refills for
a heart patient could cause either inadequate therapeutic response or toxie ef-
feets. As a result of these findings a testing and certification program at the
National Center for Drug Analysis, St. Louis. Mo., is one of several important
FDA activities to insure uniform dosage with digoxin products. Documented
bioequivalence problems have been identified with about 30 drug active ingredi-
ents. Another 80 active ingredients have been determined by the Agency to present
a potential for causing bioequivalence problems.
CAN - LINO - 168
On June 20, 1975. the FDA proposed regulations to assume the equivalence of
all marketed drug products. These regulations define certain terms relating to
bioavailability and bioequivalence, set out the purposes of bioavailability studies.
establish procedures for determining bioavailability, and provide a mechanism for
establishing a bioequivalence requirement when there is evidence that drug
products containing the same therapeutic moiety and intended to be used inter-
changeably for the same therapeutic effect are not or may not be bioequivalent.
The preamble to the proposed bioequivalence regulations contains a list of drug
products having known or potential bioequivalence problems. Although a drug
product's inclusion on the list does not in every instance imply that the FDA has
positive evidence of bioinequivalence among the various brands currently on the
market, the FDA has recommended that. until bioequivalence requirements are
established under the procedures set forth in the proposed bioequivalence regu-
lations for the drug products on the list, persons charged with procuring these
drug products purchase the products from firms holding approved new or ab-
breviated drug applications. or from firms that are named as distributors in an
approved new or abbreviated new drug application or supplemental application.
To aid purchasers, the FDA has made available to the public a list of all firms
that are authorized in an approved application to manufacture. package. or dis-
tribute the drug products listed in the preamble to the proposed bioequivalence
regulations.
Final regulations will be issued in early 1976.
PRESCRIPTION DRUG PRICE POSTING
On December 18. 1975, the FDA issued final regulations that specify the kinds
of information that must be included in any poster, catalog, mailing piece, or ad-
vertisement used to call attention to the prices charged by a pharmacy for pre-
scriptions for particular drug products. The regulations do not require the public
disclosure of prescription price information. However. the regulations will assure
that if a pharmacy elects to make such disclosure, the information provided
the consumer will be uniform and enable the consumer to determine the price he
can expect to pay for his prescription. Price disclosure information must include
the proprietary name of the drug product. if any: the established name of the
drug product. if any: the drug product's strength: the dosage form: and the
price charged for a prescription of a specific quantity of the drug product. The
stated price must include all charges to the consumer. including the cost of the
drug product, professional fees, and handling fees. The price disclosure informa-
tion may include identification of professional and convenience services provided
by the pharmacy, e.g., free delivery, maintenance of records for tax purposes. or
discounts for senior citizens. These new regulations will enable consumers, in-
cluding those with fixed incomes. to determine where they can obtain, at the
lowest cost. a particular drug product prescribed by their physician.
ESTROGENS
The FDA is concerned about the wide usage of estrogens in our society and the
recent discoveries that such use is associated with serious risks. including the risk
of cancer. Estrogens are a class of compound which share the common property
of acting a female hormones. The drugs are approved by the FDA for use in a
number of disease states. However, from the public health point of view, the
greatest exposure of premenopausal women to estrogens is through oral contra-
ceptives. and the greatest exposure of postmenopausal women is via their pre-
scription for menopausal syndrome.
In regard to labeling for oral contraceptives. the FDA will shortly propose
a major revision of both the physician's package insert and the patient brochure.
Included in the new package insert and patient brochure will be information
concerning the association between estrogens and endometrial cancer.
Because there appears to be a higher risk of endometrial cancer in association
with the long-term use of estrogen in postmenopausal women, the FDA is pre-
paring to revise the labeling for estrogens used in treating the menopausal
syndrome. The revised labeling will define more narrowly the menopausal
syndrome and will recommend that estrogens be used only for the treatment
of patients with vasomotor symptoms, commonly known as "hot flashes." These
symptoms generally disappear with time SO that most women who require such
therapy can be treated with a short course of estrogens over a period of months,
although a few patients may need estrogens for several years. The Warning
section will contain a strong statement concerning the reports linking the
postmenopausal use of estrogens to the risk of endometrial cancer. The labeling
will also recommend that, if estrogens are used. they should be administered in
a way most likely to minimize the risk of endometrial cancer. The lowest effective
dose should be used at all times. and the drug should be either discontinued or
reduced in dosage at regular intervals to assess whether the drug is still needed.
information. The FDA is also considering how best to provide the patient with the labeling
MAXIMUM ALLOWABLE COST (MAC)
Regulations to implement a three-part plan to reduce the cost of prescription
drugs to medicaid and medicare programs were signed into regulation by the
Secretary of HEW on July 25, 1975. The MAC regulations, scheduled to become
effective in April 1976, provide for establishing.
1. A new payment system for drugs which are generally available at
varying costs from more than one manufacturer. Before a MAC can be
established for these drugs. the FDA must first indicate that there are no
bioequivalence problems among its several brands. The HEW Pharmacentical
Reimbursement Board (established by the regulations) would then propose
a MAC at a level equal to the lowest cost at which the drug is generally avail-
able to providers.
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2. The reimbursement that n pharmacist receives for drugs he provides for
medicare and medicaid patients. This fee is based on estimates of the cost
of buying the drug plus a dispensing fee, or his usual charge to the public,
whichever is smaller.
3. A list of most frequently prescribed drugs, organized by therapeutic
category. and the price a pharmacy generally pays for each drug. The list
will be sent to pharmacists and physicians.
The program is estimated to provide a savings of $60-75 million a year in
Federal and State reimbursement systems resulting from dispensing lower cost
generic drug products.
STRONGER CONTROLS FOR DEVICES AND DIAGNOSTIC PRODUCTS
Medical devices and diagnostic products constitute a large and rapidly growing
segment of the health products industry. In 1971 it was estimated that total retail
sales of medical devices was more than $3 billion, and likely to double in the next
10 years.
Because of the technology of the field is highly specialized. the kinds of regula-
tion needed to protect the public from unsafe or ineffective products must also
be specialized. Legislation establishing appropriate systems of control for dif-
ferent categories of products and materials is being considered by Congress.
PROTECTING THE HEARING IMPAIRED PATIENT
In response to the open hearings on "Hearing Aids and the Older American,"
conducted by the Subcommittee on Consumer Interests of the Elderly of the
Special Committee on Aging, U.S. Senate. the Secretary of the Department of
Health, Education. and Welfare established an Intradepartmental Task Force on
Hearing Aids in March 1974. The task force was charged by the Secretary to
examine the issues related to the delivery of quality hearing aid health services
as described in "Paying Through the Ear: A Report on Hearing Health Care
Problems" prepared by the Retired Professional Action Group and the Senate
hearings on "Hearing Aids and the Older American"; determine the role depart-
mental authorities and resources should play in remedying the problems in the
hearing aid health care delivery system: and recommend a feasible course of
action to the Secretary.
The task force completed its study and prepared the "Final Report to the
Secretary on Hearing Aid Health Care." On September 26, 1975. DHEW Secretary
Mathews accepted the final report and charged the office of the Assistant Secre-
tary for Health with the responsibility for implementing the final task force
recommendations:
The Food and Drug Administration is playing a major role in the implementa-
tion of key recommendations designed to protect the health and welfare of the
hearing impaired patient. The task force recommended that the FDA develop,
promulgate, and enforce hearing aid labeling regulations, and that they contain
a provision requiring a medical clearance as a condition for sale of a hearing
aid. After studying the final report, the Commissioner of Food and Drugs has
determined that it is in the best interest of the public health to require uniform
professional and patient information for hearing aid devices. Accordingly, the
agency is developing a proposed rule for professional and patient labeling for
hearing aid devices. This proposal. which incorporates the medical clearance
recommendation, is expected to be published in the Federal Register in early
1976. This rule will protect the health and safety of hearing impaired patients
by (1) defining and clarifying the type of information that hearing aid manu-
facturers must include in the labeling to provide patients with adequate direc-
tions for the safe and effective use of the hearing aids: (2) specifying the tech-
nical performance data which must be included in the labeling to insure that
hearing aid professionals are provided with information essential to the correct
selection and fitting of a hearing aid: and (3) requiring that patients undergo
a medical evaluation prior to the purchase of a hearing aid if any of seven
otological conditions are present.
The task force recommended that the FDA enlist the assistance of appropriate
organizations in the development of performance standards for hearing aids.
For the past year, the agency has been working with the Hearing Aid Industry
Conference and the American National Standards Committee S-3-48 Working
Group on Hearing Aids to accelerate the adoption of a suitable performance
standard for hearing aids. The development and application of a hearing aid
performance standard will help reduce any variations of performance and qual-
ity found in hearing aid devices. The S-3-48 Working Group on Hearing Aids has
informed FDA that the American National Standards Institute will recognize
a voluntary consensus standard for hearing aid devices early in 1976. The Food
and Drug Administration regards the adoption of a hearing aid standard by the
industry as a positive step forward to assure that hearing impaired patients
receive quality hearing aid health care.
IMPROVED STANDARDS FOR BLOOD PRODUCTS
In late 1975. the Food and Drug Administration announced two actions to
assure uniform quality of blood products throughout the United States and to
prevent the spread of hepatitis from donated blood.
The first action makes final new standards for collecting. processing. and stor-
ing blood and blood products. The standards consist of good manufacturing prac-
tices (GMP's) that will be required of all blood banks, transfusion facilities, and
other blood processing facilities.
The second action is a proposal to require labels on all blood for transfusion
to indicate whether it was collected from a voluntary or paid donor. The label
also would be required to say that blood obtained from paid donors is associated
CAN - LINO - 170
with я higher risk of transmitting hepatitis. The proposed regulation was pub-
lished for public comment.
These two actions are part of a continuing FDA program to improve the
quality of blood provided by the nationwide blood service complex. The program
applies to 6.000-7.000 blood banks operating within the United States.
The new standards require that all blood donations be tested for hepatitis;
establish standards for performance of safety tests before administration of
blood or blood components to patients: require immediate reporting of fatal re-
actions occurring from the donation or receipt of blood to FDA: require mainte-
nance of standard operating procedure manuals; and extend recordkeeping
requirements for blood processing.
SAFER ELECTRONIC PRODUCTS
The promulgation and effectiveness of standards for consumer-type electronic
products by the FDA can be of particular importance to senior citizens because
they comprise such an important element of the consuming population. During
1975, the FDA strengthened a performance standard already on the books for
microwave ovens, and began to lay the groundwork for (1) a standard to protect
consumers from the potential hazard of exposure to ultraviolet light which can
be emitted by sun lamps, and (2) a performance standard for microwave di-
athermy equipment.
Both sun lamps and microwave diathermy can be very important adjuncts to
maintaining the health and well-being of older persons. The FDA published re-
porting requirements for both sun lamps and certain types of medical ultraviolet
lamps. The data requested will be useful in evaluating the overall radiation
safety of such products, a phase in the process of protecting the consumer who
uses sun lamps for either cosmetic or health reasons.
The use of microwave diathermy to assuage aches and pains of persons of all
ages highlights the importance of the FDA's initiating action to develop and
administer a performance standard for microwave diathermy. The agency's intent
to develop such a standard was announced June 3. Microwave diathermy heats
tissue beneath the skin and because excessive microwave radiation may be harm-
ful. the agency felt the urgency to protect the consumer by stipulating certain
equipment performance criteria.
The standard covering microwave ovens-which can be a great boon to the
aging both for convenience and speed of cooking-has been on the books since
October 1971. To keep protection of the consumer at the highest and most prac-
tical level. the FDA moved to require manufacturers to place user labels on
ovens, warning them against practices that might cause ovens to emit potentially
hazardous radiation.
FOOD PROTECTION
High overall quality and continuous change are the two main characteristics
of the American food supply. Food technology and the private enterprise system
have revolutionized the food life style of the American people. Consumers collabo-
rate in the process by providing an eager market for work-saving "convenience"
foods of all kinds. But along with the new products and technology have come
new problems of food safety and questions as to the nutritional adequacy of the
changing American diet.
Actually, this is not a new situation, but one which has grown rapidly in com-
plexity and importance. What is new is the FDA's planned efforts to cope with
today's food problems.
The Federal Food. Drug. and Cosmetic Act makes industry responsible for
food purity and safety. The FDA checks only a minute fraction of the total
supply. Its role is to motivate compliance and to inspect, when necessary, to
check compliance. The consumer's best hope for safety and quality in food there-
fore lies in the development and maintenance of adequate in-plant quality con-
trol programs. Promoting quality control at the plant level has become the pri-
mary goal of FDA regulation. In the past 2 years. a variety of new approaches
to this goal have been put into operation. They include new techniques of inspec-
tion, sampling. and analysis, and a massive development of explanatory regula-
tions and guidelines.
NUTRITIONAL QUALITY AND INFORMATION
The nutritional quality of the diet has special importance to the older gen-
eration. Reduced income and problems in food selection and preparation can have
serious effects on the health of this age group. This is one of the reasons FDA has
instituted a series of regulations which provide more nutrition information to
consumers and help to assure the quality of the American diet.
Nutrition labeling became mandatory on July 1, 1975, on foods to which a
nutrient is added or for which a nutrient claim is made, and many other foods
are nutrition-labeled voluntarily by manufacturers.
A regulation published on June 14. 1974. proposes to establish formally the
national policy in regard to addition of nutrients to foods. It seeks to assure the
proper balance and appropriate levels of nutrients, i.e., vitamins, minerals. and
protein, in the food supply. Also, regulations which establish nutritional quality
guidelines for classes of foods such as breakfast cereals, main dish products, and
meal replacements have been proposed.
Other "common or usual name" regulations assure more informative and de-
scriptive names on foods where consumers might be misled: for example, a con-
spicuous statement as to the percent of fruit juice contained in a diluted fruit
juice or the fact that an ingredient must be added to a packaged food in order
to complete the recipe.
CAN - LINO - 171
It is one thing to insure that foods are nutritious and informatively labeled.
and another to get consumers to take advantage of nutrition labeling. Therefore,
FDA has entered the field of nutrition education and is developing programs for
all educational levels. Simultaneously, ongoing studies are measuring consumer
knowledge about nutrition and how well or wisely the American consumer eats.
DIETARY SUPPLEMENTS OF VITAMINS AND MINERALS
Regulations governing the labeling and composition of vitamin/mineral prod-
ucts were issued by FDA in 1973 in response to widespread fraud and misrep-
resentation in the marketing of these products and widespread confusion among
consumers as to what is truly a useful product. Leading national organizations
representing retirees and consumers supported these regulations. but several suits
against the regulations were brought by manufacturers of vitamin/mineral prod-
ucts. These suits were consolidated in the U.S. Court of Appeals in New York
City. That court, in a judgment rendered on August 5. 1974, broadly sustained
the regulations but invalidated some parts and asked reconsideration of other
parts.
The court ruled that those high-poteney vitamins and minerals which are
generally recognized as safe for consumers and for which no therapeutic bene-
fits are claimed, could not be defined by FDA as drugs on the basis of potency
alone. FDA was directed to consider whether other combinations of vitamins
and/or minerals and higher vitamin and mineral potencies than those stipulated
in the 1973 regulations should be permitted.
The Food and Drug Administration published tentative revisions of the regula-
tions on May 28, 1975. Under the revised regulations, dietary supplements con-
sisting of a single vitamin or mineral may be sold at any potency generally recog-
nized as safe. (On the basis of proven toxicity, high potency preparations of
vitamins A and D are considered to be prescription drugs and will continue to be
regulated as such.) FDA also invited applications from interested persons for
higher potencies and different combinations from those that would be permitted
under the 1973 regulations, and these applications are being considered at this
time.
"Health food" interests have continued to argue against FDA regulations, and
bills have been introduced which would limit FDA control over vitamin/mineral
preparations. The Food and Drug Administration and the Department of Health,
Education, and Welfare, however, oppose efforts which would nullify or further
limit FDA control of these products.
C. HEALTH RESOURCES ADMINISTRATION
Although each bureau of the Health Resources Administration has been involved
to some extent in efforts which address the health concerns of the aged, the
National Center for Health Services Research and the National Center for Health
Statistics are the primary components which have conducted research activities
and data efforts primarily focused on the aged.
The National Center for Health Services Research, which has as its mission
the development of research efforts to improve the health status of the total
population, has included as an integral part of its program health services re-
search issues of the elderly. Special emphasis has been placed on research efforts
relating to acute and long-term care which will be utilized to improve the quality
of care received by the elderly.
The National Center for Health Statistics has in its data collection activities
of the general population gathered and disseminated statistical information
applicable to the aged. Its current research activities examine measurements of
the health and nutritional status of the elderly. their utilization of health facil-
ities and the characterístics of nursing home residents.
The Bureau of Health Planning and Resources Development and the Bureau of
Health Manpower, in accomplishing the goals of their overall missions, have been
involved in efforts which indirectly impact upon the health status of the elderly
(and the health services which they will receive. Presented below is a brief sum-
mary of each bureau's efforts as they relate to the health concerns of the aged.
NATIONAL CENTER FOR HEALTH SERVICES RESEARCH
The National Center for Health Services Research is responsible for under-
taking and supporting research, evaluation and demonstration projects with
regard to: (1) Accessibility, acceptability, planning. organization, distribution,
technology, utilization, quality, and financing of health services and systems; (2)
the supply and distribution. education and training. quality, utilization, organi-
zation and costs of health manpower; and (3) the design, construction, utilization,
and costs of facilities and equipment.
Inasmuch as the National Center for Health Services Research has as its
mission research to improve the health of the total population. it follows that
health services for the elderly, including the modifications and special services
required by this age group, are an integral part of the total program.
As a part of its total mission, the National Center places great emphasis on
research relating to long-term care. In recognition of the need to address these
problems. the National Center for Health Services Research is preparing a special
grant solicitation for research on innovative approaches in the area of long-term
care. It is anticipated that at least $1 million will be provided for such research.
Public Law 93-353, authorizing creation of the National Center for Health
Services Research, requires the establishment of at least six centers of health
services research, including special emphasis centers, one to be called Health Care
Technology Center, and one to be designated Health Care Management Center.
It is anticipated that when these centers become operational, long-term care and
the problems of the aged will be an integral part of research thrusts of these
centers.
CAN - LINO 172
Within the National Center for Health Services Research, the Division of
Long-Term Care carries the major responsibility for development of long-term
care strategy. research and development activities for long-term care in all set-
tings (institutional and noninstitutional) and the short term training of person-
nel who work in long-term care institutions. Moreover, the Division of Long-Term
Care works in concert with the other divisions in the National Center for Health
Services Research on all matters relating to long-term care and the elderly.
In the following description of research of relevance to the aged being con-
ducted by the National Center for Health Services Research, it should be noted
that in addition to the research specifically for the elderly. and the long-term care
research that has a strong focus on the elderly, there is also included reference to
broader research inquiries that span acute and long-term care interests. Findings
from such studies can be utilized to improve the quality of care received by the
elderly and lead to a more effective health delivery system to benefit the elderly
along with the rest of the population.
RESEARCH AND DEVELOPMENT
Program activities included extramural research experiments, demonstrations,
and technical assistance directed toward the development and evaluation of inno-
vative approaches to the improvement in the quality of life and quality of care
for the elderly and disabled.
Continued emphasis in 1975 was placed on: (1) Measuring the quality of care,
including the development of instruments to insure that the most appropriate
level of care is being provided (2) increasing the options of patients for receiving
needed care in the appropriate setting through a balanced array of institutional,
ambulatory, and home health services: and (3) offering consumers and the public
mechanisms to insure a greater and more knowledgeable voice in demanding
quality of care and increased options.
The major areas of research concentration in 1975 included intensified activity
in relation to implementation of section 222 of Public Law 92-603 in developing
demonstrations to determine cost-effectiveness of day care and homemaker serv-
ice, further testing of the collaborative patient assessment instrument, develop-
ment of a cost data reporting system for nursing homes related to patient
characteristics and developing and evaluating a quality evaluation system as a
part of a State data system to determine the feasibility and impact on quality of
the use of such indices.
Through grants and contracts, studies were conducted in the broad areas for:
(1) Quality of care: (2) management information and data systems; and (3)
alternatives in long-term care.
Quality of Care
Research and demonstration efforts are continuing in the development and test-
ing of mechanisms and instruments for patient assessment. In 1975, five projects
were completed, with three continuing into 1976 and one new contract was
awarded.
An Approach to the Assessment of Long-Term Care
The purpose of this grant is to demonstrate a system of assessment of the status
of long-term care patients that (1) Provides information about patients for deci-
sions as to type and place of care appropriate to their needs; and (2) reflects
changes over time SO that progress and outcomes of patients may be related to
information about quality of care. The basic tool for the assessments has been
the patient classification developed by four research groups and published by
the National Center for Health Services Research as HEW Publication No. HRA
74-3107, "Patient Classification for Long-Term Care: User's Manual." During
the course of the current grant, approximately 4.500 assessments have been made
of 1.500 nursing home patients. Statistical analyses are now in progress. Com-
prised of a set of descriptors that form a uniform terminology to assess individual
status, the information helps the decisionmaker in care-planning. placement,
appropriateness of care, staffing. reimbursement. utilization, and medical review.
Numerous requests have come to the Division of Long-Term Care from providers
for assistance in the implementation of the assessment system in their own
facilities. Lectures and workshop leadership have been given by the Project Direc-
tor to nursing home professional personnel. Orientation, training and consulta-
tion have been provided to other research projects and surveyors in regional offices
and State agencies.
Evaluation of Outcome of Nursing Home Care
This pilot grant studied the variables related to the outcome of nursing home
care, using a random sample of residents in six facilities. data on resident
mental and physical satus and satisfaction with services were collected twice
over a span of time. Staffing patterns, costs, employee and administrator atti-
tudes, environmental and structural variables and ownership, control status
among other variables, were considered for relationship to outcome measures
of nursing home care. Also included was an assessment of the reliability and
validity of the data collection instruments as well as ascertaining the accepta-
bility of the research protocol and design to nursing home administrators.
Regulatory Use of a Quality Evaluation System for Long-Term Care
This contract is an expansion of work initiated by Rush-Preshyterian-St.
Luke's Medical Center in 1972. The quality evaluation system (QES) consisting
of survey procedures and a quality construct for scoring the results is being
tested in a regulatory mode by incorporating it into the long-term care automated
system of the Illinois Department of Public-Health and will be utilized in 100
CAN-LINO-173
long-term care facilities by State surveyors twice. The first set of data about
patients and facilities has been completed. Should this quality module prove
feasible and valid in the regulatory mode, it will then be available for use in other
State automated systems.
A Comprehensive Community Approach to Nursing Home Care
This contract developed in a selected community, through collaboration of
nursing homes, medical care facilities and services, health and social service
agencies and programs, a realistic community plan to enable nursing homes to
utilize community resources to meet the needs of inpatients or plan for a pa-
tient's return to community living without interruption of his continuing care
needs. The project staff carefully documented the processes of planning, organiz-
ing and implementing the program to provide a foundation for future develop-
ment and testing in other communities, The final report was most informative
and this planning process should be further demonstrated.
Health Services for Long-Term Care
This related grant was directed at modifying and testing the collaborative
patient assessment instrument to determine patient profiles, assess patient care
needs, and develop the protocol for producing care plans. Appropriate care plans
are being developed and compared with observed patterns of service to develop
guidelines for review of the appropriteness and extent of services provided. Re-
fined guidelines have been implemented to selected sites to test regional generality
and applicability for PSRO. A detailed analysis of the data collected on this
phase of the project is now in process.
Evaluation of Alternative Systems for Services for Aged at High Risk for
Institutionalization
This research and demonstration project developed improved evaluation proce-
dures to assess the impact of intervention on impaired elderly persons, to study
the differential outcome of several alternative service delivery systems, to obtain
accurate estimates of the true incidence of significant impairments among elderly
persons, impairments which place them at high risk for institutional care, and
in the process of achieving the first three goals, deliver actual clinical services
to impaired elderly persons. The instrument was tested for reliability and valid-
ity, and is now in the process of modification for use in a nationwide study of
all age groups. The implications of such a study include the development of a
valid and reliable assessment tool and additional data relating to cost-effective-
ness of health and social services for individuals receiving long-term care.
Alternative Working Models for Medical Direction in Skilled Nursing Facilities
This new project will assess the first year's compliance with the new regula-
tions relative to medical direction in skilled nursing facilities, identifying the
backgrounds of and services provided by medical directors, including the benefits,
problems and costs inherent in different models.
A study is being directed toward the development of an outcome measure
of health care: The sickness impact profile (SIP). The SIP is a scaled measure
of sickness-related dysfunctions.
A "health accounting" strategy to permit physicians to establish their own
outcome standards is being developed and will be evaluated.
Support is being provided for analysis of data on lung cancer patients to
identify factors associated with differential survival, and to develop principles
for construction of clinical indices to hopefully lead to improved lung cancer
treatment.
The experiments authorized in 1972 by Public Law 92-603 have provided the
greatest challenge in implementation. Public Law 92-603 (amendments to the
Social Security Act of 1972) section 222(b) (E) and (H) enacted on October 30,
1972 authorized the conduct of experiments and demonstrations "to determine
whether coverage of intermediate care facility services and home maker services
would provide suitable alternatives to post-hospital benefits presently provided
under title XVIII of the Social Security Act" and "an experimental program to
provide day care services-for individuals eligible to enroll in the supplemental
medical insurance program established under part B of titles XVIII and XIX
of the Social Security Act
Methodology included the identification of target populations for the new
services. developing sources of referral of patients. to the demonstration proj-
ects, acceptance of potential patients in the demonstrations, initial patient assess-
ment and developing of care plans, randomization of demonstration population
into control and experimental groups, and periodie reassessments of both experi-
mental and control patients.
Valuable information should be obtained on the utilization by patients of the
new optional services and the cost not only of providing the covered medicare
sérvices, but also the new optional services to the experimental group of pa-
tients, plus out-of-pocket costs and other third party reimbursements for health
care received by the experimental group. The contribution of multidisciplinary
patient assessment and care planning with projected outcomes should also provide
a great deal of information in relation to testing the patient assessment material.
The following is a listing of contracts in this category:
Day care and homemaker services-San Francisco Home Health Service,
San Francisco, Calif.: Lexington-Fayette County Health Department,
Lexington, Ky.
Homemaker services-Inter-City Home Health Association, Los Angeles,
Calif.; Homemaker-Home Health Aide Services of Rhode Island, Providence,
R.I.
Day care-Burke Rehabilitation Center, White Plains, N.Y.; St. Camillus
Day Care Program, Syracuse, N.Y.
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In 1975. all these projects became operational with assessment teams made
up of 11 physician, a public health nurse and a medical social worker who used
the patient assessment instrument to measure performance in the areas of activi-
ties of daily living. Instrumental activities, social contacts, reality orientation,
etc., and developed care plans based upon the assessed needs.
The specific objectives of these contracts are to demonstrate, experimentally,
provision of two services, namely, homemaker services and day care services,
in order to: (1) Determine the cost of these services; (2) compare the cost of
providing the two new services and the currently covered services (skilled nurs-
ing facility care and home health services) and (3) determine and compare
the extent to which the new services (as defined) will enable an eligible indi-
vidual to reach and maintain his highest level of performance or will prevent
or retard institutionalization as compared to the effectiveness of benefits currently
provided.
Several of the contractors are also undertaking additional site-specific research
activities during the demonstration.
Long-Term Care Reimbursement Erperiments-Eraluation of Experiments in
Intermediate Care Facilities. Homemaker and Day Care Services
A separate contract was awarded for evaluation of the experimental demon-
strations with respect to the achievement of project goals and objectives. The
evaluation will isolate reliable from unreliable findings SO that policy implica-
tions can be drawn with respect to expanding medicare/medicaid benefits to
include day care and homemaker services.
Two additional projects are funded under the "222" demonstrations. "Triage:
Coordinated Delivery of Services to the Elderly" is an innovative program de-
signed to provide a central entry system for persons over 65 years of age, who
live in a seven town area in central Connecticut, and have health. social, econom-
ic needs for long-term care services. These individuals will have their needs
assessed by nurse clinicians and be referred to the appropirate agency (s)
and be followed during the duration of the project to determine how well the
needs were met. and be reassessed at regular intervals to determine emerging
needs for care. A determination will be made of the cost-effectiveness of the
services provided. Specific objectives are to: (1) Reduce per capita expenditures
for health care: (2) increase effectiveness of services: (3) reduce incidence
of institutionalization: (4) increase number of home services: and (5) lead to
greater integration of human services in central Connecticut. The purpose of
the evaluation is to determine if the quality of care was improved. evaluate
outcomes and determine cost effectiveness. Reimbursement for services provided
in this program is being made through a waiver arrangement under SSA as part
of the Public Law 92-603. section 222 experiments.
Day Hospital Service Rehabilitation Medicine
This is a grant conducted in New York State. It is designed to determine the
feasibility of operating a day hospital service in the Department of Rehabilita-
tion Medicine of a large municipal hospital serving a primarily disadvantaged
population. The study population is made up of seriously disabled adults, eligible
for medicare and medicaid. residing inwa specific hospital district. This program
is expected to become operational early in 1976.
Effects of an Emergency Alarm System for the Aged
This grant has been awarded to measure the effects of an automatic emergency
alarm and response system on the psychological and social well-being of elderly
persons at risk, including the cost-effectiveness of such an intervention. It will
be a controlled impact study of elderly persons in public housing. who are
severely or multiply handicapped and clinically judged to be physically vulner-
able and/or relatively socially isolated. The major outcome measures to be
studied for the effects of use of the automatic emergency alarm and response
system are as follows: (1) Health status: (2) quality of life indicators (morale,
social isolation, etc.) (3) institutionalization: (4) time of death: and (5) the
costs of both information as well as formal health and welfare maintenance
services. Since it is hoped that the intervention will have the potential for pro-
viding a new service for large numbers of the elderly and disabled nationwide,
this study will develop projections of cost effectiveness. guidelines for the sys-
tem's operation, and assessment procedures for effective client screening. The
staff began interviewing potential participants in October and training has begun
for "Life-Line" installers.
Alternatives to Institutionalization for the Aged
The aim of this project is to improve the quality of life of elderly inpatients in
a mental health center through placement in specialized living arrangements
(artificial family or boarding home program), as alternatives to institutional
care. at a cost lower than that of nursing home care or inpatient psychiatric
hospitalization. Evaluation of the effectiveness of this program from the stand-
point of quality of life and costs is currently underway. This project is in its
third and final year and has been joint funded with the Administration on Aging.
Housing and Health Care Paths of Dependent Elderly
A grant to study the effects of medically oriented housing deals with a specific
kind of residential care for aged persons who are at risk for long-term institu-
tional care. It is an experiment in which medically oriented housing is seen as
enabling handicapped and disabled people to remain essentially independent
in daily living. As such, medically oriented housing is viewed as an alternative
to long-term institutional care. The methodology involved impact on residents
in the housing facility over a 5-year period; development of separate prediction
scales for benefits to people for medically oriented. and assessment of what
happens to persons who moved from institutional care to the medically oriented
residence. This project is joint funded with the Administration on Aging.
CAN - LINO - 176
target populations that can, in turn, serve as a guide to determinations relating
to health service resource allocations.
Four grants were funded to provide data collection and analysis relating
to catastrophic illness. One proposal plans to develop a national profile spelling
out the characteristics of catastrophic illness in the United States: the second
involves time-series analyses of eatastrophic illness in the Nation in order to
enhance the preparation of actuarial cost estimates of national catastrophic
insurance programs: the third award plans a targeted study of entastrophic illness
addressing spinal injury and the fourth plans to target catastrophie illness
addressing myocardial infarction.
Special Project
The National Center for Aging and Black Aged plans to provide a comprehen-
sive program of coordination, communication, information. and consultative
services to meet the need for assistance in improving meaningful policies and pro-
grams involving aged blacks. Consultants include researchers, educators, and
scholars on the aged. Through knowledge gained from a comprehensive review
of research. a sound basis for program planning for black elderly will be built.
It is planned that position papers will be produced and disseminated. The center,
as an interpreter of the needs of the black elderly, will be available to provide con-
sultation to agencies and organizations, both public and private, who desire as-
sistance. This project is joint-funded with the Administration on Aging.
Future Directions
Continued research into alternatives in long-term care will be directed at
evalution of new services and the study of the cost effectiveness of different con-
stellations of services and the population base needed to support these patterns
of service. Improved assessment tools are necessary to study the behavioral and
social aspects of patients if the quality of care delivered is to be improved. Man-
agement information toois need to be further tested and the cost effective use
and limitations of each need to be better defined. The stability of the cost re-
lated patient characteristics on a sample of "average" facilities must be tested
before they are applied to the universe. Additional testing needs to be carried out
in relation to community planning for appropriate and cost effectiveness delivery
of services to meet identified health and social needs of indivduals.
TECHNICAL ASSISTANCE IN DAY CARE
In addition to its lead role in carrying out the experiments in day care con-
ducted in response to the mandate contained in Public Law 92-603, the Division
of Long-Term Care has carried on increasingly heavy burden of providing tech-
nical assistance on day care to public and private organizations throughout the
Nation as well as to other Federal components concerned with the development
of such care.
At the International Gerontological Conference in Israel, the Deputy
Director of the Division of Long-Term Care presented a paper on this
topic, after which she visited health programs for the elderly in Israel and Eng-
land, with particular emphasis on Day Hospitals. The resulting report, "Day
Hospitals in Israel and Great Brtain" has been in great demand both in the
United States and abroad.
Presentations in day care were also made by the Deputy Director at the Na-
tional Conference of the Gerontological Society, followed by technical consulta-
tion at a special post-conference workshop on day care. Technical consultation was
also provided at workshops on day care sponsored by a variety of organizations.
Future plans include sponsorship by the Division of Long-Term Care of a
national conference on day care within the next year and an international con-
ference at a later date.
PROVIDER IMPROVEMENT TRAINING AND TECHNICAL ASSISTANCE
Responsibility for directing Federal resources toward short-term training of
personnel employed in long-term care facilities continues in the Division of Long-
Term Care (Provider Improvement Branch). Since the inception of provider
training activities with the administration's nursing home initiatives of 1971,
there has been continual growth of training opportunities through a variety of
strategies. With an appropriation of $1.8 million each year since 1971, the number
of training opportunities supported has reached approximately 124,000 profes-
sional and paraprofessional long-term health care personnel as of December 31,
1975.
In 1975, the Department continued to expand efforts toward upgrading the
quality of care in the Nation's nursing homes by improving the skills of those
responsible for providing that care. Twenty-five contracts totaling almost $1.3
million were awarded: 11 of these were new contracts and 14 were continua-
tions of previously awarded contracts which have proved successful. Three addi-
tional contracts were continued without additional funds.
New Contracts
New contracts included the establishment of a Regional Long-Term Care Educa-
tion Center for region IV in the Raleigh-Hillhaven Convalescent Center in
Raleigh, N.C., under the auspices of the Hillhaven Foundation of Takoma. Wash.
A contract was awarded to the Western Consortium for Continuing Education
for the Health Professions, Inc. in San Francisco, Calif.. to explore and deter-
mine program needs and potential for patient/family education in long-term care.
CAN - LINO - 177
The Association of State and Territorial Health Officials was awarded a contract
to assist in developing State plans for purposes of implementing education pro-
grams in rehabilitation nursing for all levels of nursing personnel.
In a continuing effort to increase the capability of providers to meet Federal
regulations, a new contract was awarded to the American Nurses Association
to develop guidelines for RN consultants to intermediate care facilities. Similarly,
the contract with the American Medical Association for nationwide training of
medical directors in skilled nursing facilities was continued for an additional
year.
The National Association of Social Workers, Inc., was awarded a contract to
develop a guide for social work consultants to skilled nursing and intermediate
care facilities. The need for a consultant guide was identified during the course of
"Projected Provide." a contract to NASW to train social workers and social,
work designees in long-term care facilities.
A contract was awarded to the American Society for Geriatric Dentistry to
train dentists and dental auxiliary personnel who serve or intend to serve
patients in nursing homes in the proper techniques of oral health for the aged
and the chronically ill as well as to develop an understanding of how oral health
services may be arranged for nursing home patients. This program is being carried
out in collaboration with the American Dental Association and State dental
associations.
The American Geriatrics Society was awarded a contract to revise and update
Clinical Aspects of Aging, volume IV, of this series "Working With Older People:
A Guide to Practice." The revised volume will serve as an educational adjunct
to the clinical literature in long-term care. The volume will be practical in ap-
proach, focusing on the problems of aged patients that are often overlooked. and
is directed at the physician and other health professions with particular emphasis
on assisting the medical director of the nursing home. Topics to be included are:
general evaluation of the elderly, psychosocial aspects of aging, drug therapy,
record systems, role of the medical director. alternative settings for health care
service delivery, the role of different health professions in care of the elderly,
nutrition, and specific health problems of the elderly.
Regional Long-Term Care Education Centers
Continuing emphasis is placed on an innovative approach toward meeting train-
ing needs through the establishment of regional long-term care education centers.
These regional centers call for training for multidisciplinary teams sent to the
center by their employing facilities. The training encompasses both academic and
experiential opportunities and a philosophy of training the team to train their
coworkers. In addition, the centers are to provide to the target population of
provider personnel a series of workshops in subjects based on need in their respec-
tive areas. Still further, some centers provide a week's experience for surveyor
teams from state health departments in matters relating to quality of care of
the long-term. patient. In 1973, six regional training centers were established,
and in 1974:an additional three centers were added. In 1975, eight of these centers
were continued and a new one added, with primary emphasis given to training in-
service education personnel, enabling the Centers to establish satellite centers
to increase their trainee population, and expansion of the short-term specialty
seminars. The regional centers are: New England Rehabilitation Center, Woburn,
Mass. (region I) Burke Rehabilitation Center, White Plains, N.Y. (region II)
Philadelphia Geriatric Center, Philadelphia, Pa. (region III) Hillhaven Conva-
lescent Center, Raleigh, N.C. (region IV) : Sister Kenny Institute, Minneapolis,
Minn. (region V) Swope Ridge Health Care Center, Kansas City, Mo. (region
VII) Beth Israel Hospital and Geriatric Center, Denver, Colo. (region VIII)
Garden Crest Convalescent Hospital, Los Angeles, Calif. (region IX) and L. C.
Foss Sunset Home, Seattle, Wash. (region X).
Media Center and Audiovisual Training Aids
A contract awarded to Capital Systems Group, Inc., Rockville, Md., to develop
a media center was completed in 1975. The media center will serve as a source
of published material. audiovisual aids, training curricula and research docu-
ments related to gerontology as well as to the health, environmental and psycho-
social aspects of long-term care. This center will be for the use of contractors,
students, researchers, and others. It is anticipated that the center will become
operational in 1976.
Two contracts to develop audiovisual training aids were completed in 1975
and released through the National Audiovisual Center: "Working in a Nursing
Home," produced by Robert J. Brady Company, is for general staff develop-
ment: "This Way to Reality," produced by the American Hospital Association,
is for multidisciplinary training in reality orientation.
Regional Office Long-Term Education Coordinators
A major aspect of the approach to provider training is through the Regional
Office Long-Term Care Education Coordinators. The Regional Coordinator in each
DHEW region meets with groups from within that region to plan strategies iden-
tifying and meeting specific training needs and directing available resources to-
ward meeting needs, while at the same time helping to maximize the utilization
of local resources and local expertise. The Regional Office Long-Term Care Educa-
tion Coordinators have been very effective in maximizing the national training
contracts through their work with State affiliates of the national professional
organizations.
Approximately 30 percent of fiscal year 1975 funds were programed by the
regional offices to support State and local short-term training workshops and
institutes.
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WORKSHOPS AND CONFERENCES SPONSORED BY DIVISION OF LONG-TERM CARE
A workshop on Geriatric Aural Rehabilitation was held in February 1975,
and was attended by representatives of 25 Federal agencies and national profes-
sional, provider and consumer organizations. This workshop highlighted both the
scope of geristric aural problems and their rehabilitation potential.
In March 1975 the staff of the Division of Long-Term Care presented a seminar
on short-term training during the annual legislative workshop of the American
Association of Homes for the Aged. Discussion at the seminar evoked the con-
cern that more work needs to be done to assure that training programs impact
on those personnel directly in contact with patients on a day by day basis. The
Division plans to give increased attention to aide training and training of
trainers of aides.
In April 1975 a Workshop on Long-Term Care Staff Education was held in
cooperation with the American Health Care Association. bringing together Fed-
eral and AHCA National and State personnel concerned with provider training:
This workshop provided a forum for sharing information and discussing needs
and possible strategies. A similar workshop is planned for spring of 1976.
1976 PROJECTIONS
Findings of the Office of Nursing Home Affairs Facility Improvement Study
and the Subcommittee on Long-Term Care of the Senate Special Committee on
Aging are major factors in identifying continuing provider educational needs. In
addtion, national and State provider organizations assist in the training needs
assessment process. Evaluations emanating from completed and ongoing train-
ing contracts are a further sources of input into determining and continuing nro-
vider training needs.
As the long-term care field continues to play an increasingly important role
in the Nation's health care delivery system, it is imperative that the capability
to respond to continuing education needs of provider personnel be developed at
the facility level. Top priority will be given in 1976 to developing this capability
through such activities as supporting the training of inservice and staff develop-
ment personnel in individual facilities or consortia of facilities. Increased atten-
tion will also be given to psychosocial aspects and restorative/rehabilitative
concepts in long-term care. Continuing unmet needs in aural rehabilitation and
podiatric health care training will also be addressed.
FUNDING THROUGH THE BUREAU OF HEALTH MANPOWER
Public Law 93-353, the legislation authorizing the creation of the National
Center for Health Services Research, does not give legislative authority for
short-term training to the National Center for Health Services Research. For
this reason, starting in 1975. provider improvement short-term training activities
have been funded by the Bureau of Health Manpower of the Health Resources
Administration.
COLLABORATIVE ACTIVITIES WITH FEDERAL AGENCIES
Division of Long-Term Care staff has a strong ongoing working relationship
with the Office of Nursing Home Affairs and assisted in the preparation of the
report of the nursing home survey. The Division of Long-Term Care Director
serves as a permanent member of the Office of Nursing Home Affairs Interagency
Advisory Group and the Interagency Task Force on Short-Term Training. The
latter group has been formed to consider the special short-term training needs
that will arise as a result of publication of new regulations relating to nursing
homes.
The Division of Long-Term Care Deputy Director participates in the Work
Group of the Interdepartmental Task Force on Research in Aging, the Inter-
agency Committee on Prevention, and is an Interagency Consultat for Research
Planning In Aging (National Institute on Aging).
The Deputy Chief of the Research and Development Branch serves as a mem-
ber of the Interagency Task Force on Home Health Services and the Interagency
Advisory Group to Health Services Administration, Community Health Services
on methols and procedures for administration of grants authorized under Public
Law 94-63.
The Division of Long-Term Care staff works closely with other programs such
as the National Center for Health Statistics, Division of Health Resources Utili-
zation Statistics, the Bureau of Health Planning and Resources Development,
the Bureaus of Quality Assurance and Community Health Services of the Health
Services Administration, the Office of Planning, Research and Evalua-
tion and Medical Services Administration of the Social and Rehabil-
tation Service, the Division of Direct Reimbursement of the Social Security
Administration, the Administration on Aging, the National Institute of Mental
Health, the National Institute on Aging, the Veterans Administration, and the
Department of Labor.
PARTICIPATION WITH NON-GOVERNMENTAL ORGANIZATIONS AND AGENCIES
The Director, Division of Long-Term Care, participated in and delivered papers
on Social Work Consultation at the Midwest Health Conference, participated in
the National Assembly of the National Medical Association, was the keynote
speaker at the Social Work Symposium on "The Family and Death," sponsored
jointly by the Department of Social Services of the Presbyterian Hospital in
New York City, Columbia University's College of Physicians and Surgeons
(Department of Psychiatry), School of Social Work, and Cancer Research Center;
The Foundation of Thantology and Columbia-Presbyterian Medical Center in
New York City.
CAN - LINO 179
The Chief of the Research and Development Branch presented a paper on
Research in Long-Term Care at the North Dakota State Nurses Association.
The Division of Long-Term Care provided financial support and participated
in the National Conference on Social Welfare's Annual Forum Institute series on
Health and Health Care Delivery which was held in San Francisco in May 1975.
The Division's Institute addressed Human Factors in Long-Term Care and
commissioned four authors to develop the following position papers:
(1) Reichert, Kurt. "Social Work Contributions to the Prevention of Pre-
mature Functional Death."
(2) Brody, Elaine, "Long-Term Care: The Decision-Making Process and
Individual Assessment."
(3) Reichert. Betty, "And the Walls Come Tumbling Down: Humanizing
the Institutional Aspects of Long-Term Care."
(4) Trager, Brahna, "The Community In Long-Term Care."
There emerged from the process of the institute a set of Principles of Long-
Term Social Health Care and Recommendations for Future Actions which have
been detailed in a report entitled "Human Factors in Long-Term Health Care."
Other staff have served on committees and worked with the following national
voluntary and professional organizations to promote better services for and
understanding of older people: American Nurses Association, National League
for Nursing. the American Occupational Therapy Association, National Associa-
tion of Social Workers, National Conference on Social Welfare, the American
Dietetic Association. Catholic Hospital Association, National Recreation and
Parks Association, American Health Care Association, American Association of
Homes for the Aged, the American College of Nursing Home Administrators,
American Association of Retired Persons, the Gerontological Society and the
American Geriatric Association.
INTERNATIONAL CONSULTATION
Dr. Monnica C. Stewart. assistant physician, Edgeware General Hospital,
Geriatric Unit and Member of the Council. Geriatric Care Association of Great
Britain served as a consultant to the Division of Long-Term Care. Dr. Stewart
visited a wide variety of long-term care facilities throughout the United States,
and shared her expertise in research and education in the field of long-term
care with the Division staff. In addition, the Division sponsored a seminar for
representatives of Federal agencies and nongovernmental organizations con-
cerned with health care for the elderly, which included a presentation by Dr.
Stewart followed by dialogue between Dr. Stewart and the seminar participants.
NEW PUBLICATIONS
Addendum-Instructions for Completing Patient Assessment Form (July 1975
Revision) developed under a National Center for Health Services Research Grant,
HS 01162, by Harvard Center for Community Health and Medical Care. This
Addendum should further enhance the usefulness in nursing homes of the
Patient Classification for Long-Term Care: User's Manual published in 1973
(DHEW Publication No. HRA 74-3107). The Addendum includes a four page
Patient Assessment Check List for use in long-term care facilities which provides
for serial assessments and can show change, improvement or regression, over
time. The Addendum and User's Manual are available from the Division of Long-
Term Care, Room 11A-33, Parklawn Building.
Guidelines for Estimating the Cost of Service Packages for the Chronically Ill
Impaired, prepared under Grant No. 93-P-75172 by Duke University Center for
the Study of Aging and Human Development. The report contains information
about costs relating to service packages, determining cost estimating relation-
ships, methods to obtain data, and results of an investigation of private homes
as providers of services. This report is available from the Division of Long-Term
Care, Room 11A-33, Parklawn Building.
Medical Care Use By A Group Of Fully Insured Aged summarizes a 5-year
study of the residents of two retirement centers in California. It presents in
narrative and tabular form the changes in the residents' utilization of medical
services between 1965 and 1969 in comparison to their demographic and health
status characteristics. It also presents a comparison of costs for services. Copies
FORD
are available from the Office of Scientific and Technical Information of the
National Center for Health Services Research.
Activities Coordinators Guide was revised as a hyproduct of a contract with
the American Health Care Association, No. HSM 110-72-154, to train beginning
LIBRARY
activities workers. The revision adds many chapters to the original text and
GERALD
covers all subjects in more depth. Copies may be obtained from the National
Information Service.
Activities Orientation Teachers and Planners Guide was developed as a part
of the American Health Care Association Contract No. HSM 110-72-154 to train
beginning activities workers. It includes the organization of a 36-hour orientation
course with unit objectives, teaching activities, references and sample agendas.
Copies are available from the National Technical Information Service.
Social Aspects of Cancer Recovery, by Bernice Catherine Harper, Director of
the Division of Long-Term Care, is contained in Cancer Journal, July 1975, volume
36, No. 1 supplement.
Adult Day Care in the United States, a report prepared by Transcentury
Corporation with support from the Division of Health Services Evaluation, pro-
vides an in-depth analysis of 10 ongoing day care programs in the United States
and can be obtained from the National Technical Information Service.
Long Term Care: A Handbook for Researchers, Planners, and Providers, de-
veloped under contract to the National Center for Health Services Research
and edited by Dr. Sylvia Sherwood. provides a comprehensive summary of what
is known, what has been done, and significant research findings across a wide
CAN - LINO 180
array of topics relevant to aging and long-term care. Copies may be purchased
from Halsted Press, Division of John Wiley and Sons, 605 Third Avenue,
New York, N.Y. 10016.
A PROMISE KEPT
The Division of Long-Term Care prepared a volume entitled "A Promise Kept"
that gives an overview of its evolution since 1971 when the Presidential Initia-
tives to upgrade the quality of mursing home care were announced. In addition
to the historical perspective, it includes a status report of the two branches in
the Division, Research and Development and Provider Improvement.
NATIONAL CENTER FOR HEALTH STATISTICS
The National Center for Health Statistics has as its mission the identification
of problems and trends of health status of the general population through the
collection and dissemination of quantifiable data. As part of its mandate to
collect data on health indicators that affect the total population, the National
Center has compiled data on health issues applicable to the elderly. Acting as a
statistical resource base for the other components of PHS. NCHS has conducted
surveys which measure the health and nutritional status of persons aged 60-74:
the health status and utilization of health facilities by persons aged 65 and over,
and the characteristics of residents of nursing homes. A list of data obtained
by NCHS relevant to activities of the elderly is as follows:
National Mortality Statistics which examines death by various causes. The
statistics are broken down by age, sex, race, state, counties, and places with
more than 10,000 inhabitants.
National Mortality Survey which identifies health and related characteristics
of decedents, particularly in the last years of life. The data is divided cate-
gorically by age, sex, and socioeconomic characteristics.
Health and Nutriiton Examination Survey which provides data related to the
health and nutritional status of the population collected through actual examina-
tion of a sample of the Nation's noninstitutionalized population. The survey will
supply data for evaluation of nutritional status through analysis of dietary intake
and food frequency inter-related with physical examination, medical history and
biochemical assessment data. The survey was specifically designed to examine
population groups at high risk of poor nutrition, i.e., preschool children, the
aged. the disadvantaged and women of child-bearing age. The age group of the
sample is from 6 months to 74 years.
Health Interview Survey conducted on an ongoing basis identifies health char-
acteristics and the utilization of health services by individuals in a noninstitu-
tionalized population. Variables examined include: age, sex, color, ethnicity,
marital status, and socio-economic variables.
Hospital Discharge Survey which compiles data on discharges. diagnoses and
surgical operations or procedures of populations in short-stay hospitals in the
United States. Age, sex, race and marital status are examined.
National Ambulatory Medical Care Survey collects data on the diagnosis, treat-
ments or services. the dispositions of patients for ambulatory medical care visits
in the United States. The sample population covers non-institutionalized in-
dividuals and office based physicians in the United States. Variables used in this
study are: age, sex, race of patient, and physician characteristics.
National Nursing Home Survey conducted biennially examines the character-
istics of nursing homes, services and staff, and health and demographic char-
acteristics of nursing home residents. Age, sex, race. and ethnicity, marital
status, and source of payment are variables utilized in the survey.
BUREAU OF HEALTH MANPOWER
The Bureau of Health Manpower is geared to address the major problems of
geographic and specialty maldistribution of health manpower. Although the
activities of the Bureau are not primarily focused on alleviating the health
concerns of the aged, they impact upon this segment as well as the general
population.
A major thrust is expanded development of primary care practitioners, those
professionals who provide first contact care, provide continuous monitoring of
an individual's health status, and can refer a patient to appropriate specialists.
This includes support of family medicine training and residences, and the de-
velopment of appropriate faculty resources.
Training is also supported for physicians' assistants and dental extenders who
can perform many of the tasks traditionally performed by the physician or
dentists. These tasks can be performed without the extensive training required
for physicians and dentists. thus enabling them to expand the scope of their
activities and concentrate on more difficult cases. Support for the training of
nurse practitioners is designed to meet the particular problems of geriatric and
nursing home patients, as well as to provide primary health care in home. ambu-
latory facilities. long-term care facilities. and other health care institutions.
The problem of geographic maldistribution also receives major attention.
Through National Health Service Corps scholarships, individuals agree to serve
in health manpower shortage areas in return for scholarship assistance. The
Area Health Education Center program is designed to link health manpower
training with comunity service needs. Emphasis is placed on clinical training
of medical and other health professions students in hospitals and ambulatory
care settings in medically underserved areas.
CAN - LINO - 181
BUREAU OF HEALTH PLANNING AND RESOURCES DEVELOPMENT
The Bureau of Health Planning and Resources Development was created to
Implement the National Health Planning and Resources Development Act of
1974 (Public Law 93-641). The act calls for the creation of a nationwide
network of health systems agencies and State agencies responsible for health
planning and resources development. The program is designed to improve the
quality and delivery of health services throughout the Nation, while at the
same time containing the cost of providing health services and preventing un-
necessary duplication of health resources.
The program is designed to improve health care for the total population, not
for a particular group such as the aged. Nevertheless, to the extent that the
planning agencies improve the effectiveness and efficiency of the health care
system. the elderly will be major beneficiaries. This is particularly so in terms
of improved accessibility to health manpower and facilities, and in terms of
moderating the excessive costs of health care.
Some 200 health systems agencies, the basic elements in the new program,
will be designated during 1976. These agencies will be responsible for preparing
and implementing plans designed to improve the health of residents in their
areas. for providing technical assistance to organizations seeking to implement
the plans. and for reviewing applications for Federal funds for health programs
within the service area. State agencies will also be designated during 1976. The
functions of these agencies include integration of the health plans of the local
agencies into a State health plan, administering the facilities construction pro-
gram, and implementing the certificate-of-need programs. As these components
become operational. they should contribute greatly to a more rational health
care system which is structured to meet the needs of regional populations.
D. HEALTH SERVICES ADMINISTRATION
BUREAU or COMMUNITY HEALTH SERVICES
Programs of the Bureau of Community Health Services are directed primarily
to the medically underserved-or unserved-areas of the Nation. While the aged
are not singled out as a special target population, the betterment of their health
and welfare is promoted through a variety of program efforts which are designed
to improve the health of all age groups. Bureau activities which impact most
significantly on the aged are promoted through community health centers, mi-
grant health projects and the National Health Service Corps.
In fiscal year 1975. a total of 157 operational community health centers, lo-
cated in 41 States, District of Columbia, Puerto Rico, and the Virgin Islands,
provided a range of preventive. curative and rehabilitative ambulatory services
and arranged for inpatient services for an estimated 1,425,000 persons. These
centers are primarily located in medically underserved rural or urban areas.
Approximately 6 percent of the persons residing in those areas who were regis-
tered for center services were aged 65 or over. This age group represented 14
percent of the high frequency users in the centers (three or more MD encounters
during a quarter). a disproportionate amount of services for a relatively small
proportion of registrants.
The Migrant Health Program provides access to health care services for
migrant and seasonal farmworkers and their families. Services in fiscal year
1976 were available at 355 sites and ranged from full-time centers providing
diagnostic therapeutic and followup medical services with provisions for dental
care, health counseling, preventive and out-reach services, to scheduled clinics
with a more limited focus on specific diseases.
Migrants live and work in predominantly rural areas where health resources
are scarce. Although they face problems of shortage and maldistribution of
health resources which other rural residents must cope with, the migrants' prob-
lems are compounded by such factors as the need to travel from place to place
in search of work. language and cultural differences. In addition, the elderly
migrant is further handicapped by the multiplicity of problems which accompany
aging. An estimated 390,000 migrants and seasonal farmworkers and their
families received services through this program. Of this total, approximately 2.8
percent are 65 years of age or older.
The National Health Service Corps is designed to improve the delivery of
health services to persons residing in communities where availability of health
resources is inadequate by recruiting and placing health professionals in those
areas. The Corps is attempting to achieve a permanent improvement over the
geographic maldistribution of medical personnel by assisting communities in
developing the capacity to independently maintain viable health practices and
designing policies that will encourage health professionals, once placed. to re-
main in shortage areas on a non-Federal basis. Since older people living in these
areas often lack mobility the presence of health personnel in their communities
is of special importance. While data are not available on the number of aged
persons receiving services from Corps personnel, a total of 510,000 people were
served by 551 providers at 193 sites.
In summary. while programs of the Bureau of Community Health Services are
not designated for the elderly. per se, they are an important part of the target
population. Many of the projects are located in areas with high concentrations
of elderly people and recognition is given to their unique health needs. The
Bureau will continue its efforts in behalf of this special population group.
BUREAU OF MEDICAL SERVICES
The Bureau of Medical Services comprises five Divisions, one of which, the
Division of Hospitals and Clinics, sponsors programs relating directly and in-
directly to the aged.
CAN - LINO 182
The Division of Hospitals and Clinics holds primary responsibility for pro-
viding health care to specific groups of Federal beneficiaries. Health care is
provided on a reimbursable basis to other beneficiaries and to community resi-
dents when resources are available within the system. In addition to the pro-
vision of direct health care, the mission of the Division of Hospitals and Clinics
Includes health education and training, medical research, and community health
service programs.
During fiscal year 1975. among a total of 30,720 dischargees from hospitals
of the Division of Hospitals and Clinics. 4,151 were individuals age 65 or over.
The average length of stay for elderly men was 23.1 days and for elderly women
21.7 days, compared with an average length of stay of 16.9 days for all patients.
This observation is consistent with the fact that older patients are affected to
a greater extent by chronic conditions which require longer periods of hospitali-
zation, and for similar conditions. older patients tend to receive longer periods
of hospital care than younger patients.
A high proportion of elderly persons receiving inpatient services are American
seamen. who constitute the major beneficiary group cared for in PHS hospitals.
The problems presented by this group of patients are not identical to those pre-
sented by aging patients in general for example. there is a higher proportion
of single males in this group than in the general population. Because of this,
finding suitable nursing homes for long-term geriatric care constitutes one of
the real problems in meeting the needs of aging patients served by the Division
of Hosptials and Clinics.
In October 1975. a Day Treatment Center for the Elderly was opened at the
USPHS Hospital in Baltimore, Md. This program provides an alternative to
institutionalization for elderly patients by providing supervision and personal
care services to older persons with physical, mental or social impairments. The
capacity of families to continue helping to maintain elderly relatives at home
is depleted when no relief is available and institutional placement is often made
not because the older person needs institutional care. but because the type of
assistance needed is not otherwise available. The Day Treatment Center should
serve as an alternative to institutionalization by solving some of the problems of
daily living, provide respite to families with elderly relatives, and enable the
older person to return at night to the home setting. The aged indicate a strong
preference for remaining in their homes and the Day Treatment Center would
greatly assist both the family and the elderly in this regard.
The Day Treatment Center for the Elderly provides an organized program of
activities and health care services during the day in a protective group setting
which is designed to activate, motivate and retrain the elderly to sustain or
regain and maintain maximum functional independence. Individuals participating
in the center are aged persons referred from PHS beneficiary groups. the Geri-
atric Evaluation Service of the Baltimore City Health Department, community
organizations and private physicians.
Approximately 20 medical research projects indirectly related to aging were
ongoing within the nine hospital facilities of the Division of Hospitals and Clinics
during fiscal year 1975. These include studies of natural history of disease. descrip-
tive physiology and pathophysiology, and therapeutic trials. Studies on various
aspects of cardiovascular disease comprise the major component of the clinical
research related to aging.
During fiscal year 1976. in addition to beginning patient care in the Division's
first center for geriatric day treatment in Baltimore, plans are underway to
explore feasibility of developing additional centers for geriatric day care with the
Division's system of health care facilities. As these facilities gain experience
with day treatment centers. they will develop the capacity to undertake studies
of the relative merits of innovative concepts of geriatric health care delivery.
The Division presently envisions studies of different intermittent patient sched-
uling plans including night treatment centers. and studies on the provision of day
treatment to various selected patient subgroups including those requiring a
major commitment of conventional medical care, as opposed to the emphasis
on rehabilitation services as usually provided by day treatment centers in the
United States. Potentially, the multiple facilities of the Division of Hospitals
and Clinics could be used to study many innovative elements within the spectrum
of geriatric health care delivery as part of a centrally coordinated program
within DHEW.
Programs of the Division of Emergency Medical Services, which provides na-
tional leadership in the development and expansion of comprehensive area
emergency medical systems, are directed toward interests of the aged as part
of the general population. Additionally, this Division presently sponsors a re-
search project specifically targeted toward the aged entitled "Effects of an
Emergency Alarm System for the Aged."
Health delivery systems within the purview of the Division of Health Main-
tenance Organizations provide services to the aged as part of the general pop-
ulation. The Division of Coast Guard Medical Services and the Division of
Federal Employee Health have no programs targeted for the aged.
BUREAU OF QUALITY ASSURANCE
The Bureau of Quality Assurance is responsible for two programs which have
an impact on the aged population. During 1975. we continued implementation of
the professional standards review organization (PSRO) program. PSRO's are
voluntary, nonprofit groups of local physicians established to assure that care
provided to beneficiaries of medicare. medicaid. and maternal and child health
programs is medically necessary. meets professionally recognized standards, and
is rendered in the most appropriate setting. By the end of 1975. 120 PSRO's had
been established. During 1976, it is expected that over half of these will be per-
CAN - LINO - 185
this conclusion, we will at last have a good counterpart of human senility for
experimental study.
Another NIA grantee, Dr. Merrill F. Elias of Syracuse University, is approach-
ing the problem of mental change in the elderly from still another point of view.
Dr. Elias has been investigating the effect of sustained high blood pressure on a
person's ability to respond and make decisions quickly. The study, performed in
collaboration with colleagues at the Veterans Administration Hospital, Syra-
cuse, was done with young (18-31), middle aged (32-45), and older adults (46-
59) to see the effects of aging. The test was designed to measure verbal and
nonverbal thought processes. In some cases, participants were required to make
complex decisions selecting answers from as many as eight alternatives.
The results showed that the speed with which participants responded declined
with age. The patients with high blood pressure performed even more poorly than
healthy subjects, although not all the patients with elevated blood pressures
reacted more slowly than control subjects of the same age. Those whose blood
pressure had been previously controlled by medication showed greater slowing of
their ability. The type of hypertensive disorder each patient had seemed to dictate
whether medication improved or weakened performance. Further studies will be
unertaken to pin this down more specifically.
Alcohol and Behavior
Last year, at GRC Dr. Robert Vestal and coworkers reported on the ability of
young and old men to metabolize alcohol introduced directly into the bloodstream.
They found that older men handle alcohol, physiologically. as well as the young.
Related research by Dr. Robertson-Tehabo and colleagues, however, showed
that alcohol has a more severe behavioral effect on elderly men than it does on
younger men. All subjects studied were healthy. mal volunteers from the Balti-
more Longitudinal Study. an ongoing study of some 600 men to observe indi-
vidual changes which occur over an extended period.
The study showed that when blood alcohol levels are relatively high (above the
legal level for intoxication) the older men manifest greater declines on tests of
memory and decisionmaking. This was true even though the older men appeared
less intoxicated, with fewer reporting they felt impaired or "high."
It appears that older men under the influence of alcohol are at greater risk
to make mental errors than are younger subjects since they have larger perform-
ance impairments coupled with a decrease of awareness of these deficits.
SELF CONTROL OF BLOOD PRESSURE
An estimated 19 million Americans 45 years of age or older are victims of
hypertension, more commonly known as high blood pressure. The magnitude of
this problem in middle-aged and older adults makes it imperative that more be
learned about high blood pressure and the most effective ways to treat it.
At GRC, Dr. Bernard T. Engel and coworkers have succeeded in teaching pa-
tients with high blood pressure to control their own blood pressures using a tech-
nique known as operant conditioning. This technique selectively encourages be-
havior by rewarding the correct response.
Five patients referred to the NIA by the Baltimore City Hospital's hyperten-
sion clinic learned to increase or decrease their blood pressures while at the lab-
oratory. The patients, men and women, ranged in age from 46 to 70 years of
age.
The laboratory training taught the subjects to raise and lower systolic blood
pressure (the higher pressure on a blood pressure reading). A display of lights,
much like traffic signals, was used to help the patients learn. For example, when
the red light was on this meant they should lower their systolic blood pressure:
green meant they should raise the pressure: and, yellow indicated the correct
response was being given. This yellow light served as a patient's "feedback"
showing that the correct response had been made and thus rewarding success-
ful behavior. Another reward or reinforcement was a meter, visible to the subject,
which gave the patient an accumulated numerical score of performance with
each successful response advancing the meter two points.
When laboratory training ended, the patients continued training in their own
homes. All the patients were able to exercise self control of their blood pressure
during a three month followup period. The subjects' success in controlling their
own blood pressures during followup showed that laboratory skills, properly
taught, can also be used effectively by patients in their own homes.
THE BIOLOGY OF AGING
The Aging Immune System
The ability of the body to protect itself against disease (immune function)
decreases with age at the same time that various protective systems begin to
malfunction. The observation, made some 45 years ago, that the concentration of
natural antibodies, the most important defenses against foreign invaders such
as germs, declines with age is probably the earliest scientific evidence we have
of this system. Discoveries in recent years have pointed up the importance of
this loss, at the same time that the possibility has arisen that this can be im-
proved by medical treatment.
This year, NIA scientists in the Laboratory of Cellular and Comparative
Physiology. GRC, found what they believe to be one reason for the loss of nor-
mal immunity that occurs in older people. Research showed that older animals
have a definite increase in a population of cells known to interfere with the dis-
ease fighting activities of the body's immune cells.
Previous studies have shown that one possible way to bolster immunity in the
older animal is to combine transplants of thymic and bone marrow theques from
young animals. In some strains of old mice this restimulates the immune system.
CAN - LINO survice 186
It has now been shown that injections of a sulfur drug (Mercaptoethanol) also
restore immune function in aged mice.
At the University of California, Los Angeles, NIA grantee Dr. Roy L. Walford
has found that by restricting the number of calories or the protein content of
the diet of laboratory mice be was able to prolong their lifespan 15-40 percent,
to lower the incidence and growth of spontaneous and transplanted tumors, and
to increase resistance to some viral infections.
Using immunologic measuring devices the mice were first tested at 3-4 months.
The immune responses of the restricted mice were less than those of the controls:
but by one year of age. this was reversed. The regulated animals possessed an
immune system which remained or acted younger longer than the immune SYS-
tems of animals on a nonrestricted diet. Dr. Walford is also examining various
protein dietary combinations to study their effects. Severe restriction of pro-
tein. he found, did have an undestrable effect.
One important problem in biology concerns the way by which scavenger cells
(macrophages) recognize and remove deteriorated cells from the body. NIA in-
vestigators use human red blood cells to study this problem since the macro-
phages routinely ingest and destroy red blood cells at the end of their 120-day
useful life span in the circulation.
Some recent studies conducted by Dr. Marguerite Kay at GRC indicate that
macrophages tell the difference between young and old red blood cells by recog-
nizing an accumulation of immunoglobulin G on the surface of the old red blood
cells. Immunoglobulin G is a protein in human blood involved in immune re-
sponses. Young cells show only trace amounts of immunoglobulin G, while old
cells have deûnite accumulations on their surface.
These findings point to existence of a gradual build up of immunoglobulin G as
red blood cells age in the circulation. Once a critical level is reached, the scav-
enger cells ingest and destroy these cells.
Protein Production Errors
One fairly popular theory of aging states that the cellular machinery needed
to produce proteins necessary for cell function becomes error-prone in old cells.
This theory was tested and proved invalid by Dr. Josef Pitha and his CO-
workers using human cells in tissue culture. The cells were infected with polio
virus. Usually this virus produces a large protein molecule which is then broken
down by cellular enzymes into smaller protein units. If the large polio protein
synthesized in old cells contained errors then it would not be recognized by the
cell's enzymes. Thus the large protein would not be broken down and more of it
would be found in old than in young cells.
NIA scientists discovered that the protein is degraded in both "old" cells (those
that have gone through 50 cell divisions) and "young" (20 cell divisions) cells;
thus, proving that the protein production error theory of aging is not valid.
Heart Function in the Aged
Previous studies in the Clinical Physiology Branch, GRC. have shown that
age is associated with a defect in the relaxation phase of the rhythmic contrac-
tions in isolated rat heart muscle. This research has now been extended to studies
in men taking part in the Baltimore Longitudinal Study. Studies using a non-
invasive technique (echoeardiography) to measure heart muscle function show
that the defect in muscle relaxation also occurs in man.
Meanwhile, studies in the rat have continued. Earlier work suggested that a
defect in calcium transport underlies the muscle relaxation difficulties of aging.
Since digitalis, a drug commonly used to treat heart disease, inhibits calcium
transport in heart muscle. its effect on aging heart muscle from old and young
rats was tested. Indeed. the toxic effects of digitalis occurred earlier, that is at
lower doses, in the old heart muscle than in the young. In this sense, then, there
is an increased sensitivity to digitalis in the elderly.
The increased stiffness noted in the aging hearts of both man and rat suggest
that further studies into the mechanisms responsible for these changes could
provide information useful in treating heart disease in older people.
In related work at GRC's Laboratory of Molecular Aging the movement of cal-
cium within cells was investigated. Calcium is required for the contraction-relaxa-
tion cycle that occurs during each heart beat. Relaxation takes place when calcium
is stored in a separate compartment within the muscle cells. Contraction occurs
when this calcium is released. Biochemical studies of this compartment's ability
to store calcium reveal a decrease in this ability for older animals. Thus, the
longer time taken to relax old heart muscle may be linked to the lowered ability
of this compartment to actively transport the calcium needed to trigger heart
contractions.
HORMONES AND AGING
The body's ability to respond to stress, illness, and the like is dependent to a
great extent on the actions of hormones. With increasing age, the body's ability
to respond to these hormones generally diminishes.
It is important for scientists to learn more about the ways in which aging
causes these changes. All hormones act initially by combining in a lock and key
arrangement with certain sites or receptors on surfaces of the cells or within
the cells themselves.
Recent studies by scientists at GRC have shown that for those hormones that
act on the surface of the cells, the age-related loss of responses varies for differ-
ent hormones as well as for different tissues. For example, in fatty tissue cells
the response diminished progressively. The losses in this tissue occur first in its
response to the hormone glucagon then to another surface hormone, ACTH, and
still later to epinephrine.
CAN - LINO - 187
Liver, on the other hand, shows an entirely different aging pattern. Liver tissue
response to the hormone epinephrine actually increases with age. For other
hormones, acting within cells, an age-related loss of the specific hormone receptor
molecules has been identified for neurons and fat cells. These findings provide
important leads to a possible explanation for the differences in hormonal response
that otten accompany aging.
FOOD APPEAL
Most elderly people have a severely diminished sense of taste and smell lead-
ing to loss of appetite and ultimately to poor nutrition. The sense of smell is
often the first of the senses to decline with age. As a result. older people tend to
identify food mainly on the basis of its texture. Because their sense of taste is
lessened, the elderly tend to pour large quantities of salt on their food. This addi-
tional salt then aggravates existing heart and blood pressure problems.
In order to deal with the problem of declining sense of taste and smell with
age, an NIA grantee Dr. Susan Shiffman at Duke University is experimenting
with ways to fortify taste and smell in food with special flavor and aroma addi-
tives. Much of the experimentation is with protein-rich, inexpensive foods like
new-textured soybean products.
DEVELOPMENT OF A SUITABLE ANIMAL MODEL FOR AGING RESEARCH
One of the major obstacles to the study of the aging process has been the ab-
sence of a suitable laboratory animal on which scientists could either perform
their experiments or systematically observe the aging process. The problem was
further complicated by the fact that many animals which are similar to humans
have. like humans, life cycles which are too long for routine laboratory studies.
Until recently, investigators in laboratories throughout the country were unable
to get even the most commonly used laboratory rats and mice in the full spectrum
of the aging process within a single species. Few, if any, aged animals were
being maintained in a germ-free state. The few animals that survived to "aged"
were usually SO fragile that their use as models of aging, uncompromised by
disease, was questionable. Furthermore, if the animals did survive to "aged," the
trauma of the transfer from one laboratory to another was frequently fatal.
The establishment of a germ-free colonly of laboratory rats and mice up to
two years of age and older, whose genealogy is known, is a major contribution by
NIA and its commercial contractor to the advancement of basic studies of the
aging process. Although the animals are still available only on a limited scale,
they have been shipped to investigators from coast to coast. The project has pro-
vided a basis for the development and expansion of needed strains and species of
animals for aging research.
PLAN FOR AN AGING RESEARCH PROGRAM
The Research on Aging Act of 1974 (Public Law 93-296) provides, among other
things, for the Secretary of the Department of Health, Education, and Welfare
to prepare a comprehensive plan for an aging research program. The Secretary
has designated the NIA as the lead agency with the responsibility for the prep-
aration of this plan.
Since this designation, the Institute and the members of the National Advisory
Council on Aging have undertaken a massive effort to solicit and coordinate ex-
perts in the field of aging at universities and research institutions. In addition,
representatives of federal agencies that have missions which include the field of
agng have been assisting the Institute in the preparation of a research program
on aging to insure their continued input and review at all stages of the plan's
preparation.
It is intended that an operational plan for a research program on aging can
be developed which is a realistic document that addresses present needs and
develops future strategies within a framework of awareness of existing resources
and reasonable expectations of additional resources that are likely to be made
available for the implementation of the plan. The development of the plan is on
schedule and will be provided to the Congress by the deadline of May 31, 1976.
FORD
NEW PROGRAMS IN FISCAL YEAR 1977
The 1977 budget will allow the Institute to begin programs in several areas
LIBRARY
that are not adequately addressed by ongoing research. The Institute's present
program focuses on the biological process of aging, however, NIA plans to begin
new programs in the clinical, behavioral and societal aspects of aging. Since these
programs involve other Federal agencies. our efforts in these areas must be closely
coordinated with existing and planned efforts at NIH and elsewhere within the
Federal establishment.
One important area of concern is the finding that certain classes of therapeutic
drugs elicit unexpected responses when administered to elderly patients. Such
paradoxical reactions are frequently opposite to the response which would nor-
mally be anticipated. In view of the frequency of these occurences and the grow-
ing number of elderly patients receiving drugs, NIA will begin in 1977 a systematic
research effort to determine the cause of change in drug sensitivity and response
as a function of increasing patient age.
To date a limited number of studies supported by the Institute have dealt with
individual adjustments to the problems of aging, but little is known about the
relationship between social factors and the health of the aged. NIA will initiate
in 1977 an effort to illuminate some of these relationships. For example, approxi-
mately one million people over 65 are living in nursing homes and related institu-
tions. Yet little is known about the way decisions to place an individual in an in-
stitution are made. Several other questions concerning care within long term
facilities require investigation and study. The NIA will initiate research in
this area in fiscal year 1977.
CAN LINO 188
A major problem of the elderly is social, economic, and physical dependency.
One of the goals of the NIA is to keep elderly people independent and functioning
members of society. In order to accomplish this goal the Institute not only needs
to understand the biological aspects of aging which will keep the aged person
healthy, but also the social factors that inhibit his participation in society.
The effect of mandatory retirement. the problem of transportation to community
and medical care facilities, and the stigma attached to old age are all factors
that have to be studied SO that barriers to participation can be removed.
Other social factors have to be understood For example. what is the social
impact of the large difference in life expectancy between men and women? What
are the effects of long years of widowhood? What is the impact of remarriage?
What is the minimal level of income which will sustain needed health care?
These are but some of the questions which will be addressed in future NIA re-
search programs.
The prevention or amelioration of the debilitating effects of old age is another
area of concern to the NIA. Research findings to date indicate that changes in be-
havior early in life may have the effect of warding off some of the adverse con-
sequences of the normal aging process. For example, the longitudinal study con-
ducted by the Gerontology Research Center suggests that exercise may lead to a
longer life. There are, of course, numerous other factors that require study in
order to make similar determinations concerning current behavior and subsequent
health. The NIA plans several studies in this area during 1977.
NATIONAL INSTITUTE OF ARTHRITIS, METABOLISM, AND DIGESTIVE DISEASES
Research activities of NIAMDD can be related to the ten broad areas of re-
sponsibility of the Institute which are primarily oriented to categorical disease
(e.g., arthritis. diabetes. kidney disease. and digestive diseases). These activities
cut across age, sex, racial and other population identifiers since the diseases for
which the Institute is the NIH research focal point are not generally limited
to a particular age group. With this general statement as a background. this re-
port may be seen to document convergent interests in research related to "ag-
ing and the aged" primarily with regard to certain diseases that are usually as-
sociated with the aged, i.e., osteorarthritis, osteoporosis, and benign prostatic
hyperplasia.
There is no particular definition of the terms "aged" and "aging process" in
use within the Institute. In order that the Institute's research efforts be ad-
ministered in an orderly way. however, when grant applications are received.
they are coded by grants analysts for research area (which includes designa-
tion for any particular age group) discipline; substances, animals, tools and
techniques.
The principal research activities of NIAMDD related to aged persons involve
the diseases osteoarthritis, osteoporosis, and benign prostatic hyperplasia.
OSTEOARTHRITIS
Degenerative joint disease, commonly known as osteoarthritis, appears to be,
in part, a phenomenon of the aging process but has also been clearly related
to unusual wear on cartilage. the resilient, glistening white material which covers
the end of-bones at the joints. The wear is thought to occur through small,
repeated, damaging injuries, or "microtrauma," over extended years of use;
cartilage damage may develop in accelerated form if unusual weight has been
supported, as in obesity, or if the weight bearing surfaces are even slightly
out of line due, for example, to fractures suffered in youth. That more generalized,
systemic factors are also involved is clear from familial cases suggesting heritable
features and from the early appearance the condition in certain metabolic (or
biochemical) states known to effect the composition of cartilage.
The most disabling form of degenerative joint disease involves the hip joint
where the disease may produce constant pain and extreme limitation of motion
reducing the sufferer to bed and wheelchair existence. It is this condition,
degenerative joint disease of the hip, which has responded most dramatically
to joint replacement.
TOTAL HIP REPLACEMENT
The most advanced artificial joint under study is undoubtedly the artificial
hip. Hip joint replacement is one of the most successful orthopedic procedures
in restoring mobility to the patient. even in cases where reconstructive surgery
has failed. Investigators are currently working with a variety of reinforced
plastics, ceramics and metals in an ongoing effort to improve the effectiveness
and durability of hip replacement. Porous metals and metals coated with porous
ceramics or plastics are being used in an effort to obtain implant attachment
through ingrowth of tissue into the pores of the implant. The outlook for replace-
ment of joints of all kinds in the treatment of arthritic conditions is rapidly
improving, and the Institute will continue to support research evaluating total
hip replacement and related work at centers throughout the United States.
The general objective of the arthritis program, of which the efforts in osteo-
arthritis form one part, is to enhance the understanding of diseases of the joints
and related musculoskeletal disorders. Basic information is sought to elucidate
the problems of inflammation and tissue destruction characteristic of the
arthritic diseases and the attendant immunologie mechanics. New and better
means of joint replacement is a primary objective of the orthopedic program
that is directly related to osteoarthritis.
Research in osteoarthritis is supported by extramural grants and contracts
under both the arthritis and orthopedic programs. The intramural arthritis
and rheumatism program includes occasional clinical studies in osteoarthritis
as well.
CAN - LINO 189
Significant progress in total hip replacement has led to a restoration of mobility
to many disabled, aged persons. Continuing basic and clinical research efforts are
expected to improve treatment, understanding and bence control of osteoarthritis.
In fiscal year 1975, 14 research projects primarily concerned with osteoarthritis
were supported at grantee institutions with obligations of $721,039. Obviously,
the establishment of future priorities within NIAMDD is closely linked with the
National Plan for Arthritis that is currently being developed by the National
Commission on Arthritis. Osteoarthritis, as part of the constellation of arthritis
and related musculoskeletal diseases ranks high in NIAMDD priorities and hence
will receive additional program emphasis in the next few years.
OSTEOPOROSIS
Osteoporosis, a diffuse reduction in bone density, is a condition resulting from
a combination of disuse or immobilization. calcium deficiency, hormonal imbal-
ances, or senility. It is often found in elderly postmenopausal females, often
results in vertebral abnormalities and/or frequent fractures of the hip and long
bones. The disease is being studied through long-term data collection of individ-
uals on controlled diets and patients with disuse or immobilization of limbs.
Since osteoporosis is usually a disease of slow onset and long duration, and
bone density decreases slowly, studies of this condition must continue over many
years if the cause and possible methods of preventing, controlling, or slowing
the process are to be accomplished.
The immediate research program objectives in osteoporosis are to find:
(1) The specific role of the three suspected major etiologic factors. i.e., skeletal
disease, negative calcium balance, and endocrine decline with aging: and (2)
ways of preventing and treating the disease. To facilitate this, understanding
of the chemistry and physiology of bone formation and resorption is sought
through basic research.
This area of research is supported by extramural grants within the orthopedic
program and by an intensive intramural effort.
A 5-year study that is under way to evaluate various treatments for osteo-
porosis should provide sound data to aid in establishing the most effective treat-
ment regimen. Understanding of the mineral losses from the skeleton that have
been observed and studied in astronauts should provide related insights into
osteoporosis and could be expected to'lead eventually to its prevention.
In fiscal year 1975, seven research projects primarily concerned with osteo-
porosis were supported at grantee institutions with obligations of $373,194,
In fiscal year 1976, support will continue at the same level.
BENIGN PROSTATIC HYPERPLASIA
Enlargement of the prostrate gland or benign prostatic hyperplasia (BPH),
effects more than 60 percent of the male population over 60 years of age and
causes varying degrees of bladder outlet obstruction. Its cause is unknown but
secondary effects include infection, leading to chronic prostatitis and inflam-
mation of the bladder and upper urinary tract, and a predisposition to urinary
stone formation from statis of the urine.
Included in the kidney disease and urological disease program, the general
objectives of research activities in BPH are those of the entire program, i.e.,
investigation of etiology. pathogenesis, diagnosis. and treatment.
In addition to the support of investigator initiated extramural grants, efforts
have been made to review, evaluate and identify new directions in research in
this disorder utilizing an interdisciplinary approach. A major workshop on
this subject held in February 1975. and it is expected that this will stimulate
new initiatives and approaches in research in this area of importance.
Only one research project was supported in fiscal year 1975 with obligations of
$27,975. The Institute is prepared to make significant commitment in this area
where SO little is being done and will continue to seek new research approaches.
It is evident from the previous paragraphs that NIAMDD research activity in
osteoarthritis. osteoporosis and BPH are integral parts of larger programs for
which the Institute has research responsibility. As we seek to understand these
particular diseases, how to treat and control them, we are acting to fulfill our
mission to conduct and support research and training relating to the cause,
prevention. diagnosis and treatment of arthritis, skin diseases, diabetes and other
endocrine diseases, digestive diseases, hematologic disorders, metabolic diseases,
nutritional disorders, orthopedic diseases, and kidney and urologic iseases.
F. OFFICE OF POLICY DEVELOPMENT AND PLANNING, OFFICE OF THE
ASSISTANT SECRETARY FOR HEALTH
This office exercised its responsibility in serving as principal advisor to the
Assistant Secretary for Health concerning national health policy and developing
strategy for implementing approved policies. Needs of the elderly are given due
consideration during all phases of the policymaking and review process.
FORWARD PLAN FOR HEALTH
The annual five year plan of the Public Health Service covering fiscal years
1977-81 was released in June 1975. The plan contains seven themes which discuss
the medicare and medicaid programs, and other major Federal initiatives in health
research financing. prevention, data systems, etc. The effect of how resources
should be allocated in the field of long-term care received special attention. The
needs of patients for long-term care was viewed as a priority in improving the
health care system. For example, long-term care was handled as a case study
representing a microcosm of the larger health system.
CAN - LINO - 190
RURAL HEALTH
Being aware that lack of access to health care in rural areas constituted a
serious problem, the PHS had efforts underway to deal with the situation. OPDP
initiated action that cuiminated in establishment this spring of a Rural Health
Coordinating Committee. The group is composed of inter-agency representatives
from programs in the PHS and SRS that are currently involved in activities aimed
at improving access of rural citizens to health care. A high percentage of elderly
persons in this country in areas defined as rural.
HEALTH AND REIMBURSEMENT RESEARCH UNDER THE SOCIAL SECURITY ACT
In 1967, Congress enacted the first experimental health care provider reimburse-
ment provisions under the medicare program. These provisions were enacted at a
time when the health care system was still adjusting to the implementation of
the medicare and medicaid programs and other major Federal initiatives in health
care delivery were starting such as neighborhood health centers. Little was then
known about the potential of the comprehensive health planning legislation as a
planning and regulatory tool. At the same time the financial situation 01 many
hospitals had vastly improved, in part, as a result of increased Federal financing
under medicare.
In the period following the enactment of the 1967 experimental reimbursement
provisions there was little incentive for health care third party payors, the
Federal Government and providers to aggressively experiment wtih new ways
of reimbursement to bring about cost reductions and ways to improve the range
and methods of delivering health care. Experience demonstrated that large-scale
experimentation within the health care industry could be undertaken only with
great difficulty.
However, in more recent years the cost of health care increased sharply
causing serious concern in all sectors of the national health care system. The
effects of these escalating costs on the elderly, the poor and the other beneficiaries
of Federal health programs as well as on the programs themselves are of par-
ticular concern. Consequently, an increasing willinguess has developed on the
part of the health industry to try new ways of reimbursement and health care
delivery. It has also become apparent that unless major attempts are made to gain
additional knowledge through research and experimentation. modifications to
the financing mechanisms and benefit packages of the federally sponsored health
care insurance programs will continue to be made without adequate information
on the actual cost savings which can be achieved or the impact of changes on the
quality of care being provided.
At the present time very important changes are continuing to be made in the
health care system. Moreover, proposals for changes in Medicare benefits and
financing arrangements and significantly increased responsibility on the part of
State governments for the management and financing of health care
for beneficiaries of medicaid and other federally supported community health
programs present additional challenges for health-related reimbursement re-
search under the Social Security Act. These changes and proposals create added
opportunities for conducting new studies, and highlight the need for a con-
certed major effort to develop additional information in a systematic way to
guide policy decisions at the Federal, State, and community levels.
Section 222 of the Social Security Amendments of 1972 (Public Law 92-603)
provides the legislative basis for continuing experimentation related to titles
XVIII. XIX, and V of the Social Security Act by the DHEW in a number of
critical areas: (1) Studies concerning prospective. incentive and other methods
of payment for health care of the elderly and other beneficiaries of publicly sup-
ported health programs, (2) studies concerning the advantages and disadvan-
tages of reimbursement for new services by various groups of health care pro-
viders such as nurse practitioners, and (3) studies concerning changes in the
benefit packages which broaden the services that may now be reimbursed under
these titles with the intent of improved cost-effectiveness of expanded covered
services as well as cost savings in the delivery of care and services currently re-
imbursed. In the latter area. major emphasis is being given to alternatives to
institutional care including day care and homemaker services and other home
services.
Research conducted under this authority is being carried out by the Social
Security Administration. the Social and Rehabilitation Service and the Public
Health Service. The importance of close cooperation between these major com-
ponents of the Department, other interested agencies, including the Administra-
tion on Aging and the National Institute on Aging. has resulted in assignment
to the Assistant Secretary for Health of over all departmental program planning
and coordination related to section 222 research activities. The section 222 pro-
gram manager serves as the focal point for this function within the Division of
Health Research. Office of Policy Development and Planning. More detailed de-
scriptions of these activities are included in the statements of the participating
departmental components.
Guidelines are now in preparation which will assist the departmental com-
ponents in preparing their fiscal year 1977 section 222 implementation plans.
These implementation plans will serve as the basis for coordination and develop-
ment of the department section 222 research plan.
OTHER ACTIVITIES
OPDP is represented on the DHEW Interagency Task Force on Home Health
Services. This task force has been instrumental in securing a formal agreement
between the PHS and AoA regarding services for the elderly and particularly
CAN - LINO - 191
those needed by the older patient confined to his home. Efforts are directed to-
ward assuring compatibility of health policy as it affects Indians and other
minority groups having many elderly members. The role of advisor and con-
sultant is executed for numerous studies. projects and demonstrations being
contemplated and currently in progress in the Department. Among these are a
study to evaluate training programs for staff of long-term care institutions, a
project on alternative working models for medical directors in skilled nursing
facilities and various demonstration parts of section 222 of Public Law 92-603.
G. OFFICE OF NURSING HOME AFFAIRS, OFFICE OF THE ASSISTANT
SECRETARY FOR HEALTH
Organizations, Functions, and Relationships.-The Office of Nursing Home
Affairs was formed as the departmental and Public Health Service focal point
for nursing home-affairs called for by the President's Nursing Home Directives of
August 1971. On August 30, 1974, a revised Statement of Organization. Functions
and Delegations of Authority was issued giving ONHA responsibility to serve as
the focal point for long-term care (LTC) and for Office of Assistant Secretary
for Health's (OASH) responsibilities in departmental programs on aging. In
1975, further responsibility was delegated to ONHA for coordinating the develop-
ment of a comprehensive interagency objective to expand both beneficiaries and
services covered by home health care.
The two Divisions in ONHA are the Division of Standards Enforcement Co-
ordination and the Division of Policy Development. The former is responsible for
assuring consistent application and enforcement of LTC standards and receives
and analyzes reports of regional monitoring of survey/certification activities in
order to evaluate progress of correction of deficiencies and to give timely, re-
sponsive technical assistance in implementing standards. The latter division
recommends, develops, interprets and clarifies policies that impact on levels,
ranges, and quality of institutional and noninstitutional long-term care and on
facility improvement.
In addition to being broadly involved and working closely with PHS and de-
partmental agencies in the beadquarters area, ONHA works directly with the
Offices of Long-Term Care Standards Enforcement (OLTCSE) in all of the re-
gional offices to advise and administer the activities relating both to the approval
and termination of agreements with skilled nursing facilities (SNF's) partici-
pating in medicare and medicaid programs. These offices are established within
the Office of the Regional Directors. Their responsibilities in carrying out the
authority delegated by the Secretary in monitoring State survey/certification
activities is described in the Federal Register for June 13, 1974. Senior staff mem-
bers of ONHA meet every 3 or 4 months with the Directors of Regional OLTCSE
to present and discuss long-term care issues, new or proposed policies, operational
problems and to review issues still presenting difficulties in the field.
To assure a free flow of information and communication among all of the in-
volved agencies, an Intraagency Long-term Care Advisory Group meets regularly
to report on assigned tasks and recommend priority action areas.
Currently involved in aspects of long-term care and aging are: the Bureau
of Health Insurance of the Social Security Administration; Medical Services Ad-
ministration of Social and Rehabilitation Service: Bureau of Quality Assurance,
Health Services Administration; National Center for Health Statistics: Compre-
hensive Health Planning Service, Health Care Facilities Service (Hill-Burton),
and the Bureau of Health Services Research, all of Health Resources Adminis-
tration: National Institute of Mental Health of the Alcohol. Drug Abuse, and
Mental Health Administration: National Institute of Chile Health and Human
Development, National Institutes of Health; Administration on Aging; Office
of Facilities Engineering and Property Management; the Office of Education;
and the Bureau of Health Resources Development.
The foregoing are all DHEW agencies. Other Federal departments having
concern with long-term care and aging are: The Department of Housing and
Urban Development; the Veterans Administration; the Department of Trans-
portation: the Department of Labor; and the U.S. Department of Agriculture.
One or two Directors of regional OLTCSE also attend these meetings, and re-
port for and back to the other Directors. The special assistant to the Secretary
co-chaired these meetings with the Director of the Office of Nursing Home Affairs.
PART I. INSTITUTIONAL CARE
In addition to continued commitment to the 1971 Presidential nursing home
initiatives, new ONHA strategies for assessing and increasing the nationwide
level of compliance of individual facilities in the Federal standards were de-
veloped and initiated in 1974 and continued in 1975.
A. LONG-TERM CARE FACILITY IMPROVEMENT CAMPAIGN (LTCFIC)
The initial data gathering phases of the Long-Term Care Facility Improve-
ment Campaign was completed during November 1974. Since that time several
important actions have been taken, all designed to provide factual, meaningful
information to the public and to governmental agencies, including DHEW. An
overall analysis of the findings was made by well qualified professional statis-
ticians, mathematicians, and computer program experts following recognized
reliable statistical methodology using highly refined computer technology. In in-
terpreting the findings from this survey, it should be kept in mind that this was a
sample survey, and that the sample was designed to make national estimates.
Since all 7.526 skilled nursing homes were not surveyed, it was only possible to
present information or to make the national estimates based on the 288 homes in
the sample; the 288 homes have to represent all 7,526 homes. Inasmuch as the
estimates made from a sample survey will of course not be quite the same as
CAN-LINO-192
if a complete census had been done, it was necessary to include a "standard
error of the estimate."
As in all sampling surveys, certain difficulties were encountered in the execu-
tion of the sampling plan. For example, 9 of the 16 homes were not surveyed
either because they were closed or were no longer participating in the medicare/
medicaid programs when the surveyors went into the field or patients were not
available for interviews, To overcome these and other difficulties, estimation
procedures were introduced into the data during the analysis stage. Essentially,
the estimating procedures were corrected for "nonresponse."
A more indepth detailed analysis is now being conducted to obtain more
precise information on the drug prescribing patterns of physicians for aged
patients in nursing homes and patient characteristics and response to care, as
revealed in the patient assessment data. It is planned that evaluation and
analysis activities will continue into 1976.
In response to numerous requests for a progress report of the findings of the
National Survey of Skilled Nursing Facilities, a preview of findings to come was
made available in an interim report published in March 1975. All statements
about the survey findings were based on provisional data, and therefore, conclu-
sions were regarded as tentative. At the time of issuance of the interim report,
the computerized data were undergoing systematic analysis with the goal of
qualifying quality of care indicators in nursing homes as a necessary step to-
ward their needed improvement.
The Introductory Report issued in July 1975. is the first report in which de-
tailed findings and conclusions were presented. The report provides an excellent
and detailed discussion of the survey methodology employed, a summary of find-
ings and their implications, characteristics of facilities and patients, the patient
care setting and services, and a series of statistical tables that display the more
important findings.
The population characteristics of 283.915 patients in skilled nursing facilities
are changing--predominantly still an elderly population but one in which the
proportion of residents under 65 years of age is 22 percent (62,886). These
younger residents are primarily those who are mentally retarded or develop-
mentally disabled. The increased attention being given to the latter requires
study of the special needs of these individuals and their appropriate placement.
The high degree of dependency of patients on the nursing staff for activities
of daily living raises important questions for consideration. It was found, for
example, that 93.9 percent (263,551) required assistance with bathing. About 72
percent (202.000) required the services of another person when dressing. Those
who required assistance in order to eat amounted to 50.1 percent. Slightly more
than two-thirds (68 percent or 193,137) needed assistance with their toileting.
Approximately half of all patients were incontinent of either urine (54.7 per-
cent) or feces (50.1 percent). Over 5 percent had either an indwelling urinary
catheter or an external device or ostomy for bladder drainage. The long-term
patient with limited mobility is prone to have pressure sores. A relatively low
percent (9.2) of patients in this study was found to have bedsores, which is sur-
prising in view of the large percent of incontinent patients.
An age differential became evident in the diagnostic profile. Two out 3 of
those under 65 had neurological diseases: 1 in 4. mental retardation: and 1 in 5
had neurosis or psychosis. For 2 out of 3 patients 65 and over. the primary
dents. diagnoses were cardiovascular and cerebrovascular disease, senility, and acci-
An important implication of the findings is that quality assessment by physi-
ians requires careful examination of the patients, including laboratory tests
and should not be limited to record review. It was found that some long-stay
patients no longer were in need of skilled nursing care. This should have been
identified by periodic medical review. There is a dire need for greater physician
vided. involvement and for assessment tools that confirm that services needed are pro-
The survey findings showed that many patients in skilled nursing facilities
needed specialized rehabilitative services that they were not receiving, e.g.,
47.9 percent needed physical therapy, 35 percent needed occupational therapy, and
13 percent needed speech therapy.
It was found that the governing body frequently does not discharge its obliga-
tions in an effective manner. Policies, usually in policy manuals, were often not
implemented. Patient care policies were found to lack the input from health care
professionals other than physicians and nurses. There was a lack of coordina-
tion between personnel management practices and personnel resources. A critical
finding was the lack of opportunities for career development and continuing
education. Outside resources were often not utilized and the findings and recom-
mendations of consultants not followed. The fact that governing bodies of a
large number of SNF's do not carry out their duties and responsibilities effec-
tively inhibits the delivery of high quality of care.
It was found that few facilities met all Life Safety Code requirements. Sixty-
six percent had 1 to 9 requirements that were not met. Most important. many of
these requirements could be met with little or no additional expense. e.g.,
illumination of exit signs. One-fourth of the facilities were of fire resistive con-
struction and one-fourth of protected wood frame construction. The remaining
facilities were primarily of protected noncombustible construction, protected
ordinary construction. or ordinary construction.
Several clear needs for action emerge from the survey findings.
These needs include:
A total review of the survey/certification process.
Nationwide training and certification of all State surveyors.
A complete analysis of the entire fiscal approach to reimbursement for
services provided.
CAN - LINO INSURE 193
Alternatives to institutional care, such as home health care and day
care.
The number of requests for copies of the report was overwhelming. An initial
distribution of over 5,000 was made to Government officials, provider, consumer,
and professional groups and to individuals from all walks of life. It is clear that
there is great interest all across the country in nursing homes and what the Fed-
eral Government found in this survey.
Because of this great interest and a need to provide information to a larger
number of people, a "Popular Report" summarizing the Introductory Report was
developed utilizing multimedia techniques. This consists of a series of color slides
combined with tape-recorded commentary and a written summary sheet handout.
The Popular Report highlights the major findings of the survey and has been
distributed to each region for presentation to various consumer and provider
groups. It has proven to be very popular. The booklet on How to Select A Nurs-
ing Home: A Guide for Consumers will be ready for distribution in mid-1976.
It is planned that a series of monographs will be prepared covering the findings
of the survey and their implications in specific health care areas. Two of these
monographs are now being written. The first monograph, Assessing Health Care
Needs in Skilled Nursing Facilities-Health Professional Perspectives, is
nearly completed and should be ready for distribution early in 1976. The mono-
graph presents the viewpoints of the long-term care field by several eminently
qualified nurses and one physician. The second monograph, Drug Prescribing
Patterns of Physicians in Nursing Homes, is in the planning stage. It should be
available for distribution in late 1976.
B. DEVELOPMENT OF STANDARDS FOR LONG-TERM CARE
1. Uniform Federal regulations governing participation of skilled nursing
facilities in titles XVIII and XIX were published in January 1974 and addi-
tional standards requiring medical direction. 7-day registered nurse coverage,
discharge planning. and patient's bill of rights were published in October 1974.
In 1974, a revised definition of skilled level of care was published. Interpretive
guidelines for professional and consumer groups as well as instructional guide-
lines for forms for surveyors have been developed and implemented and are
undergoing a constant process of review and revision to assure that the standards
are being applied uniformly and consistently nationwide.
In order to maintain uniformity of standards for skilled nursing facilities, the
Department is currently developing a procedure whereby skilled nursing facili-
ties participating only in title XIX may appeal from a denial of a waiver by the
Regional Office of Long-Term Care Standards Enforcement of a requirement or
requirements of the Life Safety Code.
2. In January 1974, the regulations governing intermediate care facilities
(ICF's) were published, creating in response to congressional legislation, a new
level of care to be provided under the medicaid program. Prior to the publication
of fund regulations for this category of provider institution, many States had
used their own discretion in using medicaid funds to support individuals in facili-
ties which do not offer the ICF level of care or cannot meet the new requirements
for Federal Financial Participation (FFP). The certification procedures de-
veloped for SNF's also apply to ICF's. Rgulations effective March 1974, require
that each facility be surveyed and certified for participation in the medicaid
program within one year. All participating ICF's were surveyed at least once
in 1975. Many were visited more than once in response to complaints by patients
or other interested third parties and as a result of the need for followup visits
by surveyors to determine whether plans of correction to correct deficiencies
found on the original survey were being followed.
Regional offices are cognizant of the assistance needed by States and agencies
as changes in level of care provided by facilities result from implementation of
regulations. With the implementation of regulations governing ICF's. there was
the possibility that skilled nursing facilities certified under title XVIII and
title XIX would convert to ICF's with resultant program implications raising
the critical question of impact on patients' need for care. Studies on the following
issues: the reasons behind conversions: patients versus facility reclassification;
and the appropriate ratio of SNF's to ICF's required to meet care needs: were
issues studied in 1975. The conversion has not been of the magnitude antici-
pated and in general there is a sufficient ratio of SNF's or ICF's to meet
care needs. Theses issues. however, are still being studied SO that appropriate
action may be taken where the need develops or is shown to exist.
Policies governing the preparation of patients for any institutional transfers
necessitated by decertification or recertification at another level have been
developed and circulated by ONHA as guidelines for procedures to ease the
stresses or relocation.
Guidelines and survey forms were developed for ICF's too, including special
forms for needs of intermediate care facilities for the mentally retarded (ICF-
MR) and developmentally disabled. Bureau of Quality Assurance, which has
a lead role in interagency work groups developing guidelines and forms, projects
training needs which new regulations will require and plans expanded activities
to sensitize and alert surveyors to special needs of MR patients and facilities
and upgrade technical assistance to providers.
Operations manuals for regional and State officials were developed and dis-
tributed for SNF, ICF and ICF-MR programs and are being reviewed and re-
vised as necessary to reflect programmatic policy and regulation changes on a
continuing basis.
3. The regulations governing ICF-MR's provide that by March 1977. ICF-MI's
must meet certain standards for the care of the mentally retarded although they
may be certified under the general ICF standards for participation in the title
XIX program prior to that date providing they have submitted a plan of compli-
ance the time they are certified as a general ICF showing that they will meet
CAN - LINO originals 194
these standards in March 1977. Action is underway to assist the States through
the ROLTCSE's in fulfilling their plans of compliance so that they will meet
the ICF-MR standards timely. This will be accomplished through meetings of the
IAG meeting referred to above and in a series of meetings throughout 1976 in-
volving the regional offices and State survey officials.
C, STANDARDS ENFORCEMENT
A long-standing problem in the administration of the largely State-controlled
medicaid program was addressed in investigations which are proving to be
effective. Cooperative efforts of Federal and State agencies concerned are pro-
viding mechanisms for uncovering areas of abuse and terminating Federal
Financial Participation. One such cooperative effort is a program of unannounced
visits to SNF's and ICF's for the purpose of assuring continued high quality
care in our Nation's nursing homes. Under this program, all Federal validation
surveys are conducted totally unannounced to the facility. States are also en-
couraged to conduct unannouneed visits on a sample basis and most States have
endorsed this concept. The ROLTCSE's are assisting the States that are pres-
ently conducting such unannounced visits and working with those few States
that find it difficult to do so because of scheduling or resource problems SO that
they may also participate. In mid-1976, a review of this program will be under-
taken to assess the results to determine whether or not it should be continued.
Efforts to improve the enforcement of Life Safety Code requirements in
SNF's and ICF's were continued during 1975. This was done by providing ad-
ditional training to State surveyors at the regional office level and by increased
surveillance and review of State survey agency activities. Preliminary data for
calendar year 1975 indicates that the participation agreements with 134 skilled
nursing facilities were not renewed because of Life Safety Code deficiencies.
To insure greater uniformity in interpreting Life Safety Code requirements,
the Department has established a Codes and Technical Standards Committee
under the Office of Facilities Engineering and Property Management. The
responsibility of this committee is to provide recommendations for interpreting
the highly technical requirements of the Life Safety Code.
During 1976. the Department expects to make available to State surveyors
audio-visual training material which can be used to train new Life Safety Code
surveyors and improve the càpabilities of others.
A major effort during 1976 will be to implement Public Law 94-182 which man-
dates the application of the 1973 edition of the Life Safety Code in lieu of the
1967.
Continuing efforts will be made to insure that Life Safety Code deficiencies are
properly identified and that needed corrections are made on a timely basis.
D. TRAINING AND RESEARCH
Health Resources Administration is responsible for the training of nursing
home personnel and for conducting research in long-term care. Health Services
Administration is responsible for conducting surveyor training programs. More
detailed information on these activities appear elsewhere in this report.
1. Training of Nursing Home Personnel and Other Health Professionals in LTO
Training to upgrade the performance of long-term care health personnel will
continue to be given high priority. A wide range of short-term and continuing
education courses will be provided for all categories and levels of nursing home
personnel and other health professionals involved in long-term care activities.
2. Upgrading State Survey Agency Performance through Surveyor Training
Training efforts for surveyors will continue to focus on improving the interpre-
tation and uniform application of Federal health care standards and the overall
management of State certification programs. Basic, advanced, and supervisory
training courses of State agency personnel will prepare new surveyors, super-
visors and administrators in the certification process.
3. Innovations in the Delivery of Long-Term Care Services
Based on the LTC survey data, the PHS will encourage innovative approaches
to the delivery of long-term care services. Research, development, and evaluation
as well as technical assistance activities will be among the methods to be
utilized to improve the delivery of long-term care in both institutional and
non-institutional settings.
E. LONG-TERM CARE-MANAGEMENT INFORMATION SYSTEM
Demands for instant information on surveys, certification, status of individual
homes, Life Safety Code inspections, termination of Federal funding, and other
matters of current nursing home concern have now mounted to the point where
it is imperative to produce up-to-the-minute answers without delay.
Several of the data programs developed or being developed within the Depart-
ment contain information about long-term care facilities and needs. These
include the National Center for Health Statistics' Nursing Home Survey, the
Bureau of Health Insurance of the Social Security Administration's Health In-
surance data and the Medical Services Administration of the Social and Rehabili-
tation Service's Management data. These data are being consolidated to develop
a more consistent data base at both Headquarters and Regional levels. The Long-
CAN LINO - 195
term Care Management Information System (LTC-MIS) will become operational
in fiscal year 1976 and is continning, to develop a comprehensive data base for
use by both headquarters and regional office staff.
PART II. NONINSTITUTIONAL CARE
There are many indications that home health and related programs are a cost-
effective and humane ingredient in the continuum of care, providing alternative
and appropriate care and, at the same time, releasing valuable institutional
resources to treat patients with more complex health care requirements. A two-
pronged approach has addressed (a) the development and support of program
activities related to the organization, management, and expansion of quality
home health services; and (b) the promotion of greater utilization of home
health services by resolution of problems of reimbursement in regard to medicare
and medicaid recipients.
In January 1975. the Secretary delegated responsibility to the PHS to coordi-
nate and monitor home health care activities and program development for the
Department. Subsequently, this coordinating and monitoring function was dele-
gated to Office of Nursing Home Affairs. Through the efforts of an interagency
work group on home health service, several steps have been taken to improve
the status of this important segment of health care for the elderly including:
-Clarification and modification, as needed. of existing regulations and guide-
lines for medicare reimbursement to allow expansion of home health
services;
-Strengthening of State medicaid program efforts to encourage support of
home health services and reimbursement on a cost-related basis;
Collection of cost and outcome data on home health services;
Preparation of materials and guidelines to promote and support home
health services;
-Encouragement and assistance to support community projects to start or
expand home health services and to educate the public about the uses and
benefits of home health care:
-Analysis of other non-institutional approaches to delivery of care such as
day care, foster home care, in-home services, etc., and stimulation of needed
legislative change. Study of interrelatedness of health and social factors
in long-term care to the goal that the individual be maintained in his own
home for as long as possible and dependency and/or premature institution-
alization prevented or postponed.
PART III. NEW AND DEVELOPING LONG-TERM CARE ACTIVITIES
The findives:of:the Department's long-term care survey have provided numer-
ous implications for consideration by those concerned with the management of
skilled nursing facilities. There is now a baseline for a program of action that
can be effectively accomplished through a partnership of the surveyors, providers,
consumers, and associations working together with the Federal and State govern-
ments. This study provided a basis for the development and implementation of a
national strategy for long-term care for older Americans, the mentally retarded,
and developmentally disabled who require optimum care in a safe environment.
Further, the development of various tools, such as the cost of care index, and
the holding of meetings with provider and consumer groups jointly will assist
in providing more efficient and satisfactory care to patients in long-term care
facilities. Individual patient differences are recognized by providers. In order
to insure that all areas of patient functioning are considered in treating the
patient, Office of Nursing Home Affairs is supporting further development of a
patient assessment tool used in the LTC survey. This tool holds great promise
for more individualized patient bedside care in nursing homes. Use of this tool
will also eliminate much of the paper work now required and it will assure care
of a higher quality because of its built-in requirement of identifying the patient's
assets, liabilities-the patient's strengths as well as his weaknesses.
A. DEVELOPMENT OF A NATIONAL RATING SYSTEM ON QUALITY AND COST OF CARE
PROVIDED
A system providing a monthly cost-of-care index will be designed and main-
tained by DHEW to serve in the long-term care reimbursement areas as the Bu-
reau of Labor Statistics cost-of-living index serves in the wage rate and other
areas of the economy. Both national and regional indices will be developed. An
administratively sound patient assessment tool is in the process of being devel-
oped and tested which can be used both for survey and certification as well as
for administrative control within the facility. Uniform inspections and ratings
for nursing homes are being developed in order to have a national scorecard
which, when implemented, would grade nursing home care uniformly across the
nation, SO that an "A" rating would mean the same nationally.
In the development of these indices, two major steps are envisioned, the review
and revision of regulations and streamlining of the survey and certification
process:
1. Review of Regulations
A complete analysis of the regulations for the skilled nursing facility and inter-
mediate care facility will be conducted with the goal of revising and restructur-
ing them to provide for the measurement of performance outcomes which reflect
quality of care provided to the patients.
2. Survey-Certification Process
The present medicare and medicaid long-term care survey and certification
forms will be studied and combined into a single survey and certification package
CAN - LINO - 196
that through the use of a patient assessment tool is responsive to the need for
measuring the quality of care provided to the patient in the facility.
The effecive performance of individual surveyors and the conduct and manage-
ment of the certification process will be further supported and strengthened by
allocation training funds and furnishing technical assistance to the States for
training survey personnel.
B. consumer/provider INTEREST IN NURSING HOME CONDITIONS AND FEDERAL
STANDARDS
The Office of Nusing Home Affairs program of consumer/provider activities
has included local, State, areawide, regional and national levels of particiaption.
The consumer comprised three major groups: (1) providers of services within
the nursing home industry (i.e., industrial representatives and professional and
nonprofessional personnel) ; (2) clients as consumers of services who seek or use
these health care services (i.e., patients, families and additional community
membership) ; and (3) other interested individual and group citizenry. The con-
sumer groups were represented in terms of individual institution and through
national organizations or associations.
1. Policy Advisory and Program Planning
There was considerable policy advisory/program planning input to specific
areas such as fire safety, staffing patterns and specific areas such as fire safety,
staffing patterns and patients' rights.
General advice was furnished by individual consumer experts and national
groups, organizations, and associations through their publication of newsletters,
digest, journals, and articles. Staff continuously reviewed publications for in-
formation on new concepts, or positions taken by the consumers on issues devel-
oped by Office of Nursing Home Affairs. Future plans include expanding relation-
ships with consumers for input to policy and program planning.
2. Availability of Data to Consumers
Through the recently developed Management Information System (MIS),
data of surveys conducted in nursing homes were computerized. When fully
operational, this service will provide data indicating both general and specific
problem areas encountered by providers in the survey and certification process.
The information will be made available to the public to meet their needs for in-
formation about providers of health services.
3. Consumer Correspondence and Complaint Handling
Office of Nursing Home Affairs received numerous letters and phone calls from
consumer groups, primarily centered around new regulations or standards. All
correspondence was handled as expeditiously as possible. In each case, a response
was prepared and communication was continued until there was resolution of the
situation. Wherever feasible, the complaint was referred to the regional office
for more direct determination of the problem and resolution of the complaint.
ONHA periodically reviewed the nature of the complaints in order to determine
if there was an emergency pattern which would indicate that specific regulations
needed to be clarified, modified, revised, or revoked. ONHA continued to serve as
the PHS focal point for information on nursing home matters from members of
Congress, the White House, and the general public. Particular attention was paid
to concentrations or patterns of concern reflected, considering these in the devel-
opment establishment of ONHA policies and guidelines. Future plans are to con-
tinue these consumer activities.
4. Consumer/Provided Mcetings
A series of provider/consumer meetings have been held which were designed
to bring to approximately 100 key national organizations, and they to their con-
stituency, an interpretation of Federal regulations or policy issues. The May 15,
1975 meeting highlighted important findings that resulted from the Long-Term
Care Facility Improvement Study and a question and answer period followed.
The Secretary, DHEW delivered the opening remarks. The October 1975 meet-
ing introduced the concept of patient assessment and its present and future im-
plications for assisting consumers/providers in determining individual patient
needs and for developing an appropriate plan of care. Future meetings will be
based, as was the one held in October 1975, on joint planning and exploration
of mutual areas of concern from which consumer inputs will be obtained in de-
signing policy issuances and program plans. Consumer/Provider meetings are
held on a regular basis every 6 months.
5. Other Feedback Mechanisms
In addition to the measures described previously, other means were employed
to provide feedback to consumers. Examples include:
-Testimony at congressional hearings.
-Formal presentations by key ONHA staff at national; regional, State and
local general meetings of consumer groups.
-Preparation of materials for presentation by congressional and admin-
istration leadership.
-Publication of articles, editorials, and other technical materials in profes-
sional and trade journals.
CAN - LINO - 197
-Preparation of booklets, pamphlets, and reports for distribution to the
field.
--Development of other audio-visual aids for use at meetings and confer-
ences to present policy Issues and regulatory functions.
--Participation in specially designed seminars and conferences planned and
conducted by consumer groups.
-Provision of consultation and technical assistance to consumers on indi-
vidual or small group basis.
ONHA plans to continue these corollary feedback mechanisms and expand
those found to be most effective.
6. Consumer Education
Implicitly, all of the above mechanisms for imparting information and knowl-
edge were part of consumer education. Of particular importance are the special
client/provider/consumer meetings and the short-term training of provider staffs
developed as a special initiative in response to the Department's programming
efforts in long-term care. These short-term training programs have been carried
out since 1971 and have resulted in 100,000 short-term training opportunities for
persons engaged in providing care in nursing homes.
O. ACTIVITIES IN AGING
1. Joint Agreement between Public Health Service and Administration on Aging
Under a joint agreement between Public Health Service (PHS) and the
Administration on Aging (AoA), coordination of activities pertaining to aging
are carried out. This agreement is to provide a framework within which to orga-
nize combined efforts on consultations and sharing of expertise, the coordination
of strategies related to planning and funding, the planning and implementation
of health services delivery programs, and the recommendation for future long-
term care program directions.
2. Federal Research on Aging
The Research on Aging Act of 1974 directs the Secretary, DHEW. to develop
a departmental plan for a research program on aging. The National Institute
on Aging (NIA) and the National Advisory Council on Aging are coordinating
the efforts of numerous representatives of both the Federal and the private
sectors in formulating this plan. As an integral part of the planning process, the
NIA is canvassing all Federal agencies concerned with the aging research effort
for recommendations on future directions for such research. AoA has awarded a
contract to Documentation Associates, an organization in the private sector, to
obtain a comprehensive inventory and analysis of past and current federally
supported research on aging. ONHA, representing the Office of Assistant Secre-
tary for Health, has a lead role in providing policy guidance and direction in this
activity.
3. Interdepartmental Information and Referral Task Force
This task force is searching for more ways to be useful to the people at the
local level in relation to information and referral (I&R) services. ONHA repre-
sents the Public Health Service on this task force and is primarily concerned in
seeing that health needs and services are integrated in I&R services. The interrela-
tionships of economic, social and other factors with the health problem or the
need for health services require that consideration be given to all needs of the indi-
vidual in working out a plan of care. Accurate information about available
resources need to be available to professional persons and to citizens as well in
order that these services and resources be coordinated, effectively used, strength-
ened or established where indicated.
4. Patient Relocation
AoA has the primary responsibility for patient relocation from substandard
facilities, and can lend skills to identify service gaps and strengthen community
resources. The lead health role in this was taken by ONHA. Guidelines were given
to regional Offices of Long-Term Care Standards Enforcement to assist them in
providing consultations to State relocation efforts. The States were given tech-
nical support in assisting them in their task of moving patients to a facility
that provides better care, a more favorable environment and which meets Federal
standards.
ITEM 5. LETTER FROM G. DONALD WHEDON, M.D., DIRECTOR, NA-
TIONAL INSTITUTE OF ARTHRITIS, METABOLISM, AND DIGESTIVE
DISEASES; TO SENATOR FRANK CHURCH
DEAR MR. CHAIRMAN: In reference to your letter of March 2, 1976 concerning
the National Institute of Arthritis, Metabolism, and Digestive Diseases'
(NIAMDD) programs of particular relevance to aged persons, it is our under-
standing that the NIAMDD detailed report is being included in the National
Institutes of Health (NIH) response which may not have reached you at this
time. In addition to that report, however, we are pleased to provide additional
information about these particular programs as you have requested.
As the name of the Institute indicates, research into the causes, prevention
diagnosis. and treatment of arthritis is a major responsibility of the NIAMDD.
In fiscal year 1975, one-sixth of our total research and training efforts, which
CAN - LINO - 198
cover 10 categorieal areas including diseases usually associated with substantial
mortality rates-diabetes and kidney disease-were in the areas of arthritis and
related musculoskeletal disorders. Although the enigma of arthritis is a long
way from being solved, some progress is being made in the area of treatment par-
ticularly with the regard to osteoarthritis, the degenerative disease commonly
associated with the aging process. The outlook for joint replacement. particularly
that of the hip joint, is rapidly improving and new and better means of joint re-
placement is a primary objective of the NIAMDD.
It should be pointed out that the National Arthritis Commission, of which I
am a member, will be submitting a comprehensive plan by the end of April for
combatting arthritis and related musculoskeletal diseases. The Commission has
heard testimony from various groups and individuals including those afflicted
with osteoarthritis and will undoubtedly include in their recommendations
specific mention of the research areas which NIAMDD should emphasize. We will,
of course, proceed with implementation of the National Arthritis Plan. when
and if acceptable to the Congress, to the best of our financial and manpower
limitations.
Insofar as osteoporosis is concerned, my own personal research interests have
long been concerned with mineral metabolism of the bony tissue, the basic re-
search area which contributes to the fundamental understanding for such dis-
eases as osteoporosis, the bone-thinning condition often found in elderly,
postmenopausal women. In addition to the support of research activities both
at the NIH facility in Bethesda, Md., and in research laboratories across the
country, including such clinically oriented projects as a 5-year study to evaluate
various treatments for osteoporosis. the NIAMDD also has prepared and does
distribute a pamphlet on osteoporosis written for the general public. Through the
regular compilation and publication of the Endocrinology Index. distributed
widely, the NIAMDD insures that the latest research information on osteoporosis
is made available to investigators working in the area and to physicians con-
cerned with the disorder. as well. Finally. the NIAMDD was pleased to support
an International Conference on Bone Mineral Measurement a little over 2 years
ago in Chicago, Ill., which included in the biomedical sessions, presentation and
discussion of the problems of osteoporosis and consideration of the affect of
physical activity on bone, specifically in the aged.
Benign prostatic hyperplasis (BPH), enlargement of the prostate gland, affects
more than 60 percent of the male population over 60 years of age causing varying
degrees of bladder outlet obstruction. This in turn leads to secondary infection
which in turn may result in chronic prostatitis and inflammation of the bladder
and upper urinary tract. Resulting complications may include infection and
damage of the kidneys and a predisposition to urinary stone formation. all seri-
ous health problems affecting older American men and of concern to NIAMDD's
kidney and urology program. In an effort to stimulate research into this prob-
lem, NIAMDD held a workship in February 1975 to review, evaluate and identify
new directions in BPH research utilizing an interdisciplinary approach. The
proceedings will be published soon and will become available to interested persons,
parteularly, we hope, investigators seeking new ideas and new areas of research
focus. BPH research is admittedly an area where little is going on but we are
striving to change that through the stimulation of such activity as the workshop
and a widely disseminated publication of the proceedings. In addition, an
NIAMDD supported evaluation study of kidney and urological diseases should
help to further focus well-deserved attention on the problem.
I would hope that this detailed presentation of NIAMDD activities in three
categorical disease areas of concern to older persons will more fully serve to
denote NIAMDD interest and concern.
Sincerely yours,
G. DONALD WHEDON, M.D.,
Director, National Institute of Arthritis,
Metabolism, and Digestive Diseases.
CAN - LINO - 199
ITEM 14. COMMUNITY SERVICES ADM.
SET BLACKLETTER!!!!
DEAR MR. CHAIRMAN: In response to your request of December 30, 1975. I am
pleased to submit the enclosed summary of major activities carried out by the
Community Services Administration on behalf of the elderly poor during 1975,
as well as some planned followup efforts in 1976.
I would like to assure the committee that the Community Services Adminis-
tration remains firm in its commitment to the needs of our older poor Americans,
and I look forward to continuing cooperation with you and your colleagues in
the Congress in this regard.
Please let me know if you have need of further information.
Sincerely,
BERT A. GALLEGOS, Director.
THE 1975 ANNUAL REPORT OF THE COMMUNITY SERVICES
ADMINISTRATION'S PROGRAMS AND ACTIVITIES FOR THE
ELDERLY POOR
The Senior Opportunities and Services (SOS) Program, a CSA special emphasis
program for the elderly, has proved itself to be a most successful model in
developing comprehensive service delivery system(s) to older persons. A variety
of program components are possible through the use of these funds differing
from one community to another, depending on the existence of social service
programs or the lack thereof. etc.
In 1975. CSA funded 196 SOS projects at a cost of $10.2 million. These projects,
conservatively estimated to have served at least 1 million older poor persons,
operate in nearly 800 senior centers across the Nation. In addition to the funding
of 196 SOS projects through local community action agencies (CAA's), it is
estimated that 90 percent. 600 additional CAA's, have elderly service components
serving more than 1½ million additional older poor persons. A recent sample
survey of community action agencies indicates a total of $50.4 million is spent
annually by CAA's in providing services to the elderly. combining Federal, State,
and local resources.
Apart from the sos program and use of the section 221 local initiative pro-
gram funds, resources from CSA's Community Food and Nutrition Program/
Emergency Food and Medical Services Program: and the Emergency Energy
Conservation Program are made available for the elderly.
COMMUNITY FOOD AND NUTRITION (CFN) PROGRAM
The CFN/EFMP Program in fiscal year 1975 obligated $24,761,311. The elderly
poor, along with migrants and Indians, receive increased attention resulting
in grants in excess of $3.9 million in which elderly feeding nutrition was em-
phasized. A variety of services are available including: meals-on-wheels (delivery
of food to the home) and group feeding program.
EMERGENCY ENERGY CONSERVATION SERVICES PROGRAM
The CSA/EECS Program reported that during fiscal year 1975. a total of
$16.5 million was obligated for operating weatherization and crisis intervention
programs funded through community action agencies (CAA's).
A December 31, 1975 report of a survey of 55 percent of the 865 Community
Action Agencies received energy funds showed that during 1975. 19,634 homes
were weatherized and that the elderly poor or near poor were occupants in
10.074 of these homes; and of the 7,248 households of the poor and near poor who
received emergency energy assistance 3,039 of these assisted households had one
or more elderly poor or near poor occupants. The survey indicated that all 53
CAA's in Iowa, Kansas, Missouri, and Nebraska have weatherizing programs
with 60 percent of the resources expended on the elderly. Through December 1975,
the grantees have winterized 8,289 dwelling units. The average cost per house
in these States varies between $40 and $170.
Area agencies on aging have contributed $160,000 in title III funds for win-
terizing homes in contracts with CAA's ($120,000 is in Missouri and $40,000 in
Kansas). The State of Iowa has contributed $80,000 to CAA's for this purpose.
INTERAGENCY AGREEMENTS
These are two agreements currently geared to cooperation between CSA and
other Federal agencies to assist older persons.
STATEMENT OF MUTUAL SUPPORT BETWEEN THE ADMINISTRATION ON AGING AND THE
COMMUNITY SERVICES ADMINISTRATION, NOVEMBER 5, 1975
The statement includes several activities common to the programs of both
agencies that lend themselves to joint endeavors ranging from information ex-
change to joint service delivery for older persons.
The Administration on Aging and the Community Services Administration
will promote programs and activities which are designed to bring about maxi-
CAN - LINO - 200
mum coordination between the resources available through joint planning. pro-
graming and implementation at the Federal, regional, State and local levels.
Activities that are common to these programs and lend themselves specifically
to joint endeavors are: the exchange of information, planning and coordination,
and research and demonstration.
WORKING AGREE MENT ON ENERGY CONSERVATION ACTIONS FOR THE ELDERLY
The continuing problems experienced because of the energy crisis, in the form
of shortages and rising energy costs impose hardships upon every American.
However, the lives of many older persons, especially the low-income elderly,
are severely affected by rising energy costs. In many instances. the low-income
elderly have been forced to make eruel choices between heat or food and other
necessities.
In order to combat this crisis and to meet the critical needs that face older
low-income persons in the winter, the following Federal agencies have joined
the new Community Services Administration in a working agreement Adminis-
tration on Aging, DHEW; Agriculture Extension Services, USDA; Farmers
Home Administration, USDA; Department of Housing and Urban Development;
ACTION: Federal Energy Administration.
These agencies on January 13, 1975, agreed to work in concert, mobilizing
their various expertise and resources to achieve the following objectives)
1. To utilize existing public resources to develop and coordinate programs
which will assist in the insulation and winterization of older persons' homes, in
an effort to reduce energy costs and shortages.
2. To adopt strong advocacy roles in an effort to respond to on-going and
emergency energy-related needs of older persons.
3. To provide older persons with clear and accurate information about fuel
allocations and energy conservation in order that they may know their rights
with respect to energy costs and that they make take appropriate conservation
measures to offset the financial burden that will result from increased energy
costs.
HIGHLIGHTS OF CSA'S SENIOR OPPORTUNITIES AND SERVICES PROGRAM (AND OTHER
CSA PROGRAMS ACTIVITIES)
The following narrative program descriptions are illustrative of program
components for the older poor people provided at the local level through the 865
community action agencies or their delegates. They provide a sampling of the
broad base of other Federal, State, local, public and private resources the CAA's
have been able to generate, and provide a small cross section of programs that
are typical of CAA and SOS activities carried on to assist older poor persons.
Virtually every one of the 69 CAA's in six States in the New England area
has an active involvement with older persons programs. Examples follow:
Eastern Middleser Opportunity Council (EMOC) in Somerville, Mass., has
published a senior citizens yellow pages which provides a comprehensive direc-
tory of service providers and information about varied programs which benefit
or serve older persons. EMOC has also developed a "Food Distribution Loan Pro-
gram." The program benefits single elderly persons and alcoholies who are pro-
vided a 3-day package of canned and packaged foods which together are suffi-
cient for balanced nutritious meals. EMOC's nutritionist determines the package
composition.
OnBoard in New Bedford, Mass., uses an $11,400 CFNP grant to improve
local utilization of varied local programs. In conjunction with the Council on
Aging and the local Elderly Nutrition Program, the CAA works to increase
numbers of persons served in congregate meal programs and meals-on-wheels,
providing transportation and delivery services; develops programs with the
board of health through the CAA neighborhood centers for classes, training and
other instruction on nutrition and food preparation; uses Agency newsletter and
notices delivered with meals-on-wheels and at congregate sites to provide infor-
mation on food and nutrition; arranges regular health maintenance program
in public housing community rooms and neighborhood centers for health/
nutrition information and referral classes on problems and adjustments in aging,
diet, physiological changes. post bereavement adjustments, etc.; assists senior
citizen groups in organizing congregate meals on self-supporting basis and assist
these groups in developing their own social educational and health programs.
OnBoard's program serves as a catalyst in developing new low cost support
programs for older persons and is an enabler to see that other funded programs
reach the senior population who qualify for CAA services.
Operation See-Me, operated by the Mid Coast Human Resources Council, Inc.
in Knox County, Maine, uses Administration on Aging funds for transportation of
the elderly poor to medical appointments, nutrition related programs, shopping.
and to some extent personal business. CAA's in other counties in Maine have
similar contracts with the prime contractor. Central Senior citizens Association.
The Orleans County, (Vt.) Council of Social Agencies, Inc. (CAA), using
$20,000 in local initiative funds and working closely with labor union officials, is
developing a preretirement program aimed at blue collar workers and other
union members. The program seeks to train retired union members as senior or-
ganizers in focusing resources of other agencies on preretirement needs and to
facilitate retired members access to relevant information and programs. The pro-
gram envisions development of an advocacy capacity related to the needs and
problems of retired workers.
Champlain Valley OEO, Inc. in Buriington, Vt., serves as contractor for senior
community service programs which operate statewide. A prime focus of these pro-
grams operated with the CETA funds for the State Office of Manpower Affairs
and the National Council on Aging is to rekindle involvement of older persons,
awaken dormant skills, identify and cultivate individual natural "gifts" and re-
CAN-LINO- 201
late the participants to agencies, including CAA's. that can provide meaningful
work. The two programs together are funded at $550,000.
two programs together are funded at $550.000.
The Community Food and Nutrition Program of the Goldenrod Hills Com-
munity Action Council, Walthill, Nebr. was one of 26 organizations funded to dem-
onstrate the concept that better nutrition among the aged results in better health
and thus less medical care. Today the program is funded under title VII of the
Older Americans Act through the State of Nebraska Department of Public Wel-
fare. The program serves 108,000 meals annually.
This program is not only concerned with good nutrition but also with social
problems, such as combatting loneliness and helping senior's remain contributing
member of the communities.
The Mid-Sioux Opportunity, Inc. CAA in Remsen, Iowa is a very successful
homemaker health aid program receiving $132.420 in non-Federal funds. They are
assigned to work whenever illness, disability or other crisis threatens normal
family living. They instruct elderly in home management, budgeting. fire preven-
tion, first aid and teach them how to prepare special diets for diabetic and other
illness.
One outstanding employment program is conducted by the South Iowa Eco-
nomic Development Corporation at Ottnmwa, Towa (SIEDA).
The Department of Labor funds the National Retired Teachers Association for
a senior community services project handled through the Iowa State Commis-
sion on Aging. which selected SIEDA to operate the project.
Beginning January 5. 1976, they have 138 job slots funded at an annualized
rate-of $500,000 to provide constructive employment at 20 hours per week in local
government or private-not-for-profit organizations. SIEDA has used 15 of these
positions in their winterizing program, placed 78 in other agencies and have 60
yet to place by the end of February. Types of positions provided are secretarial,
bookkeeping. clerical. and construction positions. One is working as a coordinator
for the county personal property tax relief program for the elderly.
Also, in our winterizing programs, CETA slots are used with a very high pro-
portion being filled by retired construction craftsmen, etc.
Dakota CAA. Its delegate agencies provide variety of programs and projects
benefiting older persons. Among other accomplishments by these agencies are
the following:
Creation. operation and ongoing operation of 119 senior citizen centers
in the past three years;
Information and referral to 1,500 elderly persons annually;
840 daily meals to elderly persons in fiscal year 1976:
Transportation services to 1,800 elderly persons daily
Winterizing homes of 1,175 elderly persons in fiscal year 1976;
Supplemental security opportunities for 1,850 elderly persons in fiscal year
1976; and
Homemaker/health aid type services to 400 elderly persons per day in
fiscal year 1976.
In North Dakota, senior programs are operated somewhat differently. The
focus of senior activities rests with the CSA funded, North Dakota Seniors United
(NDSU), formed in 1975 under companion funding from the North Dakota Com-
munity Action Agency and North Dakota Aging Services. NDSU is a statewide
coalition for information exchange and services to the elderly. Basic activities in-
clude operation of a toll-free telephone for information and referral. publication
of a monthly newsletter on service programs and issues. and technical assistance
in the formation of senior organizations and county level councils on aging.
Lane County Community Action Program, Eugene, Oreg. Lane County has
six social/recreational senior services centers throughout the county which pro-
vide outreach and service delivery. A multiphasic preventive health screening
and assessment program provides medical evaluations for 800 seniors per year.
HELP, a free employment service for older workers, helps employers place seniors
in full or part-time employment. A home repair program is designed to help elderly
homeowners remain in their homes through a maintenance program which keeps
seniors' homes in the most livable state. A homemaker program provides care in
the home. Volunteers do home visiting. housekeeping, shopping assistance and
provide hygienic services. A volunteer transportation project gives seniors busi-
ness and shopping opportunities in the major populated areas in Eugene.
Twelve meals sites throughout the county provide 640 meals a day from three to
five times each week. The program also provides 300 home delivered meals a day
to home-bound elderly. The unit cost is 60 cents per meal.
The agency is also conducting a study aimed at finding out why minority elderly
and other elderly are not participating in established nutrition programs at an
acceptable level. Done in cooperation with university research students, the proj-
ect intends to design and implement new methods of increasing participation that
can be tested and shared with other elderly nutrition programs. Emergency
food vouchers and/or food services are provided for indigent elderly.
Older Persons Action Group. Anchorage, Alaska. The agency operates out of two
centers in the city of Anchorage: the Mabel T. Caverly Center is used for per-
sonal escort service, arts and crafts. and small fellowship meetings; the neigh-
borhood community building is used as agency headquarters. direct services such
as transportation, nutrition center, housing information and referral, provides
space for large board and community meetings, CSA funded credit union, out-
reach workers, human relations office and the Alaska Federation of the Blind. The
program also provides door-to-door personal escort transportation for the elderly
who reside in the greater Anchorage area horough.
"Senior Sounds" is a weekly (Sunday) radio program in several native dialects,
as well as English. and is the primary source of information on behalf of the
elderly reaching the remote villages of Alaska, and approximately 7,500 persons
in the social security age group.
CAN - LINO - 202
A quarterly statewide newsletter is provided to more than 7,000 of the State's
elderly.
A home winterization program completed 60 low-income elderly homes. All
labor for the project was donated by members of local service clubs, who worked
weekends the program during 1975.
The OPAG is the primary agency in Alaska developing housing for the elderly.
Construction was begun in Fairbanks on 100 units of low-income elderly hous-
ing. Plans were completed for the construction of 150 units in the Anchorage area
during 1976.
The OPAG was instrumental in getting State legislation passed that increased
the State longevity bonus for the elderly by 25 percent.
The organization also obtained the passage of State legislation that allows
seniors to attend community colleges at no cost, with full credit.
Pierce County Board of Commissioners (CAA), Washington. In 1975, a senior
handyman program that did minor home repairs on 360 senior citizens homes was
operated.
The program operated a mobile clinic at 10 sites in rural Pierce County, provid-
ing a wide range of services. One thousand eight hundred ninety-nine (1,899)
clinic visits were made, with 8,000 flu shots given (including nursing homes),
149 complete physical examinations including PAP smears, 150 separate PAP
smears, 598 seniors received foot care. The clinic is staffed by a Public Health
nurse as well as a nurse practitioner.
The senior program makes visits to nursing homes using volunters. One senior
center makes regular visits to five nursing homes with entertainment provided by
the senior orchestra.
Programs' staff and volunteers helped 260 senior citizens fill out property tax
relief exemption forms. This program provided relief from special levies to senior
homeowners aged 62 and older.
During the year, 3,977 volunteers provided more than 10,000 volunteer hours of
service, which included visits to nursing homes.
One successful housing demonstration program is the Eastern Kentucky Hous-
ing Development Corporation operating in eastern Kentucky's Leslie, Knott,
Letcher. and Perry Counties. More than 2,600 homes have been renovated during
the past 4 years. Some 1.200 homes were those of elderly poor persons. most of
them age 65 or older. Besides DOL funds, HEW welfare funds for buying ma-
terials. and additional loans under the Farmers Home Administration section 504
program. have been used where possible. Its housing factory is producing over 40
homes a year for low-income people whose monthly mortgage payments average
$55.
West Virginia, Project TRIP (Transportation, Renumberation and Incentive
Program) is a statewide demonstration program.
West Virginia has 16 percent of its population over 60 and 10 percent of those
over 63 are poor by CSA definition.
Its public transportation has shown an alarming decline: a drop of 22 percent
in the last 2 years alone in buses and limousines licensed to operate as public
carriers. There are only 411 public licensed vehicles operating within the State
and almost two-thirds of those operate in the four largest of 55 counties. Sixty-
seven percent of the counties have no licensed carriers (Greyhound has 1,509
buses and Trailways has two which are authorized to run through the State).
These facts define a major problem which promoted the State and the Office of
Economic Opportunity and the Department of Transportation to join together.
The program (TRIP) designed to yield a long-term solution to the meager
public transportation available in that mainly rural State involves a travel stamp
system. patterned on food stamps, which will give eligible poor persons a travel
subsidy. Keyed to this expansion of the poor individual's capacity to travel is a
State plan to expand the transportation route systems in some 145 primary and
about 70 feeder route systems mainly funded by the Department of Transporta-
tion.
JoB OPPORTUNITIES PROGRAM-TITLE X OF THE PUBLIC WORKS AND ECONOMIC
DEVELOPMENT ACT OF 1965
Of the approved proposals, CSA grantees will receive nearly $10 million for
older persons programs and the Senior Opportunities and Services (SOS) Pro-
gram that will include such activities as transportation, home health aides. home-
owner maintenance, isolated senior citizens assistance, nutrition. emergency food
and medical services, housing rehabilitation and winterization, multiple social
services. credit unions, and combined care for the aged, blind and disabled.