May 13, 1975
Page 13983
OLDER AMERICANS ACT AND THE RURAL ELDERLY
Mr. CLARK. Mr. President, today I am introducing legislation on behalf of myself and Senators CHURCH, STAFFORD, McINTYRE, ABOUREZK, McGOVERN, HUMPHREY, BURDICK, MUSKIE, DOMENICI, HOLLINGS, LEAHY, HATHAWAY, and HARTKE, to amend S. 1426, the Older Americans Act Amendments of 1975.
Right now, Congress is considering legislation to extend and revise the Older Americans Act. The House of Representatives has approved enabling legislation for this purpose, and the Senate Labor and public Welfare's Subcommittee on Aging has been working on similar authorizing legislation for some time now. The amendments that we are introducing today revise the Senate version of the Older Americans Act – S. 1426 – to make that bill more sensitive to the needs and problems of the rural elderly.
Originally approved in 1965, the Older Americans Act provides for an Administration on Aging within the Department of Health, Education, and Welfare to serve as the focal point for Federal programs relating to aging. That Federal agency, in turn, works with State agencies and local area agencies on aging that work with older people at the local level to provide services like nutrition, transportation, health care, information and referral, and legal counseling.
Over the past few years, there has been some evidence that the agencies under the Older Americans Act have not adequately served the needs of rural elderly people, and because of that, I chaired a hearing of the Senate Special Committee on Aging on April 28 that investigated the effectiveness of the Older Americans Act in rural areas. Witnesses from all parts of the country gave examples of how the act has failed toa serve over 5 million older people who reside in rural America because of fiscal restraints and other barriers to governmental services in rural areas.
We learned at the hearing that rural elderly often are neglected in the planning of services delivery, and that means that as a group, they realize few benefits from the Older Americans Act.
Certainly, the problems associated with living in a rural setting go far beyond the Older Americans Act and the rural elderly. The trend is the same across the board: this Nation's resources and technology have largely ignored the problems of rural Americans.
The recent conference on rural Americans emphasized some of the problems:
60 percent of the Nation's substandard housing can be found in rural America, yet only 20 percent of the total Federal housing subsidies go to rural areas.
Rural communities suffer from a perpetual shortage of doctors, dentists, nurses, and other essential health care personnel. One hundred thirty-eight rural counties and more than 5,000
towns must go without a single physician, but only 7 percent of the Department of Health,
Education, and Welfare's assistance money goes to non-metropolitan areas.
Public transportation in rural areas suffers as well – most Federal assistance is channeled into urban areas, leaving rural areas with no help at all.
The time has come to change this trend – to give more emphasis in Federal legislation to rural areas and rural people. The older Americans amendments is a good place to begin.
At the Committee on Aging's hearing on rural areas, many witnesses gave accounts of innovative methods their States already have developed to combat geographical obstacles. For example, Dr. Woodrow Morris of the University of Iowa College of Medicine described a program that the medical school has undertaken to find solutions to delivering health care to residents of rural areas. With the cooperation of local doctors and practitioners, the college is developing model health care programs by recruiting doctors and para-professionals to work in satellite clinics.
Another innovative health care delivery system was described to the Committee by Gov. David Pryor of Arkansas. It involves a mobile unit which travels to areas which have no resident doctor and provides free medical care to those residents. This service provides many rural people – especially older rural people – the only professional health care they get all year.
Mary Ellen Lloyd of Virginia explained in her testimony a program she directs that delivers hot meals to homebound elderly. The meals are prepared by volunteers at one site, and then additional volunteers deliver the meals to older persons in their own homes. The true success of this program, according to Mrs. Lloyd, is that it not only provides the older person with a well-balanced meal, but it also brings a very welcome visitor to their homes who often help with small chores around the home, make arrangements for the delivery of other services, and frequently, they are the only contact these older people have with the outside world.
Mr. President, the amendments that have been introduced today will help give rural areas and rural elderly the attention they need, and they will help insure that more of the programs under the Older Americans Act are developed for the rural elderly. As the Older Americans Act now is written, emphasis is placed on low-income and minority elderly. My amendments would give special attention to elderly people who reside in rural areas as well. Many older citizens are neglected because of their residence, and we can help change that by incorporating these amendments in the Senate bill.
The proposed amendments also will mandate that special attention be given to the rural elderly as State and area agencies on aging develop and implement their overall service plans. And, the
amendments would require the Administration on Aging to develop guidelines that will guarantee an equitable distribution of assistance between urban and rural areas. These services are included under title VIII of S. 1426, and they will help insure that health care, home renovation and repairs, transportation, legal counseling, and special manpower programs are developed in rural areas.
Mr. President, together these amendments will be very helpful to rural elderly persons; the need for them has been well documented, and I urge the early adoption of these amendments to S. 1426, the Older Americans Amendments of 1975.
At this point, I ask unanimous consent that the text of these amendments be printed in the RECORD.
There being no objection, the amendments were ordered to be printed in the RECORD, as follows:
AMENDMENT No. 466
On page 40, between lines 4 and 5, insert the following new subsection:
(c) Section 705 (a) (4) of the Act (42 U.S.C. 3045d(a) (4)) is amended by inserting before the word "minority" the following: "rural elderly,".
AMENDMENT No. 467
On page 38, after line 24, insert the following new section:
ACQUISITION, ALTERATION, OR RENOVATION OF MULTI-PURPOSE SENIOR CENTERS
SEC. 112. Section 502 of the Act (42 U.S.C. 3041a) is amended by adding at the end thereof the following new subsection:
"(c) The Commissioner shall establish criteria designed to achieve an equitable distribution of assistance under this part between urban and rural areas."
On page 39, line 2, strike out "Sec. 112" and insert in lieu thereof "Sec. 113".
On page 39, line 11, strike out "Sec. 113" and insert in lieu thereof "Sec. 114".
On page 40, line 7, strike out "Sec. 114" and insert in lieu thereof "Sec. 115".
On page 42, line 14, strike out "Sec. 115" and insert in lieu thereof "Sec. 116".
On page 44, line 8, strike out "Sec. 116" and insert in lieu thereof "Sec. 117".
AMENDMENT No. 468 .
On page 35, between lines 16 and 17, insert the following:
(1) In the matter in the parentheses of paragraph (1) thereof, insert after the word "area" the following: "and the number of older persons who reside in rural and nonmetropolitan areas".
On page 35, line 17, strike out "(1)" and insert in lieu thereof "(2) ".
On page 35, line 19, strike out "(2)" and insert in lieu. thereof "(3) ".
On page 35, line 22, strike out "(3)" and insert in lieu thereof "(4) "._
AMENDMENT No. 469
On page 25, line 2, before the word "minority" insert the following: "rural elderly,".
AMENDMENT No. 47
On page 5, line 19, strike out the word
"and".
On page 5, line 24, strike out the period and insert in lieu thereof a semicolon and the word "and".
On page 5, between lines 24 and 25, insert the following:
"(7) to establish criteria designed to achieve an equitable distribution of assistance under this title between urban and rural areas.
AMENDMENT No. 471
On page 14, line 4, insert "(1)" after
„(a),.
On page 14, between lines 13 and 14, insert the following new paragraph:
(2) The Commissioner shall establish criteria designed to achieve an equitable distribution of assistance between urban and rural areas.
On page 11, line 17, after the word "transportation" insert a comma and the following: "with special attention to rural and nonmetropolitan areas,".
AMENDMENT No. 473
On page 11, line 1, strike out the word
"and".
On page 11, line 4, before the period insert a semicolon and the following: "and (4) provide additional transportation, by bus or otherwise, to enable elderly who reside in rural and non-metropolitan areas to have access to low cost transportation".
AMENDMENT No. 474
On page 9, line 19, Insert "(a)" after "Sec. 832.".
On page 10, between lines 6 and 7, insert the following new subsection:
"(b) The State agency shall establish criteria designed to achieve an equitable distribution of assistance within the State between urban and rural areas.
Mr. CHURCH. Mr. President, I am pleased to join Senator CLARK in sponsoring these amendments to my bill, S. 1426, the Older Americans Amendments of 1975. Senator CLARK shares with me a keen interest in providing better services for our rural elderly. As the newest member of the Special Committee on Aging he has already distinguished himself as an energetic and enthusiastic worker for older Americans.
Mr. President, rural America has long been neglected, as the vast problems of the cities have demanded an increasing share of the Nation's attention and resources. These amendments attempt to give focus to the needs of nearly 5 million rural elderly. The Older Americans Act and the amendments of 1975 provide a comprehensive service program for the elderly. With a congressional instruction that special emphasis be given to the rural elderly, such programs as transportation, health care, information and referral, and homemaker and chore services, could be improved in rural areas. Many of these services are virtually nonexistent in many rural areas. At the recent Conference on Rural America overwhelming statistics were given on the lack of adequate services in rural counties in which nearly half a million people reside do not have a resident doctor; 146 bus companies have gone out of business in cities with small populations; approximately 60 percent of the country's substandard housing is located in rural areas, and yet less than one-fourth of the available housing funds are directed to rural America.
I am optimistic that with the acceptance of these amendments and adequate funding for the Older Americans Act, programs in rural areas can be established and expanded. If we are to come to grips with the needs of our rural citizens, it is our responsibility to assure that the special needs of our rural elderly are met.
Mr. MUSKIE. Mr. President, I am delighted to join in cosponsoring these amendments to S. 1426, the Older Americans Act Amendments of 1975. These amendments address the serious, chronic problems of the elderly living in rural areas by requiring a more equitable distribution of assistance under the Older Americans Act between urban and rural areas.
I am particularly sensitive to problems faced by our rural elderly because of the nature of my home State of Maine.
Currently, Maine has the fourth largest percentage of elderly population in the Nation, and projections indicate that by 1980 we may well lead the country in the proportion of our population classified as elderly.
At the same time, Maine is a rural State, with no town or city larger than 65,000 population and often with large distances between centers of population which provide services such as medical and dental care and a choice of markets or shops.
This means that many of our elderly live in areas cut off from social contacts, without easy access to health care, with no transportation other than the automobile, and out of touch with the senior citizens centers, nutrition programs, and agencies to which our more urban elderly can go to for help. Often they are trying to maintain their own home, and their greatest concern is improving the quality of their lives by their own actions – to continue an independent existence. The difference between success and failure for them could simply be access to transportation, the occasional company of a volunteer worker, or the knowledge of Federal programs available to help them repair their homes.
The amendments being introduced today could well provide that relatively small added service which would allow these elderly to keep their homes and remain in their communities.
I am certain that there is no shortage of imaginative ideas and approaches at the local level to help the rural elderly.
In western Maine, one experimental project is Project Independence, which serves a three-county area. The executive director, Harold Collins, wrote that:
We have ... become a model for other States, areas, or cities to follow.
Project Independence hopes to expand services to more rural areas next year if the necessary funds are made available.
Mr. President, the amendments introduced today require no new funds. They merely would end an unintentional discrimination against our rural elderly in the allocation of Federal resources set aside to improve the lives of our older citizens.