[Senate Report 105-36]
[From the U.S. Government Publishing Office]



105th Congress                                             Rept. 105-36
                                 SENATE

 1st Session                                                   Volume 2
_______________________________________________________________________


 
                      DEVELOPMENTS IN AGING: 1996
                          VOLUME 2--APPENDIXES

                               ----------                              

                                A REPORT

                                 of the

                       SPECIAL COMMITTEE ON AGING
                          UNITED STATES SENATE

                              pursuant to

               S. RES. 73, SEC. 19(c), FEBRUARY 13, 1995

  Resolution Authorizing a Study of the Problems of the Aged and Aging


 


                 June 24, 1997.--Ordered to be printed



            DEVELOPMENTS IN AGING: 1996--VOLUME 2--APPENDIXES


105th Congress                                             Rept. 105-36
                                 SENATE

 1st Session                                                   Volume 2
_______________________________________________________________________


                      DEVELOPMENTS IN AGING: 1996

                          VOLUME 2--APPENDIXES

                               __________

                                A REPORT

                                 of the

                       SPECIAL COMMITTEE ON AGING

                          UNITED STATES SENATE

                              pursuant to

               S. RES. 73, SEC. 19(c), FEBRUARY 13, 1995

  Resolution Authorizing a Study of the Problems of the Aged and Aging


 


                 June 24, 1997.--Ordered to be printed



                       SPECIAL COMMITTEE ON AGING

                  CHARLES E. GRASSLEY, Iowa, Chairman
JAMES M. JEFFORDS, Vermont           JOHN B. BREAUX, Louisiana
LARRY CRAIG, Idaho                   JOHN GLENN, Ohio
CONRAD BURNS, Montana                HARRY REID, Nevada
RICHARD SHELBY, Alabama              HERB KOHL, Wisconsin
RICK SANTORUM, Pennsylvania          RUSSELL D. FEINGOLD, Wisconsin
JOHN WARNER, Virginia                CAROL MOSELEY-BRAUN, Illinois
CHUCK HAGEL, Nebraska                RON WYDEN, Oregon
SUSAN COLLINS, Maine                 JACK REED, Rhode Island
MIKE ENZI, Wyoming
                   Theodore L. Totman, Staff Director
                Bruce D. Lesley, Minority Staff Director




                         LETTER OF TRANSMITTAL

                              ----------                              

                                       U.S. Senate,
                                 Special Committee on Aging
                                              Washington, DC, 1997.
Hon. Albert A. Gore, Jr.,
President, U.S. Senate,
Washington, DC.
    Dear Mr. President: Under authority of Senate Resolution 73 
agreed to February 13, 1995, I am submitting to you the annual 
report of the U.S. Senate Special Committee on Aging, 
Developments in Aging: 1996, volume 2.
    Senate Resolution 4, the Committee Systems Reorganization 
Amendments of 1977, authorizes the Special Committee on Aging 
``to conduct a continuing study of any and all matters 
pertaining to problems and opportunities of older people, 
including but not limited to, problems and opportunities of 
maintaining health, of assuring adequate income, of finding 
employment, of engaging in productive and rewarding activity, 
of securing proper housing and, when necessary, of obtaining 
care and assistance.'' Senate Resolution 4 also requires that 
the results of these studies and recommendations be reported to 
the Senate annually.
    This report describes actions taken during 1994 by the 
Congress, the administration, and the U.S. Senate Special 
Committee on Aging, which are significant to our Nation's older 
citizens. It also summarizes and analyzes the Federal policies 
and programs that are of the most continuing importance for 
older persons and their families.
    On behalf of the members of the committee and its staff, I 
am pleased to transmit this report to you.
            Sincerely,
                                     Charles E. Grassley, Chairman.



                            C O N T E N T S

                              ----------                              
                                                                   Page
Letter of Transmittal............................................   III
Appendix 1. Annual Report of the Federal Council on Aging........     1
Appendix 2. Report from Federal Departments and Agencies.........    17
    Item 1. Department of Agriculture............................    17
        Agricultural Research Service............................    17
        Economic Research Service................................    22
        Cooperative Extension System.............................    23
        Farmers Home Administration..............................    29
        Food and Consumer Service................................    29
        Food Safety and Inspection Service.......................    31
        Forest Service...........................................    31
        Rural Development Administration.........................    32
    Item 2. Department of Commerce...............................    33
    Item 3. Department of Defense................................    43
    Item 4. Department of Education..............................    44
    Item 5. Department of Energy.................................    76
    Item 6. Department of Health and Human Services..............    79
        Administration on Aging..................................    79
        Administration for Children and Families.................   137
        Health Care Financing Administration.....................   142
        Office of Inspector General..............................   170
        Office of the Assistant Secretary for Planning and 
          Evaluation.............................................   172
        Public Health Service....................................   175
            Centers for Disease Control and Prevention...........   175
            Food and Drug Administration.........................   188
            Health Resources and Services Administration.........   201
            National Institutes of Health........................   209
            Social Security Administration.......................   337
    Item  7. Department of Housing and Urban Development.........   348
    Item  8. Department of the Interior..........................   353
    Item  9. Department of Justice...............................   354
    Item 10. Department of Labor.................................   358
    Item 11. Department of State.................................   363
    Item 12. Department of Transportation........................   364
    Item 13. Department of the Treasury..........................   373
    Item 14. Commission on Civil Rights..........................   379
    Item 15. Consumer Product Safety Commission..................   379
    Item 16. Corporation for National and Community Service......   381
    Item 17. Environmental Protection Agency.....................   387
    Item 18. Equal Employment Opportunity Commission.............   388
    Item 19. Federal Communications Commission...................   422
    Item 20. Federal Trade Commission............................   422
    Item 21. General Accounting Office...........................   438
    Item 22. Legal Services Corporation..........................   469
    Item 23. National Endowment for the Arts.....................   470
    Item 25. National Endowment for the Humanities...............   477
    Item 25. National Science Foundation.........................   481
    Item 26. Pension Benefit Guaranty Corporation................   482
    Item 27. Postal Service......................................   497
    Item 28. Railroad Retirement Board...........................   501
    Item 29. Small Business Administration.......................   504
    Item 30. Veterans' Affairs...................................   504
    Item 31. Transmittal Letters from Agencies...................   523



105th Congress                                             Rept. 105-36
                                 SENATE

 1st Session                                                   Volume 2
_______________________________________________________________________


                      DEVELOPMENTS IN AGING: 1995
                          VOLUME 2--APPENDIXES

                                _______
                                

                 June 24, 1997.--Ordered to be printed

_______________________________________________________________________


   Mr. Grassley, from the Special Committee on Aging, submitted the 
                               following

                              R E P O R T

                          A P P E N D I X E S

                               Appendix 1

           ANNUAL REPORT OF THE FEDERAL COUNCIL ON THE AGING

              SECTION I. SUMMARY OF ACTIVITIES DURING 1994

           A. Overview of Strategic Plan and Issue Priorities

    To meet its mandate of comprehensively reviewing and evaluating 
Federal policies and programs affecting older Americans, the Federal 
Council on the Aging (FCoA) developed a multiyear strategic plan 
focusing on five priority issue areas:
          (1) Health care, with a concentration on long-term care;
          (2) Mental health and aging, with an emphasis on identifying 
        and providing preventive assistance to at-risk, isolated older 
        individuals in their homes and communities;
          (3) The Older Americans Act, with a focus on nutrition and 
        elder abuse;
          (4) Income security, particularly Social Security; and
          (5) The 1995 White House Conference on Aging, with an 
        emphasis on playing a leadership role in developing productive 
        recommendations prior to and during the Conference, and working 
        to generate a strategy and set of mechanisms for following 
        through on priority recommendations arising from the 
        Conference.
    A major guiding principle for the Council in developing these issue 
priorities is to provide a voice for older Americans and their families 
who are particularly vulnerable so that they are better able to help 
themselves lead productive and dignified lives.
    During 1994, the Council's plan was formulated around the following 
major activities:
          Listening to the concerns and recommendations of older 
        individuals in their local communities and advocating for 
        policies which preserve the dignity, independence, and 
        productivity of persons across generations and over time.
          Reviewing Federal policies and programs, identifying 
        duplication and gaps among services, and evaluating their value 
        and impact on the lives of older Americans.
          Convening quarterly public meetings designed to gather 
        information and discussing specific policy recommendations 
        pertaining to the Council's priority issue areas.
          Developing a series of informational materials and policy 
        recommendations pertaining to long-term care, mental health and 
        aging, the Older Americans Act, and the 1995 White House 
        Conference on Aging.
          Providing leadership, guidance, and recommendations for the 
        1995 White House Conference on Aging by attending more than two 
        dozen regional, State local, and mini-conference events.
          Forming cooperative partnerships with other agencies and 
        professionals in the field of aging to develop and disseminate 
        information to older consumers and their families.
          Beginning to generate strategies for assisting certain at-
        risk older individuals and their families, with an emphasis on 
        persons who are the victims of crime and elder abuse, older 
        persons living alone, economically vulnerable older Americans, 
        minorities, and older women.
          Preparing and disseminating an annual report of activities 
        and recommendations to the President.

                         B. Quarterly Meetings

    Under the Chairmanship of the Honorable John E. Lyle from Houston, 
Texas, the primary goal of the Council's meetings was to seek to 
develop and advocate for a set of targeted policy recommendations to 
provide to the President, Members of Congress, the Secretary of Health 
and Human Services, the Office of the Assistant Secretary for Aging, 
the White House Conference on Aging, and Federal and State agencies.
                     january 24th and 25th meeting
    The Council met in Washington, D.C. on January 24 and 25, 1994, to 
participate in the Administration on Aging's ``Health Care 
University.'' During this meeting the Council discussed health care 
reform in general, and particularly the growing need for long-term care 
assistance. It was noted that many families are having to assume 
increased responsibilities associated with caring for older parents and 
relatives, but that supports for these families and caregivers are 
often lacking or inconsistent from community to community. In addition, 
Medicare does not provide coverage for long-term care. The discussions 
during this first quarterly meeting helped to lay the foundation for 
the development of an issue brief and a series of policy 
recommendations on long-term care later in the year.
    The Council also met with the Assistant Secretary for Aging to 
share their thoughts and concerns on a number of issues related to the 
Older Americans Act, and to hold a constructive dialogue on possible 
future joint initiatives of the Administration on Aging and the Federal 
Council on the Aging. It was noted that the national aging network, 
through the framework of the State and area agencies on aging, is doing 
an excellent job of providing comprehensive assistance to older 
consumers and their families. However, resources are very strained. 
There is particularly a great need in local communities for nutrition 
home- and community-based care, and ombudsman assistance to better 
protect persons against elder abuse.
                      april 27th and 28th meeting

                        Mental Health and Aging

    One of the major outcomes of this meeting was the unanimous 
approval of a project to help produce and disseminate a book on mental 
health and aging to be done in conjunction with the National Institute 
of Mental Health. The purpose of the publication is to help to better 
inform health, behavioral, and social service practitioners in 
community mental health centers who have limited training in 
gerontology or mental health and aging. The publication will also 
include specific recommendations from the FC-A concerning national and 
local strategies for better addressing mental health and aging.
    The Council discussed participating in a mini-conference to the 
White House Conference on Aging sponsored by the Mental Health and 
Aging Consortium. The mini-conference is to be held on February 24-26, 
1995 in Washington, D.C. and will focus on four general themes: (1) 
strengths and weaknesses in current research; (2) positive looks at 
mental health: (3) services and training needs; and (4) the question of 
parity between physical health and mental health. The Mental Health and 
Aging Consortium anticipates that outcomes from the mini-conference 
will include a series of research topics, recommendations, and a set of 
video tapes that would be shared with individuals and families 
throughout the country. The Council subsequently agreed to join the 
Mental Health and Aging Consortium and to actively participate in the 
mini-conference.

           Discussion with the Assistant Secretary for Aging

    The Council members met with the Assistant Secretary for Aging, Dr. 
Fernando Torres-Gil, to discuss a number of topics, including health 
care reform, long-term care, the upcoming reauthorization of the Older 
Americans Act, Social Security as an independent agency, activities 
related to Older Americans Month, and the priority initiatives of the 
Administration on Aging.
    The FCoA also discussed and passed a strategic plan for 1994 and 
1995 designed to play a leadership role in: (1) preparing for the 1995 
White House Conference on Aging; (2) improving the effectiveness of 
mental health assistance for older persons and their families; (3) 
advocating for long-term care with a focus on home and community-based 
care; and (4) making recommendations related to the reauthorization of 
the Older Americans Act.
                     september 13th & 14th meeting
    The FCoA convened under the newly appointed Chairman, John E. Lyle, 
for the purpose of discussing activities related to the White House 
Conference on Aging. Other major topics included the Older Americans 
Act, Social Security, and the needs of special populations of older 
persons, including older women, urban Indian elders, and Filipino 
veterans.
    The Chairman appointed Raymond Raschko, of Spokane, Washington, to 
serve as the Council's Vice Chairman. The position of Vice Chair will 
be alternated on a rotating basis to provide opportunities for other 
members to serve in this capacity.

                    White House Conference on Aging

    Council members reported on the local, State, and regional pre-
conference activities they had participated in that were held in their 
States and communities. These activities demonstrated that there is a 
substantial grass roots enthusiasm for trying to address the many 
challenges associated with an aging society.
    The Chairman noted that members of the FCoA are in touch with older 
persons in their communities of a daily basis, and that as statutorily 
mandated advisors to the President on aging matters, have a unique and 
important role to play as delegates to the WHCoA. Discussions were held 
on a series of leadership options for the Council to propose to the 
WHCoA to be initiated both during and after the Conference.
    The WHCoA itself will be an outgrowth of the grass roots 
recommendations of Americans throughout the country. The Council 
members unanimously expressed a strong desire to build on this effort 
by helping to develop a framework and strategy for following through 
after the Conference by working for enactment of key recommendations 
that the delegates deem to be particular priorities.

                          Older Americans Act

    Also on the agenda was a discussion with the Assistant Secretary 
for Aging, Dr. Fernando Torres-Gil, pertaining to the Older Americans 
Act. The Council raised several issues concerning proposed changes in 
the intrastate funding formula. The Assistant Secretary reported that 
the Administration on Aging (AoA) received over 2,500 comments to the 
proposed regulations for the intrastate funding formula and that the 
agency is reviewing these comments carefully.
    The Assistant Secretary for Aging noted that there are many 
competing factors that must be balanced and taken into consideration in 
approving any formula. For instance, it needs to reflect the intent of 
the Older Americans Act to serve all persons aged 60 and over, but it 
also needs to be targeted to persons with the greatest social and 
economic needs. It must also account for the reality that the money the 
Administration on Aging has to work with does not meet all of the needs 
for assistance in our communities. The formula must also reflect the 
President's commitment to allow States maximum flexibility. Finally, it 
must have a component which will provide an ability to rely on an 
outcome measurement. The Assistant Secretary stated that he will 
ultimately make a decision on the formula based on an attempt to 
balance all of the above considerations.
    Dr. Torres-Gil emphasized that regardless of the outcome of the 
formula, one of the important factors to keep in mind is that States 
have used Older Americans Act dollars to leverage substantial numbers 
of other dollars. As the aging network struggles with limited sources 
of revenue, supporters of aging programs should keep in mind the need 
to continue to work to leverage other funding sources in States.
    The Council members also reported hearing in their communities a 
number of concerns about the amount of data collection being imposed on 
States and area agencies by AoA. The Assistant Secretary was asked what 
the agency expected to get out of this process, and how far States, 
area agencies, and providers were expected to go in gathering the data.
    The Assistant Secretary said that NAPIS, the National Aging 
Programs Information System, is an effort to collect hard data on 
persons being served. Increasingly the Congress and the Office of 
Management and Budget are saying that unless an agency can document how 
the money will be spent and what will be gained from each newly 
appropriated dollar, then additional resources may not be provided. In 
addition, during the last reauthorization of the Older Americans Act, 
the Congress inserted into the statute a requirement that AoA must 
improve its data collection.
    Consequently, AoA is setting new requirements in order to better 
measure what the benefits will be of additional dollars and to provide 
a clear basis for appropriations requests. While the Assistant 
Secretary noted that many States are strapped for additional resources 
to do this data collection, he said he believes this data collection is 
vitally necessary as an investment in the future.

                            Social Security

    The Council received an update of the work of the Social Security 
Advisory Council from its executive director, David Lindeman. This 
particular Advisory Council has been given three major charges by the 
Secretary of Health and Human Services, the Honorable Donna Shalala:
          Develop recommendations that deal with the long-term 
        actuarial shortfalls of the Social Security program.
          Examine issues related to how the system interacts with the 
        work patterns of women, including coverage, family structure 
        issues, dual entitlement, and other matters.
          Examine retirement policy and develop recommendations 
        concerning the way in which Social Security fits or does not 
        fit within the framework of pensions, savings, and income.
    The FCoA received an overview of the status of the trust funds and 
the many factors that need to be taken into consideration by the 
Advisory Council in carrying out its mandates. Mr. Lindeman stated that 
the earlier these Social Security issues are addressed, the more 
options there are available that can be phased in over time, and the 
better opportunity persons will have to appropriately plan for their 
retirement.
    Mr. Lindeman also stated that even though the number of workers per 
beneficiary is going down, that factor in and of itself would not be a 
big problem if there were lots of national savings and productivity 
gains. Unfortunately, since 1973, productivity gains have been 
essentially flat and national savings rates extremely low.

  Special Populations, Including Older Women, Filipino Veterans, and 
                          Urban Indian Elders

    Based on Census data which reveals that approximately three-
quarters of all elderly persons living below poverty are women, the 
FCoA and its staff worked in cooperation with the Administration on 
Aging in helping to launch its ``Initiative on Older Women.'' One of 
the major purposes of this venture is to assist the Assistant Secretary 
for Aging and AoA to better educate and inform women of all ages about 
the importance of planning for a long lifespan.
    The Council is concerned by projections which indicate that, 
despite greater participation in the labor force, in the year 2020 the 
median income of single elderly women is likely to be only three-fifths 
that of single elderly men. In addition, two out of five women aged 65 
and over who are living alone will have incomes below 150 percent of 
the poverty level. The FCoA is working in conjunction with AoA's 
Initiative on Older Women to develop strategies for optimizing the 
contributions of women to society, inform women at the grass roots 
level, and promote public and private sector partnerships that will 
better address issues related to income security, caregiving, health, 
housing, domestic violence, employment, and other issues.
    The Council also discussed a resolution pertaining to the special 
characteristics of Filipino veterans. Despite the great sacrifices and 
contributions made by Filipino veterans during World War II, these 
older persons now face many problems including inadequate living 
arrangements, no health benefits, no financial assistance, and other 
concerns that affect their basic quality of life. Yet, the U.S. 
Government has denied Filipino World War II veterans the same status 
accorded other U.S. veterans by denying them veterans benefits. The 
Council subsequently passed a resolution calling for a coordinated 
effort by related agencies to develop strategies for addressing the 
problems of Filipino veterans.
    Finally, the Council examined the status and characteristics of 
urban Indian elders. A 1990 report written by Dr. Josea Kramer and 
funded in part by the Administration on Aging revealed a number of 
serious problems faced by urban Indian elders. While this report 
proposed a series of recommendations, there seems to have been little 
or no follow-up by the appropriate government agencies to consider or 
implement these proposals. The Council subsequently passed a resolution 
to seek to determine what efforts have been made by the various 
agencies to implement any of the report's recommendations.
                       december 8th & 9th meeting
    The meeting focused particular attention on issues related to long-
term care, mental health and aging, the reauthorization of the Older 
Americans Act, and the White House Conference on Aging. Speakers 
included the Assistant Secretary for Aging, the Executive Director of 
the White House Conference on Aging, and representatives from the 
Congressional Budget Office, the National Association of State Units on 
Aging, the National Association of Area Agencies on Aging, and the 
Administration on Aging.

                             Long-Term Care

    Given the lack of passage of health care reform legislation during 
1994, the Council discussed the increasing burdens that could be placed 
on families, older persons, States, and local communities trying to 
provide adequate and appropriate long-term care assistance. Concern was 
expressed by a number of Council members that many older persons are 
released from hospitals ``sicker and quicker'' to their homes and 
communities, and families are ill-prepared and often lack appropriate 
home and community-based supports to assist them with caregiving 
responsibilities. It is estimated that nearly four-fifths of care is 
provided by family members. The Council began to examine how innovative 
home- and community-based support programs can provide caregivers with 
appropriate supports so that they are better able to help themselves 
and family members receive the care they need.
    In addition, discussions were undertaken about ways to better 
identify and reach isolated individuals who might be in need of 
assistance, particularly given the lack of a cohesive and comprehensive 
long-term care policy. Among the options examined was a report from a 
representative of the Congressional Budget Office on the status and 
characteristics of various pieces of health reform legislation that 
were being discussed by Congress at the end of the 103rd Congress. 
Other options included focusing more on various state initiatives and 
activities, as well as community-based programs and assistance provided 
through the Older Americans Act.
    The Council voted to continue to play a leadership role in 
informing the public and policymakers about the need for long-term care 
coverage, particularly home and community-based options.

                        Mental Health and Aging

    The Council received an update from Dr. Mary Harper of the National 
Institute of Mental Health on the status of the book which is being 
prepared for the FCoA entitled, ``Community-Based Mental Health 
Services/Behavioral Healthcare for the Elderly.'' Several prominent 
professionals in the field of mental health and aging have prepared, or 
are in the process of completing, chapters for the book. The book is 
scheduled for release in the spring of 1995 and will be provided as a 
resource to community mental health centers and for the 1995 White 
House Conference on Aging. Included in the publication will be a series 
of focused policy recommendations discussed and approved by the Federal 
Council members.
    Dr. Harper noted that persons aged 65 and over account for 
approximately 13 percent of the population and received nearly half of 
the medications prescribed by physicians. Yet, older Americans are 
rarely used in clinical trials designed to test for side effects. The 
Council voted to send a letter to Dr. David Kessler of the Food and 
Drug Administration and to Pharmaceutical and Pharmacist Associations 
urging better testing of the side effects of pharmaceuticals and 
combinations of drugs on older persons.
    Discussion was also undertaken about the great need for systems and 
strategies which reach out into the community to older persons who may 
be in need of mental health assistance, but who are isolated from 
families and friends. The Council noted that very often our system of 
mental health supports relies first on an individual contacting an 
agency for assistance. However, the problem is that most at-risk older 
persons do not seek this type of assistance themselves. Rather, it is 
usually a family member or friend who helps them get assistance. There 
are increasing numbers of older persons living alone who are not 
fortunate enough to have someone they can count on for these types of 
referrals. The Council subsequently discussed and passed a series of 
recommendations urging States and localities to develop early 
identification strategies, as well as great coordination between the 
area agency on aging system and the mental health system.
    The Council voted that its first issue brief for 1995 be prepared 
on the subject of mental health and aging. The Chairman and the Vice 
Chairman will participate in the White House Conference on Aging Mini-
Conference on Mental Health and Aging scheduled for February 1995.

                          Older Americans Act

    The Council received an update from the Assistant Secretary for 
Aging, staff from the Administration on Aging, and representatives from 
the National Association of State Units on Aging and the National 
Association of Area Agencies on Aging regarding issues related to the 
reauthorization of the Older Americans Act.
    Background information was received concerning the substantial 
leveraging federal Older Americans Act dollars creates from communities 
and older persons themselves. The Council expressed serious concern 
that proposals to block grant senior nutrition programs with welfare 
programs would destroy the partnership that exists between older 
persons and their families with Federal, State, and county funding 
resources. In many localities, monetary and in-kind contributions from 
older persons to the senior nutrition program provide 40-50 percent of 
the funding provided by the Federal Government, and many times more 
than is provided through county governments.
    In addition, these nutrition programs often serve as a point of 
contact and entry to other forms of assistance for vulnerable and at-
risk older persons. They provide an important function by identifying 
and reaching out to older persons so that they may be assessed and 
assisted in a more comprehensive way, enabling them to live more 
independently in their communities.
    The Council subsequently passed a resolution opposing the block 
granting of the senior nutrition programs or other titles under the 
Older Americans Act.

                               C. Reports

                  1993 Annual Report to the President

    The Council distributed its twentieth annual report to the 
President. The report detailed information along two major themes. The 
first was examining issues and characteristics within the Nation's 
diverse older population that are particularly critical to the most 
vulnerable and at-risk older persons. The second was to begin to 
develop background information on issues related to planning for the 
aging of the ``baby boom'' cohort and the next generation of older 
Americans. Issues covered in the report include: income security; 
health care; housing and living arrangements; older women; minority 
elders; mental health; and intergenerational perspectives.

                        Mental Health and Aging

    In conjunction with the National Institute of Mental Health and the 
Center for Mental Disorders and Aging Research, the FCoA worked to 
prepare a book entitled: ``Community-Based Mental Health Services/
Behavioral Health Care for Older Persons.'' The purpose of this book is 
to help educate practitioners in community mental health centers and to 
provide a wide range of specific recommendations as to what should be 
occurring in the country regarding mental health and aging.
    Chapters include: (1) an overview of aging and mental health; (2) 
psychopathology and treatment of the elderly; (3) assessment of the 
elderly; (4) psychopharmacology and the elderly; (5) health promotion; 
(6) dementia and the elderly; (7) caregiving; (8) ethics; (9) religion; 
(10) suicide; (11) special populations; (12) cost and financing of 
mental health services to the elderly; and (13) depression in the 
elderly.

                            D. Issue Briefs

    ``The Need for Home and Community-Based Long-Term Care: A Rural 
                             Perspective''

    This issue brief continues the Council's 20-year history of 
focusing on matters associated with the provision and delivery of long-
term care. Its purpose is to provide planners, policy makers, 
legislators, and delegates to the White House Conference on Aging with 
a summary overview of some key characteristics and factors surrounding 
the need for long-term care assistance in rural areas, to develop a 
series of policy recommendations, and to highlight areas where more 
information is needed.
    Its major conclusion is that rural elders and their families are 
significantly less likely than their urban counterparts to have access 
to a range of community-based, long-term care assistance. This lack of 
options not only tends to place increased burdens on rural families and 
caregivers, but it also has serious implications for taxpayers. Rural 
elders were found to be more likely to reside in nursing homes when 
they may not need 24-hour nursing. Medicaid picks up the tab for this 
assistance once an individual's resources are depleted.
    With the aging of the nation's rural population, consideration will 
need to be given to developing a comprehensive strategy for addressing 
this growing need before it increasingly overburdens families, 
caregivers, and taxpayers. Its major policy recommendations include: 
(1) health care reform which includes long-term care assistance is 
crucial; (2) the long-term care system must support a comprehensive 
range of choices and alternatives in rural as well as urban areas; (3) 
this system needs to recognize the dignity of persons in need, promote 
independence in the least restrictive settings whenever possible, and 
recognize the diversity of states and communities by allowing 
flexibility of development.

                        Mental Health and Aging

    The Council gathered background information for an issue brief to 
be released in early 1995 on the special mental health characteristics 
and needs of older persons. Specific policy recommendations are being 
developed to inform and assist professionals in community mental health 
centers, policymakers, and the general public.

                         E. Joint Partnerships

                    White House Conference on Aging

    Council members participated in more than two dozen local events 
officially sanctioned by the White House Conference on Aging. The 
Council also: provided significant recommendations regarding the theme, 
structure, and issue priorities for the Conference; provided 
recommendations as a representative to the Advisory Committee; 
developed a proposal for a leadership role at the Conference in May; 
and urged the formation of a structure and the action plan for working 
to implement and enact priority recommendations arising from the 
Conference. The Council developed a strategy for helping to assist with 
this process and provided specific policy recommendations to the 
President.
    Background materials on long-term care, mental health and aging, 
and the Older Americans Act were prepared in order to be distributed to 
delegates at the Conference, as well as policymakers, the press, and 
other interested individuals.

                  Coalition on Mental Health and Aging

    The FCoA joined in partnership with the Mental Health and Aging 
Consortium to participate in a mini-conference to the White House 
Conference on Aging pertaining to mental health and aging issues. The 
mini-conference is scheduled to take place in February 1995, and will 
focus on four general themes: (1) strengths and weaknesses in current 
research; (2) positive looks at mental health; (3) services and 
training needs; and (4) the question of parity between physical health 
and mental health. Outcomes are expected to include a series of 
research topics, a series of recommendations, and a set of video tapes 
that will be shared with people throughout the country.

                         Developments in Aging

    The FCoA provided a section on issues and activities for the Senate 
Special Committee on Aging publication, ``Developments in Aging.'' This 
report describes actions taken by the Congress, the administration, and 
the Senate Committee on Aging which are of particular relevance to 
older Americans. It also summarizes and analyzes Federal policies and 
programs that are of importance to older individuals and their 
families.

      SECTION II. MAJOR FINDINGS, RESOLUTIONS AND RECOMMENDATIONS

                      A. Health and Long-Term Care

                             major findings
    A combination of factors work to place rural elders at a higher 
risk of poor health outcomes and with a smaller number and range of 
home- and community-based alternatives that is available for older 
Americans residing in other areas.
    While there are many innovative and excellent sources of long-term 
care assistance in rural communities, these systems are uneven in terms 
of availability. Many areas do not have the resources to adequately 
meet the growing need. In general, home and community-based care for 
rural elders and their families are often less comprehensive, offered 
less frequently, and are not as accessible as they are in suburban and 
urban areas.
    Transportation is vital for providing access to and from the array 
of home and community-based services. In rural areas, both geographic 
and social isolation limit older individuals' access to services.
    Despite the nearly universal coverage by Medicare of persons aged 
65 and over, older Americans pay significant percentages of their 
incomes for medical expenses. On average, Medicare pays only around 
half of the elderly's health care bills, with out-of-pocket costs 
(inflation adjusted) doubling since Medicare was enacted.
    Shortly after the year 2000, the projected need for long-term care, 
particularly community-based care, is projected to increase 
exponentially. By the year 2040, nearly 14 million Americans will 
likely need some form of long-term care assistance, including 10 
million who will need home and community-based care.
    The date and research gathered by the FCoA indicate that if the 
growing numbers of older Americans and their families are to have 
access to a range of long-term care choices, policies and resources 
need to be developed which cost-effectively increase the availability, 
accessibility, affordability, and coordination of community-based care, 
particularly in rural areas.
    The vast majority of older Americans prefers to stay in their homes 
and communities when the appropriation supports are available. Home and 
community-based services can permit impaired elders to remain in the 
community and live as independently as possible provide a better 
quality of life for impaired elders; reduce institution care and 
related subsidy costs; maximize the options available to impaired 
elders and their caregivers; provide needed support and relief for 
family caregivers; and serve to prevent or delay further health 
problems.
    Given the rapid growth of persons aged 85 and over, the lack of a 
cohesive long-term care strategy could end up causing significant 
burdens for families and the Nation's health care expenditures. At the 
very least, the data indicate compelling reasons for gathering more 
information on this issue so that effective strategies and polices can 
be developed to address the growing needs.
                    resolutions and recommendations
    The FCoA recognizes that health care reform is critically necessary 
for America. Long-term care needs to be included in any health care 
reform strategy.
    A long-term care program must recognize the dignity of persons in 
need. To the extent feasible, it should promote independence in the 
least restrictive setting. It must recognize the diversity of states 
and communities and allow flexibility of development.
    Rural long-term care delivery and accessibility issues are growing 
national problems that need to be addressed in a comprehensive manner 
given the rapid growth of persons aged 85 and over.
    Consideration should be given to strategies which encourage the use 
of modern technology, such as telecommunications and telemedicine. Such 
systems have the potential for linking information and care between a 
patient, primary care physician, and a specialist, even when they are 
miles apart.
    Communication should be enhanced between states, area agencies on 
aging, and related service providers which encourage information 
sharing on innovative and cost-effective programs.
    Policies and programs should be encouraged which assist in the 
formation of informal support groups designed to help alleviate the 
individual stress of family caregivers and which help to share 
caregiving responsibilities.
    The Council reviewed a recent report of the Special Committee on 
Aging which reveals that the current policies of Medicare, Medicaid, 
and private insurers have left their doors wide open to fraud, costing 
the health care system more than $100 billion yearly. The Council urged 
that immediate action be taken to strengthen the criminal laws and 
enforcement tools to stop fraud and abuse of the Nation's health care 
system, and that tough anti-fraud and anti-abuse provisions be built 
into the foundation of any health care reform enacted by the Congress.

                       B. Mental Health and Aging

                             major findings
    An estimated 20 percent of all persons aged 65 and over experience 
problems serious enough to put them at risk of premature psychiatric 
and/or nursing home placement. Their ability to maintain themselves in 
the community becomes compromised as they experience serious mental, 
emotional, physical, social, and environmental problems.
    At-risk older persons do not refer themselves for help or 
assistance, including persons with Alzheimer's disease. The disease 
itself leads to denial, projection of blame, and renders the majority 
of persons incapable of understanding and acting on their own behalf. 
If these individuals receive help, it is because somebody else--usually 
a family member--identified them and sought assistance. There are 
increasing numbers of at-risk elderly, including those with Alzheimer's 
disease, who have no one to perform this invaluable function.
    One of the problems with many of our community delivery systems is 
that they are passive and generally wait to be contacted. For isolated 
older persons, a major challenge is locating and delivering assistance 
to persons who most need assistance. In almost all urban and rural 
areas of the United States, persons with Alzheimer's disease who live 
alone and have no family support become progressively worse until their 
lack of self-care and/or behavior makes them visible enough to be 
removed from their home and placed in an institution.
    ``Gatekeepers,'' or nontraditional referral sources who are trained 
to identify high-risk older persons, can be an important first step in 
helping to refer these individuals to appropriate assistance. 
Gatekeepers can include such professionals as meter readers and 
customer contact personnel from utility companies, cable television 
installers, fire, police and sheriff department staff, resident 
apartment managers, postal carriers, ambulance company staff, bank 
personnel, and others.
    Approximately one-fourth of all suicides in the United States are 
estimated to be by persons over the age of 60. Elderly white males have 
the highest rate of suicide of this group.
    When older persons attempt suicide, they are more often successful 
than are younger persons. Clinical experience suggests that as suicide 
moves from the stage of being a passive idea to more of an actual 
attempt, persons become progressively more resistant to seek and/or 
accept assistance. Consequently, an important factor for effective 
intervention is early identification and referral.
                    resolutions and recommendations
    Isolated older persons, both urban and rural, who live alone and 
have mental health problems such as Alzheimer's diseases and 
depression, are especially at-risk for suffering, hospitalization, and 
nursing home placement. The Council strongly urges States and 
localities to develop and implement specialized early identification 
strategies and in-home delivery systems for assisting these 
particularly vulnerable older Americans.
    In most States, the area agency on aging system and the mental 
health system do not integrate their activities and programs, let alone 
coordinate or cooperate with their delivery of assistance. The Council 
strongly urges greater integration of these systems, particularly as 
they relate to high risk home-dwelling older persons who have a high 
interrelationship between physical, mental, self-care, emotional, and 
support problems.
    Age integrated subsidized housing has led to much suffering for 
older persons because of violence, drugs, and crime. The Council 
recommends that representatives from the aging and disability 
communities work with the Department of Housing and Urban Development 
to form a special task force designed to assist public housing 
authorities develop guidelines about who they house, particularly in 
terms of protecting older residents from abusive residents with 
substance abuse problems.
    As health care reform progresses, the Council strongly recommends 
the inclusion of long-term care assistance, including a mental health 
benefit that takes into account the low utilization rates of older 
persons and which targets benefits to overcome access problems.
    Older persons make up 13 percent of the population and receive 45 
percent of the medications prescribed by physicians. Yet, older 
Americans are rarely used in clinical trials of pharmaceuticals that 
are designed to determine the drug's efficacy and side effects. The 
Council strongly recommends using a more representative sampling of 
older persons in clinical trials and pharmaceuticals.

                         C. Older Americans Act

                             major findings
    Health and nutrition studies indicate that 85 percent of older 
persons have a nutrition-related condition or chronic disease and that 
nutritional status is a risk factor for and predictor of visits to the 
physician, hospital emergency room, and hospital admission and 
readmission.
    The Senior Nutrition Program under the Older Americans Act 
maintains the dignity of hundreds of thousands of nutritionally at-risk 
older persons and provides mechanisms for participants to contribute 
according to their ability to pay. According to the most recent 1993 
figures, over 225 million meals were served through a nationwide 
network of more than 15,000 community nutrition sites.
    Approximately 127 million meals were provided at congregate 
settings such as senior centers (27 percent of the recipients were 
frail and disabled, 45 percent were low income, 41 percent were rural 
residents, and 17 percent were minority). Another 103 million meals 
were provided to older persons who are homebound due to illness, 
disability or geographic isolation.
    Older persons make significant contributions through volunteerism 
and financial support to substantially defray the cost of the meals. In 
Fiscal Year 1993, older Americans contributed over $180,000,000 of 
their own money to the Senior Nutrition programs. These contributions 
were used to expand services. Additionally, older individuals 
contribute substantial amounts of in-kind contributions by volunteering 
at nutrition sites and delivering meals to homebound seniors.
    In San Diego County, for instance, elderly participants contributed 
over $1.8 million in fiscal year 1993-94 under the Older Americans Act 
Senior Nutrition Program, which was four and a half times more money 
than was provided by the County of San Diego. In addition, San Diego 
County senior nutrition volunteers donated over 250,000 hours of 
service. These monetary and in-kind contributions are typical of the 
valuable nationwide partnerships that exist between funding through the 
Older Americans Act, the local aging network, and older individuals and 
their families.
    The Senior Nutrition Program is a fundamental part of a 
comprehensive service system aimed at keeping older persons in their 
home. It provides support for family caregivers, is consumer-focused, 
and has widespread support due to its flexibility and its role as a 
point of contact and link to the wider aging service system.
    The establishment and development of services through the Older 
Americans Act and its 57 State Units on Aging, 670 area agencies on 
aging, and more than 25,000 related service providers throughout the 
country, provides an effective community-based infrastructure which can 
increasingly address some of the continuum of care needs of older 
Americans. Out of this network and through a wide variety of State-
assisted mechanisms, a number of creative and innovative programs have 
been established. However, the resources provided through this network 
are presently able to assist only a small proportion of those in need 
today, and is falling behind the projected need to assist the 
increasing numbers of older persons in the future.
    Data for Fiscal Year 1993 indicate that approximately 6\1/2\ 
million individuals aged 60 and over received supportive services under 
the supportive services and senior center activities of the Older 
Americans Act. These services represent the cornerstone of the 
nationwide aging network effort to assist older persons to live 
independently in their homes and communities for as long as possible. 
Two out of five of those persons assisted were low income, and one out 
of five were minority older persons.
    There is mounting evidence that abuse, neglect, and exploitation of 
older persons is a serious national problem. Many older persons 
experience social isolation and debilitating illnesses that increase 
their susceptibility to abuse and criminal victimization. More needs to 
be done to examine this problem, and to examine the ability of 
resources provided under Title VII of the Older Americans Act and other 
sources to adequately address this problem.
                    resolutions and recommendations
    The Council is particularly concerned about draft proposals 
contained in the ``Contract With America'' that would likely break up 
the comprehensive services provided under the Older Americans Act into 
many separate functions and block grants. The Council strongly believes 
that one of the great strengths of the Older Americans Act has been its 
ability to assist older persons and their families in a comprehensive 
manner through a national aging network, and opposes any effort to 
block the senior nutrition programs with welfare programs, such as food 
stamps.
    The FCoA supports the continuation of the Older Americans Act as a 
categorical program and strongly opposes the block granting of any 
titles, responsibilities, programs, and services under the Act.
    In order to have the benefit of the recommendations from the 1995 
White House Conference on Aging, and because many programs arising from 
the last reauthorization have not had sufficient time to be implemented 
and evaluated, the FCoA supports a simple 1-year extension of the Older 
Americans Act.

                         D. Special Populations

                             major findings
    By the year 2030, minority populations will comprise one in four 
persons aged 65 and over, as compared to approximately one in eight 
today.
    Nearly three out of five persons over the age of 60 are women. Data 
gathered by the FCoA and the AoA reveal that:
          Compared to men, elderly women live longer, are three times 
        more likely to be widowed or living alone, spend more years and 
        a larger percentage of their lifetime disabled, are nearly 
        twice as likely to reside in a nursing home, and are more than 
        twice as likely to be living in poverty.
          Almost three-quarters of all elderly persons living below 
        poverty are women. Three of five Black women aged 65 and over 
        living alone, and two of five Hispanic women aged 65 and over 
        living alone have incomes below the poverty level.
          Women provide 80 percent of the informal care that their 
        families receive.
          Seven out of ten ``baby boom'' women will outlive their 
        husbands. Many can expect to be widows for 15-20 years. In the 
        year 2020, two out of five women aged 65 and over living alone 
        are likely to have incomes which are less than 150 percent of 
        the poverty level. The median income of single elderly women at 
        that time is projected to be 63 percent that of single elderly 
        men.
    Urban American Indians have been called the ``invisible minority'' 
because their conditions and needs are not generally recognized in 
comparison to other older populations. A study of elderly urban Native 
Americans living in Los Angeles by Dr. Josea Kramer found that:
          Monthly incomes were not sufficient to cover basic living 
        expenses of nearly two out of five older American Indians 
        surveyed.
          One out of nine is homeless.
          Three out of five report having health problems.
          Diabetes occurs at almost five times the expected rate.
          One in four have impairment in at least one activity of daily 
        life.
          58 government agencies received a copy of these findings and 
        a series of recommendations, but it is not clear whether there 
        has been any follow-up seeking to address this situation.
    The Council found that many Filipino veterans face critical 
problems such as a lack of adequate living arrangements, no health 
benefits, poor physical and mental conditions, no financial assistance, 
a greater susceptibility to crime victimization, and increased 
separation anxieties from family members. In addition, the U.S. 
Government has denied Filipino World War II veterans the same status 
accorded to other U.S. veterans by denying them veterans benefits.
                    resolutions and recommendations
    Greater attention and resources need to be focused on gathering 
data and initiating outreach to particularly vulnerable subgroups of 
rural elders, such as persons living alone, individuals with health or 
mobility problems, the ``old old,'' racial and ethnic minorities, and 
older women.
    The FCoA strongly supports the efforts of the Administration on 
Aging, the Social Security Administration, and the Pension and Welfare 
Benefits Administration of the U.S. Department of Labor to better 
inform persons of all ages about the need to plan early for retirement 
and for a long lifespan. The FCoA urges these agencies, the President, 
and the Congress to develop policies which pay particular attention to 
the special needs and characteristics of older women, who are much more 
likely to be living in poverty, both now and in the future, than are 
older men.
    By a unanimous vote during its quarterly meeting on September 13, 
1994, the FCoA recommends that the Assistant Secretary for Aging assume 
a leadership role in coordinating the efforts of government agencies to 
pool their resources for serving the unmet needs of urban American 
Indian elders.
    By a unanimous vote during its quarterly meeting in Washington, 
D.C., on September 13, 1994, the FCoA recommended that a meeting be 
convened consisting of representatives from the Federal Council on the 
Aging, the Veterans Administration, the Immigration and Naturalization 
Service, and the Administration on Aging in order to seek coordinated 
strategies for addressing the problems of Filipino veterans.

                   E. White House Conference on Aging

                    resolutions and recommendations
    Based primarily on the Council Members' participation in many local 
WHCoA events, as well as some of the experiences arising from the 1981 
WHCoA, the Council submitted the following recommendations to the 
Conference's executive director.
    There is widespread enthusiasm for this WHCoA at the grass roots 
level. Every effort must be made to continue the President's intention 
to make this very much a ``people's conference.'' Budget permitting, 
the President and the WHCoA should utilize advancements in 
telecommunications since the 1981 Conference to give this Conference 
more of a town hall focus. Many thousands of persons are personally 
invested in the pre-conference activities. At the very least, methods 
should be in place to have the public plugged in as observes.
    The Conference agenda must focus on at most six to eight priority 
categories of issues. Two and a half days is simply not enough time to 
adequately discuss and pass meaningful recommendations on dozens of 
issues. We urge the Policy Committee to prioritize some key issues 
going into the Conference so that discussions will not be all over the 
board. Given that these conferences occur at best only once every 10 
years, we simply cannot afford to have proposals passed in a haphazard 
way. We strongly believe that more targeted discussions around a few 
key issues will lead to more significant and productive 
recommendations.
    Regardless of the theme or agenda, it is crucial that a strategy be 
devised which is designed to follow through on key recommendations 
arising from the Conference. The FCoA intends to play a strong 
leadership role in our communities and with the President and the 
Congress to work for enactment of major WHCoA recommendations.

                        III. FUTURE DEVELOPMENTS

    In carrying out its mandate to comprehensively review and evaluate 
Federal policies and programs affecting older Americans, the FCoA has 
developed an action plan designed to advocate for the needs of older 
Americans who are particularly vulnerable so that they and their 
families are better able to lead productive and dignified lives.
    The Council's plan has been formulated on two major principles:
          Provide a voice for older persons and their families, with 
        particular sensitivity to individuals who often do not have the 
        resources to be heard, including: Frail persons in need of 
        long-term care assistance, persons with mental health needs, 
        individuals who are the victims of elder abuse, persons living 
        alone, and economically vulnerable individuals.
          Seek to focus on three or four major issues and follow 
        through with a multi-year action plan designed to develop a 
        targeted series of informational materials and policy 
        recommendations.

                        A. Goals and Objectives

    Every activity of the Council will have as its ultimate goal to 
provide productive recommendations to the President and policymakers on 
ways to improve programs and policies affecting older Americans.
    Serve as ombudsmen and spokespersons for the most vulnerable and 
at-risk older Americans, and play an important outreach role between 
older persons in their communities, the White House, and Federal 
agencies.
    Promote preventive assistance, better intergenerational 
understanding and highlight the positive contributions of older 
persons.
    Study, develop, and advocate for policy recommendations within the 
Council's priority issue areas. These priority issues are:
          Long-Term Care (Within an Emphasis on Home and Community-
        based Care);
          Mental Health and Aging;
          Older Americans Act (With an Emphasis on Reauthorization, 
        Nutrition, and Elder Abuse); and
          Providing Leadership Regarding the White House Conference on 
        Aging.

                             B. Action Plan

          develop and advocate for key policy recommendations
    Each quarterly meeting of the Council will have as its objective 
providing to the President a summary interim report of recommendations.
    The Council will prepare and publish three issue briefs annually on 
topics within its priority areas. These issue briefs will conclude with 
policy recommendations.
  The first issue brief for 1995 will be on mental health and aging.
    As mandated by the Older Americans Act, the Council will provide an 
annual report to the President of findings and recommendations.
    Each of the reports and issue briefs will be transmitted to 
policymakers, government agencies, and interested parties.
    Council members will play a leadership role in events related to 
the White House Conference on Aging.
          Members participate in local, regional and mini-conferences, 
        as well as contributing information, perspectives, and 
        recommendations to the Conference.
          Advocate for priority policy recommendations post-WHCoA. Work 
        for enactment of productive policies.
               spokespersons for at-risk older americans
    Council members will reach out into their local communities to 
determine the major concerns and contributions of older persons, and 
communicate this information to Federal agencies and the White House. 
Council members will in turn provide information about Federal programs 
to persons at the local level.
    The Council will issue statements and press releases and provide 
editorials and public comments on key issues, particularly as they 
affect vulnerable and at-risk older persons.
    Hold at least one of the Council's quarterly meetings outside of 
Washington, providing an opportunity for studying local issues and 
obtaining citizen input.
     preventive assistance and older persons as a valuable resource
    The Chairman in particular will seek opportunities for speaking on 
ways older persons can continue to serve as valuable resources in their 
communities and on the importance of preventive care. The Council's 
informational materials will also include an emphasis on these topics. 
Efforts will be made to disseminate this information through a variety 
of public-private, cooperative efforts.
    The Council will continue to utilize the media, through statements, 
press releases, and editorials to better inform the public about these 
matters.
           focus particular attention on priority issue areas

                             Long-Term Care

    Develop and disseminate an issue brief on rural long-term care, 
including policy recommendations.
    Support the inclusion of long-term care in any health care reform. 
Push for principles as contained in the long-term care resolution 
passed by the Council.
    Examine and develop recommendations regarding the role of the aging 
network in the provision of home and community-based care.

                        Mental Health and Aging

    Publish and disseminate a book on mental health and aging designed 
to assist providers of mental health services with a better 
understanding of the special characteristics and needs of older 
persons. The book will also include recommendations to improve the 
quantity and quality of community-based mental health services for the 
elderly.
    Prepare and disseminate an issue brief on mental health and aging.
    Join in partnership with the Coalition on Mental Health and Aging 
in developing and advocating for policy recommendations.
    Participate in the White House Conference on Aging Mini-Conference 
on Mental Health and Aging. Advocate for increased attention and 
visibility of mental health issues at the WHCoA, and work for the 
enactment of productive policies following the Conference.

                          Older Americans Act

    Focus on issues related to the Act's authorization.
    Study and make specific recommendations regarding Title VII of the 
Act, including the ombudsman programs, programs on elder abuse, neglect 
and exploitation, and outreach, counseling and assistance programs.
    Develop an issue brief on elder abuse and examine ways to improve 
assistance and protections under the Act.
    Examine the role of the aging network in the provision of home- and 
community-based long-term care.

                    White House Conference on Aging

    Council members will continue to play a leadership role in pre-
conference activities by serving as delegates, participants, and 
presenters in State, local, regional, and mini-WHCoA events.
    The Chairman will serve on the Advisory Committee for the 
Conference and the Council will provide guidance on the structure, 
background materials, and development of resolutions and 
recommendations.
    Members of the Council will help to serve as facilitators and 
moderators during the Conference in May.
    The FCoA will play a leadership role in helping to develop and 
advocate for key recommendations passed by the delegates at the 
Conference.

       APPENDIX A--BACKGROUND OF THE FEDERAL COUNCIL ON THE AGING

    Authorized under Section 204 of the Older Americans Act, the 
Federal Council on the Aging (FCoA) is the bi-partisan citizen advisory 
agency within the executive branch of the Federal Government charged 
with advising and assisting the President on the special needs and 
characteristics of older Americans.
    Created under the 1973 amendments to the Act, the FCoA is comprised 
of 15 members, 5 of whom are appointed by the President, 5 by the U.S. 
Senate, and 5 by the U.S. House of Representatives. Council members are 
appointed to serve 3-year terms and are chosen from among individuals 
with expertise and experience in the field of aging who represent a 
diverse cross-section of rural and urban communities, national 
organizations with an interest in aging, business, labor, Indian 
tribes, minorities, and the general public. By statute, at least 9 of 
the members must themselves be older persons.

                     Functions of the FCoA Include

    Serving as spokespersons on behalf of older persons by making 
recommendations about Federal policies and programs;
    Reviewing and evaluating policies to assess their effectiveness and 
to promote better coordination between and across Government agencies;
    Directly advising the Assistant Secretary for Aging on matters 
pertaining to services and assistance under the Older Americans Act;
    Informing the public about the problems and needs of the aging by 
collecting and disseminating information, conducting or commissioning 
studies, and by issuing reports;
    Holding public hearings and conducting or sponsoring conferences, 
workshops, and meetings;
    Serving on the Advisory Committee of the White House Conference on 
Aging; and
    Issuing an annual report to the President on key findings and 
priority recommendations.

                     Biographies of Council Members

    John E. Lyle, Chairman, of Houston, TX, is appointed by President 
Clinton to a term ending March 31, 1996. Mr. Lyle has been an attorney 
for 60 years and is presently director of Falcon Seaboard Resources, 
Inc., of Houston, Texas and is ``of counsel'' to the Houston law firm 
of Harris and Quinn. At the age of 33, while serving his country 
overseas during World War II, Mr. Lyle was elected to represent the 
citizens of the 14th Congressional district of Texas in the U.S. House 
of Representatives. Congressman Lyle served for 10 years (1944-55) as a 
powerful ally of Speaker Sam Rayburn and worked as a member of the 
House Rules Committee which guided legislation through the Congress. 
Mr. Lyle's many accomplishments and affiliations include serving two 
terms in Corpus Christi, serving as director of the State Bar of Texas, 
being elected president of the Law Enforcement Foundation for the Texas 
Attorney General, and serving on the board of St. Luke's Hospital and 
Foundation.
    Alice B. Bulos, of San Francisco, CA, is appointed by President 
Clinton to a term ending on March 31, 1997. Ms. Bulos is a community 
activist from South San Francisco who is active in a variety of civic 
organizations. She holds leadership positions as California chair of 
the Filipino-American Democratic Caucus, chair of the Sacramento Asian/
Pacific Women's Network, and the northern California chair of the 
National Filipino-American Women's Network. Ms. Bulos formerly served 
as the Health Commissioner of San Mateo County (1986-94) and as a board 
member of the regional center for Mental Disabilities. A naturalized 
American citizen, she holds a B.A. and M.A. from the University of 
Santo Tomas in Manila, where she taught and served as the chairman of 
the Department of Sociology.
    Eugene S. Callender, of New York, NY, is a reappointee of the U.S. 
House of Representatives to a term ending March 31, 1995. Dr. Callender 
is a clergyman and an attorney. He is the former director of the New 
York State Office on Aging, from 1983-89. Presently he is a vice-
chairperson of the National Caucus and Center on the Black Aged and is 
the President of the SYDA Foundation in New York.
    William B. Cashin, of Manchester, NH, is appointed by President 
Clinton to a term ending on March 31, 1995. Mr. Cashin is a vice 
president of the Catholic Medical Center in Manchester, and Dean of the 
City of Manchester's Board of Mayor and Alderman. As a hospital 
administrator, he directs the day-to-day operations of all non-clinical 
support services for a 330-bed institution. He also worked at Notre 
Dame Hospital in a similar posi
    Rudolph Cleghorn, of El Reno, OK, is a reappointee by the U.S. 
Senate to a term ending March 31, 1997. Following his retirement as a 
case manager with the U.S. Department of Justice, Mr. Cleghorn served 
for 10 years as program manager of a Title VI program, and was 
instrumental in the formation of the National Association of Title VI 
Directors. He was a staff member of Three Feathers Associates which 
administered a grant to train Title VI directors. In 1984, he was 
appointed to AARP's ad-hoc Committee on Minority Affairs, and in 1988 
to the Minority Concerns Committee of the National Council on the 
Aging. He is a member of numerous aging and Indian Organizations, and 
is a member of the Otoe-Missouria and Cherokee-Delaware Indian Tribes.
    Stephen Farnham, of Presque Isle, ME, is a reappointee by the U.S. 
Senate to a term ending March 31, 1997. Mr. Farnham is the executive 
director of the Aroostook Area Agency on Aging, Inc., and voluntarily 
directs the operation of the Caribou Congregate House Development 
Corporation. He is a strong advocate for the needs of vulnerable older 
people in Maine and has served 3 years as a board member of the 
National Association of Area Agencies on Aging (NAAAA).
    Max L. Friedersdorf, of Sanibel, FL, is appointed by the U.S. House 
of Representatives to a term ending March 31, 1996. Prior to the House 
appointment, Mr. Friedersdorf served as Chairman of the FCoA under 
former President Bush. His nearly 28 years of experience in high level 
positions in the Federal Government includes 8 years in the White House 
as Assistant to the President for Congressional Liaison under 
Presidents Nixon, Ford, and Reagan. He is Senior Vice President with 
Neill and Company in Washington, D.C. and serves as Chairman of the 
Advisory Board for the Association of Retired Americans. A native of 
Indiana, he attended Franklin College, where he was awarded a B.A. in 
Journalism and an Honorary Doctorate of Law. He also earned an M.A. in 
Communications from American University in Washington, D.C.
    Robert L. Goldman, of Oklahoma City, OK, is a reappointee by the 
U.S. Senate to a term ending on March 31, 1995. Since retiring from the 
Bell System in 1979, Mr. Goldman has been an active advocate for 
improving the quality of life for older Americans. He is a member of 
the boards of numerous senior advocacy and service organizations, and 
maintains an intergenerational interest by serving on the city's 
Educational Round Table, and by working with handicapped school 
children. Mr. Goldman has served as Chairman of the Oklahoma State 
Council on Aging and as Vice President of the Oklahoma State Board of 
Nursing Homes. Currently, he is an active member of the Oklahoma State 
Commission on Health Care
    Connie Hadley, of Kansas City, KS, is a reappointee by the U.S. 
Senate to a term ending on March 31, 1996. She is an active senior with 
a long involvement in community programs. A respected and influential 
voice in the community, she is especially active in promoting programs 
to help low-income and minority older persons. She is a former 
Executive Director of the Economic Opportunity Foundation, Inc., in 
Kansas City, and is a member of Senior Organized Citizens of Kansas. 
She also serves on the Board for Foster Grandparents in Wyandotte 
County, and was the first County Senior Citizens Coordinator.
    Olivia P. Maynard, of Flint, MI, is appointed by President Clinton 
to a term ending March 31, 1997. Ms. Maynard is the president and 
founder of Michigan Prospect for Renewed Citizenship, and is a visiting 
professor at the University of Michigan School of Social Work. She is 
the former director of the Michigan State Agency on Aging, Office of 
Services to the Aging, and was also a candidate for Lt. Governor. She 
taught adult education at C.S. Mott Community College. Ms. Maynard hold 
a B.A. from George Washington University and an M.S.W. from the 
University of Michigan School of Social Work.
    Myrtle B. Pickering, of Shreveport, LA, is appointed by President 
Clinton to a term ending on March 31, 1995. Ms. Pickering has served 
for 16 years as the Executive Director of the Caddo Council on Aging. 
She also serves on the National Council on the Aging, Louisiana State 
Citizens Committee on Mental Health, and the Louisiana Elderly Health 
Care Council. She is President of the Louisiana Senior Citizens Trust 
Fund, and former President Pro Tempore of the Louisiana Silver Haired 
Legislature.
    Josephine K. Oblinger, of Springfield, IL, is a reappointee by the 
U.S. House of Representatives to a term ending on March 31, 1997. Mrs. 
Oblinger has served 3 year terms upon the recommendation of former 
House Minority Leader Robert Michel. Mrs. Oblinger has an extensive 
career as a State Legislator and is a long-standing advocate for older 
people in Illinois. She is the former Director of the Illinois 
Department on Aging.
    Raymond Raschko, of Spokane, WA, is a reappointee by the U.S. House 
of Representatives to a term ending on March 31, 1996. Mr. Raschko 
serves as Director of Elderly Services with the Spokane Community 
Mental Health Agency, and as a member of the Washington State Long-Term 
Care Commission. He also serves as Director of the Greater Spokane 
Chapter of the Alzheimer's Association.
    Romaine M. Turyn, of Readfield, ME, is appointed by the U.S. Senate 
to a term ending on March 31, 1996. Ms. Turyn is currently Project 
Director for the Maine Alzheimer's Project, and employed by the Muskie 
Institute of Public Affairs at the University of South Maine. She 
served as the Executive Director to the Maine Committee on Aging. She 
also served as special assistant to the Senate Majority Office of the 
Maine Legislature. Recently, she was elected as Vice Chair of the 
Senior Legislative Advocacy Coalition.
    E. Don Yoak, of Spencer, WV is a reappointee by the U.S. House of 
Representatives to a term ending on March 31, 1995. He is retired from 
the West Virginia Department to Highways and has been active in the 
West Virginia Legislature for the last 54 years. Mr. Yoak currently 
serves as Doorkeeper of the West Virginia House of Delegates. He serves 
as Chairman of the Ford Motor Company Dispute Settlement Board in West 
Virginia; also as a State Coordinator for AARP, and on the board of 
directors for the West Virginia Assistive Technology Systems.
                               APPENDIX 2

                              ----------                              


              Report From Federal Departments and Agencies

                   ITEM 1. DEPARTMENT OF AGRICULTURE

                     AGRICULTURAL RESEARCH SERVICE

 Title and Purpose Statement of Each Program or Activity Which Affects 
                            Older Americans

    Studies are conducted at the Jean Mayer USDA Human Nutrition 
Research Center on Aging (HNRCA) at Tufts University, Boston, 
Massachusetts, which address the following problems of the aging:
          1. What are nutrient requirements to insure optimal function 
        and well being for a maturing population?
          2. How does nutrition influence the progressive loss of 
        tissue function associated with aging?
          3. What is the role of nutrition in the genesis of major 
        chronic, degenerative conditions associated with the aging 
        process?
    In addition, studies are performed at the Beltsville Human 
Nutrition Research Center (BHNRC), the Grand Forks Human Nutrition 
Research Center (GFHNRC), and the Western Human Nutrition Research 
Center (WHNRC) on the role of nutrition in the maintenance of health 
and prevention of age-related conditions, including cancer, coronary 
heart disease, hypertension, diabetes, neurological disorders, 
osteoporosis, and immunocompetence. Summaries of human nutrition 
research progress and a list of projects related to nutrition and the 
elderly are attached.
                  brief description of accomplishments
    Reduced ability to regulate energy balance is associated with 
aging. Investigations of the effects of aging on mechanisms of body 
energy regulation and the control of food intake were conducted at the 
HNRCA. The subjects were 35 healthy young and elderly men of normal 
body weight leading unrestricted lives and consuming a diet of typical 
composition. The results demonstrate that human aging is associated 
with a substantially reduced ability to regulate energy balance and 
control energy intake even in apparently very healthy individuals. This 
knowledge can be used to promote weight stability among the elderly and 
should thereby encourage the important goal of reducing preventable 
disability and disease late in life.
    Strength training has positive effects on glucose and chromium 
metabolism in older men (53-63 years old). Aging has been associated 
with a progressive impairment of carbohydrate metabolism, characterized 
by impaired glucose tolerance and insulin sensitivity. At the 
Beltsville Human Nutrition Research Center, strength training was 
investigated in older individuals. This training resulted in 
significant increases in strength and muscle mass, and decreases in 
body fat. Insulin's action was found to improve, and this may be due to 
the observed differences in metabolism of the essential trace element 
chromium. Chromium metabolism was followed using stable (non-
radioactive) isotopes of the element. This research will benefit 
scientists in the fields of nutrition, exercise physiology, 
kinesiology, gerontology, and diabetology.
    Exercise is an effective means to counter physical frailty in the 
oldest old. Muscle weakness and atrophy have been linked to physical 
frailty in the elderly. Although disuse of skeletal muscle and 
undernutrition have been often cited as potentially reversible 
etiologies of this frailty, the efficacy of interventions targeted 
specifically toward these deficits has not been previously evaluated in 
a large controlled trial. A randomized, placebo-controlled clinical 
trial of high-intensity progressive resistance training and/or multi-
nutrient supplementation in 100 nursing home residents was conducted at 
the HNRCA. Results showed high-intensity resistance training is a 
feasible and effective means to counter muscle weakness and physical 
frailty in the oldest old. Multi-nutrient supplementation without 
concomitant exercise may reduce ad libitum food consumption and does 
not further improve outcomes.
    Older women can offset an undesirable hereditary effect on bone 
loss by raising their calcium intake. It is well known that 
osteoporosis has an inherited component. Recently the gene regulating 
the vitamin D receptor (VDR) was linked to bone mineral density in 
adults. Vitamin D and its intestinal receptor are important in the 
process of calcium absorption, particularly in those on low-calcium 
diets. A study was conducted at HNRCA to determine whether genetic VDR 
status is related to rates on bone loss in postmenopausal women and, if 
so, whether calcium intake influences the association. Genetic VDR 
status was determined in 229 women who had participated in an earlier 
2-year calcium supplement trial. Those with the reportedly undesirable 
VDR status lost bone mineral more rapidly from the hip, spine, and 
whole body. At the hip, this genetic influence was present only in 
women with calcium intakes under 650 mg per day (average 400 mg per 
day). We conclude that genetic VDR status influences rates of bone loss 
in postmenopausal women and that individuals with the undesirable 
status can offset this hereditary effect by raising their calcium 
intake.
    Nitrogen balance data suggest elderly adults require intakes of 
protein higher than the current Recommended Dietary Allowance. There 
have been insufficient data available to determine the protein 
requirements of the elderly. This population differs from younger 
populations in body composition, physical activity, food intake, and 
disease incidence, factors which may affect protein requirements. The 
dietary protein requirements of the elderly were determined in 12 men 
and women, aged 56 to 80 years, using the short-term nitrogen balance 
technique which measures the difference between the amount of nitrogen 
ingested and excreted by the body. Volunteers were randomly assigned to 
groups that consumed protein intakes equivalent to the Recommended 
Dietary Allowance (RDA) or twice the RDA. The nitrogen balance data 
suggest that a safe protein allowance for essentially all elderly 
adults would require intakes of protein considerably higher than the 
current RDA. These results are of direct benefit to scientists, 
agencies providing for the nutrition of elderly populations, and, even 
more so, to the elderly consumers by providing evidence of higher 
protein requirements in this population.
    Cataract development may be slowed by a diet that increases 
glutathione. In the eye, glutathione appears to provide a critical 
defense mechanism against the onset of cataract. Low levels of forms of 
glutathione are found in many cataractous lenses. In cataract induced 
by galactose, a decrease in stores of a substance necessary to 
regenerate glutathione has been observed and may contribute to the 
progression of cataract. At HNRCA the dose-response relationship 
between dietary galactose and cataract formation was established by 
feeding rats various amounts of galactose. The anti-cataract potential 
of glutathione monoethyl ester was tested on rats fed 15 percent 
galactose. Progression of cataract development during the early stage 
was significantly slower than those not treated with glutathione 
monoethyl ester indicating that a diet that increases glutathione and 
thus antioxidant potential may delay cataracts in the elderly.
    Patients with Alzheimer disease exhibit altered plasma 
concentration of selected amino acids. Amino acids provide the building 
blocks for proteins within the body. Diseases of the liver and kidney 
are known to cause abnormalities in amino acid metabolism and amino 
acid concentration in blood. In normal healthy individuals, age, sex, 
and exercise have been shown to affect blood amino acid concentrations. 
Thus, characterization of the normal ranges for fasting amino acids is 
important for interpreting results from dietary and metabolic 
experiments and for diagnostic purposes in conditions where changes in 
amino acid profile are expected. At HNRCA, a study using fasting 
samples from several elderly populations provided the opportunity to 
evaluate normal fasting amino acid concentration in healthy elderly 
female subjects and a group of elderly patients diagnosed with 
Alzheimer disease. Results included: (1) Fasting amino acid 
concentrations do not reflect levels of dietary protein intake when the 
dietary amino acid composition is similar, and (2) Patients with 
Alzheimer disease exhibited altered plasma concentration of a few 
selected amino acids relative to active or sedentary control subjects.
    Small intestinal permeability is not diminished with aging. The 
effect of aging on the small intestine is a controversial topic, and it 
is unknown whether the aging process itself results in altered small 
intestinal permeability. Intestinal permeability or ``leakiness'' can 
be assessed by a test which compares the relative absorption and 
excretion of a large sugar, lactulose (absorbed in the spaces between 
cells) to a small sugar, mannitol (absorbed through cell membranes). At 
HNRCA, small intestinal integrity and permeability with advancing age 
as measured by the lactulose and mannitol absorption test were 
evaluated in 56 healthy subjects in three age groups: 20 to 39 years, 
40 to 50 years, and >60 years. Subjects were all healthy, community-
dwelling volunteers. With increasing age, both the percentage of 
lactulose excreted and the percentaged of mannitol excreted 
progressively decreased.
    However, the lactulose-to-mannitol ratio did not change with 
increasing age. Thus, there is a progressive decline in the ability to 
excrete lactulose and mannitol with age due to a decline in kidney 
function with advancing age. However, small intestinal permeability, as 
indicated by this lactulose-to-mannitol ratio, does not change with 
aging. Thus, small intestinal permeability is not diminished with aging 
measured by the lactulose/mannitol absorption test.
    The effect of beta-carotene supplementation on the distribution of 
carotenoids, vitamin E, vitamin A, and cholesterol in plasma 
lipoprotein fractions of healthy older women. Compounds present in 
fruits and vegetables called carotenoids have been shown to reduce the 
risk of certain types of cancer and of heart disease. To delineate the 
mechanisms by which beta-carotene acts in these disease states, an 
understanding of its effects on the distribution of other antioxidants 
and of fat molecules in the various compartments of blood is necessary. 
At HNRCA, the effects of taking large amounts of beta-carotene 
supplements on the concentrations of beta-carotene, other carotenoids, 
vitamin E, and cholesterol in the various fat compartments of blood 
were investigated. Also effects of taking beta-carotene supplements on 
the levels of two form of vitamin A (retinol and retinyl palmitate) 
were studied. Ten healthy older women were assigned to experimental and 
control groups. They ingested either 90 mg of beta-carotene or a 
placebo daily. Three weeks of beta-carotene supplementation resulted in 
about a 10-fold enrichment of all the lipoprotein fractions with beta-
carotene. There was no effect of beta-carotene on plasma and 
lipoprotein concentrations of other carotenoids, vitamin A, and fat 
molecules (cholesterol and triglycerides). However, there was an 
increase in vitamin E levels in plasma and in high-density 
lipoproteins. These results indicate beta-carotene may have a sparing 
effect on vitamin E and beta-carotene supplementation may protect 
vitamin E from destruction.
    Elderly may be deficient in cobalamin. A study was conducted at 
HNRCA to determine vitamin B12 deficiency in a healthy elderly group 
using measures of vitamin B12-dependent metabolism as indices. At least 
12 percent in a large sample of free-living elderly Americans (the 
Framingham Study) are cobalamin (a chemical complex associated with the 
vitamin B12 group) deficient. Many elderly persons with seemingly 
normal vitamin concentrations are, in fact, deficient by these newer 
and more sensitive criteria.

 Agricultural Research Service--Research Projects Related to Nutrition 
                             and the Elderly

                                                           Funding Level
                                                        fiscal year 1994
                                                                 dollars
Effect of Fiber or Amylose on Metabolic Parameters--BHNRC, 05/
    01/90-04/30/95. Objective: To determine the effects of 
    high amylose foods or purified versus food fiber on blood 
    parameters associated with chronic diseases and mineral 
    bioavailability...........................................   308,426
Newly Available Carbohydrates in the Development of Diet for 
    Control of Risk for Disease--BHNRC, 02/03/95-02/02/97. 
    Objective: To examine use of carbohydrate to maximize 
    physical performance in humans. To examine effects of 
    soluble fibers on cholesterol metabolism and disease risk 
    in humans and animals. To examine long-term effects of 
    carbohydrate intake on disease development or prevention..   660,711
Dietary Carbohydrates and Etiology or Prevention of 
    Degenerative Diseases and Their Complication--BHNRC, 04/
    01/91-03/31/96. Objective: To investigate the underlying 
    mechanisms of how dietary carbohydrates induce 
    biochemical, cellular, molecular and structural changes 
    that either increase or decrease the risk of degenerative 
    diseases that occur during the aging process..............   344,578
Nutritional and Biochemical Role of Chromium in Health and 
    Disease--BHNRC, 01/23/90-01/22/95. Objective: Determine 
    effects of low Cr intakes of humans on variables 
    associated with sugar and fat metabolism. Determine the 
    effects of physical performance on trace metal metabolism. 
    Develop sensitive methods to detect marginal signs of 
    chromium deficiency. Determine and define the role of 
    chromium in selected abnormalities in glucose metabolism. 
    Determine the bioavailability of various forms of chromium   354,518
Effect of Dietary Fat on Biochemical and Physiological Markers 
    of Risk for Thrombosis--BHNRC, 05/29/92-05/28/97. 
    Objective: Determine the ability of specific dietary fatty 
    acids to (a) influence eicosanoid metabolism and 
    derivative consequence on blood clotting tendency, and (b) 
    modulate platelet activity and other hemostatic factors 
    that are major determinants of thrombotic risk............   558,714
Relation Between Nutrition and Aging: Cholesterol, Bile Acid, 
    Sterol Metabolism and Fecal Mutagenicity--BHNRC, 04/08/94-
    04/07/99. Objective: To investigate the relationship of 
    fat and other nutrients or components of the human diet to 
    age-related disorders such as cancer and coronary heart 
    disease, as reflected by change in bile acid metabolism, 
    fecal mutageus hormones, serum cholesterol, platelet 
    aggregation, and other parameters affected by diet and 
    suspected of involvement in aging disorders...............   289,809
Effects of Copper Deficiency and its Modifiers on 
    Cardiovascular Metabolism and Function--GFHNRC, 03/04/91-
    03/03/96. Objective: Copper deficiency produces a host of 
    adverse anatomical, chemical, and physiological changes in 
    the cardiovascular system in several species including 
    man. Chemical factors that affect blood coagulation and 
    clot lysis and neuroendocrine mechanisms that affect blood 
    pressure will be studied. Modifying factors such as 
    commonly eaten chemicals or food will be studied 
    occasionally. These studies will provide information 
    useful in definition of copper requirements...............   395,972
Human Mineral Element Requirements and Their Modification by 
    Stressors--GFHNRC, 05/13/91-05/12/96. Objective: Determine 
    the dietary requirements of humans for magnesium, copper, 
    and boron, and whether these requirements are affected by 
    nutritional, physiological, hormonal, or metabolic 
    stressors. Specifically, for humans, to demonstrate that 
    copper is of nutritional concern and that its nutritional 
    need is enhanced by oxidant stress; to demonstrate that 
    inadequate dietary magnesium can have pathological 
    consequences; and to confirm that dietary boron affects 
    measures of macromineral metabolism....................... 1,489,999
Dietary Trace Elements and Physiology of the Cardiovascular 
    and Related Systems--GFHNRC, 02/11/91-02/10/96. Objective: 
    The physiological consequences, especially to the 
    cardiovascular system, of trace element deficiencies, 
    emphasizing copper, will be determined; the effect of 
    copper deficiency on microcirculation, platelet-blood 
    vessel wall interactions, vascular smooth muscle 
    responses, and heart mechanical function will be examined. 
    Whether oxygen-derived free radical damage is the cause of 
    any of the physiological deficits seen in trace element 
    (particularly copper) deficiencies will be determined.....   409,571
Gastrointestinal function and Metabolism in Aging--HNRC, 12/
    11/89-12/10/94. Objective: (1) Determine how aging affects 
    the human dietary requirements for vitamin B2 and vitamin 
    B6. (2) To study the effects of small intestinal bacterial 
    over-growth on ethanol metabolism, vitamin 
    bioavailability, lactose intolerance, and fecal enzyme 
    concentration. (3) To determine how aging affects carotene 
    and vitamin A metabolism in the human and in animal 
    models. (4) To delineate the pathways of intestinal 
    carotene metabolism....................................... 1,610,494
Function and Metabolism of Vitamin K and Vitamin K Dependent 
    Proteins During Aging--HNRC, 12/11/89-12/10/94. Objective: 
    Molecular, biochemical, and functional assays of vitamin K 
    nutritional status will be developed. These methods will 
    help determine human dietary vitamin K requirements and 
    establish criteria for determining subclinical vitamin K 
    deficiency in human and experimental animals. The vitamin 
    K content and bioavailability of a variety of foods common 
    to the American diet will be determined. Enzymes 
    responsible for the metabolic recycling of vitamin K will 
    be identified, isolated, purified, and characterized......   921,775
Bioavailability of Nutrients in the Elderly--HNRC, 12/11/89-
    12/10/94. Objective: (1) To determine the bioavailability 
    of food folate and the impact of aging on this process. 
    (2) To define the mechanism of body folate conservation 
    and effect of aging. (3) To assess the folate/vitamin B12 
    status in the elderly with respect to cardiovascular and 
    neuropsychiatric functions. (4) To define the mechanism of 
    age related decreases in intestinal absorption of calcium. 
    (5) To study the factors that influence the 
    bioavailability of zinc and magnesium..................... 1,635,339
Role of Nutritional Factors in Maintaining Bone Health in the 
    Elderly--HNRC, 12/11/89-12/10/94. Objective: The objective 
    of this lab is to improve the scientific basis for 
    understanding and setting the intake requirements of 
    calcium and vitamin D in aging adults. Specifically, we 
    will define the intake of calcium and vitamin D above 
    which skeletal mineral is maximally spared. This requires 
    an understanding of how demographic, endocrine, and 
    physical factors (e.g. race, sex, age, years since 
    menopause, weight, activity level, and the ability to 
    absorb calcium) affect the requirement of these nutrients. 1,007,419
Relationships Between Aging, Functional Capacity, Body 
    Composition and Substrate Metabolism and Need--HNRC, 12/
    11/89-12/10/94. Objective: To examine the effects of 
    increased physical activity, body composition, and diet on 
    the following: (1) Peripheral insulin sensitivity and 
    glucose metabolism; (2) functional capacity and 
    nutritional status of the frail, institutionalized 
    elderly; (3) cytokine production and whole body and 
    skeletal muscle protein metabolism; and (4) total energy 
    expenditure and its relationship to protein metabolism and 
    requirements.............................................. 1,447,031
Lipproteins Nutrition and Aging--HNRC, 12/11/89-12/10/94. 
    Objective: Research objectives are: (1) to test the 
    efficiency of a low saturated fat, low cholesterol diet in 
    lowering density lipoprotein (LDL) cholesterol levels in 
    elderly normal and hyperlowlipidemic subjects; (2) to 
    study effects of dietary fatty acids on the production of 
    liver lipoproteins in monkeys; (3) to study the 
    interrelationships of diet and lipoproteins in the 
    population; and (4) to study the regulation of intestinal 
    lipoprotein production by fatty acids and cholesterol in 
    vitro in Caco-2 cells..................................... 1,910,688
Effect of Nutrition and Aging on Eye Lens Proteins, Proteases, 
    and Cataract--HNRC, 12/11/89-12/11/94. Objective: One-half 
    of the eye lens cataract operations and savings of over $1 
    billion would be realized if we could delay cataract by 10 
    years. We are attempting to use enhancement of dietary 
    antioxidants, such as vitamin C, and other nutrients such 
    as carotenes and folacin to delay damage to lens proteins 
    and proteases and to maintain visual function in elderly 
    populations. This should delay (1) cataract-like lesions 
    in eye lens preparations and (2) cataracts in vivo........   772,124
Epidemiology applied to Problems of Aging and Nutrition--
    HNRCA, 12/11/89-12/10/94. Objective: (1) To define diet 
    and nutritional needs of older Americans. (2) To advance 
    methods in nutritional epidemiology. (3) To relate 
    nutrition to cataract formation and to the function of the 
    aging kidney, skeletal system, and cardiovascular system. 
    (4) To define the changes in body composition associated 
    with aging. (5) To interrelate physical activity and diet 
    with the aging process. (6) To relate low levels of 
    vitamin B12 with neurobehavioral and cognitive function... 1,192,600
Aging Nutrition and Immune Response--HNRCA, 12/24/92-12/23/94. 
    Objective: Investigate the role of nutrients and their 
    interactions with other environmental factors in age-
    associated changes of the immune response, to reverse and/
    or delay the onset of these immunological changes by 
    dietary modifications, and to use the immune response as 
    an index in determining the specific dietary requirements 
    for older adults..........................................   708,019
Amino Acid Metabolism, Aging and Risk of Chronic Disease--
    HNRCA, 02/10/93-02/09/96. Objective: Determine (1) if 
    impaired polyamine synthesis in lymphocytes of aged 
    individuals accompanies the observed age-related decline 
    in immune responsiveness, (2) if in vivo and in vitro NO/
    NO2 production and interorgan metabolism of agrinine is 
    altered by aging, and (3) if these processes can be 
    modulated and the effect on host immune function by 
    manipulation of dietary amino acid levels.................   378,952
Energy Regulation and Body Composition in Aging--HNRCA, 12/24/
    92-12/23/95. Objective: To explore the extent and causes 
    of changes in body fat and protein with aging and to 
    investigate optimal values for dietary energy intake and 
    expenditure in the aging population....................... 1,190,934
Dietary Antioxidants, Aging, and Oxidative Stress Status--
    HNRCA, 12/11/89-12/10/94. Objective: To determine the 
    effect of (1) long-term vitamin E and/or fish oil 
    supplementation in healthy subjects, lipid peroxidation, 
    immune function, and drug metabolism; (2) lowering total 
    fat in the diet in older adults on immune response and 
    eicosanoid metabolism; and, (3) vitamin E on exercise-
    induced lipid peroxidation in young and old men and the 
    effect of vitamin E and (carotenoids, vitamin C, etc.), 
    and their interactions with polyunsaturated dietary fatty 
    acids, including fish, oils, or immune function and aging.   906,221
Mechanisms involved in altered Neurotransmitter Receptor 
    Responsiveness in Senescence--HNRCA, 05-29-93-05-28-96. 
    Objective: To determine: (1) the factors involved in 
    neuronal loss and phosphoinsositide mediated signal 
    transduction (ST) deficits in senescence; (2) nutritional, 
    pharmacological, or molecular methods that will reduce, 
    retard, or reverse these deficits; and (3) if amelioration 
    of these declines will translate into improvements in 
    motor and/or cognitive behaviors..........................   409,481
Regulation of Gene Expression in Nutrient Metabolism--HNRCA, 
    06/18/93-04/17/95. Objective: Several new areas will be 
    explored aimed at defining the regulatory processes 
    controlling lipogenesis ad fatty acid homeostasis in the 
    mammalian liver. (1) What are the DNA sequence elements 
    and critical protein factors that regulate lipogenic gene 
    transcription in vitro and in vivo in response to diet and 
    metabolic hormones? (2) How does development of the 
    hepatic architecture influence homeostasis of lipogenic 
    gene expression. (3) How aging and genetic factors alter 
    lipogenic gene expression.................................   484,693

                       ECONOMIC RESEARCH SERVICE

Title and purpose statements of each program or activity which affects 
        older Americans
    The Economic Research Service conducts research and identifies 
policy issues relevant to the elderly population from the perspectives 
of rural development and of food spending, safety, nutrition, and food 
assistance.
Brief description of accomplishments
    The ongoing rural development research examine demographic and 
socioeconomic characteristics of the elderly, as well as their health 
status and living arrangements, by metro-nonmetro residence. Research 
based on the 1990 decennial census has focused on retirement areas and 
changes in the concentration of the older population by residential 
area. ERS participates in the Interagency Forum of Aging-Related 
Statistics at the National Institutes of Health and is currently 
represented on the Forum's work group on Population and Vital 
Statistics.

                   Rural Development Research Reports

    Beale, Calvin L. and Glenn V. Fuguitt, ``The Changing Concentration 
of the Older Population, 1960-90,'' Journal of Gerontology, Vol. 48, 
No. 6, S278-S288, 1993.
    Beale, Calvin L. and Kenneth M. Johnson, ``Post-1990 Demographic 
Trends in Nonmetropolitan America,'' Working Paper No. 5, Loyola 
University, Chicago, 1994.
    Rogers, Carolyn C., ``Social and Physical Context of Rural Aging,'' 
Book review of C. Neil Bull's ``Aging in Rural America,'' to be 
published in forthcoming issue of Rural Development Perspectives.
    Rogers, Carolyn C., ``Health Status of the Older Population in 
Nonmetro Areas,'' an article in forthcoming issue of Rural Development 
Perspectives.
    Rogers, Carolyn C., ``Increasing Disability among the Nonmetro 
Elderly as They Grow Older,'' article in forthcoming issue of Rural 
Conditions and Trends.
Brief description of accomplishments
    By the year 2030, those over are age 65 will comprise 20-25 percent 
of the population--that is, 1 out of every 4-5 people. In 1900, only 1 
out of 25 people were over age 65. Many physical and physiological 
changes occur during the aging process. Some of the changes observed 
among the elderly may be the result of lifelong patterns of food 
consumption and physical activity. Therefore, improvements in dietary 
patterns and physical activity could prevent, delay, or even reverse 
some of these changes. In 1992, annual per person spending increased 
with age of the household head up to age 64, then declined. However, 
the share of food expenditure spent away from home tended to decline 
with age of the household head.
    The elderly participate in a number of USDA food assistance 
programs. In January 1992, the participation rate in the Food Stamp 
Program by elderly persons was one-third, compared to an overall rate 
of 74 percent.

                      Food Issue Research Reports

    Blisard, Noel, and James Blaylock. ``Slow Growth in Food Spending 
Expected.'' Food Review, Vol. 16, No. 2, pp. 2-5, May-Aug. 1993.
    Kramer, Tim R. ``Nutrition and a Robust Immune System.'' Nutrition: 
Eating for Good Health. U.S. Department of Agriculture, AIB-685, 1994.
    Rosenberg, Irwin H. ``Nutritional Needs of the Elderly.'' 
Nutrition: Eating for Good Health. U.S. Department of Agriculture, AIB-
685, 1994.
    Smallwood, David M. and James R. Blaylock. ``Fiber: Not Enough of a 
Good Thing?'' FoodReview, Vol. 17, No. 1, pp. 23-29, Jan.-Apr. 1994.
    Smallwood, David M., Noel Blisard, James R. Blaylock, and Steven M. 
Lutz. Food Spending in American Households, 1980-92. Econ. Res. Serv., 
U.S. Dept. of Agriculture, Statistical Bulletin No. 888. October 1994.
    Weaver, Connie M. ``Maintaining a Strong Skeleton.'' Nutrition: 
Eating for Good Health. U.S. Department of Agriculture, AIB-685, 1994.

   EXTENSION SERVICE, USDA, AND STATE COOPERATIVE EXTENSION SERVICE 
                 EDUCATION PROGRAMS AND ACCOMPLISHMENTS

Title and purpose statement of each program or activity which affects 
        older Americans
    Extension in its lead role as the educational arm of USDA has 
conducted programs based on research findings that have benefitted 
older persons, their adult children and caregivers. The vision is for 
older persons to: maintain and continue a quality lifestyle while aging 
in place; have a greater opportunity to be financially secure; 
experience positive human relations; and to have available and know how 
to access health care options.
    In an effort to realize this vision, Extension is networking with 
national, State, and local organizations and agencies such as: the 
Administration on Aging, the National Rural Health Associations, the 
American Association of Retired Persons, the American Society on Aging, 
the National Council on Aging, the National Council of Negro Women, the 
White House Conference on Aging staff (WHCOA). A National program 
leader (NPL) is functioning as a member of the WHCOA Federal Liaison 
Committee. States and counties have been encouraged and provided 
information on how to conduct Mini-WHCOA sessions and to submit 
recommendations to the WHCOA staff. This NPL functions as a member of 
the National Council of Negro Women's Eldercare Institute Advisory 
committee. The National office has provided special needs funding to a 
three-State consortium to ``Assess Behavior Changes and Influences on 
Eating Behaviors in Older Adults' from Food Guide Pyramid Lessons''.
    State Extension Administrators and Specialists in 74 Land-Grant 
institutions and county agents in 3,150 local offices have networked, 
initiated, and conducted many programs. Below are some highlights of 
these efforts.
Brief description of accomplishments
                                alabama
    Alabama A&M University.--The Extension Program at Alabama A&M 
University implemented a number of programs designed to respond to the 
needs of the elderly population in North Alabama. Over 3,000 senior 
citizens in the University's 12 county service area received practical 
information applicable to critical issues which they confront daily.
    Collaborative efforts with community service agencies such as the 
Top of Alabama Regional Council of Governments (TARCOG), senior 
centers, Community Action Agencies (CAA), NACOLG/Area Agency on Aging, 
and other organizations facilitated the University's rural and urban 
programs outreach efforts. Specifically, programs were offered in 
nutrition and health, food safety, consumer fraud, housing, and home 
maintenance.
    Realizing the importance of the home environment to the physical, 
social, and psychological well being of citizens, particularly the 
elderly, a large percentage of programs efforts in the area of elderly 
housing focused on home care and maintenance. One hundred and forty-one 
home visits were made and 50 home demonstrations were conducted to 
address specific housing needs of senior citizens. Thirty-three related 
radio programs were aired and a number of newsletters were distributed.
    A Youth Elderly Service (YES) program was implemented in two 
counties. Through the program, 77 seniors received assistance with lawn 
care and general home maintenance from youth volunteers. The YES 
program seeks to improve the relationship between participating elderly 
and youth clientele. As a collaborative effort with the Juvenile 
Courts, the program also seeks to promote the rehabilitation of 
juvenile offenders, while benefiting the community and elderly 
citizens. Youth serve under careful supervision.
    Under the Decisions for Health Initiative, 1,400 elderly citizens 
participated in basic nutrition education programs including meal 
planning and use of the Food Guide Pyramid. Forty-three percent or 604 
of the participants reported eating more fruits, vegetables, and grain 
products as a result of the training.
    Under this same initiative, 1,200 individuals received training 
relative to dietary fat intake. Follow-up evaluations of program 
efforts indicated that 286 (23%) of those involved in training adopted 
recommended practices for reducing fat in the diet, and actually 
lowered their intake.
    Additionally, the Urban Component of the Cooperative Extension 
Program at Alabama A&M conducted a 15 lesson series with senior 
citizens in Madison County. Clients received information in the 
fundamental areas of nutrition and health (53 trained), food safety (63 
trained) and consumer fraud (69 trained). The participants rated the 
content of these lessons as being very good and useful.
                                colorado
    Thirteen Extension Service faculty members and six other agency 
representatives form the Gerontology Team that has provided leadership, 
resources and staff development workshops for county staff and 
volunteers since 1991. The team published 11 newsletters on Caregiving, 
Alzheimer's Disease, Parkinson's Disease, Prevention of Falls, 
Grandparenting etc. These were provided to 100 Extension County offices 
and aging network personnel in Colorado and others in the Rocky 
Mountain region. More than 1,700 customers have attended sessions on 
``Healthwise for Life'' which teaches people healthy life styles and 
health promotion and wellness practices. The team produced 36 news 
releases that were published in 15 papers. A series of 12 Nutrition 
Newsletters were provided to county offices on discs so local items and 
identification could be added. The content included research based 
information on the Dietary Guidelines and information on the how and 
where of participating in the Food Stamp and Congregate Mealsite 
programs. Currently, the newsletter method of the teaching older people 
is being evaluated to see if behavior changes result in older 
Coloradans improving their nutrition status as a result of increased 
nutrition knowledge and knowing how to participate in mealsite, food 
stamp, and other social service nutrition programs.
                                florida
    In Florida 1862 and 1890 Extension Service faculty expended a total 
of 516 days and reached 94,000 aged Whites, 27,000 Blacks, 16,000 
Hispanics, and 500 Asians. Over 4,500 seniors attended nutrition and 
health programs offered at congregate meal sites and health fairs 
throughout the State. Also, over 41,000 newsletters about nutrition and 
health concerns reached older adults; these were mailed to their homes, 
distributed to nursing homes, received in CES offices, or passed out at 
meal sites in Pasco, Lake, Jackson, and Leon Counties.
    Other programs emphasized other aspects of well-being. In Jackson 
county, over 130 older adults learned how to better manage stress. In 
Martin, over 100 seniors learned to protect themselves from crime. In 
Broward, 1,800 seniors in focus groups discussed changes associated 
with the aging process. In Lake, older adults (139) were helped to find 
information on community services.
    Over 600 seniors attended programs that provided information 
related to caregiving such as home care, personal care of the elderly, 
and caregiver stress (Brevard, Lake, Flagler).
    Volunteer networks enabled older adults to assist their peers with 
common concerns. Trained volunteers with the Widowed Persons Service in 
Lake County reached 235 bereaved persons, providing needed support to 
ease grief and lift depression, and guidance to assist in avoiding 
hasty decisions at a difficult time.
    In addition, older volunteers in intergenerational programs have 
assisted many families. In one county (Suwannee) 10 volunteers mailed 
newsletters on child development to over 200 parents of young children 
and read to 130 children in schools and libraries. In Orange County 
volunteers made 2,800 ``ouch dolls'' for children getting 
immunizations. In Broward County, 50 English-speaking seniors tutored 
85 immigrant families; 96 percent of recipients said they learned a 
great deal. Older volunteers also offered educational programs on 
consumer fraud, personal safety, financial management, exercising for 
fitness, stress management, and the aging process (Martin, Jackson, 
Lake, Volusia).
    Through programs on financial management, nearly 600 older adults 
in Lake, Volusia, Jackson, and Martin Counties increased their ability 
to make sound financial decisions. In Lake County, over three-fourths 
of 139 persons attending the program increased their financial 
knowledge, developed knowledge and confidence in their financial 
decisions, and gained greater control of their money. In Volusia, 
almost all who attended workshops (200) said they had improved their 
knowledge ``much'' or ``very much'' and most were taking steps to plan 
their finances and organize records. In Jackson County, 92 percent 
started keeping a record of where their money was going and changes 
they needed to make, and 84 percent had changed their spending habits.
    In Jackson County, a 5 part program, ``Using Medicines Wisely'' was 
presented to 6 different senior groups with 110 participants. Prior to 
the program, 93 percent did not have a complete record of medicines 
taken in their medical record; 68 percent used more than one pharmacy 
so there was not a complete patient profile for the pharmacist; and 89 
percent were not storing their medicines safely. At a 6 month follow-up 
of 55 participants, 75 percent had prepared a medicines log, 53 percent 
were using just one pharmacist, and 82 percent were storing medicines 
properly.
    In Osceola County, congregate meal site managers reported changes 
in their clients' nutritional practices. They indicated that 75 percent 
of clients (n=1,680) have started trying to add fiber to their diets; 
95 percent improved knowledge of healthy bladder and bowel habits; 75 
percent now understand food labels.
    County extension faculty supported services delivery to Florida's 
elderly by assisting providers. County faculty saved senior centers 
money by making food safety and temperature checks of foods prepared 
for congregate and home-delivered meals. In addition, congregate meal 
sites are required by law to offer educational programs to their 
clients. County Extension faculty provided useful information on 
current topics (such as food labeling and the food guide pyramid) at 
the centers. Extension extended the reach of services to older adults 
by offering information on community services available to assist the 
elderly, through Extension publications, displays, and programs.
    County faculty worked with Senior Centers or Older Americans 
Councils, and most also worked with AARP. Other organizational linkages 
included Area Agencies on Aging, volunteer agencies such as VISTA and 
RSVP, hospitals, civil groups, schools, libraries, churches, technical 
and community colleges, HRS, Hospice, Widowed Person's Service, Social 
Security Administration, banks, businesses, food banks, Red Cross, the 
public health department, consumer credit counseling, and city, county, 
and federal government.
                                kentucky
    Small Group Learning Sessions. Using materials prepared by 
Cooperative Extension, 3,100 Kentuckians participated in group learning 
sessions on the topic of Depression in Later Life. An additional 2,000 
Kentuckians participated in similar programs on Grandparenting. A 
variety of other educational sessions on aging, which reached smaller 
numbers, were conducted across the Commonwealth of Kentucky. Separate 
from these sessions, a number of new releases on aging were 
disseminated statewide.
    The 2nd Symposium on Aging: Design of Healthcare Environments. This 
symposium, targeted primarily to a diverse group of aging network 
professionals, drew an attendance of 250 and was a tremendous success. 
Both written evaluations and informal feedback reflected an 
appreciation for the range, depth, and practicality of the information 
presented during this three day event. Many found that the rich 
diversity of participants afforded refreshing and valuable networking 
opportunities. Among those attending were interior designers, nurses, 
Cooperative Extension professionals, architects, Kentucky Extension 
Homemaker Association members, University administrators, and a variety 
of other professionals, including representatives from twelve states 
outside of Kentucky. This event was particularly timely in that it 
addressed three areas of current national concern: aging, healthcare, 
and Americans with disabilities.
    Mini White House Conference on Aging. The Fayette County 
Cooperative Extension Service, in cooperation with the Association of 
Older Kentuckians, the Division of Aging Services, and Central Kentucky 
Area Agencies on Aging, conducted a regional White House Conference on 
Aging in Lexington, Kentucky on July 26, 1994. One-hundred-ninety-nine 
seniors attended this public forum, including 29 African-Americans and 
38 males. High priority issues identified by this energetic and 
outspoken group included intergenerational concerns, housings, health, 
taxes, social security, and transportation. The specific concerns 
raised were conveyed to those planning the Governor's White House 
Conference on Aging.
    GriefWork Project. During 1993, approximately 29,800 Kentuckians 
over 55 died, leaving behind a far greater number of bereaved loved 
ones. In addition to the maze of probate, Social Security settlements, 
and other financial matters bereaved individuals undergo a complicated 
and intense sequence of mental, emotional, and physical adjustment to 
the loss of a loved one. Based upon a needs assessment that included 
numerous individual interviews with key informants and community focus 
groups, the GriefWork Committee is in the process of developing 20 fact 
sheets and accompanying support materials. Volunteers will be trained 
to use these resources and will have available to them a library of 
books, pamphlets, and videotapes.
    New Video Series. An excellent collection of 13 one-hour PBS 
videotapes, which reflect the latest gerontology research and knowledge 
base, are now available statewide for special interest sessions. Study 
guides, developed by Washington State University Cooperative Extension 
Service, accompany each of the videotapes.
                                maryland
    In Maryland, a Memorandum of Understanding was signed in August, 
1992, between the Maryland Office on Aging (MOA) and the Cooperative 
Extension (CES). The focus of this is to develop and deliver the 
Nutrition Screening Initiative (NSI) through a concerted, statewide 
effort, combining State, regional and local resources. Improving the 
health and well-being of seniors by helping them develop and maintain 
beneficial nutrition practices is the overall goal. The Project is 
directed by a program management team, composed of the MOA Director of 
the NSI and two CES Nutrition Specialists. In addition, a task force 
comprised of county staff from both agencies advises the management 
team and helps implement the NSI at the local level, through the 
State's 19 area agencies on aging.
    To execute this program, specific goals, objectives, and guidelines 
have been established. A training manual for local staff conducting 
screenings in a variety of settings, such as congregate meals sites, 
home delivered meals, and health fairs has been developed. This manual 
describes the screening instrument, lists responsibilities of all 
participating staff, and suggests ways to plan, promote, and set up for 
the screening. Effective interviewing and nutrition education 
strategies are included, as well as guidelines for referral. Extension 
agents have also listed a variety of ways they can be involved, such as 
helping to develop projects at the local level, providing educational 
programs to seniors, setting up display tables, offering food 
demonstrations and computerized dietary analysis, and developing 
educational videotapes.
    A series of brochures, called ``Check it Out,'' has been developed 
by the MNSI program management team. Each brochure is focused on a 
different NSI risk factor, and contains practical tips to motivate 
seniors to make behavioral changes. The nutrition screening procedures 
have been pilot tested in four counties with a diverse group of senior 
citizens. A system for collecting and analyzing statewide data is being 
established.
    In Ann Arundel county, six ``You and Your Aging Relative'' classes 
were conducted for 60 caregivers with focus on caregiving, health, 
nutrition, financial concerns, and community resources. One 
participant, a RN, shared information and community resource 
information with patients and caregivers she has contact with at her 
position at a local medical center. Ten reported using community 
resource information to meet family needs. Twelve reported taking more 
time for personal needs when caregiving so as not to burn out.
    Three ``Grief/Loss and Depression'' classes reached 139--a day care 
group, a retired group and a church group dealing with grief and loss. 
Participants through class involvement set new goals, practiced coping 
techniques, and planned activities to focus attention on the positive.
    In Frederick County, CES and the wellness center of Frederick 
Memorial Hospital sponsored ``Senior Healthscope'' fairs at three 
Senior Centers.
    Another county conducted the Women's Financial Information Program 
for 65 persons in one of the 8 week series and 82 in the second series. 
This home economist also presents a 1 hour call-in radio program weekly 
on such topics as housing for seniors, estate planning, wills, 
nutrition etc.
    An Extension Specialist has updated and revised five publications 
for mature children of aging parents to increase their understanding of 
changing relationships, physical changes, emotional changes, mental 
changes, and dementia and Alzheimer disease. This specialist served as 
a resource person for a regional conference of the clergy who were 
developing a 5-year program for the elderly in their congregations.
    ``Preventing Foodborne Illness in Elderly Receiving Meal 
Assistance'' is a project that has been funded by Extension Service, 
USDA because foodborne illness is a widespread and expensive public 
health problem that is especially hazardous to the elderly. The staff 
at congregate sites receives minimal training in food safety 
principles, and many elderly individuals do not practice safe food 
handling at home. They propose to offer on-site education programs to 
the staff and recipients of congregate meals and home delivered meals, 
emphasizing fundamental food safety principles. They expect to see 
positive changes in knowledge and behavior as a result of the education 
intervention.
    An 1890 Extension home economists will conduct a Mini White House 
Conference on Aging Forum in which older African American Women will 
dialogue and make recommendations to the White House Conference on 
Aging.
                                michigan
    The AARP and Extension sponsored ``Women's Financial Information 
Program'' entered the distance learning arena when Michigan Cooperative 
Extension Service presented the seven-session program via satellite in 
March and April 1994. The audience: 32 participants in the campus 
studio classroom and almost 1,000 participants at 43 locations across 
the State. Each of the two-and-one-half hour sessions had three 
components; an introduction, a lecture with a question-and-answer 
period (questions were phoned in from downlink sites during a break) 
and small group discussions led by trained facilitators. One Michigan 
participant drove 124 miles round trip each week to attend the WFIP 
sessions. Another participant said, ``The satellite broadcasts give me 
the confidence to organize my finances.''
                                missouri
    Lincoln University.--Lincoln University Cooperative Extension was 
one of five Historically Black Colleges and Universities (HBCU's) 
selected to participate in the National Black Leadership Initiative on 
Cancer (NBLIC) Rural Intervention and Evaluation Program (RIEP). 
Lincoln joined four other (HBCU's) in this effort. NBLIC has provided 
an opportunity for Extension to expand its capacity to deliver 
culturally sensitive cancer education, prevention, and control programs 
for limited resource, older Black women and their families in rural 
Bootheel communities. One of the committee's major responsibilities is 
to maximize community participation and involvement in the NPLIC 
program. NBLIC served as the host for one of five press conferences 
held around the State on National Mammography Day.
    A knowledge, attitudes, and practices pilot survey was conducted in 
two Bootheel counties in order to gain a better understanding of rural 
Blacks' perceptions about cancer risks, prevention, and treatment and 
to obtain baseline data regarding the delivery of culturally 
appropriate public education and outreach activities designed to 
increase cancer survival rates. A women's breast cancer health pilot 
survey was conducted as part of the NBLIC outreach program. Both 
surveys confirmed national survey data that rural Blacks tend to accept 
common cancer myths more readily (i.e., birth control pills, X-rays, 
drinking coffee, and eating foods that contain fiber cause cancer), and 
that they have a more pessimistic attitude toward their chances of 
getting cancer. An assessment of responses indicates the following: the 
lack of knowledge, the lack of culturally appropriate data, and the 
lack of access to rural health services impede the development and 
implementation of successful cancer prevention and control programs. As 
a direct result of the success of the first two years of the NBLIC 
RIEP, Lincoln University Cooperative Extension has been awarded a 
$183,000 grant entitled, ``Cancer Screening Outreach Project for Older 
African American Women in Southeast Missouri (The Bootheel).'' This 
project has been funded as of November 1, 1994, by the Missouri 
Department of Health, Breast and Cervical Cancer Control Program (MDOH/
BCCCP). Under this grant Lincoln Cooperative Extension will: Plan and 
conduct a comprehensive outreach breast and cervical cancer 
intervention program for rural, low-income African American women, 50 
years of age and older, who live in the rural Southeast region of 
Missouri. The objective is to reduce the incidence, morbidity, and 
mortality of breast and cervical cancer among the target population.
    University of Missouri.--The Women's Financial Information Program 
(WFIP), a national program co-sponsored by AARP and the Extension 
System, has reached over 2000 Missouri women since the program started 
in 1990. WFIP covers the basic tools of financial literacy--from 
getting organized to investing for retirement. The seven part in-depth 
course includes lectures by experts as well as small group activities 
and independent assignments. Significant behavior changes have resulted 
in new or revised wills being made, financial records have been 
organized and open discussions around financial status and the future 
have occurred in the family unit. One 63-year-old participant learned 
that she did not have enough investments or capital for retirement; 
therefore, she converted a lifelong gardening hobby into a lawn care 
and gardening business employing three people to increase her retirment 
resources.
                                  ohio
    Wood County Extension involved 24 retirement village residents and 
fifth graders in an intergenerational pen-pal project. After months of 
corresponding the class visited the retirement village and met their 
pen pals. The program is on-going and students are changing their 
stereotypes of ``poor old people''. The pen-pal project was a pilot 
program of the Senior Series, a compilation of programs for older 
adults adapted from University of Missouri Extension resources. The 
Senior Series goal is to help Ohio's elderly residents improve their 
quality of life and share their experiences with other seniors and 
younger generations. Over 4,000 Ohio seniors in 19 counties have 
participated.
                                 nevada
    In collaboration with AARP and a variety of service and 
professional organizations, State and Area Resource Management 
Extension Specialists have presented the Women's Financial Information 
Program to six groups in five cities and towns in Nevada. The program 
is designed to empower participants to take control of their finances 
with confidence. The seven session series have been attended by more 
than 200 people in the past year and additional sessions are planned 
for 1995. A follow-up study of participants is in progress and will 
assess changes in financial management satisfaction with financial 
situation, and implementation of recommended financial practices (e.g., 
developing a spending plan, reviewing insurance coverage, setting up a 
financial record keeping system, etc.)
    With funding from the Nevada Division for Aging Services, faculty 
and staff from the University of Nevada, Reno are currently 
implementing the Nutrition Screening Initiative (NSI), a national 
effort to promote routine nutrition screening and improved nutritional 
care for the elderly. Efforts to date have included nutritional 
screening of over 2,000 elderly residents. Through educational efforts, 
dietitians also encouraged elders to take steps to improve their 
nutritional health. To complement these efforts, dietitians worked with 
other allied health professionals to enhance their knowledge and skill 
related to improving the nutritional health of their elderly patients. 
The next phase of this project will focus on enhancing elders' 
compliance and understanding of prescribed therapeutic (modified) 
diets.
                             north carolina
    N.C. A&T State University.--Forty-three Extension Agents across the 
State have received training on the Senior Wellness Series. The purpose 
of the Series is to provide information to help senior adults improve 
the quality of their physical and mental health, and strengthen their 
independence. Programming efforts are focused on enhancing self-care 
for the elderly. The programs deal with three important topics of 
interest to a large number of senior adults-(1) Food and Nutrition; (2) 
Elimination: Bowel and Bladder; (3) Using Medicines Wisely. A major 
emphasis for these outreach programs has been to reach the rural 
minority seniors. Networking with other organizations; having 
volunteers assist with transportation, and conducting programs at 
convenient locations such as nutrition meal sites have helped us to 
reach the targeted audience.
    Other group programs for senior citizens provide information on 
budgeting/money management, home/personal safety, estate planning and 
health insurance. Senior citizens also receive one-to-one assistance in 
budgeting and money management for those on fixed incomes. Volunteers 
receive training through the Senior Health Information Program to 
assist senior citizens with questions related to Medicare and Medicare 
Supplement policies and long-term care insurance.
    N.C. State University.--North Carolina is moving ahead in 
addressing the elder care information needs of aging and older adults 
and caregivers, with maintenance-level programs continuing on (1) elder 
care awareness, (2) planning ahead for elder care decisions, (3) 
volunteer information provider programs, and (4) training family 
caregiver programs. Over 16,000 older adults and elder care providers 
were involved.
    Networking among agencies to organize and conduct elder care 
programs have benefitted family caregivers, who report reduction of 
stress as a result of the information and emotional support they have 
received. These new partnerships have resulted in staffs understanding 
each other's programs better and in many counties they meet regularly 
to maintain better coordination among agencies. Five agents in 1993-94 
reported working with 229 members of their local aging networks, and 
many other agents reported such contacts without quantifying them. 
Extension involvement in interagency aging activities has been of value 
in many counties as they make the transition to the new way to fund 
county aging services through the Home and Community Care Block Grant 
(HCCBG). Of special note is Halifax County, where CES houses a county-
funded coordinator of aging services who monitors county use of 
$403,000 in HCCBG funds. Halifax and Northampton provide leadership for 
the annual Roanoke Valley Aging Conference, and the Unifour Counties 
this year organized an Older Families Forum, attended by 176, with 
requests that it be an annual event. A foundation funded NE Regional 
Elder Care Project is an exemplary program is which $10,000 per year (a 
3-year grant) has permitted the poorest region of the State to motivate 
professionals and volunteers to reach family caregivers with 
directories of aging services and provide emotional support to the 
people carrying out this major family responsibility.
    The Medicare Myths training for pre-retirement audiences was 
delivered in September 1994 in an attempt to reduce/avoid some of the 
financial and emotional problems of today's older adults, whose 
planning was based on misinformation. This packaged program is expected 
to reach many new audiences and to promote the use of Extension's 
interrelated financial management, elder care, estate planning, and 
retirement planning programs.

                      FARMERS HOME ADMINISTRATION

Title and purpose statement of each program or activity which affects 
        older Americans
    Currently FmHA has two programs that directly affect older 
Americans:
    Federal Domestic Assistance (FDA) Catalog Number 10.415 Rural 
Rental Housing (RRH) Loans empowers the agency authorized under the 
Housing Act of 1949, as amended, Section 515 and 521, Public Law 89-
117, 42 U.S.C. 1485, 1490a, to make RRH loans. The objectives of this 
program are to provide and construct rental and cooperative housing and 
related facilities suited for independent living for rural residents. 
Occupants must be low-to-moderate income families, and, in some cases, 
elderly (62 years or older) or disabled.
    Funds obligated for fiscal year 1994 for the 515 programs totaled 
$512,394,227.
    The second program, FDA 10.417 Very Low Income Housing Repair Loans 
and Grants (Section 504, Rural Housing Loans and Grants) is also 
authorized under the Housing Act of 1949, Title V, Section 504, as 
amended, Public Law 89-117, 89-754, and 92-310, 42 U.S.C. 1474. The 
objectives are to give very low-income rural homeowners an opportunity 
to make essential repairs to their homes to make them safe and to 
remove health hazards. Applicants must own and occupy a home in a rural 
area and be without sufficient income to qualify for a section 502 loan 
under the FmHA regular housing program. To be a grant recipient, the 
applicant must be 62 years of age.
    For fiscal year 1994, appropriations were (loans) $35,000,000; 
(grants) $25,000,000.

                    FOOD AND CONSUMER SERVICE (FCS)

Title and purpose statement of each program or activity which affects 
        older Americans
    The Food Stamp Program provides monthly benefits to help low-income 
families and individuals purchase a more nutritious diet. In fiscal 
year 1994 $22 billion in food stamps were provided to a monthly average 
of 27 million persons.
    Households with elderly members accounted for approximately 16 
percent of the total food stamp caseload. However, since these 
households were smaller on average and had relatively higher net 
income, they received only 6 percent of all benefits issued.
Brief description of accomplishments
    The Food and Consumer Service (FCS) continues to work closely with 
the Social Security Administration (SSA) in order to meet the 
legislative objectives of joint application processing for Supplemental 
Security Income households.
    In response to the recommendations of recent GAO audit report, FCS 
and SSA have formed a workgroup to address the failures and 
inadequacies of the current joint processing system. FCS published a 
Federal Register notice soliciting recommendations for joint processing 
improvements.
Title and purpose statement of each program or activity which affects 
        older Americans
    The Food Distribution Program for Charitable Institutions and 
Summer Camps provides commodities to nonprofit charitable institutions 
serving the needy. Eligible charitable institutions include non-penal, 
non-educational, nonprofit organizations such as homes for the elderly, 
congregate meals programs, hospitals and soup kitchens.
    It is thought that a large proportion of the beneficiaries of this 
program are elderly, but accurate estimates are not available.
Brief description of accomplishments
    In 1993, total distributions for the program were valued at about 
$90 million.
Title and purpose statement of each program or activity which affects 
        older Americans
    The Commodity Supplemental Food Program provides supplemental 
foods, in the form of commodities, and nutrition to infants and 
children up to age 6, pregnant, postpartum or breastfeeding women, and 
elderly who have low incomes and reside in approved project areas.
    Service to the elderly began in 1982 with pilot projects. In 1985, 
legislation allowed the participation of older Americans outside the 
pilot sites if available resources exceed those needed to serve women, 
infants and children. In fiscal year 1993, $30 million was spent on the 
elderly component.
Brief description of accomplishments
    About 33 percent of total program spending provides supplemental 
food to approximately 140,000 elderly participants a month. Older 
Americans are served by 18 of 20 State agencies.
Title and purpose statement of each program or activity which affects 
        older Americans
    The Food Distribution Program on Indian Reservations provides 
commodity packages to eligible households, including household with 
elderly persons, living on or near Indian reservations. Under this 
program, commodity assistance is provided in lieu of food stamps.
    Approximately $18 million of total costs went to households with at 
least one elderly person. (This figure was estimated using a 1990 study 
that found that approximately 39 percent of FDPIR households had at 
least one elderly individual.)
Brief description of accomplishments
    This program serves approximately 44,000 households with elderly 
participants per month.
Title and purpose statement of each program or activity which affects 
        older Americans
    The Child and Adult Care Food Program provides Federal funds to 
initiate, maintain, and expand nonprofit food service for children and 
elderly or impaired adults in nonresidential institutions which provide 
child or adult care. The program enables child and adult care 
institutions to integrate a nutritious food service with organized care 
services.
    The adult day care component permits adult day care centers to 
receive reimbursement of meals and supplements served to functionally 
impaired adults and to persons 60 years or older. An adult day care 
center is any public or private nonprofit organization or any 
proprietary Title XIX or Title XX center licensed or approved by 
Federal, State, or local authorities to provide nonresidential adult 
day care services to functionally impaired adults and persons 60 years 
or older. In fiscal year 1993, $18 million was spent on the adult day 
care component.
Brief description of accomplishments
    The adult day care component of CACFP served approximately 17 
million meals and supplements to over 36,000 participants a day.
    In 1993, the National Study of the Adult Component of CACFP was 
completed. Some of the major findings of the study include: overall, 
about 31 percent of all adult day care centers participate in CACFP; 
about 43 percent of centers eligible for the program participate. CACFP 
adult day care clients have low incomes; 84 percent have incomes of 
less than 130 percent of poverty. Many participants consume more than 
one reimbursable meal daily; CACFP meals contribute just under 50 
percent of a typical participant's total daily intake of most 
nutrients.
Title and purpose statement of each program or activity which affects 
        older Americans
    The Emergency Food Assistance Program (TEFAP) provides nutrition 
assistance in the form of commodities to emergency feeding 
organizations for distribution to low-income households for household 
consumption or for use in soup kitchens.
    Approximately $100 million in commodities were distributed to 
households including an elderly person. (This figure is estimated using 
a 1986 survey indicating that about 38 percent of TEFAP households have 
members 60 years of age or older.)
Brief description of accomplishments
    About 38 percent of the households receiving commodities under this 
program had at least one elderly individual.
Title and purpose statement of each program or activity which affects 
        older Americans
    The Nutrition Program for the Elderly (NPE) provides cash and 
commodities to States for distribution to local organizations that 
prepare meals served to elderly persons in congregate settings or 
delivered to their homes. The program promotes good health through 
nutrition assistance and by reducing the isolation of old age. USDA 
supplements the Department of Health and Human Services' Administration 
on Aging with approximately $152 million worth of cash and commodities.
Brief description of accomplishments
    In fiscal year 1993 over 245 million meals were reimbursed at a 
cost of almost $145 million. On an average day approximately 925,000 
meals were provided at over 14,000 sites.

               FOOD SAFETY AND INSPECTION SERVICE (FSIS)

Title and purpose statement of each program or activity which affects 
        older Americans
    FSIS is continuing a consumer education campaign targeted to older 
Americans, one of several groups of people who face special risks from 
food-borne illness. The goal is to reduce the incidence of food-borne 
illness caused by consumer mishandling of food. Food-borne illness can 
lead to serious health problems and even death for someone who is 
chronically ill or has a weakened immune system. The elderly, with more 
than 35 million people in their ranks, are the largest group at risk 
and are increasing in number because of longer life expectancies.
Brief description of accomplishments
    FSIS continues to distribute food safety information to this group 
through direct mail of publications and liaison work with the 
Administration on Aging.
    In addition, exhibits were presented and food safety information 
was distributed through the annual meeting of the American Society on 
Aging.

                             FOREST SERVICE

Title and purpose statement of each program or activity which affects 
        older Americans
    This program year, July 1, 1993-June 30, 1994, the USDA Forest 
Service's Senior Community Service Employment Program (SCSEP) provided 
an opportunity for 5,476 participants, age 55 years and above, to 
upgrade their work skills by receiving employment and training 
opportunities while providing community service to the general public.
    Volunteers continue to contribute to the management of the Nation's 
natural resources that are administered by the USDA Forest Service. 
During fiscal year 1994, 93,725 participants assisted in the management 
of the National Forest System, including 13,898 participants age 55 
years and above. Volunteers participate in resource protection and 
management, cooperative/international forestry, and research. Typical 
positions include campground host; information specialist; fire 
lookouts; and recreation, wildlife, and fisheries assistants.
Brief description of accomplishments
    As a result of this training, 703 of our participants received full 
or part-time employment.

                    RURAL DEVELOPMENT ADMINISTRATION

Title and purpose statement of each program or activity which affects 
        older Americans
    The Rural Development Administration's (RDA) Community Facilities 
program directly affects older Americans.
    Federal Domestic Assistance Catalog number 10.766, Community 
Facilities (CF) Loans, empowers the agency authorized under the 
Consolidated Farm and Rural Development Act, as amended, Section 306, 
Public Law 92-419, 7 U.S.C. 1926, to make CF loans. The objective of 
this program is to provide essential community services to rural 
residents. Loan funds can be used to construct new facilities. Under 
this program, RDA makes loans for the following type facilities that 
directly affect older Americans:
          Physicians and Dental Clinics
          Nursing Home
          Boarding Home for Elderly (Ambulatory Care)
          Hospital (General and Surgical)
          Outpatient Care
          Visiting Nurses (In Home Health Care)
          Rescue and Ambulance Service
          Senior Citizens Retirement Home
          Senior Citizens Community Center
          Adult Day Care Center
          Food Perpetration Center
          Public Transportation
    For the fiscal year ending September 30, 1994, RDA made Community 
Facility loans as follows:
          234 Direct Loans for $163,000,000
          40 Guaranteed Loans for $30,000,000
    Federal Domestic Assistance Catalog number 10.768, Business and 
Industrial (B&I) Loans, empowers the Agency authorized under the 
Consolidated Farm and Rural Development Act, as amended, Section 310B, 
Public Law 92-419, 7 U.S.C. 1932. The Rural Development Administration 
(RDA) B&I Loan Program provides guarantees on loans obtained through 
private lenders for business and industry located outside the boundary 
of a city of 50,000 or more and its immediately adjacent urbanized 
area. These loans are made for purposes of developing and financing 
business and industry, increasing employment and controlling pollution, 
or other facilities that directly affect older Americans.
          Hospitals
          Nursing Homes
          Doctor's Offices
          Physicians and Dental Clinics
          Outpatient Care Facilities
    For the fiscal year ending September 30, 1994, RDA made B&I loans 
as follows:
          106 Guaranteed Loans for $129,342,519.

                     ITEM 2. DEPARTMENT OF COMMERCE

                      ORGANIZATION OF THIS REPORT

    This report includes a listing of reports from the Census Bureau 
that contain demographic and socioeconomic information on the elderly 
population, and five sections describing other reports, papers, data 
bases, and continuing work from the Census Bureau relating to the 
elderly population 65 years and older. The following describes the 
contents of each component of the report.
    1. Listing of reports.--Provides a listing of the reports that 
contain data on the elderly population 65 years and over from the 
Current Population Reports series, the Current Housing Reports series, 
the International Population Reports series, and the Special Studies 
Reports series. The Current Population Reports series is an important 
source of demographic information on a wide variety of population-
related topics. Much of the current population data from the Census 
Bureau are derived from the Current Population Survey (CPS) and the 
Survey of Income and Program Participation (SIPP). The Current Housing 
Reports series presents housing data primarily from The American 
Housing Survey, a biennial national sample survey of approximately 
55,000 housing units. The International Population Reports series 
includes demographic and socioeconomic data reported by various 
national statistical offices, several agencies of the United Nations 
(UN), and the Organization for Economic Cooperation and Development. 
Most of the projected data come from data files of the Census Bureau. 
The Special Studies Reports series provides information pertaining to 
methods, concepts, or specialized data. The Census Bureau publishes 
reports on youth, women, the older population, and other topics in this 
series.
    2. Bureau of the Census Decennial Products and Projects.--Provides 
a summary of 1990 Census Printed Reports, Computer Tape Files, CD-ROMs, 
Summary Tape Files, Population Subject Summary Tape Files and Housing 
Subject Summary Tape Files that contain characteristics of persons 65 
years and over.
    3. Bureau of the Census International Research on Aging.--Provides 
a summary of analytical studies and other ongoing international aging 
projects. Reports are based on compilations of data obtained from 
individual country statistical offices, various international 
organizations, and estimates and projections prepared at the Census 
Bureau and included in the International Data Base on Aging.
    4. The Federal Interagency Forum on Aging-Related Statistics.--
Provides a summary of the activities of the Federal Interagency Forum 
on Aging-Related Statistics (The Forum) for which the Census Bureau is 
one of the lead agencies. The Forum encourages cooperation, analysis, 
and dissemination of data pertaining to the older population.
    5. Projects Between the Census Bureau and the Administration on 
Aging.--Provides a summary of projects between the Census Bureau and 
the Administration on Aging relating to the older population.
    6. Projects Between the Census Bureau and the National Institute on 
Aging.--Provides a summary of the projects between the Census Bureau 
and the National Institute on Aging relating to the older population.

         Bureau of the Census--Current Population Reports--1994

Series P-20 (Population Characteristics):                            No.
    Regularly recurring reports in this series contain data from 
      the Current Population Survey on geographical mobility, 
      fertility, school enrollment, educational attainment, 
      marital status, households and families, persons of Hispanic 
      origin, voter registration and participation, and various 
      other topics for the general population as well as the 
      elderly population 65 years and older.
    School Enrollment--Social and Economic Characteristics of 
      Students: October 1993......................................   479
    Marital Status and Living Arrangements: March 1993............   478
    Household and Family Characteristics: March 1993..............   477
    Educational Attainment in the United States: March 1993 and 
      1992........................................................   476
    The Hispanic Population in the United States: March 1993......   475
    School Enrollment--Social and Economic Characteristics of 
      Students: October 1992......................................   474
    Geographical Mobility: March 1991 to March 1992...............   473
    Residents of Farms and Rural Areas: 1991......................   472
    The Black Population in the United States: March 1992.........   471
    Fertility of American Women: June 1992........................   470
    Voting and Registration in the Election of November 1992......   466
    The Asian and Pacific Islanders Population in the United 
      States: March 1991 and 1990.................................   459
Series P-23 (Special Studies):
    Information pertaining to methods, concepts, or specialized 
      data is furnished in these publications. The reports in this 
      series contain data on mobility rates, homeownership rates, 
      and Hispanic population for the general population and the 
      older population. The report ``Sixty-Five Plus in America,'' 
      focuses on analyses of demographic, social and economic 
      trends among the older population.
    How We're Changing: Demographic State of the Nation: 1994.....   187
    Population Profile of the United States: 1993.................   185
    How We're Changing: Demographic State of the Nation: 1993.....   184
    Hispanic Americans Today......................................   183
    Households, Families, and Children: A 30-Year Perspective.....   181
    Sixty-Five Plus in America.................................... 178RV
    How We're Changing: Demographic State of the Nation: 1992.....   177
Series P-25 (Population Estimates and Projections):
    This series includes monthly estimates of the total United 
      States population, annual midyear estimates of the U.S. 
      population by age, sex, race, and Hispanic origin, and State 
      estimates by age and sex, and projections for the United 
      States and States.
    State Housing Unit and Household Estimates: April 1, 1980 to 
      July 1, 1993................................................  1123
    Projections of the Voting-Age Population for States: November 
      1994........................................................  1117
    Population Projections for States, by Age, Sex, Race, and 
      Hispanic Origin: 1993 to 2020...............................  1111
    State Population Estimates by Age and Sex: 1980 to 1992.......  1106
    Population Projections of the United States, by Age, Sex, 
      Race, and Hispanic Origin: 1993 to 2050.....................  1104
    U.S. Population Estimates, by Age, Sex, Race, and Hispanic 
      Origin: 1980 to 1991........................................  1095
    Projections of the Voting-Age Population, for States: November 
      1992........................................................  1085
Series P-60 (Consumer Income):
    This report presents data on the income and poverty status of 
      households, families, and persons in the United States for 
      the calendar year 1993. These data were derived from 
      information collected in the March 1994 Current Population 
      Survey.
    Income, Poverty, and Valuation of Noncash Benefits: 1993......   188
Series P-70 (Household Economic Studies):
    These data are from The Survey of Income and Program 
      Participation (SIPP) which is a national survey conducted by 
      the Census Bureau. Its principal purpose is to provide 
      better estimates of the economic situation of families and 
      individuals. These reports include data on the elderly 
      population 65 years and older.
    Dynamics of Economic Well Being: Poverty, 1990-1992...........    42
    Dynamics of Economic Well-Being: Program Participation, 1990-
      1992........................................................    41
    Dynamics of Economic Well-Being: Labor Force and Income, 1990-
      1992........................................................    40
    Dynamics of Economic Well-Being: Health Insurance, 1990-1992..    37
    Household Wealth and Asset Ownership: 1991....................    34
    Americans with Disabilities: 1991-1992........................    33
Statistical Briefs:
    The Earnings Ladder: Who's at the Bottom? Who's at the 
      Top?.................................................... SB/94-3RV
    Preparing for Retirement: Who Had Pension Coverage in 
      1991?...................................................   SB/93-6

                         Current Housing Reports

Series H-111:
    These reports provide statistics on occupied and vacant 
      housing units for the third quarter of 1994, 1993 and 
      selected years from 1960 to 1992. The statistics in this 
      report are based on data collected in two different sample 
      surveys conducted by the Census Bureau. Estimates and 
      characteristics of occupied and vacant housing units are 
      based on data obtained in the monthly Current Population 
      Survey/Housing Vacancy Survey (CPS/HVS).
    Housing Vacancies and Homeownership: Third Quarter, 1994...... 94/Q3
    Housing Vacancies and Homeownership: Annual Statistics: 1993..  93-A
Series H-121:                                                        No.
    These reports present data from the American Housing Survey. 
      Some characteristics shown in these reports include 
      socioeconomic status of household, physical condition of the 
      housing unit and affordability of housing in relation to 
      income.
    America's Racial and Ethnic Groups: Their Housing in the Early 
      Nineties....................................................  94-3
    Households at Risk: Their Housing Situation...................  94-2
    Tracking the American Dream: 50 Years of Housing History from 
      the Census Bureau: 1940 to 1990.............................  94-1
    Housing Characteristics of Rural Households: 1991.............  93-5
    Homeowners, Home Maintenance, and Home Improvements: 1991.....  93-4
    Who Can Afford to Buy a House in 1991?........................  93-3
    Our Nation's Housing in 1991..................................  92-2
    First Time Homeowners.........................................  93-1
Series H-123:
    This report includes housing related data from the Census 
      Bureau; the Bureau of Labor Statistics; the Federal Housing 
      Finance Board; and the National Association of Realtors. The 
      Census Bureau data were collected primarily from the 
      American Housing Survey, decennial census, and from current 
      construction statistics. This report describes selected 
      characteristics of the Nation's housing and its occupants, 
      housing costs, income of homeowners and renters and other 
      related topics.
    Housing in America: 1989/90...................................  91-1
Series H-150:
    This book presents data on apartments; single-family homes; 
      mobile homes; vacant housing units; age, sex, and race of 
      householders; income; housing and neighborhood quality; 
      housing costs; equipment and fuels; and size of housing 
      units. The book also presents data on homeowner's repairs 
      and mortgages, rent control, rent subsidies, previous unit 
      of recent mover, and reasons for moving.
    American Housing Survey of the United States in 1991..........    91
Series H-170:
    This book presents data for selected metropolitan statistical 
      areas for the same characteristics shown above in Series H-
      150.
    American Housing Survey for Selected Metropolitan 
      Statistical Areas (Eleven Metro Areas per year are 
      produced on a 4-year rotation for a total of 44 metro 
      areas)..................................................92- (MSA )

                    International Population Reports

Series P-95:
    The reports in this series contain demographic and 
      socioeconomic data on the older population as estimated or 
      projected by the Census Bureau or published by various 
      national statistical offices, several agencies of the United 
      Nations (UN), and the Organization for Economic Cooperation 
      and Development.
    Aging in Eastern Europe and the Former Soviet Union...........  93-1
    An Aging World II.............................................  92-3
    Population and Health Transitions.............................  92-2
    Aging in the Third World......................................    79
    An Aging World................................................    78

Wallchart: ``Global Aging Comparative Indicators and Future 
  Trends'' was issued in September 1991. The statistics shown in 
  the wall chart are based largely on information from the 
  International Data Base on Aging. The multicolored chart 
  includes demographic and social statistics for 100 countries. It 
  also features tables and graphs that highlight important 
  research topics in the field of aging.

                             Special Series

Profiles of America's Elderly:
    Growth of America's Elderly in the 1980's (Number 1)
    Growth of America's Oldest-Old Population (Number 2)
    Racial and Ethnic Diversity of America's Elderly Population 
      (Number 3)..................................................  93-1
    Living Arrangements of the Elderly (Number 4).................  93-2

Wallchart: ``Elderly in the United States'' was issued in 
  September 1992. The statistics shown in the wall chart are 
  intended to highlight dimensions of aging in American states. 
  Data are primarily from the 1990 Census of Population. 
  Projections for the United States and States are from Series A 
  issued in 1990 and are available through 2010.

         OTHER REPORTS, PAPERS, DATA BASES, AND CONTINUING WORK

        I. Bureau of the Census Decennial Products and Projects

                     a. 1990 census printed reports
    The Census Bureau released 1990 Census of Population, General 
Population Characteristics (CP-1) and General Housing Characteristics 
(CH-1). These volumes contain demographic data and basic housing data 
collected from all households and group quarters. There is an 
individual report for each State, a summary volume for the United 
States, a summary report for metropolitan areas, a separate summary 
report for urbanized areas, and data for individual areas below the 
state level.
    The General Population Characteristics report includes an age 
distribution to ``105 years and over'' by sex, race, and Hispanic 
origin; household and group quarters population; marital status; and 
household relationships. The General Housing Characteristics reports 
have information on age of householders. Data are available for 
households with elderly householders on the number of one-person 
households, persons per room, tenure, value and rent, number of units 
in structure, and whether meals are included in rent.
    The Census Bureau released reports containing social and economic 
information from a sample of households and persons in group quarters. 
One report, Social and Economic Characteristics (1990 CP-2), contains 
information on language, educational attainment, living arrangements, 
labor force status, and income and poverty status in 1989 by age. The 
Detailed Housing Characteristics (1990 CH-2), reports have information 
for householders 65 years and over in occupied housing units by 
selected characteristics (for example, mean household income in (1989) 
dollars, one-person households, lacking complete plumbing, and no 
telephone in unit).
    The Population and Housing Characteristics for Census Tracts and 
Block Numbering Areas (1990 CPH-3) report includes an age distribution 
to ``85 years and over'' by sex; and household type and group quarters 
information for persons ``65 years and over.'' The report also contains 
data on disability, poverty status in 1989, and selected housing 
characteristics for occupied housing units with a householder 65 years 
and over by race and Hispanic origin in selected census tracts/BNAs.
    The Population and Housing Characteristics for Congressional 
Districts of the 103rd Congress (1990 CPH-4) report includes an age 
distribution to ``85 years and over'' by sex; household type and 
relationship; and householder 65 years and over living alone. The 
report also provides information for persons 65 years and over on 
disability, poverty status by race, and Hispanic origin, and the number 
of civilian veterans. Poverty data also are shown for persons 75 years 
and over. Selected housing characteristics are shown for occupied 
housing units with a householder 65 years and older.
    The Census Bureau released six population subject reports that 
contain data on the older population. These reports include The 
Foreign-Born Population in the United States (1990 CP-31); Ancestry of 
the Population in the United States (1990 CP-3-2); and Persons of 
Hispanic Origin in the United States (1990 CP-3-3); Education in the 
U.S. (1990 CP-3-4); Asians and Pacific Islanders in the United States 
(1990 CP-3-5); Characteristics of American Indians by Tribe and 
Language (1990 CP-3-7). The Census Bureau also released the housing 
subject report, Metropolitan Housing Characteristics, which contains 
data on the older population.
    The Census Bureau issued tabulations from the 1990 census on the 
nursing home population. The report, Nursing Home Population: 1990 
(CPH-L-137), provides state-by-state information on the nursing home 
population, by age, sex, and marital status. Do You Know Which 1990 
Products Contain Data on the Older Populations? describes how census 
data are obtained, how age is defined, and which census products show 
information on the older population. We, the American Elderly uses data 
from the 1990 census to profile the Nation's older population.

                   B. Computer Tape Files and CD-ROMs

Public-Use Microdata Samples (PUMS)
    The Census Bureau released the 5-percent and 1-percent Public-Use 
Microdata Samples (PUMS) for the 1990 census. These PUMS files show 
most population and housing characteristics. The PUMS files are 
available for the Nation, each State, the District of Columbia, and 
Puerto Rico.
The Public-Use Microdata Sample on the Older Population (PUMSO)
    The Census Bureau released the 3-percent elderly PUMSO file. The 
file contains data for all household members in households occupied by 
a person 60 years and over. The file provides data users the capability 
to produce their own tabulations not available in general-purpose 
census data products. Data users also have the capability to analyze 
data on the older population, including the very old (85 years and 
over) such as living arrangements, income in 1989, and sources of 
household income from which older members may benefit.
    The Census Bureau also released the 10-percent samples for Guam and 
the U.S. Virgin Islands. The 5-percent sample for the United States is 
available on CD-ROM.
    The PUMS and PUMSO files for the United States may be combined to 
obtain a larger sample of elderly records.
Summary Tape Files
    The Census Bureau released four main data files on computer tape 
form the 1990 census. These are Summary Tape Files (STFs) 1, 2, 3, and 
4. STF 1 and STF 2 contain complete-count data, and STF 3 and STF 4 
contain sample data (``long-form'' data collected from about 1 in 6 
households).
    STF 1 and STF 3 data are also available on CD-ROM for those who use 
microcomputers. Software for finding the data is included with each CD-
ROM; the software (called ``GO'') is menu-driven and user-friendly.
Population Subject Summary Tape Files
Characteristics of Adults With Work Disabilities, Mobility Limitations, 
        or Self-Care Limitations (SSTF) 4
    This file contains both 100-percent and sample data for the United 
States, States, the District of Columbia, counties with 50,000 or more 
persons, and Metropolitan Statistical Areas with 250,000 or more 
persons. The B Record of the file has 70 population tables. This record 
presents data for civilian noninstitutionalized persons 16 years and 
over with work disabilities and without work disabilities. Some of the 
characteristics shown in this file include age, educational attainment, 
group quarters, Hispanic origin, household type and relationship, 
income in 1989, tenure, race, ratio of income in 1989 to poverty level, 
units in structure, vehicles available, and veteran status. Age as 
presented in this file has an upper category of 75 years and over in 
most tables.
Education in the United States (SSTF) 6
    This file contains population items for the United States, States, 
and the District of Columbia. Two tables in this file provide data on 
the older population. Educational attainment data are shown by sex and 
age (upper category of 85 years and over). The School Enrollment table 
includes an age distribution to ``75 years and over'' by type of school 
and sex.
Employment Status, Work Experience, and Veteran Status (SSTF) 12
    This file contains both 100-percent and sample data for the United 
States, States, the District of Columbia and each metropolitan area. 
The population items include age, class of worker, educational 
attainment, employment status, group quarters, household type and 
relationship, income in 1989, marital status, occupation, period of 
military service, residence in 1989, school enrollment, sex, veteran 
status, work status in 1989, and year last worked. Age as presented in 
this file has an upper category of 75 years and over or 85 years and 
over.
Fertility (SSTF) 16
    This file contains both 100-percent and sample data for the United 
States, States, and the District of Columbia. The population items 
include children ever born, children ever born per 1,000 women, 
citizenship, educational attainment, employment status, Hispanic 
origin, income in 1989, marital status, place of birth, poverty status 
in 1989, school enrollment, type of residence, and year of entry to the 
United States. Age as presented in this file has an upper category of 
75 years and over.
Journey to Work in the United States (SSTF) 20
    This file includes summary characteristics of economic, social, and 
housing data for the United States; metropolitan areas, central cities, 
and balance of metropolitan areas in the aggregate; nonmetropolitan 
areas in the aggregate; individual metropolitan areas, central cities 
and balance of each metropolitan area. Characteristics related to 
journey-to-work include place of work, means of transportation to work, 
travel time to work, time leaving home to go to work, and private 
vehicle occupancy for workers 16 years and over. Age as presented in 
this file has an upper category of 75 years and over.
Earnings by Education and Occupation (SSTF) 22
    This file contains earnings by education and occupation for the 
United States, States and the District of Columbia, and metropolitan 
statistical areas of 500,000 or more population. Earnings for detailed 
occupations are shown by age, sex, and education. Earnings for 
occupation groups are shown by race, age, education.
Housing Subject Summary Tape Files
Housing of the Elderly (SSTF) 8
    This file contains both 100-percent and sample data housing items 
for the United States, States and District of Columbia, inside and 
outside metropolitan areas, and Metropolitan Statistical Areas. Housing 
data are given by age of householder. The most detailed age groups show 
5-year age groups from ``60 to 64'' years of age up to ``90 years of 
age or older.'' The file also provides housing data for persons 60 
years of age or older who live in a housing unit with a householder who 
is under 60 years of age. Housing characteristics are repeated by race, 
Hispanic origin, and household type. Data by household income are 
incorporated in some of the tables, particularly ones for financial 
characteristics such as housing costs.
Housing Characteristics of New Units (SSTF) 9
    This file contains characteristics of persons by age living in new 
housing units. Data are available for the United States, regions, 
States, all metropolitan areas (MA), and central cities within the MAs.
Mobile Homes (SSTF) 10
    This file contains data on persons by age living in mobile homes. 
Data are available for the United States, regions, States, all MAs, and 
central cities within the MAs.
Condominium Housing Units (SSTF) 18
    This file contains data on persons by age living in condominium 
housing units. Data are available for the United States, regions, 
States, all MAs, and central cities within the MAs.

        II. Bureau of the Census International Research on Aging

          a. studies from the international data base on aging
    1. A brief article on ``An Aging World Population'' (by Kevin 
Kinsella) appeared in the bimonthly World Health Organization magazine 
``World Health'' (July-August 1994).
    2. A chapter discussing the demography of aging worldwide was 
prepared for publication in a forthcoming 1995 British Medical Journal 
volume entitled ``Epidemiology of Old Age.''
    3. The Census Bureau updated the 1987 publication, ``An Aging 
World.'' The new report, ``An Aging World II'', Series P95/92-3 was 
issued in February 1993, and assesses demographic, social, economic, 
and health trends from recent population censuses and surveys. The 
report also emphasizes a number of additional topics: the oldest old; 
aging in Eastern Europe; health and disability-free life expectancy; 
and institutionalization and other living arrangements.
    4. The Census Bureau released in November 1993, ``Aging in Eastern 
Europe and the Former Soviet Union'', Series P95/93-1. The report 
includes topics on basic demographic trends, health status, and various 
socioeconomic dimensions of the elderly in this region of the world.
    5. The Census Bureau completed updates in 1994 for the original 42 
countries in the International Data Base on Aging, and added 43 
countries to the data base. Additional countries are being incorporated 
on a flow basis (1994).
    6. An updated version of the paper, ``Living Arrangements of the 
Elderly and Social Policy: A Cross-National Perspective,'' by Kevin 
Kinsella of the Census Bureau was published in the proceedings of the 
International Conference on Population Aging in San Diego, September 
17-19, 1992. The paper examines family and household structure, changes 
over time, and potential implications for social support and 
expenditures.
    7. A revised version of an earlier Census Bureau report entitled 
``Population Aging in Southern Africa'' was prepared for the National 
Institute on Aging in June 1994.
    8. A paper on ``The Demography of Aging: Essentials of Short-Term 
Training'' was prepared by Kevin Kinsella for the International 
Institute on Aging Expert Group Meeting on Short-Term Training in the 
Demographic Aspect of Population Aging and its Implications for 
Socioeconomic Development, Policies and Plans, held in Malta in 
December 1993.
    9. ``Aging and the Family: Present and Future Demographic Issues'' 
is a chapter by Kevin Kinsella in the forthcoming ``Handbook on Aging 
and the Family'', to be published by Greenwood Press in January 1995. 
The chapter considers the effects of reduced fertility, lengthening 
life expectancy, the epidemiologic transition, and altered living 
arrangements on family and household structures.
    10. ``China's Aging Population: Implications in Rural and Urban 
Areas,'' a paper by Christina Harbaugh and Judith Banister, was 
presented at the annual meeting of the Association of Asian Studies in 
Los Angeles in March 1993.
    11. The Census Bureau issued in December 1992, ``Population and 
Health Transitions'', Series P95/92-2. This report looks at aspects of 
the demographic and epidemiologic transitions in Eastern Europe and the 
developing world, and discusses several implications for health policy. 
An excerpt of this report was presented at the United Nations Expert 
Group Meeting on Population Growth and Demographic Structure in Paris, 
November 16-20, 1992.
    12. ``Population Aging in Africa: The Case of Zimbabwe'' appeared 
in ``Changing Population Age Structures. Demographic and Economic 
Consequences and Implications'', published by the United Nations 
Economic Commission for Europe (Geneva) in 1992. Kevin Kinsella is the 
author.
    13. A chapter entitled ``Dimensiones demograficas y de salud en 
America Latina y el Caribe'' (Demographic and health dimensions in 
Latin America and the Caribbean), by Kevin Kinsella, was included in a 
1994 Pan American Health Organization volume ``La atencion de los 
ancianos: undesafio para los anos noventa'' (Scientific Publication No. 
546). This chapter examines demographic and socioeconomic 
characteristics of the elderly in developing countries of the Western 
Hemisphere.
    14. ``Research on the Demography of Aging in Developing 
Countries,'' by Kevin Kinsella of the Census Bureau, and Linda Martin 
of the National Academy of Sciences, was presented at the Workshop on 
the Demography of Aging, Committee on Population, National Academy of 
Sciences, Washington, DC, December 10-11, 1992, and subsequently was 
published as a chapter in Demography of Aging (National Academy Press, 
1994).
    15. The ``Journal of Cross-Cultural Gerontology'' began in 1992 to 
include an ``Aging Trends'' report in each of its issues. Reports 
appearing in 1994 included Indonesia (by Arjun Adlakha and David 
Rudolph of the Census Bureau), Southern Africa (by Yvonne Gist of the 
Census Bureau), and Taiwan (by Rose Li of the National Institute on 
Aging).
    16. ``Demographic Dimension of Population Aging in Developing 
Countries,'' by Kevin Kinsella of the Census Bureau and Richard Suzman 
of the National Institute on Aging, is an article in the ``Journal of 
Human Biology'', Vol. 4, pages 3-8, 1992. In this article, several 
demographic aspects of population aging in developing countries are 
considered: the oldest old, median population age; life expectancy and 
mortality; functional status and disability, and sex differences. While 
our understanding of the demographic impact of population aging is 
becoming better appreciated, research on the descriptive epidemiology 
of age-related changes in health and physical functioning in developing 
countries is still at an early stage.
    17. ``Population Dynamics of the United States and the Soviet 
Union'' was prepared by Barbara Boyle Torrey and W. Ward Kingkade of 
the Census Bureau for the United Nations Seminar on Demographic and 
Economic Consequences and Implications of Changing Population Age 
Structures in Ottawa, September 1990. This paper was also published in 
the journal ``Science,'' March 30, 1990, Volume 247.
    18. ``Changes in Life Expectancy--1900 to 1990'' was prepared by 
Kevin Kinsella of the Census Bureau for presentation at an 
International Conference on Aging: Nutrition and the Quality of Life in 
Marbella, Spain, and later published in the American Journal of 
Clinical Nutrition (Vol. 55, 1992). The paper summarizes levels of and 
changes in life expectancy at birth and at older ages in industrialized 
countries during the 20th century. Trends in mortality and morbidity 
are summarized in the context of the historic epidemiological 
transition from infectious to chronic diseases. Cause-specific 
mortality and decomposition of life expectancy into active and inactive 
components are examined. There is also an initial attempt to correlate 
life expectancy with physical attributes that may reflect differences 
in nutrition.
    19. ``Demography of Older Populations in Developed Countries'' was 
published as a chapter in the Oxford Textbook of Geriatric Medicine in 
1992. Richard Suzman of the National Institute on Aging, Kevin Kinsella 
of the Census Bureau, and George C. Myers of Duke University are the 
authors. The chapter explores differences and similarities in the aging 
process and among the elderly populations of 34 industrialized nations. 
The chapter reviews past and projected trajectories of the growth of 
older populations, socioeconomic characteristics, and current and 
expected health status.
    20. ``The Paradox of the Oldest Old in the United States: An 
International Comparison'' was published as a chapter in ``The Oldest 
Old'', ed. by Richard Suzman, David Willis, and Kenneth Martin, Oxford 
University Press publication, 1992. Barbara Boyle Torrey and Kevin 
Kinsella of the Census Bureau and George C. Myers of Duke University 
are the authors. The paper focuses on demographic trends, marital 
status and living arrangements, and income, related to the oldest old 
(80+) in eight countries. Data are shown from 1985 to 2025.
    21. ``Suicide at Older Ages--An International Enigma'' was prepared 
by Kevin Kinsella of the Census Bureau for presentation at the 
Gerontological Society of America Meeting, November 1991. This paper 
examines suicide rates in the United States compared with those in 20 
industrialized countries. He used data from World Health Organization 
files from 1965 through 1989.
    22. A software version of the International Data Base on Aging was 
created for use on microcomputers and is being distributed by the 
Interuniversity Consortium for Political and Social Research at the 
University of Michigan.
    23. A wall chart on Global Aging was prepared by the Census Bureau 
for distribution in September 1991. It is based largely on information 
from the International Data Base on Aging. The multicolored chart 
includes demographic and social statistics for 100 countries. It also 
features tables and graphs that highlight important research topics in 
the field of aging.
    24. ``A Comparative Study of the Economics of the Aged'' was 
presented at the Conference on Aged Populations and the Gray Revolution 
in Louvain, Belgium in 1986. Barbara Boyle Torrey and Kevin Kinsella of 
the Census Bureau and Timothy Smeeding of Vanderbilt University are the 
authors. The paper presents estimates of how social insurance programs 
for the elderly have grown as a percentage of gross domestic product in 
several countries partly as a result of lowering retirement age and an 
increase in real benefits. It then discusses how the labor force 
participation of the elderly in these countries has uniformly declined. 
Finally, it examines what contribution the Social Security benefit 
makes to the total income of the elderly and how the average income of 
the elderly compares with the average national income in each country.
    25. ``Aging in Eastern Europe and the Former Soviet Union'' was 
published in ``International Population Reports'', Series P-95, No. 93-
1 (1993).
    26. ``An Aging World II'' was published in ``International 
Population Reports'', Series P-95, No. 92-3 (1993).
    27. ``Population and Health Transitions'' was published in 
``International Population Reports'', Series P-95, No. 92-2 (1992).
    28. ``Aging in the Third World'' was published in ``International 
Population Reports'', Series P-95, No. 79 (1988).
    29. ``An Aging World'' was published in ``International Population 
Reports'', series P-95, No. 78 (1987).
    30. The Director of the Census Bureau serves as one of the 
Commissioners for the U.S.-Japan Joint Commission on Aging.
    31. Staff of the International Programs Center assisted in the 
design, provision of materials for, and teaching of a short-term 
training course on the Demography of Aging, sponsored by the United 
Nations International Institute on Aging and held in Malta in November/
December 1994.

     III. The Federal Interagency Forum on Aging-Related Statistics

    The Census Bureau is one of the lead agencies in The Federal 
Interagency Forum on Aging-Related Statistics (The Forum), a first-of-
its-kind effort. The Forum encourages cooperation among Federal 
agencies in the development, collection, analysis, and dissemination of 
data pertaining to the older population. Through cooperation and 
coordinated approaches, The Forum extends the use of limited resources 
among agencies through joint problem solving, identification of data 
gaps, and improvement of the statistical information bases on the older 
population that are used to set the priorities of the work of 
individual agencies. The participants are appointed by the directors of 
the agencies and have broad policymaking authority within the agency. 
Senior subject-matter specialists from the agencies are also involved 
in the activities of The Forum. The Forum was cochaired in 1994 by 
Harry A. Scarr, Deputy Director, Bureau of the Census; Manning 
Feinleib, Director, National Center for Health Statistics; and Richard 
J. Hodes, Director, National Institute on Aging.
    At the initial meeting of The Forum held October 24, 1986, it was 
agreed that The Forum would work on the following activities: (1) 
identify data gaps, potential research topics, and inconsistencies 
among agencies in the collection and presentation of data related to 
the older population; (2) create opportunities for joint research and 
publications among agencies; (3) improve access to data on the older 
population; (4) identify statistical and methodological problems in the 
collection of data on the older population and investigate questions of 
data quality; and (5) work with other countries to promote consistency 
in definitions and presentation of data on the older population.
    The work of The Forum facilitates the exchange of information about 
needs at the time new data are being developed or changes are being 
made in existing data systems. It also promotes communication between 
data producers and policymakers.
    As part of The Forum's work to improve access to data on the older 
population, the Census Bureau publishes a newsletter, ``Data Base News 
in Aging'', which brings news of recent developments in data bases of 
interest to researchers and others in the field of aging. All Federal 
agencies are invited to contribute to the newsletter, which is issued 
periodically.
    The Census Bureau released ``Federal Forum Report 1989-90'' (March 
of 1992). It reviews the activities of the Forum and its member 
agencies during 1989-1990. We expect to release the ``Federal Forum 
Report 1991-1993'' in early 1995. Various sections of the report 
summarize Forum work and accomplishments, cooperative efforts of 
members, publications by member agencies, and activities planned for 
the near future. An interagency telephone contact list of specialists 
on subjects related to aging is also included.
    Census Bureau staff cochair the Working Group on Data on Minority 
Aging. The group is making an inventory of Federal and other large data 
sets to identify the extent to which data are available on minority 
groups in the older population. Census Bureau staff also cochair the 
Working Group on Administrative Data on Aging. This group is 
identifying and evaluating some of the administrative data that could 
be used to develop demographic estimates of the elderly.

 IV. Projects Between the Census Bureau and the Administration on Aging

    From the 1990 Census of Population and Housing, the Census Bureau 
produced a special tabulation of 1990 census data on older Americans. 
This file is titled ``The 1990 Census of Population and Housing Special 
Tabulation on Aging (STP 14). The file contains data on ability to 
speak English, mobility and self-care limitations, marital status, 
living arrangements, earnings, educational attainment, employment 
status, poverty status, veteran status, condo status, meals included in 
rent, mortgage status, year householder moved into unit, and so forth. 
Most tables are for persons 60 and over, 65 and over, 75 and over, and 
85 and over. There is an ``A'' file for each state and a ``C'' file 
with U.S. data. The file is available on computer tape or on CD-ROM 
from Customer Services, Census Bureau, 301-457-4100.
    From the 1990 census, the Census Bureau produced special 
tabulations particularly useful to local Area Agencies on Aging for 
administering programs under the Older Americans Act. The Census Bureau 
prepared a 1990 census public-use microdata file on the older 
population (PUMSO) with individual questionnaire information (to 
protect respondents' confidentiality, the records contain no 
identifying information) for 3 percent of persons aged 60 and over and 
members of their households.

  V. Projects Between the Census Bureau and the National Institute on 
                                 Aging

    A. The Census Bureau published an updated version of the report 
titled, ``Sixty-Five Plus in America'', Series P-23, No. 178RV. This 
report is a chartbook and analysis of demographic, social, and economic 
trends among the older population. The data used in this report are 
primarily from the 1990 Census of Population and Housing and national 
surveys such as the Current Population Survey, the Survey of Income and 
Program Participation (SIPP), the Health Interview Survey, and the 
Longitudinal Survey on Aging. This reports summarizes numerous reports 
prepared by statisticians from the Census Bureau and other Federal 
agencies with information about the elderly. This report expands on 
information in ``Diversity: the Dramatic Reality'' by Cynthia M. 
Taueber, Chapter 1 of ``Diversity in Aging'' Scott A. Bass, Elizabeth 
A. Kutza, Fernando M. Torres-Gil, eds. (Glenview, IL, Scott, Foresman 
and Co., 1990).
    B. The Census Bureau published a wall chart, ``Elderly in the 
United States .'' This wall chart was produced by Cynthia Taeuber and 
Barry Ocker with the support of the Office of the Demography of Aging 
of the National Institutes on Aging. The statistics shown in the wall 
chart are intended to highlight dimensions of aging in American states. 
Data are primarily from the 1990 Census of Population. Projections for 
the United States and states are from Series A issued in 1990 and are 
available only through 2010.
    C. The Census Bureau published the first four of a series of 
``Profiles of America's Elderly.'' They are: ``Growth of America's 
Elderly in the 1980's''; ``Growth of America's Oldest-Old Population''; 
``Racial and Ethnic Diversity of America's Elderly Population (93-1)''; 
and ``Living Arrangements of the Elderly (93-2).'' These profiles 
include demographic, social, and economic trends among the elderly as 
well as topics on demographic changes during the 1980's. Additional 
profiles will be published in this series (for example, one on 
centenarians).
    D. ``The 1990 Census and the Older Population: Data for 
Researchers, Planners, and Practitioners,'' by Cynthia M. Taeuber and 
Arnold A. Goldstein, summarizes the availability of 1990 census data on 
topics of interest to researchers on the older population.
    E. The Census Bureau developed an international data base on the 
older population. The University of Michigan archives this data base 
(Nancy Fultz, 313-763-5010).
    F. Cynthia M. Taeuber wrote a chapter on the quality of census data 
on the elderly that includes an evaluation of coverage, age 
misreporting, estimates, and projections of centenarians, and so forth. 
It is ``Types and Quality of Data Available on the Elderly in the 1990 
Census,'' in ``Epidemiology Study of the Elderly'', ed. Robert B. 
Wallace, New York: Oxford University Press, 1992.
    G. The Census Bureau prepared a file from the SIPP on the health, 
wealth, and economic status of the older population. The SIPP file is 
archived at the University of Michigan (Nancy Fultz, 313-763-5010).
    H. Cynthia M. Taeuber (with Jessie Allen) wrote ``Women in our 
Aging Society: The Demographic Outlook,'' in ``Women in the Frontline: 
Meeting the Challenge of an Aging America'', ed. Alan Pifer and Jessie 
Allen, Washington, DC: The Urban Institute Press, 1993. The chapter 
looks at the demographics of population aging and its present and 
future intersection with various aspects of the experience of American 
women.
    I. Cynthia M. Taeuber wrote ``Women in our Aging Society: Golden 
Years or Increased Dependency'' in ``USA Today'' (1993). The article 
discusses the diversity of the Nation's female elderly population and 
how the experiences of younger women may affect them as they age.
    J. ``A Demographic Portrait of America's Oldest Old'' was prepared 
by Cynthia M. Taeuber, Bureau of the Census, and Ira Rosenwaike, 
University of Pennsylvania, in ``The Oldest Old,'' ed. by Richard 
Suzman and David Willis, Oxford University Press, 1992. This chapter 
looks at the rapid growth of the oldest old population, those 85 years 
and over and the reasons for that growth. This chapter also: (1) 
compares the oldest old's demographic, social, and economic 
characteristics with those of the younger old; (2) describes the 
characteristics of the centenarian population; (3) examines the quality 
of census data on the oldest old; and (4) discusses the implications of 
the growth and characteristics of this unique and important group.
    K. The Census Bureau reprogrammed the regularly published 
tabulations of the Current Population Survey to include data for the 
population ``65 to 74 years'' and ``75 years and over'' in annual 
reports (see especially P-20, Nos. 461 and 458, P-60, Nos. 181 and 
180). The report on marital status includes data for the population 85 
years and over.
    L. The Census Bureau prepared a paper on ``Emerging Data Needs for 
the Elderly Population in the 21st Century,'' for public discussion of 
the census of 2000.
    M. Nampeo McKenney and Cynthia M. Taeuber prepared a paper on 
``Coverage Improvement and Sampling Strategies in Censuses and Surveys: 
Improving Data on Minority Elderly,'' for the 1993 Conference of The 
Gerontological Society of America.

                     ITEM 3. DEPARTMENT OF DEFENSE

            DEPARTMENT OF DEFENSE 1994 ELDERCARE INITIATIVES

    The Department of Defense has undertaken several initiatives in 
support of the elderly during this past year. This is part of a 
continuum of efforts over the past years to bring eldercare resources 
and assistance to members, families, and eligible beneficiaries.

                                Research

    In order to obtain a clearer understanding of the scope of 
eldercare responsibilities within the military, several questions were 
included in a comprehensive survey of military personnel and spouses in 
late 1992. The survey was completed this past year and provided some 
important information. The survey showed that 10,720 military personnel 
had elderly dependents. That is, the elderly person resided with the 
military member and the member was responsible for over one-half of the 
elderly person's support. Survey respondents were also queried about 
other responsibilities for elderly relatives. This included those who 
had some type of responsibility for an elderly person, but he elderly 
person did not live with the member. Nine percent of the force 
(n=160,899) indicated that they had responsibilities in this category. 
In most cases, this means long-distance care on the part of the 
military member/family.
    A follow-on survey is planned to track those respondents responding 
in the affirmative to the eldercare questions from the 1992 survey. 
This survey will attempt to identify those resources military members 
and families may need in order to attend better to their eldercare 
responsibilities. As with other family responsibilities, eldercare is a 
readiness issue. Worries and concerns about eldercare impact personnel 
readiness, job performance, and retention. In order to meet this 
growing need, the Department has undertaken several initiatives.

                               Resources

    The Family Support Coordinating Subcommittee recently approved the 
WISE Workplace Information Seminars on Eldercare. These seminars, which 
will be conducted at the installation level, provide a wide range of 
valuable information on eldercare. Seminar topics include community 
resources, living arrangements options, caregiver burnout, financial 
concerns, legal safeguards and long-distance caregiving. The seminars 
are designed to enable caregivers and potential caregivers to deal with 
the numerous and complex issues of eldercare. This kind of information 
is particularly valuable for military families who, normally, are 
geographically separated from aging parents and family members. At the 
installation level, the seminars can be provided by Family Center 
staff, chaplains, and civilian personnel offices.
    The delivery of eldercare seminars is the logical next step of 
previous Departmental efforts to expand the information and resources 
available for Departmental personnel. Previous resources disseminated 
worldwide include the ``DoD Eldercare Handbook,'' ``Eldercare Guide for 
Professionals,'' and a ``Caregiver's Guide.''

                              Health Care

    The Department of Defense has begun its implementation of its new 
regionally managed care program for members of the uniformed services 
and their families, and survivors and retired members and their 
families. Retirees and their families will find that this new program 
will increase their access to high quality health care.
    TRICARE introduces to beneficiaries three choices for their health 
care delivery; TRICARE Standard, a fee-for-service option which is the 
same as standard CHAMPUS; TRICARE Extra, which offers preferred 
provider option with discounts; and TRICARE Prime, an enrolled health 
maintenance organization (HMO) option. All active-duty members will be 
enrolled in TRICARE Prime. Those CHAMPUS-eligible beneficiaries who 
elect not to enroll in TRICARE Prime, and Medicare-eligible DoD 
beneficiaries will remain eligible for care in military medical 
facilities on a space-available basis.
    TRICARE Standard.--This option is the same as the standard CHAMPUS 
program.
    TRICARE Extra.--In the TRICARE Extra program, when a CHAMPUS-
eligible beneficiary uses a preferred network provider, he/she receives 
an out-of-pocket discount and usually does not have to file any claim 
forms. CHAMPUS beneficiaries do not enroll in TRICARE Extra, but may 
participate in Extra on a case-by-case basis just by using the network 
providers.
    TRICARE Prime.--This voluntary enrollment option offers patients 
the advantages of managed health care, such as primary care manager, 
assistance in making specialty appointments, and someone else to do 
their claims filing. The Prime option offers the scope of coverage 
available today under CHAMPUS, plus additional preventive and primary 
care services. For Prime enrollees, the new cost sharing provisions do 
away with the usual standard CHAMPUS cost sharing. Of particular note, 
families of active duty personnel will have no enrollment fees. 
CHAMPUS-eligible retirees who enroll in Prime will pay an enrollment 
fee, but will pay only $11 per day for civilian inpatient care in 
comparison to the $323 per day plus 25 percent of professional fees 
charge faced by those retirees who use TRICARE Standard. For Prime 
enrollees, there will be copayments for care received from civilian 
providers. These copayments are significantly less than the other two 
options. Enrollees in TRICARE Prime obtain most of their care within 
the integrated military and civilian network of TRICARE providers. 
Additionally, under a new point of service option, Prime enrollees may 
retain freedom of choice to use non-network providers but at 
significantly higher cost sharing than TRICARE Standard.
    A major component of TRICARE is the series of managed care support 
contracts that supplement the capabilities of regional military health 
care delivery networks. There are to be seven fixed-price, at-risk 
contracts supporting the 12 Regions, competitively awarded prior to the 
end of Fiscal Year 1996. The new TRICARE Prime cost sharing provision 
will be phased in as each regional TRICARE contract begins operations. 
TRICARE Prime will first be offered to beneficiaries living in 
Washington and Oregon when the new regional TRICARE contact begins 
health care delivery services on March 1, 1995.

                    ITEM 4. DEPARTMENT OF EDUCATION

                        POSTSECONDARY EDUCATION

    The Office of Postsecondary Education administers programs designed 
to encourage participation in higher education by providing support 
services and financial assistance to students.
    In fiscal year 1994, an estimated $28 billion was made available to 
students through the student financial assistance programs authorized 
by Title IV of the Higher Education Act of 1965, as amended. In fiscal 
year 1994, an estimated 5 percent of all Title IV recipients were over 
age 40.
    The Special Programs for the Disadvantaged, commonly known as the 
``TRIO'' programs, provide support services to those interested in 
pursuing a baccalaureate education, enrolled in baccalaureate 
education, or wishing to pursue a graduate or professional degree. 
Because age is not an eligibility criterion under most of these 
programs, data on the age of participants are not available.
    In addition to these programs, the Office of Postsecondary 
Education supports innovative approaches to meeting the needs of older 
Americans through the Fund for the Improvement of Postsecondary 
Education (FIPSE). In fiscal year 1994, FIPSE funded two projects 
dealing specifically with our aging population. These projects are:
          Center for Intergenerational Learning (Temple University, 
        Philadelphia, PA): Asian, Latino, and Eastern European students 
        will team with other students to provide services to elderly 
        members of their communities. Services will include 
        translation, English as a Second Language classes, escorts on 
        public transportation, and health education.
          Generations Together/University Challenge for Excellence 
        Program (University of Pittsburgh, Pittsburgh, PA): Teams of 
        students drawn from the incoming freshman class and Pittsburgh 
        College for the over 60 Program will provide a variety of 
        services for the elderly residents of low-income housing.

                            Adult Education

    In the past, the education of persons 60 years of age and older may 
not have been considered an educational priority in the United States. 
The 1990's may well be considered the decade of growth in educational 
gerontology. Demographics have tended to make this development 
inevitable. A recent study entitled, Profiles of the Adult Education 
Target Population--Information from the 1990 Census, prepared by the 
Center for Research in Education, Research Triangle Institute, 
indicates that more than 44 million adults, or nearly 27 percent of the 
adult population of the United States, have not completed a high school 
diploma or its equivalent. These individuals make up the adult 
education target population. Of the 44 million adults in the target 
population, more than 18 million or 41 percent are 60 or more years 
old. Over 53 percent of the adults age 60 and over in the target 
population have completed fewer than 8 years of schooling. The high 
rate of under-education indicates a need for emphasizing effective 
basic skills and coping strategies in programs for older adults.
    The U.S. Department of Education is authorized under the Adult 
Education Act (AEA), Public Law 100-297, as amended by the National 
Literacy Act of 1991 (P.L. 102-73), to provide funds to the States and 
outlying areas for educational programs and related support services 
benefiting all segments of the eligible adult population. The central 
program established by the AEA is the State-administered Basic Grant 
Program. The AEA has also provided funds for programs of workplace and 
English Literacy. In addition, the 1991 amendments established four new 
programs:
          State Literacy Resource Centers,
          National Workforce Literacy Strategies,
          Functional Literacy for State and Local Prisoners, and
          Life Skills Training for State and Local Prisoners.
    The above-mentioned programs are administered by the Office of 
Vocational and Adult Education.
    In addition, amendments to the AEA State-administered Basic Grant 
Program include, in part:
          The authorization for competitive 2-year ``Gateway Grants'' 
        by States to public housing authorities for literacy programs 
        for housing residents.
          A requirement for States to develop a system of indicators of 
        program quality to be used to judge the quality of State and 
        local programs.
          An increase in the State set-aside under Section 353 for 
        innovative demonstration projects and teacher training from 10 
        to 15 percent, with two-thirds of that amount to be used for 
        training of professional teachers, volunteers, and 
        administrators.
          A requirement in allocating Federal funds to local programs, 
        that each State consider: past program effectiveness 
        (especially with respect to recruitment, retention and learning 
        gains of program participants), the degree of coordination with 
        other community literacy and social services, and the 
        commitment to serving those most in need of literacy services.
          A requirement that each State educational agency receiving 
        financial assistance under this program provide assurance that 
        local educational agencies, public or private nonprofit 
        agencies, community-based organizations, correctional education 
        agencies, postsecondary education institutions, institutions 
        which serve educationally disadvantaged adults and any other 
        institution that has the ability to provide literacy services 
        to adults and families will be provided direct and equitable 
        access to all Federal funds provided under this program.
          A requirement that States evaluate 20 percent of grant 
        recipients each year.
    Generally, the purpose of the AEA is to encourage the establishment 
of programs for adults lacking literacy skills who are 16 years of age 
and older or who are beyond the age of compulsory school attendance 
under State law. These programs will:
          (1) Enable adults to acquire the basic educational skills 
        necessary for literate functioning;
          (2) Provide sufficient basic education to enable these adults 
        to benefit from job training and retraining and to obtain 
        productive employment; and
          (3) Enable adults to continue their education to at least 
        high school completion.
    In Program Year 1992-93, 3.9 million adult learners were served 
through the AEA program nationwide. Of these learners, 597,543 were 45 
years of age or older.
    Many of the emerging workforce participants, including a large 
number of older adults, lack the basic literacy skills necessary to 
meet the increased demands of rapid change and new technology. Thus, 
employers will have to make training and retraining a priority in order 
to upgrade the labor force.
    The adult education program addresses the needs of older adults by 
emphasizing functional competency and grade level progression, from the 
lowest literacy level, to providing English as a second language 
instruction, through attaining the General Education Developmental 
Certificate. States operate special projects to expand programs and 
services for older persons through individualized instruction, use of 
print and audio-visual media, home-based instruction, and curricula 
relating basic educational skills to coping with daily problems in 
maintaining health, managing money, using community resources, 
understanding government, and participating in civic activities.
    Equally significant is the expanding delivery system, increased 
public awareness, as well as clearinghouses and satellite centers 
designed to overcome barriers to participation. Where needed, 
supportive services such as transportation are provided as are outreach 
activities adapting programs to the life situations and experiences of 
older persons. Individual learning preferences are recognized and 
assisted through the provision of information, guidance and study 
materials. To reach more people in the targeted age range, adult 
education programs often operate in conjunction with senior citizens 
centers, nutrition programs, nursing homes, and retirement and day care 
centers.
    Increases cooperation and collaboration among organizations, 
institutions and community groups are encouraged at the national, State 
and local levels. In addition, sharing of resources and services can 
help meet the literacy needs for older Americans.

               Enforcement of the Age Discrimination Act

    The Department of Education's (ED) Office for Civil Rights (OCR) is 
responsible for enforcement of the Age Discrimination Act of 1975 
(Act), as it relates to discrimination on the basis of age in federally 
funded education programs or activities. The Act contains certain 
exceptions that permit, under limited circumstances, continued use of 
age distinctions or factors other than age that may have a 
disproportionate effect on the basis of age.
    The Department of Health and Human Services (HHS) has published a 
general governmentwide regulation on age discrimination. Each agency 
that provides Federal financial assistance must publish a final agency-
specific regulation. On July 27, 1993, ED published in the Federal 
Register its final regulation implementing the Age Discrimination Act.
    The Act gives OCR the authority to investigate programs or 
activities receiving Federal financial assistance from ED. OCR 
generally does not have the authority to investigate employment 
complaints under the Act. OCR sends employment complaints to the Equal 
Employment Opportunity Commission (EEOC), which has jurisdiction under 
the Age Discrimination in Employment Act of 1967 (ADEA) for certain 
types of age discrimination cases, or closes them using the procedures 
described below.
    Under ED's final regulation, OCR forwards complaints alleging age 
discrimination to the Federal Mediation and Conciliation Service (FMCS) 
for resolution through mediation. FMCS has 60 days to mediate the age-
only complaints or the age portion of multiple-based complaints. For 
complaints alleging discrimination on the basis of age and another 
statutory basis, the applicable OCR case processing time frames are 
delayed for 60 days or until the complaint is returned from FMCS, 
whichever is earlier, to allow FMCS to process the age portion of the 
case. OCR notifies the complainant(s) of the duration of the tolling of 
the time frames. The other statutes which OCR enforces are Title VI of 
the Civil Rights Act of 1964, which prohibits discrimination on the 
basis of race, color, and national origin; Title IX of the Education 
Amendments of 1972, which prohibits discrimination on the basis of sex; 
and Section 504 of the Rehabilitation Act of 1973 and Title II of the 
Americans with Disabilities Act of 1990, which prohibit discrimination 
on the basis of physical and mental disability.
    If FMCS is successful in mediating an age-only complaint within the 
60 days, OCR closes the case. If FMCS does not resolve the case, OCR 
investigates the allegations according to OCR's case processing time 
frames. If the case was filed on the basis of age and another statutory 
basis, FMCS tries to mediate the age portion of the case, as described 
above. If FMCS is successful in mediating the age portion of the case 
within the 60 days, OCR then processes the other allegations in the 
complaint within the applicable OCR case processing time frames. If 
FMCS is unsuccessful in mediating an agreement between the complainant 
and the recipient on the age portion of the complaint, it returns the 
case to OCR. OCR processes the complaints according to applicable OCR 
case processing time frames.
    OCR helps its working relationship with FMCS by designating 
regional contact persons who coordinate directly with FMCS. OCR also 
accepts verbal or facsimile referrals from FMCS after unsuccessful 
attempts at mediation, and may grant FMCS extensions of up to 10 days 
beyond the 60 day mediation period on a case-by-case basis when 
mediated agreements appear to be forthcoming.
    Age complaints involving employment filed by persons over the age 
of 40 are referred to the appropriate EEOC regional office under the 
ADEA, and OCR closes its file. EEOC does not have jurisdiction over 
age-related complaints for persons under 40 years of age. If the 
complainant is under 40 years of age, and the complaint filed with OCR 
alleges only employment discrimination, OCR informs the complainant 
that there is no jurisdiction under the ADEA, and closes the case 
administratively.
    OCR received 212 age complaints in FY 1994. As shown in Table 1, 
below, 165 of the receipts were processed by OCR and 47 were referred 
to other Federal agencies for processing. The most frequently cited 
issues in the FY 1994 age complaint receipts were ``criteria for 
selection in hiring,'' and ``academic evaluation and grading'' and 
``student rights.''

              TABLE 1: FY 1994 AGE-BASED COMPLAINT RECEIPTS             
                                                                        
                                                                        
                                                                        
Processed in OCR...........................................          165
Referred to FMCS...........................................            9
Referred to EEOC...........................................           35
Referred to Other Federal Agencies.........................            3
                                                            ------------
      Total Receipts.......................................          212
                                                                        

    During FY 1994, OCR closed a total of 126 age-based complaints. As 
shown on Table 2, below, most of the complaints were closed for 
administrative reasons.

              TABLE 2: FY 1994 AGE-BASED COMPLAINT CLOSURES             
                                                                        
                                                                        
                                                                        
Administrative Closures....................................           72
Substantive Closures.......................................           54
    No change as a result of agency investigation..........           38
    Recipient made changes.................................           13
    Other..................................................            3
                                                            ------------
      Total closures.......................................          126
                                                                        

    Of the 54 substantive closures, change was achieved in 24 percent 
of cases. The most frequently cited issues in the cases with change 
were ``student treatment'' and ``student rights.''
    OCR confined its age discrimination activities to complaint 
investigations. OCR did not conduct compliance reviews on age 
discrimination in FY 1994.

       Older Americans in the 1992 National Adult Literacy Survey

    While for some the importance of literacy derives from the 
increasing needs of business for literate workers, for others the 
importance of literacy derives from the benefits of literacy skills in 
the everyday life of adults of all ages, including those who have 
retired from the labor force. Older adults need literacy skills to live 
independently, to manage their health care and personal finances, and 
more generally, to function in society. Knowing the nature and extent 
of the literacy problem in the United States today is an important 
early step in devising effective policies to ensure adequate literacy 
skills for every adult and to meet our Nation's literacy goal.
    The Adult Education Amendments of 1988 required the U.S. Department 
of Education to report to Congress on the definition of literacy and to 
estimate the extent of adult literacy in the Nation. To satisfy these 
requirements, the National Center of Education States (NCES) and the 
Office of Vocational and Adult Education (OVAE) cooperated to fund a 
statistical survey that would assess the literacy of the adult 
population of the United States. In September 1989, NCES awarded a 5-
year contract for the survey to Educational Testing Service, with a 
subcontract to Westat for sampling and field data collection.
    The National Adult Literacy Survey began by consulting advisors and 
then adopting a definition of literacy--one previously used by the 
National Assessment of Educational Progress in the 1985 Young Adult 
Literacy Assessment: Using printed and written information to function 
in society, to achieve one's goals, and to develop one's knowledge and 
potential. This definition of literacy differed from previous 
definitions in that it rejected such arbitrary standards as signing 
one's name, completing some number of years of school, or scoring above 
some grade level on a test of reading achievement. Further, this 
definition went beyond simply decoding words, to include varied uses of 
many forms of information.
    The literacy of adults was assessed using simulations of three 
kinds of literacy tasks adults would ordinarily encounter in daily life 
(prose literacy, document literacy, and quantitative literacy). Besides 
completing literacy tasks, participants answered questions about their 
demographic characteristics, educational backgrounds, reading 
practices, labor market experiences, and more.
    The 1992 results are based on personal interviews with nearly 
27,000 adults aged 16 and older--the oldest was 99 years old--conducted 
in their homes using an area-based sample of households located in 200 
counties throughout the United States. The sample includes 1,100 
inmates of Federal and State prisons and 1,000 extra residents in each 
of 12 States that paid for sample supplements (CA, FL, IL, IN, IA, LA, 
NJ, NY, OH, PA, TX, and WA). The survey design provides nationally 
representative results, and for participating States, State-
representative results.
    Reesults from the survey have so far been published in Adult 
Literacy in America and in Behind Prison Walls, available from NCES, 
and in State-specific reports, available from the 12 State offices of 
adult literacy. Further reports are planned in several areas: schooling 
and literacy; literacy in language minority communities; literacy in 
the labor force; reading habits, library use, voting and literacy; and 
literacy among older adults.
    Results for older adults were briefly covered in the initial survey 
report, but will be more extensively presented in a forthcoming special 
report on literacy among older adults. The forthcoming report will 
include chapters on the distribution of literacy skills among older 
adults, comparisons of older adults with adults under 60 years old, 
economic issues, civic participation, and literacy and patterns of mass 
media usage. The report is expected to be published by April 1995. The 
results of the survey will not directly benefit older adults, but will 
instead form the factual basis for policy decisions affecting literacy 
programs designed for older adults or for adults with limited literacy 
skills.
    The cost of including older adults in the survey and preparing a 
report on older adults came to about $870,000, or about 8 percent of 
the Federal share of the total costs of the survey.

          Library Services to Special Populations: The Elderly

    There are now on file more than 20 years (1971-1992) of State 
reports on the Library Services to the Elderly (through the Library 
Services and Construction Act (LSCA)). (The attached tables show the 
expenditure breakouts.) The FY 1991 reports show that $1.5 million of 
LSCA funds supported such efforts. When combined with State and local 
funds, the total reached $1.8 million. Final figures for FY 1992 
indicate that $1.7 was spent in LSCA funds and, when combined with 
State and local matching funds, amounted to $2.1 million.
    In the first few years of LCSA funding, almost all projects were 
for delivery of books to the homebound and special programs designed 
for the elderly at the library. The energy crisis caused a revamping of 
programs dependent on either cars or bookmobiles. During that period, 
Books-By-Mail took the place of site delivery. Since energy costs are 
now down and postal rates and personnel costs are up, many of the 
Books-By-Mail projects rely on delivery by volunteers. Analysis of the 
projects conducted in FY 1992 (the latest reports available) listed 
only five projects that included delivery through the mails. Forty 
projects funded delivery of programs and materials to homes, nursing 
homes, senior centers, and other congregate sites. All but one of those 
projects included rotating and/or deposit collections. The Washoe 
County Library (Nevada) project located a collection of Large Print 
books and other books of interest to the elderly in the county senior 
center. This project has proven so successful that the library will 
continue to support the program after the Federal funds have lapsed, 
and plans are underway to move it from an extension branch to a full 
branch with its own separate budget.
    Projects that funded the purchases of these rotating collections, 
as well as collections housed in the library, were usually centered 
around Large Print books (82 projects). Audio Visual Materials were 
purchased (69 projects) which included purchases of Talking Books and 
adapted games. Also noted was the purchase of special materials of 
interest to the elderly (21 projects for special reference materials, 
craft and travel books, etc.). The Newton County (Georgia) Library 
found that the addition of new Large Print books and books on cassette 
increased the circulation statistics considerably. The circulation of 
audio books was up 55 percent and Large Print books up 33 percent. When 
the Mississippi Library Commission (MLC) added new Large Print books to 
their collection, these materials were 30.5 percent of the total 
circulation from the MLC collection in 1992.
    Additional materials added to the collection at the libraries 
included multisensory kits to aid in life review and stimulation of the 
senses (14 projects). Several of these projects were like the one at 
the White Pine Library Cooperative (Michigan) which checked kits out to 
local libraries for extended periods before they rotated to another 
library for use. In this way, the kits were used in over 30 locations 
in an 11-county area. Visual aids were mentioned in 13 projects, with 
most citing the Americans with Disabilities Act as an impetus. The 
Laurens County Library (South Carolina) provided a low vision center 
which allowed the visually impaired to try the various aids prior to 
purchase.
    Funded projects in 1992 also included a large number which were for 
special programming (41). These included book talks, use of BiFokal 
kits, Read Aloud sessions, travel and other films, etc. Location 
appears to have a lot to do with the type of programming that is 
successful, with crafts and travel sessions more popular in more rural 
areas, crime prevention and social services in urban areas and all 
areas enjoying book talks and other cultural activities. The words and 
memories project by the Brooklyn Public Library (New York) presented 
178 varied programs at 23 sites. These used multi-media materials, 
read-a-loud, storytelling, poems, songs, ets., to stimulate reading and 
sharing memories. Another excellent project is the Nassau Library 
System's (New York) Lively Minds, a life-long learning program which 
used library resources for mental stimulation, enjoyment, and 
empowerment to prove that neither age nor physical infirmity can limit 
the power of the mind.
    The major change in intergenerational projects is one of emphasis. 
If mentioned in earlier reports, these projects tended to have the 
youth reading to or delivering books to the homebound or those in 
nursing homes. The current projects (16) are using the elderly to aid 
children in need of better reading skills or after school help with 
homework. Even though the actual help is being given by the senior 
citizens, projects like Read to Me in New Bedford (Massachusetts) found 
that the critical element is often the work done by the librarian 
overseeing the volunteers. The organizational skills and the enthusiasm 
of the project leader can be critical factors. The project in Fort 
Scott (Kansas) taught the seniors how many children are reading below 
grade level or have nonexistent reading skills. An outstanding project 
in Broward County (Florida) is its Prime Time which matched the elderly 
and children attending Title XX daycare centers. This project produced 
a video that captured the joy of this well-planned project. The video 
is available for the cost of reproduction.
    Projects on genealogy and community history (5) are down from 
previous reports. However, this set of reports included a well-planned 
project at the Westchester (New York) Library System. Approximately 25-
35 persons attended four sessions which studied a variety of memoirs by 
Americans and a talk by someone who had written his memoirs for his 
grandchildren. Then there were six sessions on how to write memoirs, 
and finally a computer instruction course on word processing skills. A 
second project, at the Harvin Clarendon County Library (South 
Carolina), used video equipment to record the oral history of the 
senior citizens of their community as well as produce tapes on the 
historical sites in the county to show to the immobile elderly.
    Six projects noted that Information and Referral was part of the 
project. The Bethel Park Public Library (Pennsylvania) project included 
a Senior Information Area in the library. This area was not only for 
use by the elderly, but was also intended for use by nursing home 
activity directors, families of those in nursing homes or those dealing 
with Alzheimers disease.
    One general improvement in the projects is the realization that the 
above projects will not be of value if the clientele do not know about 
the services. Forty-two projects noted the various ways they promoted 
their services to the elderly. Interagency cooperation (both for 
promotion as well as help) was noted in 20 projects. The training of 
librarians and volunteers was mentioned in 19 projects. The OWLS 
project by the Mohawk Valley Library Association (New York) received 
the Bessie Boehm Moore award. This project included three continuing 
education workshops on improving the service to the elderly in their 
area. The workshops were for the librarians in four counties. A 
statewide training institute was presented by the state library of 
Pennsylvania. This 3-day workshop was the kickoff for a funding push in 
this area of service and was somewhat patterned after an earlier 
program in New Jersey. Catalogs and bibliographies were produced in 
large print in 10 projects. Most of the latter were possible due to 
computerization and other uses of new technology (noted in 5 projects).
    There are still areas in which these projects fall short. The use 
of an advisory group (usually seniors) was noted only twice. Although 
manuals were produced in only five projects, the replication potential 
of ones like the Read Aloud Handbook produced by the Brown County 
Library (Wisconsin) are obvious. However, many more projects noted 
their inability to produce written materials. As stated by the 
evaluator of the Bethel Park project mentioned above, ``The production 
of a resource guide on programming . . . is not feasible at this time. 
. . . [I]t is the opinion of the Project Coordinator that the service 
aspect has a higher priority.'' An exemplary manual is the Library 
Service to Florida's Elders, which was produced by the Florida Division 
of Library and Information Services.

                                         TABLE 9.--HIGHEST LEVEL OF EDUCATION ATTAINED BY PERSONS AGE 18 AND OVER, BY AGE, SEX, AND RACE/ETHNICITY: 1993                                        
                                                                                         [In thousands]                                                                                         
------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------
                                                                       Elementary level              High school                                           College                              
                                                          Total     ----------------------------------------------------------------------------------------------------------------------------
                 Age, sex, and race                  population \1\  Less than    7 or 8     1 to 3                            Some                                         First-              
                                                                      7 years      yeas      years     4 years    Graduate   college   Associate  Bachelor's   Master's  professional  Doctorate
------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------
1                                                               2            3          4          5          6          7          8          9          10         11           12          13
------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------
                       Total                                                                                                                                                                    
18 and over........................................       187,135        7,199      8,610     18,553      3,063     65,140     35,626     11,471      25,388      8,411        2,247       1,427
    18 and 19 years old............................         6,508           64         95      1,855        654      1,827      1,987         26          --         --           --          --
    20 to 24 years old.............................        17,802          271        252      1,744        296      5,724      6,544      1,089       1,769        101           11           2
    25 years old and over..........................       162,826        6,864      8,263     14,953      2,113     57,589     27,095     10,356      23,619      8,310        2,236       1,425
      25 to 29 years old...........................        19,603          398        327      1,588        290      6,994      3,897      1,471       3,828        580          185          45
      30 to 34 years old...........................        22,261          502        378      1,683        331      8,042      4,151      1,843       3,969        942          292         127
      35 to 39 years old...........................        21,467          519        342      1,448        191      7,524      4,138      1,856       3,745      1,199          321         185
      40 to 49 years old...........................        34,662          900        777      2,194        360     11,592      6,590      2,644       5,748      2,787          656         414
      50 to 59 years old...........................        23,434        1,037      1,040      2,362        292      8,847      3,588      1,235       2,837      1,502          380         314
      60 to 64 years old...........................        10,529          659        798      1,347        164      4,024      1,284        410       1,095        495          121         132
      65 years old and over........................        30,870        2,849      4,602      4,331        486     10,567      3,446        897       2,396        806          280         209
                                                    ============================================================================================================================================
                        Men                                                                                                                                                                     
18 and over........................................        89,694        3,615      4,062      8,808      1,561     29,523     17,004      5,076      12,922      4,409        1,656       1,060
    18 and 19 years old............................         3,263           38         52      1,071        382        851        857         11          --         --           --          --
    20 to 24 years old.............................         8,786          141        144        928        167      2,905      3,227        463         767         40            4          --
    25 years old and over..........................        77,644        3,436      3,866      6,809      1,011     25,766     12,920      4,601      12,154      4,368        1,652       1,060
      25 to 29 years old...........................         9,767          257        171        786        149      3,565      1,894        657       1,851        294          116          27
      30 to 34 years old...........................        11,089          292        197        863        188      4,039      1,945        813       1,971        498          196          88
      35 to 39 years old...........................        10,606          249        194        736        111      3,717      1,950        867       1,840        579          243         119
      40 to 49 years old...........................        16,987          457        396      1,034        181      5,191      3,235      1,212       3,057      1,448          481         294
      50 to 59 years old...........................        11,280          542        590      1,034        135      3,773      1,738        522       1,566        853          283         244
      60 to 64 years old...........................         5,084          315        430        631         65      1,663        644        210         636        273          108         109
      65 years old and over........................        12,832        1,324      1,887      1,725        182      3,817      1,515        320       1,234        424          226         177
                                                                                                                                                                                                
                       Women                                                                                                                                                                    
18 and over........................................        97,442        3,584      4,548      9,745      1,503     35,618     18,622      6,396      12,466      4,002          591         368
    18 and 19 years old............................         3,244           25         43        784        271        976      1,130         15          --         --           --          --
    20 to 24 years old.............................         9,016          130        108        816        129      2,819      3,317        626       1,001         60            7           2
    25 years old and over..........................        85,181        3,428      4,398      8,144      1,102     31,823     14,175      5,755      11,465      3,942          584         366
      25 to 29 years old...........................         9,836          140        155        802        141      3,429      2,003        814       1,977        287           69          18
      30 to 34 years old...........................        11,171          210        181        820        143      4,003      2,207      1,029       1,998        444           96          39
      35 to 39 years old...........................        10,861          270        148        712         80      3,807      2,188        989       1,905        620           78          65
      40 to 49 years old...........................        17,675          443        381      1,160        179      6,401      3,355      1,432       2,691      1,339          175         120
      50 to 59 years old...........................        12,154          495        451      1,328        156      5,073      1,851        713       1,271        649           98          70
      60 to 64 years old...........................         5,445          344        368        716         99      2,361        640        199         460        222           14          22
      65 years old and over........................        18,038        1,526      2,714      2,606        303      6,750      1,931        577       1,163        382           54          32
                                                    ============================================================================================================================================
                White, non-Hispanic                                                                                                                                                             
18 and over........................................       144,675        2,485      6,279     12,464      1,872     51,826     28,371      9,400      21,512      7,267        1,978       1,222
    18 and 19 years old............................         4,479            7         42      1,157        366      1,350      1,544         14          --         --           --          --
    20 to 24 years old.............................        12,595           26        132        949        145      3,967      4,888        866       1,526         85            8           2
    25 years old and over..........................       127,601        2,452      6,105     10,358      1,362     46,509     21,938      8,520      19,986      7,182        1,969       1,220
      25 to 29 years old...........................        14,070           57        159        878        138      5,009      2,815      1,193       3,172        461          151          37
      30 to 34 years old...........................        16,530           94        170      1,019        191      6,099      3,089      1,476       3,277        775          253          86
      35 to 39 years old...........................        16,190           87        172        834        102      5,751      3,248      1,475       3,091        980          291         158
      40 to 49 years old...........................        27,200          195        424      1,358        207      9,144      5,433      2,164       4,893      2,450          570         363
      50 to 59 years old...........................        18,623          406        722      1,628        195      7,335      2,983      1,018       2,411      1,324          332         270
      60 to 64 years old...........................         8,647          247        630        997        115      3,494      1,136        378         951        470          113         115
      65 years old and over........................        26,342        1,366      3,829      3,643        414      9,677      3,235        817       2,191        723          258         190
                                                                                                                                                                                                
                Black, non-Hispanic                                                                                                                                                             
18 and over........................................        21,009        1,174      1,007      3,324        629      7,634      3,951      1,039       1,647        472           76          56
    18 and 19 years old............................         1,004            3          4        366        155        236        231          9          --         --           --          --
    20 to 24 years old.............................         2,473           17         29        312         74      1,036        792        108         100          6           --          --
    25 years old and over..........................        17,532        1,154        975      2,646        401      6,362      2,928        922       1,546        466           76          56
      25 to 29 years old...........................         2,579            9         26        328         85      1,101        554        134         289         43           10          --
      30 to 34 years old...........................         2,756           21         56        303         74      1,109        635        208         293         46            8           6
      35 to 39 years old...........................         2,509           36         41        309         34      1,011        515        178         296         78            6           5
      40 to 49 years old...........................         3,586           82        114        476         76      1,398        642        242         358        151           31          17
      50 to 59 years old...........................         2,432          146        138        473         64        877        361        111         156         87            9          10
      60 to 64 years old...........................         1,037          135        106        257         23        324         89         11          72          9            2           9
      65 years old and over........................         2,633          726        494        500         45        542        132         39          82         52           11          11
                                                                                                                                                                                                
                      Hispanic                                                                                                                                                                  
18 and over........................................        14,913        3,102      1,122      2,301        440      4,027      2,147        629         833        213           66          35
    18 and 19 years old............................           802           54         48        270         98        195        134          2          --         --           --          --
    20 to 24 years old.............................         2,011          225         85        441         66        590        468         79          53          4            1          --
    25 years old and over..........................        12,100        2,823        989      1,590        275      3,242      1,545        547         780        209           66          35
      25 to 29 years old...........................         2,192          317        129        353         58        683        367        102         154         19            9          --
      30 to 34 years old...........................         2,086          352        138        302         45        628        304        112         153         30           12           9
      35 to 39 years old...........................         1,898          360        119        250         46        527        262        119         156         45            9           6
      40 to 49 years old...........................         2,589          565        210        300         59        721        369        119         160         59           16          12
      50 to 59 years old...........................         1,559          445        147        191         26        390        159         61          91         34           10           3
      60 to 64 years old...........................           554          222         50         73         20        122         31         11          20          6            1          --
      65 years old and over........................         1,222          561        195        120         22        171         53         23          46         16            9           5
------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------
\1\ Civilian noninstitutional population.                                                                                                                                                       
--Data not applicable or not available.                                                                                                                                                         
                                                                                                                                                                                                
NOTE.--Data are based on a sample survey of the noninstitutional population. Although cells with fewer than 75,000 people are subject to relatively wide sampling variation, they are included  
  in the table to permit various types of aggregations. Because of rounding, details may not add to totals.                                                                                     
                                                                                                                                                                                                
SOURCE: U.S. Department of Commerce, Bureau of the Census, Current Population Survey, unpublished data. (This table was prepared May 1994.)                                                     


                             TABLE 10.--NUMBER OF PERSONS AGE 18 AND OVER WHO HOLD A BACHELOR'S OR HIGHER DEGREE, BY FIELD OF STUDY, SEX, RACE, AND AGE: SPRING 1990                            
                                                                                     [Numbers in thousands]                                                                                     
------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------
                                                                           Sex                      Race                                                 Age                                    
                                                               ---------------------------------------------------------------------------------------------------------------------------------
                  Field of study                      Total                                                                                                                            65 years 
                                                                    Men         Women      White \1\    Black \1\     18 to 24     25 to 34     35 to 44     45 to 54     55 to 64     old and  
                                                                                                                     years old    years old    years old    years old    years old       over   
------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------
1                                                            2            3            4            5            6            7            8            9           10           11           12
------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------
      Total population, 18 and over..............      182,591       87,240       95,350      156,385       20,401       25,145       43,245       37,708       25,489       21,228       29,776
                                                  ----------------------------------------------------------------------------------------------------------------------------------------------
    Number of persons with bachelor's or higher                                                                                                                                                 
     degree......................................       33,554       18,145       15,408       30,049        1,908        1,797        9,657       10,215        5,355        3,249        3,281
    Percent of population........................         18.4         20.8         16.2         19.2          9.4          7.1         22.3         27.1         21.0         15.3         11.0
                                                  ----------------------------------------------------------------------------------------------------------------------------------------------
Agriculture and forestry.........................          371          339           32          351            6            9           90           63           77           28          103
Biology..........................................          857          506          351          767           34           89          233          305          118           67           43
Business and management..........................        6,189        4,313        1,876        5,531          368          384        2,148        1,697        1,005          500          454
Economics........................................          691          467          224          581           40           76          206          114          127           84           83
Education........................................        5,879        1,633        4,246        5,296          478          220          943        2,125        1,123          702          766
Engineering......................................        3,090        2,821          269        2,635          154          159        1,104          702          466          340          321
English and journalism...........................        1,369          360        1,009        1,306           40           58          367          434          181          124          204
Home economics...................................          385            8          377          350           14            3           75           85           60           76           85
Law..............................................        1,004          797          207          948           15           14          260          320          191          123           96
Liberal arts and humanities......................        3,002        1,174        1,828        2,703          160          164          938        1,021          396          202          282
Mathematics and statistics.......................          699          467          232          648           13           72          171          173          160           84           36
Medicine and dentistry...........................        1,046          752          294          893           36           44          328          309          104          104          157
Nursing, pharmacy, and health technologies.......        1,913          353        1,560        1,717           83          111          661          602          249          156          134
Physical and earth sciences......................          856          631          225          781           35           33          239          283          147           82           73
Police science and law enforcement...............          238          183           55          201           25            9           53           94           37           33           12
Psychology.......................................        1,103          458          645        1,001           80           45          356          358          172          113           58
Religion and theology............................          488          413           75          452           24           14           85          165           72          103           47
Social sciences..................................        1,960        1,034          926        1,769          124          121          527          666          300          178          169
Vocational and technical studies.................          179          157           22          155           19           12           69           27           37           26            9
Other fields.....................................        2,233        1,277          956        1,963          162          159          803          667          329          124          149
                                                  ----------------------------------------------------------------------------------------------------------------------------------------------
                                                                                                                                                                                                
                                                                                                 Percentage distribution of degree holders, by field                                            
                                                                                                                                                                                                
                                                  ----------------------------------------------------------------------------------------------------------------------------------------------
      Total......................................        100.0        100.0        100.0        100.0        100.0        100.0        100.0        100.0        100.0        100.0        100.0
                                                  ----------------------------------------------------------------------------------------------------------------------------------------------
Agriculture and forestry.........................          1.1          1.9          0.2          1.2          0.3          0.5          0.9          0.6          1.4          0.9          3.1
Biology..........................................          2.6          2.8          2.3          2.6          1.8          5.0          2.4          3.0          2.2          2.1          1.3
Business and management..........................         18.4         23.8         12.2         18.4         19.3         21.4         22.2         16.6         18.8         15.4         13.8
Economics........................................          2.1          2.6          1.5          1.9          2.1          4.2          2.1          1.1          2.4          2.6          2.5
Education........................................         17.5          9.0         27.6         17.6         25.1         12.2          9.8         20.8         21.0         21.6         23.3
*COM001*Engineering..............................          9.2         15.5          1.7          8.8          8.1          8.8         11.4          6.9          8.7         10.5          9.8
English and journalism...........................          4.1          2.0          6.5          4.3          2.1          3.2          3.8          4.2          3.4          3.8          6.2
Home economics...................................          1.1          0.0          2.4          1.2          0.7          0.2          0.8          0.8          1.1          2.3          2.6
Law..............................................          3.0          4.4          1.3          3.2          0.8          0.8          2.7          3.1          3.6          3.8          2.9
Liberal arts and humanities......................          8.9          6.5         11.9          9.0          8.4          9.1          9.7         10.0          7.4          6.2          8.6
Mathematics and statistics.......................          2.1          2.6          1.5          2.2          0.7          4.0          1.8          1.7          3.0          2.6          1.1
Medicine and dentistry...........................          3.1          4.1          1.9          3.0          1.9          2.4          3.4          3.0          1.9          3.2          4.8
Nursing, pharmacy, and health technologies.......          5.7          1.9         10.1          5.7          4.4          6.2          6.8          5.9          4.6          4.8          4.1
Physical and earth sciences......................          2.6          3.5          1.5          2.6          1.8          1.8          2.5          2.8          2.7          2.5          2.2
Police science and law enforcement...............          0.7          1.0          0.4          0.7          1.3          0.5          0.5          0.9          0.7          1.0          0.4
Psychology.......................................          3.3          2.5          4.2          3.3          4.2          2.5          3.7          3.5          3.2          3.5          1.8
Religion and theology............................          1.5          2.3          0.5          1.5          1.3          0.8          0.9          1.6          1.3          3.2          1.4
Social sciences..................................          5.8          5.7          6.0          5.9          6.6          6.7          5.5          6.5          5.6          5.5          5.2
Vocational and technical studies.................          0.5          0.9          0.1          0.5          1.0          0.7          0.7          0.3          0.7          0.8          0.3
Other fields.....................................          6.7          7.0          6.2          6.5          8.5          8.8          8.3          6.5          6.1          3.8          4.5
------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------
\1\ Includes persons of Hispanic origin.                                                                                                                                                        
                                                                                                                                                                                                
NOTE.--Data are based on a sample survey of the civilian noninstitutional population. Because of rounding, details may not add to totals.                                                       
                                                                                                                                                                                                
SOURCE: U.S. Department of Commerce, Bureau of the Census, Current Population Reports, Series P-70, No. 32, ``What's It Worth? Educational Background and Economic Status: Spring 1990.'' (This 
  table was prepared February 1993.)                                                                                                                                                            


                                          TABLE 11.--HIGHEST LEVEL OF EDUCATION ATTAINED BY PERSONS AGE 18 AND OVER, BY SEX, RACE, AND AGE: SPRING 1990                                         
                                                                                     [Numbers in thousands]                                                                                     
------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------
                                                                                                          Some                                                                                  
                                                                              Not high   High school  college, no   Vocational   Associate    Bachelor's    Master's   Professional    Doctor's 
                      Sex, race, and age                          Total        school      graduate    degree or   certificate     degree       degree       degree       degree        degree  
                                                                            graduate\1\      only     certificate                                                                               
------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------
1                                                                        2            3            4            5            6            7            8            9            10           11
------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------
      Total population, 18 and over..........................      182,591       38,012       65,291       33,191        4,973        7,570       22,845        7,599         2,054        1,056
        Men..................................................       87,240       17,948       29,713       16,099        1,737        3,600       11,769        3,996         1,547          833
        Women................................................       95,350       20,065       35,578       17,092        3,236        3,970       11,076        3,603           506          223
                                                                                                                                                                                                
White, total\2\..............................................      156,385       30,270       56,240       28,608        4,541        6,677       20,381        6,813         1,898          956
    Men......................................................       75,262       14,425       25,556       14,076        1,588        3,242       10,629        3,552         1,449          744
    Women....................................................       81,123       15,845       30,684       14,532        2,953        3,435        9,752        3,261           449          212
                                                                                                                                                                                                
Black, total\2\..............................................       20,401        6,510        7,495        3,534          284          670        1,367          462            46           34
    Men......................................................        9,158        3,045        3,483        1,441           87          257          581          199            38           28
    Women....................................................       11,242        3,465        4,012        2,094          197          413          786          262             8            6
                                                                                                                                                                                                
Hispanic, total\3\...........................................       13,548        5,934        4,091        1,933          208          316          734          245            55           32
    Men......................................................        6,708        2,950        1,961          976           89          153          388          121            44           27
    Women....................................................        6,841        2,984        2,130          958          119          163          346          124            11            5
                                                                                                                                                                                                
                             Age                                                                                                                                                                
    18 to 24 years old.......................................       25,145        4,892        8,877        8,357          451          770        1,725           50            22           --
    25 to 34 years old.......................................       43,245        5,392       16,034        8,277        1,215        2,670        7,522        1,508           509          118
    35 to 44 years old.......................................       37,708        4,332       12,655        6,910        1,213        2,383        6,415        2,859           648          292
    45 to 54 years old.......................................       25,489        4,796        9,937        3,718          753          931        3,132        1,599           295          329
    55 to 64 years old.......................................       21,228        6,063        8,315        2,573          530          497        1,896          888           310          156
    65 years old and over....................................       29,776       12,537        9,473        3,356          811          319        2,156          694           270          160
                                                              ----------------------------------------------------------------------------------------------------------------------------------
                                                                                                                                                                                                
                                                                                                       Percentage distribution, by highest degree earned                                        
                                                                                                                                                                                                
                                                              ----------------------------------------------------------------------------------------------------------------------------------
      Total population, 18 and over..........................        100.0         20.8         35.8         18.2          2.7          4.1         12.5          4.2           1.1          0.6
        Men..................................................        100.0         20.6         34.1         18.5          2.0          4.1         13.5          4.6           1.8          1.0
        Women................................................        100.0         21.0         37.3         17.9          3.4          4.2         11.6          3.8           0.5          0.2
                                                                                                                                                                                                
White, total\2\..............................................        100.0         19.4         36.0         18.3          2.9          4.3         13.0          4.4           1.2          0.6
    Men......................................................        100.0         19.2         34.0         18.7          2.1          4.3         14.1          4.7           1.9          1.0
    Women....................................................        100.0         19.5         37.8         17.9          3.6          4.2         12.0          4.0           0.6          0.3
                                                                                                                                                                                                
Black, total\2\..............................................        100.0         31.9         36.7         17.3          1.4          3.3          6.7          2.3           0.2          0.2
    Men......................................................        100.0         33.2         38.0         15.7          0.9          2.8          6.3          2.2           0.4          0.3
    Women....................................................        100.0         30.8         35.7         18.6          1.7          3.7          7.0          2.3           0.1          0.1
                                                                                                                                                                                                
Hispanic, total\3\...........................................        100.0         43.8         30.2         14.3          1.5          2.3          5.4          1.8           0.4          0.2
    Men......................................................        100.0         44.0         29.2         14.5          1.3          2.3          5.8          1.8           0.7          0.4
    Women....................................................        100.0         43.6         31.1         14.0          1.7          2.4          5.1          1.8           0.2          0.1
                                                                                                                                                                                                
                             Age                                                                                                                                                                
    18 to 24 years old.......................................        100.0         19.5         35.3         33.2          1.8          3.1          6.9          0.2           0.1        (\4\)
    25 to 34 years old.......................................        100.0         12.5         37.1         19.1          2.8          6.2         17.4          3.5           1.2          0.3
                                                                                                                                                                                                
    35 to 44 years old.......................................        100.0         11.5         33.6         18.3          3.2          6.3         17.0          7.6           1.7          0.8
    45 to 54 years old.......................................        100.0         18.8         39.0         14.6          3.0          3.7         12.3          6.3           1.2          1.3
    55 to 64 years old.......................................        100.0         28.6         39.2         12.1          2.5          2.3          8.9          4.2           1.5          0.7
    65 years old and over....................................        100.0         4.21         31.8         11.3          2.7          1.1          7.2          2.3           0.9          0.5
------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------
\1\ Some people are still enrolled in high school.                                                                                                                                              
\2\ Includes persons of Hispanic origin.                                                                                                                                                        
\3\ Persons of Hispanic origin may be of any race.                                                                                                                                              
\4\ Less than .05 percent.                                                                                                                                                                      
--Data not available.                                                                                                                                                                           
                                                                                                                                                                                                
NOTE.--Data are based on sample surveys of the civilian noninstitutional population. Because of rounding, details may not add to totals.                                                        
                                                                                                                                                                                                
SOURCE: U.S. Department of Commerce, Bureau of the Census, Current Population Reports, Series P-70, No. 32, ``What's It Worth? Educational Background and Economic Status: Spring 1990.'' (This 
  table was prepared February 1993.)                                                                                                                                                            


                                                         TABLE 20.--HOUSEHOLD INCOME AND POVERTY RATES, BY STATE: 1990 \1\ AND 1992 \2\                                                         
------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------
                                                                       Distribution of persons by                              Percent of persons below the poverty level                       
                                                                         household income, 1990       ------------------------------------------------------------------------------------------
                                                          Median  ------------------------------------                                  1990                                          1992      
                                                        household                                     ------------------------------------------------------------------------------------------
                         State                           income,     Less   $25,000  $50,000                                                                             75                     
                                                           1990      than      to       to    $75,000           Under 5           6 to 11   12 to    18 to    65 to    years            Standard
                                                                   $25,000  $49,999  $74,999  or more   Total    years   5 years   years      17       64       74      and     Total     error 
                                                                                                                                            years    years    years     over                    
------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------
1                                                               2        3        4        5        6        7        8        9       10       11       12       13       14       15        16
------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------
      United States...................................    $30,056     41.8     33.7     15.0      9.5     13.1     20.1     19.7     18.3     16.3     11.0     10.4     16.5     14.5      0.11
                                                       -----------------------------------------------------------------------------------------------------------------------------------------
Alabama...............................................     23,597     52.3     31.3     11.2      5.2     18.3     26.1     25.8     24.3     22.3     14.6     19.2     31.1     17.1      1.93
Alaska................................................     41,408     28.0     32.2     21.3     18.6      9.0     13.6     10.6     10.9      9.8      7.9      6.4     10.6     10.0      1.45
Arizona...............................................     27,540     45.1     34.1     13.3      7.5     15.7     24.9     24.2     21.8     19.1     14.0      9.3     13.2     15.1      1.87
Arkansas..............................................     21,147     57.8     30.1      8.4      3.7     19.1     28.5     26.6     25.2     22.7     15.3     18.0     29.9     17.4      1.92
California............................................     35,798     34.1     32.9     18.4     14.7     12.5     19.0     19.3     18.3     17.1     10.9      6.5      9.5     15.8      0.71
                                                                                                                                                                                                
Colorado..............................................     30,140     41.3     35.1     15.1      8.6     11.7     17.9     16.5     15.3     12.5     10.3      8.5     15.1     10.6      1.70
Connecticut...........................................     41,721     27.5     32.4     21.7     18.4      6.8     11.7     11.9     11.2      8.9      5.3      5.6      9.7      9.4      1.73
Delaware..............................................     34,875     33.9     36.7     18.4     11.0      8.7     13.3     12.7     11.8     10.8      7.2      8.2     13.5      7.6      1.46
District of Columbia..................................     30,727     41.0     30.4     14.4     14.2     16.9     27.0     25.5     25.0     24.4     14.3     15.5     19.7     20.3      2.58
Florida...............................................     27,483     45.1     34.1     12.9      7.9     12.7     20.3     20.1     18.8     16.8     11.0      9.0     13.5     15.3      0.90
                                                                                                                                                                                                
Georgia...............................................     29,021     43.1     34.0     14.4      8.4     14.7     22.1     21.3     20.1     18.1     11.4     16.5     26.7     17.8      1.95
Hawaii................................................     38,829     29.8     33.7     20.6     15.8      8.3     12.6     12.6     11.2     10.8      6.9      6.7     10.4     11.0      1.67
Idaho.................................................     25,257     49.5     35.2     10.7      4.7     13.3     19.6     18.9     15.9     13.3     12.0      8.7     15.6     15.0      1.72
Illinois..............................................     32,252     38.3     34.5     16.7     10.5     11.9     18.9     18.7     17.0     15.0     10.0      8.9     13.4     15.3      0.98
Indiana...............................................     28,787     43.1     36.6     14.1      6.2     10.7     16.8     15.8     14.1     11.8      9.1      8.7     14.0     11.7      1.72
                                                                                                                                                                                                
Iowa..................................................     26,229     47.5     36.3     11.4      4.8     11.5     17.5     15.4     14.1     11.7     10.3      8.1     15.3     11.3      1.58
Kansas................................................     27,291     45.5     35.2     12.9      6.4     11.5     16.8     16.5     14.1     11.6     10.1      8.5     16.8     11.0      1.56
Kentucky..............................................     22,534     54.2     31.1     10.2      4.6     19.0     27.9     26.5     24.6     22.4     16.2     17.5     25.3     19.7      2.08
Louisiana.............................................     21,949     55.1     29.4     10.3      5.2     23.6     33.4     33.0     31.1     29.7     19.6     20.5     30.1     24.2      2.31
Maine.................................................     27,854     44.6     37.1     12.8      5.5     10.8     15.7     15.9     14.0     11.5      8.9     11.0     18.3     13.4      1.80
                                                                                                                                                                                                
Maryland..............................................     39,386     29.0     34.6     20.8     15.6      8.3     11.9     11.9     11.5     10.2      6.8      8.8     13.6     11.6      1.74
Massachusetts.........................................     36,952     33.3     32.4     19.7     14.6      8.9     14.5     14.8     13.8     11.0      7.3      7.3     12.6     10.0      0.85
Michigan..............................................     31,020     40.6     34.0     16.3      9.2     13.1     22.1     20.4     18.1     15.7     11.2      8.7     14.3     13.5      0.94
Minnesota.............................................     30,909     39.9     36.3     15.6      8.1     10.2     14.8     14.6     12.5     10.6      8.8      8.4     17.2     12.8      1.79
Mississippi...........................................     20,136     58.9     28.5      8.7      3.8     25.2     35.8     35.1     33.5     31.9     20.0     24.0     37.1     24.5      2.08
                                                                                                                                                                                                
Missouri..............................................     26,362     47.4     33.6     12.6      6.4     13.3     20.4     19.2     17.8     15.1     11.1     11.3     19.7     15.6      1.96
Montana...............................................     22,988     53.9     33.0      9.2      3.9     16.1     24.3     23.0     20.3     17.1     14.7      9.9     16.6     13.7      1.73
Nebraska..............................................     26,016     47.9     35.8     11.4      5.0     11.1     17.3     15.4     13.4     10.8      9.7      8.6     16.8     10.3      1.49
Nevada................................................     31,011     39.1     37.3     15.2      8.3     10.2     15.1     14.4     12.6     11.9      9.1      8.4     12.3     14.4      1.80
New Hampshire.........................................     36,329     31.8     37.8     19.8     10.7      6.4      8.5      8.7      7.3      6.2      5.4      7.7     13.9      8.6      1.63
                                                                                                                                                                                                
New Jersey............................................     40,927     28.8     32.0     20.9     18.3      7.6     11.7     12.6     11.7     10.4      6.0      6.8     11.3     10.0      0.82
New Mexico............................................     24,087     51.6     31.7     11.0      5.6     20.6     30.3     30.6     27.6     25.2     17.8     13.7     21.2     21.0      2.04
New York..............................................     32,965     38.1     31.6     16.7     13.6     13.0     20.6     21.2     19.6     17.0     11.0     10.0     14.7     15.3      0.75
North Carolina........................................     26,647     46.8     34.8     12.4      6.0     13.0     19.2     18.5     17.2     15.3     10.1     15.7     25.9     15.7      0.96
North Dakota..........................................     23,213     53.4     33.6      9.4      3.5     14.4     19.6     18.4     17.2     14.7     13.0     10.8     19.5     11.9      1.61
                                                                                                                                                                                                
Ohio..................................................     28,706     43.5     35.5     14.1      6.9     12.5     21.1     19.9     17.8     14.6     10.7      8.7     13.8     12.4      0.88
Oklahoma..............................................     23,577     52.5     31.8     10.6      5.0     16.7     25.3     23.4     21.7     18.5     14.2     13.5     24.1     18.4      1.96
Oregon................................................     27,250     45.6     35.7     12.5      6.2     12.4     19.7     16.1     14.8     13.3     11.5      8.1     13.1     11.3      1.73
Pennsylvania..........................................     29,069     43.0     35.0     14.1      7.9     11.1     17.5     17.0     15.7     13.8      9.5      8.7     13.5     11.7      0.85
Rhode Island..........................................     32,181     38.5     35.1     16.7      9.7      9.6     16.3     16.1     13.8     11.0      7.6      8.9     15.6     12.0      1.91
                                                                                                                                                                                                
South Carolina........................................     26,256     47.6     34.5     12.4      5.6     15.4     22.8     21.8     21.2     19.1     12.0     17.3     26.5     18.9      1.80
South Dakota..........................................     22,503     55.0     33.4      8.2      3.5     15.9     23.6     22.2     20.2     17.3     13.6     11.1     21.3     14.8      1.64
Tennessee.............................................     24,807     50.3     32.6     11.4      5.6     15.7     23.9     22.5     20.8     18.5     12.5     17.2     26.7     17.0      1.85
Texas.................................................     27,016     46.3     32.3     13.3      8.0     18.1     25.6     25.5     24.2     23.0     15.2     14.9     23.8     17.8      1.01
Utah..................................................     29,470     41.4     38.8     13.8      6.0     11.4     15.8     14.4     12.0     10.0     11.0      6.4     12.5      9.3      1.45
                                                                                                                                                                                                
Vermont...............................................     29,792     41.2     37.7     14.3      6.8      9.9     13.5     13.7     12.5      9.8      8.5      9.7     16.3     10.4      1.71
Virginia..............................................     33,328     36.4     34.7     17.7     11.8     10.2     14.5     14.5     13.5     11.9      8.4     11.6     18.5      9.4      1.35
Washington............................................     31,183     39.3     36.4     15.8      8.5     10.9     17.0     16.4     14.3     12.2      9.8      7.0     12.4     11.0      1.58
West Virginia.........................................     20,795     57.8     29.7      9.0      3.5     19.7     31.7     30.3     25.9     22.4     17.7     14.1     20.8     22.3      2.20
Wisconsin.............................................     29,442     42.1     37.6     14.1      6.2     10.7     17.7     16.4     15.0     11.9      9.2      6.6     12.6     10.8      1.49
Wyoming...............................................     27,096     46.0     36.5     12.8      4.8     11.9     18.3     16.2     14.1     11.2     10.8      8.4     14.3     10.3      1.83
------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------
\1\ Based on 1989 incomes collected in the 1990 Census. May differ from data derived from the Current Population Survey presented in other tables.                                              
\2\ Based on 1991 incomes.                                                                                                                                                                      
                                                                                                                                                                                                
SOURCE: U.S. Department of Commerce, Bureau of the ``Census, Decennial Census, Minority Economics Profiles,'' unpublished data: and ``Current Population Reports,'' Series P-60, no. 185,       
  ``Poverty in the United States, 1992.'' (This table was prepared May 1994.)                                                                                                                   


                                TABLE 172.--TOTAL FALL ENROLLMENT IN INSTITUTIONS OF HIGHER EDUCATION, BY LEVEL, SEX, AGE, AND ATTENDANCE STATUS OF STUDENT: 1991                               
------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------
                                                                       All levels                         Undergraduate                  First-professional                  Graduate           
          Attendance status and age of student           ---------------------------------------------------------------------------------------------------------------------------------------
                                                             Total         Men        Women       Total         Men        Women      Total      Men      Women      Total       Men      Women 
------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------
1                                                                   2           3           4            5           6           7         8         9        10          11        12        13
------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------
All students............................................   14,358,953   6,501,844   7,857,109   12,439,287   5,571,003   6,868,284   280,531   169,875   110,656   1,639,135   760,966   878,169
    Under 18............................................      213,684      87,145     126,539      213,097      86,888     126,209        51        37        14         536       220       316
    18 and 19...........................................    2,593,623   1,175,496   1,418,127    2,592,594   1,175,068   1,417,526       338       142       196         691       286       405
    20 and 21...........................................    2,752,642   1,298,156   1,454,486    2,729,707   1,287,028   1,442,679     8,092     4,080     4,012      14,843     7,048     7,795
    22 to 24............................................    2,150,871   1,095,190   1,055,681    1,820,695     930,872     889,823    97,499    57,277    40,222     232,677   107,041   125,636
    25 to 29............................................    1,897,644     910,849     986,795    1,355,909     615,336     740,573    91,607    58,668    32,939     450,128   236,845   213,283
    30 to 34............................................    1,270,208     538,698     731,510      960,503     371,317     589,186    30,409    19,311    11,098     279,296   148,070   131,226
    35 to 39............................................      965,541     356,601     608,940      736,886     252,476     484,410    15,899     9,238     6,661     212,756    94,887   117,869
    40 to 49............................................    1,053,932     337,673     716,259      773,473     236,796     536,677    12,165     6,373     5,792     268,294    94,504   173,790
    50 to 64............................................      281,986      91,315     190,671      215,507      68,904     146,603     2,335     1,202     1,133      64,144    21,209    42,935
    65 and over.........................................       63,566      24,543      39,023       58,343      22,148      36,195       172       102        70       5,051     2,293     2,768
    Age unknown.........................................    1,115,256     586,178     529,078      982,573     524,170     458,403    21,964    13,445     8,519     110,719    48,563    62,156
                                                                                                                                                                                                
Full-time...............................................    8,115,329   3,929,375   4,185,954    7,221,412   3,435,526   3,785,886   252,012   152,356    99,656     641,905   341,493   300,412
    Under 18............................................      114,591      47,016      67,575      114,435      46,921      67,514        43        32        11         113        63        50
    18 and 19...........................................    2,256,045   1,032,557   1,223,488    2,255,405   1,032,264   1,223,141       328       140       188         312       153       159
    20 and 21...........................................    2,215,877   1,064,488   1,151,389    2,196,395   1,054,778   1,141,617     7,996     4,038     3,958      11,486     5,672     5,814
    22 to 24............................................    1,376,269     753,084     623,185    1,129,520     623,063     506,457    94,910    55,708    39,202     151,839    74,313    77,526
    25 to 29............................................      799,421     433,186     366,235      510,589     259,596     250,993    83,395    53,505    29,890     205,437   120,085    85,352
    30 to 34............................................      395,588     182,117     213,471      273,210     108,334     164,876    24,589    15,465     9,124      97,789    58,318    39,471
    35 to 39............................................      254,555     100,816     153,739      183,140      63,429     119,711    11,847     6,818     5,029      59,568    30,569    28,999
    40 to 49............................................      227,918      83,407     144,511      160,276      54,915     105,361     8,355     4,335     4,020      59,287    24,157    35,130
    50 to 64............................................       43,821      15,987      27,834       30,219      10,625      19,594     1,494       772       722      12,108     4,590     7,518
    65 and over.........................................        5,500       2,685       2,815        4,702       2,266       2,436        92        55        37         706       364       342
    Age unknown.........................................      425,744     214,032     211,712      363,521     179,335     184,186    18,963    11,488     7,475      43,260    23,209    20,051
                                                                                                                                                                                                
Part-time...............................................    6,243,624   2,572,469   3,671,155    5,217,875   2,135,477   3,082,398    28,519    17,519    11,000     997,230   419,473   577,757
    Under 18............................................       99,093      40,129      58,964       98,662      39,967      58,695         8         5         3         423       157       266
    18 and 19...........................................      337,578     142,939     194,639      337,189     142,804     194,385        10         2         8         379       133       246
    20 and 21...........................................      536,765     233,668     303,097      533,312     232,250     301,062        96        42        54       3,357     1,376     1,981
    22 to 24............................................      774,602     342,106     432,496      691,175     307,809     383,366     2,589     1,569     1,020      80,838    32,728    48,110
    25 to 29............................................    1,098,223     477,663     620,560      845,320     355,740     489,580     8,212     5,163     3,049     244,691   116,760   127,931
    30 to 34............................................      874,620     356,581     518,039      687,293     262,983     424,310     5,820     3,846     1,974     181,507    89,752    91,755
    35 to 39............................................      710,986     255,785     455,201      553,746     189,047     364,699     4,052     2,420     1,632     153,188    64,318    88,870
    40 to 49............................................      826,014     254,266     571,748      613,197     181,881     431,316     3,810     2,038     1,772     209,007    70,347   138,660
    50 to 64............................................      238,165      75,328     162,837      185,288      58,279     127,009       841       430       411      52,036    16,619    35,417
    65 and over.........................................       58,066      21,858      36,208       53,641      19,882      33,759        80        47        33       4,345     1,929     2,416
    Age unknown.........................................      689,512     372,146     317,366      619,052     344,835     274,217     3,001     1,957     1,044      67,459    25,354   42,105 
                                                                                                                 Percentage distribution                                                        
                                                                                                                                                                                                
                                                         ---------------------------------------------------------------------------------------------------------------------------------------
All students............................................        100.0       100.0       100.0        100.0       100.0       100.0     100.0     100.0     100.0       100.0     100.0     100.0
    Under 18............................................          1.5         1.3         1.6          1.7         1.6         1.8     (\1\)     (\1\)     (\1\)       (\1\)     (\1\)     (\1\)
    18 and 19...........................................         18.1        18.1        18.0         20.8        21.1        20.6       0.1       0.1       0.2       (\1\)     (\1\)     (\1\)
    20 and 21...........................................         19.2        20.0        18.5         21.9        23.1        21.0       2.9       2.4       3.6         0.9       0.9       0.9
    22 to 24............................................         15.0        16.8        13.4         14.6        16.7        13.0      34.8      33.7      36.3        14.2      14.1      14.3
    25 to 29............................................         13.2        14.0        12.6         10.9        11.0        10.8      32.7      34.5      29.8        27.5      31.1      24.3
    30 to 34............................................          8.8         8.3         9.3          7.7         6.7         8.6      10.8      11.4      10.0        17.0      19.5      14.9
    35 to 39............................................          6.7         5.5         7.8          5.9         4.5         7.1       5.7       5.4       6.0        13.0      12.5      13.4
    40 to 49............................................          7.3         5.2         9.1          6.2         4.3         7.8       4.3       3.8       5.2        16.4      12.4      19.8
    50 to 64............................................          2.0         1.4         2.4          1.7         1.2         2.1       0.8       0.7       1.0         3.9       2.8       4.9
    65 and over.........................................          0.4         0.4         0.5          0.5         0.4         0.5       0.1       0.1       0.1         0.3       0.3       0.3
    Age unknown.........................................          7.8         9.0         6.7          7.9         9.4         6.7       7.8       7.9       7.7         6.8       6.4       7.1
                                                                                                                                                                                                
Full-time...............................................        100.0       100.0       100.0        100.0       100.0       100.0     100.0     100.0     100.0       100.0     100.0     100.0
    Under 18............................................          1.4         1.2         1.6          1.6         1.4         1.8     (\1\)     (\1\)     (\1\)       (\1\)     (\1\)     (\1\)
    18 and 19...........................................         27.8        26.3        29.2         31.2        30.0        32.3       0.1       0.1       0.2       (\1\)     (\1\)       0.1
    20 and 21...........................................         27.3        27.1        27.5         30.4        30.7        30.2       3.2       2.7       4.0         1.8       1.7       1.9
    22 to 24............................................         17.0        19.2        14.9         15.6        18.1        13.4      37.7      36.6      39.3        23.7      21.8      25.8
    25 to 29............................................          9.9        11.0         8.7          7.1         7.6         6.6      33.1      35.1      30.0        32.0      35.2      28.4
    30 to 34............................................          4.9         4.6         5.1          3.8         3.2         4.4       9.8      10.2       9.2        15.2      17.1      13.1
    35 to 39............................................          3.1         2.6         3.7          2.5         1.8         3.2       4.7       4.5       5.0         9.3       9.0       9.7
    40 to 49............................................          2.8         2.1         3.5          2.2         1.6         2.8       3.3       2.8       4.0         9.2       7.1      11.7
    50 to 64............................................          0.5         0.4         0.7          0.4         0.3         0.5       0.6       0.5       0.7         1.9       1.3       2.5
    65 and over.........................................          0.1         0.1         0.1          0.1         0.1         0.1       0.0       0.0       0.0         0.1       0.1       0.1
    Age unknown.........................................          5.2         5.4         5.1          5.0         5.2         4.9       7.5       7.5       7.5         6.7       6.8       6.7
                                                                                                                                                                                                
All students............................................        100.0       100.0       100.0        100.0       100.0       100.0     100.0     100.1     100.0       100.0     100.0     100.0
    Under 18............................................          1.6         1.6         1.6          1.9         1.9         1.9     (\1\)     (\1\)     (\1\)       (\1\)     (\1\)     (\1\)
    18 and 19...........................................          5.4         5.6         5.3          6.5         6.7         6.3       0.0     (\1\)       0.1       (\1\)     (\1\)     (\1\)
    20 and 21...........................................          8.6         9.1         8.3         10.2        10.9         9.8       0.3       0.2       0.5         0.3       0.3       0.3
    22 to 24............................................         12.4        13.3        11.8         13.2        14.4        12.4       9.1       9.0       9.3         8.1       7.8       8.3
    25 to 29............................................         17.6        18.6        16.9         16.2        16.7        15.9      28.8      29.5      27.7        24.5      27.8      22.1
    30 to 34............................................         14.0        13.9        14.1         13.2        12.3        13.8      20.4      22.0      17.9        18.2      21.4      15.9
    35 to 39............................................         11.4         9.9        12.4         10.6         8.9        11.8      14.2      13.8      14.8        15.4      15.3      15.4
    40 to 49............................................         13.2         9.9        15.6         11.8         8.5        14.0      13.4      11.6      16.1        21.0      16.8      24.0
    50 to 64............................................          3.8         2.9         4.4          3.6         2.7         4.1       2.9       2.5       3.7         5.2       4.0       6.1
    65 and over.........................................          0.9         0.8         1.0          1.0         0.9         1.1       0.3       0.3       0.3         0.4       0.5       0.4
    Age unknown.........................................         11.0        14.5         8.6         11.9        16.1         8.9      10.5      11.2       9.5         6.8       6.0       7.3
------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------
\1\ Less than .05 percent.                                                                                                                                                                      
                                                                                                                                                                                                
NOTE.--Because of rounding, details may not add to 100.0 percent.                                                                                                                               
                                                                                                                                                                                                
SOURCE: U.S. Department of Education, National Center for Education Statistics, Integrated Postsecondary Education Data System, ``Fall Enrollment, 1991'' survey. (This table was prepared      
  February 1993.)                                                                                                                                                                               


  TABLE 173.--TOTAL FALL ENROLLMENT IN INSTITUTIONS OF HIGHER EDUCATION, BY TYPE AND CONTROL OF INSTITUTION, AND AGE AND ATTENDANCE STATUS OF STUDENT:  
                                                                          1991                                                                          
--------------------------------------------------------------------------------------------------------------------------------------------------------
                                                All institutions                     Public institutions                    Private institutions        
    Attendance status and age of    --------------------------------------------------------------------------------------------------------------------
              student                   Total        4-year       2-year       Total        4-year       2-year       Total        4-year       2-year  
--------------------------------------------------------------------------------------------------------------------------------------------------------
1                                              2            3            4            5            6            7            8            9           10
--------------------------------------------------------------------------------------------------------------------------------------------------------
All students.......................   14,358,953    8,707,053    5,651,900   11,309,563    5,904,748    5,404,815    3,049,390    2,802,305      247,085
    Under 18.......................      213,684      113,777       99,907      162,678       66,966       95,712       51,006       46,811        4,195
    18 and 19......................    2,593,623    1,676,660      916,963    1,996,126    1,136,632      859,494      597,497      540,028       57,469
    20 and 21......................    2,752,642    1,942,306      810,336    2,132,991    1,361,340      771,651      619,651      580,966       38,685
    22 to 24.......................    2,150,871    1,515,478      635,393    1,733,554    1,129,085      604,469      417,317      386,393       30,924
    25 to 29.......................    1,897,644    1,165,950      731,694    1,484,825      784,563      700,262      412,819      381,387       31,432
    30 to 34.......................    1,270,208      678,344      591,864    1,018,605      447,336      571,269      251,603      231,008       20,595
    35 to 39.......................      965,541      504,151      461,390      784,425      336,295      448,130      181,116      167,856       13,260
    40 to 49.......................    1,053,932      549,964      503,968      853,930      361,332      492,598      200,002      188,632       11,370
    50 to 64.......................      281,986      125,802      156,184      235,622       82,214      153,408       46,364       43,588        2,776
    65 and over....................       63,566       19,394       44,172       57,733       14,211       43,522        5,833        5,183          650
    Age unknown....................    1,115,256      415,227      700,029      849,074      184,774      664,300      266,182      230,453       35,729
Full-time..........................    8,115,329    6,040,799    2,074,530    5,974,577    4,088,970    1,885,607    2,140,752    1,951,829      188,923
    Under 18.......................      114,591       81,779       32,812       76,190       46,921       29,269       38,401       34,858        3,543
    18 and 19......................    2,256,045    1,597,791      658,254    1,675,153    1,071,167      603,986      580,892      526,624       54,268
    20 and 21......................    2,215,877    1,778,684      437,193    1,633,403    1,228,607      404,796      582,474      550,077       32,397
    22 to 24.......................    1,376,269    1,147,292      228,977    1,054,517      848,962      205,555      321,752      298,330       23,422
    25 to 29.......................      799,421      606,382      193,039      578,563      406,688      171,875      220,858      199,694       21,164
    30 to 34.......................      395,588      263,746      131,842      294,925      175,975      118,950      100,663       87,771       12,892
    35 to 39.......................      254,555      164,433       90,122      190,126      107,806       82,320       64,429       56,627        7,802
    40 to 49.......................      227,918      145,874       82,044      167,759       91,977       75,782       60,159       53,897        6,262
    50 to 64.......................       43,821       26,029       17,792       31,711       15,378       16,333       12,110       10,651        1,459
    65 and over....................        5,500        3,026        2,474        3,875        1,779        2,096        1,625        1,247          378
    Age unknown....................      425,744      225,763      199,981      268,355       93,710      174,645      157,389      132,053       25,336
Part-time..........................    6,243,624    2,666,254    3,577,370    5,334,986    1,815,778    3,519,208      908,638      850,476       58,162
    Under 18.......................       99,093       31,998       67,095       86,488       20,045       66,443       12,605       11,953          652
    18 and 19......................      337,578       78,869      258,709      320,973       65,465      255,508       16,605       13,404        3,201
    20 and 21......................      536,765      163,622      373,143      499,588      132,733      366,855       37,177       30,889        6,288
    22 to 24.......................      774,602      368,186      406,416      679,037      280,123      398,914       95,565       88,063        7,502
    25 to 29.......................    1,098,223      559,568      538,655      906,262      377,875      528,387      191,961      181,693       10,268
    30 to 34.......................      874,620      414,598      460,022      723,680      271,361      452,319      150,940      143,237        7,703
    35 to 39.......................      710,986      339,718      371,268      594,299      228,489      365,810      116,687      111,229        5,458
    40 to 49.......................      826,014      404,090      421,924      686,171      269,355      416,816      139,843      134,735        5,108
    50 to 64.......................      238,165       99,773      138,392      203,911       66,836      137,075       34,254       32,937        1,317
    65 and over....................       58,066       16,368       41,698       53,858       12,432       41,426        4,208        3,936          272
    Age unknown....................      689,512      189,464      500,048      580,719       91,064      489,655      108,793       98,400       10,393
                                    ====================================================================================================================
                                                                                                                                                        
                                                                                   Percentage distribution                                              
                                                                                                                                                        
                                    --------------------------------------------------------------------------------------------------------------------
All students.......................        100.0        100.0        100.0        100.0        100.0        100.0        100.0        100.0        100.0
    Under 18.......................          1.5          1.3          1.8          1.4          1.1          1.8          1.7          1.7          1.7
    18 and 19......................         18.1         19.3         16.2         17.6         19.2         15.9         19.6         19.3         23.3
    20 and 21......................         19.2         22.3         14.3         18.9         23.1         14.3         20.3         20.7         15.7
    22 to 24.......................         15.0         17.4         11.2         15.3         19.1         11.2         13.7         13.8         12.5
    25 to 29.......................         13.2         13.4         12.9         13.1         13.3         13.0         13.5         13.6         12.7
    30 to 34.......................          8.8          7.8         10.5          9.0          7.6         10.6          8.3          8.2          8.3
    35 to 39.......................          6.7          5.8          8.2          6.9          5.7          8.3          5.9          6.0          5.4
    40 to 49.......................          7.3          6.3          8.9          7.6          6.1          9.1          6.6          6.7          4.6
    50 to 64.......................          2.0          1.4          2.8          2.1          1.4          2.8          1.5          1.6          1.1
    65 and over....................          0.4          0.2          0.8          0.5          0.2          0.8          0.2          0.2          0.3
    Age unknown....................          7.8          4.8         12.4          7.5          3.1         12.3          8.7          8.2         14.5
                                                                                                                                                        
Full-time..........................        100.0        100.0        100.0        100.0        100.0        100.0        100.0        100.0        100.0
    Under 18.......................          1.4          1.4          1.6          1.3          1.1          1.6          1.8          1.8          1.9
    18 and 19......................         27.8         26.4         31.7         28.0         26.2         32.0         27.1         27.0         28.7
    20 and 21......................         27.3         29.4         21.1         27.3         30.0         21.5         27.2         28.2         17.1
    22 to 24.......................         17.0         19.0         11.0         17.7         20.8         10.9         15.0         15.3         12.4
    25 to 29.......................          9.9         10.0          9.3          9.7          9.9          9.1         10.3         10.2         11.2
    30 to 34.......................          4.9          4.4          6.4          4.9          4.3          6.3          4.7          4.5          6.8
    35 to 39.......................          3.1          2.7          4.3          3.2          2.6          4.4          3.0          2.9          4.1
    40 to 49.......................          2.8          2.4          4.0          2.8          2.2          4.0          2.8          2.8          3.3
    50 to 64.......................          0.5          0.4          0.9          0.5          0.4          0.9          0.6          0.5          0.8
    65 and over....................          0.1          0.1          0.1          0.1          0.0          0.1          0.1          0.1          0.2
    Age unknown....................          5.2          3.7          9.6          4.5          2.3          9.3          7.4          6.8         13.4
                                                                                                                                                        
Part-time..........................        100.0        100.0        100.0        100.0        100.0        100.0        100.0        100.0        100.0
    Under 18.......................          1.6          1.2          1.9          1.6          1.1          1.9          1.4          1.4          1.1
    18 and 19......................          5.4          3.0          7.2          6.0          3.6          7.3          1.8          1.6          5.5
    20 and 21......................          8.6          6.1         10.4          9.4          7.3         10.4          4.1          3.6         10.8
    22 to 24.......................         12.4         13.8         11.4         12.7         15.4         11.3         10.5         10.4         12.9
    25 to 29.......................         17.6         21.0         15.1         17.0         20.8         15.0         21.1         21.4         17.7
    30 to 34.......................         14.0         15.5         12.9         13.6         14.9         12.9         16.6         16.8         13.2
    35 to 39.......................         11.4         12.7         10.4         11.1         12.6         10.4         12.8         13.1          9.4
    40 to 49.......................         13.2         15.2         11.8         12.9         14.8         11.8         15.4         15.8          8.8
    50 to 64.......................          3.8          3.7          3.9          3.8          3.7          3.9          3.8          3.9          2.3
    65 and over....................          0.9          0.6          1.2          1.0          0.7          1.2          0.5          0.5          0.5
    Age unknown....................         11.0          7.1         14.0         10.9          5.0         13.9         12.0         11.6         17.9
--------------------------------------------------------------------------------------------------------------------------------------------------------
NOTE.--Because of rounding, details may not add to 100.0 percent.                                                                                       
                                                                                                                                                        
SOURCE: U.S. Department of Education, National Center for Education Statistics, Integrated Postsecondary Education Data System, ``Fall Enrollment,      
  1991'' survey. (This table was prepared February 1993).                                                                                               


                  TABLE 343.--PARTICIPANTS IN ADULT EDUCATION 17 YEARS OLD AND OLDER, BY SELECTED CHARACTERISTICS OF PARTICIPANTS: 1991                 
                                                                 [Numbers in thousands]                                                                 
--------------------------------------------------------------------------------------------------------------------------------------------------------
                                                                              Ever a participant in     Participated in adult     Participated in adult 
                                                                               adult education \2\     education \2\ in past 3    education \2\ in past 
                                                               Number of   --------------------------           years                     year          
              Characteristics of participants                  adults in                             ---------------------------------------------------
                                                            population \1\     Number     Percent of                Percent of                Percent of
                                                                                          population     Number     population     Number     population
--------------------------------------------------------------------------------------------------------------------------------------------------------
1                                                                       2             3            4            5            6            7            8
--------------------------------------------------------------------------------------------------------------------------------------------------------
      Total...............................................        181,800        97,397           54       69,361           38       57,391           32
                                                           ---------------------------------------------------------------------------------------------
Age:                                                                                                                                                    
    17 to 24 years........................................         21,688         9,240           43        8,756           40        7,125           33
    25 to 34 years........................................         47,244        27,325           58       22,773           48       17,580           37
    35 to 44 years........................................         38,565        25,043           65       19,581           51       17,083           44
    45 to 54 years........................................         25,375        14,755           58        9,351           37        8,107           32
    55 to 64 years........................................         19,967        10,101           51        5,150           26        4,516           23
    65 years and over.....................................         28,960        10,934           38        3,750           13        3,031           10
                                                                                                                                                        
Sex:                                                                                                                                                    
    Men...................................................         82,154        42,163           51       29,945           36       25,963           32
    Women.................................................         99,646        55,234           55       39,415           40       31,469           32
                                                                                                                                                        
Racial/ethnic group:                                                                                                                                    
    White, non-Hispanic...................................        143,144        80,099           56       56,715           40       47,401           33
    Black, non-Hispanic...................................         20,141         8,213           41        5,552           28        4,586           23
    Hispanic..............................................         13,804         6,905           50        5,396           39        4,032           29
    Other races, non-Hispanic.............................          4,711         2,180           46        1,698           36        1,371           29
                                                                                                                                                        
Highest level of education completed:                                                                                                                   
    Less than high school diploma.........................         28,306         7,337           26        4,127           15        3,437           12
    High school diploma...................................        110,384        58,135           53       39,403           36       31,602           29
    Associate degree......................................          5,034         3,949           78        3,191           63        2,461           49
    Bachelor's degree or higher...........................         38,076        27,976           73       22,640           59       19,891           52
                                                                                                                                                        
Labor force status:                                                                                                                                     
    In labor force........................................        125,440        73,513           59       58,078           46       49,242           39
      Employed............................................        115,620        69,421           60       55,093           48       47,143           41
      Unemployed..........................................          9,820         4,092           42        2,985           30        3,099           21
    Not in labor force....................................         56,361        23,884           42       11,283           20        8,149           14
                                                                                                                                                        
Annual family income:                                                                                                                                   
    $10,000 or less.......................................         27,504        10,706           39        5,766           21        3,843           14
    $10,001 to $15,000....................................         15,465         7,014           45        4,426           29        3,178           21
    $15,001 to $20,000....................................         16,117         6,335           39        4,183           26        3,308           21
    $20,001 to $25,000....................................         16,092         7,666           48        5,343           33        4,063           25
    $25,001 to $30,000....................................         17,973         9,309           52        6,570           37        5,445           30
    $30,001 to $40,000....................................         26,110        14,922           57       10,313           39        9,043           35
    $40,001 to $50,000....................................         21,303        13,270           62       10,526           49        9,313           44
    $50,001 to $75,000....................................         24,540        16,629           68       12,971           53       11,235           46
    More than $75,000.....................................         16,695        11,546           69        9,263           55        7,963           48
--------------------------------------------------------------------------------------------------------------------------------------------------------
\1\ Persons 17 years of age and over on the date of the survey.                                                                                         
\2\ Adult education is defined as all non-full-time education activities such as part-time college attendance, classes or seminars given by employers,  
  and classes taken for adult literacy purposes, or for recreation and enjoyment.                                                                       
                                                                                                                                                        
NOTE.--Data are based upon a sample survey of the civilian noninstitutional population. Because of rounding and survey item nonresponse, details may not
  add to totals.                                                                                                                                        
                                                                                                                                                        
SOURCE: U.S. Department of Education, National Center for Education Statistics, ``Participation in Adult Education,'' unpublished data. (This table was 
  prepared July 1991.)                                                                                                                                  


      Table 344.--TYPE OF EMPLOYER INVOLVEMENT AND NUMBER OF COURSES TAKEN BY ADULT EDUCATION PARTICIPANTS \1\ 17 YEARS OLD AND OLDER, BY SELECTED      
                                                          CHARACTERISTICS OF PARTICIPANTS: 1991                                                         
--------------------------------------------------------------------------------------------------------------------------------------------------------
                                             Adult         Type of employer involvement (percent of adult education       Percentage distribution of the
                                           education                             participants)                              number of adult education   
                                         participants ------------------------------------------------------------------  courses taken in the past year
    Characteristics of participants       in the past              Given at   Employer   Employer   Employer   Employer --------------------------------
                                           year, in     Any type   place of  paid some   provided   required   provided               Two or    Four or 
                                           thousands                 work     portion     course     course    time off     One       three       more  
--------------------------------------------------------------------------------------------------------------------------------------------------------
1                                                  2           3          4          5          6          7          8          9         10         11
--------------------------------------------------------------------------------------------------------------------------------------------------------
      Total............................       57,391          64         32         51         38         30         48         43         34         21
                                        ----------------------------------------------------------------------------------------------------------------
Age:                                                                                                                                                    
    17 to 24 years.....................        7,125          54         28         39         36         26         39         46         30         22
    25 to 34 years.....................       17,530          68         31         55         40         36         50         43         34         20
    35 to 44 years.....................       17,083          70         35         56         40         30         53         38         36         23
    45 to 54 years.....................        8,107          71         39         59         44         32         55         41         36         22
    55 to 64 years.....................        4,516          64         30         48         36         27         45         50         32         16
    65 years and over..................        3,031          18          8         12          9          9         12         60         27          9
                                                                                                                                                        
Sex:                                                                                                                                                    
    Men................................       25,923          73         35         58         42         34         56         42         37         19
    Women..............................       31,469          57         29         46         35         27         41         44         31         22
                                                                                                                                                        
Racial/ethnic group:                                                                                                                                    
    White, non-Hispanic................       47,401          65         32         53         39         30         49         42         35         21
    Black, non-Hispanic................        4,586          59         36         48         41         38         44         41         31         24
    Hispanic...........................        4,032          58         30         39         33         31         43         56         27         14
    Other races, non-Hispanic..........        1,371          56         28         36         30         20         40         39         27         28
                                                                                                                                                        
Highest level of education completed:                                                                                                                   
    Less than high school diploma......        3,437          35         17         21         19         21         19         72         17          8
    High school diploma................       31,602          52         31         50         36         31         45         47         32         18
    Associate degree...................        2,461          76         47         66         51         39         63         32         40         25
    Bachelor's degree or higher........       19,891          71         34         57         44         30         56         33         39         26
                                                                                                                                                        
Labor force status:                                                                                                                                     
    In labor force.....................       49,242          72         36         58         43         34         54         41         35         22
      Employed.........................       47,143          74         37         60         44         35         56         40         36         22
      Unemployed.......................        2,099          35         12         13         12         19         18         56         23         16
    Not in labor force.................        8,149          16          7         11          9          8         10         60         26         12
                                                                                                                                                        
Annual family income:                                                                                                                                   
    $10,000 or less....................        3,843          39         18         25         24         23         29         59         20         15
    $10,001 to $15,000.................        3,178          52         27         37         24         27         37         53         32         13
    $15,001 to $20,000.................        3,308          57         28         42         35         29         39         46         37         15
    $20,001 to $25,000.................        4,063          67         34         46         37         34         48         48         32         17
    $25,001 to $30,000.................        5,445          58         30         48         38         29         39         44         34         19
    $30,001 to $40,000.................        9,043          68         35         57         43         35         50         42         32         24
    $40,001 to $50,000.................        9,313          67         34         55         42         33         50         45         32         20
    $50,001 to $75,000.................       11,235          72         35         61         43         32         58         39         37         22
    More than $75,000..................        7,963          68         30         54         37         24         53         32         41         26
--------------------------------------------------------------------------------------------------------------------------------------------------------
\1\ Adult education is defined as all non-full-time education, activities such as part-time college attendance, classes or seminars given by employers, 
  and classes taken for adult literacy purposes, or for recreation and employment.                                                                      
                                                                                                                                                        
NOTE.--Data are based upon a sample survey of the civilian noninstitutional population. Because of rounding and survey item nonresponse, details may not
  add to totals.                                                                                                                                        
                                                                                                                                                        
SOURCE: U.S. Department of Education, National Center for Education Statistics, Participation in Adult Education,'' unpublished data. (This table was   
  prepared July 1991.)                                                                                                                                  


                          TABLE 345.--PARTICIPANTS IN ADULT BASIC AND SECONDARY EDUCATION PROGRAMS, BY LEVEL OF ENROLLMNET AND STATE: FISCAL YEARS 1980, 1990, and 1991                         
------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------
                                                                                     1980                                          1990                                    1991                 
                                                             -----------------------------------------------------------------------------------------------------------------------------------
                                                                                    Level of enrollment                           Level of enrollment                     Level of enrollment   
                     State or other area                                  ---------------------------------------             ---------------------------             --------------------------
                                                                 Total                     Adult                     Total                      Adult        Total                      Adult   
                                                                           Adult basic   secondary     Ungraded                 Adult basic   secondary                 Adult basic   secondary 
                                                                            education    education                             education\1\   education                education\1\   education 
------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------
1                                                                       2            3            4            5            6             7            8            9            10           11
------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------
      United States.........................................    2,018,906      915,936      531,663      571,307    3,535,970     2,435,649    1,100,321    3,694,217     2,513,371    1,180,846
                                                             -----------------------------------------------------------------------------------------------------------------------------------
Alabama.....................................................       51,599       36,726       12,372        2,501       40,177        32,984        7,193       45,700        36,319        9,381
Alaska......................................................        5,667        2,200        2,188        1,279        5,067         4,267          800        5,399         4,488          911
Arizona.....................................................        9,996        9,968           22            6       33,805        24,915        8,890       36,717        26,709       10,008
Arkansas....................................................        8,583        7,308        1,275  ...........       29,065        17,103       11,962       30,845        17,437       13,408
California..................................................      267,625       60,385  ...........      207,240    1,021,227       753,282      267,945    1,022,583       761,637      260,946
Colorado....................................................        9,381        4,295        2,644        2,442       12,183         9,877        2,306       13,742        10,764        2,978
Connecticut.................................................       21,889        8,882        4,805        8,202       46,434        25,560       20,874       57,188        32,117       25,071
Delaware....................................................        1,797        1,110          503          184        2,662         2,348          314        2,567         2,167          400
District of Columbia........................................       25,214        4,928        6,502       13,784       19,586        12,631        6,955       20,309        13,207        7,102
Florida.....................................................      467,162      100,958      184,568      181,636      419,429       249,339      170,090      436,766       260,761      176,005
Georgia.....................................................       50,820       26,734       17,008        7,078       69,580        49,622       19,958       80,119        59,107       21,012
Hawaii......................................................       16,457       16,457  ...........  ...........       52,012        31,766       20,246       53,051        29,816       23,235
Idaho.......................................................       12,851        8,915        3,010          926       11,171         9,180        1,991       10,215         8,407        1,808
Illinois....................................................       76,456       59,314       17,142  ...........       87,121        69,770       17,351       91,383        72,997       18,386
Indiana.....................................................       20,882       18,127        2,660           95       44,166        27,138       17,028       50,483        31,101       19,382
Iowa........................................................       25,851       16,928        5,153        3,770       41,507        30,470       11,037       38,998        28,009       10,989
Kansas......................................................       14,405        3,687        7,436        3,282       10,274         9,191        1,083       11,179         8,877        2,302
Kentucky....................................................       27,800        6,147        4,735       16,918       28,090        20,406        7,684       23,248        16,683        6,565
Louisiana...................................................       16,046       12,608        2,485          953       40,039        20,941       19,098       43,349        22,254       21,095
Maine.......................................................        5,327        3,029          942        1,356       14,964         6,620        8,344       16,573         7,505        9,068
Maryland....................................................       34,572       23,421        6,043        5,108       41,230        36,244        4,986       53,505        49,804        3,701
Massachusetts...............................................       20,420       10,241        5,044        5,135       34,220        28,140        6,080       23,218        18,289        4,929
Michigan....................................................       40,973       29,945  ...........       11,028      194,178        80,206      113,972      205,545        75,897      129,648
Minnesota...................................................       10,826        8,627          877        1,322       45,648        33,190       12,458       48,853        31,964       16,889
Mississippi.................................................       14,317       10,340        2,918        1,059       18,957        15,834        3,123       20,015        17,269        2,746
Missouri....................................................       33,292       27,206        3,732        2,354       31,815        27,274        4,541       33,060        28,211        4,849
Montana.....................................................        3,525        1,795          978          752        6,071         3,962        2,109        5,942         3,665        2,277
Nebraska....................................................        7,514        5,152        2,362  ...........        6,158         5,349          809        6,597         5,786          811
Nevada......................................................        3,063          845           82        2,136       17,262         7,270        9,992       19,682         6,329       13,353
New Hampshire...............................................        4,844        2,657        1,625          562        7,198         5,073        2,125        7,137         4,282        2,855
New Jersey..................................................       35,770       17,152        6,790       11,828       64,080        46,526       17,554       65,379        43,162       22,217
New Mexico..................................................       13,102        3,590        5,147        4,365       30,236        18,069       12,167       30,287        17,154       13,133
New York....................................................       94,574       57,217       20,002       17,355      156,611       125,893       30,718      182,879       146,265       36,614
North Carolina..............................................       84,252       33,854       46,679        3,719      109,740        71,698       38,042      120,347        79,641       40,706
North Dakota................................................        2,810        1,963          538          309        3,587         2,500        1,087        3,853         2,725        1,128
Ohio........................................................       50,056       42,421        7,635  ...........       95,476        79,527       15,949      108,753        88,302       20,451
Oklahoma....................................................       14,701        6,983        5,697        2,021       24,307        19,131        5,176       26,707        20,473        6,234
Oregon......................................................       27,645       10,690       12,594        4,361       37,075        24,915       12,160       40,285        24,791       15,494
Pennsylvania................................................       29,477       19,246        6,436        3,795       52,444        40,108       12,336       48,590        38,054       10,536
Rhode Island................................................        5,844        2,266        1,357        2,221        7,347         5,874        1,473        7,264         5,431        1,833
South Carolina..............................................       69,659       27,959       35,165        6,535       81,200        37,117       44,083       86,776        35,911       50,865
South Dakota................................................        4,067        2,080        1,109          878        3,184         2,458          726        3,079         2,349          730
Tennessee...................................................       26,268       17,079        3,244        5,945       41,721        39,604        2,117       49,556        40,702        8,854
Texas.......................................................      157,349       94,245       51,126       11,978      218,747       145,067       73,680      220,027       150,322       69,705
Utah........................................................       18,541        3,756       14,785  ...........       24,841         6,003       18,838       24,028         6,788       17,240
Vermont.....................................................        4,583        3,990  ...........          593        4,808         4,452          356        5,330         4,862          468
Virginia....................................................       21,525       10,480        3,804        7,241       31,649        30,005        1,644       25,456        14,450       11,006
Washington..................................................       16,286        7,245        3,894        5,147       31,776        25,336        6,440       34,401        27,752        6,649
West Virginia...............................................       14,628        9,743        3,672        1,213       21,186        14,227    \2\ 6,959       23,077        16,903        6,174
Wisconsin...................................................       16,158       14,185        1,973  ...........       61,081        45,116       15,965       70,838        53,524       17,314
Wyoming.....................................................        2,457          857          905          695        3,578         2,071     \2\1,507        3,337         1,952        1,385
                                                             ===================================================================================================================================
                       Outlying areas                                                                                                                                                           
American Samoa..............................................          313          252           61  ...........  ...........  ............  ...........  ...........  ............  ...........
Northern Marianas...........................................  ...........  ...........  ...........  ...........  ...........  ............  ...........          290           270           20
Guam........................................................        1,346          612          471          263        1,311           414       \2\897        1,466           478          988
Puerto Rico.................................................       30,164       17,844        9,010        3,310       28,436        28,436  ...........       26,845        26,845  ...........
Trust Territory of the Pacific..............................        3,753        2,138          699          916  ...........  ............  ...........  ...........  ............  ...........
Virgin Islands..............................................        3,500        1,002          859        1,639        1,653         1,215          438  ...........  ............  ...........
------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------
\1\ Includes English as a second language.                                                                                                                                                      
\2\ Estimated.                                                                                                                                                                                  
--Data not available or not applicable.                                                                                                                                                         
                                                                                                                                                                                                
SOURCE: U.S. Department of Education, National Center for Education Statistics, ``Women and Minority Groups Make Up Largest Segment of Adult Basic and Secondary Education Programs;'' and      
  Office of Vocational and Adult Education, ``Adult Education Program Facts, Program Year 1990-1991.'' (This table was prepared June 1993).                                                     


                               LSCA TITLE I--EXPENDITURES FOR THE ELDERLY, FY 1991                              
----------------------------------------------------------------------------------------------------------------
                                                                                                    POPULATION  
              STATE                   FEDERAL          STATE           LOCAL           TOTAL          SERVED    
----------------------------------------------------------------------------------------------------------------
ALABAMA.........................         $29,900              $0         $13,981         $43,881          15,115
ALASKA..........................               0               0               0               0               0
ARIZONA.........................          10,025               0               0          10,025         109,722
ARKANSAS........................           9,000               0               0           9,000          23,452
CALIFORNIA......................         401,600               0               0         401,600         141,500
COLORADO........................          30,825               0               0          30,825             515
CONNECTICUT.....................               0               0               0               0               0
DELAWARE........................           5,569           4,040               0           9,609           5,500
DIST OF COLUMBIA................          72,000          73,530               0         145,530          76,000
FLORIDA.........................          74,280               0          43,966         118,246         188,334
GEORGIA.........................          10,000           2,000           2,120          14,120         138,590
HAWAII..........................               0               0               0               0               0
IDAHO...........................               0               0               0               0               0
ILLINOIS........................               0               0               0               0               0
INDIANA.........................          20,399               0               0          20,399          21,000
IOWA............................           3,876               0               0           3,876          10,482
KANSAS..........................          39,625               0               0          39,625          54,576
KENTUCKY........................          73,728               0               0          73,728         290,269
LOUISIANA.......................          11,747           6,684               0          18,431         468,991
MAINE...........................               0          42,158               0          42,158             500
MARYLAND........................          11,297               0               0          11,297           6,173
MASSACHUSETTS...................               0               0               0               0               0
MICHIGAN........................           9,510               0               0           9,510           2,549
MINNESOTA.......................           5,146               0               0           5,146          21,716
MISSISSIPPI.....................               0               0               0               0               0
MISSOURI........................          48,681               0               0          48,681             200
MONTANA.........................               0               0               0               0               0
NEBRASKA........................           1,501               0               0           1,501         205,684
NEVADA..........................           5,800               0               0           5,800          12,500
NEW HAMPSHIRE...................           3,177           1,000               0           4,177         165,000
NEW JERSEY......................               0               0               0               0               0
NEW MEXICO......................               0               0               0               0               0
NEW YORK........................         153,970               0               0         153,970          58,874
NORTH CAROLINA..................               0               0               0               0               0
NORTH DAKOTA....................               0               0               0               0               0
OHIO............................          20,527           8,605               0          29,132          20,672
OKLAHOMA........................          48,430               0               0          48,430               0
OREGON..........................             906               0               0             906          20,000
PENNSYLVANIA....................          34,470               0               0          34,470          21,000
RHODE ISLAND....................               0               0               0               0               0
SOUTH CAROLINA..................          23,950               0          19,450          43,400          10,000
SOUTH DAKOTA....................          12,942          14,434               0          27,376         123,063
TENNESSEE.......................          51,167               0               0          51,167         841,907
TEXAS...........................         152,506               0               0         152,506         130,285
UTAH............................               0               0               0               0               0
VERMONT.........................               0               0               0               0               0
VIRGINIA........................          20,128               0               0          20,128           3,030
WASHINGTON......................          20,993               0               0          20,993             665
WEST VIRGINIA...................               0               0               0               0               0
WISCONSIN.......................         107,847               0               0         107,847         104,655
WYOMING.........................               0               0               0               0               0
GUAM............................           2,000           2,000               0           4,000               0
PUERTO RICO.....................               0          11,525               0          11,525           4,135
VIRGIN ISLANDS..................               0               0               0               0               0
                                 -------------------------------------------------------------------------------
      TOTAL.....................       1,527,522         165,976          79,517       1,773,015       3,296,654
----------------------------------------------------------------------------------------------------------------


                               LSCA TITLE I--EXPENDITURES FOR THE ELDERLY, FY 1992                              
----------------------------------------------------------------------------------------------------------------
                                                                                                    POPULATION  
              STATE                   FEDERAL          STATE           LOCAL           TOTAL          SERVED    
----------------------------------------------------------------------------------------------------------------
ALABAMA.........................               0               0               0               0               0
ALASKA..........................               0               0               0               0               0
ARIZONA.........................           3,500               0               0           3,500             550
ARKANSAS........................               0               0               0               0               0
CALIFORNIA......................               0               0               0               0               0
COLORADO........................          28,175               0               0          28,175             833
CONNECTICUT.....................               0               0               0               0               0
DELAWARE........................          10,690               0          12,774          23,464           5,628
DIST OF COLUMBIA................           3,005         103,921               0         106,926          76,000
FLORIDA.........................         151,814               0         111,343         263,157          60,083
GEORGIA.........................          16,000           2,000           2,290          20,290          97,991
HAWAII..........................               0               0               0               0               0
IDAHO...........................             697               0               0             697             447
ILLINOIS........................          31,234               0               0          31,234          60,000
INDIANA.........................           5,826               0               0           5,826             100
IOWA............................           9,313               0               0           9,313             500
KANSAS..........................          30,000               0               0          30,000           7,776
KENTUCKY........................          62,830               0               0          62,830         347,002
LOUISIANA.......................          15,240           3,891               0          19,131         468,991
MAINE...........................             124          41,624               0          41,748             500
MARYLAND........................          32,050               0               0          32,050           3,675
MASSACHUSETTS...................          20,800               0               0          20,800           3,030
MICHIGAN........................          76,284               0               0          76,284       1,505,154
MINNESOTA.......................           5,185               0               0           5,185          22,000
MISSISSIPPI.....................               2              94               0              96          15,132
MISSOURI........................          47,360               0               0          47,360         200,000
MONTANA.........................               0               0               0               0               0
NEBRASKA........................           1,845               0               0           1,845         205,684
NEVADA..........................          25,000               0               0          25,000         266,800
NEW HAMPSHIRE...................           1,423           1,500               0           2,923         168,522
NEW JERSEY......................          20,000               0               0          20,000             250
NEW MEXICO......................               0               0               0               0               0
NEW YORK........................         103,970               0               0         103,970          10,752
NORTH CAROLINA..................          21,602               0               0          21,602           (\1\)
NORTH DAKOTA....................               0               0               0               0               0
OHIO............................          16,969           1,120          21,000          39,089          21,859
OKLAHOMA........................          49,365               0               0          49,365           1,641
OREGON..........................          12,116               0               0          12,116           1,600
PENNSYLVANIA....................         409,209               0               0         409,209          71,710
RHODE ISLAND....................          11,098          24,449               0          35,547         239,750
SOUTH CAROLINA..................          29,824          37,839          24,483          92,146          19,409
SOUTH DAKOTA....................           7,445           6,223          13,668          27,336           (\1\)
TENNESSEE.......................          58,650               0               0          58,650         131,548
TEXAS...........................         264,840               0               0         264,840         187,295
UTAH............................               0               0               0               0               0
VERMONT.........................               0               0               0               0               0
VIRGINIA........................               0               0               0               0               0
WASHINGTON......................               0               0               0               0               0
WEST VIRGINIA...................               0               0               0               0               0
WISCONSIN.......................         111,452               0               0         111,452         122,983
WYOMING.........................               0               0               0               0               0
GUAM............................           2,000           2,000               0           4,000           (\1\)
PUERTO RICO.....................               0          11,525               0          11,525           1,307
VIRGIN ISLANDS..................               0               0               0               0               0
                                 -------------------------------------------------------------------------------
      TOTAL.....................       1,696,937         236,186         185,558       2,118,681       4,326,502
----------------------------------------------------------------------------------------------------------------
\1\ Not available.                                                                                              

  NATIONAL INSTITUTE ON DISABILITY AND REHABILITATION RESEARCH AGING 
                           PROGRAMS--FY 1995

    The National Institute on Disability and Rehabilitation Research 
(NIDRR), authorized by Title II of the Rehabilitation Act, has specific 
responsibilities for conducting and coordinating research that relates 
directly to the rehabilitation of persons with disabilities. Disability 
is very closely associated with increasing age. Grants and contracts 
are made to public and private agencies and organizations, including 
institutions of higher education, Indian Tribes and tribal 
organizations, for the purpose of planning and conducting research, 
demonstrations, and related activities which bear directly on the 
development of methods, procedures and devices which assist in the 
provision of rehabilitation services.
    The Institute is also responsible for facilitating the distribution 
of information concerning developments in rehabilitation procedures, 
methods, and devices to rehabilitation professionals and to disabled 
persons to assist them in leading more independent lives.
    The Institute accomplishes its mission through the following 
programs:
            Rehabilitation Research and Training Centers
            Rehabilitation Engineering and Research Centers
            Research and Demonstration Projects
            Field-Initiated Projects
            Dissemination and Utilization Projects
            Career Development Projects, which include:
                  Fellowships
                  Research Training

                        Aging-Related Activities

                     research and training centers
1. Rehabilitation Research and Training Center (RRTC) on Aging, Rancho 
        Los Amigos Medical Center, Downey, CA
    This Center is a collaborative effort between the Rancho Los Amigos 
Medical Center, the University of Southern California School of 
Medicine and the Andrus Gerontology Center.
    Research addressed by the Center includes:
    The applicant is developing an RRTC which focuses on the problems 
experienced by people who are aging with a disability acquired before 
late life and includes some of the problems of people with onset of 
disability late in life. Four kinds of conditions (cerebral palsy, 
post-polio, rheumatoid arthritis and stroke) are chosen for in-depth 
study and serve as a basis for developing models from which to 
understand other impairments.
          Study One (Variations in Late Onset Complications).
          Study Two (Preventing and Treating Late Life Complications 
        Through Improved, Quantified Identification of Weakness).
          Study Three (Evaluation of Residential Care Facilities as an 
        Alternative Community Service Model for Disabled Older Adults).
          Study Four (Role of Training to Enhance Utilization of Inhome 
        Support: A Comparison Between Older Disabled Hispanics and 
        Anglos).
          Study Five (Use of Technology Services to Maintain Employment 
        Among People Aging with a Disability).
          Study Six (A Study of Policy Barriers that Impede Utilization 
        of Technology).
2. Rehabilitation Research and Training Center on Aging With Mental 
        Retardation, The University of Illinois at Chicago, University 
        of Illinois UAP, 1640 West Roosevelt Road, Chicago, IL
    The Illinois University Affiliated Program in Developmental 
Disabilities (UAP), University of Illinois at Chicago (UIC), has 
established the Rehabilitation Research and Training Center on Aging 
with Mental Retardation. This center will build on the strength and 
continuity of the current RRTC on Aging and Developmental Disabilities 
and bring to it the resources of a major university with considerable 
commitment, applied research and clinical expertise in the fields of 
mental retardation and aging. The RRTC will build on the continuity of 
its collaboration over the last 5 years. The RRTC has developed a 
greater understanding of aging and developmental disabilities by 
capitalizing on large data bases, longitudinal investigations, and 
multi state sites.
    Investigators from other universities in Minnesota, Ohio, Indiana, 
Wisconsin, Kentucky, and Hawaii contribute strengths to the RRTC in 
epidemiological and clinical research on age-related changes, family 
future planning, self-determination, cultural diversity, and public 
policy analysis. In addition, the RRTC has assembled a network of 
national, state, and local organizations to ensure that the RRTC 
programs are widely disseminated, have practical applications, and will 
stimulate public policy change.
    The research is applied and examines individuals' lives in their 
natural settings. It is focused on outcomes in the lives of older 
persons with mental retardation. The main goal of the research is to 
translate the knowledge gained into practice through broad-based 
training; technical assistance; and dissemination to persons with 
mental retardation, their families, service providers, administrators 
and policy makers, advocacy groups, and the general community.
3. Rehabilitation Research and Training Center on Stroke 
        Rehabilitation, Rehabilitation Institute Research Corporation, 
        345 East Superior, Chicago, IL
    Enhancing the quality of life of individuals with stroke and their 
families requires reducing the impact of medical comorbidity, 
maximizing functional independence, and promoting optimal psychosocial 
adaptation. The objectives of the Rehabilitation Research and Training 
Center are to develop, evaluate, and demonstrate the usefulness and 
effectiveness of a variety of medical, rehabilitative, psychological, 
and social strategies designed to improve outcomes in survivors of 
stroke. Major areas of focus for this project will include the 
assessment of functional performance, of psychological well being, of 
the contributions of medical and psychological factors to functional 
capabilities, and the dissemination of information and innovations to 
patients, their families, and rehabilitation professionals.
4. Rehabilitation Research and Training Center on Aging with Spinal 
        Cord Injury, Craig Hospital and the University of Colorado, 
        Health Science Center, Research Department, 3425 South 
        Clarkson, Englewood, CO
    This rehabilitation and research training center in aging with 
spinal cord injury describes a 4-year collaborative effort. The project 
targets ``aging'' spinal cord injury survivors--those injured 20 or 
more years ago, and/or those over the age of 55 years when initially 
injured--as well as their families and personal caregivers, and the 
physicians and health care professionals who treat them.
    The RRTC proposes six specific research investigations addressing 
the broad research goal, ``to conduct longitudinal research to document 
the natural course of aging with spinal cord injury and identify risk 
factors associated with increasing medical complications, functional 
limitations, psychosocial concerns, and escalating costs.''
          Study One (The completion of longitudinal medical, health, 
        functional, and psychosocial follow-up of 282 British spinal 
        cord injury survivors who have been injured 20 or more years).
          Study Two (The follow-up and assessment of Craig Hospital's 
        clients who have been injured two or more decades).
          Study Three (The initiation of a population-based study 
        comparing the outcomes of individuals who are over 55 years old 
        when initially spinal cord injured with those who are under age 
        35 at the time of injury).
          Study Four (Analysis of the National Database of the Model 
        Spinal Cord Injury Systems with respect to aging issues).
          Study Five (A study of the lifetime costs of spinal cord 
        injury and its care).
          Study Six (Implementation of longitudinal study of 
        psychological adjustment to spinal cord injury 20 or more years 
        post-injury).
5. Rehabilitation Research and Training Center on Spinal Cord Injury 
        and Aging, Rancho Los Amigos Medical Center, Downey, CA
    The center will conduct programmatic research on the medical, 
functional, psychological, social, and service delivery issues 
important to rehabilitation of older persons with either an early onset 
or late life onset of disability; and provide state-of-the-art training 
to health professionals, students, researchers, families and consumers 
about test practices of geriatric rehabilitation service; and research 
and disseminate information on geriatric rehabilitation. Research on 
the late effects of life disability is comparing older persons with 
early-life onset of spinal cord injury and polio and assessing their 
medical, psychological, social, and rehabilitation service needs and 
how these needs should be addressed. Research on attitudes of and 
toward older disabled persons is examining the impact of these 
attitudes on effective service delivery and rehabilitation success. 
Research on technology solutions for older persons is developing and 
evaluating the benefits of a sub-center on technology within a 
rehabilitation program. Research on policy and funding alternatives to 
promote community and supportive services of older persons with 
disabilities is examining various policies and their impact on the 
rehabilitation of the older person. The Center's training activities 
are designed to improve knowledge and skills regarding the 
rehabilitation of older persons and are targeted to students and 
practitioners in rehabilitation and other health disciplines.
6. Disability Statistics Rehabilitation Research and Training Center, 
        University of California, San Francisco, Institute for Health 
        and Aging, Box 0646, Laurel Heights, San Francisco, CA
    The center conducts research in areas of high priority in the field 
of disability and disability policy, including costs, employment 
statistics, health and long-term care statistics, statistical 
indicators, and congregate living statistics. Statistical information 
is disseminated through published statistical reports and abstracts, a 
CD-ROM subscription, journals, professional presentations, and a 
publications mailing list. Training activities and resources (such as a 
predoctoral program) disseminate scientific methods, procedures, and 
results to both new and established researchers, policy makers, and 
other consumers, and assists them in interpreting statistical 
information. A National Disability Statistics and Policy Forum is being 
conducted periodically to establish a national dialogue between people 
with disabilities and representative organizations, researchers, and 
policy makers.
            rehabilitation engineering and research centers
1. Rehabilitation Engineering Center: Assistive Technology and 
        Environmental Interventions for Older Persons with 
        Disabilities, University of New York at Buffalo, Buffalo, NY
    This Rehabilitation Engineering Center is composed of a trans-
disciplinary group of clinical and research faculty and also has 
participation by consumers. There are three research programs which 
represent the main elements of assistive technology utilization: 
consumer assessments, environmental design and assistive technology. 
These three research programs represent:
          The assistive potential of low and high technology devices
          Exploring the environment in which older persons with 
        disabilities apply technology, and
          Improving the public and private sector systems delivering 
        assistive technology services.
    Also included in the Center's plan are three programs addressing 
dissemination and utilization. These three programs are organized 
around the main elements of assistive technology service delivery, 
which include:
          device utilization,
          professional education, and
          technical assistance.
                    field initiated research program
1. Evaluation of Methods for the Identification and Treatment of 
        Visually Impaired Nursing Home Residents, The Lighthouse, New 
        York Association for the Blind, New York, NY
    This 3 year project's focus is to implement, evaluate and 
disseminate information on an intervention strategy designed to 
facilitate the identification and rehabilitation of older visually 
impaired persons in nursing homes. The intervention strategy being 
tested includes nursing home staff training to ensure identification of 
persons with visual problems; provision of standard eye care services 
to ensure that excess disability due to simple refraction error is 
avoided; and provision of low vision clinical and other rehabilitation 
teaching services to minimize the functional implications of vision 
loss due to age related vision disorders.
2. Rehabilitation of Visually Impaired Older Persons, The Lighthouse, 
        New York Association for the Blind, New York, NY
    The primary long-range goal of the proposed project is to enhance 
the availability, accessibility and effectiveness of rehabilitation 
services and technological resources for visually impaired and blind 
older persons in order to maximize functional independence and well-
being in later life.
    This research and demonstration project will provide an accumulated 
fund of knowledge about programs and services for visually impaired 
older adults. This knowledge is critical to consumers, families, 
service providers and planners as they prepare for the continued 
increase of this population.
    A national survey of programs and services will document the 
current status of service delivery to visually impaired older persons 
and describe model programs and their development. A low vision 
curriculum targeted to generic health and human service providers, to 
be developed and tested, will offer a systemic assessment of the impact 
of low vision training on non-eye care professionals, the gatekeepers 
to service for a majority of older adults. The expertise of State 
program directors and agency executives in the development of programs 
funded under the Older Blind Independent Living Program will be tapped 
along with that of program consumers in a series of focus groups 
intended to pinpoint effective strategies for program delivery under 
this appropriation.
3. Assistive Technology Training for Individuals With a Visual 
        Disability Preparing to Enter the Job Market, The Carroll 
        Center for the Blind, Inc., 770 Centre Street, Newton, MA
    The project will develop, implement, evaluate and disseminate 
assistive technology training curricula dedicated to helping people 
with visual disabilities to develop skills for successful employment in 
actual work settings. These curricula contain practical knowledge and 
enable the acquisition of functional skills related to the uses and 
benefits of assistive technology in the workplace. Content is intended 
to go beyond the technical aspects of assistive devices and systems, 
and is sufficiently comprehensive to permit individualized and 
personalized usage. Substantive content is being drawn from a body of 
knowledge accumulating in such fields as post-secondary education, 
corporate training, access technology, career development and 
transition, and adjustment to disability. The focus, relevance, scope 
sequence and understandability of the training activities are being 
guided by a curriculum steering committee consisting of consumers, 
their families, special educators, rehabilitation professionals, 
employers, technical support personnel and human resource specialists.
    The overall project goal is to produce three stand-alone curricula 
which will prepare blind job seekers to use individually-tailored 
assistive technology in three distinct career alternatives. The first 
curriculum to be developed is on the preparation of medical 
transcriptionists.
4. Measuring Functional Communication: A Research Project to Establish 
        the Reliability and Validity of a Functional Communication 
        Measure for Adults, American Speech-Language-Hearing 
        Association, 10801 Rockville Pike, Rockville, MD
    The project will revise the American Speech-Language-Hearing 
Association Functional Communication Scales for Adults (ASHS FCS-A); 
complete the first of a series of field testing and evaluation projects 
to establish the reliability and validity of the scales with various 
communication disordered individuals at various intervention sites; and 
develop administration and scoring materials for dissemination to users 
of the instrument.
    Objectives of the project include the identification of the 
functional communication abilities and needs of adults with 
communication disorders in order to maximize their ability to 
communicate in natural environments.
5. Aging and Vision Loss: The Development of Guidelines for Innovative 
        Personnel Preparation Curriculum in Gerontology, American 
        Foundation for the Blind, 15 W. 16th Street, New York, NY
    The project will research, develop, and disseminate guidelines for 
a model competency-based curriculum on aging and vision loss for 
accredited institutions of higher education offering coursework in 
gerontology. The guidelines for the curriculum model will be designed 
for use by faculty of these institutions to establish a course in aging 
and vision loss, or to infuse content on aging and vision loss into 
existing course curricula. The project objectives will be accomplished 
by conducting a national survey of university gerontology programs and 
vision loss; convening a curriculum development workshop to determine 
curriculum competencies, content, and teaching methods; and 
disseminating findings and guidelines for a model curriculum on aging 
and vision loss through the publication of articles in relevant aging 
and vision journals and presentations at national conferences.
6. Aging and Adjustment after Spinal Cord Injury: A 20-Year 
        Longitudinal Study, Shepherd Center for Spinal Injuries, Inc., 
        2020 Peachtree Road, NW, Atlanta, GA
    This fourth study phase will be the most extensive follow-up yet 
performed and will use an expanded version of the same questionnaire 
that was used in each of the three previous followups (1973, 1984, 
1988). Three types of research designs will be used for data analysis, 
including: (1) traditional longitudinal analysis of 1973 to 1992 data 
from the original participant sample; (2) cross-sequential analysis of 
the repeated measures data from 1984 to 1992 for samples one and two; 
and (3) time-sequential analysis of time-lagged data comparing the 1984 
data for sample two with that of the new third sample.
7. Rehabilitation of Visually Impaired Older Persons, The Lighthouse, 
        Inc., 111 East 59th Street, New York, NY 10022
    This research and demonstration project will provide an accumulated 
fund of knowledge about programs and services for older adults with 
visual impairments. This knowledge is critical to consumers, families, 
service providers, and planners as they prepare for the continued 
increase of this population. A national survey of programs and services 
will document the current status of service delivery to older people 
with visual impairments and describe model programs and their 
development. A low-vision curriculum targeted to generic health and 
human service providers, to be developed and tested, will offer a 
systemic assessment of the impact of low-vision training on noneye care 
professionals, the gatekeepers to service for a majority of older 
adults. The expertise of State program directors and agency executives 
in the development of programs funded under the Older Blind Independent 
Living Program will be tapped along with that of program consumers in a 
series of focus groups intended to pinpoint effective strategies for 
program delivery under this appropriation.
8. Rehabilitation Research Fellowship on Aging and Cerebral Palsy, Gary 
        B. Seltzer, PhD, 3501 Blackhawk Drive, Madison, WI 53705
    The fellowship will research the following: to follow up a cohort 
of persons with cerebral palsy, all of whom had bone scans about 4 
years ago; to compare the results to normative data on persons of the 
same age without cerebral palsy; to conduct a survey of persons 
identified through the United Cerebral Palsy Association that examines 
relationships among coping strategies, functional abilities, social 
support systems, and access to health care on this group's 
psychological well being; to conduct a series of focus groups with 
older persons who have cerebral palsy; and to continue involvement with 
small groups of persons who are disseminating material on the topic of 
aging and cerebral palsy and identifying funding sources for future 
research.
9. Perceived Direction and Speech Intelligibility in Sensorineural, 
        Hearing Loss and Blindness, Smith-Kettlewell Eye Research 
        Institute, 2232 Webster Street, San Francisco, CA
    Experiencing great difficulty processing speech in noise is one of 
the most characteristic and devastating aspects of the sensory deficit 
of hearing loss in aging (presbycusis). Conventional binaural hearing 
aids do not satisfactorily solve this problem. The digital four-channel 
hearing aid is innovative because of its use of temporal as well as 
intensity parameters, unlike any other binaural hearing aid on the 
market. Since sensorineural hearing loss (SNHL) and blindness may 
interfere with localization of potentially hazardous situations, a 
second goal of this project is to explore and develop the parameters 
for improved localization as well as improved speech intelligibility 
(comprehension) utilizing a new rationale. According to the project's 
model, a binaural balance of interaural intensity difference (IID) and 
interaural time delay (ITD) across frequencies is required to restore 
optimum speech intelligibility and localization ability by eliminating 
or lessening exaggerated dominance consequent of asymmetric hearing 
loss. Variations of either or both IID and ITD at different frequencies 
would impair directional localization and, therefore, intelligibility 
of one speaker in a group. This new hearing aid may permit people with 
SNHL and blindness, using acoustic cues, to locate and avoid a hazard. 
To accomplish this, the project will adjust the physical inputs of 
intensity and interaural delay time across frequencies to compensate 
for perceptual imbalances (i.e., deviations from IID and ITD) and to 
test for the consequent restoration of optimal localization and speech 
intelligibility inherent in normally balanced auditory systems.

                 Rehabilitation Services Administration

independent living services for older individuals who are blind program
    The Rehabilitation Act of 1973, as amended (the Act), authorizes a 
program to provide independent living services to individuals who are 
blind (OIB). This specialized program supports projects that provide 
independent living services to individuals who are age 55 or older and 
whose severe visual impairment makes competitive living goals are 
feasible. This program also supports projects that conduct activities 
that will improve or expand services for these individuals and conduct 
activities to help improve public understanding of the problems of 
these individuals.
    Any designated State agency is eligible for an award under this 
program if the designated State agency is authorized to provide 
rehabilitation services to individuals who are blind. A designated 
State agency may operate or administer the program or projects under 
this program either directly or through grants to public or private 
nonprofit agencies or organizations; or through contracts with 
individuals, entities, or organizations; or through contracts with 
individuals, entities, or organizations that are not public or private 
nonprofit agencies or organizations. A designated State agency also may 
enter into assistance contracts, but not procurement contracts, with 
public or private nonprofit agencies or organizations.
    The program currently supports programs in 48 States and expects to 
fund additional States and outlying areas in fiscal year 1995. The 
fiscal year 1995 appropriation for this program is $8,952,000. An 
estimated 12,000 older persons are receiving core services under this 
program, with over half of these persons being older than age 75 and 
having a disability in addition to blindness.
    The program is designed to be flexible to meet the wide variety of 
independent living needs of older individuals who are blind that remain 
after considering the service gaps of State supported and other related 
programs. Independent living services supported under this program 
include:
          (1) services to help correct blindness, such as--
                  (A) outreach services;
                  (B) visual screening;
                  (C) surgical or therapeutic treatment to prevent, 
                correct, or modify disabling eye conditions; and
                  (D) hospitalization related to such services;
          (2) the provisions of eyeglasses and other visual aids;
          (3) the provision of services and equipment to assist an 
        older individual who is blind to become more mobile and more 
        self-sufficient;
          (4) mobility training, Braille instruction, and other 
        services and equipment to help an older individual who is blind 
        adjust to blindness;
          (5) guide services, reader services, and transportation;
          (6) any other appropriate service designed to assist an older 
        individual who is blind in coping with daily living activities, 
        including supportive services or rehabilitation teaching 
        services;
          (7) independent living skills training, information and 
        referral services, peer counseling, and individual advocacy 
        training; and
          (8) other independent living services including--
                  (A) (i) information and referral services;
                  (ii) independent living skills training;
                  (iii) peer counseling, including cross-disability 
                peer counseling;
                  (iv) individual and systems advocacy; and
                  (B) (i) counseling services, including psychological, 
                psychotherapeutic, and related services;
                  (ii) services related to securing housing or shelter, 
                including services related to community group living, 
                and supportive of the purposes of this Act and of the 
                titles of this Act, and adaptive housing services 
                (including appropriate accommodations to and 
                modifications of any space used to serve, or occupied 
                by, individuals with disabilities);
                  (iii) rehabilitation technology;
                  (iv) mobility training;
                  (v) services and training for individuals with 
                cognitive and sensory disabilities, including life 
                skills training, and interpreter and reader services;
                  (vi) personal assistance services, including 
                attendant care and the training of personnel providing 
                such services;
                  (vii) surveys, directories, and other activities to 
                identify appropriate housing, recreation opportunities, 
                and accessible transportation, and other support 
                services;
                  (viii) consumer information programs on 
                rehabilitation and independent living services 
                available under this Act, especially for minorities and 
                other individuals with disabilities who have 
                traditionally been unserved or underserved by programs 
                under this Act;
                  (ix) education and training necessary for living in 
                the community and participating in community 
                activities;
                  (x) supported living;
                  (xi) transportation, including referral and 
                assistance for such transportation;
                  (xii) physical rehabilitation;
                  (xiii) therapeutic treatment;
                  (xiv) provision of needed prostheses and other 
                appliances and devices;
                  (xv) individual and group social and recreational 
                services;
                  (xvi) training to develop skills specifically 
                designed for youths who are individuals with 
                disabilities to promote self-awareness and esteem, 
                develop advocacy and self-empowerment skills, and 
                explore career options;
                  (xvii) services for children;
                  (xviii) services under other Federal, State, or local 
                programs designed to provide resources, training, 
                counseling, or other assistance of substantial benefit 
                in enhancing the independence, productivity, and 
                quality of life of individuals with disabilities;
                  (xix) appropriate preventive services to decrease the 
                need of individuals assisted under this Act for similar 
                services in the future;
                  (xx) community awareness programs to enhance the 
                understanding and integration of individuals with 
                disabilities; and
                  (xxi) any other services that may be necessary to 
                improve the ability of an individual with a significant 
                disability to function, continue functioning, or move 
                toward functioning independently in the family or 
                community or to continue in employment and that are not 
                inconsistent with any other provisions of the Act.
    The programs are currently funded by competitive discretionary 
grants. If the appropriation for this program is equal to or greater 
than $13 million, funds are awarded to States on a formula basis. An 
application for a grant under this program may be funded only if it is 
consistent with the State Plan for Independent Living in each State 
that is jointly developed by the State Vocational Rehabilitation agency 
and the Statewide Independent Living Council.

                      ITEM 5. DEPARTMENT OF ENERGY

                              INTRODUCTION

    During 1994, the Department of Energy (DOE) made significant 
progress in adapting its culture and operations to reflect its new 
missions and priorities since the end of the Cold War.
    In February, Secretary Hazel R. O'Leary announced sweeping 
revisions in DOE's contracting system to carry out the Administration's 
effort to ``reinvent government, make government work better and cost 
less.'' The reforms are designed to increase competition, reduce waste, 
eliminate duplication and make contractors more accountable. Contracts 
previously issued on a cost-reimbursable basis now include incentives 
for better performance and job creation through technology transfer. 
And major contracts routinely extended in the past are now being 
recompeted. In 1994 alone, some $28 billion was competed, and over 5 
years that sum will rise to $40 billion.
    In April, the department released its first comprehensive Strategic 
Plan which identified key lines of business, strategies to reach the 
department's goals, and ways to measure progress. ``The end of the Cold 
War, the globalization of world markets, increasing public demands for 
environmental quality, and the election of President Clinton have given 
us a new national agenda,'' said Secretary O'Leary. ``Through a 
comprehensive strategic planning process, the department must now focus 
on new goals: fueling a competitive economy, improving the environment 
through waste management and pollution prevention, reducing the nuclear 
danger, and sustainable energy development.''
    The Strategic Plan identifies five business lines that most 
effectively utilize and integrate the department's unique scientific 
and technological assets, engineering expertise and facilities: 
economic productivity; energy resources; science and technology; 
national security; and environmental quality.
    Critical to the success of these business lines is a commitment to 
improving communication and trust; realigning human resources and 
changing missions; making improved environment, safety and health a 
part of every employee's job; and instituting better management 
practices to enable DOE and its laboratories to operate in more 
business-like ways. The department also pledged to replace a cultural 
of secrecy with a culture of openness.
    In December, Deputy Secretary Bill White announced the DOE 
contribution to the Administration's plan to reduce Federal spending: a 
reduction in outlays of $10.6 billion over a 5-year period. The Deputy 
Secretary noted that, ``These are real cuts from existing levels of 
funding, not simply cuts from projected levels of future funding.'' He 
explained that, ``The budget cuts we have identified result from 
eliminating unnecessary middle management and internal regulations; 
getting more for the dollars of services we buy; and getting out of 
some businesses that the Federal Government just does not need to be 
in.''
    Also in December, Secretary O'Leary announced the next phase in 
realigning the department to meet the needs of the post-Cold War era: 
human and capital resources will be matched with the business lines and 
goals identified in the Strategic Plan. A Structure Team of 
approximately 40 employees began a comprehensive review of all 
departmental functions for the purpose of developing recommendations to 
improve efficiency, eliminate redundancy, and streamline overlapping 
programs and management. Where DOE's support service contractors are an 
integral part of the agency's operations, they are included in this 
review. The Structure Team is scheduled to report its recommendations 
for consolidation and cost reduction to the Steering Committee in April 
1995.

                       Energy Efficiency Programs

    Weatherization Assistance Program.--The elderly and persons with 
disabilities receive priority under this program, which provides grants 
to States for the installation of energy saving building and heating 
and cooling system improvements in low-income homes. In 1994, the 
Weatherization Assistance Program awarded $202.9 million of 
appropriated funds through grants to the 50 States, the District of 
Columbia, and six Native American tribal organizations. Awards for 1995 
are projected at $225.5 million.
    The program operates through a network of State grantees and 
approximately 1,200 local subgrantee agencies. Local service providers 
are predominantly Community Action Agencies. In addition to DOE 
appropriations, State and local programs receive funding from the 
Department of Health and Human Services Low Income Home Energy 
Assistance Program, from utilities and from States.
    As of September 30, 1994 about 4.4 million homes had been 
weatherized with Federal, State, and utility funds; of these an 
estimated 1.73 million--or 40 percent--were occupied by elderly 
persons.
    State Energy Conservation Program.--The State Energy Conservation 
Program (SECP) was created to promote energy efficiency and reduce 
growth in energy demand. Under this program, DOE provides technical and 
cost-shared financial assistance to States to develop and implement 
comprehensive plans for specific energy goals. At present, all States, 
the District of Columbia, and U.S. Territories participate in the SECP.
    Senior citizens are eligible for services provided through the 
SECP. In addition, many States have developed and implemented projects 
specifically for the elderly. Examples include senior citizen 
weatherization projects and related training, hands-on energy 
conservation workshops, low-interest loan programs, senior energy 
savings months, and numerous seminars addressing the needs of senior 
citizens. These projects are often cosponsored with agencies whose 
primary focus is on senior citizens. In FY 1995, $23.99 million was 
appropriated for the SECP.

                Information Collection and Distribution

    The Energy Information Administration collects and publishes 
comprehensive data on energy consumption in the residential sector 
through two triennial surveys: the Residential Energy Consumption 
Survey (RECS) and the Residential Transportation Energy Consumption 
Survey (RTECS). The Residential Energy Consumption Survey includes data 
collected from individual households throughout the country, along with 
actual billing data from the households' fuel suppliers for a 12-month 
period. The data include information on energy consumption, 
expenditures for energy, cost by fuel type, and related housing unit 
characteristics (such as size, insulation, and major energy-consuming 
appliances). The Transportation Survey collects data on characteristics 
of household vehicles and annual miles traveled. Both surveys contain 
data pertaining to older Americans.
    The results of these surveys are analyzed and published by the 
Energy Information Administration. The most recent survey for which all 
reports have been published is the 1990 RECS. Results of the 1990 RECS 
are published in three reports: Housing Characteristics 1990 (published 
in May 1992); Household Energy Consumption and Expenditures 1990; and 
Household Energy Consumption and Expenditures 1990 Supplement: Regional 
Data (both published in February 1993). The data file for the 1990 RECS 
is available on diskettes for use with personal computers. The data 
file contains demographic characteristics of the elderly such as age, 
employment status, marital status, and family income.
    Preliminary data from the 1993 RECS are available. Tables from 
Housing Characteristics 1993 are available through an electronic 
bulletin board (202-586-2557) or in paper copy from the National Energy 
Information Center (202-586-8800). The report is scheduled for 
publication in May 1995. Energy consumption and expenditures data will 
be available in preliminary form in May 1995 and the two-part report 
will be published in the fall 1995.
    Household Energy Consumption and Expenditures 1990 provides 
estimates of consumption and expenditures for electricity, natural gas, 
fuel oil, kerosene, and liquefied petroleum gas for elderly households. 
These data are presented by the age of the householder.
    Analysis of the 1990 RECS data shows that consumption patterns 
differed between the elderly and the nonelderly for some uses of 
energy. The elderly used slightly more energy to heat their homes, for 
example, but used less energy for air conditioning, water heating, and 
appliances. Expenditures followed the same pattern. Differences in use 
of energy for refrigerators were very small. Approximately 61 percent 
of the elderly's total energy consumption and about 38 percent of their 
total energy expenditures were for space heating.
    Household Energy Consumption and Expenditures 1990 Supplement: 
Regional Data provides energy consumption and expenditure data by four 
Census regions and nine Census divisions. These data are also presented 
by the age of the householder. Consumption and expenditure patterns in 
each of the Census regions mirrored those seen at the national level.
    The most recent triennial RTECS was conducted for the calendar year 
1991 and the results reported in Household Vehicles Energy Consumption 
1991 (published December 1993). Data presented in this publication are 
categorized by age of householder for vehicle miles traveled, gallons 
of motor fuel consumed, and expenditures for motor fuel. These data 
show that for calendar year 1991, the elderly drove fewer miles and 
used less motor fuel on a per household basis than the average for all 
households. For example, households with an elderly householder (and no 
other adults in the household) drove 7,300 miles and consumed 417 
gallons of fuel. Those households with an elderly householder and one 
or more other adults in the household drove 15,000 miles and consumed 
822 gallons of fuel. These averages are below the average for all 
households which is 18,900 miles and 979 gallons of fuel.

                       Research Related to Aging

    In 1994, the Office of Environment, Safety and Health sponsored 
research to further an understanding of the human health effects of 
radiation. As part of this research program, DOE sponsored 
epidemiological studies concerned with understanding biological changes 
over time, including those of aging. Lifetime studies of humans 
constitute a significant part of the research related to aging. The 
Department also supports research to characterize late-appearing 
effects induced by chronic exposure to low levels of physical agents 
and some basic research concerning a few diseases of aging. Summarized 
below and specific research projects addressing aging in humans that 
the Department sponsored in 1994.
    Because health effects resulting from chronic low-level exposure to 
energy-related toxic agents may develop over a lifetime they must be 
distinguished from normal aging processes. To distinguish between 
induced and spontaneous changes, information is collected from both 
exposed and nonexposed groups on changes that occur throughout the life 
span. These data help characterize normal aging processes as well as 
the toxicity of energy related agents.
    As in the past, lifetime studies of humans constitute a significant 
part of the research related to biological aging sponsored by the 
Office of Environment, Safety and Health. Research concerned with the 
aging process has been conducted at several of the Department's 
contractor facilities. Summarized below are specific research projects 
addressing aging that the Department sponsored in 1994.
                 long-term studies of human populations
    Through the Office of Environment, Safety and Health, DOE supports 
epidemiological studies of health effects in humans who may have been 
exposed to chemicals and radiation associated with energy. Information 
on life span and aging in human populations is obtained as part of 
these studies. Because long-term studies of human populations are 
difficult and expensive, they are initiated on a highly selective 
basis.
    The Radiation Effects Research Foundation (RERF), sponsored jointly 
by the United States and Japan, continued work on a lifetime follow-up 
of survivors of atomic bombings that occurred in Hiroshima and Nagasaki 
in 1945. Over 100,000 persons are under observation in this study.
    One important feature of this study is the acquisition of valuable 
quantitative data on dose-response relationships. Studies specifically 
concerned with age-related changes are also conducted. No evidence of 
radiation-induced premature aging has been obtained.
    After being accidentally exposed in 1954 to radioactive fallout 
released during the atmospheric testing of a thermonuclear device, a 
group of some 200 inhabitants of the Marshall Islands has been followed 
clinically, along with unexposed controls, by medical specialists at 
the Brookhaven National Laboratory. Thyroid pathology, which has 
responded well to medical treatment, was prevalent in individuals 
heavily exposed to radioiodine.
    Nearly 2,000 persons exposed to radium, occupationally or for 
medical reasons, have been studied at the Center for Human 
Radiobiology, Argonne National Laboratory.
    Other epidemiologic or human studies currently involving the 
department include:
          An epidemiologic study of plutonium workers at three 
        Department of Energy facilities. An estimated 14,000 to 20,000 
        workers will be followed in this retrospective mortality study 
        which is being managed by the Department of Health and Human 
        Services (DHHS).
          Another epidemiologic study of some 600,000 contractor 
        employees at Department of Energy facilities is being managed 
        by DHHS to asses health effects produced by long-term exposure 
        to low levels of ionizing radiation.
          The U.S. Uranium/Transuranium Registry, which is operated by 
        Washington State University, is collecting occupational data 
        (work, medical, and radiation exposure histories) and 
        information on mortality in worker populations exposed to 
        plutonium or other transuranic elements.

            ITEM 6. DEPARTMENT OF HEALTH AND HUMAN SERVICES

                        ADMINISTRATION ON AGING

                              INTRODUCTION

    This report describes the major activities of the Administration on 
Aging (AoA) in Fiscal Year 1994. Title II of the Older Americans Act of 
1965 (the Act; OAA) established the Administration on Aging as the 
principal Federal agency for carrying out the provisions of the Act. 
The 1992 Amendments to the Act reaffirmed the responsibilities of AoA, 
the State Agencies on Aging, and Area Agencies on Aging to assure that 
provisions for serving older people are established, strengthened, and 
extended throughout the Nation. Through the Amendments, Congress 
underscored the concern it had for the most vulnerable elderly and 
emphasized that particular attention should be given to strengthening 
community level services for these individuals. The Technical 
Amendments of 1993 formally elevated the Commissioner on Aging to 
Assistant Secretary for Aging and served as a catalyst for the creation 
of the Office of the Assistant Secretary for Aging in the Department of 
Health and Human Services. The Presidential appointment of Fernando M. 
Torres-Gil to this post has elevated aging issues both within the 
Department and at the national level, and reaffirmed the commitment of 
the Federal Government to address the issues of an aging society.
    The Older Americans Act seeks to remove barriers to economic and 
personal independence for older persons and to assure the availability 
of appropriate services for those older individuals age 60 and over 
with particular attention to those in greatest social or economic need. 
The provisions of the Act are implemented primarily through a national 
``aging network'' consisting of the Administration on Aging at the 
Federal level, State and Area Agencies on Aging, and community level 
agencies and organizations. In Fiscal Year 1994, Congress appropriated 
$871,687,000 to support AoA-administered programs and activities to 
implement the provisions of the Act. This excludes $177,000 available 
for the Federal Council on the Aging and $16,563,000 for Federal 
Program Administration.
    This report is divided into 11 sections. Section I discusses the 
OAA Technical Amendments of 1993. Section II describes the Office of 
Assistant Secretary for Aging. Section III examines the office of Field 
Operations. Section IV discusses operations and management of AoA and 
Section V highlights interagency agreements and priority Initiatives of 
the Assistant Secretary for Aging. Section VI provides an overview of 
the provisions of Title III of the Older Americans Act and a summary of 
the principal activities of the network of State and Area Agencies on 
Aging in Fiscal Year 1994, particularly as they relate to the provision 
of supportive in-home and community services, and congregate and home-
delivered meals. Section VII describes the vulnerable elder rights 
protection activities under Title VII of the Act. Section VIII 
describes the Title VI program of grants to Indian tribal 
organizations, Native Hawaiians, and Alaskan Natives as well as AoA's 
efforts in assessing the effectiveness of outreach to older Native 
Americans. Section IX presents a summary of AoA's Fiscal Year 1994 
discretionary activities under Title IV (Research, Demonstrations, and 
Training). Section X discusses the 1995 White House Conference on Aging 
(WHCOA), the first such conference since 1981. Section XI describes the 
Federal Council on the Aging (FCoA) and its activities.

         SECTION I--THE OFFICE OF ASSISTANT SECRETARY FOR AGING

    Soon after being named Secretary of Health and Human Services, 
Donna E. Shalala elevated aging issues within the Department by 
creating an entirely new operating division--the Office of the 
Assistant Secretary for Aging. One of the major responsibilities of 
this office is to educate citizens, government departments and 
agencies, businesses and community organizations about ways to plan for 
an aging America. This is critically important because by the year 
2030, one out of every five Americans will be 60 or older.
    After being nominated by President Clinton and confirmed by the 
U.S. Senate, Fernando M. Torres-Gil was sworn in as the first Assistant 
Secretary for Aging in the Department of Health and Human Services 
(HHS) on May 6, 1993. The Assistant Secretary for Aging serves as the 
principal advisor to the Secretary of Health and Human Services on 
matters related to an aging society and functions as the Federal 
Government's leading advocate for older Americans. In this capacity, he 
is also responsible for directing the Administration on Aging, which 
carries out a wide range of responsibilities under the Older Americans 
Act.
    As the first Assistant Secretary for Aging, his primary goals are 
to serve today's older population while creating a blueprint to meet 
the needs of future retirees. Torres-Gil stresses that in planning for 
an aging society, all segments of government and our communities must 
recognize and plan for the needs of the growing number of older 
Americans. In this context, the Office of the Assistant Secretary for 
Aging will have major responsibility for developing aging policy not 
only within HHS, but also in cooperation with Departments across the 
Federal Government, including Housing and Urban Development, Labor, 
Transportation, Justice and Treasury. In so doing, Federal laws, 
policies, and programs can be better coordinated and improved. A focal 
point for aging policy will enable the Federal Government to better 
assist the elderly as well as to help younger Americans to plan, far in 
advance, for a secure and creative old age.
    The Immediate Office of the Assistant Secretary for Aging has 
responsibility for legislative oversight and Congressional liaison to 
assist in meeting the mandates of this elevated status. This 
responsibility includes handling and/or disseminating all Congressional 
inquiries and requests for information to the proper offices or 
individuals within the Administration on Aging. In addition, this 
office produces in final form all Congressional testimony, statements 
and speeches given by the Assistant Secretary for Aging in 
Congressional settings, as well as being the liaison between 
Congressional offices and the Administration on Aging. The 
Congressional Liaison also works with the Department's Office of 
Legislation and attends regular weekly meetings.
    The Office of the Assistant Secretary for Aging also includes a 
general publications request hotline for printed materials of 
information on various subject matters pertaining to the elderly. 
Requests through the mail are also handled in the Office of the 
Assistant Secretary. When materials are not available through AoA, 
information and referral to other appropriate agencies/organizations is 
provided to assure that individuals have access to requested 
information in a timely fashion.
    Public affairs and press relations are maintained in the Office of 
the Assistant Secretary for Aging. There is active coordination with 
the Office of the Assistant Secretary for Public Affairs to enhance 
this effort. A number of press releases were disseminated in fiscal 
year 1994 relating to a variety of issues affecting older Americans 
(see end of this Report for a listing of these releases).

    SECTION II--THE OLDER AMERICANS ACT TECHNICAL AMENDMENTS OF 1993

    P.L. 103-171, the Older Americans Act Technical Amendments of 1993, 
was signed by the President on December 2, 1993. These technical 
amendments, which were introduced in March, 1993, accomplished several 
things:
          (1) extended the deadlines on many Congressionally mandated 
        requirements that appear throughout the Act;
          (2) formally changed the name of Commissioner on Aging to 
        Assistant Secretary for Aging; and
          (3) changed the date of the mandated White House Conference 
        on Aging from no later than December 31, 1994, to no later than 
        May 31, 1995.

                SECTION III--OFFICE OF FIELD OPERATIONS

    The AoA Office of Field Operations (OFO) was created in 1991. A 
Director was selected in April 1993. The primary responsibility of OFO 
is to provide leadership and technical guidance to the 10 AoA Regional 
Offices (ROs) as they implement the national programs of the Older 
Americans Act.
    During fiscal year 1994, OFO developed the agency's National Plan 
for AoA Regional Office visits to State Agencies to assess compliance 
requirements of Title III of the OAA in the following areas:
          Financial Management
          Ombudsman
          Nutrition
          Targeting
          Stewardship
    Regional Office staff visited 25 States and 1 Territory to assess 
implementation requirements of Title III of the OAA in the areas of 
Financial Management, Ombudsman, Targeting and Stewardship. Twenty-five 
additional States were visited by Regional Office staff to assess 
implementation of the Nutrition requirements. OFO also provided 
oversight to Regional Office staff in the monitoring of 75 Title VI 
Tribal Organizations, and 40 Title IV grantees.
    In fiscal year 1994 OFO also developed AoA's first Action Plan to 
strengthen the Disaster response capacity of AoA and the Aging Network 
to serve older people. OFO provided oversight and technical guidance to 
Regional Offices and State staff in the application for and award of 
disaster funds totaling $14.4 million. The funds were combined Title IV 
dollars ($377,000) and Supplemental Appropriations ($14,023,000).
    In addition, the Assistant Secretary for Aging appointed within AoA 
a National Disaster Coordinator and 10 Regional Disaster Officers to 
elevate the importance of Emergency Preparedness during times of 
disaster to serve older persons. A National Emergency Preparedness on 
Aging Conference was planned for November 8-9, 1994 to strengthen 
disaster response capacity of the Aging Network.

                 SECTION IV--OPERATIONS AND MANAGEMENT

                             Reorganization

    AoA's reorganization was implemented early in September 1994. The 
reorganization identified AoA as an Operating Division (OPDIV), 
established two Offices headed by Deputy Assistant Secretaries, under 
which all programmatic units were grouped, implemented recent revisions 
to the Older Amerians Act, and made other minor organizational 
revisions for more logical functional alignment and flow of authority.
    The reorganization improved the manager-to-staff ratio and provided 
a more efficient base for streamlining. This streamlining has begun 
with the elimination of two deputy managerial positions in headquarters 
and the proposed elimination of five Deputy Regional Administrator 
positions in AoA's Regional Offices.
                  continuous improvement process (cip)
    AoA's reorganization represents one step toward its commitment to 
reinventing government and continuous improvement efforts. The 
Continuous Improvement Process (CIP) provided AoA with an opportunity 
to reinvigorate an agency that had experienced a steady decline in 
funding levels and staffing resources in recent years. By creating an 
atmosphere that supports employee empowerment to benefit AoA's 
customers (i.e. seniors), the staff has developed a vision statement 
and a strategic plan.
    The plan presents such goals as ``Providing Leadership for an Aging 
Society,'' and ``Making the Administration on Aging a Premier Model 
Government Agency.'' The vision statement and strategic plan are the 
foundation through which AoA is pursuing several of the Assistant 
Secretary for Aging's priority areas including a Blueprint for an Aging 
Society, home and community-based long-term care, older women, 
nutrition and malnutrition among older Americans, and crime/violence 
prevention.
    AoA has also worked closely with HHS's CIP efforts, making great 
strides in reducing internal controls in areas including correspondence 
and assignment control, information resources management, the Federal 
Managers' Financial Integrity Act, and grants management.
    In addition, AoA has developed customer service standards to 
document its commitment to a higher level of support to the Aging 
Network entities in delivering services to older Americans and their 
families.
                 aoa's division of management services
    During FY 1994, AoA continued to integrate the principles of the 
Federal Managers' Financial Integrity Act (FMFIA) into daily agency 
operations such as discussions in management meetings and Continuous 
Improvement Program processes. The Division of Management Services 
worked to carefully monitor activities, and adapt planned actions in 
order to proactively address vulnerabilities in management control 
areas rated as ``High Risk.''
    In the past year, AoA has witnessed the benefits of its proactive 
approach to addressing weaknesses in management controls. One example 
of this is success in the area of Grants Management, a management 
control area formerly rated ``High Risk'' and the subject of a material 
weakness. During this past Fiscal Year, this Division has:
          Developed an internal Grants Operations Manual;
          Eliminated the awarding of unsolicited proposals and 
        supplements to existing grants in excess of 25 percent outside 
        the competitive process;
          Resolved 66 audit reports for FY 1992, 1993, and 1994, and 
        have no unresolved audit reports over 6 months old;
          Intensified monitoring of reports in Titles III, VI, and VII, 
        with follow-up by grants specialists, and more readily assigned 
        ``high risk'' rating to grants as a result of a grantee's 
        failure to report in a timely manner; and
          Funded all new FY 94 discretionary grants prior to September 
        30.
    The FMFIA principles are also fundamental elements of AoA's 
``Rightsizing Initiative,'' a multi-year effort to institute dramatic 
changes in the efficiency of operations and in the effectiveness of 
information management. This new initiative, and the resulting 
information systems will provide managers and staff at every level in 
AoA with access to information and linkages to other systems not 
currently available. Management controls such as security, availability 
of data, and the like, will be centralized and will help to ensure the 
most effective use of limited resources.
    These activities illustrate significant progress toward improving 
management controls throughout AoA's programs so that limited resources 
are maximized. This outcome reflects the guiding principle of the FMFIA 
program.
    In early FY 1994, AoA senior managers reviewed administrative and 
personnel delegations of authority previously delegated to OPDIVs or 
STAFFDIVs as mandated by ASMB and ASPER. As a result of that review and 
subsequent discussions and evaluations of agency operations, AoA has 
clarified and formalized delegations for 46 authorities. These 
delegations are consistent with the National Performance' Review's 
recommendation to maximize the decentralization of the decision making 
process.
             aoa's information resources management program
    AoA's Information Resources Management (IRM) Program supports the 
Department and AoA's programs, administrative components, and Regional 
Offices in meeting their responsibilities. The Program also ensures 
that AoA's IRM goals, policies, plans, strategies, and requirements 
support the mission of HHS and AoA.
    The purpose of the IRM Program is to strengthen the use and 
management of information resources in AoA. The IRM Program addresses 
two major enterprises in AoA: the IRM Infrastructure and the Corporate 
Data Enterprise. The IRM Infrastructure provides a foundation for 
managing the information resources in AoA. The Corporate Data 
Enterprise represents all the actions necessary to turn raw data 
associated with AoA programs (corporate data) into a usable information 
resource.
    The Assistant Secretary for Aging appointed the Director of the 
Office of Administration and Management to serve as the AoA Principal 
IRM Official. Certain other responsibilities for IRM in FY 1994 were 
fulfilled by the AoA Information Resources Management Board (IRMB) 
representatives. The Board, appointed by the Assistant Secretary for 
Aging, was comprised of the Deputy Assistant Secretaries, Associate 
Commissioners and Directors of AoA offices. The Board advised the 
Principal IRM Official and the Assistant Secretary for Aging on the 
efficient management and utilization of information resources in AoA. 
The Principal IRM Official disbanded the IRM Board at the end of FY 
1994. However, the development of a newly-configured IRM advisory body, 
however, will be begun during the first 6 months of FY 1995.
    The AoA IRM Program supports the program goals and strategies of 
the agency in the most cost efficient manner possible. IRM works to 
provide an expanding range of automation tools designed to improve 
AoA's staff's capacity to more effectively, efficiently, and 
economically use AoA's information resources to carry out the agency's 
program goals.
    AoA's Information Resources Management Goals for 1993-99 include:
          (1) Designing, establishing and maintaining an IRM 
        Infrastructure that provides the most effective support tools 
        and structure to help agency staff meet their programmatic 
        responsibilities; and
          (2) Designing, establishing and maintaining an IRM Corporate 
        Data Enterprise to structure, organize, and standardize the 
        Agency's data and information resources.
    An IRM annually revised developed by the IRM staff with input from 
all offices within the Agency, directs the efforts of the IRM staff in 
achieving the various strategies under each of the above-stated goals. 
Each successfully completed project creates or enhances instruments for 
AOA staff and managers to more effectively achieve AoA's mission and 
address the priority areas of the Assistant Secretary for Aging.
    As its major strategy to address the two IRM goals, AoA has 
undertaken its Rightsizing Initiative similar to the systems currently 
maintaining the Administration for Children and Families (ACF) 
mainframe computer. The IRM Division has undertaken this approach to 
take advantage of the more economical and efficient hardware and 
software currently available and to re-engineer the way we perform our 
business functions. The initial emphasis for this effort was support 
for the administrative responsibilities of AoA. Our FY 1994 IRM 
discretionary funds were entirely devoted to the re-design and 
implementation of our grants management and financial management 
systems.
    The movement to a new computing platform has offered AoA the 
opportunity to thoroughly reassess how the basic support functions are 
performed, organized and automated. Fiscal Year 1994 could be 
considered the ``cusp'' for the Rightsizing Initiative. Efforts that 
were initiated in FY 1992 and implemented in 1993 culminated in the 
deployment of the first products under the Rightsizing Initiative. In 
September 1994, the first re-engineered components of the Grants 
Management System (GMS) were implemented for the Title IV Discretionary 
Grants Program. The work completed under the Rightsizing Initiative 
serves as an excellent foundation upon which to build future 
applications.
                                training
    In Fiscal Year 1994, more training dollars were spent on 
managerial/supervisor training than in the past years. As a result of 
the National Program Review (NPR), managers have been asked to deal 
more directly with employees on a variety of issues. Two managers 
within AoA have completed the Federal Executive Institute (FEI) 
training, two attended Management Development Seminars, six attended 
the Supervisor in Context Program offered through the Mary Switzer 
Training Center (two are now certified instructors for this program), 
and the Assistant Secretary for Aging convened a senior management 
caucus late in September 1994.
    During this past year, AoA also opened its own Training Center 
equipped with capabilities for independent learning and career 
assessment. All staff have completed mandatory HIV/AIDS Training, and 
those who were required to completed the annual (mandatory) Ethics 
Training have done so. All staff also received Windows Training.
    In addition, AoA was one of the first organizations to go on line 
with Time and Attendance Information Management (TAIMS).

   SECTION V--INTERAGENCY AGREEMENTS, SPECIAL PROJECTS AND PRIORITY 
                              INITIATIVES

                Coordination With Other Federal Agencies
    In accordance with Title II of the Older Americans Act, the 
Assistant Secretary for Aging and the Administration on Aging (AoA) 
functions as the focal point within the Federal Government for aging-
related concerns. In that capacity, the Assistant Secretary advises the 
Secretary of Health and Human Services on matters affecting older 
Americans and provides consultation and information to entities across 
the Federal Government on the characteristics, circumstances, and needs 
of older persons. AoA has a strong commitment to working with other 
Federal agencies on policy and program development in areas of 
importance to older Americans. To carry out its national level program 
and advocacy responsibilities, AoA places major emphasis on developing 
collaborative relationships with other Federal agencies aimed at 
coordinating diverse and wide-ranging Federal program resources and 
linking those resources to the diverse needs of older persons.
    Dating back two decades, AoA has worked hard to develop and 
implement a network of Federal Interagency Agreements to better serve 
older Americans, combining its resources with those of the Departments 
of Transportation, Housing and Urban Development, Labor, and Education, 
the Farmers Home Administration, and the Corporation for National and 
Community Service (formerly ACTION). Agreements were also made with 
other agencies within the Department of Health and Human Services, such 
as the Social Security Administration (SSA), the Health Care Financing 
Administration (HCFA), the Administration for Children and Families 
(ACF), and the Public Health Service (PHS) (including the National 
Institute on Aging).
    Interagency collaborations represent a strategic coupling of AoA's 
resources to serve the Nation's elderly, especially those at risk of 
losing their independence. Current AoA Federal Interagency Agreements 
cover a spectrum of program efforts including: in-home and community-
based long-term care; board and care homes; and living (ASPE); aging 
and disability (NIDRR); housing (HUD); employment (DOL); elder abuse 
(ACF); and aging research (NIA).
    During FY 1994, interagency agreements designed to effectively 
coordinate research, demonstration, training, and dissemination 
initiatives were implemented with the following agencies:
    National Institute on Aging (NIA).--AoA has an agreement with NIA 
to support workshops in stimulating research on the aging process and 
ensuring the use of research information to improve health and social 
service delivery to the elderly. A workshop focusing on improving the 
quality of life of minority elderly was held at San Diego State 
University. This workshop is producing papers on issues in research on 
minority aging including areas such as long-term care, in-home and 
community-based care, and attitudes of this population toward health 
care. A seminar will be conducted for science writers on the 
demographics of the Nation's aging population and the growing 
importance of population studies for aging and national health policy. 
A multidisciplinary work group will be convened to address a number of 
questions on socioeconomic status, aging and health. Two workshops are 
planned to outline research data needs on the health status of the 
Asian elderly and to explore the feasibility of conducting a national 
survey on aging and health among Asian Americans.
    Office of the Assistant Secretary for Planning and Evaluation 
(ASPE).--Two interagency agreements covering FY 1994 and FY 1995 have 
been signed with ASPE. The FY 1994 agreement will support a study to 
determine the capacity and potential of States and localities to manage 
and deliver home- and community-based long-term care, as well as 
research and evaluation activities related to board and care homes. A 
clearinghouse will be established to disseminate information about 
board and care facilities. ASPE will also support AoA's efforts to 
develop a blueprint for how the Nation can and should prepare for the 
retirement of future generations.
    The FY 1995 agreement will support a national study of how assisted 
living facilities are developed and of how they operate. Under the FY 
1995 agreement, AoA and ASPE will analyze data from the State 
Performance Reports on Titles III and VII to determine the 
effectiveness of new uniform data collection procedures.
    National Institute on Disability and Rehabilitation Research 
(NIDRR).--AoA's agreement with NIDRR supports research which can be 
applied directly to the development of effective community and in-home 
long-term care and rehabilitative services. Both AoA and NIDRR are 
supporting a project at the University of Buffalo on ``The 
Effectiveness of Environmental Interventions and Assistive Technology 
Devices in Maintaining Independence in Home-Based Elderly Persons.''
    Employment and Training Administration of the Department of 
Labor.--This interagency agreement has a number of objectives that 
include: Encouraging employers to hire, instruct, and retain older 
workers; promoting research and demonstrations, training; and 
disseminating information that fosters improved employment 
opportunities for older persons.
    Substance Abuse and Mental Health Services Administration 
(SAMHSA.--This agreement supports activities to increase the detection 
of mental illness among the rural elderly and to provide referral for 
treatment. AoA and SAMHSA have jointly funded project grants that are 
testing the feasibility of training non-mental health care providers in 
meeting the needs of older persons suffering from mental health 
impairments who reside in areas which are underserved by mental health 
professionals. In addition, funding is being provided by the Community 
Mental Health Service for the dissemination of technical assistance 
materials to State mental health and aging agencies to plan future 
programs to better serve the rural elderly.
    Agency for Health Care Policy and Research (AHCPR).--AoA 
collaborated with AHCPR to support a conference conducted by the Boston 
Hebrew Rehabilitation Center for the Aged on ``Overcoming Barriers to 
Mental Health Care of Nursing Home Residents.''
    Administration for Children and Families (ACF).--The agreement with 
the ACF supports the investigation of the national incidence of elder 
abuse, neglect and financial exploitation in domestic settings. 
Advocates for the elderly agree that incidents are substantially under 
reported and undetected and that reports by states of all types of 
elder maltreatment represent only the ``tip of the iceberg.''
    AoA is also actively participating on a number of interagency 
committees and task forces. One example is the Historically Black 
Colleges and Universities (HBCU) Initiative Steering Committee which is 
implementing the Executive Order on HBCUs by looking at the special 
academic and research interests of historically Black institutions of 
higher education. AoA is a member of the HBCU Steering Committee of the 
Subcommittee on Capacity Building which is specifically looking at 
strategies to offer training and employment opportunities to HBCU 
students and graduates. Another example is AoA's membership of the HHS 
Cross Cutting Healthy People 2000 Task Force, which is developing and 
coordinating health promotion objectives of the Department. AoA also 
actively participates on the Geriatrics and Gerontology Committee of 
the Department of Veterans Affairs, as well as the National Institute 
on Aging's Interagency Committee on Research in Aging.
          sharing experiences with the international community
    During 1994, the Assistant Secretary for Aging and the AoA 
continued to participate in international aging activities which 
included:
          Hosting a number of individual and group delegations visiting 
        from other countries (i.e. Japan, Canada, Russia, Latvia, 
        Israel, Belgium, and Taiwan) interested in aging policies and 
        programs.
          Responding to numerous written requests for information from 
        other countries.
          Continuing to participate in the United States-Japan Joint 
        Commission on Aging established by the United States and the 
        Japanese Governments. This Commission will address a wide range 
        of long-term care issues of interest to both countries. The 
        first Commission meeting was held in Washington, DC in October 
        1993. The second meeting is scheduled to be held in Tokyo, 
        Japan in September 1995.
          Presenting a 1 day briefing session on U.S. aging programs 
        and policies to an official delegation interested in starting 
        senior centers.
          Participating in a briefing session for members of the Moscow 
        Duma.
          Assisting HHS in developing its response to the State 
        Department's request for input to the U.S. National Report to 
        the International Conference on Population and Development.
          Serving on HHS's follow-up committee to the Cairo 
        International Conference on Population and Development. This 
        committee is considering the Department's involvement and 
        responsibilities with respect to the Programme of Action of the 
        Conference.
          Providing comment on the proposed U.N. documentation for the 
        1995 World Summit for Social Development, ``Reshaping the World 
        Summit for Social Development.''
          Hosting an official from the Japanese Ministry of Health and 
        Welfare through a fellowship of the National Personnel 
        Authority of Japan. This official will spend 5 months with the 
        Administration on Aging, learning about U.S. aging policy and 
        programs.
          Providing funding to the First International Expert Group 
        Meeting on Indigenous Elderly People held at the University of 
        New Mexico Center on Aging.
          Co-sponsoring the inaugural Conference of the World 
        Organization for Care in the Home and Hospice.
          Participating through video remarks by the Assistant 
        Secretary for Aging, in the PanAmerican Day Care Conference 
        held in Miami, Florida.
          interagency agreements with the bureau of the census
    During Fiscal Year 1992, AoA entered into four multi-year 
interagency agreements with the Bureau of the Census under which the 
Bureau will prepare a variety of statistical materials. In Fiscal Year 
1993, one of these projects were completed and work continued on the 
remainder. The projects are briefly described below.
    (1) AoA had an interagency agreement with the Bureau of the Census 
whereby the Bureau produced a special tabulation of 1990 census data, 
known as the Special Tabulation on Aging. The specifications for this 
tabulation were designed by a working group on its principal users, the 
State and area agencies on aging. The entire tabulation consisting of 
711 tables of population and housing data for each of approximately 
100,000 geographic units of the United States has been completed. One 
version is stored on computer tape and has been archived with the 
National Archive of Computerized Data at the University of Michigan. In 
addition, selected summary data were printed for States and their 
individual planning and service areas. A technical documentation report 
has been produced of this summary data.
    During the period from July to October 1994, the Bureau delivered 
to AoA the final major products from this project--a set of 22 CD-ROM 
disks containing the entire tabulation. Each disk contains 711 tables 
of data for each geographic unit in one or more States, as well as an 
electronic version of the printed technical documentation and easy-to-
use, but powerful access software. The geographic units include States, 
counties, minor civil divisions (towns and cities), metropolitan 
statistical areas, urbanized areas, places with 2,500 or more 
inhabitants, census tracts, American Indian reservations, planning and 
service areas, and their components.
    The aging network has never before had a statistical resource like 
the Special Tabulation on Aging and the reaction to this instrument has 
been quite enthusiastic. Each State agency on aging has received the 
printed summary tables for its State, the printed technical 
documentation, and the CD-ROM disk for its State. AoA also disseminated 
copies of the CD-ROM disks and printed tables to various national aging 
organizations. The Bureau of the Census has made all of the products 
from the tabulation available for purchase by the public.
    (2) AoA will enhance the use of the Microdata Sample of Older 
Persons. This computer file contains actual 1990 census questionnaire 
responses for a 3 percent sample of households containing one or more 
members 60 years of age or older. The file enables users to tabulate 
raw census data for individuals (without identifying information) in 
any way the user desires.
    The geographic codes attached to each record of this file will only 
identify relatively large geographic areas (e.g., region, State, 
metropolitan area). This project was completed during Fiscal Year 1993.
    (3) The Census Bureau will explore alternative techniques for 
estimating the 60+ population by age group, sex, race, and ethnicity 
for States and sub-State areas. The project includes an evaluation of 
estimation techniques, an evaluation of data sets e.g., the various 
Medicare files) and the development of a pilot program of estimates for 
selected areas. The Bureau will prepare an outline, with cost 
estimates, for a full-scale program to develop annual estimates of the 
elderly population for States and sub-State areas. This project has 
been completed by early fiscal year 1994.
                             Transportation
    AoA has worked with the National Eldercare Institute on 
Transportation and the Joint DOT/DHHS Coordinating Council on Human 
Services Transportation to highlight transportation as an important 
factor in permitting on older persons to continue to live independently 
and remain involved in their communities.
    National Eldercare Institute on Transportation.--The National 
Eldercare Institute on Transportation is conducted by the Community 
Transportation Association of America (CTAA) in partnership with the 
National Association of Area Agencies on Aging, the National Caucus and 
Center on Black Aged, Inc., the National Council on the Aging, Inc. and 
the National Association of State Units on Aging. The Institute has 
provided technical assistance to many State and Area Agencies to enable 
them to meet the mobility and transportation access needs to older 
persons. The Institute sponsored a mini-White House Conference on Aging 
where older persons presented their issues, views, and concerns about 
transportation and a report was prepared for dissemination. A poster 
was developed to promote the availability of transportation services in 
a local community and was received well by the State Agencies on Aging 
and the Area Agencies on Aging. A series of articles on the five AoA-
sponsored transportation demonstrations was prepared and disseminated 
through the CTR magazine. Two national teleconferences were convened 
with the State Units on Aging to discuss the Americans with 
Disabilities Act of 1990 (ADA) and the opportunities for public 
participation in transportation planning. Currently, in development is 
a transportation primer explaining the demographics of the aging 
population, the transportation services that exist now, and 
recommendations to address the anticipated future mobility and 
transportation needs of an aging population.
    Joint DOT/DHHS Coordinating Council on Human Services 
Transportation.--The Administration on Aging has worked with the 
Coordinating Council over the past year to improve the availability and 
quality of transportation options for clients of HHS-funded programs 
through more effective use of existing resources. Activities included 
the development of several reports. Ecosometrics, Inc. prepared a 
report on the Transportation Needs and Problems Among the Elderly. The 
National Eldercare Institute prepared a report on successful examples 
of transportation where State Units on Aging and State Departments of 
Transportation have coordinated their efforts. The Coordinating Council 
and the National Highway Traffic Safety Administration have signed an 
Interagency Agreement to look at older driver safety issues. AoA will 
participate as an advisor to the joint effort. AoA brought tribal 
sovereignty concerns and Native American transportation issues (on and 
off the reservation) to the attention of the Coordinating Council. AoA 
activity participated in the Department of Transportation's Roundtable 
where States were asked to come in to discuss their transportation 
issues and concerns.
                       aoa activities in housing
    AoA has worked with the Institute for Housing and Supportive 
Services to enhance opportunities for older persons to continue to live 
independently and be involved in their communities. The Institute has 
provided technical assistance to many State and area agencies to meet 
the needs of older persons seeking alternatives to long-term care.
    AoA/HUD Workgroup.--The mission of the AoA/HUD Coordination and 
Access to Services Housing Work Group is to strengthen access to 
services in multifamily federal-assisted housing. The Assistant 
Secretary for Aging, public and private agencies, foundations and 
housing and community organizations are working together to demonstrate 
the value of public/private partnerships in helping to address issues 
of concern to both the aging and disability communities.
    In light of diminishing public resources, the Assistant Secretary 
for Aging has intensified AoA efforts to foster continued relationships 
with the private sector, and promote partnerships and new approaches to 
service delivery in housing for the elderly and disabled. AoA activity 
in this area has generated a favorable response from public and private 
agencies involved in the management and operation of housing facilities 
for the elderly.
                    housing coalition participation
    AoA has become an active participant in meetings of the Elderly 
Housing Coalition. This activity improves AoA's ability to disseminate 
information and encourages the enhanced exchange of information related 
to housing and long-term care issues.
          evaluation of the nutrition program for the elderly
    A contract to perform a Congressionally mandated program evaluation 
was awarded to Mathematica Policy Research, Inc. (MPR) of Princeton, NJ 
on September 27, 1993. The 2 year study addresses the following 
research questions:
          1. What are the characteristics of program participants and 
        to what extent does the program reach special populations of 
        the elderly, such as low-income and minority elderly?
          2. What is the impact of the program on the dietary intake, 
        health status, and socio-psychological well-being of the 
        elderly?
          3. Are the organizational, administrative and service 
        delivery components of the program efficient and cost 
        effective?
          4. How much program funding is available, what are its 
        sources, how is it used, and is it adequate?
    Design, sampling tasks, and pre-testing of study instruments have 
been completed. Telephone and in-person surveys to State and Area 
Agencies on Aging, Indian Tribal Organizations, providers, and 
participants of congregate and home-delivered nutrition services began 
in September 1994 and should be completed in December 1994. Preliminary 
findings will be available in March 1995 and the final report should be 
released in July 1995.
    The data from this study will provide descriptive tabular, cross 
tabulations, multivariate and descriptive policy analyses used to 
address the research questions. The results of this study will assist 
the Administration on Aging in determining how effective the Elderly 
Nutrition Program has been, where changes need to be made to make the 
services more efficient, and what policy directions should be 
considered to better meet the evolving needs of the elderly.

 Institute of Medicine, National Academy of Sciences Study to Evaluate 
 the State Long-Term Care Ombudsman Programs of the Older Americans Act

    On September 30, 1993, The Institute of Medicine was awarded a 
contract to conduct a Congressionally-mandated national effectiveness 
study of the following aspects of State ombudsman programs:
          1. The availability, access, and effectiveness of the 
        ombudsman program for residents of long-term care facilities 
        (including board and care and other similar adult care 
        facilities);
          2. The adequacy of Federal and other resources available to 
        operate the programs throughout the United States;
          3. State compliance and the barriers to compliance in 
        implementing the program;
          4. The presence of any actual and potential conflicts of 
        interest in the administration and operation of the program; 
        and
          5. The need for and feasibility of providing ombudsman 
        services to older individuals who are not residing in long-term 
        care facilities, but are users of health and long-term care 
        services.
    The increasing responsibilities assigned to the ombudsman program, 
often without regard to the resources available, has been of particular 
concern to many people familiar with the program. This study will 
examine whether those aspects of the program that possibly contribute 
to its success in long-term care facilities are transferable to 
settings, such as private homes, community health clinics, and the 
like. Most of the field work has been completed and the draft final 
report should be available in January or February of 1995.
                      public-private partnerships
    The Administration on Aging held several meetings with the Business 
and Aging Leadership Roundtable to strengthen the business and 
government partnership in support of aging issues. The Assistant 
Secretary for Aging has taken a strong role in coordinating efforts of 
corporations and business organizations to demonstrate the value of 
public/private partnerships in helping to address aging-related issues 
in the workplace, market place, and the community-at-large. As a result 
of these meetings in FY 1994, the Roundtable was instrumental in 
identifying and developing a visible role for business in the 1995 
White House Conference on Aging. HHS Secretary Donna E. Shalala signed 
the charger for the establishment of the Business Advisory Council to 
the White House Conference on Aging. Planning meetings are underway to 
discuss events and activities for the business community. The Business 
Advisory Committee to the White House Conference on Aging will advise 
and recommend to the Secretary ways to plan, conduct and review 
business issues as they relate to the problems of an aging society. The 
Roundtable will assist in reviewing a broad range of aging issues and 
identify and prioritize business aspects of those issues. The 
Roundtable will also play a role in implementing policy recommendations 
following the 1995 White House Conference on Aging.
           national eldercare institute on business and aging
    The National Eldercare Institute on Business and Aging is 
administered by the Washington Business Group on Health (WBGH) in 
partnership with the American Society on Aging (ASA). The efforts of 
the Institute emphasized the initiatives established by the Assistant 
Secretary for Aging with a particular focus on health care reform, 
long-term care and preparation for the elderly of tomorrow. The 
Institute provided ongoing training, technical assistance, and 
dissemination activities to enhance collaboration between the aging 
network and the business company. The Institute conducted a Workshop on 
Managed Care and Medicare Options, a survey of corporate retirement 
planning programs for baby boomers, a Design for Maturity Technology 
Conference, a Think Tank of Products, Designs and Technologies for the 
Mature Market, and a Roundtable on Telecommunications and Aging.
                         volunteerism and aging
    AoA continued its efforts in the area of volunteerism and aging by 
providing funding for the third year to the National Eldercare 
Institute on Employment and Volunteerism. The Institute has worked to 
increase public awareness of volunteerism issues and opportunities in 
the care of the elderly and to enhance the potential for the 
development of new or expanded approaches in volunteerism in both the 
public and private sectors.
    AoA, in conjunction with the National Eldercare Institute on 
Employment and Volunteerism, the Corporation for National and Community 
Service, and AARP, sponsored on interactive leadership development 
program entitled the National Training Institute for Leadership in 
Senior Volunterrism. The 4 day Training was developed in order to 
respond to the evolution of senior volunteerism in a variety of 
organizations and agencies at the federal, state, and local levels, 
creating an environment required strong leadership and management 
capabilities. The training was offered at four sites nationwide--
Washington, DC, Atlanta, GA, Denver, CO, and Minneapolis, MN.
                 collaborative efforts in volunteerism
    AoA has been meeting on a regular basis with representatives from 
AARP, the Corporation for National and Community Service, the Points of 
Light Foundation and the National Eldercare Institute on Employment and 
Volunteerism. The purpose of these meetings has been to explore ways in 
which these organizations can more closely and collaboratively work at 
the national, State, and local levels. In their first joint effort, 
these agencies engaged in a dialogue with local organizations in 
Richmond, Virginia to discuss strategies for now national organizations 
can best promote State and local collaboration in senior volunteerism.
  collaborative efforts with the office of personnel management (opm)
    AoA continues to work with the OPM in an effort to promote and 
encourage the development of eldercare programs throughout the U.S. 
Government. AoA assisted OPM in the planning of a caregivers conference 
which provided Federal personnel directors and employees information on 
issues surrounding aging and caregiving. AoA and OPM co-sponsored a 
lunchtime seminar on caregiving during National Caregivers Week.
          priority areas of the assistant secretary for aging
    In the spring of 1993, the Assistant Secretary for Aging identified 
several; priority Initiatives for the Administration to focus its 
attention upon that would comprehensively address the needs of our 
older constituents and their families. These include: A Blueprint for 
An Aging Society, Long-Term Care Agenda, Older Women's Intitiative, 
Nutrition/Malnutrition Initiative, and Crime Violence Prevention 
Initiative. During FY 1994 AoA continued in its efforts to implement 
several goals in these priority areas in order to prepare older persons 
for a long lifespan. These priority areas served to focus AoA's 
discretionary and research and funding under Title IV of the OAA as 
discussed in Section IX of this Report.
    AoA's Blueprint for an Aging Society is the overarching theme for 
each of the Assistant Secretary's priority areas. It is designed to 
provide a framework for responding to the issues of preparing older 
persons for a long lifespan which include long-term care, older women, 
nutrition/malnutrition, and crime/violence prevention. In the spring of 
1994, AoA commissioned the National Academy on Aging to examine a 
comprehensive array of issues that affect the baby boom population and 
to offer suggestions as to how to address such concerns. The National 
Academy's report, entitled ``Old Age in the 21st Century'' underscores 
the need to comprehensively address the myriad issues that will impact 
our aging society. AoA has started working on formulating a public 
education agenda which will focus on personal responsibility in the 
aging process.
    AoA's Home and Community-Based Long-Term Care Agenda is a 
comprehensive series of plans and activities for the continued 
development of consumer-driven home and community-based systems of care 
for persons who need services. It is a multi-year effort and includes 
plan to work with other agencies and organizations that are interested 
in promoting home and community-based care. During FY 1994, a number of 
actions were taken to implement the Agenda:
          AoA conducted a Health Care University in January 1994 for 
        several hundred staff of State Units and Area Agencies on 
        Aging. This event provided important information to the aging 
        network about the health care reform proposals of the 
        Administration, as well as the AoA Agenda for home- and 
        community-based long-term care.
          AoA strengthened its relationships with other Federal 
        agencies and offices in HHS, including Planning and Evaluation 
        (ASPE) and the Health Care Finance Administration (HCFA). AoA 
        participated in the HHS-Department of Transportation 
        Coordinating Council on elderly transportation issues. In 
        addition, a new relationship with Housing and Urban Development 
        was implemented to enhance the provision of supportive services 
        in federally assisted housing. AoA also participated in a HCFA 
        task force seeking to develop recommendations to improve the 
        long-term care components of Medicare and Medicaid.
          AoA signed an interagency agreement with the Office of the 
        Assistant Secretary for Planning and Evaluation to do a 
        national study on assisted living. This study will investigate 
        the role of community-based living arrangements in the long-
        term care continuum.
          AoA funded a new National Long-Term Care Center on Housing 
        and Supportive Services to assist the aging network to develop 
        housing options and supportive services for the frail elderly. 
        The center will provide important support for the development 
        of systems of care for home and community-based services.
          AoA funded several projects for the development of models to 
        coordinate home and community-based services for the disabled 
        and the frail elderly.
          AoA established a national data base on home and community-
        based services. Data were collected from all State Units on 
        Aging to create a profile of the major publicly funded Federal 
        and state programs providing home and community-based services. 
        Briefings on the highlights of the data analysis were provided 
        to a variety of interested groups, including the staff of 
        several Congressional committees, Federal agencies and public 
        interest groups. AoA developed a State Source Book which 
        provides data on a State by State basis.
    AoA's Older Women's Initiative was formally launched on September 
27, 1994, at a ``Celebration of Older Women'' reception which honored 
older Americans who represent the countless contributions that women 
make to society in areas of public/community service, intergenerational 
caregiving, and successful aging. A concept paper for the Initiative 
was fully developed and released to the public.
    To heighten sensitivity to older women's issues, AoA also organized 
a brown bag luncheon in conjunction with the Employee Assistance 
Program and Office of Personnel Management to highlight National Family 
Caregivers Week (Week of Thanksgiving). The luncheon highlighted the 
services offered by the AoA-funded Eldercare Locator which assists 
caregivers and older persons to access the services necessary to 
maximize their independence.
    AoA's Nutrition/Malnutrition Initiative was launched by the 
Assistant Secretary for Aging at the American Dietetic Association's 
annual meeting in October 1994. By July 1995, the Congressionally-
mandated Elderly Nutrition Program Evaluation will be completed and the 
findings publicized.
    AoA also began a series of 10 Regional forums to increase awareness 
of the issues and inter-relationships of adequate nutrition, 
malnutrition, hunger and food insecurity on health, independence, and 
quality of life for older individuals. The Assistant Secretary for 
Aging has met with officials at the Department of Agriculture to 
explore the development of a joint task force to address common 
concerns dealing with nutrition, food access, and the elderly.
    The Crime/Violence Prevention Initiative was newly-conceptualized 
in FY 1994. It will focus on prevention efforts. As part of this 
Initiative, AoA has signed an Interagency agreement with the 
Administration for Children, Youth and Families to study the incidence 
of elder abuse. AoA will also continue public awareness activities 
under Title VII, Vulnerable Elder Rights Protection Activities, of the 
OAA. During FY 1994, the Assistant Secretary for Aging, along with 
Attorney General Janet Reno, participated in a House of Representatives 
Older Americans Caucus symposium on violence against the elderly.

        SECTION VI--TITLE III SUPPORTIVE AND NUTRITION SERVICES

    For FY 1994, 57 States and territories received a total of $799.992 
million of Title III funds to carry out the objectives of the Older 
Americans Act (OAA) to ensure that older Americans (present and future) 
have an independent, productive, healthy and secure life. A network of 
State units on aging, 670 Area Agencies on Aging, 25,000 service 
providers, and 227 tribal organizations which have been in place for 
almost three decades, have been faced with the twin challenges of 
escalating numbers of older persons and decreasing resources to serve 
them. In response to these challenges, the network continued to build 
upon the foundation provided by the OAA resources to enhance 
comprehensive and coordinated systems which are responsive to the needs 
of the elderly. As advocates, State and Area Agencies on Aging use OAA 
funds to leverage State and local resources to expand and improve 
services. These services make a vital difference in the lives of older 
persons who are attempting to remain self-sufficient and to live in 
their homes and communities for as long as possible.
    The debate over health care reform during this year provided an 
opportunity for the aging network to join in the national dialogue on 
home and community based long-term care which is essential to achieving 
the goals of the OAA. While national health care reform was not 
achieved home and community-based care, once thought expendable, is now 
closely identified with health care reform. State and Area Agencies on 
Aging and service providers will continue to engage in coordinated and 
comprehensive long term care systems building and strengthening their 
role in providing home and community-based services.
    As a result of the 1992 amendments to the Older Americans Act, the 
Administration on Aging has been involved in two major efforts which 
impact on the network: the promulgation of regulations regarding the 
development and approval of intrastate funding formulas (IFFs), and the 
development of a new data collection and reporting system.
                    intrastate funding formula (iff)
    The 1992 amendments to the Older Americans Act (P.L. 102-375) now 
require States to submit their intrastate funding formulas (IFFs) to 
the Assistant Secretary for Aging for approval, rather than only for 
review and comment, as was the case prior to the 1992 amendments. The 
amendments also require the Assistant Secretary to provide guidance to 
States in the development of their intrastate funding formulas. AoA has 
interpreted the amendments to require that this guidance be in addition 
to the language contained in section 305(a)(2)(C) of the statute which 
requires State Units on Aging to take into account the geographic 
distribution, greatest economic and social need of older individuals in 
the development of their IFFs. If the Assistant Secretary does not 
approve the IFF, a new requirement under section 304(c) mandates the 
Assistant Secretary to withhold the State's allotment of funds.
    On March 17, 1994, the Notice of Proposed Rulemaking (NPRM) on the 
Intrastate Funding Formula was published in the Federal Register. 
During the 60-day comment period following publication of the NPRM, AoA 
received over 2,300 comments: Members of Congress (11), national aging 
organizations (8), State Units on Aging (33), State human services 
agencies (3), Area Agencies on aging (117), community service provider 
agencies (66), and individuals (2,114). The greatest number of comments 
pertained to the proposed definition of ``rural'' and the IFF 
regulations. In general, the comments supported the goal of the 
proposed changes and additions to provide a standard definition for the 
term ``rural area,'' and to develop standards for the review and 
approval of intrastate funding formulas. Numerous comments confirmed 
the need to recognize the diversity of conditions between and within 
States. Others expressed a variety of interests seeking either greater 
or less prescriptiveness. Diverse and competing interests were 
presented by the comments. Representatives of State and local 
organizations were seeking optimum flexibility to develop a formula 
based on a consensus of parties within each State. Minority and rural 
advocates wanted a more prescriptive stance by AoA and inclusion and 
exclusion of specific factors and weights of AoA's guidance 
requirements.
    The current rules are revised by the final rule in order to comply 
with the new statutory requirements, as well as to address the intent 
of Congress that the targeting of services and resources to those older 
individuals identified as having the greatest economic need, the 
greatest social need, or is a low-income minority, be accomplished 
through the intrastate funding formula. In the rule, the Assistant 
Secretary has developed standards for review and provided directions to 
State Agencies on Aging on how to evaluate whether their formulas meet 
those standards. The regulations were designed to provide States with 
flexibility to either maintain their current formula or, if necessary, 
to allow for the development of a modified or new formula that 
addresses the requirements set out by Congress in section 305(a)(2)(C) 
of the OAA.
           national aging program information system (napis)
    The Older Americans Act requires annual reports from State Units on 
Aging on the performance of the services programs for the elderly 
provided through the aging network. The information is used by AoA to 
administer the program and to report to the Congress and the public 
about the program. Over the last 30 years, the aging network has 
developed and evolved into a diverse network of programs and services 
which support the goal of the OAA to help older individuals remain 
independent in their own homes and communities for as long as possible. 
The ``Government Performance and Results Act of 1993'' (GPRA) (P.L. 
103-62) focuses on the need to improve Federal program effectiveness, 
particularly using information about program results and service 
quality to set program goals and measure performance against those 
goals. Therefore, the need to accurately portray who is served and what 
types of services are provided is more critical today than it has ever 
been. The introduction of these new reporting requirements is a 
significant and important step in bringing about improved data and 
enhancing the capacities of the aging network at all levels to utilize 
the data in support of policy development and advocacy including the 
requirements for the development of the IFF.
    The 1992 Reauthorization of the Older Americans Act directed AoA to 
develop reporting procedures for use by States to correct deficiencies 
in current reporting practices. In response to this mandate, AoA has 
developed a revised reporting system known as the National Aging 
Program Information System (NAPIS). NAPIS will provide for improved 
reporting guidelines for Title III (Grants for State and Community 
Programs on Aging) Title VII (Allotments for Vulnerable Elder Rights 
Protection Activities). It will also include a separate reporting 
component for the Ombudsman Program to be effective in Fiscal Year 
1996.
    The improved components of NAPIS will allow AoA to meet a number of 
new legislative requirements. Some of the new reporting requirements 
are uniform definitions and nomenclature, standardized data collection 
procedures, and a participant identification and description system. In 
addition, the new system will improve reporting accuracy, focus data 
collection on clients and their characteristics, and make performance 
data part of a broader information acquisition and analysis strategy 
within AoA.
    AoA sought considerable input from the aging network, including 
policy and technical review committee meetings in 1992, workgroup 
sessions, selected State visits, phone conversations and opportunities 
for the network to provide written comments to draft copies of the two 
major components of NAPIS: the Title III State Program Performance 
Report (SPR) and the State Annual Ombudsman Report. Three major areas 
of concern were identified in the public comments from State and Area 
Agencies on Aging, service providers and other aging advocates: (1) 
timing of the implementation; (2) cost of implementation; and (3) level 
of reporting detail. In response to these comments, AoA scaled down our 
initial reporting design and submitted revised requirements to the 
Office of Management and Budget (OMB) for clearance. This data 
collection effort is now intended to be phased in over a 3-year period 
with levels of detail increasing annually.
    Several State Agencies on Aging indicated that they already collect 
many of the data elements which are required, or that they could do so 
with little effort. AoA is strongly encouraging those States to 
voluntarily report on all of the data elements, even if the required 
implementation date is delayed. In addition, many State and Area 
Agencies on Aging collect data which are not required to be reported. 
Though the States are not expected to report this information to AoA, 
some information may be useful to plan and develop responsive service 
systems for Older Americans.
               reauthorization of the older americans act
    It must be recognized that the political context for addressing the 
present challenges of an aging society is far different from that of 
the mid 1960's when the Older Americans Act was first enacted. The 
reauthorization process of the OAA will help to identify needed changes 
to enable the aging network to face the challenges of an aging society. 
The possibility of a 1-year delay in the reauthorization would enable 
AoA to incorporate recommendations and policy proposals from the May 
1995 White House Conference on Aging and to receive input from events 
and studies which are also critical in shaping the direction of the 
aging network.
    Three are many questions which arise to the impending 
reauthorization. To explore answers to those questions, the Assistant 
Secretary convened a meeting of representatives from all levels of the 
aging network to discuss a broad range of issues, particularly the role 
of the Aging Network in long term care. This dialogue raised as many 
questions as it answered, but there was a general consensus that the 
reauthorization of the OAA needed to support and enhance the 
development of an infrastructure for home and community-based care 
built by the aging network. Additionally, AoA staff held special 
workshops at the annual meeting of State Agency on Aging Directors and 
the annual meeting of the National Association of Area Agencies on 
Aging to provide an opportunity for broad-based discussion and input 
into the reauthorization process.

                           TITLE III SERVICES

    All individuals age 60 and over are eligible for services, although 
the OAA directs that priority be given to serving those with greatest 
economic and social need, with particular attention to low-income 
minority older individuals. There are no mandatory fees in this 
program. Older persons, however, are encouraged to make voluntary 
contributions to help defray the costs of services. Under current law, 
these contributions are used to expand services. In addition, volunteer 
support is an integral component of the service system.
                    title iii-b supportive services
    In FY 1994, the $306.711 million provided through Title III served 
to support the infrastructure needed to provide home and community 
based care as well as leveraged resources from other Federal, State, 
and local entities. Most supportive services fall under three broad 
categories: access services such as transportation, outreach, 
information and assistance, and case management; in-home services such 
as homemaker and home health aides, chore maintenance, and supportive 
services for families of older individuals who are victims of 
Alzheimer's disease; and community services such as adult day care, 
legal assistance, and recreation.
    Supportive services are designed to maximize informal support 
provided by caregivers and to enhance the capacity of the older 
individual to remain self-sufficient. Program data FY 1993 indicate 
that information and assistance services were provided to over 3 
million older persons and their caregivers. Over 3 million outreach 
contacts were made to identify older persons who needed to gain access 
to services. Transportation continued to be one of the most heavily 
used services. Over 800,000 older persons received over 40 million 
units of transportation services to their doctor, clinic or senior 
center. Nineteen percent of all Title III-B participants were 
minorities and 39 percent were low-income. (See Table 1 in the Tables 
and Charts Section at the end of this Report.)
            title iii-c congregate and home delivered meals
    Nutrition services are provided under Title III-C of the Older 
Americans Act (OAA). The title contains two Parts, Congregate Nutrition 
Services (C-1) and Home-Delivered Nutrition Services (C-2). The 
services provided under these parts are similar but are targeted to 
different populations of older people. A State may elect to transfer up 
to 20 percent of the funds appropriated among Supportive Services and 
Senior Centers, and the Nutrition Services according to service need.
    Although meals are the primary service provided, other nutrition 
services are rendered including nutrition screening, education, 
counseling, and outreach. Congregate meals provided under the OAA must 
comply with the Dietary Guidelines for Americans and provide a minimum 
of 33 percent of the Recommended Dietary Allowances (RDA) if one meal 
is served; a minimum of 66 percent of the RDA if two meals are served; 
and 100 percent of the RDA if three meals are served. Service providers 
are encouraged to expand meal service to more than one meal per day, 
more than 5 days a week, to persons with increased needs. Where 
feasible and appropriate, meals are provided to meet the special 
health, religious, and ethnic requirements of participants.
    There is substantial private sector, state, and local community 
financial and volunteer support for the program. Although there are no 
fees in this program, older persons are encouraged to contribute 
through volunteerism and financial support to help defray the cost of 
services. In FY 1993, program income, including contributions from 
Congregate Nutrition Program participants, was over $170 million. Under 
current law, these contributions are used by local programs to expand 
services. Also, volunteers, many of them older Congregate Nutrition 
Program participants, perform essential program tasks such as managing 
nutrition sites, delivery of meals and record keeping.
    Many of the participants in this program have one or more disabling 
condition. The nature of this program has evolved over the years so 
that the importance of nutrition intervention and nutrition services is 
more critical then ever as an essential service component integral to 
ensuring that older people are maintained in their homes and 
communities. Most recent data for FY 1993 indicates that 126.3 million 
congregate meals were served to 2.36 million older persons of whom 28 
percent were frail and disabled; 47 percent were low-income; 42 percent 
were rural residents; 18 percent were minority; and 13 percent were 
low-income minority. Also in FY 1993 102.5 million home-delivered meals 
were served to 794.5 thousand persons of whom 77 percent were frail and 
disabled; 58 percent were low-income; 45 percent were rural residents; 
19 percent were minority; and 15 percent were low-income minority. (See 
Chart 1 in the Tables and Charts Section at the end of this Report.)
    Adequate nutritional status is essential to well-being, health, 
self-sufficiency, and quality of life for all older persons--from those 
who are well, healthy, more able older persons to those who are frail, 
ill, and functionally impaired. The nutrition services program strives 
to provide a continuum of services to meet these individual needs.
             title iii-d in-home services for frail elderly
    In FY 1994 $7.075 million was provided via Title III to provide in-
home services to frail older individuals, including services to older 
individuals who are victims of alzheimer disease. Services provided 
under this part include homemaker and home health aides, visiting and 
telephone reassurance, chore and maintenance services, in-home respite 
care and adult day care as respite service, minor modification of homes 
to facilitate continued occupancy by older individuals, and personal 
care services and other in-home services as defined by the State and 
area agencies on aging.
    The main objective of in-home services to the frail aged is to 
direct resources specifically at the group of older Americans most at 
risk of losing their self-sufficiency. In FY 1993 in-home services were 
provided to over 70,000 persons of whom 19 percent were minority and 87 
percent were low income. (See Chart 2 in the Tables and Charts Section 
at the end of this Report for FY 1993 percentage of expenditures in the 
various general service categories.)
      title iii-f disease prevention and health promotion services
    The 1992 amendments to the Older Americans Act added Part F to 
Title III entitled ``Disease Prevention and Health Promotion 
Services.'' In FY 1994 $17,032,000 was allocated to the State Unit on 
Aging for activities in this area. Title III-F funds are used to 
leverage other resources to increase public understanding of how 
healthy lifestyle choices throughout life reduces the risk of chronic 
health conditions in later years. (See Chart 3, p. for FY 1993 
percentage of expenditures by service category.)
    To gather more detailed data on the implementation of Title III-F, 
a survey of SUAs was undertaken in 1994 by the American Association of 
Retired Persons' (AARP) National Eldercare Institute of Health 
Promotion in collaboration with AoA and the National Association of 
State Units on Aging (NASUA). The highlights of the findings of this 
study are as follows:
          1. Approximately half of the SUAs allocated Title III-F funds 
        according to formula they used for allocation of Title III-B 
        and C funds and the others developed special formula for 
        allocating Title III-F funds but often based on or adapted from 
        their Title III-B and C formulas.
          2. Some common issues regarding the allocation of III-F funds 
        were:
                  Permitted uses of funds;
                  Definition and documentation of medically underserved 
                populations;
                  Funding level;
                  Insufficient information and guidance from AoA; and
                  Insufficient time to properly plan for implementation 
                of new program.
    SUAs allocated funds to over 20 general types of organizations with 
public health, education, community-based agencies, hospitals/medical 
institutions, and senior centers being the most common. Most SUAs 
indicated that there were formal or informal mechanisms at the local 
level for coordination or collaboration among agencies receiving III-F 
funds. Ten types of such local-level mechanisms were identified.
    The percentage of SUAs funding each of the OAA prescribed III-F 
categories of programs and services are as follows: (93%)--routine 
health screening; (89%)--physical fitness programs; (85%)--health 
promotion programs on chronic disabling conditions; (76%)--nutritional 
screening and educational services/educational programs on preventive 
health services; (75%)--health risk assessments/information on age-
related diseases and chronic disabling conditions); (69%)--mental 
health screening, education and referral; (65%)--home injury control 
services; (51%)--counseling regarding social services and follow-up 
health services; (35%)--gerontological counseling. Most SUAs are not 
funding any other health promotion or disease prevention programs or 
services.
    The percentage of SUAs identifying and maintaining continuing 
barriers to the availability and accessibility of disease prevention 
and health promotion for older adults identified were as follows: 
(33%)--rural/geographic isolation; (29%)--lack of funds; (27%)--lack of 
transportation; (27%)--insufficient supply of trained staff and/or 
volunteers; (20%)--program accessibility/lack of programs; (18%)--
elders need to take more responsibility; (15%)--lack of providers, 
especially in rural areas; (13%)--many older adults lack basic 
[related] knowledge; (13%)--insufficient collaboration and coordination 
among agencies.

       SECTION VII--VULNERABLE ELDER RIGHTS PROTECTION ACTIVITIES

                        Background on Title VII
    The 1992 Amendments to the Older Americans Act (the Act) brought 
about a significant development in the Act--Title VII, the Vulnerable 
Elder Rights Protection Title. In creating Title VII, Congress 
recognized the critical importance of strong and effective advocacy to 
protect and enhance essential rights and benefits of vulnerable older 
people. Congress refocused the Older Americans Act on its original 
advocacy mission and empowered State Agencies on Aging to ``provide 
firm leadership . . . to assure that the rights of older individuals . 
. . [are] protected.'' (S. Rep. No. 102-151, 102nd Cong, 1st Sess, 103 
(1991)). Congress also recognized that while the profile of the older 
population has improved markedly since 1965, there remain many very 
vulnerable older persons who suffer serious deprivation, are denied 
basic rights and benefits, and need strong and vigorous advocacy on 
their behalf. Title VII therefore encourages State Agencies to 
concentrate advocacy efforts on issues affecting those who are the most 
socially and economically vulnerable.
    Title VII has a dual focus. It brings together and strengthens (in 
Chapters 2, 3, 4 and 5) four existing advocacy programs--Long-Term Care 
Ombudsman Program; Programs for the Prevention of Abuse, Neglect and 
Exploitation; State Elder Rights and Legal Assistance Development 
Programs; and Insurance/Benefits Outreach, Counseling and Assistance 
Programs--and calls for their coordination and linkage within each 
State. In addition, Title VII (in Chapter 1) calls on State Agencies to 
look beyond individual programs and take a holistic approach to elder 
rights advocacy, not only by coordinating the four programs, but by 
fostering collaboration among programs and with other advocates across 
each State to address--at a systems level--issues of the highest 
priority for the most vulnerable elders.
    The FY 1994 appropriation for programs under Title VII included 
funding for the Long-Term Care Ombudsman Program, Programs for 
Prevention of Elder Abuse, Neglect and Exploitation, and for pension 
counseling activities under the new Title VII. The appropriation did 
not include funding for the State Elder Rights and Legal Assistance 
Development Program or for elder rights activities to assist Native 
American Organizations under Subtitle B. The amounts allocated to the 
States were $4,648,000 for elder abuse prevention; $4,370,000 for 
ombudsman activities; and $2,000,000 for pension counseling.
    Combining the State advocacy programs under a single title has 
fostered increased collaboration among advocates within a State--and 
between States--to assist individual older people, their families and 
representatives, while preserving and strengthening the distinct 
mission and function of each program.
                  fy 1994 ombudsman program highlights
    The Long-Term Care Ombudsman Program:
          Assists residents of long-term care facilities and their 
        family and friends to express themselves regarding the 
        conditions of their life and care; and
          Promotes policies and practices needed to improve the quality 
        of life in nursing and board and care homes and similar adult 
        care facilities.
    Working through hundreds of grassroots programs, ombudsmen and 
ombudsman volunteers monitor both private and publicly-subsidized care. 
They educate consumers and providers about residents' rights and good 
care practices, such as alternatives to chemical and physical 
restraints, that limit individual freedom, leading to physical and 
spiritual deterioration. The date in some States demonstrate that 
ombudsman presence in a facility can help reduce the level of 
deficiencies in the facility. The ombudsman's role in preventing 
neglect and even abuse of residents is one of their most important 
roles.
    A 1994 American Association of Retired Persons survey of ombudsman 
programs found that, nationwide, 839 paid staff and 6,591 volunteers in 
the program.
    State Ombudsman reports for FY 1994 are not yet available, but 
reports for FY 1993 provided the following data on the nationwide 
program:
          there are 549 local or regional ombudsman programs;
          there were 154,400 thousand people who filed complaints;
          there were 197,800 thousand complaints were filed;
          seventy-four percent of complaints were resolved; and
          the program was funded at a level of $37.4 million (21% of 
        which was State funds).
    During FY 1994, AoA provided active leadership and support to State 
long-term care ombudsman programs. AoA also promoted increased 
collaboration between the ombudsman and State adult protective services 
programs. AoA activities included:
          Completion and clearance of proposed regulations for 
        implementation of Title VII statutory requirements. (Although 
        the NPRM will not be published in the Federal Register until FY 
        1995 on November 15, 1994.)
          Continued financial support for an independent, comprehensive 
        study of the effectiveness of the Ombudsman Program being 
        conducted by the Institute of Medicine (IOM). (The report on 
        this study will be released in January 1994.)
          Completion of a 2-year effort to revise the State ombudsman 
        reporting system that will enable the States and AoA to comply 
        with the reporting requirements in Sections 207(b) and 712(c) 
        and (h) of the Act. The result, the National Ombudsman 
        Reporting System (NORS), was submitted to the Office of 
        Management and Budget for approval for required use by the 
        States beginning in FY 1996. (Thirty-five States had 
        voluntarily converted to the NORS by or before October 1, 
        1994.)
          Award of a 2-year grant to the University of Louisville to 
        develop software for optional use by States to collect and 
        analyze data on complaints made to the ombudsman and other 
        ombudsman activities. Kentucky, New Hampshire, South Carolina, 
        Utah, Florida and North Dakota are participating in the pilot 
        work on the software.
          Steps to ensure that States meet the Title VII and ombudsman 
        requirements of the Act, including:
                  Completion of an instrument for use by the AoA 
                regional offices in their review of States' ombudsman 
                programs carried out under the Act;
                  Completion of the first AoA Regional Office review of 
                State ombudsman programs using the new instrument (see 
                the Office of Field Operations section of this report);
                  Issuance of a series of guidance memoranda to the AoA 
                Regional Offices and the States regarding Title VII and 
                ombudsman fiscal requirements and development of 
                standard procedures to ensure State and Area Agency 
                adherence to the minimum ombudsman funding requirements 
                in Section 306(a)(11) and 307(a)21 of the Act; and
                  Enforcement in several States of the ombudsman 
                conflict-of-interest requirements in the Act.
                  Establishing dialogue and a basis for coordination 
                between the ombudsman and State Adult Protective 
                Services programs (APS) through:
                  Holding, in October 1993, a 2-day symposium of 
                ombudsman, APS, and legal experts to discuss the 
                similarities and differences in the functions and roles 
                of ombudsman and APS workers and related legal issues, 
                and to recommend to AoA policies and activities to 
                clarify roles and increase collaboration between these 
                programs;
                  Issuing a report on the October 1993 symposium to the 
                Directors of State and Area Agencies on Aging, State 
                ombudsman, State legal assistance developers, and 
                directors of State adult protective services programs; 
                and
                  Arranging for a presentation at the national meeting 
                of State Adult Protective Services Directors on 
                successful collaboration between ombudsman and adult 
                protective services workers at the county level.
          Intensive support, technical assistance and training for 
        State ombudsmen through the AoA-funded National Long-Term Care 
        Ombudsman Resource Center. The Center, which is operated by the 
        National Citizens Coalition for Nursing Home Reform (NCCNHR), 
        in collaboration with the National Association of State Units 
        on Aging (NASUA), carried out the following activities in its 
        first full year of operation;
                  Responded to approximately 480 calls for information 
                and assistance from State and regional ombudsman (These 
                calls were received in addition to the nearly 2,500 
                telephoned requests to NCCNHR for information on a 
                broad range of institutional care issues in FY 1994; 
                approximately two-thirds of those callers were referred 
                to State and/or regional ombudsman programs for 
                assistance);
                  Conducted a National Training Conference for State 
                Ombudsman in San Antonio, Texas. The over 100 
                participants representing 40 States gave the conference 
                excellent evaluations. Program materials were 
                distributed to the ombudsman who were unable to attend, 
                as well as to conference participants;
                  Provided special training to new State ombudsman 
                prior to the National Training Conference;
                  Developed a comprehensive orientation curriculum for 
                new ombudsman;
                  Provided on-going review of newsletters from State 
                and regional ombudsman programs to assess regulatory 
                and legislative activity, as well as best practices in 
                such key areas as fund raising, problem solving, and 
                community involvement projects; incorporated highlights 
                in speeches, training and technical assistance to the 
                States, and in the Center's bi-monthly newsletter to 
                State ombudsmen, InfoBulletin;
                  Expanded information for ombudsmen on the computer 
                bulletin board used by State units on aging;
                  Distributed on operations manual to all State 
                ombudsmen;
                  Researched and produced a paper on methods of 
                providing legal backup for the Ombudsman Program for 
                use by the Institute of Medicine committee studying the 
                effectiveness of the program (A paper based on this 
                research entitled ``Legal Counsel for LTCO's: Seven 
                Years Later,'' was published in the Clearinghouse 
                Review in October 1994.);
                  Distributed five technical assistance mailings, with 
                contents ranging from program management materials to 
                substantive issues to reference lists;
                  Expanded the Ombudsman Desk Reference by 
                approximately 150 pages (to include such substantive 
                issues as the Americans With Disabilities Act, spousal 
                impoverishment, the Patient Self-Determination Act, and 
                a history of the Ombudsman Program) and distributed to 
                all State ombudsmen;
                  Updated the Ombudsman's Guide to OBRA and distributed 
                it to all State ombudsmen;
                  Developed a resource guide for attorneys and 
                distributed it for comment;
                  Conducted special ombudsman training and or provided 
                on-site consultation in New England, South Carolina, 
                Alabama, Kentucky, Georgia, Indiana, Louisiana, and 
                Missouri;
                  Delivered presentations, which included information 
                on the Ombudsman Program and its services to residents 
                at least twice a month during the year, to such 
                organizations as the Association of Medical Directors, 
                the American Society on Aging, the Gerontology Society 
                of America, and many others;
                  Revised a video tape of the Ombudsman Program and 
                distributed to all States, with the new opening by Dr. 
                Arthur Flemming;
                  Provided exhibits featuring ombudsman services to 
                residents at six national conferences;
                  Facilitated exchange of State program promotion and 
                community education materials;
                  Assisted the American Association of Retired Persons' 
                Legal Counsel for the Elderly with meetings for 10 
                State and local ombudsmen on recruiting and managing 
                volunteers and developing a manual for ombudsman 
                programs;
                  Facilitated the teleconferences on both the housing 
                ombudsman program and ombudsman services in home-care 
                situations and distributed reports to all States;
                  Held a 1-day symposium on neglect and abuse in 
                nursing homes which was attended by over 40 people 
                representing national organizations;
                  Provided State and local ombudsman contacts through 
                national minority associations to assist in the 
                recruitment of mentor facilities across the country;
                  Participated in meetings and training events with the 
                Health Care Financing Administration on an average of 
                twice a month, focusing primarily on survey protocols 
                and resident assessment issues;
                  Surveyed the States, collected and categorized State 
                law and regulation in the areas of ombudsman enabling 
                legislation, residents rights, contracts, memoranda of 
                understanding, volunteer training manuals, promotional 
                materials, and any existing regulations governing other 
                institutional care; matrixed this information and 
                distributed it to all programs, enabling them to 
                examine which States had materials already developed. A 
                matrix specific to each State was also produced and 
                distributed, for use as a checklist of what materials 
                needed to be developed in each State; and
                  Surveyed the satisfaction level of State ombudsmen 
                with the Center.
     fy 1994 programs for prevention of elder abuse, neglect, and 
                        exploitation highlights
    The goals of the Prevention of Elder Abuse, Neglect, and 
Exploitation Programs are to:
          develop and strengthen activities for the prevention and 
        treatment of elder abuse, neglect, and exploitation;
          use a comprehensive approach to identify and assist older 
        individuals who are subject to abuse, neglect, and 
        exploitation; and
          coordinate with other State and local programs and services 
        for the protection of vulnerable adults, particularly older 
        individuals.
    Since Fiscal Year 1991, the State Elder Abuse Prevention Program 
has used its funds to strengthen prevention and treatment programs 
through statewide and local professional and public education 
initiatives. Following the pasage of the 1992 Older Americans Act 
Amendments, States increased use of Title III funds to support 
activities promoting coordination among programs (e.g., multidisplinary 
teams, interagency working groups, and coalitions).
    During FY 1994, AoA has provided leadership for State elder abuse 
prevention programs. AoA activities have emphasized: (1) increasing 
professional awareness of the need for coordination among service 
systems to prevent elder abuse and combat crimes against the elderly; 
(2) increasing professional awareness outside the aging network of the 
potential of Older American Act programs to prevent abuse and combat 
crime against the elderly; and (3) increasing public awareness of the 
seriousness of the problem of crimes against the elderly. The Assistant 
Secretary for Aging promoted these ideas by: delivering major addresses 
at the National Training Conference for Law Enforcement Agencies 
participating in the TRIAD programs and the Joint Conference on Law and 
Aging; and giving a statement at the U.S. House of Representatives 
Older Americans Caucus Symposium on ``Crime and Violence Against the 
Elderly.'' Two Deputy Assistant Secretaries delivered major addresses 
at State elder abuse training conferences on the implementation of the 
new Title VII and coordination of service systems to prevent and treat 
elder abuse. AoA staff participated in the Family Violence Subgroup of 
the Department's Violence Working Group which developed a report for 
submission to the Interagency Working Group. AoA assisted the American 
Medical Association in the development of its ``Diagnostic and 
Treatment Guidelines on Elder Abuse and Neglect.'' AMA distributed the 
``Guidelines'' nationwide to physicians. AoA continued follow-up work 
generated by the distribution of the ``Guidelines'' and AMA's National 
Conference on Violence, held in March, 1994. AoA has been working with 
the American Bar Association Commission on Legal Problems to develop 
recommendations for state courts on the handling of elder abuse cases. 
AoA worked with the Police Executive Research Forum, the Justice 
Department, and the American Association of Retired Persons to improve 
the response of the law enforcement community to the problems of crimes 
against the elderly and elder abuse.
    Programs for prevention of elder abuse, neglect, and exploitation 
were also supported by awarding Title IV funds to establish the 
National Center on Elder Abuse (Center). The Center supported State 
elder abuse prevention programs through providing a national 
information clearinghouse at the University of Delaware, conducting 
short term studies, and providing training and technical assistance 
activities. The Center participated in the National Elder Rights 
Dissemination Conference, sponsored by AoA and the AoA supported 
National Dissemination Center. The Center shared information about its 
activities and products that the Aging network can use in Title VII 
Elder Rights advocacy and in implementing State and local elder abuse 
prevention programs. The Center has started the first phase of an elder 
abuse incidence study, supported jointly by the Administration for 
Children and Families and AoA. Increased information from this study 
will enable program administrators to design programs appropriate to 
meet prevention and treatment needs as part of an elder abuse specific 
program and an elder rights advocacy strategy. (See Section IX for more 
information on this grant.)
    fy 1994 outreach, counseling, and assistance program highlights
    The State Outreach, Counseling, and Assistance Program for 
Insurance and Public Benefits was funded for the first time during this 
fiscal year. The States implemented the program in a variety of ways in 
consonance with the needs found within their States. The States 
coordinated their activities with related counseling and outreach 
programs. Different States emphasized areas such as pensions, outreach 
to those eligible for SSI and Food Stamps, and expansion of health 
insurance counseling and assistance efforts.
 the administration on aging bi-regional meetings on title vii: a call 
                        to elder rights advocacy
    AoA planned to convene five 2\1/2\-day bi-regional meetings between 
November, 1994 and January, 1995, in order to facilitate the 
development of an effective elder rights system in each State. Meetings 
are to be held in Boston, Atlanta, Chicago, Denver, and San Francisco. 
The goals of the bi-regional meetings are:
          To provide to States an overview of the mission and mandates 
        of Title VII;
          To foster issues advocacy for systems change within each 
        State;
          To organize and plan for elder rights issues advocacy;
          To examine the potential of the four Title VII chapters 
        within the context of an overall system of protecting the 
        rights of the vulnerable elderly;
          To foster coordination and collaboration among Title VII 
        programs between and among States;
          To facilitate the development of State elder rights plans.
    The following key players from each State are to participate in the 
bi-regional meetings: The State Unit on Aging Director, the State Elder 
Rights Unit Director (from those States that have one), the State Long-
Term Care Ombudsman, the Adult Protective Services Director, the Legal 
Assistance Developer, the Benefits Counselor, the Information & 
Referral Specialist, a regional member of the National Association of 
Area Agency on Aging Board, and a regional member of the National 
Association of Title VI Grantees Board.
    The Assistant Secretary for Aging planned to attend several of the 
meetings along with other AoA Headquarters and Regional staff. The 
meetings were to be facilitated by faculty members who are experts in 
each of the Title VII program areas.
    On the final day of each bi-regional meeting, AoA will hold open 
hearings on the Title VII proposed regulations.

            SECTION VIII--SERVICES TO OLDER NATIVE AMERICANS

    Under Title VI of the Older Americans Act, AoA annually awards 
grants to provide supportive and nutritional services for older Native 
Americans. Title VI is divided into two parts, Part A (Indian Program), 
and Part B (Native Hawaiian Program). The 1992 Amendments to the Older 
Americans Act provided a directive for coordination between Title VI 
and Title III and a ``hold harmless'' clause for all current Title VI 
grantees (subject to the availability of appropriations). Of the total 
amount appropriated to carry out Part A and 10 percent to carry out 
Part B.
    In Fiscal Year 1994, under Title VI, Part A, 227 grantees were 
awarded funds. The Amendments required that AoA hold harmless all 
current grantees at their Fiscal Year 1991 level and that AoA increase 
any grantee who received greater funds in Fiscal Year 1980 to their 
1980 level. The funding increase was from $13,599,130 for 1993 to 
$15,211,800 for 1994. One grant was awarded under Title VI, Part B. The 
funding increased from $1,511,014 for 1993 to $1,690,200 for 1994.
    Congregate and home-delivered meals and a variety of supportive 
services were provided by Indian Tribes under Title VI, Part A. All 
grantees provided the required service of information and referral 
unless other arrangements existed. Other supportive services included 
transportation, counseling and home assistance services.
    The most recent service delivery data available is for FY 1992. 
Approximately 2,441,392 meals were provided under Title VI, Part A in 
FY 1992, including 1,173,082 congregate meals, and 1,268,310 home-
delivered meals. Approximately 41,294 meals were provided under Title 
VI, Part B in 1992.
    A proposed monitoring policy for Title VI grants were developed in 
FY 1992. The ``Title VI Compliance Monitoring Instructions and Guide'' 
was implemented in FY 1993 and continues to be used successfully. One 
third of the Title VI grantees were monitored on site by staff from the 
Regional AoA offices in FY 1994. All Regions continue to receive 
feedback and ongoing training on monitoring Title VI grantees from the 
AoA Central Office in Washington, D.C. Technical assistance to the 
grantee is consistently being offered by the Regional staff and Three 
feathers Associates, an organization funded to provide training and 
technical assistance to Title VI program directors. A relationship of 
trust and assistance is continuing to evolve. Continued monitoring will 
occur in 1995.
    In FY 1993, grantees were asked to include information on Title 
III/Title VI coordination in their area in the grant applications. In 
FY 1994, a Title III/Title VI Coordination Task Force was formed. There 
were representatives from the central office, the regional offices, the 
State Area Agencies on Aging, the Area Agencies on Aging and Title VI 
Program Directors. The Task Force has met several times via conference 
calls and is currently developing a definition for ``coordination.'' 
The long-term goal of this group is to provide recommendations to the 
Assistant Secretary for Aging on necessary action to improve service 
delivery, outreach, coordination to address particular problems faced 
by older Native Americans.
    The National Title VI Directors Association was awarded a grant by 
AoA in FY 1991 to conduct a public awareness campaign on the needs of 
``at risk'' Native American, Native Alaskan, and Native Hawaiian 
elders. The purpose of the grant is to educate individuals, agencies, 
organizations, and businesses on the needs of these at-risk groups, to 
secure resources to improve the quality of services to these 
populations. In FY 1992, a video and information packet on the needs of 
this population was developed. Film presentations have been delivered 
at the national, regional, and local levels. In FY 1993, the 
Association included the State Indian Councils on Aging to promote 
coalition building. This project ended in August 1994. The Association 
is currently completing their final report of their collaborative 
efforts. They will continue to develop more effective community 
networks for Indian Elders.
    In Fiscal Year 1994, the Three Feathers Associates was provided a 
grant for the training and technical assistance of the Title VI program 
directors. A very successful National Conference was held in Salt Lake 
City, Utah in June 1994. The conference was attended by a majority of 
the Title VI program directors. The Association has continued to 
provide training and technical assistance to the 228 Title VI grantees 
as needed on site, through teleconferences and cluster meetings. 
Another National Conference to be held in Washington, D.C. is being 
planned for 1995.
    Also established in FY 1994 were two Native American Resource 
Centers. The Universities of North Dakota and Colorado were selected 
for this grant. Meetings with the representatives from the two Resource 
Centers have been held to discuss their work plans and research agenda. 
The Resource Centers were developing an approach and methodology to 
gather valid data to address issues related to community-based long-
term care among the Indian community on reservations. The final 
analysis will help to develop strategies to meet the needs of Indian 
Elders. Also being explored are ways that the work of the Interagency 
Task Force on collaboration can be supported through the Resource 
Centers capacities and mission. Possible ways that resource centers can 
support the work of Interagency Task Force are also being explored.
                       activities under title ii
    In FY 1993, two Roundtables on Native American Elders were held to 
identify the priority needs of older Native Americans, including those 
from Federally Recognized Tribes, State Tribes and urban areas. In FY 
1994, AoA addressed many of the recommendations from the Roundtables, 
particularly issues around transportation and other service delivery 
components. Another Roundtable is scheduled in December 1994. Community 
Based Long Term Care will be the topic of this forum which will provide 
another opportunity to dialogue with the network. Proceedings will be 
available from the three Roundtables to share with the Assistant 
Secretary for Aging and the aging network at-large.
            federal interagency task force on older indians
    Section 134 of the 1987 Amendments to the Older Americans Act (OAA) 
directed the Assistant Secretary for Aging to establish a permanent 
Interagency Task Force comprised of representatives of Federal 
departments and agencies with ``an interest in older Indians and their 
welfare.'' The purpose of the Task Force is to improve services to 
older Indians. The Director of the Office of American Indian, Alaskan 
Native and Native Hawaiian Programs is mandated to chair the Task 
Force. Participation on the Task Force is voluntary for other 
representatives.
    The Task Force is required to report to the Assistant Secretary for 
Aging semi-annually, including recommendations designed to facilitate 
coordination among Federally-funded programs and to improve services to 
older Indians. The Assistant Secretary, in turn, is directed to include 
these recommendations in the Administration on Aging's Annual Report to 
Congress as required by section 207 of the Act.
    While the Act specifically mandates the Assistant Secretary for 
Aging to establish an Interagency Task Force on Older Indians, the Task 
Force also has its genesis in the requirements specified under Section 
203 of the Act which requires consultation between the Assistant 
Secretary for Aging and the heads of ``each Federal agency 
administering any program substantially related to the purposes of this 
Act.''
                             current status
    As a result of past work by the Task Force and recommendations from 
Indian constituents, Task Force members decided to focus on three areas 
of concern to older Indians: health, transportation and data. Three 
subcommittees were formed to gather and analyze salient information; 
make recommendations for action to the Task Force that would further 
interagency collaboration and enhance services to older Indians; and 
highlight problems, issues and/or barriers that prevent or diminish 
collaboration. These subcommittees have continued their efforts in FY 
1994.
    The Health Subcommittee has met with key people from the Department 
of Veterans Affairs, the Department of Transportation and the Office of 
Minority Health on three separate occasions. There was an opportunity 
at this meeting to become familiar with the major initiatives being 
undertaken by each department or agency, to promote specific 
collaboration, and/or to focus on the importance of including Indian 
elders in the planning and implementation of programs. The Health 
subcommittee has also decided to focus on promoting collaboration and 
coordination regarding initiatives on elder abuse.
    The Transportation Subcommittee in coordination with the Health 
Subcommittee, is promoting transportation as a significant issue 
affecting access to health care.

                 SECTION IX--AOA DISCRETIONARY PROGRAMS

                 A. Objectives of the Title IV Program
    The Discretionary Funds Program, authorized by Title IV of the Act, 
constitutes the major research, demonstration, training and development 
effort of the Administration on Aging. The Title IV mandate is aimed at 
enhancing the field of aging through building knowledge, developing 
innovative model programs, training personnel for service in the aging 
arena, and matching these resources to the changing needs of older 
persons and their families in the coming decades. In particular, AoA's 
research, demonstrations, training and other discretionary projects are 
focused on:
          Advancing the knowledge and understanding of current program 
        and policy issues (e.g., community and in-home long term care 
        service systems and programs) that is significant to the well-
        being of the older population;
          Improving the effectiveness of the Older Americans Act 
        programs by testing new models, systems, and approaches for 
        enhancing the provision and delivery of services to older 
        persons; and
        Providing training, technical assistance, and information that 
        will increase the ability of providers to serve older Americans 
        with skill, care, and compassion.
    New Title IV project grant awards are made through a competitive 
review of applications submitted under an annual AoA Discretionary 
Funds Program Announcement. For Fiscal Year 1994, the announcement was 
published in the Federal Register on May 13, 1994, and had two major 
emphases: (1) the major strategic priorities of the Assistant Secretary 
for Aging; and (2) the specific mandates of the Older Americans Act, 
which are directed toward the needs of vulnerable older population and 
certain aging program areas.
    The next section on New Program Initiatives in Fiscal year 1994 
describes the projects that were initiated in FY 1994 in response to 
these two program directions. Title IV funds were also used to continue 
support for activities that began in prior years and were still active 
in FY 1994. The second section on Continuation Activities in Fiscal 
Year 1994 describes a wide variety of activities utilizing Title IV 
funds to further such priorities as home and community-based long term 
care; transportation demonstration projects; intergenerational bonding; 
expanded access to services with special attention to the most 
vulnerable elderly; and dissemination of information to professionals, 
the elderly, and the lay public.
             B. New Program Initiatives in Fiscal Year 1994
                  1. aoa's major strategic priorities
    The Secretary of Health and Human Services charged the Assistant 
Secretary for Aging with primary responsibility within the Department 
for several strategic initiatives (priority areas): home and community-
based long term care; older women; an aging blueprint for future 
generations; and nutrition and malnutrition. These initiatives were 
accorded priority consideration in the funding of new grant awards in 
FY 1994. Each Initiative is described in Section V of this Report. 
Below is a brief account of the new projects which scored high enough 
to be funded under priority area(s) responsive to some of these 
initiatives. The Compendium of Active Grants Under Title IV of the 
Older Americans Act, which accompanies this Annual Report, provides 
abstracts of each project.
           A. Home and Community-Based Long Term Care Agenda
    Through the FY 1994 Discretionary Funds Program (DFP) new grant 
award competition, AoA provided leadership for the continued 
development of consumer-driven home and community-based systems of care 
for older persons and other persons with disabilities. Funded project 
included:
       1. consumer participation in home and community-based care
    AoA awarded five grants for 5-year projects to develop model 
strategies that will enable States and localities to promote the 
informed participation of consumers in the planning and development of 
systems for home and community-based care (HCBC).
    Coalition of Wisconsin Aging Groups.--This project will build upon 
and improve the existing state HCBC system by : (1) increasing consumer 
participation in community-based care; (2) revitalizing Wisconsin's 
formal structure for requiring consumer participation; and (3) 
establishing three model cross-disability coalitions mobilized around 
expanding HCBC programs.
    Mountain States Group.--This project (which will demonstrate a 
model of consumer involvement that has proven successful in resolving 
rural health care issues) will create HCBC Councils made up of 
consumers and others invested in HCBC in each of Idaho's six service 
regions. The Councils, after being trained in decision making skills, 
will set priorities and goals for HCBC, analyze obstacles, research 
strategies, and prepare recommendations.
    Virginia Commonwealth University.--This project will initiate and 
coordinate a grassroots movement in four regions in Virginia to promote 
the informed participation of older adults and family caregivers in the 
planning, development, and delivery of home and community based care. 
Through a partnership of state and local organizations, this project 
will: (1) educate 300 consumers regarding the complex issues inherent 
in the HCBC system, (2) construct a framework for alliances between 
consumer groups and service providers; and (3) develop the capacities 
of consumers and family caregivers to informally provide competent HCBC 
to the members of their communities.
    Portland State University.--In this project, individuals in all 18 
planning and service areas in Oregon will be trained to participate in 
a process that can provide on-going and systematic consumer/stakeholder 
input into decisionmaking around the planning, development, and 
delivery of the state's community care system. The process, called the 
``Negotiated Invention Strategy'' (NIS), involves a mechanism for input 
from five major groups who have a stake in the service system: 
disability advocates, senior advocates, service providers, AAA staff, 
and staff from the Oregon State Unit on Aging (Senior and Disabled 
Services Division, SDSD).
    Public Interest Center on Long Term Care.--The project will 
establish 11 Regional Advisory Groups (RAGs) in California which will 
be the core organizations for project dissemination and consumer input. 
The RAGs (e.g., long-term care consumers, family caregivers, 
individuals from senior and disease specific groups, advocates, 
researchers, and service providers) will bind diverse long term care 
interests into a cohesive movement to develop the Long Term Care Vision 
for California document, the project's shared plan and organizing tool.
    2. aging and disability: models for coordinated service systems
    Four grants for 3-year projects were awarded to encourage closer 
collaboration among the aging, disability and rehabilitation 
communities through models for coordinating the delivery of services to 
the final elderly and the disabled.
    Massachusetts Executive Office of Elder Affairs.--The goal of this 
project is to coordinate the aging, disability and rehabilitation 
networks to provide better long-term care services to their target 
populations. This will be accomplished by developing a model strategy 
and an action oriented Blueprint for Autonomy. The Blueprint will be 
designed for the use of State and local policy makers, the media, 
national, State and local aging and disability networks.
    Kentucky Department for the Blind.--The goal of this project is to 
demonstrate a model for the expansion and enhancement of services to 
aged blind persons. This will be accomplished by developing and pilot 
testing a model for collaboration of services between the networks 
serving the aging and blind of Kentucky. The project will be conducted 
jointly by the State Department for the Blind and the State Division of 
Aging Services.
    George Washington University.--The goal of the project is to 
improve the delivery of services to aging individuals who have mental 
and physical disabilities. This will be accomplished by establishing a 
system of continuous information dissemination about existing networks 
of successful community based partnerships among mental health and 
aging professionals and supporting agencies. The target population 
includes older adults with dementia or other late onset mental 
disorders and older adults with a history of long term mental illness, 
such as schizophrenia.
    The American Society on Aging.--The goal of this project is to 
create changes in the existing system for delivering assistive 
technology and home accessibility services that will result in more 
effective strategies for independent life styles. This project will 
demonstrate new models, and increase national awareness of existing 
models proven effective in coordinating aging and disability systems.
 3. national policy and resource center for housing and long term care
    AoA made a three-year cooperative agreement award to the Andrus 
Gerontology Center, University of Southern California, to establish and 
carry out the activities of a policy and resource Center which will act 
as a focal point for the development of home- and community-based long-
term care services specializing in elderly housing and supportive 
services. The Center will support the development of community-based 
systems of services for older persons, and assist AoA to develop 
successful strategies and approaches for coordinating program efforts 
with HUD programs. In addition, the Center will conduct research, 
provide training and technical assistance to the Aging Network, 
disseminate housing information, and provide policy analysis oriented 
toward results and outcomes that have practical applications to those 
working on housing and long-term care issues.
                          4. eldercare locator
    The Eldercare Locator is designed to help direct both local and 
long-distance caregivers to the appropriate source of information about 
services for older persons in every locality in the United States. 
Begun in 1991, the Eldercare Locator along with the National Aging 
Information and Referral (I&R) Support Center are part of an 
Administration on Aging initiative to improve access to and quality of 
I&R assistance that older people and their caregivers receive.
    In FY 1994, the Assistant Secretary for Aging made a 3-year 
cooperative agreement award to continue the Eldercare Locator and the 
National Aging I&R Support Center. Under the cooperative agreement, the 
National Association of Area Agencies on Aging will work in conjunction 
with the National Association of State Units on Aging to strengthen and 
expand the Locator Service, increase public awareness and understanding 
of the Locator, and enhance the access of older people and their 
caregivers to community-based long term care services. In addition, the 
National Aging I&R Support Center will provide training and technical 
assistance to State and local I&R programs so that the latter can 
better serve as links between Locator callers and local services.
    The Administration on Aging also conducted two other grant 
competitions under the home and community-based long term care 
initiative, one for a project to conduct a Capacity Building and 
Mentoring Program in Home and Community Based Care, the second for two 
to three projects to test models of Employment of Public Assistance 
Recipients in Home Care. Awards under these competitions will be made 
in early 1995.
                      B. Older Women's Initiative
          1. protecting older women against domestic violence
    Under this priority area, AoA funded five projects for two years. 
The purpose of these projects is to link organizations at State and 
local levels that work to combat domestic violence together with aging 
agencies. The collaborating agencies will demonstrate effective model 
projects aimed at protecting older women against domestic violence.
    The key elements of these domestic violence prevention projects 
include: (1) safe housing, advocacy, and support of women, (2) criminal 
justice system action, (3) effective civil protection, (4) counseling/
education groups for the men who batter, (5) systems cooperation, and 
(6) coordination, participation by, and accountability to battered 
women. The five funded projects are listed below.
    Wisconsin Coalition Against Domestic Violence.--This project will 
develop a statewide program to improve services and support for older 
battered women by building upon an existing system of advocacy, 
technical assistance, policy development and education in the area of 
domestic violence. The program will include a training and education 
program, cross-training for domestic violence, and elder abuse 
practitioners, advocacy, technical assistance, policy and legislative 
development, housing and support services, a statewide public awareness 
campaign, and self-defense training for older battered woman.
    Vermont Network Against Domestic and Sexual Assault.--This project 
will develop a statewide response to domestic violence against older 
women by linking the 14 domestic violence programs and the 14 Adult 
Protective Service (APS) teams in Vermont. The project will develop a 
statewide model protocol for serving older battered women, specialized 
safehomes to provide shelter for older battered women, and a training 
curriculum for domestic violence advocates, APS teams, and health care 
professionals.
    Mount Zion Institute on Aging.--This project will build upon the 
Mt. Zion Institute on Aging's Consortium for Elder Abuse Prevention to 
establish linkages between San Francisco area elder abuse and domestic 
violence networks aimed at creating a more integrated approach to 
serving elderly battered women. Program objectives are: improve 
services for elderly victims of domestic violence; enrich community 
understanding of domestic violence; adapt such services as shelters, 
support groups, and crisis counseling to the specific needs of older 
women; and develop a training curriculum and community outreach/public 
awareness materials and events.
    Massachusetts Health Research Institute.--The Massachusetts Health 
Research Institute, the State Department of Public Health, the State 
Executive Office of Elder Affairs, and the Massachusetts Association of 
Older Americans will collaborate on this project to build a statewide 
system of services to educate and ensure shelter, counseling, and other 
care for older battered women. The project will develop a resource 
guide of materials and services for older battered women in 
Massachusetts, cross-training for service providers, an media campaign, 
a peer outreach worker component, evaluation and national dissemination 
of results.
    Women's Center.--This project will involve coordination between the 
Women's Center and the local Area Agency on Aging to improve services 
to older battered women in rural Bloomsburg, Pennsylvania. The project 
will develop a safe home system and conduct support groups, provide 
legal advocacy and representation, conduct public education and 
outreach, and provide training to professionals within the local 
community service systems.
    The Administration on Aging also conducted another grant 
competition under the Older Women Initiative's to establish a National 
Policy and Resource Center on Older Women. The award under this 
competition will be made in early 1995.
                C. Nutrition and Malnutrition Initiative
    (1) In support of the nutrition and malnutrition initiative, the 
Assistant Secretary for Aging is investing approximately $2.8 million 
dollars in an evaluation of the National Nutrition Program for the 
Elderly funded under Title III of the Older Americans Act. A contract 
to perform the evaluation has been awarded to Mathematica Policy 
Research, Inc., of Princeton, N.J.
    (2) The Administration on Aging also conducted a grant competition 
under the Nutrition and Malnutrition Initiative to establish a National 
Resource and Policy Center on Nutrition and Aging. The award under this 
competition will be made in 1995.
                   D. Blueprint for an Aging Society
                      1. national academy on aging
    In September 1994, the Assistant Secretary for Aging awarded to The 
Gerontological Society of America the future development and operation 
of a National Academy on Aging. National Academy on Aging serves as a 
national forum for policy analysis and debate on the major issues of 
our current and future aging society.
    The goals of The Gerontological Society of America in carrying out 
the functions of the Academy are to encourage greater national 
leadership on the attention to aging issues through (1) the 
clarification of critical issues in the field of aging, (2) the 
thoughtful analysis and informed discussion of those issues in public 
forums, and (3) the reporting of those policy analyses and debates to 
key decisionmakers. A major outcome of Academy events and activities 
will be an analytical and educational framework for better informing 
leaders, policy officials, and the public about the need to plan 
comprehensively for the growing and diversifying numbers of older 
Americans in the 21st century.
                 E. Other Older Americans Act Mandates
    Other areas of emphasis in AoA's new FY 1994 awards derive from 
certain specific mandates of the Older Americans Act, which concentrate 
discretionary funding resources on making specific aging programs more 
effective in serving vulnerable population groups. the priority program 
area (in addition to long-term care, nutrition, older women, and a 
future aging society) include gerontology education and training, 
housing, multigenerational and intergenerational programs, 
volunteerism, and minority aging.
                 1. gerontology education and training
a. Gerontological Training & Education Programs in Institutions of 
        Higher Education with High Minority Student Enrollment--
        Gerontology Program Improvement Grants
    The purpose of these project awards is to improve and strengthen 
established education and training programs at institutions of higher 
education with high minority student enrollment. The ultimate goal is 
to help gerontological education and training resources keep pace with 
the needs of the growing minority aging populations.
    The Assistant Secretary for Aging has made six awards for 2 year 
projects under this priority area:
    Grambling State University (LA): The project goal is to increase 
the pool of adequately trained African-American professionals and 
paraprofessionals sensitive to and knowledgeable of the specific needs 
of African-American elderly. The project will develop a 
multidisciplinary, multi-institution gerontology program in cooperation 
with the aging network in Louisiana (and surrounding States).
    University of the District of Columbia: The grantee, an 
Historically Black College/University (HBCU), will improve, strengthen, 
and expand undergraduate and graduate gerontological education and 
training across academic disciplines. Expected improvements include: 
increased number and better coordination of departments/disciplines 
with concentration in gerontology; expanded and enhanced university-
wide curricula with gerontological content; homemaker/home health aid 
certification program expanded to include Spanish and Chinese-speaking 
trainees; and improved services for at-risk minority elderly.
    Howard University (DC): This project will establish a consortium of 
six HBCUs in partnership with six AAAs to increase the capacity of the 
Aging Network to meet the needs of low-income minority older persons. 
Expected outcomes include: a model replicable strategy for linking 
HBCUs with AAAs; a model curriculum; 120 trained, credentialed minority 
students; faculty development for faculty coordinators at six HBCUs; 
and an expanded service system for at-risk elderly.
    University of Hawaii at Manoa: This project will improve and better 
coordinate gerontological education at the University of Hawaii at 
Manoa, with a special emphasis on Asian/Pacific Islander (A/PI) 
elderly. A few objectives of the project are: new courses, such as the 
physiology of aging (at the School of Nursing), geriatric nutrition (at 
the School of Public Health), and working with A/PI elders (at the 
School of Social Work); a Geriatric Nurse Practitioner Program; a 
Native Hawaiian Elder Focus Clinical Program (at the School of Law); 
and wider availability of courses via television.
    Association for Gerontology and Human Development in HBCUs (AGHD/
HBCUs), (DC): The grantee, in collaboration with the Association for 
Gerontology in Higher Education (AGHE), will implement a national 
gerontology education improvement program among 10 selected minority 
and non-minority institutions in rural and urban areas. The project 
goal is to greatly enhance academic programs, faculty development, and 
curricula in gerontology/geriatrics, with a focus on community-based 
support systems.
    Roybal Institute for Applied Gerontology at California State 
University, Los Angeles, CA: The purpose of this project is to augment 
the gerontological training of Hispanics and to enhance the provision 
of health and human services to Hispanic older adults. The grantee, in 
partnership with Hispanic students and faculty, community agencies, and 
key academicians at local colleges and universities, will address the 
acute need for more Hispanic service providers with formal education 
and training in applied gerontology.
b. Gerontological Training and Education Programs in Institutions of 
        Higher Education with High Minority Student Enrollment (Program 
        Development Grants)
    The purpose of these four awards is to develop gerontological 
training and education programs in academic institutions with 
substantial enrollments of students from one or more of the four racial 
and ethnic minority populations. Each of the 2-year projects funded by 
AoA will focus on establishing gerontological programs through which 
students will graduate with an educational emphasis, specialty, 
certificate or degree in gerontology/aging.
    University of New Mexico: The University of New Mexico Center on 
Aging will create an ethnically focused gerontological education 
program which offers certificates in Indian Aging. Some of the 
objectives of the project include: (1) developing a multidisciplinary 
program which targets graduate, undergraduate and non-degree students; 
(2) creating multiple options for certifications with an emphasis on 
Indian aging; and (3) develop a resource center on Indian Aging.
    Charles R. Drew University of Medicine and Science (CA): The 
Charles Drew University of Medicine and Science, with Martin Luther 
King, Jr. Hospital as its teaching hospital, and in cooperation with 
the University of California, Los Angeles, will develop a 
gerontological training and education program focused on improving the 
quality of gerontologic and geriatric practice in Central, South East 
and South Central Los Angeles. The project will create a network of 
trainers and specialists on ethnogeriatrics.
    Tuskegee University (AL): Tuskegee University will establish a 
Multidisciplinary Training Program in Gerontology with a special focus 
on minority rural elderly. The goal of this new Tuskegee University 
program is to increase the number of minorities trained in gerontology 
and specifically trained to address the needs of rural minority 
elderly.
    Central State University (OH): Central State University will 
develop a structured program in gerontology that is designed to 
increase the number of African Americans who are trained in 
gerontology. The program of training will lead to a minor in 
gerontology consisting of 30 quarter hours of courses including a 
practicum.
c. Faculty and Curriculum Program Development in Gerontology
    The Administration on Aging continued to support grants to 
institutions of higher education for gerontological training and 
development projects in FY 1994. These institutions of higher learning 
are in a position to greatly benefit the elderly now and in the future. 
They have at their disposal information, know-how, manpower and other 
resources, that, when applied to the problems facing the elderly, could 
greatly retard the loss of independence in the at-risk older 
population.
    Highly-trained faculty members are needed to help students 
understand the aging process, gain sensitivity about the needs and 
values of older persons, and most importantly, to discover ways for our 
society to meet the challenges of an aging society. Five new projects 
were funded in FY 1994, for 2 years each, that focused on key areas 
including faculty development in gerontology, community immersion, 
replication of successful curricula in institutions where gerontology 
has not been extensively taught, development of gerontological faculty, 
and development of programs in minority institutions. These projects 
included:
    San Diego State University Foundation (CA): This project will 
utilize the Total Immersion method to enable 12 faculty to study 
various minority populations in depth. Aided by community elders, the 
participants will visit churches, clinics, and senior centers. They 
will spend a minimum of two periods of 24-consecutive hours each with 
the older adults in their primary living environment. They will develop 
curricula materials to improve the content of the courses they are 
scheduled to teach.
    Bowman Gray School of Medicine, Wake Forest University (NC): The 
focus of this project is to extend the expertise of Wake Forest 
University in conducting faculty in-service training in gerontology to 
Winston-Salem State University, an HBCU, and Forsyth Technical 
Community College, a community college that places emphasis on the 
training of allied health professionals. Twenty faculty will be 
selected from the two institutions for participation in a 1 year in-
service training program that will teach basic principles and concepts 
of gerontology. The participants will then be taught methods for 
integrating gerontology principles and concepts into their curricula.
    AIA/ASCA Council (DC): This project will develop comprehensive 
guidance for architectural faculty on how to teach design for aging in 
a studio setting. The design studio is at the core of the architectural 
curriculum and constitutes a major vehicle for reaching and influencing 
the 35,000 students and faculty in North American schools of 
architecture with respect to eldercare issues and their impacts on 
facilities. No such comprehensive guidance currently exist, and the 
completed module will be the first resource of its kind available to 
architecture schools.
    Hunter College of CUNY: Ten faculty members from two colleges of 
the City University of NY system will participate in a geriatric 
education program and then develop curriculum on aging for 
implementation at their colleges. Faculty with geriatric experience 
will assist as mentors and an advisory board will be formed consisting 
of faculty and representatives of the aging network services to forge 
links between the two systems for purposes of student placements and 
future career opportunities.
    University of Washington: This project proposes embedding geriatric 
content into (rather than appending it as one course) to an entry-level 
Occupational Therapy (OT) program. Results will be an increase in the 
quality and quantity of Occupational Therapists trained to work with 
older adults in rehabilitation, long-term care, home health, and 
wellness programs with a focus on the special needs of low-income and 
minority elderly.
d. Gerontology Instructional Programs for Career Development in Two-
        Year Academic Institutions
    The Older Americans Act authorizes the development of comprehensive 
and coordinated non-degree education, training programs, and curricula 
at institutions of higher education, including long-term educational 
activities to prepare personnel for career in the field of aging. A 
recent survey of 2,000 academic institutions found more than 600 
graduate level programs on more than 40 campuses, but less than 60 
programs at an equal number of 2-year institutions. This represents 
nearly a zero rate of growth in training programs at 2-year schools 
during a period of time when consumer demand for in-home, community, 
and institutional services for frail elderly has increased 
dramatically.
    In order to stimulate interest in gerontology training in 2-year 
colleges or institutions which provide more than 25 percent of the 
trained paraprofessional and professional workforce in the United 
States, AoA solicited proposals for the establishment or strengthening 
of certificate program models which would comply with quality standards 
and guidelines established by the Associations for Gerontology in 
Higher Education. The Assistant Secretary for Aging has made five new 
awards for 2-year projects based on this competition:
    Community College of Denver: The Division of Health and Human 
Services of the Community College of Denver will develop the first 
community college gerontology certificate program in the State with a 
special focus on recruitment of American Indian, Asian, Hispanic and 
African American students living in the metropolitan area of Denver. 
The certificate program will feature service learning, a form of 
cooperative work education, to fulfill the practicum experience called 
for in national standards for two-year gerontology programs.
    Valencia Community College (FL): The Department of Health and Human 
Services of Valencia Community College will build upon its Kellogg 
Foundation gerontological nursing curriculum model by integrating 
gerontology into the college's eight allied health programs. A 
replicable training model will be developed through training 
partnership activities in community-based settings, faculty 
development, and revision of allied health curriculum and instructional 
strategies.
    Saddleback Community College (CA): The Division of Health Sciences 
and Human Services of Saddleback Community College will expand its 
existing gerontology certificate program to significantly increase the 
number of job-ready graduates available to work in community and in-
home service settings. A new community advisory board will help expand 
the nursing and psychology technician programs, increase linkages to 
employers in the region, and advise on student learning outcomes that 
affect on-the-job performance. The number of courses will be increased 
to make the program consistent with Association for Gerontology in 
Higher Education standards and guidelines.
    Miami-Dade Community College (FL): The Division of Business/
Technology of Miami-Dade Community College, in coordination with 
Florida International University, will develop a 30-credit hour 
certificate program to expand opportunities for gerontology education 
to low-income, ethnic minorities. The certificate program will be 
developed in accordance with the standards and guidelines of the 
Association for Gerontology in Higher Education, with articulation to 
Associate Degree programs at all campuses of the college and 4-year 
programs in the Miami area, with guidance from a gerontology 
coordinating council and community advisory committee.
    Lehigh Carbon Community College (PA): A new certificate program in 
gerontology will be developed at Lehigh Carbon Community College by 
social science, nursing biology, allied health and gerontology faculty 
in accordance with Association for Gerontology in Higher Education 
standards and guidelines. A minimum of 20 students will be recruited 
and enrolled in evening courses for three semesters during the grant. 
The program is expected to attract both new students and 
paraprofessionals and professionals already employed in aging service 
related jobs.
e. Employment Training of Older Adults in Two-Year Academic 
        Institutions
    The Older Americans Act authorizes the Assistant Secretary for 
Aging to award grants that provide education and training to older 
individuals designed to enable them to lead more productive lives by 
broadening their education, occupation, cultural or social awareness. 
In response to their geographic location, governance and funding, most 
2-year academic institutions provide both vocational and academic 
instruction and community education services, making them a unique 
resource for older adult education and training.
    The Assistant Secretary for Aging made five awards for 2-year 
projects to encourage these institutions to develop and improve model 
employment training programs for low-income older workers whose needs 
are not adequately addressed by other training and employment programs, 
with special emphasis on: (1) programs that support recruitment, 
counseling, and employment placement of older students receiving 
instruction in age-integrated classrooms; and (2) programs that work 
with employers to retrain and employ workers who have recently lost 
their jobs due to corporate downsizing, plant shutdowns or facility 
relocation.
    Grand Rapids Community College (MI): Grand Rapids Community College 
will draw upon its past experience as a training subcontractor with the 
Senior Employment and Senior Community Service Employment Programs to 
develop its own older worker training program with a major focus on 
displaced homemakers and older workers losing employment through 
industry downsizing and relocation. Sixty to ninety participants each 
year will be given counseling and training on job search, application 
and interview techniques. Thirty to forty adults, age 50 and over, will 
be recruited for job training courses using the colleges occupational 
training facilities at the main campus and at its new Applied 
Technology Center in neighboring Bid Rapids.
    Hawaii Community College, University of Hawaii: The Older Hawaiian 
Human Services Certification Demonstration Program will develop and 
implement training for low-income older native Hawaiians and assist 
them in finding employment in human service programs. The curriculum 
will include existing age-integrated classes modified for program 
participants and a new core course and practicum. The project adapts a 
model training program for training kupuna (knowledgeable Hawaiian 
elders) as substance abuse counselors developed by ALU LIKE, Inc., a 
major service provider for Native Hawaiian elders.
    Westchester Community College (NY): The Mature Work Options project 
of Westchester Community College's Mainstream Program--the Retirement 
Institute, will expand training opportunities for low income, minority, 
and high risk unemployed older adults through the creation of curricula 
to be developed in collaboration with local industry and faculty. 
Forty-five persons, age 50 and over, will be trained in instructional 
programs targeted to unemployed older workers including individuals 
displaced by the impending relocation of a major automobile assembly 
plant in the county served by the college. Two new curricula will be 
developed in advanced computer-based office skills and computer-
assisted drawing (CAD) applications.
    Lane Community College (OR): The Division of Training and 
Development will develop and implement a model job training program at 
the Lane Community College main campus in Eugene and at the Florence 
Center on the coast of Oregon. Older low-income, minority, rural 
adults, age 50 and higher will be offered information, training and 
support for re-entry into employment or to enhance employment skills 
for greater advancement. The program will feature career and life 
planning, individualized action plans and case management, peer 
support, age-integrated classes, computer training, and job search 
training and assistance.
    Northern Virginia Community College: The Community Education and 
Services Departments at the Alexandria and Woodbridge campuses of 
Northern Virginia Community College, will develop a unified training 
program for certified Personal Care Aides, Homemaker-Home Health Aide, 
and Nurse Aides. Outreach and recruitment for this training program 
will collaborate with local Title V Older Americans Act and Job 
Training Partnership Act senior employment and training programs. An 
emphasis will be placed on reaching out to low-income adults aged 50 
and over whose primary language is not English, and older workers who 
have recently lost their jobs due to corporation downsizing, plant 
shutdowns, or facility relocation.
f. Research and Technology: Innovation in Gerontological Education and 
        Training
    The three projects funded for 17 months under this priority, as 
described below, have two principal objectives: (1) to develop and 
demonstrate new uses of instructional technology in gerontological 
education and training; and (2) to convert research findings and state-
of-the-art materials more effectively and more expeditiously into 
gerontology course curricula and classroom teaching for students 
preparing for careers in the field of aging.
    American Society on Aging (CA): Under this project, the American 
Society on Aging will develop a state-of-the-art training program on 
late-life depression and suicide, using multimedia and computer 
technology, and incorporating research and practice focused on 
culturally diverse elders. Target audiences are primary care physicians 
and nurses, hospital discharge planners/case managers, social workers, 
home care and adult day care workers, ``gatekeepers'' such as utility 
company personnel, and family caregivers.
    Oregon Health Sciences University: This project will link the 
Oregon Geriatric Education Center in the School of Medicine to four 
community colleges in rural areas of the state using teleconferencing 
technology to deliver continuing education to practicing health 
professionals regarding health promotion and aging topics.
    University of Montana: The University of Montana's Center for 
Continuing Education will work with the School of Pharmacy and Allied 
Health Science, the Rural Institute on Disabilities, and the 
Gerontology Education Committee to develop and evaluate core courses 
delivered through distance education technology for a certificate 
program designed to meet the needs of persons working with the elderly 
throughout the State.
                  2. housing programs for the elderly
a. Supportive Services in Federally Assisted Housing Demonstrations 
        Projects
    The purpose of the projects funded under this priority area is to 
develop and test model supportive service programs to frail residents 
in federally assisted housing projects. These projects involve the 
network of State and Area Agencies on Aging in the development and 
operation of these model supportive services programs, working in 
collaboration with local housing agencies. The Assistant Secretary for 
Aging made five awards for 2-year projects.
    Multnomah County Department of Human Services (OR): This project, a 
collaboration between Multnomah and Clackamas County social services, 
builds on a current model elderly housing program which works directly 
with residents to identify needs and broker services. Three new 
components will be initiated: (1) special outreach to link minority 
residents to community services; (2) recruitment of teams of senior 
resident I&R volunteers in two rural communities; and (3) targeting a 
wide array of in-home services to frail residents by an intensive 
services team.
    Chicago Department on Aging: This project, a joint effort between 
the Chicago Department on Aging and United Charities, will demonstrate 
a collaborative method of providing case management and supportive 
services to 350 low-income minority elderly in HUD 202 or Section 8 
housing. Four different elderly housing developers will work together 
to share resources and to examine different techniques of case 
management delivery.
    New Jersey Department of Community Affairs: This project will 
develop, implement, evaluate, and make policy recommendations based 
upon an assisted living, supportive services demonstration project in 
two subsidized senior housing developments. The project will develop 
effective outreach, education, and training techniques to encourage 
participation of low-income tenants.
    New York City Department for the Aging: This project, a 
collaboration of the NYC Department for the Aging, the NYC Housing 
Authority and the Henry Street Settlement, will provide coordinated, 
community-based services to frail, low-income minority elderly at 
Vladeck Houses, a public housing authority site. The project will 
provide data on--the most effective methods to reach and serve frail, 
minority populations, the degree to which informal volunteer support 
can lessen isolation and augment services; and the identification of 
services and supports which may be significant in assisting frail 
elderly to age-in-place.
    Alliance for Aging, Miami, FL: This project will develop a model 
for correcting deficiencies in the present level of support services to 
frail older individuals currently facing premature institutionalization 
with the expectation that they can be appropriately maintained in their 
current housing units. The project hopes to develop policy and 
practical cost-saving implications of its model. The project will 
target elderly individuals affected by Hurricane Andrew.
b. Housing Ombudsman Demonstration Projects
    The purpose of the 2-year projects funded under this priority area 
is to demonstrate the effectiveness of the housing ombudsman approach 
in protecting the rights, safety and welfare of older people living in 
publicly-assisted housing and in resolving issues related to their care 
and services. These five demonstration projects involve the network of 
State and Area Agencies on Aging, as well as other nonprofit entities 
in developing and operating model programs in collaboration with local 
housing agencies. The findings, results, and products of these projects 
are expected to significantly advance our capacity to develop and 
implement comprehensive systems of housing ombudsman programs.
    Connecticut Department of Social Services: Building on the 
Connecticut Department of Social Services' current ombudsman program, 
this project will show that the housing ombudsman approach is an 
optimal model of service coordination. The project will educate 
residents, enhance service accessibility through coordination, foster 
group activism, establish dialogue between residents and management, 
and facilitate conflict resolution through a Site-Based Resolution 
Council.
    City of Portland (OR): This project, conducted by the Portland/
Multnomah Commission on Aging, will develop, implement and evaluate a 
training program for the housing ombudsman to serve low-income seniors 
residing in and applying for subsidized housing in Multnomah County, 
OR. Using the Oregon Long-Term Car Ombudsman program as a model, the 
project will produce standards and training for the certification of 
volunteer housing ombudsman.
    Volunteer Center of Greater Riverside (CA): The project will 
develop and manage a Senior Ombudsman Service (S.O.S.) project in 
Riverside County. This service will provide information and referral, 
advocacy, complaint resolution, and assistance for low-income seniors 
residing in or seeking publicly-assisted housing. In addition to 
recruiting and training volunteers, the project will also hire a 
bilingual S.O.S. Project Coordinator to compile up-to-date information 
about the complex public housing system and form a development team of 
key community leaders and seniors to analyze needs and corresponding 
services.
    National Caucus and Center on the Black Aged, Inc. (NCBA) (DC): 
This project will train Title V older workers to act as Housing 
Ombudsman Aides. NCBA's community-building approach emphasizes the 
development of relationships between housing and social service 
providers, the provision of training and technical assistance to 
housing managers, service providers, and resident councils, and the 
expansion of linkages to local volunteer networks.
    Southwestern Illinois Area Agency on Aging: This project will be 
administered by a ``coalition'' which includes an Area Agency on Aging, 
a local senior service provider, a mid-size and diverse public housing 
authority, and a State University. The focus is on helping frail and 
aging seniors living in or wanting to live in federally assisted 
housing to maintain an independent living arrangement longer by 
improving the quality and suitability of their housing situation 
through advocacy, intervention in problems and complaints, counseling 
and/or referral assistance, and effective coordination of services.
c. Foreclosure and Eviction Assistance and Relief Services 
        Demonstration Program
    The projects funded under this priority area are aimed at 
demonstrating effective and timely strategies/approaches for 
formulating or implementing laws, regulations and programs that:
          (1) Prevent or delay the foreclosure on housing owned and 
        occupied by older persons or the eviction of older individuals 
        from housing the individuals rent;
          (2) Assist older individuals to obtain alternative housing as 
        a result of such foreclosure or eviction;
          (3) Assist older individuals to understand the rights and 
        obligations of individuals (including lessor and lessee) under 
        laws relating to housing ownership and occupancy; and
          (4) Address the effects of land use/zoning restrictions, as 
        well as escalating property values and the resulting property 
        tax increases, on the housing options of older persons.
    The Assistant Secretary for Aging made six awards for 2-year 
projects as listed below:
    New Hampshire Legal Assistance: This statewide project, a 
collaboration between the New Hampshire Legal Assistance and the New 
Hampshire Department of Elderly and Adult Services, will demonstrate a 
program to prevent foreclosures, property tax sales and evictions of 
the elderly. The project will enhance linkages with the aging and 
federally assisted housing networks to advance housing options and 
create new networks with bankers and tax assessors through training on 
property tax relief.
    Legal Assistance for Seniors (CA): This citywide project will 
demonstrate a strategy to address the problem of foreclosures on homes 
of the elderly as a result of fraud, abuse, and exploitation. The 
project will study neighborhoods where lenders foreclose on elderly 
homeowners as a result of ``scams'' and develop a profile of ``at 
risk'' neighborhoods for use in other communities. The project will: 
develop a pro bono attorney panel, develop and produce community 
education materials about deceptive home remodeling practices; train 
the aging network in techniques for identification of ``at-risk'' 
neighborhoods; and mobilize the community to develop an action agenda 
of legal and regulatory reforms.
    Housing Counseling Services, Inc. (DC): This citywide project, a 
collaboration of Housing Counseling Services, Inc., and the Legal 
Counsel for the Elderly, will demonstrate a program to prevent or delay 
evictions and foreclosures against elderly individuals. Expected 
outcomes will include efforts to pass legislation in the District of 
Columbia to protect elders against foreclosures and redress abuses by 
unscrupulous lenders; curriculum for training of homeowners and tenants 
concerning their rights; legal services and housing counseling for 
elderly tenants and homeowners facing foreclosure and eviction.
    The Salvation Army (CA): This countywide project is a joint effort 
of the Salvation Army Senior Meals & Activities Program and the San 
Francisco Sheriff's Department. The project will demonstrate a model of 
bilingual services on the days preceding evictions by the Sheriff's 
Department. Expected outcomes include an information campaign to 
increase awareness of elderly tenants and homeowners on how to avoid 
the problems of foreclosure and eviction, and a training ``how to'' 
manual for use by other agencies in replicating the program.
    North Carolina Housing Finance Agency: This statewide project will 
identify information, actions, and resources needed by older consumers 
to avoid or delay eviction and foreclosure. The project will develop 
training models for housing managers, developers, and providers of 
legal and supportive services, and the State's 18 Area Agencies on 
Aging in order to increase their knowledge of older adults' housing 
rights and their capacities to advocate, inform, and assist older 
persons.
    National Consumer Law Center (MA): This statewide project is a 
collaboration of four organizations: (1) the National Consumers Law 
Center, the Homeowners Options for Massachusetts; (2) the Ecumenical 
Social Action Committee; and (3) the Greater Boston Legal Services. It 
is designed to demonstrate a model of coordination of services to 
recognize and respond to foreclosure threats to elderly homeowners. The 
project will design training on how to avoid foreclosure for Area 
Agencies on Aging, elderly homeowners, housing advocates, social 
service providers, attorneys, and lenders.
                           3. minority aging
a. Minority Management Training Program Projects
    Minority Management Training Programs are special training projects 
that increase the number of qualified minority individuals in key 
management and/or administrative positions in the Aging Network. The 
four racial and ethnic minority populations targeted are African-
Americans, Hispanics, Native Americans and Pacific Islanders/Asians.
    The program goal is to increase the professional credentials and 
experiences of project trainees by helping them to make the transition 
from staff level positions to managerial and/or administrative 
positions. Five awards for 2-year projects were funded under this 
priority area as described below:
    National Caucus & Center on Black Aged, Inc. (DC): The project 
objectives are: (1) to secure the participation of seven long-term care 
facilities willing and able to train African American professionals as 
interns in all phrases of nursing home operations; (2) to prepare the 
interns to pass state and national nursing home administrator licensure 
examinations; (3) to obtain employment for the newly licensed nursing 
home administrators; and (4) to expand the very small network of 
minority administrators nationwide.
    Association Nacional Pro Personas Mayores (The National Association 
for Hispanic Elderly, (CA): The project objectives are: (1) to select 
and place eight Hispanic graduates or professionals in paid, 6-month, 
administrative and managerial traineeships in public and private aging-
related agencies; (2) to place four interns each year of the 2-year 
traineeship; (3) to give administrative and management training to the 
interns and guide host agencies in providing the on-site training; (4) 
to place interns in permanent positions; and (5) to strengthen 
cooperative links between the Aging Network and the program sponsor in 
designing appropriate services for the elderly and for professional 
Hispanics.
    Area Agency on Aging, Region One, Inc. (AZ): The project will 
increase the professional credentials of Native American trainees by: 
helping them to make the transition from staff-level to managerial and 
administrative positions; and enhancing their work experience, 
knowledge base and career opportunities. The traineeship for two groups 
of four trainees provides 6 months of structured, culturally-sensitive 
opportunities for innovative, hands-on, educationally meaningful 
experiences in aging services management and administration. Trainees 
are based with the sponsoring agency, and will intern at training 
agency sites including: the Inter-Tribal Council of Arizona; Maricopa 
County Department of Social Services; Maricopa Association of 
Governments; the Governor's Advisory Council on Aging; and public and 
nonprofit providers in the statewide aging services network.
    Louisiana Association of Councils on Aging: The project will 
increase the number of qualified minority gerontologists in key 
management and/or administrative positions in the aging network 
agencies in Louisiana, which have an impact on older persons, 
especially minority elderly who are at risk of losing their 
independence. Five minority persons with specified qualifications are 
selected for a 12-month training session. The trainees receive two 
intensive seminars and on-the-job instruction at host agencies. Host 
agencies will be selected from Parish Councils on Aging or Area 
Agencies on Aging that are members of the Association.
    University of Southern California, School of Public Administration: 
The project will enable 10 minority individuals to move from staff, 
professional, or paraprofessional occupations into management positions 
or management career tracks in the field of aging. The School of Public 
Administration and the Leonard Davis School of Gerontology at the 
University of Southern California (USC) will collaborate with host 
agencies in the public and private sectors to: (1) identify minority 
individuals with commitments to the field of aging; (2) enroll these 
individuals in a training program combining on-the-job experience with 
intensive classroom work to develop strong management capabilities; and 
(3) help place these trainees in management positions or tracks in the 
Host Agencies or elsewhere.
b. Responding to the Needs of the Minority Elderly Through National 
        Minority Aging Organizations
    The initiatives of the Assistant Secretary on Aging (i.e., (1) Home 
and Community-Based Long Term Care, (2) Special Concerns of Older 
Women, (3) Nutrition and Malnutrition Among the Elderly, and (4) 
Developing a Blueprint for Future Aging) have special relevance to low 
income minority older persons. This priority area is intended to 
support the efforts of national minority aging organizations in 
representing the interests of minority aging in long-term care, older 
women issues, nutrition and malnutrition, and the future aging society.
    Each of these 2 year projects is expected to develop culturally 
specific models for coordinating the delivery of services to minority 
older persons and their families. These models should produce 
strategies for more responsive, cost-effective programs that will 
assist the minority aged, their families and communities to maintain 
life styles of maximum independence through access to comprehensive 
community based services, enhanced personal autonomy and greater 
opportunities for consumer choice.
    The National Indian Council on Aging (NICOA) (NM): The goal of this 
project is to positively impact public policy and increase public 
awareness to affect improvement in strategies for the provision of 
home- and community-based long-term care to the minority elderly, 
especially Indian elders.
    National Caucus & Center on the Black Aged, Inc. (DC): The project 
goal is to improve the response of health and social support systems to 
older residents of public housing experiencing problems related to 
alcohol and drug abuse. This will be accomplished by developing a model 
strategy to identify problems and provide assistance through the 
delivery of home and community-based services.
    Asociacion Nacional Pro Personas Mayores (CA): The goal of this 
project is to make the formal Aging Network accessible to the Hispanic 
elderly and their families and to broaden the base of agencies and 
groups involved in providing aging services to the Hispanic elderly. 
The project will demonstrate a model of home and community-based long-
term care for the Hispanic elderly by developing linkages between the 
formal and informal long term care systems.
    National Hispanic Council on Aging (DC): The goal of this project 
is to increase the positive life chances of older Latinos by reducing 
the factors that lead to economic disadvantage. This will be 
accomplished by educating Latino older women about advocacy strategies 
designed to positively impact their economic security. Project 
activities include a series of educational and informational materials; 
conducting training to provide empowerment skills; and establishing 
linkages and collaborative relationships with national organizations, 
coalitions and networks focused on issues related to income security.
    National Asian Pacific Center on Aging (WA): The project goal is to 
improve the quality of life for Asian and Pacific Island elders. This 
will be accomplished by strengthening the national network of Asian 
Pacific elderly community based service systems. Project objectives 
include: implementation of two pilot projects focused on long-term 
care; documentation of best practices; development a culturally-
sensitive training manual; publication of a bimonthly newsletter; 
synthesis of findings and development of objectives based on 
recommendations from the 1995 Mini-White House Conference on Aging 
entitled, Respect for the Elderly: An Asian Pacific Legacy.
             4. intergenerational programs and volunteerism
a. National Volunteer Senior Aides/Family Friends Demonstration 
        Projects
    In Fiscal Year 1991, AoA implemented Section 10404 of the 1989 
Omnibus Budget Reconciliation Act which authorized a community-based, 
intergenerational demonstration program. The purpose of the program is 
to determine to what extent basic medical assistance and support, 
provided by volunteer senior aides, can reduce the costs of care for 
disabled or chronically-ill children. The prototype program upon which 
the authorizing provisions were based is ``Family Friends,'' an 
intergenerational program established in 1986 by the National Council 
on the Aging, Inc. (NCOA), with funding support provided by the Robert 
Wood Johnson Foundation.
    To implement the Volunteer Senior Aides Program (VSA), in FY 1991 
AoA awarded demonstration grants to six Area Agencies on Aging to 
collaborate with local organizations, over a 3-year period in their 
respective communities to: (1) determine the impact of the older 
volunteers' services on the costs of care for disabled/chronically ill 
children; (2) promote the self-sufficiency of individuals and families 
vulnerable to a loss of independence; and (3) increase the volunteer 
senior aides' feelings of self-worth. Increased collaboration is 
expected among private, voluntary, and public sector organizations in 
establishing and operating programs from which children, families, and 
older persons gain mutual support and benefits.
    Last fiscal year, AoA awarded continuation grants to all six 
projects to continue these demonstrations for a third and final year. 
AoA also provided support to NCOA to provide technical assistance and 
training to these VSA grantees, based upon their ``Family Friends'' 
expertise. In addition, a summary evaluation of outcomes has been 
designed and is being conducted by one of the grantees, the Mid-America 
Regional Council Commission on Aging (Kansas City, MO). This summary 
evaluation should be completed in the Spring of 1995. These six 
demonstration projects were being carried out by the following 
agencies:
          The Los Angeles County AAA (Los Angeles, CA), in 
        collaboration with Jewish Family Services of Los Angeles and 
        Huntington Memorial Hospital of Pasadena;
          The CrossRoads of Iowa Area AAA (Des Moines, IA), in 
        collaboration with the Easter Seals Society of Iowa;
          The Mid-America Regional Council AAA (Kansas City, MO), in 
        collaboration with the Children's Mercy Hospital in Kansas City 
        and the University of Missouri's University Affiliated Program 
        for Developmental Disabilities;
          The Region IV AAA (St. Joseph, MO), in collaboration with the 
        local Foster Grandparents Program;
          The Philadelphia Corporation for Aging (Philadelphia, PA), in 
        cooperation with Temple University's Center for 
        Intergenerational Learning and the Institute on Disabilities; 
        and
          The County of Riverside Office on Aging (Riverside, CA), in 
        cooperation with V.I.P. Tots of Temecula, California.
    Because of the continuing need for and the proven success of the 
VSA program model, during FY 1994, AoA awarded funds for six new VSA 
demonstration projects to public or nonprofit community-based 
organizations in communities which previously had not had VSA projects. 
The six new demonstration projects are;
          Action for Community Development (Boston, MA) in partnership 
        with Boston Children's Hospital and the Medical Foundation.
          Clara Barton Hospital Foundation (Hoisington, KS) in 
        partnership with the retired senior Volunteer Program (RSVP).
          Easter Seal Society for the Redwood Coast, Inc. (Eureka, CA) 
        in cooperation with RSVP to operate the Northern California 
        Family Friends Project.
          Eastern Seal Society of Utah, Inc. (Salt Lake City, UT) in 
        partnership with the Intermountain Health Care Pediatric 
        Respite Program, State Aging and Adult Services and three Area 
        Agencies on Aging to serve rural Utah counties.
          Elwyn, Inc. (Elwyn, PA) in collaboration with the Center for 
        Intergenerational Learning at Temple University to serve 
        Delaware County.
          Generations Together, University of Pittsburgh (Pittsburgh, 
        PA) in collaboration with the Diabetes Center at Children's 
        Hospital of Pittsburgh and the Allegheny County Department of 
        Aging to serve children with insulin dependent diabetes and 
        their families.
    The National Council on Aging (NCOA) has received a grant to 
provide training, technical assistance, research and summary evaluation 
efforts for the six new VSA demonstration projects. NCOA will 
disseminate information on the VSA program to the 32 projects operating 
nationwide and to other interested communities.
b. Volunteer Service Credits Demonstrations
    The purpose of the five projects funded under this priority area is 
to test new models and replicate existing models of the volunteer 
service credits concept. The basic service credit concept is to give 
volunteers a unit of credit for each service hour performed, regardless 
of the type of service, in the expectation that accrued credits will be 
redeemed for services by the volunteers at some future time of need. 
Grantees are expected to test the feasibility of implementing service 
credit projects in new areas and to replicate existing models in new 
sites. These five demonstration projects, funded for 17 months each, 
involve two Area Agencies on Aging and several nonprofit organizations.
    Foundation on Aging, (KS): The grantee will establish a volunteer 
service credit bank in Kansas, in conjunction with several 
participating agencies across the State. The project will improve the 
effectiveness of and access to home and community based long-term care 
services by targeting frail, minority, and rural elderly. The 
cooperative efforts of the coalition will: provide short-term respite 
for caregivers; assist frail older persons to maintain their 
independence and prevent premature institutionalization; and train and 
utilize an estimated 100 to 200 older and younger volunteers to provide 
respite services. Also, an innovative Kansas/Missouri interstate model 
program will be established through a cooperative agreement with the 
Missouri Volunteer Service Credit Bank. As a result, volunteers will be 
able to accumulate credit hours in one State and donate them to 
residents of the adjoining State.
    Area IV Agency on Aging and Community Services, Inc. (IN): This 
project has two main objectives: (1) to enable rural elderly and others 
who are at-risk to avoid becoming homeless or prematurely 
institutionalized by providing them with needed non-medical, non-
professional services through the use of volunteers; and (2) to allow 
the volunteers to earn service credits for the time they spend helping 
others so that they, in turn, can ``buy'' services when they need them.
    Senior Citizens of Greater Minneapolis, Inc: This project will 
establish a cooperative venture among senior volunteer organizations to 
test new ways to care for frail, elderly people. Grantee will test the 
feasibility of: (1) incorporating volunteers from a variety of 
organizations into a single Time Bank; and (2) establishing a volunteer 
package that will be attractive to elders of color.
    County of Bucks Area Agency on Aging (PA): This project will 
implement a senior service project in low income and minority housing 
units to provide in-home support services to at-risk persons age 60 and 
over to avoid premature and inappropriate institutionalization. 
Approaches include: working collaboratively with low-income apartment 
complexes to establish the sites for the project; and working 
cooperatively in the Area Agency on Aging with Aging Care Managers, 
VISTA Volunteers, and Retired Senior Volunteer Program.
    Time Dollar Network (DC): This project will: (1) develop a 
replicable, church-based program utilizing service credits as the 
currency to generate services that meet the economic and social needs 
of minority, low-income elderly; and (2) enable seniors to gain 
entitlement advocacy in exchange for volunteer service they perform.
                   5. legal services for the elderly
1. Statewide Legal Hotlines for Older Americans
    Statewide Legal Hotlines utilize paid, specially-trained, and 
experienced attorneys to provide: (1) answers to legal questions; (2) 
brief assistance (such as letters or phone calls to third parties, and 
document review); and (3) referrals to older persons needing legal 
advice at no charge. Referrals are made, as appropriate, by the 
Statewide Legal Hotline to legal service providers or to lawyers 
working either pro bono or at reduced fees.
    AoA made three awards under this priority area for 3-year projects.
    Legal Services of Northern California: This project will establish 
and operate a Statewide Legal Hotline to serve thirty-nine (39) 
counties in Northern California. Through targeted outreach and 
cooperation with other service providers the project will serve low-
income minority seniors and those seniors in greater economic and 
social need. The project will be able to serve non-English speaking 
older people through the use of both multilingual staff and expert 
translators.
    Puerto Rico Legal Services, Inc: This project will establish and 
operate an Island-wide Legal Hotline to serve Puerto Rico. The project 
will bring legal services directly to the at-risk elderly, maximizing 
the delivery of service to the great number of older people who reside 
in isolated geographic areas.
    American Association for Retired Persons: Legal Counsel for the 
Elderly (DC): The project will use a variety of approaches to helping 
the new and previously-funded AoA hotlines to develop strong and 
continuing projects. A high priority will be placed on developing 
future funding to insure that Statewide Legal Hotlines become self-
supporting.
               6. dissemination and utilization projects
    Title IV of the Older Americans Act calls upon AoA to support a 
broad range of research, demonstration, and training projects to 
improve the well being of older persons. In order for these efforts to 
be effective, it is critical that the information developed by Title IV 
projects be disseminated as widely as possible. In recent years, there 
has been considerable interest in this issue by those in the field of 
aging as well as members of Congress. In response to this interest, AoA 
has increased its efforts to insure that up-to-date information is 
widely available to those addressing the issues of an aging society.
a. The National Aging Dissemination Center
    Grant and contract activities supported by the Older Americans Act 
Title IV Discretionary Funds Program have produced a wide range of 
usable findings and products. In order to appropriately utilize program 
results, AoA established the National Aging Dissemination Center at the 
National Association of State Units on Aging in Washington, D.C. The 
Center, through a cooperative agreement with AoA, promotes more 
effective dissemination of findings and products to a larger number of 
potential users.
    The Center engages in a number of activities designed to promote 
the dissemination of Title IV project findings and products. These 
activities include: (1) Developing a database that contains information 
on Title IV program projects and approaches to retrieving this 
information upon request; (2) selecting the most promising projects and 
providing assistance in disseminating their results to Eldercare 
coalitions, aging network agencies, national aging organizations, and 
others; (3) providing technical assistance to Title IV grantees to help 
them expand their dissemination activities; (4) publishing a yearly 
compendium of Title IV program products; (5) conducting, jointly with 
AoA, a National Dissemination Forum and a mini-forum to bring the 
results of Title IV projects to the attention of practitioners; and (6) 
developing a range of general dissemination channels which can be used 
by Title IV grantees.
b. The National Aging Information Center
    The Administration on Aging is supporting the development of a 
National Aging Information Center (NAIC) in order to increase its 
ability to serve as an information resource on aging issues to a broad, 
national audience. The NAIC is being established in response to Section 
202(e)(1)(A) of the 1992 Amendments to the Older Americans Act, and 
will provide information about a wide range of topics concerning the 
Nation's older citizens. The NAIC will meet the needs of the aging 
field through easy access to a variety of information that will support 
their efforts in planning, program development, and implementation, as 
well as data collection analysis.
    The NAIC will be established through a contract and preparatory 
work including the development of a Statement of Work the receipt of 
all necessary clearances, and the issuance of a Request For Proposals 
on August 17, 1994 in the Commerce Business Daily. The solicitation 
deadline will be October 25, 1994 and a pre-proposal conference was 
held with prospective offerors on September 13, 1994. The purpose of 
this conference was to provide information concerning the Government's 
requirements which could facilitate the preparation of proposals, as 
well as to answer any questions which prospective offerors may have had 
regarding the solicitation. The conference was well attended and there 
appeared to be a great deal of interest in this solicitation. An award 
is expected in 1995.
c. AoA Dissemination Projects
    Substantial resources are invested each year in Title IV research, 
demonstration, and training projects to improve the availability and 
quality of services vital to the at-risk elderly. To maximize the 
utility of this program to older Americans, AoA funded 14 Dissemination 
Projects in FY 1993. The goal of these projects is to significantly 
expand, beyond that of the original projects, the dissemination and 
utilization of existing Title IV products and results. Some of the 
projects enhanced dissemination of previously developed products that 
were exceptionally useful and for which there was a continuing demand 
or need. Other projects were continuations of numerous products/results 
of earlier Title IV project ``clusters'' (groups of projects sharing a 
common theme). The 1993 AoA Dissemination Projects are briefly outlined 
below.
    Four of the Dissemination Projects focus on health or health care. 
The American Medical Association (AMA) is replicating a clinical 
education model in several States to train physicians in the practical 
implementation of the AMA's Title IV-supported ``Guidelines for the 
Medical Management of the Home Care Patient.'' The Harvard University 
Medical School is using enhanced dissemination of culturally/
linguistically adapted products from the Massachusetts Elderly Injury 
Prevention Project to prevent injuries and medication misuse among 
ethnic minority elderly. Florida A & M University will expand 
dissemination of products from their Diabetic Retinopathy Education 
Program to a National audience, including a range of health 
professionals to educate high risk ethnic elderly. The National 
Hispanic Council on Aging will expand the use of a training-of-trainers 
product from an earlier project and include elderly Promotores de Salud 
in a strategy for empowerment to improve the health and well being of 
vulnerable Hispanic elderly.
    Elder rights are the concern of three of the Dissemination 
Projects. The National Committee for the Prevention of Elder Abuse is 
synthesizing results of relevant Title IV projects/research to produce 
six Elder Abuse Briefs and a compendium of products to disseminate to 
the array of practitioners who come into contact with victims. The 
Center for Social Gerontology is maximizing the utility of critically 
important findings from the National Study of Guardianship Systems by 
adapting and repackaging the products to foster judicial education, 
research, and system change. The Illinois Department on Aging will 
synthesize and disseminate results of three of their elder abuse 
research projects to offer knowledge of best practices to a variety of 
audiences that can be applied to preventing abuse as well as serving 
victims.
    Two projects, in addition to some projects already mentioned, 
target ethnic minorities. The National Indian Council on Aging is 
adapting recent Indian aging research/demonstration findings to formats 
which will be useful to tribal leaders, tribal service providers, 
Indian elders and their caregivers, and the aging network. The National 
Asian Pacific Center on Aging is facilitating the utilization of their 
training module on Supplemental Security Income from a prior project to 
address the low rate of participation by eligible Asian and Pacific 
Islander elderly.
    Community-based services, linkages, and information and referral 
(I&R) are addressed in the following: (1) the American Society on 
Aging's ``Aging in Place--Enhanced Dissemination'' and utilization of 
its previously developed multimedia package, ``A Good Place To Grow 
Old;'' (2) the Portland (Oregon) Multnomah Commission on Aging's 
replication of four Project CARE Coalition models addressing needs such 
as crime prevention, telephone reassurance, and an urgent help 
telephone line; (3) Catholic Charities, USA's network-building 
dissemination (and translation into Vietnamese and Korean) of their 
guidebook, ``Linking Your Congregation with Services for Older 
Adults;'' and (4) the National Association of State Units on Aging's 
promotion of aging I&R products to enhance the capacity of military I&R 
specialists to meet the needs of a growing number of military personnel 
with long distance caregiver responsibilities and other aging related 
family problems.
    Finally, unique among these set of projects is ``Enhancing 
Awareness of Aging Issues among Television Industry Leaders: The 
Sequel.'' The grantee, the University of California, Los Angeles, is 
facilitating the utilization of products from an earlier project to 
assist television professionals in depicting aging issues more 
effectively and portraying older adults in an informed, sensitive 
manner.
    In FY 1994, AoA funded six new projects to maximize the 
dissemination and utilization of Title IV project products and results 
that can directly benefit older Americans in need of services. To 
accomplish this goal, two types of projects were funded: (1) enhanced 
dissemination of product(s) of significant value; and (2) synthesis and 
dissemination of the results of a project ``cluster,'' a group of 
projects sharing a common purpose.
    Five of the projects were funded under Part A, to support enhanced 
dissemination/utilization of exemplary Title IV products of 
demonstrated value to older Americans. Enhanced dissemination will: (1) 
promote understanding of certain laws and programs affecting older 
persons, especially those dealing with health and financial 
decisionmaking and planning for incapacity; (2) increase diabetes-
related symptom recognition, help seeking, and adherence among ethnic 
minority elderly; (3) improve access to community services for at-risk 
older Vietnamese, Korean, and Hispanic Americans and their families; 
(4) educate consumers about their choices for home care, when to use 
it, and how to select, hire, and supervise a home-care worker; and (5) 
educate older Hispanic American women about the nature of osteoporosis 
and how to prevent it. A sixth project, funded under Part B, will 
synthesize and disseminate materials to increase the capacity and 
effectiveness of Title VII of the Older Americans Act vulnerable elder 
rights protection programs to reach and serve minority elders.
D. AGING Magazine
    The Administration on Aging's magazine, AGING, continued this year 
to report on innovative programs throughout the United States that 
serve the elderly. AGING is circulated to 720 State and Area Agencies 
on Aging, national organizations concerned with the elderly, 
professionals who work with them, university and public libraries, and 
to older constituents and their families. A key goal of the magazine is 
to inspire staff who work with the elderly to find better ways to meet 
their clients' needs and to insure that they receive up-to-date 
information on prevention and treatment of health problems. A ``Health 
Watch'' section in each issue covers subjects of special interest to 
older people.
    The most recent issue, for example, included articles on warning 
signs of heart attack and stroke, the role of vitamins in preventing 
disease, the dangers of sleeping pills, the vital importance of getting 
the one-time shot that protects against pneumonia, how to read the new 
FDA-required food labels in order to develop much healthier eating 
habits, and new Federal guidelines for cataract surgery.
    Although prevention of health problems is routinely covered, this 
was a special 88-page double issue that focused on a topic neglected in 
an aging field--the need to ``Nurture the Creative Spirit'' in the 
years after 50. The goal of the issue, which had an outstanding design 
and used photos, drawings, and paintings either of or done by older 
people, was to defy the common presumption that individuals become less 
creative as they age. Included in this issue were articles: on a well-
known artist who began drawing in her 60's; an exciting program that 
brings art appreciation and discussion groups to nursing homes; an art 
center for the disabled; and arts and humanities programs of interest 
to seniors that have been developed by the National Council on the 
Aging, the Smithsonian Institution, and other organizations.
    In addition to featuring the arts, this issue included articles on 
a rural Community Mental Health Center that uses 72 volunteer peer 
counselors to help older people with mental illness; programs 
throughout the country that assist grandparents raising grandchildren; 
and a Baltimore project that equipped a row house as a showcase for 
adaptive devices that enable frail elderly people to remain in their 
homes. Regular sections also keep agencies up to date on new State and 
community programs, and on the latest publications and books can help 
staff to enhance services to constituents.
             3. continuation activities in fiscal year 1994
    This Section of the Title IV Discretionary Program Report describes 
a wide variety of activities funded prior to FY 1994, but were still 
active in FY 1994 which carry out general mandates of the Act and 
support priority initiatives of the Assistant Secretary for Aging.

     A. Home and Community Based Long Term Care for At-Risk Elderly

            (i) national resource centers for long term care
    Pursuant to Section 407 of the Older Americans Act Amendments of 
1992, four National Resource Centers for Long Term Care were awarded 
continuation grants in Fiscal Year 1994. The Centers are responsible 
for conducting research, disseminating information, and providing 
training and technical assistance to improve national, State, and local 
systems for the provision of home and community-based long-term care. 
Each Center is focused on one or more specialty areas and is described 
below.
    University of Minnesota.--This Center assists the aging network to 
develop, administer, and refine current community-based long-term care 
systems and services, with special emphasis on ethical issues and case 
management.
    Brandeis University.--This Center conducts research and training, 
provide technical assistance, and disseminate information about the 
increasing diversity among the frail elderly and other disabled and 
chronically ill with respect to their race and ethnic background, 
economic status, gender, the communities in which they live, and types 
of disability or disease they encounter.
    National Association of State Units on Aging.--This Center develops 
and improves community-based long-term care infrastructures and their 
components to better meet the needs of long-term care consumers, 
including the aged and disabled.
    University of Kansas Medical Center.--This Center improves the 
availability of, and access to effective, appropriate community-based, 
long-term care services for the rural elderly.
         (ii) national long term care ombudsman resource center
    In FY 1994, AoA continued support for the National Long Term Care 
Ombudsmen Resource Center which was established in 1993 through a 
Cooperative Agreement with the National Citizens Coalition For Nursing 
Home Reform for a project period of 4 years. The Center acts as a 
resource for policy analysis. It promotes the more effective 
organization and operation of Federal, State, and local long-term care 
ombudsman programs through technical assistance, consultation and 
information dissemination. The Center provides training modules and 
materials, volunteer recruitment efforts and cooperative activities 
with other agencies. In addition, the Center emphasizes preventing 
abuse and neglect and extending services to non-institutional settings.
         (iii) special projects in comprehensive long-term care
    Consistent with Section 407--Special Projects in Comprehensive Long 
Term Care, as enacted by the 1992 Amendments, the Administration on 
Aging made 13 17-month awards for demonstration projects to improve the 
delivery of long-term care to the at-risk elderly. The findings, 
results and products from these projects are expected to advance 
significantly the Nation's capacity to develop and implement 
comprehensive systems of home and community-based, long-term care. 
These currently active projects include:
    Rhode Island Department of Elderly Affairs.--Will reduce 
duplication of State-level administrative functions and decrease 
fragmentation of case managed services.
    Oklahoma Department of Human Services.--Will develop and 
demonstrate a plan that builds on the Aging Network's capacity to 
assume a significant role in the State's newly mandated long-term care 
system which places increased emphasis on providing home and community-
based care services.
    Cherokee Nation.--Will establish a comprehensive system of services 
based on the PACE Model of care and financing developed by On Lok 
Senior Health Services in San Francisco, California.
    Ohio Department of Aging.--Will implement innovations including: 
(1) flexible case management; (2) a modified assessment and care 
planning process that takes greater account of client autonomy; and (3) 
an expanded model of service delivery to expand our thinking about, and 
knowledge of, the home-care system and ways to best enhance client 
autonomy and functioning within reasonable cost constraints.
    Marin County Department of Health and Human Services.--Will bring 
private agencies into one system that screens and refers home care 
workers for the aged and young adults with disabilities.
    Philadelphia Corporation for Aging.--Will produce, evaluate and 
disseminate 12 protocols for care management in community-based long-
term care.
    Baylor College of Medicine.--Will demonstrate, along with other 
community organizations, the feasibility of forming an alliance for at-
risk elderly known as ALTCARE.
    Senior Focus of Burlingame, California.--Will establish and 
evaluate a medication counseling project for at-risk older persons in 
two managed-care settings.
    Huntington Memorial Hospital of Pasadena, California.--Will develop 
and test an in-home medications management program which decreases 
threats to the health and independence of high risk older persons and 
fills a gap in the care continuum.
    Wisconsin Department of Health and Social Services.--Will improve 
care management for older clients by incorporating techniques into the 
assessment, care planning and monitoring processes that will prolong 
their ability to remain in their own homes.
    Vermont Department of Aging and Disabilities.--Will set up and 
evaluate a single point-of-entry model for long-term care services for 
the elderly and adults with disabilities through Regional Service 
Centers.
    Area Agency on Aging 1-B of Southfield, Michigan.--Will develop a 
Performance Management System that (1) defines service standards in 
measurable terms; (2) uses benchmarks to encourage providers to focus 
on excellence rather than mere compliance; (3) creates consumer-based 
definitions of quality; and (4) trains other States and Area Agencies 
on Aging to develop their own systems.
    New York State Office for the Aging.--Will replace a fragmented and 
duplicative long-term care assessment process by developing a consensus 
plan based on input from various professionals and agencies that assist 
the at-risk elderly.

                   B. National Center on Elder Abuse

    AoA continued support for the National Center on Elder Abuse, which 
was funded in response to the legislative mandate in the Older 
Americans Act Amendments of 1992, Section 202(d)(1). The Center 
supports efforts under Title VII of the Act which calls attention to 
the problem of elder abuse, neglect, and exploitation at home and in 
institutional settings and which stresses the need to take coordinated 
action on behalf of those elderly who are least able to advocate for 
themselves.
    The Center award was made to the American Public Welfare 
Association (APWA) for a 4-year project period. The National 
Association of State Units on Aging, the National Committee for the 
Prevention of Elder Abuse, and the University of Delaware will 
collaborate with APWA in carrying out the work of the Center.
    With joint funding from AoA and the Administration for Children and 
Families, the National Center on Elder Abuse began in late FY 1994 a 
national study to accurately estimate the incidence of elder abuse. 
Other activities of the Center include: (1) performing clearinghouse 
functions by providing information about best practices in the 
organization, planning and delivery services to combat elder abuse; (2) 
compiling, publishing and disseminating training materials for 
personnel working in the field; (3) providing training and technical 
assistance to public and private agencies to assist in improving 
programs to combat elder abuse, neglect, and exploitation; and (4) 
conducting research and demonstration projects regarding elder abuse, 
neglect, and exploitation with an emphasis on causes, prevention, 
identification and treatment.

       C. Training and Technical Assistance for Title VI Grantees

    AoA continued its support for the project conducted by the Three 
Feathers Associates of Norman, Oklahoma to provide training and 
technical assistance that is consistent with Section 411(a)(4) of the 
Older Americans Act. The project will strengthen the capacity of Title 
VI program directors and staff to provide comprehensive and coordinated 
systems of nutritional and supportive services for older American 
Indians, Alaskan Natives, and Native Hawaiians. The project is focusing 
particular attention on coordinating resources under Title VI and Title 
III of the Older Americans Act and strengthening Title VI program 
accountability

               D. National Leadership Institute on Aging

    The Administration on Aging, under the Title IV discretionary funds 
program, has a cooperative agreement with the University of Colorado at 
Denver for the continued funding of the National Leadership Institute 
on Aging. The Leadership Institute was established to enhance the 
leadership capacity of women and men in the aging network and others 
with a stake in aging America. The goal is to encourage greater 
creativity and innovative solutions to the complexities of an aging 
society. The leadership development curriculum including modules on the 
context of leadership in a changing society; the concepts of leadership 
for the future executive; the goals and tools of leadership in 
community systems building; and self-development for enhancing 
effectiveness.
    The Institute provides an intensive and supportive residential 
learning environment, for a select number of executives from State and 
Area Agencies on Aging, Tribal Units, national organizations. Its goal 
is to enhance leadership development and increase the competence of 
agents responsible for social change. Since its inception in 1988, the 
Leadership Institute has conducted 17 residential Leadership 
Development Programs for close to 600 participants from all areas 
across the Nation. It has also conducted a number of Mini-Institutes in 
several States, provided a number of refresher events for alumni and 
staff have staged several pre-intensive, leadership-development 
workshops in conjunction with national meetings and conferences.

                E. Senior Transportation Demonstrations

    The Older Americans Act Amendments of 1992 include several 
provisions which recognize the transportation barriers which older 
persons often face. The Amendments directed AoA to carry out a Senior 
Transportation Demonstration Program. AoA funded five 2-year awards in 
Fiscal Year 1993 to demonstrate innovative approaches to improve older 
persons' access to services, to develop comprehensive, integrated 
senior transportation services, and to leverage resources for senior 
transportation services through coordination with other funding 
sources. The five project grantees, refunded in FY 1994, were:
    Central Plains Area Agency on Aging (KS).--The Central Plains AAA 
will produce a model senior transportation program that improves the 
effectiveness of and access to a community-based long-term care system 
through an enhanced multi-county (urban and rural) coordinated 
transportation network.
    CARE-A-VAN, INC. (CO).--CARE-A-VAN, Inc., will develop a rural-to-
urban transportation demonstration model project to benefit seniors by 
bringing frail, disadvantaged elderly from as many as seven rural 
communities to urban services in Fort Collins, Colorado.
    Portage Area Regional Transportation Authority (PARTA) (OH).--PARTA 
will demonstrate how agencies providing housing, nutrition, adult day 
care, and related services can work effectively with a regional 
transportation authority to improve the quality and increase the level 
of transportation services that are responsive to the critical needs of 
the area's elderly.
    District III Area Agency on Aging, Inc. (MO).--The District III AAA 
project will help meet the documented transportation needs of those 
rural elders who require health, nutrition, and supportive services by 
demonstrating a comprehensive approach to coordinating transportation. 
The project will establish a special organization for coordinating 
transportation services; implement a pilot project covering two 
counties; formulate solutions to barriers to coordination; and raise 
awareness regarding rural elders' transportation needs.
    Florida Department of Elder Affairs.--The Florida State Agency on 
Aging, in cooperation with the Mid-Florida Area Agency on Aging, the 
Center for Gerontological Studies, and the Florida Transportation 
Disadvantaged Commission, will demonstrate a senior transportation 
services program servicing rural dwelling, minority, low income elders, 
in Hamilton, Suwannee and Lafayette Counties. The model project seeks, 
in particular, to establish several Inter-County Alliances among rural 
churches to improve and expand current transportation service delivery.

  F. Demonstration Projects for Older Individuals With Developmental 
                              Disabilities

    Consistent with Section 415 of the 1992 Amendments to the Older 
Americans Act, AoA made five 2-year awards in Fiscal Year 1993 to 
support the efforts of agencies that serve older and developmentally 
disabled persons. The grantees, all State agencies, are leading efforts 
to collaborate on State and local planning, coordination, and programs 
that will improve services to older persons with developmental 
disabilities as well as those older persons who care for younger family 
members with developmental disabilities. The five State agnecies, re-
funded in FY 1994, were:
    Hawaii Department of Health.--This project seeks to combine two 
pertinent areas: the identification of current issues in the care of 
aging persons with developmental disabilities in Hawaii and the cross-
training of personnel involved in integrated programs for aging 
persons.
    New York Research Foundation for Mental Hygiene, Inc.--This project 
will test the feasibility of incorporating low-cost and low-tech 
methods into the daily practice of an Area Agency on Aging to conduct 
outreach to adults with developmental disabilities, link AAA programs 
with those of developmental disabilities agencies, and support family 
caregivers of adults with developmental disabilities. From this 
experience, implications will be drawn for use in replicating the AAA 
model in other parts of New York State and the Nation.
    Illinois Department on Aging.--This Illinois project is designed to 
(1) bolster supports for family caregivers of individuals with 
developmental disabilities; (2) encourage future planning activities to 
prevent crises from occurring when they are no longer able to provide 
care; and (3) improve access to Older American Act programs and 
services for older adults with developmental disabilities.
    Rhode Island Developmental Disabilities Council.--This project is 
developing a collaborative agency network in Rhode Island to design an 
educational workshop program and interdisciplinary support team to 
assist elderly parents with adult sons/daughters with developmental 
disabilities in making family-centered plans for their futures, 
including residential, financial, and service-related dimensions.
    Virginia Department for the Aging.--This project is drawing upon 
practice and policy innovations in Virginia and Maryland in order to 
build and test an integrated model program that will improve services 
to older persons with developmental disabilities and older persons who 
care for younger family members with developmental disabilities.

   G. Linking Generations--Intergenerational and Multigenerational: 
                             Demonstrations

    In response to Sections 406 and 409 the Older Americans Act 
Amendments of 1992, in FY 1993 AoA funded eight projects to develop and 
implement intergenerational and multigenerational programs designed to 
assist families at-risk. The currently active projects are:
    Action for Boston Community Development (MA).--The Boston Reaching 
Across Generations (BRAG) project is focusing on aspects of social 
support needs among elders and at-risk youth which have not been fully 
addressed in other intergenerational mentoring programs. The project 
will respond, specifically, to the exceptional isolation experienced by 
low-income, minority elders with functional impairments by training 
frail and disabled elders as mentors to at-risk youth. In return, youth 
will volunteer to assist elderly mentors with services such as shopping 
or escorting elderly individuals to the doctor.
    Eastern Michigan University.--The Teaching-Learning Communities: 
Multigen-erational Family Empowerment Project of Eastern Michigan 
University aims at demonstrating a model that links three programs 
found in many communities: (1) older adults (senior aides) 
participating in the U.S. Department of Labor Senior Community Service 
Employment program; (2) children, youth and their parents receiving 
Section 8 housing support; and (3) the local school district.
    Easter Seal Society for Disabled Children and Adults (DC).--The 
Easter Seal Society for Disabled Children and Adults and Family Friends 
of the National Capital Area are collaborating to develop a model 
program to link senior volunteers with at-risk families of children 
with disabilities. The project will develop an intergenerational model 
program for national dissemination that utilizes senior volunteers to 
teach at-risk families how to access existing health care services, 
community resources and support networks.
    New York City Department for the Aging.--As a collaborative effort 
of the New York City Department for the Aging and the Division of 
Adoption and Foster Care Services of the Child Welfare Administrations, 
the Kinship Foster Care Support Project is working with ``skipped 
generation'' families linking kinship foster parents, 50 and older, and 
their foster children with senior volunteers. The project will recruit, 
select, train, and supervise 50 senior volunteers to provide in-Home 
assistance and support to 100 kinship foster care families.
    Pennsylvania Department of Aging.--``Skip Generation'' families are 
emerging as grandparents become full or part-time caregivers of pre- 
and school-age children. This project links those increased caregiving 
responsibilities with the need for children to be immunized by 
establishing immunization clinics in six senior centers in different 
regions of Pennsylvania. The clinics will operate through a 
collaborating between health, aging and community agencies, volunteer 
physicians and nurses, and child advocacy groups. The project aims to 
improve immunization levels of children who cannot access services in 
traditional ways and to enhance the roles of older people in family 
systems.
    University of North Texas.--This Seniors for Childhood Immunization 
project, to be demonstrated in partnership with the Retired Senior 
Volunteer Programs (RSVP), is an intergenerational and 
multigenerational project designed to improve the immunization rate for 
preschool children. The objectives of the project are to: (1) develop a 
system-integrated intergenerational model to link senior volunteers and 
college students to immunization-providing agencies, and hospitals 
within a community; (2) field test the model in 16 sites within the 
Denton and Dallas counties of Texas; (3) evaluate the demonstrations 
for their impact on immunization schedule completion and model 
effectiveness; and (4) disseminate project results through the senior 
volunteer aging and public health networks.
    North Carolina Central University.--The goals of the Hand in Hand: 
Multigenerational Assistance Exchange Project are to improve service to 
at-risk minority elderly and children and to recruit and train minority 
students for service employment. The project will employ minority 
college students as outreach aides to inform and assist older people in 
applying for public benefits and obtaining aging services. In exchange, 
elders will be invited to volunteer as mentors, tutors, and companions 
for at-risk children in the Head Start and Youth Enrichment Experience 
Programs.
    Generations United (Child Welfare league of America) (DC).--
Generations United, in conjunction with its partners, the National 
Council on the Aging, the University of Pittsburgh's Generations 
Together Program, and the Temple University Center for 
Intergenerational Learning, will carry out a program of comprehensive 
technical assistance, training, and information dissemination focused 
on intergenerational/multigenerational linkages. This project will 
assist the newly-funded AoA intergenerational projects, create a 
national public awareness campaign, and provide support for strategic 
planning at the local and national levels.

       H. Rural Mental Health Care Training of Services Providers

    The Administration on Aging (AoA) with the support of the Center 
for Mental Health Services (CMHS), part of the Public Health Service's 
Substance Abuse and Mental Health Services Administration, made three 
2-year awards in FY 1993 to increase detection of mental illness of 
rural elderly, and to provide for the appropriate referral of those 
elderly for treatment. The projects will test the feasibility and 
effectiveness of training non-mental health care providers in meeting 
the needs of older persons suffering from, or at risk of mental health 
impairment in areas underserved by mental health professionals. In 
addition, additional funding will be provided by CMHS for coordination, 
evaluation and dissemination of technical assistance materials which 
will be used by State mental health and aging authorities in planning 
future programs and budgets to better serve the growing number of older 
persons living in rural areas.
    The three new project grants jointly funded by AoA and CMHS are as 
follows:
    The Center for Mental Health Policy and Services Research at the 
University of Pennsylvania (Philadelphia) is working with 
representatives of agencies, organizations and the public in three 
rural counties (Berks, Franklin, and Fulton) to develop a curriculum 
and training model to increase the knowledge and ability of non-mental 
health human services workers, caregivers, and community volunteers to 
recognize the symptoms and functional indicators of mental disorders.
    The Center on Rural Elderly at the University of Missouri at Kansas 
City is developing and testing a model mental health training program 
for non-mental health service providers to improve their recognition 
and assessment of mental health problems and communications with mental 
health professionals. In addition to testing the materials with nearly 
2,000 providers of services to rural elderly, the Center will 
facilitate collection and analysis of information and data from other 
project sites for dissemination to local, State, and national officials 
in mental health and aging.
    The Center on Aging at the University of Arizona (Tucson) is 
developing and pilot testing training materials for providers of health 
and social services to rural Hispanics, American Indians, and Anglos. 
Material sensitive to cultural differences in mental health illness 
will be developed with the consultation of the Indian Health Service 
and the assistance of the InterTribal Council of Arizona and Chicanos 
por La Causa.

      I. Pension Information and Counseling Demonstration Program

    Recognizing the large unmet need to provide older Americans with 
information and counseling in the area of pension benefits, Congress 
provided in Section 419 of the Amendments to the Older Americans Act of 
1992 for the funding of Pension Information and Counseling 
Demonstration Projects. AoA made seven 17-month awards in fiscal year 
1993 for demonstration projects that seek to provide outreach, 
information, counseling, referral and assistance in the area of pension 
benefits. A national training and technical assistance project that 
will strengthen the role of the demonstration projects, State and Area 
Agencies on Aging and legal services providers, both public and 
private, in providing pension assistance and encouraging coordination 
among these groups was also funded to run concurrently with the model 
projects.
    Legal Services for the Elderly (NY).--This model project provides 
telephone service to individuals to enable them to learn about their 
pension and other retirement benefit rights. Retirement benefit 
claimants receive the following information: (1) How to apply for 
benefits and exhaust plan remedies by appealing a denial of benefits 
within their respective plans; (2) how to assess whether a retirement 
plan complies with ERISA's minimum standards; and (3) referrals to 
private attorneys and bar associations for representation and 
litigation. The project will serve as a resource center with an expert 
attorney on call to answer individual's questions and offer guidance to 
pensioners on how to obtain their rights.
    National Senior Citizens Education and Research Center (DC).--This 
project involves a statewide pension information, counseling and 
advocacy program in Minnesota which is addressing pension problems of 
retirees and their families. The goals of this project include: (1) 
Informing seniors about pension rights and personal pension management 
by utilizing trained volunteer and paid staff comprised principally of 
retirees; (2) assisting seniors to obtain essential pension information 
and resolve widespread problems such as disputes about expected 
benefits, survivors's rights, records, integration with Social 
Security, etc., and identify effective courses of action to secure full 
right and benefits; (3) gather data and analyze experience to increase 
replicability; and (4) design permanent local models of pension 
information and advocacy centers.
    Michigan Office of Services to the Aging.--This project is 
demonstrating a comprehensive program model for assisting older people 
to understand, obtain and wisely use their pension benefits. The 
project is being tested in two of Michigan's most urban counties and 
four of its most rural counties and will provide individual pension 
counseling services to a minimum of 320 seniors. Legal advice and 
counsel are available to as many as 50 of those individuals. The 
project also provides financial counseling services. The project builds 
on a proven model for providing health insurance counseling to older 
people and uses intensively trained volunteers who are supported by 
regional coordinators.
    Older Women's League (DC).--This project sponsors a pension 
information and counseling center in St. Louis to maximize retirement 
income and access to pension information among working and retired 
persons with a particular emphasis on low-income and minority elders 
and older women. Through an information and counseling service, a 
pension hotline, financial workshops, consumer materials, and volunteer 
training, the project strengthens financial independence, increase 
access to retirement income and serves as a unique resource on women's 
retirement issues.
    University of Massachusetts, Boston.--This project, a cooperative 
effort with the Massachusetts State Unit on Aging, is engaged in: (1) 
educating older workers, retirees and the community about different 
types of pensions and retirement income as well as issues affecting 
eligibility and benefit levels; (2) increasing older persons's 
awareness of their financial status with regard to their pension and 
Social Security eligibility and benefit level; (3) assisting 
individuals in exercising their rights to protect their pensions and 
challenge unfavorable decisions; and (4) maximizing an individual's 
retirement standard of living through counseling and referrals to 
appropriate programs and professionals.
    National Committee to Preserve Social Security and Medicare (DC).--
This project is establishing a model local Pension Information and 
Counseling Program in Tucson, Arizona. The goals of this project are 
to: (1) Determine the degree of need for pension information and 
counseling particularly among older persons of low and moderate means; 
(2) learn what types of information are most useful and necessary for 
such persons to ensure that they secure the full level of benefits to 
which they are entitled and make the best use of these assets within 
the context of their own financial standing; and (3) determine what 
resources are available and/or lacking on a national basis which could 
be used to help meet the needs of locally based pension counseling 
programs.
    California Advocates for Nursing Home Reform.--This project is 
adding pension counseling to its current program of consumer counseling 
and professional attorney and estate planning training. It includes 
development of a consumer pension handbook, a professional estate 
planner training package, and development of a pension data base. 
Special outreach attempts are being made to low income minorities, 
especially Hispanics and Chinese.
    Pension Rights Center (DC).--This project supports the AoA funded 
Pension Information and Counseling Demonstration projects as well as 
other groups providing pension assistance. Activities include staff and 
volunteer training, development of local technical assistance support 
systems, provision of day-to-day technical assistance, and facilitation 
of coordination between the demonstration projects and other national 
and local sources of assistance. A secondary objective is to offer 
recommendations for future pension assistance programs based on a 
assessment of the demonstration projects.

      J. Activities in Support of the National Eldercare Campaign

    During fiscal year 1994, the Title IV program continued to support 
the National Eldercare Campaign and its goals to increase advocacy, 
collective planning, and action on behalf of the most vulnerable older 
Americans. Several components of the National Eldercare Campaign, 
initiated in fiscal year 1991, concluded in fiscal year 1994: (1) 
Project CARE grants to State and Area Agencies on Aging to encourage 
development of coalitions of local organizations and businesses; and 
(2) grants to National Eldercare Institutes to advance our knowledge 
base in several important issue areas and to provide technical 
assistance and training.
         1. project care: community action to reach the elderly
    The Administration on Aging launched Project CARE (Community Action 
to Reach the Elderly) in Fiscal Year 1991 as a major component of the 
National Eldercare Campaign. The goal of Project CARE is to tap the 
expertise, energy, and experience of individuals and organizations and 
encourage new ideas and approaches for meeting the needs of vulnerable 
older Americans through formation of State and local community 
coalitions.
    By Fiscal Year 1994, more than 900 eldercare coalitions were 
operational through AoA grants to State and Area Agencies on Aging. 
About 30 States had also started statewide coalitions. The statewide 
coalitions were formed to support the work of the community coalitions. 
State coalitions provide a mechanism for building widespread public 
awareness about the needs of older persons. They also provide a way to 
focus attention on the need for State-level, comprehensive strategies 
to help vulnerable older persons.
    Continuation funding was provided in Fiscal Year 1993 to the 
community coalitions which are implementing practical, immediate 
service projects to help vulnerable older persons. Each is working to 
broaden the base of support for eldercare concerns by empowering local 
community leadership to take greater responsibility for their 
vulnerable older persons. The coalitions include a significant number 
of non-aging organizations which traditionally have not been involved 
with aging concerns.
                    2. national eldercare institutes
    As part of the National Eldercare Campaign, AoA has supported a 
number of specialized National Eldercare Institutes located in national 
organizations and academic institutions. In Fiscal Year 1991, 12 
National Eldercare Institutes were awarded project grants under the 
terms of a 3-year cooperative agreement.
    In 1992, an additional award was made to establish a second 
National Eldercare Institute in the area of long-term care. Each 
Institute has focused on a critical substantive area relevant to 
improving eldercare services, both in the home and community.
    In Fiscal Year 1994, working in close collaboration with eldercare 
coalitions across the Nation, the Institutes also undertook a variety 
of activities designed to support and assist State and Area Agencies on 
Aging in carrying our their missions as planners and coordinators of 
aging services within their jurisdictions.
    The National Eldercare Institutes active in 1994 are described 
below by subject area:
a. Long Term Care
    The National Eldercare Institute on Long-Term Care and Alzheimer's 
Disease at the Suncoast Gerontology Center, University of South Florida 
designed activities that would provide the aging network with current, 
practical information on critical long-term care issues, especially 
Alzheimer's disease. The Institute also focused on the areas of home 
and community-based model long-term care programs and services, and 
caregivers and caregiving.
b. Older Women
    The National Eldercare Institute on Older Women is directed by the 
National Council of Negro Women (Washington, D.C.). The Institute was 
designed to address issues affecting diverse populations of older women 
with special attention to those most at-risk. The Institute conducted 
training and technical assistance at a variety of conferences, 
symposia, forums, and workshops. A major focus of the Institute was to 
serve as a catalyst and encourage national women's organizations to 
adopt an older women's issues agenda in their national and local 
program activities.
c. Multipurpose Senior Centers and Community Focal Points
    The National Eldercare Institute on Multipurpose Centers and 
Community Focal Points is conducted through the National Council on 
Aging (Washington, DC). The Institute's mission was to encourage 
communities to develop senior centers to serve at-risk older people in 
their homes as well as in congregate facilities, and, conversely, to 
encourage existing senior centers to expand their services for at-risk 
elderly and increase their linkages to non-traditional community 
groups.
d. Transportation
    The National Eldercare Institute on Transportation was conducted by 
the Community Transportation Association of America, (CTAA) in 
collaboration with the National Association of Area Agencies on Aging 
(NAAA), the National Center and Caucus on Black Aged (NCBA) and the 
National Council on the Aging (NCOA) (all located in Washington, DC). 
The goals of the Institute were to increase public awareness and 
commitment to the transportation and mobility needs of at-risk older 
persons; to serve as a resource institute on aging and transportation/
mobility issues to the National Eldercare Campaign and its Project CARE 
coalitions; to gather, analyze and disseminate data on aging and 
transportation issues; and to provide training and technical assistance 
on aging and transportation issues.
e. Housing and Supportive Services
    The National Eldercare Institute on Housing and Supportive Services 
was operated by the University of Southern California (Los Angeles, CA) 
in collaboration with the National Association of Area Agencies on 
Aging and the Federal National Mortgage Association (both in 
Washington, DC). The Institute mobilized public, private and voluntary 
sector resources to better link elderly housing with supportive 
services and increase supportive housing options for the at-risk 
elderly population.
f. Nutrition Services
    The National Eldercare Institute on Nutrition was a joint effort 
conducted by the National Association of Nutrition and Aging Services 
Programs (Grand Rapids, MI) in collaboration with the National 
Association of Meals Programs, the National Association of State Units 
on Aging, the National Meals on Wheels Foundation (all located in 
Washington, DC), the DuPont Corporation (Wilmington, DE), Ross 
Laboratories (Columbua, OH) and the Nestle Corporation (Washington, 
DC). The Institute focused on nutritional issues concerning the at-risk 
elderly and their impact on improving nutritional services and product 
development in community settings.
g. Human Resources Development
    The National Eldercare Institute for Human Resource Development was 
operated by the Brookdale Center on Aging, Hunter College of the City 
of New York in collaboration with the American Society on Aging in San 
Francisco, California. The purpose of the Institute was to help State 
Units on Aging, Area Agencies on Aging, and eldercare coalitions 
promote the most effective use of human resources in programs serving 
the elderly.
    The Institute provided training and technical assistance in such 
areas as training techniques, staff recognition, and team building and 
management; solicitation, evaluation, and dissemination of best 
practice in human resource development for use in aging programs; 
presentation of human resource best practice awards to exemplary staff 
development programs in health and long-term care organizations; and 
preparation and dissemination of Institute training calendars and 
newsletters.
h. Health Promotion
    The National Eldercare Institute on Health Promotion was conducted 
by the American Association of Retired Persons (Washington, DC) in 
collaboration with Meharry Medical College (Nashville, TN). The purpose 
of the Institute was to encourage healthy behaviors among older persons 
and their caregivers and serve as a knowledge base and program resource 
on health promotion and disease and disability prevention for 
vulnerable older persons.
    The Institute collected and disseminated information about 
successful health promotion program models which assist older persons 
in maintaining their well-being and independence and provided 
information on overcoming barriers to reaching low-income minority 
populations. Research findings and best practice information on health 
promotion was incorporated into technical assistance guides and 
training materials for use in conjunction with the work of national, 
State, and community Eldercare Coalitions and disseminated to health 
care networks.
i. Income Security
    The National Eldercare Institute on Income Security was 
administered by Families USA, Foundation, Inc. (Washington, DC). The 
Institute focused on the living standards of the low-income elderly and 
their access to benefits and entitlement programs that meet their 
needs. It conducted analyses on selected topics related to income 
security to identify key factors that served as the basis for a public 
awareness campaign and stimulated interest among Eldercare Coalitions, 
such as examination of the elderly poverty rate, a study of the 
``Medicaid Gap'' as it relates to coverage of health services and 
nursing home care, the affordability of long-term care insurance, and 
the proportion of out-of-pocket health costs not being paid by Medicare 
and Medicaid.
    The Institute worked with other interested organizations to promote 
outreach activities to make low income older persons aware of their 
possible eligibility as ``Qualified Medicare Beneficiaries''. Under 
this program, Medicaid pays their Medicare premiums and deductibles. 
The Institute also promotes public education to increase the 
participation of the low-income elderly in the Supplemental Security 
Income (SSI) program.
j. Employment and Volunteerism
    The National Eldercare Institute on Employment and Volunteerism was 
conducted by the Center on Aging, University of Maryland (College Park, 
MD) in collaboration with the National Council on the Aging 
(Washington, DC), the National Retiree Volunteer Center (Minneapolis, 
MN), and the American Association of Retired Persons (Washington, DC). 
The Institute's overall mission was to improve the quality of life for 
older persons by enhancing and increasing volunteer and employment 
opportunities. The Institute operated a clearinghouse on volunteerism 
designed to synthesize knowledge and information on curriculum and 
training models, effective programming, and policy analysis which was 
designed to enhance the effective use of volunteers in eldercare 
service organizations.
k. Business and Aging
    The National Eldercare Institute on Business and Aging was 
conducted by the Washington Business Group on Health (Washington, DC) 
in collaboration with the American Society on Aging (San Francisco, 
CA). The Institute developed and disseminated many useful products and 
programs to business organizations, foundations, and the aging network, 
including Project Care Coalitions. These included several publications, 
a regular newsletter, fact sheets and a board game which teaches the 
steps in developing public/private partnerships. The Institute also 
conducted seminars at the major national aging conferences on such 
topics as public/private partnerships and working with the business 
community on eldercare programs. In addition, the Institute has 
gradually increased its role in providing technical assistance through 
teleconferences, on-site presentations and telephone consultation.

      K. Supporting Resources for Legal Assistance to the Elderly

    The new Title VII, established by the 1992 Amendments to the Older 
Americans Act, mandates support for legal assistance programs funded 
through State and Area Agencies on Aging. In addition, Section 424 of 
Title IV requires the Administration on Aging to establish a national 
legal assistance support system that provides State and Area Agencies 
and local legal assistance programs with case consultations, training, 
legal advice, and assistance in the design and implementation of 
delivery systems by local providers. Under this mandate, the 
Administration on Aging has supported technical assistance grants to 
national, nonprofit legal assistance organizations for a number of 
years through multi-year grant projects on the basis of periodic 
national competitions.
    In Fiscal Year 1992, eight 3-year project awards were made in 
support of the national legal assistance support system and these 
projects received continuation awards in FY 1994. Continuation funding 
was also awarded to three demonstrations of statewide legal hotlines. 
The projects are summarized below:
         1. national system of legal assistance project grants
    The National Senior Citizens Law Center (Washington, DC).--The 
Center is providing legal assistance support services to State and 
local legal assistance programs for the elderly, legal assistance 
developers, ombudsmen, and State and Area Aging Agencies. Assistance 
focuses on case consultation, legal assistance, technical assistance 
(TA), training, and joint sponsorship of the National Law and Aging 
Conference.
    The Commission on Legal Problems of the Elderly of the American Bar 
Association (Washington, DC) is engaged in strengthening the capacity 
of State and Area Aging Agencies and legal services providers to 
develop accessible and responsive systems of legal assistance for older 
persons. The Commission is providing technical assistance on legal 
assistance systems related to subjects such as private bar involvement, 
senior attorney pro bono services, aging network linkages with 
disability networks, offices of attorney generals, and eldercare 
coalitions.
    The Commission is also providing substantive legal advice on aging 
law issues, such as grandparent visitation/kinship care, health care 
decisionmaking, age discrimination, and others. The Commission is a 
joint sponsor of the National Law and Aging Conference.
    The Mental Health Law Project of Washington, D.C. provides 
training, technical assistance, and case consultation to advocates to 
meet the legal needs of elders with mental disabilities. The project 
emphasizes protection of the rights of elders to age in place and 
promote community-based alternatives to nursing homes and appropriate 
care for the mentally disabled in nursing homes and hospitals, 
including options for community placements.
    The Pension Rights Center (Washington, DC) is expanding its Legal 
Outreach Program, targeted to the needs of at-risk elderly and the 
legal services providers that serve them. The Center is also developing 
new case consultation, training and pro bono resources and establishing 
a Clearinghouse to collect and disseminate pension information to 
eldercare providers.
    The Legal Counsel for the Elderly (LCE) of the American Association 
of Retired Persons (Washington, DC) provides training and technical 
assistance on substantive law and advocacy skills to past recipients of 
``training the trainers'' in 20 States. The project also provides 
training to volunteers, staff of legal assistance and aging advocacy 
agencies, substantive experts who want to become trainers, and 
advocates in multidisciplinary coalitions who will, in turn, serve as 
trainers. It is also providing training and assistance to States 
interested in passing new protective services legislation 
(guardianship, health care decisionmaking, durable powers of attorney, 
living will) and in expanding legal services programs for Disability, 
Medicare and Veterans benefits based on documents maintained in its 
clearinghouse on these topics. LCE is a joint sponsor of the annual 
National Law and Aging Conference.
    The LCE project is also continuing previous activities to test, 
and, if successful, replicate methods for providing free legal 
assistance through the use of: (1) private practice paralegals as 
volunteers, (2) retired and semi-retired attorneys as volunteers, and 
(3) bar-sponsored lawyer referral programs to provide low cost wills 
and advance directives.
    The National Clearinghouse for Legal Services (Chicago, IL) 
provides a full range of publications and information services to 
agencies funded through AoA to provide legal assistance to older 
persons. Services include: computer-assisted legal research, 
Clearinghouse Review, Brief Bank services, and a computer newsletter.
    The Center for Social Gerontology, Inc. (Ann Arbor, MI) provides 
training and technical assistance, and substantive legal advice and 
assistance to enhance the capability of the State and Area Agencies on 
Aging and legal services providers to plan and deliver legal assistance 
to at-risk elderly. Through an application process, the Center selected 
16 to 18 States to receive technical assistance and training programs, 
designed specifically for each State and which focus on such tasks as 
developing statewide standards for legal assistance elder rights 
planning, setting priorities, and coordinating statewide legal 
assistance program activities. The Center is a joint sponsor of the 
annual Joint Law and Aging Conference.
    The National Consumer Law Center, Inc. (Boston, MA) provides legal 
support to local practitioners (attorneys, legal services providers, 
legal service developers and eldercare advocates) in applying consumer 
law to resolve legal problems facing elderly clients. The project will 
develop a series of educational materials and guides, including model 
pleadings and defenses, model legislation, legal practice guides, 
newsletters and consumer education materials, with a special focus on 
threats to loss of shelter and financial exploitation.
    The project is developing a series of educational materials and 
guides, including model pleadings and defenses, model legislation, 
legal practice guides, newsletters and consumer education materials. 
The project is focusing on (1) threats to shelter, in such areas as 
problems with home equity, mobile home park tenancy issues, or utility 
services; and (2) financial exploitation, such as fraudulent sales of 
medical and emergency response products and unfair debt collection 
defenses.
              2. improvement of access to legal assistance
    The current legal assistance network for older persons has been 
operational for a number of years and has won general acceptance as an 
effective resource for older persons needing legal assistance. 
Experience has indicated, however, that barriers persist in reaching 
selective populations of older persons who area at-risk for a variety 
of reasons and could be aided if access were improved.
                        statewide legal hotlines
    In Fiscal Year 1990, the AoA entered into a memorandum of 
understanding with the American Association of Retired Persons (AARP), 
(Washington, DC) to expand the availability of Legal Hotlines for older 
people. With the support of AoA and AARP, Legal Hotlines are in 
operation in nine States/Regions (Pennsylvania--the prototype, the 
District of Columbia, Texas, Florida, Michigan, Ohio, Main, New Mexico, 
and Arizona), with nearly one-third of the Nation's older people having 
access to free or low cost legal advice. When an older person with a 
legal problem calls the Hotline, specially-trained lawyers either 
provide step-by-step advice on how to resolve their problems 
immediately, or, on more difficult issues, consult with local legal aid 
specialists or a panel of attorneys in private practice who agree to 
charge reduced fees.
    Three Legal Hotline projects were awarded start-up grants by AoA in 
Fiscal Year 1991 and received continuation funding in FY 1993:
          The Maine hotline, operated by the Legal Services for the 
        Elderly (Augusta) is serving as the primary intake mechanism 
        for their statewide network of legal assistance offices.
          The Arizona hotline, operated by Southern Arizona Legal Aid 
        (Tucson), is testing new outreach strategies for the State's 
        Native American and Hispanic populations.
          In New Mexico, the hotline is operated by the State Bar of 
        New Mexico (Albuquerque) that is expanding and improving its 
        current pro bono program.

    L. Multidisciplinary Centers at Historically Black Colleges and 
                              Universities

    The Administration on Aging initiated support, in Fiscal Year 1992, 
to establish Multidisciplinary Centers of Gerontology at Historically 
Black Colleges and Universities (HCBU's). This initiative responds to 
Executive Order No. 12677, which encourages the Department of Health 
and Human Services to support the involvement of HCBU's in the health 
and social service concerns of low-income, socially disadvantaged and 
minority older persons by initiating efforts to increase the number of 
minorities trained in the health, allied health and supportive services 
professions.
    Three grants for 3-year project periods were made by AoA under the 
Historically Black College and University Initiative. The 
Multidisciplianry Centers are:
          Howard University (Washington, DC) has established its 
        Multidisciplinary Center of Gerontology in the School of Social 
        Work. Center efforts focus on education, training, curiculum 
        development, research, information dissemination and 
        development of a repository of information on minority elders, 
        especially the African American elderly. The Center's 
        activities are concentrated on education and training, a 
        minority aging research agenda, and a campaign for sustained 
        support of the Center's operation initiated. Anticipated 
        products include models for a multidisciplinary center on 
        gerontology at an Historically Black College or University; 
        curricula for professionals and service providers; a directory 
        of gerontological courses and curricula offered at Washington 
        area colleges and universities, public service announcements 
        and a research agenda for HBCUs.
          Lincoln University (Philadelphia, PA) has established a 
        Multidisciplinary Center of Gerontology under the coordination 
        of the Master of Human Services Program. Center activities are 
        concentrated in the areas of: (1) development of gerontology 
        faculty and curriculum; (2) development of an advanced 
        certificate in gerontology; (3) establishment of gerontology 
        and geriatrics continuing education institutes; (4) research in 
        gerontology and geriatrics; and (5) restructuring the 
        undergraduate certificate in gerontology as a formal 
        undergraduate program. The Center plans to serve as a resource 
        center for professionals and aging service providers in the 
        Mid-Atlantic region by providing training and technical 
        assistance and disseminating information. Anticipated products 
        include a model for a multidisciplinary center on gerontology 
        at an HBCU and curricula for professionals and services 
        providers and other technical assistance materials.
          Morehouse School of Medicine (Atlanta, GA) has established a 
        Multidisciplinary Center of Gerontology that serves as 
        Coordinator of a Consortium of HBCUs in Georgia. Particular 
        attention is being paid to the needs of the rural elderly. 
        Center activities are concentrated on: (1) developing an 
        infrastructure for interdisciplinary collaborative efforts; (2) 
        faculty developing in curriculum and clinical skills; (3) 
        continuing education with a rural focus; (4) stimulating 
        research on minority aging issues to provide technical 
        assistance to policy makers and service providers; and (5) 
        establishing a clearinghouse and resource center. Anticipated 
        products include a model consortium approach for establishing a 
        multidisciplinary center on gerontology at an HBCU and 
        curricula for professionals and services providers that focus 
        on the rural minority elderly and other technical assistance 
        materials.

                      M. Small Business and Aging

    The market for goods and services for vulnerable non-
institutionalized elderly is especially suited for small businesses who 
are willing to take risks that larger companies will not until market 
information supports their capital investment. The Administration on 
Aging has been a participant in the Small Business Innovation Research 
Program (SBIR) coordinated by the U.S. Small Business Administration 
since Fiscal Year 1990.
    In FY 1994, three AoA-funded SBIR projects were active. As 
described below, these projects address applications of technology to 
meet the needs of older persons for devices which assist them to 
perform tasks of daily living:
          TechnoView, Inc. (Newport Beach, CA) is establishing the 
        technical feasibility for developing an Intravenous Drug 
        Delivery Monitor for use by elderly patients being treated for 
        serious diseases at home via home health care service providers 
        and family members when nurses are not present.
          American Research Corporation of Virginia (Radford, VA) is 
        developing the specifications for a personal communication 
        system to permit caregivers to monitor the well-being of 
        homebound elderly family members.
          Kinophase, Inc. (Nashua, NH) is developing a visual/audio 
        system that will investigate the use of a kinoform lens to 
        overcome the effects of macular degenerative visual problems 
        often found among the elderly.

               SECTION X--WHITE HOUSE CONFERENCE ON AGING

    The 1995 White House Conference on Aging was authorized under the 
terms of P.L. 102-375, the Older Americans Act Amendments of 1992 and 
later amended by P.L. 103-171 to change the dates of the Conference 
from December 31, 1994 to no later than May 31, 1995. President Clinton 
officially called the White House Conference on Aging on February 17, 
1994, and it was formally scheduled for May 2-5, 1995 by virtue of a 
vote by the Congressionally-mandated, 25-member Policy Committee. This 
Policy Committee includes HHS Secretary Donna E. Shalala, HUD Secretary 
Henry Cisneros, and VA Secretary Jesse Brown.
    This will be the fourth White House Conference on Aging in history, 
the first since 1981, and the final one of the 20th century. 
Historically, the White House Conference on Aging is intended to 
produce policy recommendations to guide national aging policy over the 
next decade. Under the terms of P.L. 102-375, Congress specifically 
identified specific primary purposes for the White House Conference on 
Aging which include the increase of public awareness of the 
interdependence of generations and the essential contributions of older 
individuals to society for the well-being of all generations, and the 
identification of the problems facing older individuals and the 
commonalities of the problems with problems of younger generations.
    On the same day that President Clinton was formally announcing the 
Conference in February of 1994, the White House Conference on Aging was 
holding its first local event in Tampa, Florida. In the ensuring months 
since then, the White House Conference on Aging has recognized 
approximately 600 pre-conference events in all 50 States. In addition, 
there have been 24 funded Mini-White House Conference on Aging events 
that have been issue specific. More than 13,000 individuals have 
attended pre-WHCOA events to date with approximately 75 percent being 
seniors.
    There will be approximately 2,000 delegates participating in the 
1995 White House Conference on Aging. The majority of these delegates 
are to be named by Members of Congress (one each) and by each Governor 
(in proportion to each State's senior population). This number was 
decided by the FY 1994 appropriation and agreed to by the Policy 
Committee. These delegates will be focusing on issues of importance to 
seniors across the Nation, including health care, long term care, 
crime, independence, income security and retirement. These issues were 
decided as a result of public comments from a proposed list published 
in the October 12, 1994 Federal Register.
    Upon adjournment of the 1995 White House Conference on Aging, a 
post-Conference implementation strategy will take effect to bring the 
recommendations from the Conference to the attention of lawmakers and 
the general public. It is hoped that the recommendations from this 
Conference will guide our rapidly growing senior population into the 
21st century and beyond, and prepare the baby boomers for their 
retirement. On October 23, 1993, the President announced his intention 
to appoint an Executive Director for the White House Conference on 
Aging. Internal departmental activities are ongoing in preparing for 
the announcement of the Conference, and its planning, development, and 
implementation.

                SECTION XI--FEDERAL COUNCIL ON THE AGING

                             I. Background

    Authorized under Section 204 of the Older Americans Act, the 
Federal Council on the Aging (FCoA) is the citizen advisory agency 
within the executive branch of the Federal Government charged with 
advising and assisting the President on the special needs of older 
Americans.
    Created under the 1973 amendments to the Act, the FCoA is comprised 
of 15 members, 5 of whom are appointed by the President, 5 by the U.S. 
Senate, and 5 by the U.S. House of Representatives. Council members 
serve 3-year terms and are chosen from among individuals with expertise 
in the field of aging who represent a diverse cross-section of rural 
and urban communities, national organizations with an interest in 
aging, business, labor, Indian tribes, minorities, and the general 
public. By statute, at least nine of the members must themselves be 
older persons.
    Mandates of the FCoA include: advising the President on matters 
related to the special needs of older Americans; serving as 
spokespersons on behalf of older persons by making recommendations 
about Federal policies and programs; advising the Assistant Secretary 
for Aging on matters affecting the special needs of older individuals 
for services and assistance under the Older Americans Act; reviewing 
and evaluating policies to assess their effectiveness and to promote 
better coordination between and across government agencies; informing 
the public by conducting or commissioning studies and by issuing 
reports; holding public hearings and conducting or sponsoring 
conferences, workshops, and meetings; serving as appointees to the 
Advisory Committee of the White House Conference on Aging; and issuing 
an annual report to the President of its findings and recommendations.

                  II. Development of a Strategic Plan

    In carrying out its mandate to comprehensively review and evaluate 
Federal policies and programs affecting older Americans, the FCoA 
developed a multi-year strategic plan. This plan is designed to 
advocate for the needs of older Americans and their families who are 
particularly vulnerable so that they are better able to lead productive 
and dignified lives.
    The Council's plan was formulated on the following major 
objectives: Providing a voice for older persons and their families, 
with particular attention on frail persons in need of long-term care 
supports; compiling information on the special characteristics of older 
persons with mental health needs; developing strategies for protecting 
and assisting older individuals who are the victims of crime and abuse; 
generating recommendations for targeting assistance to persons living 
alone; examining the needs and characteristics of economically 
vulnerable older Americans; developing a series of informational 
materials and policy recommendations in the areas of health care, long-
term care, mental health and aging, the Older Americans Act (with an 
emphasis on nutrition and elder abuse), and the 1995 White House 
Conference on Aging.

                        III. Quarterly Meetings

    The FCoA is mandated to meet quarterly, at the call of the 
Chairman. With the appointment by the President of a new Chairman, Mr. 
John Lyle from Houston, Texas, the Council's meetings focused on 
developing and implementing a targeted strategy designed to make policy 
contributions to the White House, the Office of the Assistant Secretary 
for Aging, the White House Conference on Aging, and other Federal 
agencies.
    A. January 24 & 25, 1994.--The Council met in Washington, D.C. to 
participate in the ``Health Care University'' sponsored by the 
Administration on Aging. During this meeting, the Council undertook an 
extensive discussion of health care reform in general, and long-term 
care in particular. These discussions helped to lay the foundation for 
the development of an issue brief and series of policy recommendations 
on long-term care. The Council also met with the Assistant Secretary 
for Aging to share their thoughts and concerns on a number of issues, 
and to hold a constructive dialogue on future initiatives of the 
Administration on Aging and the Federal Council on the Aging.
    B. April 27 & 28, 1994.--One of the major outcomes of this meeting 
was the unanimous approval of a book on mental health and aging to be 
developed in conjunction with the National Institute of Mental Health. 
The purpose of the publication, as discussed at the meeting, is to help 
educate health, behavioral, and social service practitioners in 
community mental health centers who have limited training in 
gerontology or mental health and aging. The publication is also 
designed to include strong recommendations as to what should be 
occurring in the country regarding mental health and aging.
    The structure for a focused and multi-year action plan was 
developed, including: (1) preparing for the 1995 White House Conference 
on Aging; (2) improving the effectiveness of mental health assistance, 
particularly in community mental health centers; (3) advocating for 
long-term care with a focus on home- and community-based care; and (4) 
making recommendations related to the reauthorization of the Older 
Americans Act.
    C. September 13 & 14, 1994.--This quarterly meeting was the first 
one convened under the newly appointed Chairman, John E. Lyle. The 
major focus of this discussion was participation in activities related 
to the White House Conference on Aging. Council members have 
participated in, or are scheduled to participate in nearly two dozen 
local, State, and regional conferences throughout the country. The 
Council also strongly urged the Assistant Secretary for Aging and the 
President that its members be appointed as delegates to the WHCoA in 
May 1995 and proposed a series of options for the Council to play a 
leadership role during and after the Conference. The Council strongly 
expressed its interest in working toward a strategy which seeks to 
follow through on enacting key recommendations arising from the 
Conference.

                              IV. Reports

    A. 1993 Annual Report to the President. The Council distributed its 
twentieth annual report to the President. The report detailed 
information along two major themes. The first was examining issues and 
characteristics within the nation's diverse older population that are 
particularly critical to the most vulnerable and at-risk older persons. 
The second was to begin to develop background information on issues 
related to planning for the aging of the ``baby boom'' cohort and the 
next generation of older Americans. Issues covered in the report 
include: income security; health care; housing and living arrangements; 
older women; minority elders; mental health; and intergenerational 
perspectives.
    B. Mental Health and Aging. In conjunction with the National 
Institute of Mental Health and the Center for Mental Disorders and 
Aging Research, the FCoA worked to prepare a book entitled: 
``Community-Based Mental Health Services/Behavioral Health Care for 
Older Persons.'' The purpose of this book is to help educate 
practitioners in community mental health centers and to provide a wide 
range of specific recommendations as to what should be occurring in the 
country regarding mental health and aging.
    Chapters include: (1) an overview of aging and mental health; (2) 
psychopathology and treatment of the elderly; (3) assessment of the 
elderly; (4) psychopharmacology and the elderly; (5) health promotion; 
(6) dementia and the elderly; (7) caregiving; (8) ethics; (9) religion; 
(10) suicide; (11) special populations; (12) cost and financing of 
mental health services to the elderly; and (13) depression in the 
elderly.

                            V. Issue Briefs

    A. ``The Need for Home and Community-Based Long-Term Care: A Rural 
Perspective''. This issue brief continued the Council's twenty year 
history of focusing on matters associated with the provision and 
delivery of long-term care. The purpose of the issue brief was to 
provide planners, policy makers, legislators, and delegates to the 
White House Conference on Aging with a summary overview of some key 
characteristics and factors surrounding the need for long-term care 
assistance in rural areas, to develop a series of policy 
recommendations, and to highlight many of the important areas where 
more information is needed.
    Its major conclusion is that rural elders and their families are 
significantly less likely than their urban counterparts to have access 
to a range of community-based, long-term care assistance. This lack of 
options tends not only to place increased burdens on rural families and 
caregivers, but also has serious implications for taxpayers. Rural 
elders were found to be more likely to reside in nursing homes when 
they may not need 24-hour nursing. Medicaid picks up the tab for this 
assistance once an individual's resources are depleted.
    The Council pointed out that with the aging of the nation's rural 
population, consideration will need to be given to developing a 
comprehensive strategy for addressing this growing need before it 
increasingly overburdens families, caregivers, and taxpayers. Its major 
policy recommendations included: (1) health care reform which includes 
long-term care assistance is crucial; (2) a support system that has a 
comprehensive range of choices and alternatives in rural as well as 
urban areas; (3) a system to recognize the dignity of persons in need, 
promote independence in the least restrictive settings whenever 
possible, and recognize the diversity of States and communities by 
allowing flexibility of development.
    B. Mental Health and Aging. The Council gathered background 
information for an issue brief to be released in early 1995 on the 
special mental health characteristics and needs of older persons. 
Specific policy recommendations were developed to inform and assist 
professionals in community mental health centers, policymakers, and the 
general public.

                         VI. Joint Partnerships

    A. Coalition on Mental Health and Aging. The FCoA joined in 
partnership with the Mental Health and Aging Consortium to plan a mini-
conference to the White House Conference on Aging pertaining to mental 
health and aging issues. The mini-conference is scheduled to take place 
in February 1995, and will focus on four general themes: (1) strengths 
and weaknesses in current research; (2) positive examination of mental 
health; (3) services and training needs; and (4) the question of parity 
between physical health and mental health. Outcomes are expected to 
include a series of research topics, a series of recommendations, and a 
set of video tapes that will be shared with people throughout the 
country.
    B. Developments in Aging. The FCoA provided a section on issues and 
activities for the Senate Special Committee on Aging publication, 
``Developments in Aging.'' This report describes actions taken by the 
Congress and the Administration which are of particular relevance to 
older Americans. It also summarizes and analyzes Federal policies and 
programs that are of importance to older individuals and their 
families.
    C. Administration on Aging's Initiative on Older Women.--The 
Council worked in partnership with the AoA to develop issues and 
activities related to its special initiative on older women, 
particularly the economic insecurity of present and future older women 
living alone.
    D. White House Conference on Aging.--Council members participated 
in more than two dozen local events officially sanctioned by the White 
House Conference on Aging. The Council also: provided significant 
recommendations regarding the theme, structure, and issue priorities 
for the Conference; provided recommendations as a representative to the 
Advisory Committee; developed a proposal for a leadership role at the 
Conference in May; and urged the formation of a structure and action 
plan for working to implement and enact priority recommendations 
arising from the Conference. The Council developed a strategy for 
helping to assist with this process and provided specific policy 
recommendations to the President.
    Background materials on long-term care, mental health and aging, 
and the Older American Act were prepared in order to be distributed to 
delegates at the Conference, as well as policymakers, the press, and 
other interested individuals.

                  VII. Resolutions and Recommendations

                           a. long-term care
    The FCoA recognizes that health care reform is critically necessary 
for America.
    A long-term care program must recognize the dignity of persons in 
need. To the extent feasible, it should promote independence in the 
least restrictive setting. It must recognize the diversity of States 
and communities and allow flexibility of development.
    The Home and Community-Based Care program, as proposed in the 
Health Security Act, embodies the above principles. Therefore, the FCoA 
strongly endorses the Home and Community-Based Care provisions of the 
Health Security Act.
    Rural long-term care delivery and accessibility issues are a 
growing national problem that need to be addressed in a comprehensive 
manner given the rapid growth of persons aged 85 and over. Health care 
reform which includes long-term care assistance is critical for 
addressing this growing need.
    Consideration should be given to strategies which encourage the use 
of modern technology, such as telecommunications and telemedicine. Such 
systems have the potential for linking information and care between a 
patient, primary care physician, and a specialist at long distances.
    Communication should be enhanced between States, area agencies on 
aging, and related service providers which encourage information 
sharing on innovative and cost-effective programs.
                             b. caregiving
    Policies and programs should be encouraged which assist in the 
formation of informal support groups designed to help alleviate the 
individual stress of family caregivers and which help to share 
caregiving responsibilities.
           c. anti-fraud and abuse provisions and health care
    The Council reviewed a recent report of the Special Committee on 
Aging which reveals that the current policies of Medicare, Medicaid, 
and private insurers have left their doors wide open to fraud, costing 
the health care system more than $100 billion yearly. The Council urged 
that immediate action be taken to strengthen the criminal laws and 
enforcement tools to stop fraud and abuse of the Nation's health care 
system, and that tough anti-fraud and anti-abuse provisions be build 
into the foundation of any health care reform enacted by the Congress.
                           d. social security
    The Council expressed its concern with a number of proposals by the 
Chairman of the Ways and Means Committee to reduce cost-of-living 
adjustments, increase taxation of beneficiaries, expedite the proposal 
to increase in the age at which persons can receive full Social 
Security benefits, and adjust the Social Security tax rate.
    While understanding the need to address the long-term financing 
shortfalls projected by the Social Security Trustees, the Council 
expressed particular concern that these proposals had not been 
subjected to a national debate. A resolution was unanimously passed and 
sent to the President urging him to vigorously oppose these significant 
changes to Social Security unless there is opportunity for national 
debate on these issues to take place. The Council also expressed its 
concern that the Ways and Means Committee Chairman had unnecessarily 
alarmed many older persons in their communities through the unexpected 
manner in which the proposals were raised.
                           e. transportation
    Federal policymakers should more aggressively pursue coordination 
of national policies affecting the provision of transportation services 
to older individuals, particularly frail persons.
    Federal policy must review existing data on alternative modes of 
transportation services for rural communities. Since fixed route 
services are not always the most efficient in rural areas and demand/
response is often too costly, alternatives such as service routes and 
volunteer services should be studied and encouraged if found to be 
cost-efficient.
    State and Federal resources which are available for training and 
technical assistance in the transportation field should be actively 
marketed and utilized by the rural aging community, with support from 
the State and area aging network.
                         f. special populations
    Greater attention and resources should be focused on gathering data 
and initiating outreach to particularly vulnerable subgroups of rural 
elders, such as persons living alone, individuals with health or 
mobility problems, the ``old old,'' racial and ethnic minorities, and 
older women.
    More resources should be provided to encourage the training of 
professionals and support of informal caregivers in rural settings.
    The Council found that many Filipino veterans face critical 
problems such as a lack of adequate living arrangements, no health 
benefits, poor physical and mental conditions, no financial assistance, 
a greater susceptibility to crime victimization, and increased 
separation anxieties from family members. In addition, the U.S. 
Government has denied Filipino World War II veterans the same status 
accorded to other U.S. veterans by denying them veterans benefits. The 
Federal Council on the Aging, by unanimous vote during its quarterly 
meeting in Washington, D.C., on September 13, 1994, recommended that a 
meeting be convened consisting of representatives from the Federal 
Council on the Aging, the Veterans Administration, the Immigration and 
Naturalization Service, and the Administration on Aging in order to 
seek coordinated strategies for addressing the problems faced by 
Filipino veterans.

       Press Releases Issued by the Assistant Secretary for Aging

    10/07/93 Assistant Secretary for Aging and Secretary Shalala 
announced that Medicare will now pay for flu shots for older Americans.
    10/22/93 Assistant Secretary for Aging announced that $65 million 
in relief contingency funds are being provided in nine States impacted 
by flooding this summer.
    10/27/93 Assistant Secretary for Aging announces grants of $4.3 
million for demonstration projects in the area of long-term care.
    10/27/93 Assistant Secretary of Aging announces AoA's support of 
National Consumer's Week. (Also released in Spanish)
    10/27/93 Assistant Secretary for Aging announces an award to the 
Institute of Medicine to conduct a national effectiveness study of 
State Long Term Care Ombudsman Programs.
    10/29/93 Assistant Secretary for Aging announced that AoA has 
awarded grants totaling approximately $4.3 million for 13 demonstration 
projects in area of long-term care and four long-term care resources 
centers.
    11/09/93 Assistant Secretary for Aging announces the FY 1994 
appropriations for Older Americans Act programs.
    11/10/93 Assistant Secretary for Aging joins the President in 
recognizing Veterans Day.
    11/16/93 Assistant Secretary for Aging joins the President and 
Secretary Shalala in celebrating National Family Caregivers Week.
    11/16/93 Assistant Secretary for Aging announces a $2.4 million 
contract to Mathematica Policy Research to evaluate the Administration 
on Aging's Nutrition Program for the Elderly.
    11/16/93 Assistant Secretary for Aging joins the NIA and the 
Alzheimer's Association in recognizing November as National Alzheimer's 
Disease Month.
    11/19/93 Assistant Secretary for Aging issues breast cancer 
awareness release (as it relates to older women).
    11/24/93 Assistant Secretary for Aging joins the Secretary in 
celebrating November as National American Indian Heritage Month (as it 
relates to Indian elders).
    12/01/93 Assistant Secretary for Aging joins the Department in 
recognizing December 1, 1993, as World AIDS day (as it relates to older 
Americans).
    12/09/93 Assistant Secretary for Aging issues a special warning 
about hypothermia.
    12/09/93 Assistant Secretary for Aging joins the Secretary and 
President in recognizing December as National Drunk and Drugged Driving 
Prevention Month (as it relates to older Americans).
    01/21/94 Assistant Secretary for Aging will convene the U.S. 
Administration on Aging's Health Care University (as it relates to 
older Americans).
    01/29/94 Assistant Secretary for Aging announced that DHHS is 
making available almost $28 million to respond to earthquake-related 
needs at HHS-supported facilities in the Los Angeles area.
    01/31/94 Assistant Secretary for Aging announced that AoA is 
providing $100,000 in immediate disaster relief assistance to the 
California Department of Aging (as it relates to older Americans).
    02/01/94 Assistant Secretary for Aging announces grants totaling 
$449,997 in the area of supportive services in federally assisted 
housing.
    02/07/94 Assistant Secretary for Aging joins Secretary Shalala in 
announcing the AoA Budget for FY 1995.
    02/17/94 Assistant Secretary for Aging will present keynote address 
at the Colorado Department of Social Services Aging and Adult Services 
Leadership Symposium: ``Planning for the 21st Century.''
    01/18/94 Assistant Secretary for Aging announces grants totaling 
$500,000 to the University of Colorado and the University of North 
Dakota to establish and conduct two National Resource Centers for Older 
Indians, Alaskan Natives and Native Hawaiians.
    4/14/94 Assistant Secretary for Aging will address Russian 
delegates attending a training Institute on Aging in the United States 
on ``The History of Social Welfare in the United States''.
    May 1994 Aging America: Priority Initiatives of the Administration 
on Aging.
    05/06/94 Assistant Secretary for Aging joins Commissioner of Social 
Security, Assistant Secretary of Labor for Pension and Welfare 
Benefits, and the Women's Pension Policy Consortium to launch a 
campaign to promote public awareness of the critical importance of 
pensions (as it relates to older women).
    05/06/94 Betty Friedman to receive Older Americans Month Award.
    05/13/94 Assistant Secretary for Aging announces the availability 
of AoA's discretionary program funds for FY 1994.
    05/13/94 Assistant Secretary for Aging announces the honoring of 
four individuals as recipients of the first annual Older Americans 
Month Congressional Award.
    05/23/94 Assistant Secretary for Aging will convene the first 
annual Administration on Aging Media Roundtable.
    06/01/94 Assistant Secretary for Aging joins the President and the 
Nation in recognizing the 50th anniversary of the D-Day invasion.
    06/07/94 Assistant Secretary for Aging announces the collaboration 
with NIH in support of research and research-related activities to 
study and improve the delivery of health and social services to the 
elderly.
    06/23/94 Assistant Secretary for Aging announces the signing of two 
Interagency agreements between AoA and ASPE to support research, 
development and evaluation activities to benefit older Americans.
    07/14/94 Assistant Secretary for Aging joins NIA, Department of 
Veterans Affairs, and the American Lung Association in a nationwide 
fight against pneumonia.
    07/25/94 Assistant Secretary for Aging announces the release of 
$160,000 in disaster relief funds to aid elderly victims in Arkansas.
    07/15/94 Assistant Secretary for Aging will address the National 
Council of LaRaza (NCLR) Hispanic Senior Citizens Day Opening Plenary 
Session.
    07/19/94 Assistant Secretary for Aging pays tribute to the fourth 
anniversary of the enactment of the Americans with Disabilities Act 
(ADA).
    08/22/94 Assistant Secretary for Aging will address National White 
House Conference on Indian Aging.
    08/06/94 Assistant Secretary for Aging joins the Nation in 
celebrating National Grandparenting Day.
    09/15/94 Assistant Secretary for Aging announces Elder Abuse Study 
to be conducted by AoA and ACF.
    09/20/94 Assistant Secretary for Aging will receive the Claude 
Pepper Award.
    09/23/94 Secretary Shalala to kick off AoA's Celebration of Older 
Women.
    09/29/94 AoA/HUD joins forces on behalf of Elderly and Disabled.

                            TABLES AND CHARTS

TABLE 1. TITLE III-B Composition of Persons Served, Selected Categories 
                        (Not mutually exclusive)

                                                                 Percent
Frail/Disabled....................................................    36
Low-Income Minority...............................................    12
Rural.............................................................    30
Minority..........................................................    19
Low Income........................................................    39


                ADMINISTRATION FOR CHILDREN AND FAMILIES

              Title XX Social Service Block Grant Program

    The major source of Federal funding for social services programs in 
the States is Title XX of the Social Security Act, the Social Services 
Block Grant (SSBG) program. The Omnibus Budget Reconciliation Act of 
1981 (PL 97-35) amended Title XX to establish the SSBG program under 
which formula grants are made directly to the 50 States, the District 
of Columbia, and the eligible jurisdictions (Puerto Rico, Guam, the 
Virgin Islands, American Samoa, and the Commonwealth of the Northern 
Mariana Islands) for use in funding a variety of social services best 
suited to the needs of individuals and families residing within the 
State. Public Law 97-35 also permits States to transfer up to 10 
percent of their block grant funds to other block grant programs for 
support of health services, health promotions and disease prevention 
activities, and low-income home energy assistance.
    Under the SSBG, Federal funds are available without a matching 
requirement. In fiscal year 1994, a total of $2.8 billion was allotted 
to States. The same amount has been appropriated for these activities 
in fiscal year 1995. Within the specific limitations in the law, each 
State has the flexibility to determine what services will be provided, 
who is eligible to receive services, and how funds are distributed 
among the various services within the State. State and/or local Title 
XX agencies (i.e., county, city, regional offices) may provide these 
services directly or purchase them from qualified agencies and 
individuals.
    A variety of social services directed at assisting aged persons to 
obtain or maintain a maximum level of self-care and independence may be 
provided under the SSBG. Such services include, but are not limited to 
adult day care, adult foster care, protective services, health-related 
services, homemaker services, chore services, housing and home 
maintenance services, transportation, preparation and delivery of 
meals, senior centers, and other services that assist elderly persons 
to remain in their own homes or in community living situations. 
Services may also be offered which facilitate admission for 
institutional care when other forms of care are not appropriate. Under 
the SSBG, States are not required to submit data that indicate the 
number of elderly recipients or the amount of expenditures provided to 
support specific services for the elderly. States are required, prior 
to the expenditures of funds under the SSBG, to prepare a report on the 
intended use of the funds including information on the type of 
activities to be supported and the categories or characteristics of 
individuals to be served. States also are required to report annually 
on activities carried out under the SSBG. Beginning with fiscal year 
1989, the annual report must include specific information on the 
numbers of children and adults receiving services, the amount spent in 
providing each service, the method by which services were provided, 
i.e., public or private agencies, and the criteria used in determining 
eligibility for each service.
    Based on an analysis of pre-expenditure reports submitted by the 
States for fiscal year 1992, the list below indicates the number of 
States providing certain types of services to the aged under the SSBG.

                                                    Number of States \1\
Services:
    Home-Based Services \2\.............................              46
    Adult Protective Services...........................              33
    Transportation Services.............................              26
    Adult Day Care......................................              28
    Health Related Services.............................              29
    Information and Referral............................              30
    Home Delivered/Congregate Meals.....................              20
    Adult Foster Care...................................              11
    Housing.............................................              15

\1\ Includes 50 States, the District of Columbia, and the five eligible 
territories and insular areas.
\2\ Includes homemaker, chore, home health, companionship, and home 
maintenance services.

    In enabling the elderly to maintain independent living, most States 
provide Home-Based Services which frequently includes homemaker 
services, companion and/or chore services. Homemaker services may 
include assisting with food shopping, light housekeeping, and personal 
laundry. Companion services can be personal aid to, and/or supervision 
of aged persons who are unable to care for themselves without 
assistance. Chore services frequently involve performing home 
maintenance tasks and heavy housecleaning for the aged person who 
cannot perform these tasks.
    Based on the FY 1992 data, 33 States provided Adult Protective 
Services to persons generally 60 years of age and over. These services 
may consist of the identification, receipt, and investigation of 
complaints and reports of adult abuse. In addition, this service may 
involve providing counseling and assistance to stabilize a living 
arrangement. If appropriate, Adult Protective Services also may include 
the provision of, or arranging for, home based care, day care, meal 
service, legal assistance, and other activities to protect the elderly.
    In addition to the $2.8 billion in on-going funding for social 
services programs under title XX described above, the Act was amended 
in 1993 to authorize a total of $1 billion in funds for activities to 
be undertaken in communities that are designated as Empowerment Zones 
or Enterprise Communities by the Secretary of Housing and Urban 
Development and the Secretary of Agriculture. One billion dollars was 
appropriated for these activities in the Labor/HHS Appropriations Act 
for FY 1994. Two grants will be made to States for activities in each 
Empowerment Zone in the State--one on the day of the designation and 
the second on the first day of the following fiscal year. One grant 
will be made to States for each Enterprise Community. The initial 
grants will be made in FY 1995 and the remainder in FY 1996. No 
additional appropriations under this amended section of title XX are 
expected.

               Low-Income Home Energy Assistance Program

    The Low Income Home Energy Assistance Program (LIHEAP) is one of 
six block grant programs administered within the Department of Health 
and Human Services (HHS). LIHEAP is administered by the Office of 
Community Services (OCS) in the Administration for Children and 
Families.
    LIHEAP helps low income households meet the cost of home energy. 
The program is authorized by the Omnibus Budget Reconciliation Act of 
1981, as amended most recently by the Augustus F. Hawkins Human 
Services Reauthorization Act of 1990, the NIH Revitalization Act of 
1993 (P.L. 103-43), and the Human Services Amendments of 1994 (P.L. 
103-252). In fiscal year 1989, Congress appropriated $1.383 billion for 
the program. Congress appropriated $1.443 billion for LIHEAP in fiscal 
year 1990. In fiscal year 1991, Congress appropriated $1.415 billion 
plus a contingency fund of $195 million, which went into effect when 
fuel oil prices went above a certain level. For FY 1992, $1.5 billion 
was appropriated, plus a contingency fund of $300 million that would 
have been triggered if the President had declared an emergency and had 
requested the funds from Congress. Congress appropriated funding of 
$1,346,049,760 for FY 1993 and funding of $1,437,408,000 for FY 1994, 
of which $141,950,240 could be used by grantees to reimburse themselves 
for FY 1993 expenses. The FY 1994 appropriations act provided advance 
FY 1995 funds of $1.475 billion. The FY 1995 HHS appropriations act 
rescinded part of the advance FY 1995 appropriations included in the FY 
1994 appropriations law, leaving funding of $1,319,204,000 for FY 1995. 
It also provided for advance FY 1996 funding of the same amount.
    Block grants are made to States, territories, and eligible 
applicant Indian Tribes. Grantees may provide heating assistance, 
cooling assistance, energy crisis interventions, and low-cost 
residential weatherization or other energy-related home repair to 
eligible households. Grantees can make payments to households with 
incomes not exceeding the greater of 150 percent of the poverty level 
or 60 percent of the State's median income.\1\ Most households in which 
one or more persons are receiving Aid to Families with Dependent 
Children, Supplemental Security Income, Food Stamps or need-tested 
veterans' benefits may be regarded as categorically eligible for 
LIHEAP.
---------------------------------------------------------------------------
    \1\ Beginning with fiscal year 1986, States are prohibited from 
setting income eligibility levels lower than 110 percent of the poverty 
level.
---------------------------------------------------------------------------
    Low income elderly households are a major target group for energy 
assistance. They spend, on average, a greater portion of their income 
for heating costs than other low income households. Grantees are 
required to target outreach activities to elderly or handicapped 
households eligible for energy assistance. In their crisis intervention 
programs, grantees must provide physically infirm individuals the means 
to apply for assistance without leaving their homes, or the means to 
travel to sites where applications are accepted.
    In fiscal year 1993, about 35 percent of households receiving 
assistance with heating costs included at least one person age 60 or 
over, as estimated by the March 1993 Current Population Survey.
    OCS is a member of the National Energy and Aging Consortium, which 
focuses on helping older Americans cope with the impact of high energy 
costs and related energy concerns.
    No major program and policy changes for the elderly occurred in the 
1990 or 1993 reauthorization legislation. The 1994 reauthorization 
legislation specifically allows grantees to target funds to vulnerable 
populations, mentioning by name ``frail older individuals'' and 
``individual with disabilities''. No other new initiatives commenced in 
1994 or are planned for 1995 that would impact on the status of older 
Americans.

       The Community Services Block Grant (CSBG) and the Elderly

    I. Community Service Block Grant--The Community Service Block Grant 
Act (Subtitle B, Public Law 97-35 as amended) is authorized through 
fiscal year 1998. The Act authorizes the Secretary, through the Office 
of Community Services (OCS), an office within the Administration for 
Children and Families in the Department of Health and Human Services, 
to make grants to States and Indian tribes or tribal organizations. 
States and tribes have the authority and the flexibility to make 
decisions about the kinds of local projects to be supported by the 
State or tribe, using CSBG funds. The purposes of the CSBG program are:
          (A) to provide a range of services and activities having a 
        measurable and potentially major impact on causes of poverty in 
        the community or those areas of the community where poverty is 
        a particularly acute problem.
          (B) to provide activities designed to assist low-income 
        participants including the elderly poor--
                  (i) to secure and retain meaningful employment;
                  (ii) to attain an adequate education;
                  (iii) to make better use of available income;
                  (iv) to obtain and maintain adequate housing and a 
                suitable living environment;
                  (v) to obtain emergency assistance through loans or 
                grants to meet immediate and urgent individual and 
                family needs, including the need for health services, 
                nutritious food, housing, and employment-related 
                assistance;
                  (vi) to remove obstacles and solve problems which 
                block the achievement of self-sufficiency;
                  (vii) to achieve greater participation in the affairs 
                of the community; and
                  (viii) to make more effective use of other programs 
                related to the purposes of the subtitle,
          (C) to provide on an emergency basis for the provision of 
        such supplies and services, nutritious foodstuffs and related 
        services, as may be necessary to counteract conditions of 
        starvation and malnutrition among the poor;
          (D) to coordinate and establish linkages between governmental 
        and other social services programs to assure the effective 
        delivery of such services to low income individuals; and
          (E) to encourage the use of entities in the private sector of 
        the community in efforts to ameliorate poverty in the 
        community; (Reference Section 675(c)(1) of Public Law 97-35, as 
        amended).
    It should be noted that although there is a specific reference to 
``elderly poor'' in (B) above, there is no requirement that the States 
or tribes place emphasis on the elderly or set aside funds to be 
specifically targeted on the elderly. Neither the statute nor 
implementing regulations include a requirement that grant recipients 
report on the kinds of activities paid for from CSBG funds or the types 
of indigent clients served. Hence, it is not possible for OCS to 
provide complete information on the amount of CSBG funds spent on the 
elderly, or the number of elderly, or the numbers of elderly persons 
served.
    II. Major Activities or Research Projects Related to Older Citizens 
in 1994 and 1995--The Office of Community Services made no major 
changes in program or policy related to the CSBG program in 1994 and 
none is planned for 1995.
    The Human Services Reauthorization Act of 1986 contained the 
following language: ``each such evaluation shall include identifying 
the impact that assistance . . . has on . . . the elderly poor.''
    III. Funding Levels--Funding levels under the CSBG program for 
States and Indian Tribes or tribal organizations amounted to $385.5 
million in fiscal year 1994. For fiscal year 1995, $391.5 million has 
been appropriated.

              Aging and Developmental Disabilities Program

                       critical audiences project
    Grantee: Institute for the Study of Developmental Disabilities, 
Indiana University
    Project Director: Barbara Hawkins, Ph.D., (812) 855-6506; Fax (812) 
855-9630
    Project Period: 7/1/90-6/30/94, FY '90-$90,000, FY '91-$90,000, FY 
'92-$90,000, FY '93-$90,000, FY '94-$90,000
    The project provides training in a late-life functional-
developmental model for audiences that are critical to effective 
planning and care of older persons. Activities include developing 
training modules and instructional videos for interdisciplinary 
university credit courses, and illustrating the model by demonstration 
projects in community retirement settings.
          center on aging and developmental disabilities/cadd
    Grantee: University of Miami/CADD, Miami, FL
    Project Director: John Stokesberry, Ph.D., (305) 325-1043
    Project Period: 7/1/90-6/30/94, FY '90-$90,000, FY '91-$90,000, FY 
'92-$90,000, FY '93-$90,000, FY '94-$90,000
    CADD is providing education and training to service providers, 
parents and families; advocacy and outreach for consumers, information 
to the public on aging and developmental disabilities; networking, 
policy direction and community-based research. Materials will include a 
manual for parents/caregivers, a resource guide and a handbook on 
developing a peer companion project.
                   interdisciplinary training center
    Grantee: UAP, Institute for Human Development, University of 
Missouri-Kansas City
    Project Director: Gerald J. Cohen, J.D., M.P.A., (816) 235-1770; 
Fax (816) 235-1762
    Project Period: 7/1/90-6/30/94, FY '91-$90,000, FY '92-$90,000, FY 
'93-$90,000, FY '94-$90,000
    The Center addresses personnel preparation needs with a focus on 
administration, interdisciplinary training, exemplary services, 
information/technical assistance/research; and evaluation. Materials 
include training guide for aging, infusion models, inservice fellowship 
curriculum, resource bibliography, guide for training volunteers, and 
course syllabus.
                    training models for rural areas
    Grantee: Montana University Affiliated Rural Institute 
Disabilities, Missoula, MT
    Project Director: Philip Wittekiend, M.S., (406) 243-5467; Fax 
(406) 243-2349
    Project Period: 7/1/90-6/30/94, FY '90-$90,000, FY '91-$90,000, FY 
'92-$90,000, FY '93-$90,000, FY '94-$90,000
    Montana's focus is on linking existing networks and expertise to 
meet the unique needs of a rural area with sparse populations and 
limited professional resources. The project will develop audio 
conference packages with simultaneous long distance training for remote 
areas and involve nontraditional networks such as churches and senior 
groups.
                  consortium of educational resources
    Grantee: UAP, University of Rochester Medical Center, Rochester, NY
    Project Director: Jenny C. Overeynder, ACSW, (716) 275-2986; Fax 
(716) 256-2009
    Project Period: 7/1/90-6/30/94, FY '90-$90,000, FY '91-$90,000, FY 
'92-$90,000, FY '93-$90,000, FY '94-$90,000
    An inter-university interdisciplinary consortium of educational 
resources in gerontology and developmental disabilities is being 
established in western New York, to be linked to local and state 
networks. The project will develop and implement preservice and 
inservice education curriculum for direct care and nursing home staff.
aging and developmental disabilities clinical assessment, training and 
                                service
    Grantee: Waisman Center UAP, University of Wisconsin-Madison
    Project Director: Gary B. Seltzer, Ph.D., (608) 263-1472; Fax (608) 
263-0529
    Project Period: 7/1/90-6/30/94, FY '90-$90,000, FY '91-$90,000, FY 
'92-$90,000, FY '93-$90,000, FY '94-$90,000
    Waisman Center operates an interdisciplinary clinic, provides 
training to health care and other professionals, and disseminates 
information and technical assistance to director care networks. 
Materials include a functional assessment instrument and curricula for 
medical students, geriatric fellows and physician assistants.
                interdisciplinary training models (idt)
    Grantee: UAP, College of Family and Consumer and Consumer Sciences
    Project Director: Zolinda Stoneman, Ph.D., (404) 542-4827; Fax 
(404) 542-4815
    Project Period: 7/1/90-6/30/94, FY '91-$90,000, FY '92-$90,000, FY 
'93-$90,000, FY '94-$90,000
    This project is using IDT models for graduate and undergraduate 
training; developing community-based internship and practicum sites; 
collecting audiovisual materials for dissemination; and providing 
information to the UAP regional information and referral service. 
Products will include training videotapes and modules, course 
materials, and radio program recordings.
      training initiative in aging and developmental disabilities
    Grantee: Institute for the Study of Developmental Disabilities, 
University of Illinois at Chicago
    Project Director: David Braddock, Ph.D., (312) 413-1647
    Project Period: 7/1/93-6/30/96, FY '93-$90,000, FY '94-$90,000, FY 
'95-$90,000, FY '96-$90,000
    The project addresses three priority areas emerging from the UAP's 
research activities and clinical programs: (1) advocacy and futures 
planning for older adults with developmental disabilities and their 
families; (2) to maintain functioning and promote community inclusion 
for aging persons with cerebral palsy; and (3) to enhance the 
psychosocial well-being of aging persons with Down's Syndrome and 
bolster older families' caregiving efforts.
         community membership through person-centered planning
    Grantee: Eunice Kennedy Shriver Center, Inc., Shriver Center UAP
    Project Director: Karen E. Gould, Ph.D., (617) 642-0238
    Project Period: 7/1/92-6/30/95, FY '92-$89,999, FY '93-$89,999, FY 
'94-$89,999, FY '95-$89,999
    The Center has two primary goals which are: (1) to implement a 
service delivery model that creates a new vision for individuals who 
are labeled ``old'' and ``developmentally disabled'' in Massachusetts, 
one in which entry into valued adult roles is expected and capacities 
and interests form the basis for structuring support; and (2) to 
provide training to persons with developmental disabilities, family 
members and friends, graduate students, professionals and community 
members so that they can develop the skills necessary to support 
community entry and inclusion in valued roles and relationships for 
older adults with developmental disabilities, and learn to use these 
skills in other settings.
a collaborative interdisciplinary training approach to improve services 
            to aging persons with developmental disabilities
    Grantee: Institute for Disability, University of Southern 
Mississippi
    Project Director: Valerie M. De Coux, (601) 266-5163
    Project Period: 7/1/93-6/30/96, FY '93-$90,000, FY '94-$90,000, FY 
'95-$90,000, FY '96-$90,000
    The project develops a collaborative interdisciplinary training 
approach to meet pre-service, in-service, and consumer needs. Training 
of professionals and paraprofessionals occurs at both the pre-service 
and in-service levels and focuses on cross-network training in best 
practices which ensures an optimal quality of life for older persons 
with developmental disabilities.
 north dakota project for older persons with developmental disabilities
    Grantee: North Dakota Center for Disabilities, Minot State 
University
    Project Director: Dr. Rita Curl and Dr. Demetrios Vassiliou, (701) 
857-3580
    Project Period: 7/1/93-6/30/96, FY '93-$90,000, FY '94-$90,000, FY 
'95-$90,000, FY '96-$90,000
    The project seeks to upgrade the training opportunities available 
to North Dakotans: (1) project staff works with pre-service geriatric 
programs to develop strong DD components; (2) project staff expands on 
an existing inservice training program to provide information on aging 
DD service provision; and (3) the project supports the development of 
training opportunities for secondary consumers and advocates.
   interdisciplinary training initiative on aging and developmental 
                              disabilities
    Grantee: Graduate School of Public Health, University of Puerto 
Rico--Medical Sciences
    Project Director: Dr. Margarita Miranda, (809) 758-2525, ext. 1453, 
(809) 754-4377
    Project Period: 8/2/94-6/30/97, FY '94-$90,000, FY '95-$90,000, FY 
'96-$90,000, FY '97-$90,000
    The project provides pre-service training including practical 
experience on best practices in serving the older population with 
developmental disabilities to three graduate and to three undergraduate 
students from different disciplines per year (from the second funding 
year on); provides culturally adapted inservice training to the Catano 
Family Health Center's interdisciplinary team and to at least 40 
professionals in the aging service per year through the Graduate School 
and implementation of five regional Seminars on Aging and Development 
Disabilities throughout Puerto Rico.
      teaming to promote the full inclusion of aging persons with 
                       developmental disabilities
    Grantee: Hawaii Department of Health
    Project Director: Ronald Quarles
    Funding: FY '93-$99,243, FY '94-$109,243
    This project identifies current issues in the care and development 
of aging persons with developmental disabilities in Hawaii (day care 
programs and services, senior programs, and family care givers). 
Project providers cross-training of personnel in integrated programs 
for aging persons. The project is undertaken cooperatively with the 
Hawaii Developmental Disabilities Council, State Executive Office of 
Aging, the Hawaii University Affiliated Program.
   supporting caregivers: a demonstration of linkages to help older 
      caregivers of family members with a developmental disability
    Grantee: New York State Developmental Disabilities Planning 
Council, Albany, NY
    Project Director: Matthew Janicki, Ph.D., (518) 473-7855
    Project Period: 10/01/93-9/30/95, FY '94-$99,751, FY '95-$99,878
    A series of demonstration programs were established at the local 
level which model strategies for conducting outreach and coordinating 
services to older individuals with caretaker responsibilities for 
family members with a developmental disability. The project tests the 
feasibility of incorporating into daily practice at the area agency on 
aging, low-cost methods for conducting outreach, linking developmental 
disability agencies, and supporting family caregivers of adults with 
developmental disabilities.
        colloquium on alzheimer's disease and mental retardation
    Grantee: Research Foundation for Mental Hygiene (New York State 
Developmental Disabilities Planning Council, Albany, NY
    Project Director: Matthew Janicki, Ph.D., (518) 473-7855
    Project Period: 7/25/94-6/30/95, FY '94-$37,500
    A project designed to convene a group of experts on aging, 
Alzheimer's disease and mental retardation to determine diagnostic 
criteria, epidemiology, and practice guidelines to be used by 
researchers, providers, and clinicians. Final products include a 
project report and a series of peer-reviewed journal articles on 
diagnostic criteria and practice guidelines on Alzheimer's disease and 
mental retardation to appear in the journals of the American 
Association for Mental Retardation and the International Association 
for the Scientific Study of Intellectual Disability and a consumer 
information booklet on Alzheimer's disease and developmental 
disabilities developed and published in conjunction with the New York 
State Developmental Disabilities Council.

                  HEALTH CARE FINANCING ADMINISTRATION

                             Long-Term Care

    The mission of the Health Care Financing Administration (HCFA) is 
to promote the timely delivery of appropriate, quality health care to 
its beneficiaries--approximately 70 million aged, disabled, and poor 
Americans.
    Medicaid and Medicare are the principal sources of funding for long 
term care in the United States. The primary types of care reimbursed by 
these programs of HCFA are a variety of institutional (e.g., skilled 
nursing facilities (SNFs), intermediate care facilities for the 
mentally retarded (ICFs/MR), inpatient rehabilitation), and home and 
community-based care services.
    HCFA's Office of Research and Demonstrations (ORD) conducts 
research studies of a broad variety of issues relating to long term 
services and their users, providers, costs, and quality. ORD also 
conducts demonstration projects that demonstrate and evaluate optional 
payment, coverage, eligibility, delivery mechanisms, and management 
alternatives to the present Medicaid and Medicare programs.
                          research activities
    Long term care research activities in ORD can be classified 
according to the following objectives:
          Assessing and evaluating long term care programs in terms of 
        costs, effectiveness, and quality;
          Examining the effect of the hospital prospective payment 
        system (PPS) on subacute and long term care providers;
          Examining alternative payment systems for long term care; and
          Supporting data development and analyses.
    Because of interest in promoting noninstitutional care, and recent 
increase in the utilization of these services, ORD's research is 
examining the cost, quality, and effectiveness of the services in home 
and community-based settings. These efforts include comparison of the 
quality, case mix, and cost of noninstitutional services, as well as 
the examination of home care provided under different payment 
arrangements, e.g., fee-for-service versus capitation. As part of these 
efforts, some studies are developing groupings of patients in both 
institutional and noninstitutional settings that have similar expected 
outcomes. Such groupings are essential since home health care serves so 
many different types of patients, some of whom may fully recover and 
some who, even under the best of circumstances, are still expected to 
continue to decline.
    A major responsibility of ORD is assessing the effects of various 
Medicare and Medicaid programs and policies affects subacute and long 
term care services. Since the implementation of PPS for paying 
hospitals, ORD has been assessing the effects of this change on other 
parts of the health care system. Included in this research is the 
examination of the effects of the prospective payment system (PPS) on 
subacute and long term care case mix, utilization, costs, and quality. 
Changes in the supply of long term care providers are also being 
studied. Major research projects are underway to analyze the 
appropriateness of post-hospital care and the course and outcomes of 
that care. In recent years, there has been increased emphasis on 
examining episodes of care rather than utilization of just one type of 
service. Medicare files, which link hospital with post-hospital care, 
continue to be analyzed to provide information on trends in the post 
acute care utilization of post-hospital care since the passage of the 
PPS legislation.
    Several research studies by ORD are examining the course and 
outcomes of post-hospital care. After the implementation of PPS, there 
was increased interest in the post-acute care area because the 
resulting shorter average hospital stays were expected to increase 
patients' post-acute care utilization. In addition, another purpose of 
funding this research was to gather information about decisionmaking at 
the point of hospital discharge and the types of patients who are 
referred to the various post-acute modalities of care. These research 
studies involve collection and analysis of data in order to provide 
Medicare payment, quality assurance, and coverage policy 
recommendations relating to subacute care (e.g., home health care, 
nursing homes, and rehabilitation hospitals).
    Efforts are also underway to improve the data bases, statistics, 
and baseline information upon which future assessment of needs, problem 
identification, and policy decisions will be based. HCFA continues to 
support the National Long Term Care Survey, the Disability Supplement 
to the 1994 and 1995 National Health Interview Survey, the Medicare 
Current Beneficiary Survey, and the National Recurring Data Set 
project.
                        demonstration activities
    Demonstration activities in ORD include the development, testing, 
and evaluation of:
          Alternative methods of service delivery for post-acute and 
        long term care, focusing on service systems that integrate 
        acute and long term care;
          Alternative payment systems for post-acute and long term care 
        services; and
          Innovative quality assurance systems and methods.
    In 1994, HCFA continued the operation of a major demonstration 
testing the effectiveness of community-based and in-home services for 
victims of Alzheimer's disease and other dementia. This project focuses 
on the coordination and management of an appropriate mix of health and 
social services directed at the individual needs of these patients and 
their families. In 1994, HCFA also continued operation of a major 
demonstration aimed at testing prospective payment for Medicare home 
health agencies. This program is being conducted in two phases. The 
first phase involves testing of prospectively established per-visit 
payment rates for Medicare covered home health visits. A second phase, 
scheduled to begin in 1995, will test per-episode payment rates for an 
entire episode of Medicare covered home health services. Substantial 
effort also was devoted to the design and development of a multi-State 
demonstration program testing innovative case-mix payment and quality 
assurance methods for nursing homes that participate in Medicare and 
Medicaid. This project is scheduled to begin in 1995.ORD also continued 
work on several other major initiatives to test innovative 
reimbursement strategies to promote cost containment and foster quality 
of care. ORD has devoted extensive effort to the testing of capitated 
payment systems for a combination of acute and long term care services, 
including conducting and evaluating the demonstration of Social/Health 
Maintenance Organizations (Social HMOs) and conducting the Program for 
All-inclusive Care for the Elderly (PACE). The purpose of the PACE 
demonstration has the purpose of replicating a unique model of managed 
care service delivery for very frail community dwelling elderly, most 
of whom are dually eligible for Medicare and Medicaid coverage and all 
of whom are assessed as being eligible for nursing home placement 
according to the standards established by participating States. Work is 
continuing to develop a ``second generation'' model of the Social HMO 
that can be tested in a future demonstration. HCFA also awarded 
contracts to four community nursing organizations (CNOs) in 1992. This 
demonstration will test the feasibility and effect on patient care of a 
capitated, nurse-directed service delivery system. The CNO sites 
completed a 1-year developmental period and began a 3-year operational 
period in January 1994. HCFA also is working with United HealthCare 
Corporation, Inc. to implement the EverCare demonstration. This 
demonstration tests the effectiveness of managing acute care needs of 
nursing home residents by pairing physicians and geriatric nurse 
practitioners who will function as primary medical care givers and case 
manager. Payment is on a prepaid, capitated basis.
    Information follows on specific HCFA research and demonstrations.
Community Nursing Organization Demonstration
    Period: September 1992-September 1996
    Contractors: See Below.
    The purpose of the Community Nursing Organization (CNO) 
Demonstration is to develop and evaluate a nurse-managed health care 
delivery system that provides Medicare-covered home health services, 
ambulatory care services, and durable medical equipment, in addition to 
nurse case management, to eligible beneficiaries. Section 4079 of 
Public Law 100-203 directed the Secretary to conduct this demonstration 
at four or more sites. The authorizing legislation identified a package 
of mandatory services that each CNO has to provide. It also required 
that the demonstration have a capitated payment method modeled after 
the adjusted average per capita cost payment used with health 
maintenance organizations. Another provision of the legislation 
stipulated that an alternative capitation formula be implemented in at 
least one of the four sites. The participating organizations will 
assume full financial risk for the demonstration's mandatory service 
package. In addition to these services, CNOs may provide optional 
services such as homemaker/home health aide services. The project's 
evaluation will examine the feasibility and viability of a capitated 
nurse-coordinated service model.
Contractors:
    Carle Clinic Association, 307 East Oak No. 3, Mahomet, IL 61853
    Carondelet Health Services, Inc., Carondelet St. Mary's Hospital, 
1601 West St. Mary's Rd., Tucson, AZ 85745
    Living at Home/Block Nurse Program, Ivy League Place, Suite 225, 
475 Cleveland Ave. North, St. Paul, MN 55104
    Visiting Nurse Service of New York, 107 East 70th St., New York, NY 
10021-5087
    Four sites were awarded contracts on September 30, 1992. During the 
project's developmental year, these CNO sites established their 
operational protocols, marketing and enrollment plans, service delivery 
systems, and data collection plans. The 3-year operational phase of the 
demonstration began in January 1994 and sites expect to enroll 6,000 
beneficiaries in the demonstration. Abt Associates Inc. was selected to 
evaluate the project and to provide technical assistance to the four 
CNO sites.
Evaluation of the Community Nursing Organizations Demonstration
    Period: September 1992-February 1997
    Funding: $2,414,634
    Contractor: Abt Associates Inc., 55 Wheeler St., Cambridge, MA 
02138-1168
    Investigator: Robert Schmitz, Ph.D.
    Section 4079 of Public Law 100-203 directs the Secretary of Health 
and Human Services to conduct a 3-year community nursing organization 
(CNO) demonstration designed to increase access to needed services as 
well as promote timely and appropriate service use. The legislation 
mandates a CNO service package that includes home health care, durable 
medical equipment, and certain ambulatory care services, in addition to 
nurse case management. The evaluation of the CNO demonstration will 
test the feasibility and effect on patient care of a capitated, nurse 
case-managed service delivery model. Both qualitative and quantitative 
components are included in the evaluation design. The qualitative 
component will use a case study approach to examine the operational 
feasibility and financial viability of the CNO model. The quantitative 
component will use a randomized design and assess patient-level impacts 
on such measures as mortality, hospitalization, physician visits, 
nursing home admissions, and Medicare expenditures.
    The four CNO demonstration sites have undergone a 1-year 
developmental period and began a 3-year operational period in January 
1994.
Social Health Maintenance Organization Project for Long-Term Care
    Period: August 1984-December 1997
    Grantees: See Below.
    In accordance with Section 2355 of Public Law 98-369, this project 
was developed and is currently implementing the concept of a social 
health maintenance organization (Social HMO) for acute and long-term 
care. A Social HMO integrates health and social services under the 
direct financial management of the provider of services. All services 
are provided by or through the Social HMO at a fixed annual prepaid 
capitation sum. Four sites have been selected to participate in this 
project.
    Of the four Social HMO demonstration sites selected, two are HMOs 
that have added long-term care services to their existing service 
packages and two are long-term care providers that have added acute 
care service packages. The demonstration sites utilize Medicare and 
Medicaid waivers, and all initiated service delivery by March 1985. 
During the first 30 months of operation, Federal and State governments 
shared financial risk with the sites. This risk sharing ended August 
31, 1987. This demonstration was extended three times by legislation. 
The current legislation (P.L. 103-66) extends the demonstration period 
through December 31, 1997. The Social HMO sites are:
Elderplan, Inc.
    Grantee: Elderplan, Inc., 6323 Seventh Avenue, Brooklyn, NY 11220
Seniors Plus
    Grantee: Health Partners, and Ebenezer Society, 8100 34th Avenue 
South, Minneapolis, MN 55440-1309
Medicare Plus II
    Grantee: Kaiser-Permanente Center for Health Research, 3800 North 
Kaiser Center Drive, Portland, OR 97227-1098
SCAN Health Plan
    Grantee: Senior Care Action Network, 521 East Fourth Street, Long 
Beach, CA 90802
Evaluation of the Social Health Maintenance Organization
    Period: September 1985-July 1991
    Funding: $3,533,396
    Contractor: Institute for Health and Aging, University of 
California, San Francisco, 201 Filbert Street, San Francisco, CA 94133
    Investigator: Robert Newcomer, Ph.D.
    The social health maintenance organization (Social HMO) seeks to 
enroll, voluntarily, persons 65 years of age or over in an innovative 
prepaid program that integrates medical, social, and long-term care 
delivery systems. The Social HMO merges the health maintenance 
organization concepts of capitation financing and provider risk sharing 
developed by the Health Care Financing Administration under its 
Medicare capitation and competition demonstrations with the case 
management and support services concepts underlying the long-term care 
demonstrations serving the chronically ill aged, which are sponsored by 
the Department of Health and Human Services.
    An interim report was forwarded to Congress in August 1988. A copy 
of the report, ``Evaluation of the Social/Health Maintenance 
Organization Demonstration,'' may be obtained from the National 
Technical Information Service (NTIS), accession number PB89-215446. The 
evaluation and data collection plan for the demonstration is available 
from NTIS as a technical appendix and may be obtained by using 
accession number PB89-191779. The data collection phase has been 
completed. Data analysis has been completed and findings are under 
review. The following papers and book chapters have been published:
          Harrington, C., Newcomer, R., and Moore, T. 1988. Factors 
        that contribute to Medicare HMO risk contract success. Inquiry, 
        25(2):251-262.
          Harrington, C., and Newcomer, R.J. 1990. Social health 
        maintenance organizations as innovative models to control cost. 
        Generations, 14(2):49-54.
          Newcomer, R.J., Harrington, C., and Friedlob, A. 1990. 
        Awareness and enrollment in the Social HMO. The Gerontologist, 
        30(1):86-93.
          Newcomer, R.J., Harrington, C., and Friedlob, A. 1990. Social 
        health maintenance organizations: Assessing their initial 
        experience. Health Services Research, 25(3):425-454.
          Harrington, C., and Newcomer, R.J. 1991. Social health 
        maintenance organization service use and costs, 1985-1989. 
        Health Care Financing Review, 12(3):37-52.
          Harrington, C., Lynch, M., and Newcomer, R. 1993. Medical 
        services in the social health maintenance organizations. The 
        Gerontologist, 33(6):790-800.
          Harrington, C., Newcomer, R., and Preston, S. 1993. A 
        comparison of S/HMO disenrollees and continuing members. 
        Inquiry, 30(4):429-440.
          Manton, K.G., Newcomer, R., Vertrees, J., Lowrimore, G., and 
        Harrington, C. 1993. Social health maintenance organization and 
        fee-for-service health outcomes over time. Health Care 
        Financing Review, 15(2):173-202.
          Manton, K., Newcomer, R., Vertrees, J., Lowrimore, G., and 
        Harrington, C. 1994. A method for adjusting capitation payments 
        to managed care plans using multivariate patterns of health and 
        functioning: The experience of social health maintenance 
        organizations. Medical Care, 32(3):277-297.
          Newcomer, R., and Harrington, C. 1994. Health plan 
        satisfaction among S/HMO members and disenrollees, and Medicare 
        beneficiaries in fee for service care. In HMOs and other Health 
        Care Systems for the Elderly (Luft, H. ed), Health 
        Administration Press.
          Newcomer, R., Manton, K., Harrington, C., Yordi, C., and 
        Vertrees, J. 1995. Case mix controlled service use and 
        expenditures in the social health maintenance organization 
        demonstration. Journal of Gerontology: Medical Sciences, 
        forthcoming.
    Three additional articles are under review. A second Report to 
Congress is being prepared, based on the published evaluation findings.
Site Development and Technical Assistance for the Second Generation 
        Social Health Maintenance Organization
    Period: September 1993-January 1998
    Funding: $1,777,189
    Contractor: University of Minnesota, School of Public Health, 
Institute for Health Services Research, Box 197, D-351 Mayo Memorial 
Building, 420 Delaware Street, SE, Minneapolis, MN 55455
    Investigator: Robert L. Kane, M.D.
    The Health Care Financing Administration is planning to implement a 
second generation Social Health Maintenance Organization (Social HMO) 
Demonstration. This project will refine targeting and financing 
methodologies and the benefit design of the current Social HMO 
demonstration. Under this contract, the University of Minnesota will 
provide technical assistance in the site selection, development, 
implementation, and operation of the second generation model.
    Pre-award site visits were conducted during September 1994, and 
site selection is scheduled for January 1995. The second generation 
Social HMO will have a 1-year developmental phase. Organizations 
participating in the demonstration will offer Medicare beneficiaries 
the opportunity to receive a wide range of services including 
prevention and primary care, acute and post-acute care, and long-term 
care.
On Lok's Risk-Based Community Care Organization for Dependent Adults
    Period: November 1983-Indefinite
    Grantee: On Lok Senior Health Services, 1333 Bush Street, San 
Francisco, CA 94109, and California Department of Health Services, 714-
744 P Street, P.O. Box 942732, San Francisco, CA 94234-7320.
    As mandated by sections 603(c)(1) and (2) of Public Law 98-21, the 
Health Care Financing Administration granted Medicare waivers to On Lok 
Senior Health Services and Medicaid waivers to the California 
Department of Human Services. Together, these waiver permitted On Lok 
to implement an at-risk, capitated payment demonstration in which more 
that 300 frail elderly persons, certified by the California Department 
of Health Services for institutionalization in a skilled nursing 
facility, are provided a comprehensive array of health and health-
related services in the community. The current demonstration maintains 
On Lok's comprehensive community-based program, but has modified its 
financial base and reimbursement mechanism. All services are paid for 
by a predetermined capitated rate from both Medicare and Medicaid. The 
Medicare rate is based on the average adjusted per capita cost for the 
San Francisco county Medicare population. The Medicaid rate is based on 
the State's computation of current costs for similar Medicaid 
recipients, using the formula for prepaid health plans. Individual 
participants may be required to make copayments, spend-down income, or 
divest assets, based on their financial status and eligibility for 
either or both programs. On Lok has accepted total risk beyond the 
capitated rates of both Medicare and Medicaid with the exception of the 
Medicare payment for end stage renal disease. The demonstration 
provides service funding only under waivers. The research and 
developmental activities are funded through private foundations.
    Section 9220 of Public Law 99-272 has extended On Lok's Risk-Based 
Community Care Organization for Dependent Adults indefinitely, subject 
to the terms and conditions in effect as of July 1, 1985, with 
exception of the requirements relating to data collection and 
evaluation.
Frail Elderly Demonstration: The Program for All-Inclusive Care for the 
        Elderly
    Period: June 1990-March 1996
    Grantees: See Below.
    As mandated by Public Law 99-509, as amended, the Health Care 
Financing Administration will conduct a demonstration which replicates, 
in not more than 15 sites, the model of care developed by On Lok Senior 
Health Services in San Francisco, California. The Program for All-
Inclusive Care for the Elderly (PACE) demonstration replicates a unique 
model of managed-care service delivery for 300 very frail community-
dwelling elderly, most of whom are dually eligible for Medicare and 
Medicaid coverage and all of whom are assessed as being eligible for 
nursing home placement according to the standards established by 
participating States. The model of care includes as core services the 
provision of adult day health care and multidisciplinary case 
management through which access to and allocation of all health and 
long-term care services are arranged. Physician, therapeutic, 
ancillary, and social support services are provided onsite at the adult 
day health center whenever possible. Hospital, nursing home, home 
health, and other specialized services are provided extramurally. 
Transportation is also provided to all enrolled members who require it. 
This model is financed through prospective capitation of both Medicare 
and Medicaid payments to the provider. Demonstration sites are to 
assume financial risk progressively over 3 years, as stipulated in the 
Omnibus Budget Reconciliation Act of 1987. The nine sites and their 
State Medicaid agencies that have been granted waiver approval to 
provide services are:
Elder Service Plan
    Period: June 1990-May 1993 (yearly continuation)
    Grantee: East Boston Geriatric Services, Inc., 10 Gove St., East 
Boston, MA 02128
    Period: June 1990-May 1993 (yearly continuation)
    Grantee: Massachusetts State Department of Public Welfare, 180 
Tremont St., Boston, MA 02111
Providence ElderPlace
    Period: June 1990-May 1993 (yearly continuation)
    Grantee: Providence Medical Center, 4805 Northeast Glisan St., 
Portland, OR 97213
    Period: June 1990-May 1993
    Grantee: Oregon State Department of Human Resources, 313 Public 
Service Building, Salem, OR 97310
Comprehensive Care Management
    Period: February 1992-January 1995 (yearly continuation)
    Grantee: Beth Abraham Hospital, 612 Allerton Ave., Bronx, NY 10467
    Period: February 1992-January 1995 (yearly continuation)
    Grantee: New York State Department of Social Services, 40 North 
Pearl St., Albany, NY 12243
Palmetto SeniorCare
    Period: October 1990-September 1993 (yearly continuation)
    Grantee: Richland Memorial Hospital, Fifteen Richland Medical Park, 
Columbia, SC 29203
    Period: October 1990-September 1993 (yearly continuation)
    Grantee: South Carolina State Health and Human Services Finance 
Commission, P.O. Box 8206, Columbia, SC 29202
Community Care for the Elderly
    Period: November 1990-October 1993 (yearly continuation)
    Grantee: Community Care Organization, 5228 W. Fond du Lac Avenue, 
Milwaukee, WI 53216
    Period: November 1990-October 1993 (yearly continuation)
    Grantee: Wisconsin State Department of Health and Social Services, 
P.O. Box 7850, Madison, WI 53707
Total Longterm Care, Inc.
    Period: October 1991-September 1994 (yearly continuation)
    Grantee: Total Longterm Care, Inc., 3202 West Colfax, Denver, CO 
80204
    Period: October 1991-September 1994 (yearly continuation)
    Grantee: Colorado Department of Social Services, 1575 Sherman St., 
Denver, CO 80203
Bienvivir Senior Health Services
    Period: June 1994-May 1995 (yearly continuation)
    Grantee: Bienvivir Senior Health Services, 6000 Welch, Suite A-2, 
El Paso, TX 79905-1753
    Period: June 1994-May 1995 (yearly continuation)
    Grantee: Texas Department of Human Services, P.O. Box 149030, 
Austin, TX 78714-9030
Independent Living for Seniors
    Period: April 1992-March 1995 (yearly continuation)
    Grantee: Rochester General Hospital, 311 Alexander Street, 
Rochester, NY 14604
    Period: April 1992-March 1995 (yearly continuation)
    Grantee: New York Department of Social Services, 40 North Pearl 
St., Albany, NY 12243
    Up to six additional sites will be phased in over the next 2 years. 
A contract to evaluate the PACE demonstration was awarded in June 1991. 
Presentations of the demonstration implementation and evaluation issues 
were given at the following national meetings: American Public Health 
Association and Gerontological Society of America annual meetings.
Evaluation of the Program for All-Inclusive Care for the Elderly 
        Demonstration
    Period: June 1991-February 1996
    Funding: $4,486,514
    Contractor: Abt Associates, Inc., 55 Wheeler St., Cambridge, MA 
02138-1168
    Investigator: Laurence Branch, Ph.D.
    The Program for All-Inclusive Care for the Elderly (PACE) 
demonstration replicates a unique model of managed-care service 
delivery for 300 very frail community-dwelling elderly, most of whom 
are dually eligible for Medicare and Medicaid coverage and all of whom 
are assessed as being eligible for nursing home placement according to 
the standards established by participating States. The model of care 
includes as core services the provision of adult day health care and 
multidisciplinary team case management through which access to and 
allocation of all health and long-term care services are arranged. This 
model is financed through prospective capitation of both Medicare and 
Medicaid payments to the provider. The purpose of the evaluation is to 
examine PACE sites before and after assumption of full financial risk, 
with the purpose of determining whether the PACE model of care, as a 
replication of the On Lok Senior Health Services model of care, is cost 
effective relative to the existing Medicare and Medicaid systems. 
Specific evaluation questions relate to the model of care and the 
effects of the model on participant utilization, expenditures, and 
outcomes.
    Reports based on site visits have been received by the contractor, 
and primary data collection should begin in January 1995.
Managing Medical Care for Nursing Home Residents
    Period: December 1992-December 1998
    Funding: Waiver Only
    Awardee: United HealthCare Corporation, Inc., P.O. Box 1459, 
Minneapolis, MN 55440-8001
    Investigator: Jeannine Bayard
    The objective of this demonstration is to study the effectiveness 
of managing acute care needs of nursing home residents by pairing 
physicians and geriatric nurse practitioners (GNPs) who will function 
as primary medical caregivers and case managers. The major goals of the 
demonstration are to reduce medical complications and dislocation 
trauma resulting from hospitalization and to save the expense of 
hospital care when patients could be managed safely in nursing homes 
with expanded services. The operating principal of this demonstration 
is EverCare, a subsidiary of United Health Care Corporation, Inc. 
EverCare will receive a fixed capitated payment (based on a percentage 
of the adjusted average per capita cost) for all nursing home residents 
enrolled and will be at full financial risk for the cost of acute care 
services for the enrollees. Nine demonstration sites are expected to 
participate, with each site enrolling approximately 300 persons. GNPs 
will provide initial assessments of enrollees; make monthly visits; 
authorize clinic, outpatient, and hospital visits; and communicate with 
the patients' physicians, nursing facility staffs, and families. 
Physician incentive plans will be structured to offer a higher 
reimbursement rate for a nursing home visit and a lower reimbursement 
rate for services furnished in physicians' offices or in other 
settings. By increasing the intensity and availability of medical 
services, Ever Care believes that the model will reduce total care 
costs; improve the quality of care received by participants through 
better coordination of appropriate acute care services; and improve the 
quality of life for and the level of satisfaction of enrollees, and 
their families.
    Waivers were awarded in the summer of 1994, and EverCare is in the 
process of securing the appropriate State approvals for operating the 
nine targeted States. Work has entered on identifying payment 
methodologies for primary care physicians, identifying barriers to 
marketing approaches through the use of customer focus groups, and in 
interviewing staff for several target sites. Site operations are 
expected to begin early in 1995.
A Randomized Controlled Trial of Expanded Medical Care In Nursing Homes 
        for Acute Care Episodes
    Period: March 1992-August 1996
    Funding: $1,054,007
    Awardee: Monroe County Long Term Care Program, Inc., 349 West 
Commercial Street, Suite 2250, East Rochester, NY 14445
    Investigator: Gerald Eggert, Ph.D.
    The objective of this demonstration is develop, implement, and 
evaluate the effectiveness of expended medical services to nursing home 
residents who are undergoing acute illnesses, or deterioration in 
chronic ones, which would ordinarily require acute hospitalization. The 
intervention will include many services which are available in acute 
hospitals and which are feasible and safe in nursing homes. These 
include an initial physician visit, all necessary follow-up visits, 
diagnostic and therapeutic services, and additional nursing care 
including private duty if necessary. The major goals of the 
demonstration are to reduce medical complications and dislocation 
trauma resulting from hospitalization, and to save the expense of 
hospital care when a patient could be managed safely in the nursing 
home with expanded services.
    Basic preparation for the implementation of the demonstration has 
been completed. The awardee is in the process of developing provider 
contracts and in negotiating necessary payments with nursing 
facilities. Implementation of the demonstration is expected in June 
1995.
Nurse Practitioner/Physician Assistant Aggregate Visa Demonstration
    Period: September 1990-September 1993
    Funding: $130,538
    Awardee: The Urban Medical Group, 545 D Centre St., Jamaica Plain, 
MA 02130
    Investigator: Rita Change, Ph.D.
    Under section 6114(e) of Public Law 101-239, the Medicare program 
provides Part B coverage to nursing home residents for medical visits 
rendered by nurse practitioners who are members of a physician/
physician assistant/nurse practitioner team. Under this legislation, 
the number of visits supplied to any nursing home patient is limited to 
an average of 1.5 visits per month. Section 6114(e) mandates a 
demonstration project under which the visit limitation would be applied 
on an average basis over the aggregate total of residents receiving 
services from members of the provider team. A preliminary Massachusetts 
demonstration project, Case Managed Medical Care for Nursing Home 
Patients, used nurse practitioners and physician assistants to provide 
visits to nursing home patients. This demonstration ended on September 
30, 1990. Many of the original Massachusetts demonstration sites are 
also participating in this section project.
    The project was conducted in two phases. The first phase (primarily 
involving planning and development activities) was completed in March 
1992. The second phase, which included the actual implementation and 
operation of the demonstration, was completed in March 1993. Although 
negotiations with the Medicare carrier, Massachusetts Blue Cross and 
Blue Shield, were concluded during the first phase, the grantee has 
experienced a great deal of difficulty in securing usable/clean data. A 
6-month no-cost extension of the grant was provided (until September 
29, 1993). However, as Massachusetts Blue Cross and Blue Shield was 
unable to provide corrected data until spring 1994, the project's final 
report was received in fall 1994.
Evaluation and Technical Assistance of the Medicare Alzheimer's Disease 
        Demonstration
    Period: September 1989-September 1994
    Funding: $4,444,674
    Contractor: Institute for Health and Aging, University of 
California, San Francisco, Box 0646, Laurel Heights, San Francisco, CA 
94134-0646
    Investigator: Robert J. Newcomer, Ph.D.
    The Medicare Alzheimer's Disease Demonstration was authorized by 
Congress under Section 9342 of Public Law 99-509 to determine the 
effectiveness, cost, and impact on health status and functioning of 
providing comprehensive services to beneficiaries who have dementia. 
Two models of care are being studied under this project. Both provide 
case management and a wide range of in-home and community-based 
services, including homemaker and personal care services, adult day 
care, and education and counseling for family caregivers. The two 
models vary by the intensity of the case management beneficiaries and 
their families receive and the level of Medicare reimbursement that is 
available each month to pay for demonstration services. Clients are 
responsible for a 20-percent coinsurance just as they are under the 
regular Medicare program. There are four Model A and four Model B sites 
participating in this demonstration. Under Model A, each site has a 
case manager to client ratio of 1:100. Monthly client expenditure caps 
which have been adjusted for geographical cost variations range from 
$336 to $407. Model A sites are located in Memphis, Tennessee; 
Portland, Oregon; Rochester, New York; and Urbana, Illinois. The case 
management ratio in the Model B sites is 1:30 and their monthly 
expenditure caps are between $549 and $662. Model B sites are located 
in Cincinnati, Ohio; Miami, Florida; Minneapolis, Minnesota; and 
Parkersburg, West Virginia. Major questions to be addressed by the 
evaluation include:
           What factors are associated with the cost effectiveness of 
        providing an expanded package of home care and community-based 
        services to Medicare beneficiaries with Alzheimer's disease or 
        related disorders?
          How do various services impact on the health status and 
        functioning of dementia patients and their caregivers?
          What are the effects of providing community-based services on 
        caregiver burden and stress?
          Do additional home care services delay or prevent 
        institutionalization of beneficiaries with dementia?
    A provision in the Omnibus Budget Reconciliation Act of 1990 
extended the demonstration from 3 to 4 years. It also increased the 
funding for the project's administrative and service costs from $40 
million to $55 million and for the evaluation from $2 million to $3 
million. OBRA 93 extended the demonstration an additional year and 
increased funding for administrative and service costs to $58 million 
and funding for the evaluation to $5 million. During the first 2 years 
of the demonstration, the sites enrolled approximately 6,000 Medicare 
beneficiaries, including both treatment and control group members. 
However, there has been an unexpectedly high client attrition rate. 
Most of the individuals who have left the project have been disenrolled 
because of death or nursing home placement. The demonstration ended in 
November 1994. An interim report describing the initial project 
implementation phase has been send forward for submission to Congress. 
A final report indicating the project's findings and recommendations 
for possible legislative changes will be available in late 1995.
Special Care Managed-Care Initiative
    Period: February 1992-February 1995
    Funding: $652,270
    Awardee: Wisconsin Department of Health and Social Services, 1 West 
Wilson Street, P.O. Box 309, Madison, WI 53701-0309
    The purpose of the Special Care Initiative project is to gain 
improved understanding of the need, utilization, and cost of delivery 
of health services to high risk, severely disabled persons. The 
severely disabled population is a significant user of medical services. 
Moreover, costs since 1988 have increased at a rate double the rate of 
population increase. Therefore, an important objective is to contain 
the cost and utilization of Medicaid services of the severely disabled 
while maintaining or improving the level of client satisfaction. 
Special Care, Inc. (SCI), is an independent, nonprofit organization and 
represents a joint venture between a Milwaukee rehabilitation facility 
(the Milwaukee Center for Independence) and the Wisconsin Health 
Organization, an established HMO. SCI will create specialized services, 
including a dedicated physician's panel, case management services and 
clinical services as strategies to assess medical need and to better 
coordinate service resources available in the community. The State of 
Wisconsin will use a capitation methodology for reimbursement of SCI. 
Enrollment in SCI will be voluntary.
    Service provision for this program began in June 1994. Enrollment 
will be phased in during the first year of operations beginning with 
approximately 100 recipients. In April 1994, a contract for the 
evaluation of the I Care Project was signed between the Department of 
Health and Social Services and Human Services Research Institute 
(HSRI). A site visit was conducted in June 1994, and a draft work plan 
is being developed.
MAINE-NET: Medicaid and Medicare Managed Care for the Elderly and 
        Physically Disabled in Maine
    Period: October 1994-September 1997
    Funding: $944,940
    Grantee: State of Maine Department of Human Services, State House 
Station #11, Augustus, ME 04333
    Investigator: Carreen Wright, M.B.A.
    This project is designed to demonstrate integrated models for the 
financing and delivery of managed health care and social services for 
Medicare and Medicaid elderly and physically disabled persons in Maine. 
The project seeks to promote the development of regional service 
delivery networks or health plans, particularly in rural areas of the 
State that would be responsible for the management, coordination and 
integration of services, including multi-disciplinary approaches to 
care planning and service delivery. The demonstration will provide a 
comprehensive package of primary, acute, and long term care 
(institutional and noninstitutional) services as part of a prepaid 
capitated health plan for the target populations. The demonstration 
will use and expand nursing home quality indicators developed in the 
HCFA-sponsored multiState Nursing Home Case Mix and Quality (NHCMQ) 
demonstration, and will incorporate HCFA's quality assurance guidelines 
for managed care plans. In addition, the project will develop and use 
an ADL-based case mix adjustment for long term care services in the 
construction of capitation payment rates, using the RUGs-III 
classification system also developed in the NHCMQ demonstration. For 
services provided in boarding homes and in the community, two new case 
mix methodologies will be developed for use in the demonstration. The 
project is in the early developmental stage.
Managed-Care System for Disabled Children and Youth with Special Needs
    Period: August 1994-August 1995
    Funding: $150,000
    Grantee: Government of the District of Columbia, Commission on 
Health Care Finance, 2100 Martin Luther King Jr. Avenue, S.E., Suite 
302, Washington, D.C. 20020
    Investigator: A. Sue Brown
    The District of Columbia submitted a request for section 1115 
waivers, which will permit the District to implement a Medicaid 
managed-care initiative to serve approximately 3,600 children with 
disabilities and complex medical needs. A number of key issues within 
the waiver application required further development. For example, it 
was felt that the District needed to clearly identify: the service 
delivery network and clinical management systems, payment methodology 
and cost projections. As a result, the District was awarded a 12-month 
development grant for the project, during which the District will 
complete project development, followed by an application for section 
1115 waivers required to implement the demonstration.
Community-Supported Living Arrangements Program: Process Evaluation
    Period: September 1993-August 1996
    Funding: $411,941
    Contractor: SysteMetrics/MedStat, 104 West Anapamu Street, Santa 
Barbara, CA 93101
    Investigator: Brian Burwell
    The Community-Supported Living Arrangements (CSLA) program is 
designed to test the effectiveness of developing, under section 1930 of 
the Social Security Act, a continuum of care concept as an alternative 
to the Medicaid-funded residential services provided to individuals 
with mental retardation and related conditions (MR/RC) as an optional 
State plan service. The CSLA program services individuals with MR/RC 
who are living in the community either independently, with their 
families, or in homes with three or fewer other individuals receiving 
CSLA services. This model of care includes: personal assistance; 
training and habilitation services necessary to assist individuals in 
achieving increased integration, independence, and productivity; 24-
hour emergency assistance; assistive technology; adaptive technology; 
support services necessary to aid these individuals in participating in 
community activities; and other services as approved by the Secretary 
of Health and Human Services. Costs related to room and board and to 
prevocational, vocational, and supported employment services are 
excluded from coverage. In accordance with the legislatively set 
maximum, eight States, California, Colorado, Florida, Illinois, 
Maryland, Michigan, Rhode Island, and Wisconsin, have implemented CSLA 
programs. The purpose of this contract is to provide an evaluation of 
the CSLA program to the Health Care Financing Administration's Medicaid 
Bureau and Congress for their consideration of policy options regarding 
the continuation and/or expansion of the Medicaid State Plan optional 
service. The evaluation will address five areas:
           Philosophy or goals guiding States' CSLA programs.
           A description of CSLA programs with respect to recipients, 
        types of services received, and the cost of such services.
           A description and discussion of quality assurance mechanisms 
        being implemented.
           An exploration of the question of compatibility of the 
        supported living concept with current goals and the structure 
        of the Medicaid program.
           An exploration of the relationship between the supported 
        living concept and the Americans with Disabilities Act.
    The contract was awarded on September 30, 1993. As of September 
1994, five of the eight site visits to the participating States have 
been conducted. The final evaluation report is due in February 1995.
Project Demonstrating and Evaluating Alternative Methods to Assure and 
        Enhance the Quality of Long Term Care Services for Persons with 
        Developmental Disabilities through Performance-Based Contracts 
        with Service Providers
    Period: September 1994-September 1997
    Funding: $350,000
    Grantee: Minnesota Department of Human Services, Health Care 
Administration, 44 Lafayette Road, St. Paul, MN 55155-3853
    Investigator: Helen M. Yates
    The purpose of this project is to determine whether and how well 
the implementation of new approaches to quality assurance, with 
outcome-based definitions and measures of quality, will replace the 
input and process measures of quality and in the process contribute to 
improving quality of life for persons with developmental disabilities. 
The Minnesota Department of Human Services will seek Federal authority 
to waive necessary provisions of intermediate care facilities for the 
mentally retarded (ICFs/MR) regulations to permit alternative quality 
assurance mechanisms in selected demonstration, residential, and 
support service programs. The Department will enter into performance-
based contracts with counties, and participating ICF/MR providers. 
These contracts will specify the amount and conditions of 
reimbursement, requirements for monitoring and evaluation, and expected 
client-based outcomes. These will be determined by the client and by 
the legal representative, if any, and with the assistance of the county 
case manager and provider. Desirable outcomes include (among others) 
the enhancement of consumer choice and automony, employment, and 
integration into the community. Criteria for measuring participating 
agency achievement will be drawn from, but not limited to, outcome 
standards developed by the National Accreditation Council for Services 
for Persons with Developmental Disabilities; the ``values experiences'' 
of Frameworks for Accomplishments; and the goals established in 
Personal Futures Plans, Essential Lifestyle, and person-centered 
planning. According to the proposed quality assurance framework, 
monitoring and the individual outcomes will be done jointly among 
family members, case managers and other members of the local review 
team on a quarterly basis. This project is in the development stage.
Development of Outcome-Based Quality Assurance Measures for Small, 
        Integrated Services Settings.
    Period: July 1994-July 1995
    Funding: $22,750
    Contractor: The Accreditation Council, 8100 Professional Place, 
Suite 204, Landover, MD 20785
    Investigator: James Gardner, Ph.D.
    The purpose of this contract is to determine the cost of applying 
outcome measures in small, integrated service settings. This study will 
provide a data base to maintain information on quality reviews of 
organizations that serve people with disabilities, an analysis of 
individual and organizational variables that relate to desirable 
outcomes, and a final report which analyzes quality reviews conducted 
in accordance with the Outcome-Based Performance Measures developed by 
the Accreditation Council on Services for People with Disabilities. The 
results of this study will be used to assess the quality of services in 
facilities serving people with chronic mental illness, physical 
challenges, and mental retardation in diverse settings such as 
supported independent living or intermediate care facilities for the 
mentally retarded. Of particular importance is the assessment of the 
extent to which Outcome Based Performance Measures can coexist with the 
traditional quality assurance variables such as abuse, neglect, safety, 
health and physical and psychological welfare.
    A workplan was developed in August 1994. The data collection forms 
and instructions for data collection were developed, refined, and field 
tested in September 1994.
Texas Nursing Home Case-Mix Demonstration
    Period: September 1987-April 1994
    Funding: $532,830
    Awardee: State of Texas Department of Human Services, P.O. Box 
149030 (MC-E-601), Austin, TX 78714-9030
    Investigator: Ken C. Stedman
    This Texas Department of Human Services project has two parts. The 
first part was to develop, implement, and evaluate a Medicaid 
prospective case-mix payment system. The payment system is based on 
feasibility studies sponsored by the Health Care Financing 
Administration (HCFA). The major Medicaid objectives of this part of 
the project are to:
          Match payment rates to resident need.
          Promote the admission of heavy-care patients to nursing 
        homes.
          Provide incentives to improve quality of care.
          Improve management practices.
          Demonstrate administrative feasibility of the new system.
    The second phase of the project is to develop and pilot test a 
case-mix adjusted prospective payment system for Medicare patients in 
skilled nursing facilities. The objective for the Medicare pilot test 
is to develop and implement the administrative processes for a Medicare 
prospective payment system in four facilities based on a resource 
utilization group (RUG) classification. The index that will be used for 
the classification of Medicare patients is the RUG-T18, which uses the 
same clinical groups and the activities of daily living (ADL) scale 
used in the New York RUGs II system. The difference occurs in the 
expanded rehabilitation groups for Medicare patients. Texas will use a 
quasi-experimental design for the Medicare pilot test to compare the 
effect of introducing case-mix payment in an experimental catchment 
area versus continuing the flat-rate, cost-based system in a control 
catchment area. The State is using a pre-post design for the Medicaid 
system.
    The case-mix classifications are based on a review of six different 
systems in which the New York RUGs II explained the greatest variance 
of staff time. The case-mix indexes borrow major elements of the RUGs 
II system and some of the rationale from the Minnesota system. The 
Texas index of level of effort (TILE) uses four clinical groups to form 
clusters and develop subgroups using an ADL scale. Two third-party 
evaluations will be conducted--one of data reliability and a second of 
the validity of the data analysis methods.
    During the first year, the TILE and RUG-T18 indexes were reviewed 
for compatibility. The Medicaid payment system became operational 
statewide under the Texas Medicaid State plan in April 1989. As of the 
end of the Medicaid part of the project in fall 1992, over 102,000 
Medicaid recipients had been a part of the demonstration. An evaluation 
data base consisting of the Medicaid Client Assessment, Review, and 
Evaluation (CARE) claims documents for the 102,000 recipients with at 
least 3 assessments is being used for the evaluation of the 
demonstration. Medicare waivers were approved, and the Medicare pilot 
test was implemented in three Austin area nursing homes in November 
1992 for a period of 18 months.
    At the time of their 1991 Federal certification survey, the pilot 
test facilities had 59 Medicare Part A covered residents. Cost analyses 
of both national and State samples of Medicare providers were performed 
to arrive at baseline costs for calculating the rates for the RUG-T18 
groups. The modified patient assessment instrument, the MDS plus, that 
was developed for the multistate Nursing Home Case-Mix and Quality 
(NHCMQ) demonstration will be used for Medicare classification. In the 
Medicare pilot, a nurse has reviewed new admissions weekly onsite to 
classify residents into the RUG-T18 groups and to give prior 
authorization of the Medicare stays for specific time intervals. The 
interrater reliability of the project nurse and the facility nurses has 
been excellent. A paper entitled ``Texas Medicare Case-Mix pilot 
Study,'' which describes the pilot test and data reliability processes, 
has been prepared. The lessons learned from this pilot will be used in 
the implementation of the NHCMQ demonstration.
The Use of Medicaid Reimbursement Data in the Nursing Home Quality 
        Assurance Process
    Period: June 1988-August 1993
    Funding: $925,389
    Awardee: Center for Health Systems Research and Analysis, 
University of Wisconsin-Madison, Room 1163, WARF Office Bldg., 610 
Walnut Street, Madison, WI 53705
    Investigator: David Zimmerman, Ph.D.
    The purposes of this project are to assess the feasibility of using 
Medicaid reimbursement data to target facilities and residents in the 
nursing home quality assurance survey process and to develop a set of 
quality of care indicators (QCIs) using resident assessment data. 
Medicaid reimbursement data on medication use, sentinel health event, 
and other indicators are being provided to surveyors in preparation for 
the field survey to help target facilities for more intensive review, 
identify specific areas of deficient care, and identify individual 
residents for more detailed review. The objectives of the project are 
to:
          Convert reimbursement data into specific QCIs.
          Identify the Federal regulations for which the use of QCIs 
        has the greatest potential benefit.
          Develop and demonstrate in one State (Wisconsin) procedures 
        for providing QCIs to survey staffs.
          Assess the potential for implementing the system in other 
        States.
          Develop a set of quality indicators (QIs), using resident 
        assessment information, sometimes in combination with claims 
        data, that can be used in the survey process as part of The 
        Multistate Nursing Home Case-Mix and Quality (NHCMQ) 
        Demonstration.
    A program was implemented on December 1, 1990, in which a randomly 
assigned group of survey teams in two Wisconsin regions were provided 
information on 33 QCIs for each nursing facility prior to the survey. 
Surveyors used the QCI information in selecting residents for indepth 
review and in determining whether care deficiencies should be cited. 
The surveyors completed and returned a feedback report that documented 
the results of QCI residents' investigations. Through November 1991, 
QCIs were used in approximately 120 surveys, in addition to the 17 
surveys in which they were used in a pilot study. The quality 
monitoring information system has been pilot tested, and quality 
indicators for 12 quality of care domains have been revised. Wisconsin 
produced a training manual for the four States in the pilot test, as 
well as an overview of the proposed QIs and the process for using these 
QIs in the Federal nursing home survey process. These are available for 
distribution. The final report covering the QCIs which use Medicaid 
claims data and the QIs which use minimum data set information has been 
submitted.
Multistate Case-Mix Payment and Quality Demonstration
    Period: May 1990-June 1996
    Funding: $98,718
    Awardee: New York State Department of Health, Room 1683 Corning 
Tower, Albany, NY 12237
    Investigator: David Wilcox
    New York State will participate in the multistate Nursing Home 
Case-Mix and Quality (NHCMQ) Demonstration presently in its development 
phase. The objective of the demonstration is to test the feasibility 
and cost effectiveness of a case-mix payment system for nursing 
facility services under Medicare and Medicaid that are based on a 
common patient classification system.The addition of New York to the 
demonstration enhances the Health Care Financing Administration's 
ability to project the results of the demonstration on a national 
basis. New York represents a heavily regulated, northern industrialized 
area with larger, high-cost nursing facilities that are medically 
sophisticated and highly skilled Sixteen percent of the national 
Medicare skilled nursing facility days are incurred in New York State. 
New York is uniquely suited for inclusion in this demonstration because 
it has already implemented a complementary system for its Medicaid 
nursing facility payment program.
    In early 1991, project staff completed the minimum data set field 
tests in 25 facilities on 993 residents. These data have been added to 
the data base analyzed to develop the new NHCMQ Medicare Medicaid 
classification system. The inclusion of the New York data has resulted 
in the addition of a very high rehabilitation group to the upper end of 
the classification. The State has implemented the minimum data set plus 
(MDS+) statewide as their resident assessment instrument. In November 
1992, the State began receiving the information monthly from all 
facilities; by October 1, 1993, they had received a total of 397,040 
assessments. The State has conducted analyses of 1990 Medicare Cost 
Report data and Medicare provider analysis and review Part A skilled 
nursing facility stay data. The New York patient review instrument data 
also were used in estimating the average facility case-mix for the 
design of the Medicare case-mix payment system. The Medicare portion of 
the demonstration is expected to become operational in 1995.
The Multistate Nursing Home Case-Mix and Quality Demonstration
    Project Nos.:
          Kansas, 11-C-99366/7
          Maine, 11-C-99363/1
          Mississippi, 11-C-99362/4
          South Dakota, 11-C-99367/8
    Period: June 1989-June 1995
    Funding: $5,322,941
    Awardees: State Medicaid Agencies
    This project builds on past and current initiatives with case-mix 
payment and quality assurance. The 6-year demonstration will design, 
implement, and evaluate combined Medicare and Medicaid system in four 
States--Kansas, Maine, Mississippi, and South Dakota. The purpose of 
the demonstration is to test a resident information system with 
variables for classifying residents into homogeneous resource 
utilization groups for equitable payment and for quality monitoring of 
outcomes adjusted for case mix. The new minimum data set plus (MDS+) 
for resident assessment will be used for resident care planning, 
payment classification, and quality monitoring systems. The project 
consists of three phases: systems development and design, systems 
implementation and monitoring, and evaluation.
    The project has conducted a field test of the minimum data set on 
6,660 nursing home residents. The average direct-care staff time across 
the States is 115 minutes per day per resident. A new patient 
classification system and a Medicare/Medicaid Payment Index (M \3\PI) 
containing 44 groups has been created. The States implemented the MDS+ 
in fall 1990 with the approval of the Health Standards and Quality 
Bureau. A 35-group variation was approved in January for the Medicaid 
portion of the demonstration in Mississippi and South Dakota. The 
variation collapse the 12 rehabilitation groups into three groups split 
only on the project's activities of daily living (ADL) index. The 
States have collected and reviewed over 600,000 MDS+ documents on over 
200,000 different residents assessed between September 1990 and July 
1993.
    In preparation for developing the payment systems for the 
demonstration, the resident characteristic data and facility cost 
reports are being analyzed to determine the case-mix of residents and 
patterns of service utilization. All of the participating states have 
implemented their Medicaid payment systems, and the Medicare case-mix-
adjusted payment system will be implemented in early 1995. The quality 
monitoring information system has been pilot tested, and 30 quality 
indicators have been developed for facility-level and resident-level 
quality monitoring.
Long-Term Care Case-Mix and Quality Technical Design Project
    Period: September 1989-September 1993
    Funding: $3,097,982
    Contractor: The Circle, Inc., 8201 Greensboro Drive, Suite 600, 
McLean, VA 22102
    Investigator: Robert Burke, Ph.D.
    This 4-year contract has supported the design phase of The 
Multistate Nursing Home Case-Mix and Quality (NHCMQ) Demonstration. The 
demonstration combines the Medicare and Medicaid nursing home payment 
and quality monitoring system across several States--Kansas, Maine, 
Mississippi, New York, South Dakota and Texas. This project builds on 
past and current initiatives with nursing home case-mix payment and 
quality assurance in nursing homes. The purpose of the demonstration is 
to test a resident information system with variables for classifying 
residents into homogeneous resource utilization groups for equitable 
payment and for quality monitoring of process and outcomes adjusted for 
case mix. The project will have three phases:
          Systems design and development.
          Systems implementation and monitoring.
          Evaluation.
    The classification system to be used across the demonstration 
States for Medicare and Medicaid was completed in June 1991 by 
researchers from The University of Michigan and Rensselaer Polytechnic 
Institute. The resource utilization groups, version III (RUG-III) uses 
44 groups to explain approximately 45 percent of the variance in 
nursing staff time and 52 percent of the costs across nursing, 
occupational therapy, physical therapy, speech pathology, 
transportation, and social work services. The RUG-III groups are split 
on clinical conditions, including signs and symptoms of distress, type 
and intensity of service, and activities of daily living. The 27 groups 
at the top of the classification match the Medicare coverage criteria. 
A working paper entitled ``Description of the Resource Utilization 
Group, Version III (RUG-III),'' which describes the classification, is 
available from the Division of Long Term Care Experimentation. The 
common assessment tool, the minimum data set plus (MDS+), has been 
developed and implemented as the State resident assessment instrument 
in the demonstration States: Feldman, J., and Boulter, C., eds.: 
Minimum Data Set Plus (MDS+). Multistate Nursing Home Case Mix and 
Quality Demonstration Training Manual. Natick, MA. Eliot Press, 1991.
    A coordinated effort has been undertaken to develop the State-
specific Medicaid payment systems. Four Medicaid systems have been 
completed and are being implemented at the present time. The analysis 
of 1990 Medicare cost reports and 1990 case-mix data to develop the 
Medicare payment design is completed. A working paper entitled ``Issue 
Paper on Development of Medicare SNF Payment Rates'' has been developed 
and distributed to persons working on the payment system design. The 
Medicare payment system portion of the demonstration is expected to be 
approved for implementation in early 1995.
    Under a subcontract with Allied Technology, the University of 
Wisconsin's researchers have completed the development of a preliminary 
list of 30 facility-level quality indicators (QIs) that were used in a 
4-State pilot test. They were reviewed by expert surveyors from the 6 
States, a research-oriented quality panel, and a clinical workgroup of 
60 health professionals representing about 15 disciplines working in 
long term care. A working paper entitled ``Description of the Quality 
Indicators and System for Using Them in the Nursing Home Survey 
Process'' has been developed and distributed to persons interested in 
the demonstration. The QIs will serve to enhance the quality assurance 
process to be used for the operational phase of the demonstration. The 
final set of QIs will be implemented demonstration wide in 1995. The 
final report of the technical design of the Multistate NHCMQ 
Demonstration was received in January 1994. The products of the design 
phase of the demonstration include several software programs.
Implementation of the Multistate Nursing Home Case Mix and Quality 
        Demonstration
    Period: February 1994-July 1996
    Funding: $3,209,538
    Contractor: Allied Technology, Group, Inc., 1803 Research 
Boulevard, Suite 601, Rockville, MD 20850
    Investigator: Robert E. Burke, Ph.D.
    This contract will support the implementation of the multistate 
Nursing Home Case Mix and Quality (NHCMQ) demonstration. The 
demonstration combines the Medicare and Medicaid nursing home payment 
and quality monitoring systems across several States: Kansas, Maine, 
Mississippi, New York, South Dakota, and Texas. This project builds on 
past and current initiatives with case mix payment and quality 
assurance in nursing homes. The purpose of the demonstration is to test 
a resident information system with variables for classifying residents 
into homogeneous resource utilization groups for equitable payment and 
for quality monitoring of process and outcomes adjusted for case mix. 
Implementation of the Medicare prospective case mix adjusted system and 
quality monitoring system is projected to begin January 1994. 
Implementation of the Medicaid payment system was phased in across 
States beginning in July 1993.
Evalution of the Nursing Home Case Mix and Quality Demonstration
    Period: September 1994-September 1999
    Funding: $2,980,219
    Contractor: Abt Associates Inc., 55 Wheeler Street, Cambridge, MA 
02138-1168
    Investigator: Robert J. Schmitz, Ph.D.
    Through the Nursing Home Case Mix and Quality (NHCMQ) 
demonstration, the Health Care Financing Administration is 
investigating the feasibility of paying skilled nursing facilities 
(SNFs) on a prospective basis. Currently, SNFs are retrospectively 
reimbursed for their reasonable costs. The facility's prospective 
payment is intended to approximate the actual costs of residents' care. 
Though some costs will continue to be paid on a retrospective basis, 
the prospective rate will include inpatient routine nursing costs and 
therapy costs. In addition, quality indicators (QIs) will be derived 
from resident assessment data and will be used to assess the relative 
performance of participating facilities. The evaluation will analyze 
facility responses to the demonstration intervention and will assess 
the usefulness of the QIs in the State survey and certification 
process. This project is in the early developmental stage.
Validation of Nursing Home Quality Indicators
    Period: July 1992-July 1995
    Funding: $788,808
    Awardee: SysteMetrics/McGraw Hill, 104 West Anapamu Street, Santa 
Barbara, CA 93101
    Investigator: Tamra Lair, Ph.D
    This project is a continuation of a cooperative agreement to 
investigate the usefulness of claims data from Medicaid and Medicare 
administrative record systems as sources of nursing home quality of 
care measures. The previous study involved retrospective analysis of 
1987 Medicare and Medicaid claims data and facility deficiency data 
from two States. The goal of this project is to further the development 
of an automated quality assurance system using Medicare and Medicaid 
claims data to provide continuous monitoring of the quality of care 
rendered to Medicaid recipients in long term care facilities. The 
objective of this study is to validate the resident level claims-based 
quality of care indicators (QCIs) by: recomputation of the claims-based 
indicators for two States using data from 1990; physician and nurse 
examination of medical records for a sample of residents in a sample of 
nursing homes from the above States; and establishment of the 
relationship of the QCIs to deficiencies cited and adverse outcomes.
    The project has developed preliminary QCIs and is refining these 
indicators for continuing analysis.
Use of Long Term Care Services by Mentally Ill Persons
    Period: September 1994-September 1996
    Funding: $201,938
    Grantee: Center for Health Policy Research and Evaluation, 
Institute for Policy Research and Evaluation, Pennsylvania State 
University, Office of Sponsored Programs, 110 Technology Center, 
University Park, PA 16802
    Investigator: Dennis Shea, Ph.D.
    Recent regulatory policies addressing mental health care in nursing 
homes and current debate on the role of long term care and mental 
health care reform have ignored the connections between the two. The 
significant physical and mental comorbidity among younger and older 
mentally ill persons links the two however. To understand the impact of 
policy and regulations on nursing homes, nursing home residents, and 
mentally ill persons, the long term care service use by mentally ill 
persons will be examined. The first project objective is to describe 
the patterns of nursing facility use by persons with a mental illness, 
including admission and discharge, use of services while in a nursing 
facility, length of stay, and expenditures. The second objective is to 
analyze individual, facility and systemic determinants of the use of 
nursing facilities and other services--especially psychiatric and 
psychological services--by persons with mental illness. The ultimate 
goal of the research is to provide a complete description and analysis 
of the long term care service use patterns of persons with mental 
illness, adding to our understanding of the likely impact of current 
policy and future policy changes on the service use of this special 
population. This project is in the developmental stage.
Changing Roles of Nursing Homes
    Period: September 1994-September 1997
    Funding: $199,478
    Grantee: Institute of Gerontology, University of Michigan, 300 
North Ingalls Building, Room 900, Ann Arbor, MI 48109-2007
    Investigator: Brant Fries, Ph.D.
    Over the past two decades, the role of nursing homes in caring for 
the elderly and disabled has changed. While considered primarily 
custodial in the mid-1970's, nursing homes are increasingly caring for 
populations requiring more special and rehabilitative care, and this 
role is likely to increase in the future. This study will examine two 
special populations in nursing homes: the chronically mentally ill 
(beyond those with dementia) and hospice terminal care residents. A 
large sample of resident assessments collected on nursing home 
residents in several States is to be assembled and linked to Federal 
data sets such as the Online Survey and Certification Reports, the Area 
Resource File, and Medicare Part A and Part B claims to answer the 
research questions. The assessment tool, the Minimum Data Set for 
Nursing Home Resident Assessment and Care Screening, is currently used 
to collect health status data on all nursing home residents in Medicaid 
and Medicare certified nursing facilities. Several quality, 
utilization, and cost issues will be examined. It is hypothesized, for 
example, that residents with chronic mental illness are more likely 
than are other similarly impaired residents to be chemically 
restrained, to experience increasing functional impairment, and to have 
increased behavior problems. Consequently, it is also hypothesized that 
the chronically mentally impaired have greater overall utilization of 
Medicare services than do non-mentally impaired residents with similar 
levels of function impairment. With regard to the population of hospice 
users, it is hypothesized that these residents would have a lower rate 
of rehospitalization than do nonhospice nursing home residents with 
similar medical conditions. The secondary data analysis will permit an 
analysis of these special populations and will provide policy-relevant 
information to HCFA on future directions for nursing homes. This 
project is in the development phase.
Study of Post-Acute Care
    Period: December 1986-May 1994
    Total Funding: $3,702,330
    Awardee: University of Minnesota, School of Public Health, Post-
Acute Care Project, 704 Washington Ave., SE, Suite 203, Minneapolis, MN 
55414
    Investigator: Robert Kane, M.D.
    This is a study of the course and outcomes of post-acute care. It 
has two major components--an analysis of Medicare data to assess 
differences in patterns of care across the country and to determine the 
extent of substitution where various forms of post-acute care services 
are more or less available and a detailed examination of clinical cases 
from the most common diagnostic-related groupings receiving post-acute 
care in a few selected locations. Measures of the complexity of the 
clinical cases will be developed using a modification of the medical 
illness severity grouping system. This project is jointly funded by the 
Health Care Financing Administration and the Office of the Assistant 
Secretary for Planning and Evaluation. The conditions specifically 
being examined in the clinical analyses are stroke, chronic obstructive 
pulmonary disease, congestive heart failure, hip fracture, and hip 
replacement. The three locations from which patients were obtained for 
the case studies are Houston, Minneapolis/St. Paul, and Pittsburgh. 
Patients and caregivers were followed with interviews 6 weeks, 6 
months, and 1 year after hospital discharge, whether the patients were 
discharged to nursing homes, rehabilitation hospitals, or home. The 
results of direct observation of selected aspects of patients' 
functional ability over time were also recorded. The study will provide 
extensive clinical and functional information about the kinds of 
patients who receive post-acute care and what happens to them.
    The final report was reviewed and accepted in May 1994. This study 
produced a number of important findings. Home health care is usually 
the least expensive PAC choice and often is associated with good 
patient outcomes. Inpatient rehabilitative care is significantly more 
expensive than other forms of care and fails to reduce subsequent 
medical costs. However, in certain cases, it produces better patient 
outcomes. Nursing home care generally does not produce good patient 
outcomes. In many cases, patients who go home without formal home 
health services tend to have good patient outcomes. This underlines the 
critical role of informal caregivers and the need to find ways to 
provide them with support without creating uncontrolled demands for 
payment of their services. Discharge planning choices often fail to 
maximize patient outcomes. However, it may be possible to begin 
developing an empirical data base that relates patient outcomes to 
post-acute care modalities by further refining the methodology used in 
this study.
    The findings from this study are being prepared in the following 
article: Kane, R.L., Finch, M., et. al: 1994. The Use of Home Health 
Care in Post-Hospital Care for Medicare Patients. Health Care Financing 
Review, 15(5), forthcoming.
Policy Study of the Cost Effectiveness of Institutional Subacute Care 
        Alternatives and Services: 1984-92
    Period: May 1990-January 1995
    Funding: $1,427,400
    Awardee: University of Colorado, Health Sciences Center, 1355 South 
Colorado Blvd., Denver, CO 80222
    Investigator: Andrew Kramer, M.D.
    The University of Colorado will assess which subacute institutional 
settings and combinations of services are most cost effective and 
provide more positive outcomes for various types of patients. 
Researchers will identify potential Health Care Financing 
Administration (HCFA) policy changes that might encourage use of the 
most appropriate settings and services. This project will use primary 
and secondary data from three previous HCFA-sponsored studies to 
compare quality, cost effectiveness, case mix, service mix, and 
utilization among institutional subacute care alternatives (e.g., 
skilled nursing facilities and rehabilitation hospitals) within and 
between two time periods--1984-87 and 1990-92. This methodology is 
designed to determine the most cost-effective combinations of services 
and provider settings for various types of patients requiring subacute 
care; i.e., stroke and hip fracture. Functional related groups (FRGs) 
and alternative groupings will be tested to explain variation in 
resource consumption. Several prospective and per-case payment methods 
for selected types of subacute care will be modeled.
    Cross-sectional and longitudinal data collection started in October 
1991. By May 1993, 160 facilities had been recruited and visited. Of 
these facilities, 117 are participating in the longitudinal component. 
The sample from these 160 facilities includes 1,410 Medicare patients 
and 1,040 non-Medicare patients. A report on cross-sectional analysis 
is expected in October 1994 and the report on longitudinal analyses is 
expected in January 1995.
Acute and Long Term Care: Use, Costs and Consequences
    Period: September 1994-August 1997
    Funding: $595,787
    Grantee: The Urban Institute, 2100 M Street, NW, Washington, D.C. 
20037
    Investigator: Korbin Liu, Ph.D.
    This study will provide current information that will aid 
policymakers in developing options to better integrate acute, subacute 
and long term care services. Data from the Medicare Current Beneficiary 
Survey will be used to address three issues: transitions among acute, 
subacute and long term care; ``catastrophic'' costs resulting from the 
use of those services; and the interactions between Medicare and 
Medicaid home health care. The tranistions analysis is designed to 
measure differences in the patterns of acute, subacute and long term 
care by the characteristics of Medicare beneficiaries, and to determine 
potential areas of access or quality of care problems. The costs 
analysis is designed to assess the cumulative risks over 3 years of 
incurring ``catastrophic'' health care costs or experiencing Medicaid 
spend-down. The effects of the Qualified Medicare beneficiaries program 
will be evaluated. The home health care analysis is designed to 
estimate the interactions, and possible overlaps between two rapidly 
expanding public programs that finance similar services. The 
relationship between home health care use and costs, and the personal 
characteristics of Medicare beneficiaries and the characteristics of 
geographic areas, including Medicaid policies, will be estimated. The 
project is in the developmental phase.
Predictors of Access and Effects of Medicare Post-Hospital Care for 
        Beneficiaries 65 Years of Age and Over
    Period: September 1994-September 1996
    Funding: $502,614
    Grantee: Georgetown University, Division of Community Health 
Studies and Family Medicine, Office of Sponsored Programs, 37th & O 
Street, NW, Washington, D.C. 20057
    Investigator: David L. Rabin, Ph.D.
    As a consequence of regulatory and legislative changes in the late 
1980's, Medicare post-hospital care (PHC) has become the most rapidly 
growing Medicare expenditure. PHC consists of home health care, 
inpatient skilled nursing facility care, and rehabilitation 
hospitalization care. The growth in use, changes in eligibility 
requirements, and the increase in Medicare costs have raised questions 
about equal access and the effects of PHC use. The literature on PHC 
suggest two important trends. A few diagnosis-related groups (DRGs) 
account for most PHC, but within these DRGs large variations exist in 
use. Personal health, economic, socio-demographic and household factors 
as well as area and health system characteristics are predictive of use 
of PHC despite equal access under the Medicare program. This study uses 
the Medicare Current Beneficiary Survey to investigate the following 
three major research objectives:
          To describe the personal, area, and health system 
        characteristics of users and those of similar persons with 
        unmet needs for PHC in order to assess differences by gender, 
        race, and income class and potential for substitution of care 
        modes will be examined.
          To study the longitudinal effects of PHC on Medicare program 
        costs and rehospitalization.
          To study the personal health effects associated with PHC.
    This project is in the developmental phase.
Rehabilitating Medicare Beneficiaries at Home
    Period: April 1993-April 1994
    Total Funding: $80,000
    Awardee: Wellmark Healthcare Services, Inc., 60 William Street, 
Wellesley, MA 02181
    Investigator: Samuel Scialabba
    Wellmark intends to conduct a 2-year Medicare demonstration that 
will provide beneficiaries with acute rehabilitation services at home 
as an alternative to more expensive inpatient rehabilitation hospital 
services The Health Care Financing Administration has awarded a 
cooperative agreement to Wellmark to further refine its project design 
to develop information on: specific eligibility and screening criteria 
for patient enrollment, detailed cost data on the proposed service 
package, and informed consent policies to adequately inform patients 
and caregivers of the risks and responsibilities of rehabilitative home 
care. Medicare waivers will be required to allow Wellmark reimbursement 
as a prospective payment system-exempt rehabilitation hospital. Funding 
for the evaluation of this demonstration will be provided by the Robert 
Wood Johnson Foundation as part of a national study entitled Evaluation 
of Innovative Rehabilitation Alternatives and Critical Dimensions of 
Rehabilitative Care.
    A final report has been submitted. A request for Medicare waivers 
to implement the project is under review. The projected implementation 
date for this demonstration is March 1995.
Implementation of the Home Health Agency Prospective Payment 
        Demonstration
    Period: June 1990-June 1995
    Total Funding: $1,629,606
    Awardee: Abt Associates Inc., 55 Wheeler St., Cambridge, MA 02138-
1168
    Investigator: Henry Goldberg
    This contract implements and monitors the demonstration design 
developed by an earlier contract with Abt Associates Inc., The Home 
Health Agency Prospective Payment Demonstration. The project will 
implement a demonstration testing two alternative methods of paying 
home health agencies (HHAs) on a prospective basis for services 
furnished under the Medicare program. The prospective payment 
approaches to be tested are Phase I, payments per visit by type of 
discipline, and Phase II, payments per episode of Medicare-covered home 
health care. Home health agency participation in the demonstration is 
voluntary.
    Following the initial home health agency recruitment, operations of 
the first phase of the demonstration began October 1, 1990. Forty-nine 
HHAs are participating in Phase I. All agencies under Phase I will have 
completed their three year participation in the demonstration as of 
October 1994. Implementation of the second phase testing the per 
episode payment method is scheduled to begin in spring 1995. 
Recruitment for Phase II agencies will begin in Fall 1994. In each 
phase, HHAs that agree to participate are randomly assigned to either 
the prospective payment method or to a control group that continues to 
be reimbursed in accordance with the Medicare current retrospective 
cost system. Each HHA will participate in the demonstration for 3 
years.
Evaluation of the Home Health Prospective Payment Demonstration
    Period: September 1990-June 1995
    Total Funding: $2,858,676 (Phase I)
    Contractor: Mathematica Policy Research, Inc., P.O. Box 2393, 
Princeton, NJ 08543-2393
    Investigator: Randall Brown, Ph.D.
    The purpose of this contract is to evaluate the first phase of a 
demonstration designed to test the effectiveness of using prospective 
payment methods to reimburse Medicare-certified home health agencies 
(HHAs) for services provided under the Medicare program. In Phase I, a 
per visit payment method which sets a separate payment rate for each of 
six types of home health visits (i.e., skilled nursing, home health 
aide, physical therapy, occupational therapy, speech therapy, and 
medical social services) will be tested. Mathematica Policy Research 
will evaluate the effects of this payment method on HHAs' operations, 
quality of services HHAs deliver to Medicare beneficiaries, and 
Medicare expenditures. The contractor will also analyze the 
relationship between patient characteristics and the cost and use of 
HHA services in order to develop improved methodologies for adjusting 
prospective payment rates for case-mix variations.
    By October 1994, all demonstration agencies will have exited the 
demonstration. Mathematica has submitted a preliminary impact report 
based on the findings from the first year of the demonstration. These 
preliminary findings suggest that treatment agencies have not decreased 
their cost per visit, increased their total revenues and net revenues, 
or altered their behavior in ways that affect the quality of home 
health care. The following article discusses preliminary results from 
Phase I of the demonstration: Phillips, B.R., Brown, R.S., et al. 1994 
Do Preset Payment Rates Affect Home Health Agency Behavior? Health Care 
Financing Administration, 15(5), forthcoming.
Quality Review for the Home Health Agency Prospective Payment 
        Demonstration
    Period: September 1991-December 1994
    Total Funding: $1,499,085
    Contractor: New England Research Institute, Inc., 9 Galen St., 
Watertown, MA 02172
    This contract involves quality review of the care received by 
Medicare beneficiaries who are clients of the home health agencies that 
are participating in the Home Health Agency Prospective Payment System 
demonstration (HHA/PPS). The HHA/PPS demonstration is testing the costs 
and benefits of prospective payment for Medicare home health services 
compared to the current retrospective cost reimbursement system. In 
order to assure that the incentives created under the HHA/PPS 
demonstration do not result in the provision of inadequate home health 
care to Medicare beneficiaries, the New England Research Institute, 
Inc. (NERI), the quality review contractor, implemented the quality 
assurance plan that calls for a review of patient records for a sample 
of Medicare beneficiaries receiving care under the HHA/PPS 
demonstration. If potential or actual problems are discovered, the 
contractor implements a defined protocol to address the situation.
    During the initial year of the contract, NERI staff completed all 
of the activities related to the start-up of the quality assurance 
plan, including baseline training for nurse reviewers. Throughout the 
demonstration period, NERI assessed patterns of problems within home 
health agencies, which require educational follow-up or additional 
medical reviews. As the Phase I demonstration period was completed 
September 30, 1994, NERI has completed analysis of its final sample of 
records.
Evaluation of Phase II of the Home Health Agency Prospective Payment 
        Demonstration
    Period: September 1994-September 1999
    Funding: $3,528,408
    Contractor: Mathematica Policy Research, Inc., P.O. Box 2393, 
Princeton, N.J. 08543-2393
    Investigator: Barbara Phillips, Ph.D.
    This contract will evaluate Phase II of the Home Health Agency 
Prospective Payment demonstration. This demonstration is testing two 
alternative methods of paying home health agencies (HHAs) on a 
prospective basis for services furnished under the Medicare program. 
The prospective payment approaches that are being tested include 
payments per visit per types of discipline (Phase I), and payment per 
episode of Medicare-covered home health care (Phase II). Implementation 
of Phase II, which will test the per episode payment approach, is 
scheduled to begin in Spring 1995. HHAs that agree to participate in 
the demonstration are randomly assigned to either the prospective 
payment method or to a control group that continues to be reimbursed in 
accordance with the current Medicare retrospective cost system. HHAs 
will participate in the demonstration for 3 years.
    The evaluation will combine estimates of program impacts on costs, 
service use, access and quality with detailed information on how 
agencies actually change their behavior to produce a full understanding 
of what would happen if prospective payment replaced the current 
payment methodology nationally. The findings will indicate not only the 
overall effects of the change in payment methodology, but also how the 
effects are likely to vary with the characteristics of agencies and 
patients. This information will be of great value for estimating the 
potential savings from a shift to prospective payment for home health 
care, for identifying types of patients who might be at risk of 
restricted access to care as a result of their need for an unusually 
large amount of care. Because of the relatively small number of HHAs 
participating in the demonstration, the use of qualitative information 
obtained in discussion with agencies concerning their characteristics 
and behavior will be essential for avoiding erroneous inferences. This 
project is in the developmental phase.
Determinants of Home Health Use
    Funding: Intramural
    Investigator: Elizabeth Mauser, Ph.D.
    Modifications in the eligibility requirements for home health 
services, implementation of the prospective payment system in 
hospitals, and beneficiary preferences to remain in the community have 
resulted in significant increases in home health care expenditures. 
Although home health expenditures continue to rise, relatively little 
is known about home health users and market characteristics that affect 
home health use. Consequently, we have implemented several intramural 
studies to support future efforts of policy reform in the area of post 
acute care. Using the Medicare Current Beneficiary Survey (MCBS), we 
are exploring:
          Whether home health users can be classified into distinct 
        subgroups in order to understand the special care needs of home 
        health users, determine how specific policies affect different 
        groups of users, and develop case mix adjustments for payment 
        reform.
          How home health use has changed over time using 1991, 1992, 
        and 1993 MCBS.
          The effect of supply factors on home health use by linking 
        the MCBS with the Area Resource File.
          The extent of substitution among different post acute care 
        settings such as skilled nursing, home health and 
        rehabilitation facilities. To identify beneficiaries using 
        rehabilitation services, we are linking the MCBS with the 
        provider of service files.
    Using the 1992 MCBS, we have examined the characteristics of 
beneficiaries using home health as well as estimating multivariate 
models of the factors that affect utilization and expenditures. Based 
on this work, the following article is being prepared: Mauser, E., and 
Miller, N.A. 1994. A Profile of Home Health Users in 1992. Health Care 
Financing Review, 15(5), forthcoming.
Maximizing the Cost Effectiveness of Home Health Care: The Influence of 
        Service Volume and Integration with Other Care Settings on 
        Patient Outcomes
    Period: September 1994-December 1997
    Funding: $1,231,466
    Grantee: Center for Health Policy Research, 1355 South Colorado 
Boulevard, #706, Denver, CO 80222
    Investigator: Peter W. Shaughnessy, Ph.D.
    Home health care (HHC) is the most rapidly growing component of the 
Medicare program in recent years. The rapid growth in home health 
utilization has occurred despite limited evidence about the necessary 
volume of HHC to achieve optimal patient outcomes and whether it 
substitutes for more costly institutional care. Little is known about 
integrating HHC with care in other settings to reduce overall health 
care costs. The central hypotheses of this study are: volume-outcome 
relationships are present for HHC for common patient conditions; upper 
and lower volume thresholds exist that define the range of services 
most beneficial to patients; and a strengthened physician role and 
better integration of HHC with other services during an episode of care 
can optimize patient outcomes while controlling costs. To test these 
hypotheses, a total of 3,600 patients will be enrolled from a 
nationally representative sample of home health agencies. Trained data 
collectors at each agency will record patient health status and service 
information between HHC admission and discharge to assess patient 
outcomes and costs within the HHC episode. Long term, self-reported 
outcomes will be assessed from telephone interview data at HHC 
admission and at 6-month followups. These primary data concerning 
patient status and outcomes will be combined with Medicare claims data 
over the episode of care to assess the relationship between service 
volume in HHC and both patient outcomes and costs. Analyses of data 
relating to physician involvement and the sequence of use of other 
providers will address issues of integration with other services. This 
project is in the development phase.
Development of Outcome-Based Quality Measures for Home Health Services
    Period: September 1988-June 1994
    Funding: $1,965,389
    Contractor: University of Colorado, Center for Health Policy 
Research, 1355 South Colorado Boulevard, Denver, CO 80222
    Investigator: Peter Shaughnessy, Ph.D.
    The purpose of this study is to develop and test outcome-based 
measures or indicators of qualify for Medicare home health services. 
The measures are designed for use in monitoring and comparing quality 
of home health care across agencies. The study was designed to have 
three phases. During the first phase, a number of approaches to home 
health care quality assurance and quality measurement were examined. In 
the second phase, data sets, data collection approaches, and 
measurement methods were assessed and a manageable set of outcome 
measures was developed. The measures include both end-result outcomes 
(i.e., measures of patient status and utilization) and intermediate-
result outcomes (i.e., measures of nonphysiological or nonfunctional 
status intrinsic to the patient or caregiver). During the third phase, 
data will be collected from a nationally representative sample of 49 
home health agencies.
    The third and final phase of the study was designed to 
systematically collect data for assessing the reliability, validity, 
and utility of each outcome measure. In this phase, longitudinal data 
were collected to measure outcomes for approximately 3,000 patients 
from 49 home health agencies. Further, preliminary analysis from this 
final phase of the study resulted in an initial design for a Medicare 
home health quality assurance demonstration.
    The final report was submitted in July 1994. The report outlines 
the findings and conclusion from the final empirical phase of the study 
and presents the proposed home and health outcomes measures system.
    A summary of the findings are being prepared in the following 
article: Shaughnessy, P., Crisler, K.S., et al. 1994. Measuring and 
Assuring the Quality of Home Health Care. Health Care Financing Review, 
15(5), forthcoming.
Design and Implementation of Medicare Home Health Quality Assurance 
        Demonstration
    Period: September 1994-May 1999
    Funding: $3,234,881
    Grantee: Center for Health Policy Research, 1355 South Colorado 
Boulevard, Denver, CO 80222
    Investigator: Peter W. Shaughnessy, Ph.D.
    Currently, Medicare's home health survey and certification process 
is primarily focused on structural measures of quality. Although this 
process provides important information about home health care, an 
approach based on patient outcome measures would substantially increase 
the Medicare program's capacity to assess and improve patient well 
being. To address this need, the Medicare home health quality 
demonstration will test an approach to developing outcome-oriented 
quality assurance and promoting continuous quality improvement in home 
health agencies. The demonstration is designed to serve two purposes: 
(1) increase HCFA's capacity to assess the quality of Medicare home 
health care services; and (2) increase health agencies' ability to 
systematically evaluate and improve patient outcomes. The proposed 
quality assurance approach would complement existing home health 
certification and review programs and could be used with current survey 
and certification, and PRO intervening care screen approaches. The 
study's conceptual framework for home health quality assessment is 
based on home health outcome measures developed under a HCFA-funded 
study by the University of Colorado, entitled ``Development of Outcome-
Based Quality Measures in Home Health Services'' (contract No. 500-88-
0054). This project is in the developmental stage.
Home Care Quality Studies
    Period: October 1989-September 1995
    Total Funding: $2,848,782
    Contractor: University of Minnesota, School of Public Health, Box 
197, 420 Delaware St., SE., Minneapolis, MN 55455
    Investigator: Robert Kane, M.D.
    For this study, the contractor will carry out research on the 
following topics:
          Quality of long-term care services in community-based and 
        custodial settings.
          Effectiveness of (and need for) State and Federal protections 
        for Medicare beneficiaries that ensure adequate access to 
        nonresidential long-term care services and protection of 
        consumer rights.
    The contractor will focus on in-home care, examining traditional 
home health services that are reimbursed by Medicare and Medicaid, as 
well as personal care and supportive services which have more recently 
been covered by Federal and State sources of funding. Primary project 
tasks include:
          Development of a taxonomy clarifying the various objectives 
        and goals ascribed to home and community-based care from the 
        various perspectives of consumers, payers, and care providers.
          Development and feasibility-testing of a survey design that 
        would measure the extent of, need for, and adequacy of home 
        care services for the elderly.
          A study of variations in labor supply and related effect(s) 
        on home care quality, as well as factors that contribute to 
        these variations.
          Recommendations to improve the quality of home and community-
        based services by identifying best practices and promising 
        quality assurance approaches.
    The first project task (development of a taxonomy of goals and 
objectives) has been completed, and a report on this component has been 
received. The University of Minnesota is continuing work on each of the 
remaining primary tasks. The final report for this contract is expected 
in September 1995.
    Findings from this project will be presented in the following 
article: Kane, R.L., et al., 1994. Multiple Perspectives on Quality of 
Home Care, Health Care Financing Review, 15(5), forthcoming.
Study of Home Health Care Quality and Cost under Capitated and Fee-for-
        Service Payment Systems
    Period: June 1987-February 1994
    Total Funding: $1,683,773
    Awardee: Center for Health Policy Research, 1355 South Colorado 
Blvd., Denver, CO 80222
    Investigator: Peter Shaughnessy, Ph.D.
    This project is designed to evaluate service utilization, quality, 
and cost of Medicare home health care provided under capitated and 
noncapitated (fee-for-service) payment systems. The Center for Health 
Policy Research will collect patient-level, case-mix, and service use 
data on a sample of approximately 4,000 patients from 44 agencies 
nationwide. A random and stratified patient sample will be drawn from 
both fee-for-service and capitated payment environments to assess and 
compare cost effectiveness of care, quality of care, and incentives to 
admit and provide care in the two payment environments. Secondary data 
analysis will also be completed on a sample of 10,000 Medicare 
beneficiaries using Medicare claims data to compare service use 
patterns among post-hospital Medicare patients discharged to skilled 
nursing facilities, home health care facilities, and the community, as 
well as Medicare home health patients admitted from the community.
    The Final Report was submitted in February 1994. The data indicate 
that fee-for-service patients had better home health outcomes and 
higher costs than managed care patients. Further, managed care patients 
in health maintenance organization (HMO)-owned home health agencies had 
poorer outcomes than patients who received care from HMO-contractual 
agencies. Typically, the fee-for-service patients received more home 
health visits than HMO patients and within the managed care 
environment, HMO-owned home health agency patients received fewer 
visits than HMO-contractual agency patients. The findings suggest that 
HMOs and particularly HMO-owned home health agencies are overly 
restrictive in providing home health services.
    The findings from this study are being prepared in the following 
article: Shaughnessy, P.W., Schenkler, R.E., et al. 1994. Home Health 
Outcomes Under Capitated and Fee-for-Service Payment. Health Care 
Financing Review, 15(5), forthcoming.
Sources of Medicare Home Health Expenditure Growth: Implications for 
        Control Options
    Period: February 1992-February 1995
    Funding: $210,706
    Awardee: Brandeis University, Heller School, Bigel Institute for 
Health Policy, P.O. Box 9110, Waltham, MA 02254
    Investigator: Christine Bishop, Ph.D.
    The overall objective of the project is to develop and consider 
options for restraining home health expenditure growth. The project has 
two phases. The first is to use secondary data to examine Medicare home 
health expenditure growth from 1985 through 1989, and from 1989 through 
1991 to attribute total growth to the growth in the number of persons 
served, visits per person, mix of visits, and visit charges; and to 
attribute growth to types of agencies by auspice and scale. The second 
is to examine data from the Regional Home Health Intermediary data base 
to measure variations in types of patients served at intake, and 
characteristics of high use patients, by auspice and region, and to 
consider difference in mix and intensity of services provided.
    The first phase of the project was completed, resulting in an 
overview, entitled ``Recent Growth in Medicare Home Health: Sources and 
Implications.'' An edited version of this analysis was published in 
Health Affairs (Fall 1993). The second phase will be completed in 
February 1995.
Study of Medicare Home Health Agency Use of the Home Health Care 
        Management Benefit
    Period: September 1991-January 1993
    Total Funding: $81,848
    Awardee: Project HOPE Research Center, 7500 Old Georgetown Road, 
Suite 600, Bethesda, MD 20814-6133
    Investigator: Robyn Stone, Ph.D.
    For this study, researchers will analyze Medicare claims and plan 
of treatment data for home health agencies (HHAs) in order to examine 
the provision of skilled patient management by HHAs. Recent information 
suggests that the use of this service has significantly increased in 
recent years as a result of changes in the interpretation of coverage 
requirements for home health care. This study will provide the Health 
Care Financing Administration with information on the characteristics 
of patients who are receiving this service, and the types of HHAs that 
are furnishing the service.
    Construction of data/analytical files is complete. These files were 
used to conduct episode analyses and to link plan-of-treatment 
information with Medicare claims data. The final report for this 
project has been submitted and is under review.
Determinants of Home Care Costs
    Period: August 1990-January 1993
    Funding: $125,140
    Awardee: Brandeis University Research Center, 415 South S., 
Waltham, MA 02254
    Investigator: Christine Bishop, Ph.D.
    The original purpose of this project was to investigate the 
determinants of formal and informal home care and the mix of the two 
types of care. However, two shortcomings in the data from Connecticut 
Community Care, Inc. (CCCI) for the study period preclude this: (1) 
prior to January 1991, only the services paid for by CCCI and not other 
sources (eg., Medicaid) were included; and (2) detailed information was 
not available for informal care. Instead, the study will investigate 
the patterns and determinants of nursing home use in this community-
based population. In addition, Medicaid spend-down among a community-
based population will be analyzed.
    The final report, entitled ``Converting to Medicaid in the 
Community: The Forgotten Stepchild'', has been completed. In the study 
sample, about eight percent of the persons were found to enroll in the 
Medicaid program while still living in the community over a 53-month 
observation period. As expected, community conversion to Medicaid is 
driven largely by financial status. What was not expected was that 
Medicaid conversion did not appear to be influenced by the use of 
medical services. This study did not find any significant relationship 
between use of drugs or use of hospitals and Medicaid conversion. 
However, the study did find a marginally significant relationship 
between temporary nursing home use and conversion. The results also 
indicate that functional and cognitive status was not significantly 
related to Medicaid conversion. The final report will be sent to the 
National Technical Information Service.
Improving the Discharge Planning Process
    Period: March 1994-March 1995
    Funding: $130,471
    Contractor: University of Minnesota, School of Public Health, Box 
197,420 Delaware St., SE., Minneapolis, MN 55455
    Investigator: Robert Kane, M.D.
    Enactment of the Medicare prospective payment system has focused 
attention on discharge planning. The increased pressure to eliminate 
medically unnecessary hospital days and the shorter amount of time 
available for discharge planning has underscored the need to develop a 
discharge planning process that better relates post acute care services 
to patient outcomes. The purpose of this project is to examine 
approaches to improving discharge planning at both the micro and policy 
level and recommend innovative research or demonstration projects. 
Currently, a concept paper is bearing developed and a Technical Expert 
Panel will meet in winter 1995.
Analysis and Comparison of State Board and Care Regulations and Their 
        Effect on the Quality of Care in Board and Care Homes
    Period: September 1991-September 1991
    Total Funding: $200,000
    Awardee: Office of the Assistant Secretary for Planning and 
Evaluation, Room 410-E, Hubert H. Humphrey Building, 200 Independence 
Ave., SW., Washington, DC 20201
    Investigator: Catherine Hawes, Ph.D.
    The Health Care Financing Administration (HCFA) has transferred 
funds to the Office of the Assistant Secretary for Planning and 
Evaluation (ASPE) in support of an existing contract with the Research 
Triangle Institute (RTI). ASPE has funded RTI to conduct a study to 
examine the relationship between the type and amount of State 
regulation and the quality of care in board and care homes. In 
addition, the study will document the characteristics of a large sample 
of board and care homes, their residents, and owners/operators. HCFA's 
support will enable the contractor to increase the project's sample 
size to allow for analysis of the relationship between additional 
characteristics of board and care homes and to conduct a more detailed 
field test.
    The following 10 states have been selected to participate in the 
study: New Jersey, Texas, Oklahoma, Georgia, Kentucky, Arkansas, 
Florida, Illinois, California, and Oregon. Survey instruments are 
currently under revision and pre-test activities are underway in 
facilities in North Carolina and the District of Columbia.
A 1994/1995 National Health Interview Survey Disability Supplement
    Period: June 1993-June 1994
    Award: Interagency Agreement
    Agency: Centers for Disease Control, National Center for Health 
Statistics, 6325 Belcrest Road, Room 850, Hyattsville, MD 20782
    Investigator: Owen Thornberry
    The Health Care Financing Administration's (HCFA) transfer of funds 
to the National Center for Health Statistics is in support of the 
implementation of the 1994/1995 disability survey as a supplement to 
the National Health Interview Survey. Although HCFA provides extensive 
support for the disabled through Medicare and Medicaid, very little is 
known about this population. The National Health Interview Survey 
Disability Supplement (NHISDS) will be the first comprehensive survey 
on the disabled in 15 years. The NHISDS will be conducted during 1994 
and 1995 calendar years, with approximately 250,000 people of the 
96,000 sampled households. The survey will consist of two phases:
          Phase I will screen the relevant populations and will collect 
        basic descriptive information.
          Phase II will obtain information on all household members who 
        experience limitations caused by a health condition.
    Data from Phase I will be used to make estimates of the prevalence 
of disability and to determine eligibility for Phase II questionnaires. 
In Phase II, separate questionnaires will be given to adult and child 
respondents. This survey will be the first source of information to 
determine the size, characteristics, service use, and out-of-pocket 
costs for individuals with mental retardation and related conditions. 
The survey of children will provide information on the number, 
characteristics, severity, and effects on families of children with 
disabilities. This survey will collect information on income and 
assets, along with basic disability information, to better understand 
the characteristics of actual and potential Supplemental Security 
Income recipients. The information gathered from the NHISDS will be 
crucial for addressing a broad number of HCFA policy concerns affecting 
persons with disabilities.
    The questionnaires for the disability supplement have been revised. 
Phase I interviews began in January 1994 and Phase II adult and 
children interviews began during summer 1994.
Long-Term Care Survey
    Period: September 1990-February 1993
    Award: Interagency Agreement
    Agency: National Institute on Aging, 9000 Rockville Pike, Bethesda, 
MD 20892
    Investigator: Richard Sussman
    The Office of the Assistant Secretary for Planning and Evaluation 
and the Health Care Financing Administration agree to transfer funds to 
the National Institute on Aging (NIA) to support an existing NIA grant 
to Duke University, Center for Demographic Studies. This grant, number 
1R37AG07198, is entitled Functional and Health Changes of the Elderly, 
1982-89. The National Long-Term Care Survey (NLTCS) is a detailed 
household survey of persons 65 years of age or over who have some 
chronic (90 days or more) functional impairment. The survey has been 
administered three times. The first, conducted in 1982, was devised as 
a cross-sectional survey. The second conducted in 1984, added a 
longitudinal component to the sample design. The third, administered in 
1989, used the cohorts from the previous surveys in addition to persons 
becoming 65 years of age to form a nationally representative sample of 
impaired elderly persons. To facilitate the use of the data base, the 
following tasks related to the 1982, 1984, and 1989 NLTCSs will be 
carried out under this agreement:
          File linkage over the entire period 1982-89.
          Derivation of new longitudinal sample weights.
          Linkage of Medicare administrative records.
          Improvement of coding by checking consistency of survey 
        items.
          Improvement in survey documentation.
          Seminars and education.
    A second version of the public use data file, containing Medicare 
Part A and B files, was sent to the Michigan Archives in fall 1993. 
This public use version can be obtained from Michigan Archives by 
calling (313) 763-5011. However, this second version has recently been 
found to have incomplete Medicare data for certain years; another 
version with complete Medicare data will be sent once Medicare files 
have been received from HCFA.
Long-Term Care Program and Market Characteristics
    Period: February 1992-September 1995
    Funding: $808,047
    Awardee: University of California, San Francisco, Office of 
Research Affairs, 3333 California Street, Suite 11, San Francisco, 
California 94143-0962
    Investigator: Charlene Harrington, Ph.D.
    This project will collect data on and study the effects of nursing 
home and home health care characteristics and markets for Medicare and 
Medicaid services in 50 States. Primary and secondary data for the 
1990-93 period will be collected to update earlier data collected in 
previous studies for the 1978-89 period. A comprehensive survey will 
collect data on licensed nursing home bed supply and occupancy rates, 
State certificate-of-need programs, State preadmission screening 
programs, and Medicaid nursing home and home health reimbursement. A 
special analysis will provide detail on each States' current 
methodology for determining nursing home capital costs, the impact of 
proposed case-mix reimbursement on operating income, reimbursement 
methodology for free-standing sub-acute services/units, and Medicaid 
methodology used to reimburse for care in board and care homes, 
geriatric day care centers, and ICF-MR facilities. A public use 
database will be prepared to provide a complete set of data for the 
period 1978-93.
    The first 2 years of the project have been completed, with a 
continuation of the studies for the third year under way. An additional 
study is planned for the third year to collect information on State 
loan programs to identify those agencies making loans to health care 
facilities. The following State data book that presents data on long-
term care program and market characteristics across the 50 States and 
the District of Columbia has been published: State Data Book on Long-
Term Care Program and Market Characteristics, Health Care Financing 
Extramural Report, HCFA Pub. No. 03354.
Long-Term Care Studies (Section 207)
    Period: September 1989-July 1995
    Funding: $3,790,000
    Contractor: Health and Sciences Research Incorporated, 9302 Lee 
Highway, Suite 500 Fairfax, VA 22031
    Investigator: David Kennell
    The purpose of this project is to conduct research related to the 
Health Care Financing Administration's Medicare and Medicaid programs 
in the area of long-term care (LTC) policy development. The contractor 
will focus primarily on four major areas:
          The financial characteristics of Medicare beneficiaries who 
        receive or need LTC services.
          How the Medicare beneficiaries' characteristics affect their 
        utilization of institutional and noninstitutional LTC services.
          How relatives of Medicare beneficiaries are affected 
        financially and in other ways when beneficiaries require or 
        receive LTC services.
          How the provision of LTC services may reduce expenditures for 
        acute care health services.
    Analyses will use existing LTC and other survey data bases (e.g., 
the National Long-Term Care Surveys, the Longitudinal Study of Aging, 
the National Nursing Home Survey, the Survey of Income and Program 
Participation, and the National Medical Care Expenditure Survey). 
Medicare administrative records and other extant information will also 
be utilized. A number of focused analytic studies, policy reports, 
syntheses, and special studies are required under the contract.
    With the repeal of the Medicare Catastrophic Coverage Act of 1988, 
this project is no longer congressionally mandated. A large number of 
studies have been initiated, and several draft reports have been 
received. Current studies include:
          Health Care Service Use and Expenditures of the Non-
        Institutionalized Population
          An Examination of the Relation of Part A and Part B Medicare 
        Expenditures
          The Catastrophic Costs of Long Term Care
          Issues in Long Term Care Policy for the Disabled Elderly with 
        Cognitive Impairment
          Synthesis of Literature on Targeting to Reduce Hospital Use
          Synthesis on Reimbursement Options for Medicaid and Medicare 
        Nursing Home Stays
          Elderly Wealth and Savings; Implications for Long Term Care
          Synthesis of the Literature on Effectiveness of Special 
        Assistive Devices in Managing Functional Impairment
          Nursing Home Bed Supply: Synthesis of the Literature and 
        State Initiatives
          Synthesis of the Literature on Unmet Need for Long Term Care 
        Services
          Synthesis of the Literature on Financing and Delivery of Long 
        Term Care for the Disabled Non-Elderly
          Analysis of Nursing Home Payment with Current Beneficiary 
        Survey (CBS) Data
          Analysis of Informal and Formal Care
          The Potential of Coordinated Care Targeted to Medicare 
        Beneficiaries with Medicaid Coverage
          Analysis of Non-Participation in the 2176 Program
          Regional Variations in Medicare Home Health
          Case Studies of Medicaid Estate Planning
          Effect of Geographic Variations on Medicare Capitation Rates
          Consumer Protection and Private LTC Insurance
          Key Issues for Private LTC insurance
          Simulations of SNF Payment Options
          Longitudinal Health Care Use and Expenditures of Disabled 
        Persons
          Interrelationship of Medical Conditions in the Nursing Home 
        Population
          Analysis of Post-Acute Care and Therapy Services Using the 
        HCFA Episode Database
          Analysis of Choice Processes in Capitated Plan Enrollment: 
        Statistical Models for Evaluation of Voluntary Demonstration 
        Projects
          Analysis of Transitions in the Characteristics of the LTC 
        Populations
          Costs of Medicare Skilled Nursing Facility Therapy
          Catastrophic Costs and Medicaid Spenddown
          State Responses to Medicaid Estate Planning
    A conference to present selected findings of the contract was 
convened November 1994 and conference proceedings will be published by 
July 1995.
Testing the Predictive Validity of Using Medicare Claims Data to Target 
        High-Cost Patients
    Period: August 1991-July 1993
    Total Funding: $139,898
    Awardee: Brandeis University Research Center, P.O. Box 9110, 
Waltham, MA 02254-9110
    Investigator: Christine Bishop, Ph.D.
    For this study, Brandeis will investigate the feasibility of using 
historical Medicare claims data of patients hospitalized with certain 
primary diagnoses in order to identify a subset of patients who are 
more likely to incur high levels of Medicare reimbursements in the 
future. Analysis will be restricted to a sample of hospital patients 
with selected illnesses where past research indicates the specific 
patient diagnosis eventually results in higher Medicare costs, and it 
is determined that targeted case management or coordinated care 
programs can be potentially effective (based on research and/or 
professional clinical judgment) in reducing overall health care costs.
    A preliminary study design has been completed. However, the 
development of an analytic research file has been delayed. The final 
report for this project is anticipated in late 1994.
Interaction of Medicaid and Private Long-Term Care Insurance
    Period: August 1991-July 1993
    Funding: $80,000
    Awardee: Brandeis University Research Center, 415 South St., 
Waltham, MA 02254
    Investigator: Christine Bishop, Ph.D.
    For this study, researchers will examine the characteristics of 
purchasers and nonpurchasers of private long-term care insurance, the 
types of insurance purchased, and the role of State Medicaid program 
characteristics and personal characteristics in influencing the 
purchase decision.
    The study found, that after accounting for available control 
variables, purchase of private long-term care insurance is less likely 
where Medicaid supports a relatively high level of input intensity in 
nursing homes; where nursing home beds are more available; and where 
higher-income persons may be eligible for Medicaid as ``medically 
needy'' due to nursing home spending. These results suggest that the 
Medicaid ``safety-net'' deters long-term care insurance purchase, and 
that improvements, in Medicaid coverage of long-term care may further 
suppress demand for private long-term care insurance. The final report 
will be sent to the National Technical Information Service.

                  Future Directions for Long-Term Care

    During 1994, HCFA devoted substantial resources to the further 
development and implementation of demonstrations to test the cost-
effectiveness of prospective payment systems for nursing homes and home 
health agencies, to implement and monitor new coordinated care systems 
for the frail elderly, and develop outcome-oriented quality measures to 
improve the quality of care in these settings.
    We will continue to test alternative financing schemes for long 
term care services, including implementation of the Multi-State Nursing 
Home Case Mix and Quality Demonstration. The Home Health Agency 
Prospective Payment Demonstration will continue during 1995.
    We will continue our efforts to develop, operate, and evaluate 
coordinate care systems for the frail elderly, including the Medicare 
Alzheimer's Disease Demonstration, the Program for the All-inclusive 
Care of the Elderly Demonstration, the Social/Health Maintenance 
Organization Demonstration, the Community Nursing Organization 
Demonstration, and the EverCare Demonstration.
    We also will continue the development and testing of outcome-
oriented measures of quality for nursing home and home health services 
and assessment of the applicability of using payment generated data to 
monitor quality. In this light, we will implement a multi-State 
demonstration integrating resident assessment and case-mix payment data 
with the quality assurance process for nursing home providers.
    Another very important area that will continue to be explored is 
alternative financing mechanisms for long-term care. Although the 
majority of the elderly are covered by both Medicare and supplemental 
insurance, a large portion of long-term care services remain uncovered. 
Medicaid covers long-term nursing care, but only after the elderly 
individuals have depleted their resources. Research is continuing that 
will identify the sources of financing for long-term care at various 
points throughout institutionalization. This research will further 
examine characteristics of individuals who come to rely upon Medicaid 
for payment for their care. By identifying the risks associated with 
nursing home use, we hope to be able to propose improved methods of 
paying for this care. Alternatives being studied as a solution for some 
of the elderly's problems in financing long-term care are life care 
centers and private long-term care insurance. Other ORD financing 
research continues to examine various States' reimbursement of long-
term care in order to assess the feasibility of recommending policy 
changes, e.g., prospective payment for SNF care.
    We will continue to support data collection and data analyses from 
projects that gather detailed information from representative national 
samples or other large segments of the elderly population. Research is 
continuing on the estimated future acute and long term care utilization 
based on information from available surveys on the morbidity, 
disability and mortality of different birth cohorts. We will continue 
initiatives to make additional data bases available for research and 
analysis, such as the 1989 Long Term Care Survey, State Medicaid data, 
and the Medicare Current Beneficiary Survey.
    In 1995, we also will continue an evaluation of the Community 
Supported Living Arrangements (CSLA) program, mandated by section 4712 
of OBRA 90. Eight States are receiving funding through this optional 
Medicaid State plan service to develop CSLA programs, in which service 
individuals with mental retardation and relate conditions living in the 
community independently, with their family or in a home of three or 
fewer individuals. HCFA will also expand its research activities 
related to the nonelderly disabled. In particular, we will be working 
with State Medicaid agencies to develop integrated systems for 
providing acute and long-term care services to various subgroups of the 
disabled, including those dually eligible for Medicare and Medicaid, 
SSI recipients, and others.

                      OFFICE OF INSPECTOR GENERAL

                              Introduction
    The mission of the Office of Inspector General (OIG), as mandated 
by Public Law 95-452, as amended, is to protect the integrity of HHS 
programs, as well as the health and welfare of beneficiaries served by 
those programs. The OIG has a responsibility to report both to the 
Secretary and to the Congress program and management problems and 
recommendations to correct them. The OIG's statutory mission is carried 
out through a nationwide network of audits, investigations, and 
inspections.
    The OIG's Office of Audit Service (OAS) provides auditing services 
for HHS, either by conducting audits with its own audit resources or by 
overseeing audit work done by others. Audits examine the performance of 
HHS programs and/or its grantees and contractors in carrying out 
programs and operations in order to reduce waste, abuse, and 
mismanagement and to promote economy and efficiency throughout the 
Department.
    The OIG's Office of Investigations (OI) conducts criminal, civil 
and administrative investigations of allegations of wrongdoing in HHS 
programs or to HHS beneficiaries. The investigative efforts of OI lead 
to criminal convictions or civil judgments, program exclusions or civil 
monetary penalties. The OI also oversees State Medicaid fraud control 
units which investigate and prosecute fraud and patient abuse in the 
Medicaid program.
    The OIG's Office of Evaluation and Inspections (OEI) conducts 
short-term management and program evaluations (called inspections) that 
focus on issues of concern to the Department, the Congress and the 
public. The findings and recommendations contained in these inspection 
reports generate rapid, accurate, and up-to-date information on the 
efficiency, vulnerability, and effectiveness of departmental programs.
    Over the years, OIG findings and recommendations have been the 
basis for extensive oversight hearings and legislation improving the 
management of the department's programs. The OIG acts as an independent 
fact finder, with no vested interest in particular programs or 
operations. The OIG performs a variety of self-initiated reviews as 
well as reviews requested by the Secretary, departmental senior staff, 
and congressional committees. The OIG works with departmental and 
congressional officials, so long as such relationships do not 
compromise our independence or integrity.

                            Accomplishments

    Our continuing resource constraints demand that we direct our 
activities with great care while streamlining our work force and 
expenditures. This is a challenge all Government agencies are facing, 
and we take it very seriously. At the same time, FY 1994 was a year of 
noteworthy successes. Our total savings surpassed $8 billion, which 
represents $80 in savings for each dollar invested in OIG and $6.4 
million in savings per OIG employee. Our accomplishments included a 
record $379 million settlement of criminal fines, civil damages, and 
penalties for fraud and kickbacks by a health care corporation.
                              Health Care
    To leverage our limited resources, we continue to coordinate our 
activities with a number of outside entities, especially in the health 
care area. Working with the Department of Justice, the Federal Bureau 
of Investigation and the HHS Office of General Counsel, we are 
developing a voluntary disclosure program to offer certain federally 
funded health care providers incentives to disclose any fraud and abuse 
they discover within their companies. We are also embarking on a 
Federal/State partnership with State auditors to provide broader audit 
coverage of significant Medicaid issues.
    Over the years, OIG findings and recommendations have contributed 
to many significant reforms in the Medicare program. Such reforms 
include implementation of the prospective payment system (PPS) for 
inpatient hospital services and fee schedule for physician services; 
the Clinical Laboratory Improvement Amendments of 1988; regional 
consolidation of claims processing for durable medical equipment (DME); 
establishment of fraud units at Medicare contractors; prohibition on 
Medicare payment for physician self-referrals; and new payment 
methodologies for graduate medical education (GME).
    The OIG has documented excessive payments for hospital services, 
indirect medical education, DME and laboratory services, leading to 
statutory changes to reduce payments in those areas. To ensure quality 
of patient care, OIG has assessed clinical and physiological 
laboratories; evaluated the medical necessity of certain services and 
medical equipment; analyzed various State licensure and discipline 
issues; reviewed several aspects of medical necessity and quality of 
care under PPS, including the risk of early discharge; and evaluated 
the care rendered by itinerant surgeons and the treatment provided by 
physicians performing in-office surgery.
    Electonic Data Interchange and Paperless Processing.--This OIG 
report identifies emerging issues in the expansion of HCFA's use of 
electronic data interchange and related technology to achieve paperless 
processing. Some significant issues affecting implementation of this 
initiative are: the development of systems to process electronically 
submitted claims and manage data more efficiently; the establishment of 
standards to facilitate the electronic flow of data among providers, 
payers and quality of care reviewers; the identification of incentives 
and barriers, to encourage providers to submit claims and patient data 
electronically; and the use of companion technologies. The report also 
discusses concerns involving the trustworthiness and reliability of 
data as it moves from one partner in electronic commerce to another and 
from one process to another.
    Medicare Secondary Payer.--The OIG has estimated that the Medicare 
program may be paying out as much as $1 billion a year unnecessarily 
because Medicare fiscal intermediaries and carriers do not always 
identify the primary payers, and because insurers, underwriters and the 
third party administrators often do not pay as primary payers when they 
are required to do so. This problem, which was first identified as a 
high risk area in 1989, has been addressed through several initiatives, 
including proposals for legislative remedies and legal actions against 
noncomplying insurers.
    Use of Nursing Home and Medigap Guides.--The Assistant Secretary 
for Public Affairs (ASPA) requested that OIG examine departmental 
strategies for distributing various publications to ensure that they 
are received by intended users. As part of its 1993 Medicare 
beneficiary satisfaction survey, OIC questioned beneficiaries about 
their awareness of two HCFA booklets that provide guidance to Medicare 
beneficiaries and their families: Guide to Choosing a Nursing Home and 
Guide to Health Insurance for People with Medicare. The OIG determined 
that less than 15 percent of the beneficiaries surveyed know about the 
booklets, and only 2 percent or fewer had ever used either of them. The 
OIG found that beneficiaries who used the booklets found them useful, 
and most beneficiaries stated that they would use the guides if they 
needed nursing home care or Medigap insurance. The OIG recommended that 
HCFA work with SSA and ASPA to develop a more effective strategy to 
make the guides available to beneficiaries. All three agencies agreed 
with the recommendation and have begun to explore ways to make the 
booklets more accessible to beneficiaries.
                            Social Security
    The Office of Inspector General reviews all aspects of SSA's 
programs and operations, including: disability insurance benefits, 
information resources management, program integrity and efficiency, 
quality of service, representative payees and SSI benefits. The OIG is 
also providing oversight to SSA's financial management by auditing 
SSA's financial statements, examining internal controls and reporting 
on the status of debt management activities.
    Social Security Client Satisfaction.--The OIG has conducted annual 
client satisfaction surveys of Social Security beneficiaries since 
1987. In the overview report of this year's survey, OIG noted that 
overall satisfaction had leveled off after a few years of decline. Over 
77 percent of respondents rated service as good or very good. However, 
disabled clients gave markedly lower satisfaction ratings than 
nondisabled clients in this and prior years. This is significant 
because the proportion of disabled clients in OIG's sample has 
increased over the last 3 years, consistent with an increase in SSA's 
disability workloads. Moreover, these lower ratings account for the 
decline in overall satisfaction since 1990. Factors that continued to 
foster high satisfaction ratings were staff job performance and staff 
courtesy, while service delays appeared to lower satisfaction. A 
separate report on client subgroups noted that non-English speaking 
clients and clients with frequent contact with SSA were less satisfied 
than other clients, but key indicators of service delivery in urban 
offices had significantly improved.
    Satisfaction with 800 Number.--We compared local and 800 number 
telephone service based on client responses to the last three Social 
Security client satisfaction surveys. A review of over 30 questions 
showed no real difference in satisfaction between clients who called 
the 800 number and callers to local offices. For example, both groups 
gave similar ratings on staff job performance, staff courtesy and the 
clarity of explanations given by staff. Differences were identified in 
only three areas; local callers' overall satisfaction ratings remained 
essentially unchanged for 3 years, while 800-number callers' ratings 
declined; SSI clients were more likely to call a local number than the 
800 number; and access, measured by the number of call attempts 
required to reach SSA, appeared to have improved for urban local 
callers and declined for rural local callers.

     OFFICE OF THE ASSISTANT SECRETARY FOR PLANNING AND EVALUATION

    The Office of the Assistant Secretary for Planning and Evaluation 
(ASPE) serves as the principal advisor to the Secretary on policy and 
management decisions for all groups served by the Department, including 
the elderly. ASPE oversees the Department's legislative development, 
planning, policy analysis, and research and evaluation activities and 
provides information used by senior staff to develop new policies and 
modify existing programs.
    ASPE is involved in a broad range of activities related to aging 
policies and programs. It manages grants and contracts which focus on 
the elderly and coordinates other activities which integrate aging 
concerns with those of other population groups. For example, the 
elderly are included in studies of health care delivery, poverty, 
State-Federal relations and public and private social service programs.
    ASPE also maintains a national clearinghouse which includes aging 
research and evaluation materials. The ASPE Policy Information Center 
(PIC) provides a centralized source of information about evaluative 
research on the Department's programs and policies by tracking, 
compiling and retrieving data about on-going and completed HHS 
evaluations. In addition, the PIC database includes reports on ASPE 
policy research studies, the Inspector General's program inspections 
and investigations done by the General Accounting Office, the 
Congressional Budget Office and the Office of Technology Assessment. 
Copies of final reports of the studies described in this report are 
available upon completion from PIC.
    During 1994, staff of the Office of the Assistant Secretary for 
Planning and Evaluation undertook or participated in the following 
analytic and research activities which had a major focus on the 
elderly:
                      1. Policy Development--Aging
                   task force on alzheimer's disease
    As a member of the DHHS Council on Alzheimer's Disease, each year 
ASPE helps prepare the annual report to the Congress on selected 
aspects of caring for persons with Alzheimer's disease. The report 
focuses on the Department's current and planned services research 
initiatives on Alzheimer's disease.
         federal interagency forum on aging-related statistics
    ASPE is a member of the Federal Interagency Forum on Aging-Related 
Statistics (The Forum). The Forum was established to encourage the 
development, collection, analysis, and dissemination of data on the 
older population. The Forum seeks to extend the use of limited 
resources among agencies through joint problem solving, identification 
of data gaps and improvement of the statistical information bases on 
the older population that is used to set the priorities of the work of 
individual agencies.
         departmental data planning and analysis working group
    The Data Planning and Analysis Working Group chaired by ASPE 
analyzes Departmental data requirements and develops plans minimizing 
barriers to full utilization of such data. The Group identifies needs 
for data within HHS, evaluates the capacity of current systems to meet 
these needs and prepares recommendations for ensuring effective and 
efficient performance of HHS data systems.
                  long-term care microsimulation model
    During 1994 ASPE continued to use extensively the Long-Term Care 
Financing Model developed by ICF, Inc. and the Brookings Institute. The 
model simulates the utilization and financing of nursing home and home 
care services by a nationally representative sample of elderly persons 
for the period 1986 to 2020. It gives the Department the capacity to 
simulate the effects of various financing and organizational reform 
options on future public and private expenditures for nursing home and 
home care services.
                 2. Research and Demonstration Projects
Institute for Research on Poverty, University of Wisconsin
    Robert M. Hauser, Principal Investigator.
    A research agenda of diverse but interrelated two-year studies 
concerned with the relationships between poverty and family structure, 
education and social welfare, child support and paternity, labor force 
behavior, and welfare dependence. In the 1991-93 biennium there are no 
projects dealing exclusively with the elderly. However, the Institute 
does do a number of activities and publishes a number of materials on 
poverty which include the elderly as an important subgroup.
    Funding: Fiscal Years 1993-95--$3,300,000
    End Date: June 1996
                     panel study of income dynamics
    University of Michigan, Institute for Social Research
    James N. Morgan, Greg J. Duncan, and Martha S. Hill, Principal 
Investigators
    Through an interagency consortium coordinated by the National 
Science Foundation (NSF contributes approximately $1.5 million per 
year), ASPE assists in the funding of the Panel Study of Income 
Dynamics (PSID). This is an ongoing nationally representative 
longitudinal survey that began in 1968 under the auspices of the Office 
of Economic Opportunity. The PSID has gathered information on family 
composition, attitudes, employment, sources of income, housing, 
mobility, and a host of other subjects every year since then on a 
sample of approximately 5,000 families and has followed all original 
sample members that have left home. The current sample size is over 
7,000 families. The data files have been disseminated widely and are 
used by hundreds of researchers both within this country and in 
numerous foreign countries to get an accurate picture of changes in the 
well-being of different demographic groups including the elderly.
    Funding: ASPE (and HHS precursors)--FY67 through FY79--$10,559,498; 
FY80--$698,952; FY81--$600,000; $200,000; FY93--$250,999; FY84--
$550,000; FY85--$300,000; FY86--$225,000; FY87--$250,000; FY88--
$250,000; FY89--$250,000; FY90--$300,000; FY93--$300,000; FY94--
$800,000
                      health and retirement study
    University of Michigan, Survey Research Center
    Principal Investigator: Tom Juster
    The Survey of Health and Retirement is a new nationally 
representative longitudinal survey that will gather data on health and 
retirement issues from U.S. households. In addition, financial and 
background histories will be gathered. Data from the survey are 
expected to be used for investigating how changes in the Social 
Security system and private pension systems have affected retirement 
plans. These data will support research on health care needs and costs. 
The survey was jointly sponsored by the Department of Health and Human 
Services and the National Institute on Aging (NIA).
    Funding: NIA--FY91--$2,500,000; FY92--$2,500,000; FY93--$2,500,000; 
FY94--$100,000
 analysis and comparison of state board and care regulations and their 
         effects on the quality of care in board and care homes
    Research Triangle Institute
    Catherine Hawes, Principal Investigator
    As the Nation's long-term care system evolves, more emphasis is 
being placed on home and community-based care as an alternative to 
institutional care. Community-based living arrangements for dependent 
populations (disabled elderly, mentally ill, persons with mental 
retardation/developmental disabilities) play a major role in the 
continuum of long-term care and disability-related services. Prominent 
among these arrangements are board and care homes.
    There is a widespread perception in the Congress and elsewhere that 
too often board and care home residents are the victims of unsafe and 
unsanitary living conditions, abuse and neglect by operators, and 
fraud. There is also the perception that an increasing number of board 
and care residents are so disabled that they require a level of care 
greater than board and care operators are able to provide.
    This project will analyze the impact of State regulations on the 
quality of care in board and care homes and document characteristics of 
board and care facilities, their owners and operators, and collect 
information on the health status, level of dependency, program 
participation and service needs of residents.
    Funding: FY 1989--$350,000; FY 1990--$300,000; FY 1991--$400,000
    End Date: September 1995
              evaluation of the elderly nutrition program
    Mathematica Policy Research
    Michael Ponza
    At the request of Congress (Section 206 of the 1992 Older Americans 
Act Amendments), the Department of Health and Human Services is 
conducting an evaluation of the Elderly Nutrition Program. The 
evaluation, which is co-sponsored by ASPE and the Administration on 
Aging, will provide reliable estimates of the impact of the program's 
nutritional components on the nutrition, health, functioning, and 
social well being of participants. It will also describe how the 
program is administered, operated and funded, and the effectiveness of 
those components. The study will also describe and compare the 
characteristics of congregate and home-delivered meal participants, and 
assess how well the program is reaching special populations, such as 
low-income and minority elderly.
    Funding: FY 1993--$1,200,000; FY 1994--$1,245,000
    End Date: September 1995
                 post-acute care for medicare patients
    University of Minnesota
    Robert Kane, Principal Investigator
    The primary objective of this study is to describe the ``natural 
history'' of care received by patients with five different impairments 
(identified by DRG) in three post-acute care modalities. These 
modalities include home health care, skilled nursing care, and 
rehabilitation. This study will not only provide a history of what care 
was delivered in which settings, but will also assess and compare 
outcomes and costs of care across settings and impairments. In 
addition, the study will determine the factors that influence hospital 
discharge decisionmaking. This study's findings may then be used to 
construct a revised payment method for post-acute care in the Medicare 
program.
    Two sets of data will be collected. The first set will contain 
information from hospital discharge records and pre and post discharge 
client interviews in three U.S. cities. The second set will include a 
20 percent national sample of Medicare acute care discharges to be 
linked with the utilization files of Medicare covered services provided 
in post-acute care settings. Data collection has been completed, and 
the analysis phase is currently underway.
    Funding: FY 1987 $500,000; FY 1988 $727,000; FY 1989 $695,335
    End Date: October 1994
                  a national study of assisted living
    Research Triangle Institute--Catherine Hawes, Principal 
Investigator
    Assisted living refers to residential settings that combine 
housing, personal assistance and other supportive service arrangements 
for persons with disabilities. These settings are thought to offer 
greater autonomy and control to consumers over their living and service 
arrangements than is typically provided by more traditional residential 
settings, such as nursing homes or board and care homes.
    Where assisted living fits in the long-term care system and its 
potential for addressing the needs of the elderly and persons with 
disabilities is the focus of this ASPE study. The study will examine 
the role of assisted living from the perspective of consumers, owners, 
workers, regulators, developers and investors, and others who have a 
stake in the Nation's long-term care system.
    The study will focus on such issues as (a) trends the supply of 
assisted living facilities, (b) barriers to development, (c) the 
existing regulatory structure, (d) the extent to which assisted living 
embodies in reality the principles of consumer automony and choice in a 
supportive residential setting, and (e) the effect of such features (or 
their absence) on persons who live and work in assisted living 
facilities. The contractor will interview legislators, regulators, 
housing finance agency experts at the State and national levels; speak 
with investors and developers; and survey over 900 assisted living 
operators, plus their staffs and residents across the country.

   PUBLIC HEALTH SERVICE--CENTERS FOR DISEASE CONTROL AND PREVENTION

   1994 Update of Senate Special Committee on Aging's Annual Report, 
                         Developments in Aging
  national center for chronic disease prevention and health promotion
    The Health Promotion and Education Database and Cancer Prevention 
and Control Database contain health information that pertains to aging. 
The databases include disease prevention, health promotion, and health 
education information on nutrition, smoking cessation, cholesterol, 
high blood pressure, injury prevention, exercise, weight management, 
stress management, diabetes mellitus, and breast and cervical cancer 
screening. The databases are a valuable resource for health providers 
working with the elderly. They are available through CDC's CDP (Chronic 
Disease Prevention) File CD-ROM, the Public Health Service's Combined 
Health Information Database (CHID) and CDC's WONDER/PC system. CDP File 
is available from the Superintendent of Documents, Government Printing 
Office, Washington, DC 20402, 202-512-1800 (Stock No. 717-145-00000-3). 
CHID can be accessed through most library and information services. 
Persons who wish to access CHID directly can contact CDP Online, 333 
Seventh Avenue, New York, NY 10001, 1-800-950-2035. For more 
information about WONDER/PC, contact CDC WONDER/PC Customer Support at 
404-332-4569.
    In 1990, the Aging Studies Branch in the Division of Chronic 
Disease Control and Community Intervention was established to: (1) 
conduct epidemiological research, investigations, and surveillance of 
selected chronic diseases and conditions in older adults; (2) develop 
and evaluate prevention strategies and demonstration projects; and (3) 
provide consultation and technical assistance to States and other 
agencies. Research and programmatic efforts are focused on 
musculoskeletal diseases (osteoarthritis, osteoporosis), chronic and 
neurological disease (Alzheimer's disease), urinary incontinence, 
depression, developing measures of health status and quality of life, 
assessing long-term care needs among minorities and promoting/
supporting State efforts in these areas.
    Musculoskeletal diseases are prevalent and disabling chronic 
diseases, affecting approximately 38 million persons in the United 
States. Data indicate that 49.4 percent of persons 65 years and older 
have symptomatic musculoskeletal diseases and 11.6 percent of persons 
in this age group have arthritis as a major or contributing cause of 
activity limitation. Data are needed to describe the natural history of 
disease as well as to direct development of effective intervention 
efforts. CDC has several projects underway addressing these issues 
related to osteoporosis and arthritis. Chronic neurological diseases, 
conditions common among elderly, rank high in measures of morbidity, 
disability, family stress, and economic burden. For example, the costs 
due to dementias alone were estimated at $24-$48 billion in 1985, and 
will increase as the population ages. However, the epidemiology of 
these conditions is poorly understood. CDC is collaborating in a 
research study to better understand the epidemiology of Alzheimer's 
disease.
    Urinary incontinence (UI), the involuntary loss of urine so severe 
as to have social or hygienic consequences, affects 15-30 percent of 
community-dwelling older people and at least half of all nursing home 
residents. UI costs are conservatively estimated at $10.3 billion 
annually. UI goes largely untreated in millions of people, although a 
third of cases can be cured and another third helped significantly. CDC 
is investigating incidence and prevalence rates for different types of 
UI in those 65 and older using National Health and Nutrition 
Examination Survey-Epidemiologic Follow-up Study. CDC has funded 
intervention demonstration projects in two States and one university to 
develop and evaluate strategies to decrease disability due to this 
cause among older individuals. Results from these efforts should be 
forthcoming in the next year.
    Quality of life is often thought to be more valuable than quantity 
of life. Several of the measures have been included in the Behavioral 
Risk Factor Surveillance System (BRFSS) to assess quality of life in 
the States. Findings from the 1993 BRFSS indicate population subgroup 
differences in health-related quality of life that can be used to 
target intervention efforts.
    Other projects are examining: co-morbidities among older adults 
hospitalized with depression, unusual kidney disease among the Zuni 
Indians, long-term care needs among Southwest Americans Indians, and 
surveillance of neurological problems resulting from folate 
supplementation in Vitamin B12 deficient individuals.
    The CDC-funded Center for Health Promotion in Older Adults (CHPOA) 
at the University of Washington School of Public Health is focused on 
``Keeping Older People Healthy and Independent.'' Compared with those 
receiving standard HMO care, seniors at the HMO Group Health 
Cooperative of Pugent Sound who had a nurse-educator assessment and up 
to six interventions had fewer injurous falls, fewer restricted 
activity days, and better physical function. The Center has identified 
muscle weakness, lack of physical activity, psychoactive drugs, and 
home hazards as preventable risk factors for falls and hip fractures 
which are devastating and costly problems of older adults. The Center 
also found that a low-cost, low-risk program emphasizing group exercise 
at a community senior center produced significant improvements in 
physical function, pain, and indicators of depression. In addition, the 
Center demonstrated a model of social activation necessary for health 
promotion among elderly residents of low-income housing facilities.
    Diabetes is a major contributor to morbidity and mortality among 
persons 65 and older. An estimated 2,810,000, or 9 percent of all 
Americans 65 years of age and older have diagnosed diabetes, compared 
with less than 2 percent of all Americans below age 65. Each year about 
181,000 new cases of diabetes are identified among those who are 65 and 
older. In 1990, diabetes contributed to over 128,000 deaths and an 
estimated 1,650,000 hospitalizations among Americans 65 and older. 
About $5.2 billion in direct medical costs can be attributed annually 
in the United States to diabetes among persons 65 and older. Across all 
population groups, diabetes accounts for about $91 billion in direct 
costs and lost productivity each year in the United States.
    During 1994, CDC's effort continued to focus on the prevention of 
eye disease and cardiovascular disease associated with diabetes. All 
diabetes control programs funded through cooperative agreements with 46 
State and territorial health departments currently address visual 
impairment associated with diabetes and at least one of the following 
complications: lower extremity disease or cardiovascular disorders 
associated with diabetes. In 1990, among Americans with diabetes age 65 
and older, there were 31,000 hospital discharges for non-traumatic 
amputations, In 1989, 62,135 diabetic persons over age 65 died of 
cardiovascular disease (CVD); CVD is the cause of death for 80 percent 
of all diabetic persons over 65. In 1989, 4,791 persons over 65 years 
of age began treatment for end-stage renal disease. Decisions about 
diabetes control program directions reflect State judgments about 
disease burden, past program direction and interests, and existing 
resources within the Department of Health. In FY 1995, as a new 5-year 
project period began, diabetes control programs will evolve from highly 
localized demonstration projects to central coordinative mechanisms of 
fully developed programs, involving the entire State health system, to 
reduce the burden of diabetes. As such, their activities will be 
organized around, (1) defining the diabetes burden, (2) developing new 
approaches to reducing the diabetes burden, (3) implementing specific 
measures to reduce the burden of diabetes, and (4) coordinating overall 
program efforts of the health care system to reduce the burden of 
diabetes.
    Breast cancer is the most commonly diagnosed cancer and the second 
leading cause of death from cancer among American women. Breast and 
cervical cancer tend to be diagnosed in advanced stages relative to 
advancing age. Breast cancer mortality could be reduced by up to 30 
percent, among women over age 50, if currently recommended screening 
guidelines, including mammography and clinical breast examinations were 
followed (PHS 1991). Cervical cancer mortality rates continue to 
decrease from 14.8/100,000 in 1973/74 to 3.0/100,000 in 1990. However, 
in those women 50 and older, the rates are still significantly higher 
than those of women under the age of 50, 2 and 1.3 respectively. Recent 
data indicate that older women have not been receiving routine 
screening for cervical cancer. Currently, CDC is funding 50 States, 3 
territories, and the District of Columbia through the National Breast 
and Cervical Cancer Early Detection Program.
                national center for environmental health
    The National Center for Environmental Health (NCEH) has finalized 
Phrase III of the 5-year observation study of women experiencing the 
climacteric, and a manuscript is in the process. Risk factors for 
osteoporosis were studied. The study has shown that women have hormone-
dependent bone loss before menopause and that androgens as well as 
estrogens may be important to maintaining bone density in women.
    CDC also maintains the national accuracy base for the 
standardization of lipid and lipoprotein measurements by maintaining 
reference methods for cholesterol, triglyceride, and high-density 
lipoprotein cholesterol. In collaboration with the National Heart, 
Lung, and Blood Institute, CDC provides standardization service to 150 
domestic and international lipid laboratories participating in 
longitudinal studies and clinical trials involving lipid metabolism and 
the assessment of risk factors associated with coronary heart disease. 
CDC has also established a national reference method laboratory network 
for cholesterol. This network standardizes clinical laboratories and 
manufacturers of diagnostic products to assist in meeting the Healthy 
People 2000 objective that at least 90 percent of clinical laboratories 
measure cholesterol within the recommended national standard for 
accuracy.
                 national center for health statistics

                               Background

    The National Center for Health Statistics (NCHS) is the Federal 
Government's principal health statistics agency. The NCHS data systems 
address the full spectrum of concerns in the health field from birth to 
death, including overall health status, life style, and onset and 
diagnosis of illness and disability, and the use of health care.
    The Center maintains over a dozen surveys and vital statistics data 
files that collect health information through personal interviews; 
physical examination and laboratory testing; review of hospitals, 
nursing home, and physician records; administrative records; and other 
means. These data systems, and the analysis and reports that follow, 
are designed to provide information useful to a variety of policy 
makers and researchers. NCHS frequently responds to requests for 
special analyses of data that have already been collected and solicits 
broad input from the health community in the design and development of 
its surveys.
    Since most of the data systems maintained by NCHS encompass all age 
groups in the population, a broad range of data on the aging of the 
population and the resulting impact on health status and the use of 
health care are produced. For example, NCHS data have documented the 
continuing rise in life expectancy and trends in mortality that are 
essential to making population projections. Data are collected on the 
extent and nature of disability and impairment, limitations on 
functional ability, and the use of special aids. Surveys currently 
examine the use of hospitals, nursing homes, physicians' offices, home 
health care and hospice, and are being expanded to cover hospital 
emergency rooms and surgi-centers.
    In addition to NCHS surveys of the overall population that produce 
information about the health of older Americans, a number of activities 
provide special emphasis on the aging. They are described below.

                    A Focal Point for Data on Aging

    NCHS has established a focal point for data on aging by creating a 
position of Coordinator of Data on Aging. Dr. Joan F. Van Nostrand is 
the Coordinator. This focal point cuts across the Center's data systems 
to coordinate:
          The collection, analysis and dissemination of health data on 
        older Americans,
          International research in data on aging, and
          Measurement research in aging in such areas as development of 
        questions on cognitive impairment for population-based surveys 
        and assessment of disability.
    The Coordinator provides information to the general public about 
NCHS activities and data on aging Americans.

 International Collaborative Effort on Measuring the Health and Health 
                           Care of the Aging

    NCHS launched the International Collaborative Effort on Measuring 
the Health and Health Care of the Aging (abbreviated as the ICE on 
Aging) in 1988. The purpose of the ICE on Aging is to join with 
international experts in conducting research to improve the measurement 
of health and health care of the aging. Research results will be 
applied to the Center's programs to strengthen the collection, 
analyses, and dissemination of data on older persons. Results also will 
be disseminated widely to encourage their international application. 
The international emphasis of the research permits the exchange of 
perspectives, approaches, and insights among nations facing similar 
situations and challenges. The first International Symposium on Data on 
Aging was held in late 1988 to develop proposals for research in 
selected areas. Proceedings from the 1988 Symposium were published in 
1991 in the Center's Vital and Health Statistics Series. The following 
research projects began in 1989:
          Comparative Analysis of Health Statistics for Selected 
        Diseases Common in Older Persons--Hip Fracture: USA and Hong 
        Kong;
          Measuring Outcomes of Nursing Home Care: USA, Australia, 
        Canada, The Netherlands, Norway;'
          The Measurement of Vitality in Older Persons: USA, Italy and 
        Israel;
          Health Promotion and Disease Prevention Among the Aged: USA 
        and the Netherlands; and
          Functional Disability: USA, Canada, and Hungary.
    A second International Symposium presenting interim results of 
these research projects was held in 1991. Proceedings were published in 
1993. A third and final international symposium is planned for 1995-96 
to present final research results. Articles presenting data from the 
hip fracture research and the nursing home outcomes research have been 
published:
          Van Nostrand, J.F., R. Clark, and T. Romoren. Nursing home 
        care in five nations. Ageing International: XX, 2.1-6. 1993.
          Ho, S., et al. Hip fracture rates in Hong Kong and U.S., 
        1988-89. American Journal of Public Health. 93(5) 694-97.
    NCHS has issued several Information Updates for the ICE on Aging. 
They described each research project in depth and detail progress. To 
be placed on the mailing list for past and future Information Updates, 
contact the NCHS Coordinator of Data on Aging, Joan F. Van Nostrand, 
DPA, Room 1120, National Center for Health Statistics, 6525 Belcrest 
Road, Hyattsville, MD 2782, phone (301) 436-7104.

         Federal Interagency Forum on Aging-Related Statistics

    The NCHS, in conjunction with the National Institute on Aging and 
the Bureau on the Census, co-chairs the Federal Interagency Forum on 
Aging-Related Statistics. The Forum encourages communication and 
cooperation among Federal agencies in the collection, analysis, and 
dissemination of data on the older population. The Forum membership 
consists of over 20 Federal agencies that produce or analyze data on 
the aging population.
    In 1994, the Forum has produced the following publications. Copies 
are available from the NCHS Coordinator of Data on Aging:
          Cohen, R.A., and J.F. Van Nostrand. Highlights from Trends in 
        the Health of Older Americans: United States, 1994. National 
        Center for Health Statistics, 1994.
    Forum activities for 1995 include:
          Publication of a report titled Trends in the Health of Older 
        Americans: United States, 1994 Vital Health Statistics 3 (30), 
        1995.
          Publication of a bibliography. Health of an Aging America: 
        1994 Bibliography, Guide to Reports About Older Americans from 
        the National Center for Health Statistics.
          Development of a report on the relationship between health 
        promotion activities and mortality.
          Development of a report on projections of the health and use 
        of care of older Americans in the 21st century.

       Measuring Cognitive Impairment in Population-Based Surveys

    A Work Group has been established by the Federal Interagency Forum 
on Aging-Related Statistics with the task of measuring cognitive 
impairment in national, population-based surveys. The Work Group is to 
produce field-tested questions on cognitive impairment and its impact 
on functional disability. These questions will be suitable for 
national, population-based surveys which focus on the elderly. This 
activity builds on the previous work of the Forum in developing 
research recommendations for strengthening assessment of cognitive 
impairment. Activities in 1994 included a presentation at the Third 
Practical Aspects of Memory Conference at the University of Maryland 
entitled Issues in Measuring Impairment in National Sample Surveys. 
Specific activities for 1994-95 are to: (1) Identify the state-of-the-
art in measuring cognitive impairment of the elderly in national 
surveys, (2) implement a research agenda for strengthening its 
measurement in national surveys, (3) conduct field-tests of questions. 
The final product will be several sets of tested questions on cognitive 
impairment and functional disability which could be used in national, 
population-based surveys of the elderly.

                       Vital Statistics on Aging

    Mortality statistics from the national vital statistics system 
continue to play an important role in describing and monitoring the 
health of the elderly population. The data include measures of life 
expectancy, causes of death, and age-specific trends in death rates. 
The basis of the data is information from death certificates, completed 
by physicians, medical examiners, coroners, and funeral directors, used 
in combination with population information produced by the U.S. Bureau 
of the Census.
    At NCHS two efforts are currently underway to both assess and 
improve mortality data for the elderly. NCHS is looking into the 
possibility of increasing the level of age detail shown in tabulations 
of mortality for the elderly, focussing on the age group 85 years and 
over, which is often treated in tabulations as an aggregated category. 
As life expectancy has increased, the need for detailed mortality data 
for the ``extreme aged'' has increased accordingly. Current efforts 
involve assessing both the availability and quality of mortality and 
population data for more detailed age groups among the elderly.
    Also under study is the process by which medical information on the 
death certificate is collected, including issues related to the format 
of the cause-of-death section. The format presently in use, prescribed 
by the World Health Organization, requests that the certifying 
physician report a single causal chain of medical events that led to 
death, initiated by an ``underlying'' cause of death. The single 
sequence concept presents difficulties in certification for some 
elderly deaths which may reflect the consequences of several concurrent 
disease processes. These and other issues related to certification are 
now under study.

          National Mortality Followback Survey: 1986 and 1993

    The 1986 National Mortality Followback Survey (NMFS) was the first 
such survey in 18 years. Over 100 papers and publications have used the 
data. The followback survey broadens the information available on the 
characteristics of mortality among the population of the United States 
from the routine vital statistics systems by making inquiry of the next 
of kin of a sample of decedents. Because two-thirds of all deaths in 
the Nation in a year occur at age 65 or older, the 1986 survey focussed 
on the study of health and social care provided to older decedents in 
the last year of life. This is a period of great concern for the 
individual, the family and community agencies. It is also a period of 
heavy care use. Agency program planning and national policy development 
on such issues as hospice care and home care can be informed by the 
data from the survey. A public use data tape from the next-of-kin 
questionnaire was released in 1988. A second tape, combining data from 
the next-of-kin and hospitals and other health care facilities, was 
available in 1990. Several survey reports focused on the aging. They 
were about persons dying of diseases of the heart, cerebrovascular 
disease, utilization of home health care and nursing homes, and risk 
factors associated with the elderly.
    A pretest of the 1993 National Mortality Followback Survey was 
completed in June, 1992 and field operations for the main survey began 
in July 1994. The 1993 NMFS design parallels the design of the 1986 
survey, with an additional emphasis on deaths due to external causes 
(homicide, suicide, and accidents) and disability in the last year of 
life. Hospital records are not included in the 1993 survey; however, 
medical examiner/coroner records are included for deaths referred to 
medical examiners/coroners. To investigate death among the elderly, a 
specific sub-sample of 1,000 centenarians will be included in the 
survey. Release of a public use data tape is anticipated for mid-1996.

            National Health Interview (NHIS): Special Topics

    The NHIS continues to collect data on a wide range of special 
health topics for the civilian, non-institutionalized population, 
including the aging population. Data collection has begun for 1994-95 
for the special health topics on disabilities. The disability topic has 
two phases. The first phase questionnaire identifies persons with 
disabilities. The second phase collects detailed information about 
persons identified as having a disability.
    Disability Phase 1 includes section on.--Sensory, communication and 
mobility problems; selected chronic conditions; activities and 
instrumental activities of daily living (ADL/IADL); functional 
limitations (including work disability); mental health; services and 
benefits; self-perceived disability; condition pages; (the following is 
asked only of persons under 18 years of age) special health needs of 
children; early child development; education; and relationships to 
respondent.
    Disability Phase 2 includes section on.--Housing and long-term care 
services; transportation; social activity; work history/employment; 
vocational rehabilitation; assistance with key activities; other 
services; self direction; communication (the following is asked only of 
persons 70 years and over) family structure, relationships and living 
arrangements; conditions and impairments; help with care; health 
opinions and behaviors; community services and social support; and 
interviewer observations.
    Data collection for an NHIS data year begins in January of that 
year and ends in December. Public-use data tapes are usually available 
about one year after the end of data collection.

                  Second Supplement on Aging (SOA II)

    In 1994 the National Center for Health Statistics will conduct a 
second Supplement on Aging (SOA II) as part of the National Health 
Interview Survey. Interviews will be conducted with a nationally 
representative sample of approximately 10,000 civilian non-
institutionalized Americans age 70 years and older. The study will 
provide important data on the elderly that can be compared with similar 
data from the 1984 SOA. In addition SOA II may serve as a baseline for 
a second Longitudinal Study on Aging (LSOA-II), which would follow the 
baseline cohort through one or more followback waves.
    Information for SOA II will be obtained from the 1994 NHIS core 
questionnaire and Phase 1 of the 1994 Disability Supplement (both of 
which are administered to household respondents), from functional 
limitation questions asked of all healthy and disabled elderly age 70 
years and older as part of Phase 2 of the Disability Supplement, and 
from questions on a separate Supplement on Aging asked of all 
individuals age 70 years and older. Both the Phase 2 Disability 
Supplement and the Supplement on Aging will be administered during a 
separate contact, 6 to 9 months after the core questionnaire. Survey 
questions and methodology will be similar to the first Longitudinal 
Study on Aging (LSOA-I), but improvements will reflect a number of 
methodological and conceptual developments that have occurred in the 
past decade, as well as suggestions made by users of LSOA-I and others 
in the research community.
    A primary objective of SOA II is to examine changes which may have 
occurred in physical functioning and health status among the elderly 
over the past decade. To this end, questions concerning physical 
functioning and health status and their correlates will be repeated in 
SOA II. These include questions on Activities of Daily Living (ADL), 
Instrumental Activities of Daily Living (IADL), and functional 
limitations (Nagi), as well as medical conditions and impairments, 
family structure and relationships, and social and community support. 
In addition to these repeated items, the SOA II questionnaire has been 
expanded to include information on risk factors (tobacco and alcohol 
use), additional detail on both informal and formal support services, 
and questions concerning the use of prescription medications.
    The data, when used in conjunction with data from LSOA-I, will 
enable users to identify changes in functional status, health care need 
so living arrangements, social support, and other important aspects of 
life across two cohorts with different life course perspectives. This 
will provide researchers and policy planners with an opportunity to 
examine trends and determinants of ``healthy aging.''

                      Longitudinal Study on Aging

    The Longitudinal Study on Aging (LSOA) has been a collaborative 
effort of the National Center for Health Statistics and the National 
Institute of Aging. The baseline information for the LSOA came from the 
Supplement on Aging (SOA), a supplement to the 1984 National Health 
Interview Survey (NHIS).
    The SOA included 16,148 persons 55 years of age and over living in 
the community in 1984. The Supplement obtained information on housing, 
including barriers and ownership; support, including number and 
proximity of living children and recent contacts in the community; 
retirement, including reasons for retirement and sources of retirement 
income; and measures of disability, including activities of daily 
living, instrumental activities of daily living and ability to perform 
work-related activities.
    The sample for the LSOA came from the 7,541 persons who were 70 
years of age and older at the time of the SOA in 1984. The survey was 
designed to measure changes in functional status and living 
arrangements, including institutionalization. Reinterviews were 
conducted in 1986, 1988, and 1990. The recontacts were primarily by 
telephone using Computer Assisted Telephone Interviewing (CATI); 
however, when the telephone contact was not feasible, a mail 
questionnaire was sent to the sample person. In addition, to the three 
reinterviews, permission was obtained from the sample person or proxy 
to match their records with other records maintained by the Department 
of Health and Human Services.
    The fourth version of the LSOA public use data tape was released in 
October 1991. The information for the Version 4 files was obtained 
from:
          1984 NHIS, SOA, and Health Insurance Supplement to the NHIS
          1986, 1988, and 1990 telephone interviews with mail follow-up
          1984-1989 National Death Index (NDI) match
          1984-1990 Medicare records match
    The public use data tape includes three files--one for persons, one 
for Medicare hospitalizations, and one for other Medicare use. Each 
file includes the information obtained in the previous reinterviews. 
These data are also available on CD-ROM. A diskette containing detailed 
multiple cause of death data for the LSOA sample is available. The 
diskette complements the Version 4 public use data tape. Future 
releases of the LSOA public use data tape will include information from 
additional matches to the NDI and Medicare files.
    The LSOA public use data sets are available from three sources: The 
National Technical Information Service (NTIS), The Division of Health 
Interview Statistics, NCHS, and the National Archives of Computerized 
Data on Aging. The diskette on multiple cause of death is available 
from NTIS.

          National Health and Nutrition Examination Survey III

    The National Health and Nutrition Examination Survey (NHANES) 
provides valuable information available through direct physical 
examinations of a probability sample of the population. The third cycle 
of this survey, NHANES III, went into the field in 1988. Data 
collection ended in October 1994. NHANES III will provide a unique data 
base for older persons, as a number of important methodologic changes 
have been made in the survey structure. There is no upper age limit 
(previous surveys had an age limit of 74 years), and the sample has 
been selected to include approximately 1,300 persons aged 80 or older. 
The focus of the survey includes many of the major chronic diseases of 
aging which cause morbidity and mortality including cardiovascular 
disease, osteoarthritis, osteoporosis, pulmonary disease, dental 
disease and diabetes. Preliminary Data on Nutrition for the Elderly has 
been published in McDowell MA, Briefel RR, Alaimo K, et al. Energy and 
Macronutrient Intakes of Persons Ages Two Months and Over in the United 
States: Examination Survey, Phase 1, 1988-91. Advance Data from Vital 
and Health Statistics; No. 255. Hyattsville, Maryland: National Center 
for Health Statistics, 1994.
    In addition to the focus on nutrition, information on social, 
cognitive and physical function is incorporated into the survey. Data 
from home examinations will be available for those unable or unwilling 
to come to the central examination site, the Mobile Examination Center.

                 NHANES I Epidemiologic Followup Study

    The first National Health and Nutrition Examination Survey (NHANES 
I) was conducted during the period 1971-75. The NHANES I Epidemiologic 
Followup Study (NHEFS) tracks and reinterviews the 14,407 participants 
who were 25-74 years of age when first examined in NHANES I. NHEFS was 
designed to investigate the relationships between clinical, 
nutritional, and behavioral factors assessed at baseline (NHANES I) and 
subsequent morbidity, mortality, hospital utilization, as well as 
changes in risk factors, functional limitation and 
institutionalization. Followups were conducted in 1982-84, 1986 
(limited to persons age 55 and over at baseline) and 1987. Data 
collection for the fourth wave of the followup, the 1992 NHEFS, was 
completed in June 1993. The preliminary editing phase is underway and 
is scheduled for completion in February 1994. Detailed editing will 
begin March 1994 and is scheduled to be completed in February 1995.
    While persons examined in NHANES I were all under age 75 at 
baseline, by 1987 more than 3,600 subjects were over 75, providing a 
valuable study group to examine the aging process. Public use data 
tapes are available from the National Technical Information Service for 
the first three waves of followup. Each set of four tapes contain 
information on vital and tracing status, subject and proxy interviews, 
health care facility stays in hospitals and nursing homes, and 
mortality data from death certificates. All NHEFS Public Use Data Tapes 
can be linked to the NHANES I (baseline) Public Use Data Tapes.

                   National Health Care Survey (NHCS)

    In order to provide more comprehensive data describing the Nation's 
use of health care providers into an integrated family of surveys, 
collectively called the National Health Care Survey (NHCS). The 
objectives of the NHCS are to provide national data describing the 
utilization of services in ambulatory, hospital and long-term care 
settings; to provide these data on an annual basis using an integrated 
cluster sample design; and to develop the capability of conducting 
patient follow-up studies.
    Currently, the NHCS includes six ongoing national data collection 
activities:
          The National Ambulatory Medical Care Survey--visits to non-
        Federal, office-based physicians;
          the National Home and Hospice Care Survey--patients of 
        hospices and home health agencies;
          the National Hospital Discharge Survey--discharges from non-
        Federal, short-stay hospitals;
          the National Hospital Ambulatory Medical Care Survey--visits 
        to emergency and outpatient departments of non-Federal, short-
        stay hospitals;
          the National Health Provider Inventory--a national listing of 
        nursing homes, hospices, home health agencies and licensed 
        residential care facilities; and
          the National Survey of Ambulatory Surgery--discharges from 
        hospital-based and free-standing ambulatory survey centers.
    Details on specific surveys relevant to the elderly are presented 
below by specific survey. Plans call for the implementation of the 
National Nursing Home Survey in 1995 and in 1997.

                 National Home and Hospice Care Survey

    The National Home and Hospice Care Survey (NHHCS) is a national 
probability sample survey of home health and hospice care agencies, and 
their patients. The 1992 NHHCS, the first of an annual survey, 
collected data from a nationally representative sample of 1,500 
hospices and home health agencies. The second survey was conducted in 
1993. All agencies providing home health and hospice care were included 
in the survey without regard to licensure or to certification status 
under Medicare and/or Medicaid. Information about the agency was 
collected through personal interview with the administrator. 
Information was collected about a sample of six current patients and 
six discharged patients through personal interview with designated 
agency staff. Data from the NHHCS will allow analysis of the 
relationships that exist between utilization, services offered, and 
charges for care, as well as provide national baseline data about home 
health an hospice care agencies, and their patients.
    Data from the NHHCS was analyzed and published in 1993 and 1994 in 
NCHS Advance Data reports. Other analyses will be released in Series 13 
Vital and Health Statistics. In addition, data are released in the form 
of public use computer tapes and in the form of special tabulations 
prepared for individual requestors.

               National Health Provider Inventory (NHPI)

    The National Center for Health Statistics (NCHS) conducted the 
NHPI, formerly called the National Master Facility Inventory, in the 
spring of 1991. This mail survey includes the following categories of 
health care providers: nursing and related care homes, licensed 
residential care facilities, facilities for the mentally retarded, home 
health agencies, and hospices. Data from the 1991 NHPI was used to 
provide national statistics on the number, type, and geographic 
distribution of these health providers and to serve as sampling frames 
for future surveys in the Long-Term Care Component of the National 
Health Care Survey. The 1991 NHPI public-use tapes are available at 
National Technical Information Service.

              National Survey of Ambulatory Surgery (NSAS)

    The National Survey of Ambulatory Surgery (NSAS) is currently in 
the field. Data will be available in late 1995.

                   National Hospital Discharge Survey

    The National Hospital Discharge Survey (NHDS) is the principal 
source of national information on impatient utilization of non-Federal, 
short-stay hospitals. The NHDS was redesigned in 1988 as one of the 
components of the National Health Care Survey. This survey collects 
data on the demographic characteristics of patients, expected source of 
payment, diagnoses, procedures, length of stay, and selected hospital 
characteristics.
    Data reports and public-use tapes are available from 1970 through 
1992. A multi-year dataset covering the years 1979 through 1992 is 
available on CTAPE from the National Technical Information Service 
(NTIS) Fall of 1994. Diskettes containing tabulations published in the 
Series 13, Detailed Diagnoses and Procedures Report, are available for 
1985 through 1992.

                      National Nursing Home Survey

    During 1985, NCHS conducted the National Nursing Home Survey (NNHS) 
to provide valuable information about older persons in nursing homes. 
The NNHS was first conducted in 1973-74 and again in 1977. Preliminary 
data from the 1985 survey were published in 1987-88 and a summary 
report, which integrated final data from the various components of the 
survey, was published in 1989. Also published were analytical reports 
on: diagnostic and related groups, utilization, discharges, current 
residents and mental health status. Public-use computer tapes are 
available through the National Technical Information Service. Plans 
call for implementation of the next NNHS in 1995.

                 National Nursing Home Survey Followup

    The National Nursing Home Survey Followup (NNHSF) is a longitudinal 
study which follows the cohort of current residents and discharged 
residents sampled from the 1985 NNHS described above. The NNHSP builds 
on the data collected from the 1985 NNHS by extending the period of 
observation by approximately 5 years. Data collection has been 
completed. Wave I was conducted from August through December 1978, and 
Wave II was conducted in the fall of 1988. Wave III began in January of 
1990 and continued through April. The study is a collaborative project 
between NCHS, HHS and the National Institute on Aging (NIA). The 
followup was funded primarily by NIA and was developed and conducted by 
NCHS.
    The NNHSF interviews were conducted using a computer-assisted 
telephone interview system. Questions concerning vital status, nursing 
home and hospital utilization since the last contact, current living 
arrangements, Medicare number, and source of payment were asked. 
Respondents included subjects, proxies, and staff of nursing homes.
    The NNHSF provides data on the flow of persons in and out of long-
term care facilities and hospitals. These utilization profiles will 
also be examined in relation to information on the resident, the 
nursing home and the community. Public-use computer tapes for WAVES I, 
II, and III of the NNHSF are available through the National Technical 
Information Services (NTIS). In addition, the National Nursing Home 
Survey Followup Mortality Data Tape, 1984-90 is now available through 
NTIS.

           National Employer Health Insurance Survey (NEHIS)

    The National Employer Health Insurance Survey is being jointly 
conducted by the NCHS, the Health Care Financing Administration, and 
the Agency for Health Care Policy and Research. The NEHIS will provide 
data necessary to produce national level estimates of total employer-
sponsored private health insurance premiums, the employer and employee 
premium share, the total amount of benefits provided, and the 
administrative cost. In addition to the number of workers, retirees, 
and former workers covered, the survey will provide the breadth of 
policy benefits and the number and characteristics of plans in each 
establishment.
    The NEHIS is being conducted in all 50 States and the District of 
Columbia. Interviews will be completed for approximately 43,000 
business establishments, sampled from several size categories. The data 
collection method will be Computer Assisted Telephone Interviewing 
(CATI). Data will be released to the public in the form of published 
reports and electronic data products.
    The estimates will be used to gain an understanding of geographic 
variations in spending for health care and the probable differential 
impacts that proposed health policy initiatives will have by State. As 
the private sector, State and Federal Governments develop and implement 
reforms of the health care system, there are likely to be major changes 
in the extent and form of private health insurance coverage, benefits, 
and premium sharing. No discussion of the impact of the reform upon 
business and individuals can be complete without analysis of these 
changes. Over the past several years, the task of producing national 
private health insurance premiums and benefit estimates has increased 
in difficulty as the industry has become more complex. Simultaneously, 
the importance of accurate health care costs estimates has increased as 
the pressure or burden of health care costs have mounted on the primary 
health care payers such as government, business and households and as 
initiatives to contain cost growth have been discussed and implemented.

             Improving Questions on Functional Limitations

    The National Laboratory for Collaborative Research in Cognition and 
Survey Measurement of NCHS conducted several cognitive research 
projects with old (65-74), very old (75-84), and oldest (85+) 
respondents. The objectives were to test the adequacy and suggest 
improvements to existing survey questions for collecting information on 
functional limitations (e.g., limitations on bathing, dressing, 
transferring), life history events (education, employment, residence, 
onset of health conditions) and falls.
    Activities include:
          Publication of Problems Eliciting Elders' Reports of 
        Functional Status by Keller, Kovar, Jobe, and Branch in Journal 
        of Aging and Health, Vol. 5, No. 3.
          Presentation of Cognitive Techniques in Interviewing Older 
        People by Jobe, Keller, and Smith at the Conference on Methods 
        of Determining Cognitive Processes Used to Answer Questions, 
        Champaign, IL, November, 1993.
                national center for infectious diseases
    Infectious diseases have a disproportionate impact on older 
Americans. Pneumonia and influenza remain the sixth leading cause of 
death in the United States and septicemia has risen dramatically during 
the past three decades to become the 13th leading cause of death. 
Pneumonia and septicemia are also contributing and precipitating 
factors in the deaths of many Americans with other illnesses, 
especially cardiovascular diseases, cancer, and diabetes. Quality of 
life declines for millions of older Americans as a result of infectious 
illnesses. Prevention and control of infectious disease will enhance 
and lengthen the lives of older Americans.
    CDC emphasizes surveillance and training to prevent and control 
hospital-acquired and other institutionally acquired infections in 
elderly patients. CDC conducts surveillance of elderly patients in 
hospitals and trains practitioners in nursing homes. Additionally, CDC 
staff provides education regarding infection control to care providers 
at nursing home and patient care conferences. This education focuses on 
patient care treatment and procedures associated with the highest risk 
of infection. Through the National Nosocomial Infections Surveillance 
(NNIS) system, special infection risks of elderly patients have been 
identified. According to NNIS, over half of the hospital-acquired 
infections occur in elderly patients, although these patients represent 
about one-third of all discharges from hospitals. The use of certain 
devices, such as urinary catheters, central lines, and ventilators, are 
associated with high risk of infection in all types of patients. In 
elderly patients, the risk of infection is high even when a device is 
not used, suggesting that infection control must address other risk 
factors such as lack of mobility and poor hygiene and nutrition, in 
addition to device use.
    Although delivering the influenza vaccine to persons at risk is a 
critical step in preventing illness and death from influenza, 
immunization is only part of the prevention equation. CDC's efforts to 
combat influenza in the elderly include: (1) conducting prospective 
surveillance for influenza and other respiratory viruses in nursing 
homes; (2) conducting studies to better define the immunological 
response of the elderly to influenza vaccines and to natural infection; 
(3) conducting immunological studies involving laboratory and clincial 
evaluation of inactivated and live attenuated influenza vaccines in an 
effort to identify improved vaccine candidates; (4) increasing 
surveillance of influenza in the People's Republic of China and other 
countries in the Pacific Basin to better monitor antigenic changes in 
the virus; (5) improving methodologies for rapid viral diagnosis; and 
(6) using recombinant DNA techniques to develop influenza vaccines that 
may protect against a wider spectrum of antigenic variants.
    Pneumococcal pneumonia causes an estimated 40,000 deaths each year; 
80-90 percent of these are in persons  65 years old. 
Prevention of pneumococcal disease in the elderly requires widespread 
application of effective immunization. CDC is currently evaluating the 
emergence of drug-resistant pneumococcal strains through laboratory-
based surveillance and is actively promoting increased vaccine use in 
the elderly and other groups at risk. This is critical to decrease 
illness and death from pneumococcal infections in the elderly. Cost-
benefit analyses are favorable for the current vaccine; however, the 
benefits to the population, and to society in general, would 
significantly increase with a more effective vaccine.
    Recent studies have suggested that noninfluenza viruses such as 
respiratory syncytial virus and the parainfluenza viruses may be 
responsible for as much as 20 percent of serious lower respiratory 
tract infections in the elderly. These infections can cause outbreaks 
that may be controlled by infection control measures and be treated 
with antiviral drugs. Consequently, it is important to define the role 
of these viruses and risk factors for these infections among the 
elderly population. CDC is completing a collaborative investigation of 
respiratory syncytial virus, the parainfluenza viruses, and adenovirus 
infections associated lower respiratory tract infections among 
hospitalized adults to determine the proportion caused by these viruses 
and associated risk factors.
    Group B streptococcus (GBS) is a major cause of invasive bacterial 
disease in elderly persons in the United States. To document the 
magnitude of GBS disease in the elderly and develop preventive 
measures, CDC established population-based surveillance for GBS disease 
and case control studies to identify risk factors for GBS disease in 
the elderly. An article published in June 1993 in The New England 
Journal of Medicine documents some of the findings. The incidence of 
GBS disease in nonpregnant adults increased with age and was 
particularly high in older blacks. For example, the incidence of black 
adults who are 70 years and older was 47 per 100,000 compared to 5 per 
100,000 in black adults ages 20-29. The in-hospital mortality rate for 
this particular study was 21 percent among the nonpregnant adults. This 
data will be utilized to develop and evaluate vaccines and to promote 
the prevention and treatment of GBS disease in the elderly population.
    Foodborne disease is of particular concern in the elderly, who 
typically can have higher illnesses and death from foodborne pathogens 
than younger persons. Of particular concern are Salmonella enteritidis 
infections, often caused by undercooked eggs, and Escherichia coli 
0157:H7 infections, often caused by undercooked hamburger. CDC is 
working with USDA and FDA to encourage use of pasteurized eggs in 
nursing homes and thorough cooking of hamburger meat.
    Studies using information from national data bases show that of all 
age groups, the elderly (*70 years) have the greatest number of 
hospitalizations and deaths associated with diarrhea in the United 
States. Efforts to control this important cause of illness requires 
further study of the agents involved and their transmission. The recent 
identification of rotavirus as a cause of epidemic diarrhea in the 
elderly suggests that one approach to control may involve use of 
vaccines currently being developed for young children.
           national center for injury prevention and control
    Several CDC funded Extramural Injury Research Grants have focused 
on injury prevention in the elderly. The following Extramural Research 
Grants to study problems affecting the elderly include:

  Hip Fracture Prevention from Falls in the Elderly Research Program 
                             Project Grant

    The theme of the Research Program Project grant in ``Hip Fracture 
Prevention from Falls in the Elderly'' and as such addresses falls as a 
leading cause of unintentional injury, the elderly as a target 
population at greatest risk, prevention as a major phase of injury 
control, and biomechanics as one of its major disciplines. The proposed 
RPPG is an outgrowth of a CDC Injury Prevention and Control Research 
Project entitled ``Biomechanics of Hip Fracture Risk'' which provided 
new evidence that fall severity is a dominant factor in the etiology of 
hip fractures in the elderly. Based on the findings of the RO1 grant, 
this project will attempt to extend these concepts to a prevention 
program which represents a cluster of three interdisciplinary research 
projects focusing on injury prevention through the integrated 
application of biomechanics, engineering and geriatric medicine. Three 
projects will accomplish this goal: (1) Hip Fracture Prevention by 
Trochanteric Padding; (2) Bisphosphonate Therapy for Prevention of 
Femoral Osteoporosis, and (3) Biomechanics of Hip Fracture Risk.

        Dually Stiff Floors for Injury Prevention of the Elderly

    The aim of this project is to develop an intervention to reduce 
injuries from falls based on ``Dually Stiff Flooring.'' The 
investigator proposes a floor designed to offer both a non-compliant 
configuration during normal motions and a significant advance in 
protection from injuries due to falls. The proposed intervention could 
have wide application in living areas for the elderly.

           Biomechanics of Slips on Ramps and Level Surfaces

    The long-term goal of this study is to improve the design of ramps 
and walkways to reduce slip and fall injuries. This will be 
accomplished by gaining an improved understanding of the biomechanics 
of slips and falls on level walkways and ramps under varying 
conditions. Body kinematics and foot forces of subjects walking on 
ramps of differing angles under slippery conditions will be performed. 
This biomechanical analysis will then be compared to slip resistance 
measurements of the floor surface acquired by six different testing 
devices currently used in the evaluation of the shoe/floor interface.

                    Elderly Driver Referral Project

    The proposed study will attempt to ascertain relationships between 
the capabilities of drivers and their safety of operation in order to 
enable license administrators to initiate licensing actions that 
minimize the threat from those who cannot operate safely while 
preserving the mobility of those who can. The psychophysical 
capabilities of the entire sample will be assessed through a battery of 
test measures designed specifically to tap capabilities shown to relate 
separately to age and highway accidents. The relationships obtained in 
this manner will be applied to (1) improve the methods of detecting 
drivers whose abilities may be diminished by age, (2) develop tests to 
validly assess drivers' ability to drive safely, and (3) formulate 
licensing actions capable of achieving an optimum balance between 
safety and mobility.

       Spectral Signature as a Predictor of Falls in the Elderly

    This proposal will develop a method to identify elderly individuals 
that may be at risk of falling. This method will involve the use of the 
spectral signature of force plate data obtained from postural sway to 
predict the potential of falls among elderly patients. Data from this 
study will augment existing knowledge in the area of biomechanical 
prevention of falls.

              Preventing Falls in the Nursing Home Elderly

    This study seeks to evaluate an intervention to reduce falls among 
nursing home residents by comparing rates of falls between intervention 
and control nursing homes. The intervention targets environmental 
safety, caregiving practices, medications, resident activity, and 
resident and staff education.

                 Antidepressants and the Risk of Falls

    This study proposes a retrospective, inception cohort study of an 
estimated 2,500 new antidepressant users and 2,500 nonusers for the 
period of 7/1/93 through 6/30/95. The study will be conducted in 
nursing homes because residents have the highest prevalence of 
depression and antidepressant use, are particularly vulnerable to 
tricyclic antidepressants (TCA) adverse effects, and have the highest 
rates of falls and related injuries. Study findings will further injury 
control by providing information clinicians need to chose 
pharmacotherapy that minimizes risk of falls.

        Driving Ability and Car Crashes in Old Age and Dementia

    The investigators propose to objectively determine which 
neuropsychological and psychophysical measures best discriminate 
between safe and unsafe drivers, by comparing the performance of the 
Alzheimer's Disease (AD) patients on the driving simulator and on a 
battery of off-road behavioral tests with their actual road-test scores 
and State driving records. One of the ultimate goals of this line of 
research is the development of fair and accurate criteria to predict 
driving ability in cognitively disabled populations.

    Longitudinal Studies of Elderly Drivers: Functional and Medical 
                  Correlates of Motor Vehicle Crashes

    This study extends the current ``Longitudinal Study of Elderly 
Drivers'' project which began in 1992 and was scheduled to be completed 
in 1995. The investigators have assembled a 20 year longitudinal crash 
history file for 400,000 drivers 65 or older for the period 1971-90. 
They plan to utilize this file and access to state DOT personnel and 
beginning this spring to conduct a prospective cohort study of 5,000 
elderly drivers who successfully complete application renewal 
procedures.
    The following Intramural Research Grants to study problems 
affecting the elderly include:
    The Study to Assess Falls Among the Elderly (SAFE) was a 
population-based case-control study of falls among community dwelling 
elderly in South Miami Beach, Florida from 1987 through 1989. The SAFE 
data set includes 175 female hip fracture cases and 935 controls age 65 
and older. Two projects are planned using these data.
          1. CDC, in collaboration with the Miami Veterans 
        Administration Center, will develop a self-administered home 
        hazards assessment instrument using female VA patients over age 
        65. CDC will distribute this validated instrument to state 
        health departments where it will be used as the basis for fall 
        intervention and prevention strategies.
          2. SAFE also contains the names of both prescription and non-
        prescription medications that study participants took in the 
        month before their injury occurred. These data will be used to 
        describe medication use and to determine whether certain 
        classes of medications increase hip fracture risk among elderly 
        women.
                     national immunization program
    CDC is continuing its efforts to increase the awareness of adults 
to be immunized against the vaccine-preventable diseases of influenza, 
pneumococcal disease, hepatitis B, measles, mumps, rubella, tetanus, 
and diphtheria. As a liaison with outside organizations that promote 
adult immunization activities, such as the Administration on Aging, the 
American College of Physicians, and the American Hospital Association, 
CDC provides speakers for conferences and technical review of 
documents. CDC responds to public inquiries and has available a booklet 
for the lay public, ``Immunization of Adults: A Call to Action,'' which 
promotes immunization of adults in the community. CDC is also 
continuing assistance to State and local health systems in expanding 
immunization program coverage of adult populations through promotion of 
the recommendations of the Advisory Committee on Immunization Practices 
(ACIP). These recommendations were revised and published in November 
1991.
    CDC continues to include adult immunization issues in its annual 
National Immunization Conference. In the 26th and 27th Conferences held 
in St. Louis, MO in June 1992 and in Washington, D.C. in June 1993, 
respectively, at least one poster and eight oral presentations 
addressed various adult immunization issues. In the 28th Conference 
held in Charlotte, NC in June 1994, three poster and four oral 
presentations focused on adult immunization.
    The National Vaccine Advisory Committee (NVAC) Report on Adult 
Immunization was adopted January 1994 and establishes five major goals 
for adult immunization in the United States, 18 recommendations for 
achieving these goals, and 72 strategies recommended for 
implementation. The goals include:
          improving provider and public awareness,
          assuring adequate delivery of vaccines to adults,
          assuring adequate financing mechanisms for adult vaccination,
          improving disease surveillance and monitoring of vaccination 
        levels, and
          assuring adequate support for research in five key areas.
    Assistant Secretary for Health, Dr. Philip R. Lee, has also asked 
the National Vaccine Program Office (NVPO) to consult with CDC, the 
National Institutes of Health (NIH), the Food and Drug Administration 
(FDA), Health Care Financing Administration (HCFA), and other relevant 
agencies to identify steps to implement the report's recommendations. 
Dr. Lee also asked the NVPO to encourage States and private sector 
organizations to address the recommendations in the report.
    CDC continues to participate in the National Coalition for Adult 
Immunization (NCAI), a network of 73 private, professional, volunteer 
organizations, and public health agencies with the common goal of 
improving the immunization status of adults. Each year during the last 
week of October, the NCAI promotes National Adult Immunization 
Awareness Week to emphasize the importance of vaccinating all adults. 
To unify the diverse interests of the member organizations and offer a 
foundation of common goals, the NCAI has developed and adopted the 
Standards for Adult Immunization Practice. The Standards outline basic 
strategies that, if fully implemented, would improve delivery of 
vaccines to adults and help achieve the Year 2000 National Health 
Objectives. The objectives of the NCAI are accomplished by three 
working Action Groups--Influenza/Pneumonia, Measles-Mumps-Rubella, and 
Hepatitis B--that conduct disease-specific informational and 
educational activities for health care providers and the public.
    The Healthy People 2000 goal for influenza vaccination coverage of 
noninstitutionalized persons at risk of complications is 60 percent. 
Influenza vaccination levels in such persons 65 years of age 
have steadily improved from 23 percent in 1985 to 41 percent in 1991. 
The 1993 vaccination level in this age group was 51.2 percent, based on 
preliminary data from the NCHS' 1993 National Health Interview Survey. 
The increases in older persons may be attributable to better acceptance 
by practitioners and the public of preventive medical services, 
increasing delivery of vaccine by nonphysicians such as visiting nurse 
and home health agencies, and lack of perceived risk associated with 
vaccination.
    CDC and the Health Care Financing Administration are also 
participating in an interagency agreement, begun in 1989, to study the 
effectiveness of pneumococcal vaccine in preventing morbidity and 
mortality among the Medical Part B beneficiaries in Hawaii. Medicare 
records are being used to: (1) evaluate the clinical effectiveness of 
pneumococcal vaccination in preventing hospitalization and death of 
Medicare beneficiaries; (2) describe medical care utilization patterns 
of vaccinated and unvaccinated persons; (3) evaluate hospital care 
patterns of vaccinated and unvaccinated persons; and (4) evaluate long-
term outcomes of individuals in relationship to vaccination status. The 
final reports of the project will be completed in 1994.
                national center for prevention services

                              Tuberculosis

    During 1993, 5,847 TB cases were reported among persons 65 and 
older--the case rate for persons of all ages was 9.8 per 100,000 
population while the rate for persons age 65 and older was 17.8.
    Elderly residents of nursing homes are at even higher risk for 
developing TB than elderly persons living in the community. According 
to a CDC-sponsored 1978-85 survey of 15,379 reported TB cases in 29 
States the incidence of TB among elderly nursing home residents was 
39.2 per 100,000 person-years while the incidence of TB among elderly 
persons living in the community was 21.5 per 100,000 person-years. 
Investigators have also documented transmission of tuberculosis 
infection to residents and staff in nursing homes during TB outbreaks.
    During 1990, the CDC and the HHS Advisory Council for Elimination 
of Tuberculosis published recommendations for controlling TB among 
nursing home residents and employees. The recommendations called for TB 
screening of nursing home residents upon admission and employees at 
entry, annual rescreening for employees, attention to timely case-
finding among symptomatic elderly persons, and the use of appropriate 
precautions to prevent the spread of TB in facilities providing 
residential care for elderly persons.

               Oral Health and Dental Disease Prevention

    CDC and the National Institute of Dental Research, NIH, have 
developed a plan to achieve functional and healthy oral conditions for 
all Americans. The U.S. Public Health Service (PHS), through its Oral 
Health Coordinating Committee, is taking steps to implement the PHS 
Oral Health 2000 Adult Initiative. This initiative, viewed as a decade-
long commitment, represents the collective effort of PHS agencies to 
accelerate improvement in oral health for adult Americans particularly 
those at increased risk of oral diseases including older adults. The 
private and voluntary sector will also be involved to facilitate 
comprehensive approaches to reduce the occurrence and severity of oral 
diseases; prevent the unnecessary loss of teeth in the U.S. population; 
and alleviate physical, cultural, racial/ethnic, social educational, 
economic, health care delivery, and environmental barriers that prevent 
adults from achieving good oral health.
    Persons are at higher risk for oral cavity and pharyngeal cancer as 
their age increase. Approximately 95 percent of oral cavity and 
pharyngeal cancer occurs in persons aged 40 and over, with 60 years as 
the average age at diagnosis. Individuals aged 65 and over experience 
poorer survival rates from these cancers.
    CDC has developed liaisons with Federal and State agencies to (1) 
assess the magnitude of the disease burden from cancers of the oral 
cavity and pharynx; (2) determine the extent of programs currently in 
place that address the problem; and (3) begin development of a 
comprehensive public health strategy to reduce incidence and morality 
rates in the United States. CDC and NIH have developed a monograph on 
oral cavity and pharyngeal cancers to provide public health, research, 
education, and health care provider communities with detailed 
information on the incidence, mortality, and 5-year relative survival 
rates for oral and pharyngeal cancer in the United States. This 
publication was published in November 1991.
    A work group composed of representatives from Federal agencies, 
academic institutions, private dentistry, and State health departments 
was convened by CDC in early December to begin developing a national 
strategy.

                      FOOD AND DRUG ADMINISTRATION

    As the percentage of elderly in the Nation's population continues 
to increase, the Food and Drug Administration (FDA) has been giving 
increasing attention to the elderly in the programs developed and 
implemented by the agency. To enhance this effort, the FDA Working 
Group on Aging-Related Issues was established in 1992. FDA has been 
focusing on several areas for the elderly that fall under its 
responsibility in the regulation of foods, drugs, and medical devices. 
Efforts in education, labeling, drug testing, drug utilization, and 
adverse reactions are of primary interest. Working relationships exist 
with the National Institute on Aging, the Centers for Disease Control, 
and the Administration on Aging of the Department of Health and Human 
Services to further strengthen programs that will assist the elderly 
now and in the future. Some of the major initiatives that are underway 
are described below.

                           Consumer Education

    To further the goals established by the joint Public Health 
Service/Administration on Aging Committee on Health Promotion for the 
Elderly, during the last 8 years FDA has coordinated the development 
and implementation of significant consumer education programs with the 
National Council on Patient Information and Education (NCPIE) and many 
private sector organizations. NCPIE is a nongovernmental group 
consisting of professional (e.g., medical, pharmacy, nursing), 
consumer, and pharmaceutical industry organizations whose goal is to 
stimulate consumer education and program development. Special emphasis 
has been placed on the elderly, who use more prescription drugs per 
capita than the rest of the population.
    The ``Get the Answers'' campaign is a program urging consumers to 
ask their health professionals questions about their prescriptions. The 
major component of the campaign is a medical data wallet card that 
lists the five questions consumers should ask when they get a 
prescription. These questions are:
          What is the name of the drug and what is it supposed to do?
          How and when do I take it--and for how long?
          What foods, drinks, and other medicines, or activities should 
        I avoid while taking this drug?
          Are there any side effects, and what do I do if they occur?
          Is there any written information available about the drug?
    The ``Get the Answers'' message has been widely disseminated to 
consumers through news releases, advice columns, and other media. 
Wallet cards with the ``Get the Answers'' message are available through 
FDA's Office of Consumer Affairs and around the country in FDA's local 
offices from Public Affairs Specialists (PAS).
    The Women and Medicines Campaign was initiated during ``Talk About 
Prescriptions'' month, October 1991. The purpose of the campaign is to 
ensure safer and more effective use of medicines through improved 
communication between women and health care providers (e.g., doctors, 
pharmacists, dentists, nurses). The campaign focuses on concerns 
related to all women, but especially targets vulnerable populations 
such as the elderly and minorities. It is important because women use 
more medicines than men and serve as the medicine managers for other 
family members. A brochure and planning guide were produced by NCPIE 
with the support of FDA. These materials can be used in many settings, 
including classrooms, waiting rooms, workplace seminars, and health 
fairs.
    The brochure, ``Medicines: What Every Woman Should Know,'' shares 
information that will assist women to improve communication with health 
care providers. The planning guide, ``Women Have Special Medicine 
Information Needs,'' shares information that will assist health care 
providers to improve communication with Women.
    Concurrent with the activities aimed at consumers, FDA, NCPIE, and 
many private sector organizations are conducting a major campaign to 
encourage health professionals to provide drug information to their 
patients. Urging consumers to ``Get the Answers'' and health 
professionals to ``Give the Answers'' is vital to bridge the 
communications gap--to get both sides to talk to each other about 
medications.
    Currently, NCPIE is advocating the use of ``Brown Bag Mediation 
Review.'' This is a procedure to permit health professionals to review 
all medication being taken by elderly patients. Patients are asked to 
bring in all their current medication (in a brown bag) to an 
appointment with a physician, nurse, pharmacist, or other health 
professional. NCPIE is using funds from a grant from the Administration 
on Aging to disseminate materials and promote the program to health 
professionals. FDA's Field Public Affairs Specialists (PAS) promote and 
coordinate these brown bag review in their local areas.
    In additional to consumer education initiatives, FDA and NCPIE are 
continuing to evaluate the effectiveness of consumer education programs 
and are monitoring the attitudes and behavior of consumers and health 
professionals about consumer drug information. FDA is encourage by the 
number and quality of consumer education activities undertaken by the 
various sectors. FDA will continue to provide leadership to foster the 
consumer education initiative.
    FDA's continuing consumer education initiatives include the 
publication of the reprints ``Testing Drugs in Older People'' and 
``Unproven Medical Treatments Lure the Elderly'' from the FDA Consumer 
magazine. The first article discusses the physiological changes that 
occur in aging bodies and the need for medication adjustment. The 
second article illustrates the impact unproven remedies pose to the 
elderly population.
    FDA's Office of Consumer Affairs continues to provide the elderly 
with consumer education about FDA-regulated products through consumer 
briefings, meetings, consumer advisory committee participation, 
information campaigns, ``Dear Consumer'' letters, information through 
the Consumer Inquiry Line, and the Consumer Quarterly. One example of a 
``Dear Consumer'' letter included a Hearing Aid Outreach targeted to 
over 200 key consumer organizations alerting them to FDA's public 
hearing on this issue and to urge them to submit comments during the 
open period.

                       Clinical Study Guidelines

    In 1989, FDA published the ``Guidelines for the Study of Drugs 
Likely to be Used in the Elderly.'' The guideline provides detailed 
advice on the study of new drugs in older patients. It is intended to 
encourage routine and thorough evaluation of the effects of drugs in 
elderly populations so that physicians will have sufficient information 
to use drugs properly in their older patients. The guideline serves as 
a stimulus to the development of this information and suggests 
additional steps to sponsors who are already assessing the effects of 
their drugs in the elderly.
    On August 2, 1994, FDA published a final guideline in the Federal 
Register entitled ``Studies in Support of Special Populations: 
Geriatrics.'' The guideline was prepared by the Efficacy Working Group 
of the International Conference on Harmonization of Technical 
Requirements for Registration of pharmaceuticals for Human Use. The 
guideline is intended to reflect sound scientific principles for 
testing drugs in geriatric populations. It provides useful information 
for sponsors submitting applications to the Food and Drug 
Administration.
    FDA's efforts to ensure that premarket testing adequately considers 
the needs of older people also include regulation and education of 
institutional review boards (IRBs). An IRB must review all research in 
humans involving FDA-regulated products to ensure adequate protection 
of the study subjects, and must assure FDA that adequate additional 
safeguards are in place during research involving vulnerable 
populations, such as the elderly. Through the bioresearch monitoring 
program, FDA inspects IRBs to ensure compliance with FDA requirements. 
The program also informs and educates IRBs by means of national and 
regional conferences and through the dissemination of information 
sheets on a variety of topics of interest to IRBs.

                Postmarketing Surveillance Epidemiology

    The Office of Epidemiology and Biostatistics prepares an annual 
report, ``Annual Adverse Drug Experience (ADE) Report,'' which analyzes 
the ADE reports FDA receives each year through direct reporting by 
health professionals or through manufacturers' reports. The annual 
report includes an analysis of ADE reports by age and sex, identifying 
the number of reports involving males and females 60 years or older. Of 
77,274 ADE reports received and computerized in 1993, 49,919 (65 
percent) reported the age and sex of the patient. Of these reports, 
16,962 (34 percent) were for individuals 60 years or older.

                           Geriatric Labeling

    On November 1, 1990, FDA published a proposed rule to amend its 
regulations pertaining to the content and formation of prescription 
drug product labeling (55 FR 46134). The proposed rule would require a 
person marketing a prescription drug to collect and disclose available 
information about the drug's use by the elderly (persons aged 65 years 
and over). ``Available information'' would encompass all information in 
the applicant's possession relevant to an evaluation of the appropriate 
geriatric use of the drug, including the results from controlled 
studies, other pertinent premarketing or postmarketing studies or 
experience, or literature entitled ``Geriatric use'' with reference, as 
appropriate, to more detailed discussions in other parts of the 
labeling, such as the ``Warnings'' or ``Dosage and Administration'' 
sections.
    The proposed rule is not intended to alter the type or amount of 
evidence necessary to support drug approval but rather to ensure that 
special information about the use of drugs by the elderly is well 
organized, comprehensive, and accessible. Public comments on the 
proposed rule have been evaluated, and FDA is preparing a final rule.

           Medication Information Leaflets (MILS) for Seniors

    The American Association of Retired Persons (AARP) Pharmacy 
Services Division, in conjunction with FDA's Drug Marketing Practices 
and Communications Branch (MPCB) publish MILS--educational leaflets 
about drugs written for use through the AARP prescription drug mail 
order program. The leaflets provide the patient with:
          A description of the contents
          A list of the diseases for which the drug is used as a 
        treatment
          Information the patient should tell the physician before 
        taking the medication
          Dosage information--how the medication should be taken
          Instructions on what to do if a dose is missed
          Possible interactions with other medications
          Possible serious and non-serious side effects

                      ``Marketing Research'' Study

    The FDA designed and supervised the data collection of a survey to 
assess information needs and motivations of subgroups of older 
individuals with hypertension who subscribe to the AARP Pharmacy 
Service. Analyses identified four distinct sub-audiences who are 
expected to respond differently to varying health promotion message 
strategies.
    An article entitled ``A Segmentation Analysis of Prescription Drug 
Information-Seeking Motives Among the Elderly'' was published in the 
Journal of Public Policy and Marketing (fall 1992) and was presented at 
the 1992 Marketing and Public Policy Conference in Washington, D.C. 
Additional studies with AARP on patient education messages for older 
Americans are being conducted.

                      Year 2000 Health Objectives

    A consortium of over 300 government and private agencies developed 
a set of health objectives for the Nation which is serving as a 
national framework for health agendas in the decade leading up to the 
year 2000. The overall program is called ``Healthy People 2000.'' In 
the food and drug safety area, FDA has responsibility for objective 
12.6, which sets as a target to:
          Increase to at least 75 percent the percentage of health care 
        providers who routinely review all prescribed and over-the-
        counter medicines taken by their patients 65 years and older 
        each time medication is prescribed or dispensed.
    FDA's Marketing Practices and Communications Branch conducted a 
number of studies that track patients' receipt of medication 
information from doctors and pharmacists from 1982 to 1992, documenting 
that 58% of Americans over 65 received at least some information about 
prescriptions. The survey is being conducted again in 1994 to track 
progress toward meeting this objective.
    During the coming year, FDA will work with private sector 
organizations to advance medication counseling activities.

                          Pharmacy Initiative

    During the past few years, Dr. David Kessler, FDA Commissioner, has 
personally sought to encourage greater pharmacy-based counseling. 
Through speeches, articles, and editorials in major medical (New 
England Journal of Medicine) and pharmacy (American Pharmacy) journals, 
Dr. Kessler has encouraged the increased role of pharmacists, using 
computers to generate targeted information informing patients about the 
uses, directions, risks and benefits of medication. The pharmacy 
profession has responded positively, bringing many examples of their 
initiatives to FDA's attention. In particular, several organizations 
have informed FDA of the expanded use of new technology to provide 
patient instructional materials to their customers. FDA will continue 
to work closely with these organizations in an effort to disseminate 
more information to patients about their medications.

                              Health Fraud

    Health fraud--the promotion of false or unproven products or 
therapies for profit--is big business. These fraudulent practices can 
be serious and often expensive problems for the elderly. In addition to 
economic loss, health fraud can also pose direct and indirect health 
hazards to those who are misled by the promise of quick and easy cures 
and unrealistic physical transformations.
    The elderly, more often than the general population, are the 
victims of fraudulent schemes. Almost half of the people over 65 years 
of age have at least one chronic condition such as arthritis, 
hypertension, or a heart condition. Because of these chronic health 
problems, senior citizens provide promoters with a large, vulnerable 
market.
    To combat health fraud, FDA uses a combination of enforcement and 
education. In each case, the Agency's decision on appropriate 
enforcement action is based on considerations such as the health hazard 
potential of the violative product, the extent of the product's 
distribution, the nature of any mislabeling that has occurred, and the 
jurisdiction of other agencies.
    FDA has developed a priority system of regulatory action based on 
three general categories of health fraud: direct health hazards, 
indirect hazards, and economic frauds. The Agency regards a direct 
health hazard to be extremely serious, and it receives the Agency's 
highest priority. FDA takes immediate action to remove such a product 
from the market. When the fraud does not pose a direct health hazard, 
the FDA may choose from a number of regulatory options to correct the 
violation, such as a warning letter, a seizure, or an injunction.
    The Agency also uses education and information to alert the public 
to health fraud practices. Both education and enforcement are enhanced 
by coalition-building and cooperative efforts between government and 
private agencies at the national, State, and local levels. Also, 
evaluation efforts help ensure that our enforcement and education 
initiatives are correctly focused.
    The health fraud problem is too big and complex for any one 
organization to effectively combat by itself. Therefore, FDA is working 
closely with many other groups to build national and local coalitions 
against health fraud. By sharing and coordinating resources, the 
overall impact of our efforts to minimize health fraud will be 
significantly greater.
    FDA and other organizations have worked together to provide 
consumers with information to help avoid health fraud. Since 1986, FDA 
has worked with the National Association of Consumer Agency 
Administration (NACAA) to establish the ongoing project called the 
NACAA Health Products and Promotions Information Exchange Network. 
Information from FDA, the Federal Trade Commission (FTC), the U.S. 
Postal Service (USPS), and State and local offices is provided to NACAA 
periodically for inclusion in the Information Exchange Network. This 
system provides information on health products and promotions, consumer 
education materials for use in print and broadcast programs, and the 
names of individuals in each contributing agency to contact for 
additional information.
    In 1994, FDA's Public Affairs Specialists (PASs) continued to alert 
diverse and culturally specific elderly populations throughout the 
United States by sponsoring community workshops. These exchanges 
provided an opportunity for seniors to convey their concerns about 
suspected health fraud products. Dietary supplements, herbal remedies, 
and unproven medical treatments, such as shark cartilage, were key 
issues. Health Fraud Workshops during 1994 included the Districts of 
San Juan, Miami, Orlando, Atlanta, New York, Nashville, and Phoenix. 
PASs also convey this important information via additional mechanisms 
such as radio and television shows as well as public service 
announcements.

               Regional Hispanic Health Fraud Conference

    FDA has made special efforts to target health fraud information to 
Hispanics, particularly the elderly. As a special population, they are 
particularly at risk because of language and cultural considerations 
that may limit their access to health care and information about health 
fraud.
    The Hispanic Health Fraud Initiative was kicked off at the model 
1989 National Health Fraud Conference in San Juan, Puerto Rico. The 
primary conference goal was to provide practical guidance to 
individuals and organizations in the Commonwealth that would enable 
them to recognize and defend themselves against health fraud, quackery, 
and misinformation.
    FDA has conducted a series of followup regional conferences 
throughout Puerto Rico and the continental United States. The series 
began in Puerto Rico in September 1990 in the Carolina Region. In 1991, 
the series was continued in Caguas, Fajardo, Ceiba, and Humacoa. These 
conferences were cosponsored by the Congress of Workers and Consumers 
of Puerto Rico (COTACO) and the Puerto Rico Department of Consumer 
Affairs. The first in the statewide series of conferences was held in 
FDA's Pacific Region (Culver City, CA), in September 1990. In 1993, FDA 
conducted two regional Health Fraud conferences to target health fraud 
information to Hispanics. The conferences were held in May in Miami, 
Florida, and Albuquerque, New Mexico. In 1994, FDA PASs conducted 
Hispanic health fraud workshops targeting the elderly in San Juan, 
Puerto Rico, and Miami, Florida. One concern expressed was about the 
practice of medication-sharing by seniors.

             ``Health Is Life'' Consumer Education Campaign

    FDA, the Food Marketing Institute (FMI), and the National Urban 
League (NUL) launched a cooperative consumer health education campaign 
which is culturally specific (language and graphics) and focused to 
promote healthy lifestyles among African Americans. The campaign 
components include seven nutritional and health promotion posters. The 
posters promote good health behaviors and are targeted to the following 
African American audiences: elderly and young males; pregnant women; 
children 6 to 12 years of age; adolescents 12 to 17 years of age; and 
the general population.
    The campaign was unveiled at the July 1991 annual convention of the 
National Urban League and has been promoted through over 150 other 
national African American multiplier organizations, such as the 
Auxiliary to the National Medical Association; National Council of 
Negro Women; LINKS, Inc.; Delta Sigma Theta Sorority; and the 
Congressional Black Caucus. The NUL's affiliate network of 114 local 
organizations are displaying the posters and promoting the relationship 
between diet and health to their constituencies. An additional 3,000 
copies of the posters were provided to the FMI membership for display 
in member food store chains.

                             Food Labeling

    Food labeling is very important to the elderly. Elderly people have 
a greater need for more information about their food to facilitate 
preparation of special diets, maintain adequate balance of nutrients in 
the face of reduced caloric intake, and ensure adequate levels of 
specific nutrients which are known to be less well absorbed as a result 
of the aging process (e.g., vitamin B12).
    The new food label, which is now required on most foods, offers 
more complete, useful, and accurate nutrition information to help the 
elderly meet their nutritional needs. Significant labeling changes 
include: nutrition labeling for almost all foods; information on the 
amount per serving of saturated fat, cholesterol, dietary fiber, and 
other nutrients of major concern to today's consumers; nutrient 
reference values to help consumers see how a food fits into an overall 
daily diet; uniform definitions for terms that describe a food's 
nutrition content (e.g., light, low fat, and high-fiber), claims about 
the relationship between specific nutrients and disease, such as sodium 
and hypertension; standardized serving sizes; and voluntary 
quantitative nutrition information for raw fruit, vegetables, and fish.
    Manufacturers were required to comply with most of the new labeling 
requirements as of May 1994--although a 3-month extension was granted 
to firms who were unable to meet the May deadline, Regulations 
pertaining to health claims became effective a year earlier, in may 
1993. A recent survey indicates that the vast majority of food in the 
stores now carries the new food label and that more than 87 percent of 
the nutritional information accurately measures what is in the package. 
This is an important indication to consumers that they can trust what 
it says on the food label.
    To help consumers get the most from the new food label, educational 
materials are being widely disseminated. Among materials now available 
is a large-print brochure, ``Using the New Food Label to Choose 
Healthier Foods,'' which is easier to read for senior citizens who may 
have vision problems.
    FDA, in coordination with USDA, has established a national database 
and information hotline at the National Agricultural Library to record 
and disseminate information about educational activities, seminars, 
packages of materials, and lesson plans. They have sponsored four 
national seminars on aspects of food label education, particularly on 
ways to reach underserved populations. AARP member Dorothy Campbell 
represented senior citizens at the May 1994 seminar. She stressed the 
benefits of the increased legibility of the new label to older 
Americans, and urged meeting attendees to educate older Americans on 
the positive aspects of using the new label; i.e., help them focus on 
what to eat, not what to avoid.
    Material on the new food label is available from FDA's Office of 
Consumer Affairs.

                          Dietary Supplements

    The Dietary Supplement Health and Education Act of 1994 was signed 
by the President in October 1994. This Act required FDA to withdraw its 
Advanced Notice of Proposed Rulemaking requesting comment on approaches 
to assuring the safety of dietary supplements. The Act also defines 
supplements, defines new dietary ingredients as dietary ingredients 
that were not marketed in the U.S. before October 15, 1994, places the 
burden of proof for safety on FDA, and sets standards for the 
distribution of third party literature (e.g., books, publications, and 
articles).
    The law also allows statements of nutritional support under certain 
conditions. Such statements may describe the role of a nutrient or 
ingredient intended to affect the structure or function in humans or 
describe general well-being from consumption of a nutrient or dietary 
supplement ingredient. The manufacturer must be able to substantiate 
that such a statement is truthful and not misleading, and the statement 
must contain the following disclaimer, ``This statement has not been 
evaluated by the FDA. This product is not intended to diagnose, treat, 
cure, or prevent disease.''
    The law authorizes the FDA to issue regulations for Good 
Manufacturing Practices for dietary supplements, including expiration 
date labeling. It also establishes a 7-member Commission on Dietary 
Supplement Labels to conduct a study and issue a report making 
recommendations on the regulation of label claims for dietary 
supplements by October 25, 1996. The law further requires the Secretary 
of HHS to establish an ``Office of Dietary Supplements'' at the 
National Institutes of Health.

                           Total Diet Studies

    The Total Diet Study, as part of FDA's ongoing food surveillance 
system, provides a means of identifying potential public health 
problems related to the diets of the elderly and other age groups. 
Through the Total Diet Study, FDA is able to measure the levels of 
pesticide residues, toxic elements, chemicals, and nutritional elements 
in selected foods of the U.S. food supply. In addition, the study 
allows FDA to estimate the levels of these substances in the diets of 
12 age groups: infants 6 to 11 months old; children 2, 6, and 10 years 
old; 14- to 16-year-old boys; 14- to 16-year-old girls; 25- to 30-year-
old men; 25- to 30-year-old women; 40- to 45-year-old men; 40- to 45-
year-old men; 60- to 65-year-old men; 60- to 65-year-old women; men 70 
years and older; and women 70 years and older. Because the Total Diet 
Study is conducted yearly, it also allows for the determination of 
trends and changes in the levels of substances in the food supply and 
in daily diets.

               Postmarket Surveillance of Food Additives

    FDA's Center for Food Safety and Applied Nutrition (CFSAN) monitors 
complaints from consumers and health professionals regarding food and 
color additives, dietary supplements, and dietary practices as part of 
its Adverse Reaction Monitoring System. Currently, the database 
contains approximately 9,900 records. Of the complainants who reported 
their age, approximately 17 percent were individuals over age 60.

                     Project on Caloric Restriction

    FDA is participating in research which could lead to significant 
insight into the relationship between dietary habits and life span. The 
Project on Caloric Restriction (PCR) is a collaborative effort of FDA's 
National Center for Toxicological Research (NCTR) and the National 
Institute on Aging (NIA). It is designed to study whether a diet that 
is calorically restricted will add to the longevity and health of 
laboratory rats and mice. An increasing interest in the role of caloric 
restriction in aging coupled with the potential economic impact 
associated with health care was the impetus of the creation of the PCR.
    The extraordinary interest displayed by research groups across the 
country and the NCTR's commitment to the PCR project has produced a 
scientific environment conducive to the interchange of ideas and the 
formulation of new approaches to the diverse scientific disciplines. 
NCTR developed a matrix which identifies areas of ongoing research, 
identifies additional research areas that need to be addressed and 
helps to avoid duplication of research effort.
    Current studies into the mechanisms of aging and cancer inhibition 
by caloric restriction (CR) have been exploring the effects of 
glucocorticoids and sex steroids on aging and cancer. Other studies 
have demonstrated CR-induced increase of apoptosis, a process also seen 
in aging animals, providing support for hypotheses of action of this 
process that include selective cell-killing. CR increases the ability 
of the heart to resist anoxia manyfold in aging hearts, and the 
mechanism of that process is being investigated. CR has been found to 
significantly slow the progress of retroviral-induced disease. The 
inhibitory effect on spontaneous disease seems to occur through the 
inhibition of recombination ``rescuing'' defective virus, a process 
that increases in aging. The inhibitory effect of CR on induced 
retroviral disease has yet to be understood, but appears to be related 
to the inhibition of viral function. CR has also been shown to 
significantly improve immune function. Modulation of basic aspects of 
chronic disease by CR provides both a mechanistic tool to understand 
the diseases and suggests intervention to inhibit them. The results of 
extensive epidemiologic analyses of the National Health and Nutrition 
Survey have resulted in characterizing a series of markers for the 
impact of dietary parameters for man, and have demonstrated the 
relationship of risk of breast and colorectal cancer with appropriate 
CR-related parameters.
    Also, based on the recent demonstrations of the salutatory impact 
of CR in both non-human primates and man, projects are being designed 
to extend many of the biomarkers of health developed in rodents to more 
human-like systems as well as people.
    In addition to these efforts, an extensive analysis of animal 
testing data has shown the impact that dietary modulation has on all 
long-term animal experiments, and has led to new approaches to the 
interpretation of aging and toxicity studies.
    Many of these results are consistent with the idea that CR induces 
an adaptation phenomenon within at least some animal species. Not all 
functions are altered. Rather, those processes that appear to be most 
affected are those which have been previously referred to as longevity 
assurance processes. These processes have as their primary role 
maintenance of the information flow and content of biological systems 
and work in concert with one another with the end result being the 
multiple of these interactive changes. By fine tuning these processes, 
possible via altering gene expression is some very basic way, animals 
may keep themselves alive until a more advantageous period for 
reproduction. By studying mechanisms of action, we can hopefully gain 
the advantages of this adaptation phenomena without its negative 
consequences and discomforts.
    The collaborative project between NCTR and NIA is currently 
undergoing expansion in order to provide animals to more interested 
researchers and broaden the information base on biomarkers and 
mechanisms of aging.

                           Intraocular Lenses

    Data on intraocular lenses (IOLs) continue to demonstrate that a 
high proportion (85-95 percent) of the patients will be able to achieve 
20/40 or better corrected vision with the implanted lenses and that few 
(3 to 5 percent) will experience poor visual acuity (20/200 or worse). 
The data also demonstrate that the risks of experiencing a significant 
postoperative complication are not great. Furthermore many of the 
complications result during the early postoperative period and are 
associated with cataract surgery; the incidence of these complications 
is generally not affected by IOL implantation. Approved lenses have a 
significant impact on the health of elderly patients having surgery to 
remove cataracts. The IOLs, because they are safe and effective, have 
become the treatment of choice, allowing elderly patients to maintain 
their sight and thus their ability to drive and otherwise lead normal 
lives. FDA continues to monitor several hundred investigational IOL 
models and has, to date, approved thousands of models as having 
demonstrated safety and effectiveness.
    FDA scientists have tested the optical quality of the IOLs being 
marketed. FDA nonclinical studies include measurement of focal length, 
resolving power, and image quality. This information provides useful 
data on the optical quality of new IOL designs. In addition clinical 
study data for the evaluation of the product is obtained on 
preoperative and postoperative visual acuity, intraocular pressure, and 
evaluations of the visual field in addition to any patient factors that 
may affect the performance of the lens. Test results show that the 
overall optical quality of currently marketed IOLs is excellent.
    At the December 1994 Eye Care Technology Forum at NIH, FDA agreed 
to pursue incorporating the standard operating procedures (SOPs) used 
by the National Eye Institute in the testing. Those SOPs for the 
measurement of visual acuity, intraocular pressure, and for automated 
perimetry for evaluating visual fields will be presented for panel and 
public comment at the Ophthalmic Devices Panel meeting on January 26, 
1995.

                               Pacemakers

    Dysfunction of the electrophysiology of the heart can develop with 
age, be caused by disease, or result from surgery. People with this 
condition can suffer from fainting, dizziness, lethargy, heart flutter 
and a variety of similar discomforts or ills. Even more serious life-
threatening conditions such as congestive heart failure or fibrillation 
can occur.
    The modern pacemaker is designed to supply stimulating electrical 
pulses when needed to the upper or lower chambers of the heart or both. 
It has corrected many pathological symptoms for a large number of 
people.
    Approximately 750,000 elderly persons have pacemakers. An estimated 
125,000 pacemakers are implanted annually, 20 percent being 
replacements. An estimated 75 percent of these are for persons 65 years 
of age or older. Without pacemakers, some of these people would not 
have survived. Others are protected from life-threatening situations 
and, for most, the quality of life has been improved.
    FDA, in carrying out its responsibilities of ensuring the safety 
and efficacy of cardiac pacemakers, has classified the pacemaker as a 
Class III medical device. Devices in Class III must undergo testing 
requirements and FDA review before commercial release of the device.
    Under the Deficit Reduction Act of 1984 (P.L. 98-369, Sec. 23.04), 
Congress mandated that data be collected on all implants and explants 
of pacemakers in order to recover costs in the case of defective 
pacemakers. HCFA has been collecting these data (at a cost of at least 
$250,000 a year) and sending them to FDA. FDA was to use them for 
direct patient notification and studies of pacemaker problems. HCFA and 
FDA have developed an operational registry with a data base of 
approximately 1.2 million pacemaker and lead entries to date.
    Physicians and providers of health care services must submit 
information to a national cardiac pacemaker registry if they request 
Medicare payment for implanting, removing, or replacing permanent 
pacemakers and pacemaker leads. The final rule implementing the 
registry became effective on September 21, 1987.
    In June 1994, OMB informed FDA that, in accordance with the 
Paperwork Reduction Act, it would not reinstate approval of FDA's 
activity because any need for these data has been eliminated by 
implementation of requirements for manufacturers to track high-risk 
devices under the Safe Medical Devices Act of 1990 (final rule, August 
1993). FDA and HCFA staff recently decided to approach Congressional 
staff to argue for amendment of the original law to eliminate the 
registry provision.

                             Renal Dialysis

    There were a projected 226,000 patients with kidney failure in the 
United States in 1994. More than 100 individuals are diagnosed with end 
stage renal disease (ESRD) each day. ESRD patients will need to remain 
on either hemodialysis or peritoneal dialysis for the rest of their 
lives unless they are able to receive a successful kidney transplant. 
Therapy can be delivered at dialysis facilities or in the home, 
depending on various factors.
    In 1992, 42 percent of the ESRD population was over 60 years of 
age. Through age 50, the average remaining life span is greater than 5 
years for ESRD patients. Although the remaining lifetimes are shorter 
for the elderly ESRD population, the general population also faces 
higher mortality with aging. The projected expected remaining lifetime 
for dialyzed patients with ESRD is approximately one-fourth to one-
sixth that for the general population through age 50, while the ratio 
is often closer to one-third for older patients. These figures are 
based on actuarial calculations and assumed death rates, and are taken 
from the U.S. Renal Data System 1991 Annual Data Report.
    Because of the nature of the underlying disease and necessary 
supportive therapy, ESRD patients are at risk for a number of potential 
complications during or as a result of their therapy. Many of the 
potential complications can occur from a failure to correctly maintain 
or use dialysis equipment, insufficient attention to safety features of 
the individual dialysis system components, or insufficient staffing or 
personnel training. FDA's Center for Devices and Radiological Health 
(CDRH), in conjunction with major hemodialysis organizations, such as 
the Health Industry Manufacturers Association (HIMA), the Renal 
Physicians Association (RPA), and the American Nephrology Nurses 
Association (ANNA), has been active in helping to develop several 
educational videotapes (soon to be distributed) which address human 
factors, water treatment, infection control, reuse, and delivering the 
prescription (soon to be distributed) as well as manuals on water 
treatment and quality assurance. Complimentary videos illustrating 
health and safety concerns and the use of proper techniques have been 
distributed to every ESRD facility in the United States. These videos 
have received a favorable acceptance from the nephrology community.
    CDRH is currently working on a draft guidance document for the 
labeling of hemodialyzers for safe and effective reprocessing for reuse 
manufacturers. A video on the methods for correct reprocessing and 
reuse of hemodialyzers developed by the FDA, RPA, and other concerned 
groups is available. The video attempts to follow the standard 
protocols that have been detailed in the Association for the 
Advancement of Medical Instrumentation (AAMI) Recommended Practice for 
the Reuse of Hemodialyzers. These practices also have been adopted by 
HCFA as a condition of coverage to ESRD providers that practice reuse.
    A multistate study conducted for the FDA in 1987 indicated that 
dialysis facilities appeared to have inconsistent quality assurance 
(QA) techniques for many areas of dialysis treatment. To address this 
problem, FDA funded a contract to develop guidelines that could be used 
by all dialysis facility personnel to establish effective QA programs. 
The guidelines printed in February 1991 were mailed to every dialysis 
facility in the United States free of charge.
    In the past year, FDA has continued to work cooperatively with the 
nephrology community and the ESRD patient groups to improve the quality 
of dialysis delivery. These efforts appear to be yielding positive 
results. CDRH has also been cooperating with CDC and HCFA in the 
exchange of information to try to increase the safety of dialysis 
delivery.

                              Mammography

    Since 1975, CDRH (formerly the Bureau of Radiological Health (BRH)) 
has conducted a great many mammography activities. These have been done 
with several goals in mind:
          Reduce unnecessary radiation exposure of patients during 
        mammography to reduce the risk that the examination itself 
        might induce breast cancer; and
          Improve the image quality of mammography so that early tiny 
        carcinoma lesions can be detected at the state when breast 
        cancer is most treatable with less disfiguring and more 
        successful treatments.

  The National Strategic Plan for the Early Detection and Control of 
                       Breast and Cervical Cancer

    FDA, NCI and CDC have coordinated a combined effort to cover 75 
professional, citizen, and government groups to develop the National 
Strategic Plan for the Early Detection and Control of Breast and 
Cervical Cancer. The goal of this plan, approved by the Secretary of 
Health and Human Services on October 15, 1992, is to mount a unified 
effort by all interested groups to combat these two serious cancer 
threats. FDA staff took the lead in writing the Breast Cancer Quality 
Assurance section, one of six components of the plan, and anticipated 
in the development of the other components.

               Mammography Quality Standards Act of 1992

    On October 27, 1992, the President signed into law the Mammography 
Quality Standards Act (MQSA) of 1992. This Act requires the Secretary 
of Health and Human Services to develop and enforce quality standards 
for all mammography of the breast, regardless of its purpose of source 
of reimbursement. By October 1, 1994, any facility wishing to produce, 
develop, and enforce quality standards for all mammography of the 
breast, regardless of its purpose of source of reimbursement. By 
October 1, 1994, any facility wishing to produce, develop, or interpret 
mammograms will have to meet these standards to remain in operation. 
The Secretary delegated the responsibility for implementing the 
requirements to FDA on June 1, 1993, and Congress first appropriated 
funds for these activities on June 6, 1993. Implementation of MQSA is a 
key component of Secretary Shalala's National Strategic Action Plan 
Against Breast Cancer.
    FDA's accomplishments since the Agency was delegated authority to 
implement MQSA in June 1993 include--staffing of a new division; 
development of interim standards; approval of three accreditation 
bodies; certification of several thousand facilities by the statutory 
deadline of October 1, 1994; implementation of a rigorous training 
program for inspectors; development of a compliance and enforcement 
strategy (coordinated with HFA); outreach to facility and consumer 
communities; and planning for program evaluation.
    MQSA inspections will supplant the Health Care Financing 
Administration's Medicare Screening Mammography Inspections. Under 
MQSA, HCFA has agreed to recognize FDA-certification of a mammography 
facility as meeting quality standards for reimbursement purposes.

                         Blood Glucose Monitors

    Recent publications estimate the number of diagnosed diabetics in 
the United States to be 7 million and increasing at a rate of 600,000 
per year. Over 65 percent of diabetics are 55 years and, of course, 
many must monitor their blood glucose.
    Since the implementation of Medical Device Reporting (MDR) 
regulations in December 1984, approximately 3,500 reports were 
submitted to FDA regarding erroneous test results encountered by users 
of self-monitoring blood glucose (SMBG) systems. As a result of these 
findings, a project was conducted to study and provide strategies to 
reduce the likelihood of problems with use of these devices. The study 
was conducted in four phases: (1) information/data analysis including 
labeling, instructional and training materials; (2) identification of 
problems and contributing factors, including the use of data obtained 
by survey, contract, scientific literature, laboratory testing and MDR 
submissions; (3) development of a strategy for corrective action(s); 
and (4) implementation of corrective actions that could include 
assistance and collaboration with interested organizations.
    Because the limitations of the elderly (e.g., slowed response time 
and deficient vision) are important considerations in properly using 
glucose meters, FDA conducted a human factors analysis of blood glucose 
meters. Completed in May 1990, the goals of the analysis were:
          Determine if operation and instructional materials of blood 
        glucose meters are compatible with users' ability;
          Determine if the features of blood glucose meters contribute 
        to user error; and
          Determine the quality and quantity of instructional material 
        available to meter users for learning proper meter operation.
    The study found that instructional materials did not adequately 
prepare users to obtain accurate results. In addition, the study 
pointed out the need for proper training of users by health 
professionals. It also led to suggestions for design changes to enhance 
the user's ability to obtain accurate readings.
    A National Steering Committee for Quality Assurance Glucose 
monitoring was formed in 1991 to address findings of the human factor 
study. The Committee developed user education strategies and 
instructional material designed to reduce problems associated with the 
use of blood glucose meters. This material was incorporated into 
several documents.
    A consumer brochure containing tips for safe and accurate self-
testing of blood glucose was completed in FY 1993. Also, procedural 
checklists for both the diabetic and the diabetic health care trainer 
were completed in FY 1993. Camera-ready copies were sent to SMBG system 
manufacturers who agreed to print and distribute the material.

                           Patient Restraints

    Protective patient restraints are devices used to protect patients 
from falls and other injuries. Restraints are used mostly on elderly 
patients. FDA's Manufacturers Medical Device Reporting (MDR) database 
has documented 79 deaths related to patient restraint use. The 
scientific literature suggests that the annual deaths related to use of 
this device may be as high as 200. Moreover, the use of patient 
restraints is expected to increase as the number of elderly persons 
increases. FDA believes that the users of these devices, including 
doctors, nurses, nursing assistants, and nurses aides need better 
instructional materials and labeling to be able to use these devices 
properly. Accordingly, FDA initiated an educational campaign aimed at 
development of graphic messages to be used on the restraints and in the 
package labeling to effectively convey important safety information to 
restraint users.
    FDA made restraints ``prescription use'' devices in March 1992, and 
proposed regulations so that FDA can review the devices for safety, 
labeling, and design prior to marketing. Final regulations are expected 
to publish in January 1995.

                              Hearing Aids

    Several events have occurred in 1993 which have caused FDA to 
reevaluate the regulatory framework governing the sale and distribution 
of hearing aids. In 1993, FDA reviewed the advertising, promotional 
material, and labeling of commercially available hearing aids. For 
numerous products examined, FDA found the manufacturer was making 
unsubstantiated performance claims. Based on this review, FDA sent 
letters to eight major hearing aid manufacturers directing them to 
immediately remove all misleading promotional literature and 
advertising. FDA also issued letters to all other hearing aid 
manufacturers indicating that FDA believes this is an industry wide 
problem and directing them to review and correct their promotional 
literature and advertising as needed. Manufacturers who want to make 
claims of user benefit beyond the general claim of improved hearing 
will be required to substantiate those claims by submitting valid 
scientific evidence from clinical trials. To assist manufacturers, FDA 
has developed a guidance document that sets forth the criteria 
necessary for clinical protocols. The guidance document was developed 
in August of 1993.
    In 1994 FDA developed a proposal which would amend the current 1977 
hearing aid regulation. Major considerations in developing the draft 
proposal included reexamining whether the pre-purchase medical 
evaluation to determine hearing aid candidacy should be replaced by, or 
supplemented with, a more comprehensive pre-purchase hearing assessment 
and whether to eliminate the existing waiver provision for a pre-
purchase medical evaluation required by the current 1977 regulation. 
FDA has come to question whether the Federal waiver provision of the 
existing 1977 hearing aid regulation is consistent with the Federal 
policy that each hearing aid purchaser receive a clinically appropriate 
pre-purchase hearing evaluation.
    Data from a 1991 survey of 11 hearing aid dispensers in Vermont 
demonstrated that 70 percent of hearing aid purchasers did not have a 
medical examination prior to purchasing a hearing aid. Results from a 
field survey of four FDA districts conducted in the fall of 1993 
verified that the waiver is still used in a majority of cases.
    In the Federal Register of November 3, 1993, FDA published an 
advance notice of proposed rulemaking (ANPRM) announcing its intentions 
to review and potentially revise the Federal hearing aid regulations. 
Over 3,000 comments were received from manufacturers, physicians, 
audiologists, hearing aid dispensers, professional organizations, 
consumers, consumer interest groups, educational institutions, State 
governments, State professional organizations, and State licensing 
boards. These comments and testimony at a December 6 and 7, 1993 public 
hearing concerning the ANPRM are addressed in the draft regulation's 
preamble.
    On June 13, 1994, FDA sent a letter to State Attorneys General, 
Device Program Directors, and Health Officers asking that they respond 
to questions concerning the effectiveness of state licensure for 
determining competency to conduct a hearing assessment, current 
licensing systems in place, and the probable economic impact of 
instituting or modifying current State licensure systems to conform 
with the proposal's requirement that professionals who dispense hearing 
aids be competent to perform a hearing assessment.

                                Vaccines

    The use of pneumococcal vaccine and influenza vaccine in this 
population has the potential for saving many lives annually. Death 
attributed to pneumonia and influenza is the only category representing 
infectious diseases among to top 10 causes of mortality in the United 
States. One of the objectives of the Healthy People 2000 is to increase 
the use of vaccines in order to reduce the number of deaths caused by 
epidemic-related pneumonia and influenza. In addition, another 
objective of this Public Health Service Goal is to reduce the number of 
pneumonia-related days of restricted activity.
    Elderly persons are at increased risk for complications after 
influenza virus infection, particularly secondary pneumonia caused by 
Streptococcus pneumoniae (pneumococcus), Hemophilus influenzae, 
Staphylococcus aureus, and other bacteria. In addition, pneumococci are 
the most frequent cause of bacterial pneumonia, and mortality related 
to pneumococcal pneumonia increases with age. Therefore, the elderly 
represent a target group for special vaccination programs.
    Scientists at the Center for Biologics Evaluation and Research 
(CBER) perform lot release testing on both the influenza virus vaccines 
and the pneumococcal vaccine which help achieve the objectives of 
Healthy People 2000 by ensuring the quality of the vaccines. CBER is 
active in programs directed at improving pneumococcal, influenza virus 
and other vaccines that may be useful in the elderly, including 
diagnostic skin tests for tuberculosis and blood products.
    Scientists and other staff at CBER work with others at the Centers 
for Disease Control and Prevention (CDC), the World Health Organization 
(WHO), and national control authorities to ensure that the influenza 
virus vaccines available contain the proteins of the virus strains that 
would provide the best match and most effective vaccine for the viruses 
likely to cause influenza that year. CBER, through its Vaccines and 
Related Biological Products Advisory Committee, makes the 
recommendation for strain selections after review of scientific data 
related to the viruses causing disease in human populations. In 
addition, the scientists at CBER develop and provide specific reference 
reagents that are used for production of influenza virus vaccines and 
for surveillance and identification of currently circulating influenza 
strains.

                           Immune Senescence

    Elderly individuals are especially vulnerable, as evidenced by 
increased morbidity and mortality, to a wide spectrum of infectious 
diseases caused by bacterial and viral etiologic agents. Moreover, the 
incidence of most malignancies increases and peaks among the elderly. 
The immune system is responsible for protection against infections, and 
its proper function is also thought to be instrumental for protection 
against the outgrowth of malignant cells. It is now well documented 
that advancing age compromises the ability of the immune system to 
fulfill its function. The decreased vigor of the immune response with 
age is believed to be, at least in large part, responsible for the 
increased vulnerability of the aged to infectious and malignant 
diseases.
    Efforts are underway, by investigators at CBER to understand and 
dissect mechanisms underlying the immunologic decline with age. 
Investigators at CBER are trying to understand why the activity of T 
cells is decreased with age. Proper function of T cells, central 
players in the immune system, is especially crucial to fending off 
infection and rejecting tumors. Investigators at CBER have demonstrated 
that the expression of certain proteins, and the genes which encode 
them, is reduced with advanced age. These proteins, known as perforin 
(or poreforming protein or cytolysin) and granzymes, are found within 
granules in killer T cell. They are released upon contact with foreign 
cells (e.g., tumor cells) or virally infected cells, and are believed 
to be involved in the lysis and death of the target cells. Moreover, 
the function of another class of T cell, the helper T cell, is also 
compromised with age, and compromise of its function may further 
magnify the decremental function of killer T cells. Investigators at 
CBER, using a rodent model, have shown that these cells exhibit reduced 
activity within the whole aged animal. Investigators have further shown 
that a new cytokine can restore the decreased CTL function of the aged 
individual to more youthful levels in vitro.

                Dialogue With Alzheimer's Organizations

    The Office of AIDS and Special Health Issues has initiated efforts 
to establish communications channels with Alzheimer's organizations. 
Preliminary interactions have been coordinated efforts between FDA's 
leaders and scientists and the Alzheimer's organizations, patients, and 
caregivers. At these meetings, the Commissioner and others explained 
the agency's Neurological Assessment Team concept to facilitate and 
coordinate the functions of the drug process. The Office of AIDS and 
Special Health Issues is creating an information system to support 
liaison activities with the appropriate Alzheimer's advocacy groups. 
Future efforts to respond to the concerns of Alzheimer's patients and 
caregivers on both a short- and long-term basis are underway. Over the 
past 2 years, several meetings have been held with individuals from a 
number of organizations representing Alzheimer's patients and their 
families, to begin a dialogue aimed at better understanding their needs 
and concerns. At these meetings the Commissioner and others emphasized 
that there are no distinctions made by FDA in dealing with issues and 
products related to life-threatening illnesses, and that the Agency is 
in the process of establishing mechanisms to ensure this. Subsequent to 
these meetings, the FDA announced the creation of the Office of AIDS 
and Special Health Issues (OASHI). This Office has been charged both 
with internal coordination of issues related to serious and life-
threatening diseases and with providing a liaison function between the 
FDA and groups representing individuals with these diseases. The growth 
of this function in the face of other limitations in growth at FDA 
reflect the commitment of the Commissioner and other senior FDA staff 
to improving the relationship between FDA and these groups. OASHI began 
hiring personnel in late 1993.

                             Women's Health

    The FDA Office of Women's Health (OWH) was established in July 
1994. Its priorities are to serve as the principal advisor to the 
Commissioner and other key officials on scientific, ethical, and policy 
issues relating to women's health; provide leadership and policy 
direction for the Agency regarding women's health; coordinate efforts 
to establish and advance a women's health agenda; monitor the inclusion 
of women in clinical trials and completion of gender analysis as 
specified in the 1993 Guidelines for the Study and Evaluation of Gender 
Differences in the Clinical Evaluation of Drugs; identify and monitor 
the progress of crosscutting and multidisciplinary women's health 
initiatives; and serve as the Agency's liaison with other agencies, 
industry, and associations.
    Since its inception, the Office has collaborated with other FDA 
entities on a broad range of health issues concerning older women in an 
effort to expedite the review of products for prevention, diagnosis, 
and treatment, and to ensure the safety and efficacy of FDA regulated 
products. The OWH is establishing a special intra-agency working group 
to focus particularly on cardiovascular disease and osteoporosis.
    The Office participated with other Federal agencies and private 
sector entities in several activities. This included the Federal 
conference, ``A Public Health Agenda for an Aging Society,'' which 
examined the implications of the aging of the population in the setting 
of public health policy; the National Council on Patient Information 
and Education meeting, ``Advancing Prescription Medicine Compliance: 
New Paradigms, New Practices,'' which focused on improving out-patient 
medicine use; and the launching of the Older Women's League and 
Campaign for Women's Health national public education campaign designed 
to promote prevention and early treatment of osteoporosis and heart 
disease.

              HEALTH RESOURCES AND SERVICES ADMINISTRATION

    The Health Resources and Services Administration (HRSA) has lead 
responsibility for Federal efforts to promote access to health care 
services, primarily through programs which increase the availability of 
community health resources.
    HRSA's programs are far-reaching in their support of health 
services to disadvantaged and underserved groups. In addition to older 
people, our clients include mothers and children, minorities, the 
homeless, the poor, drug users, migrant workers, people with AID/HIV, 
those with Hansen's Disease, and those who need organ transplants. Our 
challenge is to help assure the best possible care to as many 
individuals as possible at reasonable cost.
    HRSA also provides technical assistance and resources to improve 
the education, supply, distribution, and quality of the Nation's health 
professionals, and access to health services and facilities. Our 
partners in these efforts include State and local health departments, 
universities, private nonprofit organizations, and many other 
participants in the Nation's public health care system.
    A primary emphasis during the past year has been on strengthening 
the role of State and local health departments. HRSA, in conjunction 
with the Centers for Disease Control, has been instrumental in 
assisting the three organizations representing public health officials, 
the Association of State and Territorial Health Officials (ASTHO), the 
National Association of County Health Officials (NACHO), and the U.S. 
Conference of Local Health Officers (USCLHO), in forming a coordinated 
approach to public health practice with the creation of the Joint 
Council of Official Public Health Agencies. They are currently working 
on the development of a strategic plan.
    HRSA is concerned about training our Nation's professionals to 
provide care for today's older individuals and individuals who will be 
old in the future. The Agency provides services to underserved older 
Americans, such as those who live in rural areas and those with low 
incomes. One-quarter of older Americans live in rural areas. One out of 
four elderly Americans, or 7.4 million, are poor or near poor.
    Several HRSA components significantly influence programs and 
activities that benefit older Americans.

                     Bureau of Primary Health Care

    The Bureau of Primary Health Care (BPHC) helps assure that primary 
health care services are provided to persons living in medically 
underserved areas and to persons with special health care needs. It 
also assists States and communities in arranging for the placement of 
health professionals to provide care in health professional shortage 
areas. The Bureau provides services to older Americans through 
Community and Migrant Health Centers (C/MHCs), the National Health 
Service Corps, the Division of Federal Occupational Health, the Home 
Health Demonstration Program, and the Alzheimer's Demonstration Grant 
Program.
                  community and migrant health centers
    During fiscal year 1994, C/MHCs located in medically underserved 
areas, provided a range of family-oriented, preventive and managed care 
primary care services to those individuals who would otherwise lack 
access to care, particularly the poor and minorities. Approximately 7 
million people were served in FY 1994, of which approximately 8 percent 
(or 525,000) were age 65 or older.
    In FY 1994, the Bureau awarded funds to a C/MHC to develop an 
integrated service network for the provision of comprehensive primary 
health services to frail elderly population located in Boston, 
Massachusetts. In addition, the Bureau is currently working with the 
Health Care Financing Administration to determine the feasibility of C/
MHCs serving as service delivery contractors for Medicare managed care 
patients.
    To review the geriatric care provided in C/MHCs, the Bureau 
assesses the following clinical measures, pertinent to geriatric care 
in C/MHCs. These measures include: (1) functional measurement, (2) 
evaluation of multiple medication use, and (3) immunization tracking. 
The development of clinical protocols and establishment of baseline 
values are currently in progress.
                   the national health service corps
    The National Health Service Corps places physicians, nurse 
practioners, physician assistants, certified nurse midwives, and other 
health professionals in health personnel designated shortage areas. 
Older Americans with special health care needs and reduced mortality 
need primary care providers close at hand. The Corps works closely with 
C/MHCs, other primary care delivery systems and the Indian Health 
Service to provide assistance in recruiting and retaining health 
personnel for populations in need.
                division of federal occupational health
    The Division of Federal Occupational Health (DFOH) provides a 
variety of services related to health promotion and disease prevention 
in the elderly to managers and employees of over 3,000 Federal 
agencies. Retirement planning, care of aging parents, and prevention of 
osteoporosis are some examples of geriatric issues that are regularly 
addressed in educational seminars and counseling sessions provided by 
the Division's clinical and employee assistance programs.
         health care services in the home demonstration program
    The Health Care Services in the Home Demonstration Program was 
developed to identify low-income persons who can avoid unnecessary 
institutionalization or hospitalization if case-managed skilled home 
health services are provided in the homes. Through the program, these 
services are provided to technology-dependent children, disabled 
adults, the frail elderly, and others who are uninsured or 
underinsured.
    Five State health departments have been awareded demonstration 
grants--Hawaii, Mississippi, North Carolina, South Carolina, and Utah. 
There were significant variations in terms of demographics, service 
needs, health resources available, cultural attitudes, and 
organizational structure among the grantees.
    Each State found people who were uninsured or underinsured for case 
managed skilled home health services provided by a multidisciplinary 
team. Many people were inadequately served both in terms of their 
needs, preferences, and quality of care by current services. Together 
these States have provided services to approximately 8,700 uninsured or 
underinsured clients in the first 5 years of the program.
    Approximately $15.5 million has been awarded for this 6-year 
program. The first grants were awarded in fiscal year 1988; the 
demonstration will continue through June 1995.
                alzheimer's demonstration grant program
    The Alzheimer's Demonstration Grant Program was established under 
Section 398 of the Public Health Service Act as amended by Public Law 
101-157, the Home Health Care and Alzheimer's disease amendments of 
1990. In fiscal year 1992, $3.9 million in grants were awarded to 
governmental agencies in nine States, the District of Columbia and to 
Puerto Rico. In fiscal years 1993 and 1994, $4.9 million was awarded, 
and four additional States were added, bringing the program to its 
legislative ceiling of 15 grantees. Funding remains level in fiscal 
year 1995.
    The purpose of this program is to demonstrate how existing public 
and private nonprofit resources within States may be more effectively 
identified, utilized, and coordinated to deliver appropriate respite 
care and supportive services to underserved persons with Alzheimer's 
disease, their families and their caregivers. In addition, the program 
seeks to identify service gaps and barriers to access within 
communities and, where possible, develop innovative and creative 
approaches to bridge these gaps and overcome barriers. Lastly, the 
program will result in permanent infrastructure development and yield 
important information via evaluation about appropriate models and the 
provisions of respite care and supportive services for diverse 
underserved populations.
    To date, approximately 2,185 clients have been served by the 
program, 56 percent of whom reside in rural areas. Of this total, 51 
percent are Caucasian, 21 percent are African American, 20 percent are 
Hispanic, 5 percent are Asian and Pacific Island American and 1 percent 
are Native American.
    The primary type and number of respite service delivery sites 
supported by the program are: 40 stipended and unstipended in-home 
respite programs; 50 adult day care programs; 28 support groups; 28 
case management programs; 12 legal assistance programs; 5 institutional 
respite programs; 3 telephone helplines; and 3 transportation programs.
    Descriptive and outcome-oriented (client satisfaction) evaluation 
activities are currently in progress. A preliminary descriptive report 
is expected in early 1995.

                     Office of Rural Health Policy

    The Office of Rural Health Policy was established in 1987 at the 
urging of the Senate Special Committee on Aging in order to address 
severe shortages of health services in rural areas, where one-quarter 
of the Nation's elderly live. Aging-related issues are of particular 
importance to the Office, since rural counties have, on average, a 
higher percentage of seniors over 65 years of age than urban counties; 
and these residents are often poorer, sicker, and more isolated than 
their urban counterparts.
    To strengthen support for health services in rural areas, the 
office plays a collaborative role throughout the Department and with 
the States and the private sector. For example, it apprises interest 
groups, such as the National Council on Aging and the American 
Association of Retired Persons about its activities and about the needs 
of the rural elderly. Within the Department the Office advises the 
Secretary, in particular, on the effects that Medicare and Medicaid 
programs have on rural health care, on the shortage of healthcare 
providers, the viability of rural hospitals, and the availability of 
primary care and also emergency medical services to elderly and other 
rural residents.
    The Office supports local and State initiatives to build rural 
health care services through a $27 million grant program to rural 
communities, themselves, and a $3.9 million program of matching grants 
to the States to support State offices of rural health which can 
recruit rural providers and assist their rural communities in 
developing more local health services.
    The Office of Rural Health Policy also promotes informed 
policymaking by administering a small $2.7 million program of grants 
for policy-relevant studies at established rural research centers 
throughout the country. These centers provide data capability on a wide 
range of rural health concerns, including areas relevant to the 
elderly.
    The Office also participates in the Vice President's multi-
departmental initiative to develop the Nation's information highway. In 
concert with the effort to explore the development of rural healthcare 
networks, the Office administers $9.5 million in telemedicine grants to 
rural communities who want to test the ability of telecommunications 
technologies to bring specialized health care to their citizens.
    The Office of rural Health Policy has worked with other Federal 
offices and agencies, such as the Health Care Financing Administration, 
the Department of Agriculture, the Department of Transportation, and 
the National Institute on Aging, to sponsor workshops and seek public 
advice on a range of rural needs that include emergency medical 
services, managed care options for Medicaid and Medicare clients, 
physican recruitment, and rural economic development.
    To enhance dissemination of information on strategies for better 
health services to rural regions, the Office initiated a national rural 
health information and referral service with USDA that is available to 
rural residents throughout the Nation with a toll-free line (1-800-633-
7701) and through an electronic bulletin board.
    The Office also channels public advice on rural issues to the 
Department by staffing the Secretary's National Advisory Committee on 
Rural Health, a citizen's advisory panel chartered in 1987 to address 
health care crises in rural America.
                      Bureau of Health Professions
    The Bureau of Health Professions (BHPR) monitors and guides the 
development of health resources by providing leadership to improve the 
education, training, distribution utilization, supply, and quality of 
the Nation's health personnel.
    The Bureau has established Seven Strategic Directions to achieve 
the Department's Year 2000 National Health Promotion and Disease 
Prevention Objectives and to guide the implementation of the Bureau's 
programs in an era of health care reform.
    The Seven Directions are:
          1. Health Care Reform: Promotion Primary Health Care 
        Education;
          2. Health Care Reform: Increasing the Number of Health Care 
        Providers from Minority/Disadvantaged Backgrounds;
          3. Health Care Reform: Establishing Linkages Between 
        Education Programs and Service Settings;
          4. Health Care Reform: Assuring Health Care Quality Through 
        Publicly-Responsive Reforms in Health Professions Education 
        Practice and Liability Management;
          5. Health Care Reform: Strengthening Public Health Education 
        and Practice;
          6. Health Care Reform: Strengthening Health Professions Data, 
        Information Systems and Research; and
          7. Health Care Reform: Building the Capacity of Nursing and 
        Allied Health Professions to Meet the Demands for Health 
        Services.
    The strategy defined by these seven directions will be implemented 
through a variety of collaborative public and private efforts and 
programs supported and operated by the Bureau. Programs include: 
education and training grant programs for institutions such as health 
professions schools and health professions education and training 
centers; loan and scholarship programs for individuals, particularly 
those from disadvantaged backgrounds; the National Practitioner Data 
Bank; and the Vaccine Injury Compensation Program.
    The Bureau supports the Council on Graduate Medical Education. The 
Council reports to the Secretary and the Congress on matters, related 
to graduate medical education, including the supply and distribution of 
physicians, shortages, or excesses in medical and surgical specialties 
and subspecialties, foreign medical graduates, financing medical 
educational programs, and changes in types of programs. It also 
supports the National Advisory Council on Nurse Education and Practice 
which advises the Secretary on PHS title VII nursing authorities. In 
addition, the Bureau has established the National Commission on Allied 
Health.
    BHPR administers several education-service network 
multidisciplinary and interdisciplinary programs such as the Area 
Health Education Centers (AHECs), the Geriatric Education Centers 
(GECs), and Rural Interdisciplinary Training Programs. In addition, it 
also administers the AIDS Regional Education and Training Centers 
Program which provides multidisciplinary training for primary health 
care providers in the care of HIV-infected individuals and people with 
AIDS.
    The National Vaccine Injury Compensation Program is administered by 
BHPR. The program, which became effective October 1, 1988, was created 
by the National Childhood Vaccine Injury Compensation Act of 1986, as a 
no-fault system through which families of individuals who suffer injury 
or death as a result of adverse reactions to certain childhood vaccines 
can be compensated without having to prove negligence on the part of 
those who made or administered the vaccines.
    BHPr maintains a federally sponsored health practitioner data bank 
on all disciplinary action and malpractice claims. The National 
Practitioner Data Bank (NPDB) was created by The Health Care Quality 
Improvement Act of 1986, Title IV of P.L. 99-660, as amended November 
1986. The Act authorized the Secretary of Health and Human Services to 
establish a data bank to ensure that unethical or incompetent medical 
and dental practitioners do not compromise health care quality. The 
NPDB is a central repository of information about: malpractice payments 
made on behalf of physicians, dentists, and other licensed health care 
practitioners; licensure disciplinary actions taken by State medical 
boards and State boards of dentistry against physicians and dentists; 
and adverse professional review actions taken against physicians, 
dentists, and certain other licensed health care practitioners by 
hospitals and other health care entities, including health maintenance 
organizations, group practices, and professional societies. The NPDB 
opened on September 1, 1990.
    Under Section 777, three programs received funding in FY 1994, the 
Geriatric Education Centers (777a), Faculty Fellowship Program in 
Medicine and Dentistry (777b), and Optometry Training (777c).
                      geriatric education centers
    Of the 47 GECs that make up the membership of the National 
Association of Geriatric Education Centers, 20 received awards in FY 
1994. Fifteen GECs are consortia partnerships of two or more 
universities with many representing multiple schools of the health 
professions in their respective States. At the State and national level 
the GECs comprise a comprehensive educational system, serving as the 
primary coordinating body for the preparation of faculty, health 
professions students, and health care personnel to better serve the 
Nation's elderly in their own homes and in long-term care institutions 
and community based agencies. A total of 42 fellows are enrolled, 24 
physicians and 18 dentists.
    Awards were made to the following institutions in FY 1994:

Consortia:
                                                           FY 1994 Award
    Univ. of California, LA...................................  $508,958
        Univ. of California, Davis
        Univ. of California, San Francisco
    University of Colorado....................................   242,571
        Regional Colorado AHEC
        Univ. of Colorado, Colorado Springs
        Univ. of Northern Colorado
        University of Denver
    Columbia University.......................................   290,761
        New York University
        Beth Abraham Hospital
    University of Pittsburgh..................................   352,239
        Pennsylvania State University
        Temple University
    Harvard Medical School....................................   250,209
        Dartmouth College
    Research Fdn. of CUNY.....................................   314,594
        New York Medical College
        New York School of Podiatric Med.
        SUNY College of Optometry
    Univ. of Illinois, Chicago................................   308,880
        Southern Illinois University System
        Sangamon State University
    University of Miami.......................................   492,294
        Barry University
        Florida A&M
        Florida International University
    St. Louis University......................................   296,878
        U. of Missouri, School of Optometry
        Washington U., Occupational Therapy
        St. Louis College of Pharmacy
        Kirksbille Coll. of Osteopathic Med.
    University of Kentucky....................................   308,264
        East Tennessee State Univ.
        U. of Ohio, Cincinnati
    Baylor University.........................................   284,769
        Univ. of Texas, Houston HSC
        Univ. of Texas Medical Branch
        Univ. of North Texas
        Univ. of Texas-Pan Am
        Texas Southern Univ.
        Univ. of Houston
        Texas A&M University
    University of Florida.....................................   247,902
        Florida A&M University
    George Washington Univ....................................   270,000
        Georgetown University
        Howard University
    Case Western Reserve Univ.................................   297,000
    Marquette University......................................   444,552
        Univ. of Wisconsin-Madison
        Univ. of Wisconsin-Milwaukee
        Milwaukee Area Technical College
        Medical College of Wisconsin
Single Institution:Inst. of Sinai Samaritan Medical Center
    Univ. of Minnesota........................................   270,000
    Univ. of Nevada, Reno.....................................   325,350
    Univ. of Med. & Dent. of NJ...............................   239,742
    University of Hawaii......................................   242,664
    Stanford University.......................................   345,373

    Awards for these 20 GECs totaled $6,333,000 for Fiscal Year 1994. 
Funding for FY 1995 under Section 777(a) is expected to be 
approximately $6 million. These Centers are educational resources 
providing multidisciplinary and interdisciplinary geriatric training 
for health professions faculty, students, and professionals in 
allopathic medicine, osteopathic medicine, dentistry, pharmacy, 
nursing, occupational and physical therapy, podiatric medicine, 
optometry, social work, and related allied and public or community 
health disciplines. They provide comprehensive services to the health 
professions educational community within designated geographic areas. 
Activities include faculty training and continuing education for 
practitioners in the disciplines listed above. The Centers also provide 
technical assistance in the development of geriatric education programs 
and serve as resources for educational materials and consultation.
    In preparation for the National Forum on Geriatric Education and 
Training to be held in FY 1995, 11 study groups were provided minimal 
funds to develop white papers on the status of geriatric education in 
medicine, nursing, dentistry, public health, social work, allied and 
associated health, interdisciplinary education, enthnogeriatrics, case 
management, managed care and long-term care. Resulting recommendations 
will be presented to Federal and non-Federal response panels during the 
Forum and an agenda for action to meet workforce needs will be 
developed within the context of shared responsibility for projected 
outcomes.
    faculty training projects in medicine, dentistry, and psychiatry
    Nine joint medicine and dentistry projects were funded under the 
Faculty Fellowship Program in Geriatric Medicine, Dentistry, and 
Psychiatry. Currently, Section 777b provides the only funding for 
faculty development in geriatric medicine and dentistry in the country. 
These interdisciplinary programs have four learning components: 
longitudinal clinical experience, teaching, research, and 
administration.
    The following institutions received five year awards in FY 1994:

University of California, Los Angeles.........................  $177,571
University of Connecticut.....................................   278,727
Boston University.............................................   283,009
Harvard University............................................   335,007
University of Michigan........................................   253,282
University of Medicine and Dentistry of New Jersey............   295,138
Duke University...............................................   309,369
University of North Texas.....................................   176,869
        Baylor School of Dentistry
University of Texas, San Antonio..............................   307,690
                           optometry training
    A $24,899 contract was awarded in FY 1994 to the Association of 
Schools and Colleges of Optometry to examine and document the status of 
and the need for faculty training in geriatric optometry.
    There are 17 Schools of Optometry with total of 186 faculty; 16 
schools have geriatric content in their curricula. Of the 27 faculty 
currently teaching geriatrics, 9 have had some formal geriatric 
training. A need exists for significant knowledge and skill enhancement 
of a minimum of 18 faculty with opportunities for advanced training for 
the remaining 9. Barriers to the development of separate faculty 
development programs relate to the low numbers of persons to be 
trained. Opportunities for the basic and interdisciplinary training 
required by optometric faculty exist through the Geriatric Education 
Centers programs. Some Schools of Optometry who are affiliated with the 
GECs are encouraged to develop optometric-specific learning experiences 
for faculty. Schools of Optometry continue to be eligible applicants 
for Geriatric Education Centers grants.

                          Division of Medicine

    The Division continues to support through its grant and cooperative 
agreement programs significant educational and training initiatives in 
geriatrics.
    Fourteen predoctoral grantees and 53 graduate program grantees 
under section 747, Family Medicine Training, indicated that they are 
actively involved in the development, implementation, and evaluation of 
their geriatrics curriculum and training. The predoctoral grantees 
received funds totaling $573,243, the residency program grantees 
received funds totaling $353,686 specifically for developing and 
enhancing geriatrics curriculum and training experiences. In addition, 
13 faculty development programs reported that they provided geriatrics 
training. Seven of the section 747 Family Medicine Departments program 
grants received awards totaling $483,624 for the purpose of 
strengthening geriatric training and carrying out research activities 
in this area.
    Under section 748, the General Internal Medicine and General 
Pediatrics Residency Training Programs reported nine grantees who 
provided geriatric medicine training a total of $152,634 was awarded.
    The Area Health Education Center (AHEC) Program (section 746) 
awarded $18.7 million to 19 Basic/Core AHEC Programs and $3.2 million 
to 13 Model State-supported AHEC programs. Approximately 5 percent of 
these awards support geriatric activities. Trainees include a full 
range of health professions students (i.e., medicine, nursing, nurse 
practitioner, physician assistant, pharmacy, dentistry, mental health), 
primary care residents (family medicine, general internal medicine, 
general pediatrics) and local health care providers.
    Geriatrics training components will be developed by 3 of 10 
grantees under the Health Education and Training Centers Program 
(section 746(f)). Approximately $2.8 million was awarded for this 
program. Approximately 3 percent of this amount was directed to 
geriatric activities that impacted physicians, social workers, nurses, 
community health workers, and public health trainees.
    Nine Physician Assistant Training Program (section 750) grantees 
have instituted training activities in geriatrics. These grantees were 
awarded $153,422 specifically for their efforts in this area.
    Six grantees receiving support for Pediatric Primary Care Residency 
Training under section 751 authority have included curricular emphasis 
in geriatric health. These grantees received a total of $299,700.
    Geriatrics training components will be developed by 4 to 13 
grantees under the Health Education and Training Centers Program 
(section 746(f)). Approximately $2,800,000 was awarded for this 
program. Approximately 3 percent of this amount was directed to 
geriatric activities that impacted physicians, social workers, nurses, 
community health workers, and public health trainees.

                          Division of Nursing

    The Division of Nursing continues to administer grants awarded 
through four programs: (1) Advanced Nurse Education, (2) Nurse 
Practitioner-and-Nurse-Midwifery, (3) Special Projects, and (4) 
Professional Nurse Traineeships. The fourth program provides funds to 
schools which allocate these funds to individual full-time master's and 
post-master's nursing students who are preparing to be nurse 
practitioners, nurse-midwives, nurse educators, public health nurses, 
or in other clinical nursing specialties.
    Activities relating to the Aging, Advanced Nurse Education and 
Nurse Practitioner/Nurse Mid-Wifery programs during FY 1993 include.--
The Advanced Nurse Education Program (section 821) authority supported 
7 grants totaling $1,188,126 for gerontological and geriatric nursing 
concentrations in programs leading to a master's or doctoral degree in 
nursing. Graduates of these programs are prepared broadly to meet a 
wide range of needs relative to the elderly in many settings, but are 
particularly prepared to deal with the older individual who is acutely 
ill. In addition, the program prepares nurses who can teach and do 
research in this important field.
    Under the Nurse Practitioner and Nurse-Midwifery Program (section 
822(a)) 8 master's or post-master's gerontological nurse practitioner 
programs received $716,061 in grant support. As nurses with advanced 
academic preparation and clinical training, they are prepared as 
primary health care providers to manage the health problems of the 
elderly in a variety of settings, such as long-term care facilities, 
ambulatory clinics and the home. They provide nursing care which 
includes the promotion and maintenance of health, prevention of 
disease, assessment of health needs, and long-term nursing management 
of chronic health problems.
    Emphasis is placed on teaching and counseling the elderly to 
actively participate in their own care and to maintain optimum health.
    The Nursing Special Projects Grant Program (section 820) supported 
11 projects, amounting to $1,337,130 for paraprofessional fellowships 
for LPN to RN training, and for nursing practice arrangements in 
communities to demonstrate methods to improve access to primary health 
care in medically underserved communities. The nursing practice 
arrangements targeted the elderly as an integral component of services 
provided. Project activity was based in home settings and in the 
community in both urban and rural areas.
    Below is highlighted one of the specific special projects.--A 
special project was awarded to Old Dominion University, Norfolk, VA 
over a 3-year period to compare the effectiveness of utilizing a case 
management system implemented by a family nurse practitioner in a 
mobile health unit to assess, coordinate, and deliver services to 
individuals 65 years of age or older in a rural setting with the 
current method of providing services. The project will focus on 
providing access to health care services for those individuals who have 
difficulty obtaining care because of illness, transportation problems, 
or financial factors. The nurse practitioner associated with the 
project will provide nursing services in the home as well as at 
designated community sites via the mobile health unit.
    The proposed project will study changes in access to care, 
functional status, health status, and health promotion behaviors after 
implementation of the project as well as evaluate the impact of the 
project on the community, and test the cost effectiveness of the 
service delivery model. It is anticipated that data from this project 
will be useful in determining the health status of the rural elderly 
and provide a better understanding of the life conditions affecting 
health in a rural area.

            Active Contracts Under Title VII of the PHS Act

Funding--FY 1994
Project
State University of New York at Buffalo
``Categorization of Secondary Outcomes of GEC Activities''
8/30/94-2/28/95--$24,349.
    The purposes of this project area: (1) to categorize the secondary 
outcomes identified under HRSA contract number HRSA 93-901(P) to 
delineate the multiple types of secondary outcomes possible through GEC 
activities; (2) to review and revise the existing primary outcomes 
reporting instrument; and (3) to propose categories for secondary 
outcomes identification and recommendations for their adaptation by 
GECs.

Project
240-BHPr-1(4)
1/1/94-1/1/95--$137,693.
Baylor College of Medicine
    The purpose of this contract is to plan, develop, and conduct a 
workshop, including logistical support, which will enable key staff 
from Geriatric Education Centers (GECs) to interact, exchange 
information, share strategies, and jointly plan needed actions to 
accomplish GEC purposes.

Project
HRSA 94-750(P)
7/8/94-1/8/95--$24,993.50
Baylor College of Medicine
    The purpose of this contract is to provide logistic services for 
meetings of three Study Groups of the National Forum for Geriatric 
Education and Training to be held before and during the 9th Workshop 
for Key Staff of Geriatric Education Centers.

                              Publications

    ``GEC Materials Related to Minority Aging.'' Bibliography. Revised 
September 1994.
    ``Selected Materials Produced by Geriatric Education Centers.'' 
Updated listing of approximately 500 curriculum guides, conference 
proceedings, audiovisual materials, and monographs. October 1993.
    Georgia J. Anetzberger, Ph.D., ``Elder Abuse Programming Among 
Geriatric Education Centers'', Journal of Elder Abuse & Neglect. 
Haworth Press. Vol. 5(3) 1993.
    Gary L. Mancil, O.D., Sheree J. Aston, O.D., Ph.D., Tanya L. 
Carter, O.D., Rosalie A. Gilford, Ph.D.; ``Geriatric Optometry Faculty 
Preparedness in Schools and Colleges of Optometry'' accepted for 
publication in Journal of Optometry Education.

                                 Events

    White House Conference on Aging Mini-Conference--Ninth GEC 
Workshop, ``The Challenge of the Next Ten Years'' held in Washington, 
D.C., August 25-28, 1994.
    ``Evolution of GEC Evaluation Efforts'' presented at the Ninth GEC 
Workshop in Washington, D.C., August 27, 1994.
    ``Faculty Training in Geriatric Optometry'' presented at the 47th 
Annual Scientific Meeting of the Gerontological Society of America in 
Atlanta, GA, November 20, 1994.
    ``Integrated Learning Among Fellows in the Faculty Training 
Projects in Geriatric Medicine and Dentistry'' presented at the 47th 
Annual Scientific Meeting of the Gerontological Society of America in 
Atlanta, GA, November 20, 1994.
    ``Analysis of Secondary Outcomes Data from Geriatric Education 
Center (GEC) Programs'' presented at the 47th Annual Scientific Meeting 
of the Gerontological Society of America in Atlanta, GA, November 20, 
1994.
    ``Health Professions Reform, Directives & Policy Formation: 
Geriatric Education in the New Century'' presented at the 47th Annual 
Scientific Meeting of the Gerontological Society of America in Atlanta, 
GA, November 20, 1994.

             Funding Factors Used in BHPr Training Programs

    The Bureau utilizes several funding factors to address national 
priority areas. These factors are designed to place applicants 
responding to these national needs in a more competitive funding 
position. The following programs used a geriatric funding priority in 
awarding funds in FY 1994:
          Geriatric Education Centers--section 777(a).
          Geriatric Faculty Fellowships--section 777(b).
    The following programs used a geriatric special consideration in 
awarding funds in FY 1994:
          Advanced General Dentistry--section 749.
          Allied Health Special Projects--section 767.

       NATIONAL INSTITUTES OF HEALTH--NATIONAL INSTITUTE ON AGING

                              Introduction

    Finding ways to provide effective health care for the rapidly 
expanding population of older Americans and keeping costs down is one 
of the greatest challenges faced by our Nation. The success of this 
balancing act depends upon persistent efforts to avoid doing the same 
old things in the same old way. Research into age-related processes 
provides the underpinnings to this progress. Of equal importance is our 
success at communicating these scientific advances to physicians so 
they can be applied in clinical settings. This report highlights a 
number of research advances made during 1994 conducted or funded by 
scientists by the National Institutes of Health (NIH), the principal 
biomedical research arm of the Federal Government. Part of NIH, the 
National Institute of Aging (NIA), is the primary sponsor of aging 
research in the United States. The first section of this report 
outlines some key research advances conducted or funded by the NIH. The 
second section covers recent advances in Alzheimer's disease (AD), an 
NIA research priority.

                          Understanding Aging

    NIA scientists and grantees take a multidisciplinary approach to 
finding ways to improve the ability of doctors to diagnose, treat, and 
prevent the health problems of older adults. Other NIH components 
conducting or supporting aging research are the National Cancer 
Institute; the National Center for Research Resources; the National Eye 
Institute; the National Heart, Lung, and Blood Institute; the National 
Institute for Nursing Research; the National Institute of Arthritis and 
Musculoskeletal and Skin Diseases; the National Institute of Dental 
Research; the National Institute of Diabetes and Digestive and Kidney 
Diseases; the National Institute of Mental Health; the National 
Institute on Alcohol Abuse and Alcoholism; and the National Institute 
and Other Communication Disorders.
Pumping Iron Improves Strength, Mobility of 80- and 90-Year-Olds
    Pumping iron at 90? Is there really any point? Absolutely, 
according to a recent NIA study. In fact, frail people in their 
eighties and nineties became stronger and more mobile with high-
intensity weight training in a clinical trial conducted by Dr. Maria 
Fiatarone at the Hebrew Rehabilitation Center of Aged, a long-care 
facility in Boston Massachusetts.
    Fiatarone and her colleagues found that a carefully designed 
program of strength training for the muscles of the hips and knees can 
counteract muscle weakness in very old people. Ultimately, this type of 
intervention could be a key to reducing disability and its costs as 
people age, and may help delay entry into a nursing home altogether.
    The study found an average 113-percent increase in muscle strength 
among the participants, compared with 3 percent improvement in people 
who did not take part in the exercise program. The exercisers 
experienced a 12-percent increase in walking speed and a 28-percent 
increase in ability to climb stairs. People in the exercise group even 
showed an increase of 34 percent in their levels of spontaneous 
activity, such as walking to meals and participating in art and 
educational activities. In addition, after doing the exercises, several 
participants required the support of only a cane rather than a walker. 
Earlier groundbreaking research by Fiatarone had suggested that 
strength training could build muscle strength in the very old and 
frail. But these latest findings go a step further by demonstrating the 
practical benefits of increased muscle strength and size.
    This study is especially important because it shows that 
improvements in strength translate to significant improvements in 
mobility. For some, this is the difference between being able to go to 
the dining room for a meal instead of having to stay in their rooms.
    The findings are among the first reported from FICSIT (Frailty and 
Injuries: Cooperative Studies of Intervention Techniques) clinical 
trials funded by NIA and launched in 1990 to reduce and prevent 
frailty. Funding for Fiatarone's work was also provided by the U.S. 
Department of Agriculture Human Nutrition Research Center on Aging at 
Tufts University.
    The study included 63 women and 37 men, ranging from 72 to 98 years 
of age. More than one-third of participants were 90 and older. The 
participants were divided into four groups, comparing resistance 
training (in which muscles are worked against weights), nutritional 
supplements, both interventions together, and neither. People assigned 
to the exercise training group participated in a program of high-
intensity progressive resistance training of the hip and knee extensor 
muscles under professional supervision 3 days a week for 10 weeks. 
Training sessions lasted 45 minutes.
    The researchers note that this study is also important for its 
finding that nutritional supplements alone are ineffective in 
increasing the strength or physical activity of nursing home patients. 
The supplement used in the study boosted calories by about 20 percent 
and provided one-third of the recommended daily allowance of vitamins 
and minerals, like supplements commonly ordered by physicians for 
nursing home patients. In the Boston study, when the supplement was 
given without exercise, people cut down on the amount of food they ate, 
essentially replacing their food with the supplement. The exercisers, 
however, increased their caloric intake significantly when given the 
supplement, suggesting that activity might work to increase appetites 
in older people.
    Physical frailty represents one of the biggest threats to older 
people's functioning and quality of life. Studies like this will help 
improve everyday life for America's aging population and may eventually 
contribute to reducing health care costs.
    A number of national health surveys indicate that substantial 
numbers of older Americans report difficulties in the ability to climb 
10 steps, walk one-quarter mile, or lift 10 pounds. Frailty increases 
the risk of institutionalization among older people, whose annual 
nursing home care costs are estimated to be well over $30 billion. 
Frailty also greatly raises the risk of falls in older people, and 10 
percent of falls result in serious injury, such as fracture. An 
estimated $7 billion is spent on the 250,000 hip fractures that occur 
each year among older Americans, almost all due to falls.
One More Reason to Exercise
    There is yet another reason for older people to exercise. According 
to new studies by NIA scientists, regular exercise, such as walking or 
gardening, is associated with nearly a 50-percent reduction in the risk 
of severe gastrointestinal (GI) hemorrhage in older people. The study 
is the first to show an association between physical activity and 
reduced risk of serious intestinal bleeding.
    The study is one of two which analyze the risks of severe GI 
hemorrhage. The second report looks at the other end of the spectrum, 
finding that physical disability increases the risk of severe GI 
bleeding in older people.
    The first group of findings, associating physical activity with a 
reduced risk of serious intestinal bleeding, are important in showing a 
possible way to prevent GI hemorrhage without drugs or surgery. It is 
already known that people who engage in regular physical activity are 
less likely to develop coronary heart disease, diabetes, obesity, and 
other conditions that may cause disability and death. Now, scientists 
are closer to adding to the list a reduced risk for severe GI 
hemorrhage, a problem that affects large numbers of older people each 
year. However, additional research is needed to confirm these findings 
and to explain how exercise and fitness may reduce the risk of GI 
hemorrhage. The analysis was led by Dr. Marco Pahor, a visiting 
scientist to NIA from the department of gerontology, Catholic 
University, Rome, Italy, and his colleagues, who include Dr. Jack 
Guralnik, NIA's chief of the Office of Epidemiology and Demography.
    Some 8,205 people age 65 and older, participants from three 
communities of NIA's Established Populations for Epidemiologic Studies 
of the Elderly, were asked by researchers about the frequency of taking 
walks, gardening, and doing vigorous physical activity and were 
followed for 3 years. People engaged in these activities three or more 
times per week were compared to the other study participants for GI 
hemorrhage. Scientists also looked at other factors linked to 
intestinal bleeding including age, gender, body-mass index, blood 
pressure, chronic diseases, hospitalizations, and certain drugs. The 
mean age of participants was 76.8 years.
    Overall, people who were inactive were 40 percent more likely to 
experience a GI hemorrhage than those with regular exercise. Regular 
walking, for example, a common activity of older people, was associated 
with a 50-percent reduced risk of severe intestinal bleeding.
    The investigators believe the results, though new, make sense 
biologically. Under physical stress, chronic disease, or overexertion, 
the blood flow to issues (such as the intestine) may be reduced and 
fall below the threshold of how much blood and oxygen is needed. When 
that flow is inadequate, there is a disruption that may lead to 
anything from a minor dysfunction to death of some tissues. The lining 
of the intestine is a vital organ and very sensitive to that kind of 
stress; it may not be able to regenerate cells normally when the blood 
supply is compromised. This can lead to damaged tissues and bleeding. 
The scientists hypothesize that people who are active and physically 
fit have a better blood flow and may be better able to avoid these 
problems.
    People over age 65 are about five times more likely to be admitted 
to the hospital for intestinal bleeding than middle-age adults. The 
most recent data show that GI hemorrhage was the main reason for more 
than 300,000 hospitalizations annually in the late 1980's. Death rates 
for the disease have not changed much in the past decade despite 
advances in medical and surgical care.
Half of Men Over Age 40 Experience Impotence
    Fifty-two percent of men between ages 40 and 70 have at least some 
degree of impotence, with the risk increasing significantly with age. 
NIA grantee Dr. John B. McKinlay and colleagues at the New England 
Research Institute also found that while the risk of impotence was 
linked to age, heart disease, and hypertension and their treatments 
further increased risk for older men. In addition, cigarette smoking 
nearly doubled the risk for those being treated for these diseases.
    This study is among the first to report on impotence in healthy 
people. Based on questionnaire responses from over 1,200 men 
participating in the Massachusetts Male Aging Study, the finding 
suggests that, in light of its high prevalence, impotence is a major 
health concern.
    The finding may also point to ways that impotence among older men 
can be greatly alleviated. For example, the study shows that many of 
the problems associated with impotence may be modifiable, such as 
cigarette smoking, as well as other risk factors for vascular disease.
A Challenge to Traditional Views on Treating Urinary Tract Infections 
        in Older Women
    Routine screening and treatment of older women for silent urinary 
tract infection is not warranted, according to research from a team of 
scientists at the Medical College of Pennsylvania. Their 9-year study 
found that urinary tract infections without symptoms do not increase 
the risk of death for older women, contrary to a view held by some in 
the medical community.
    The NIA-supported study is one of the most comprehensive to date on 
the contested issue of bacteriuria, or urinary tract infection, and 
mortality. A longitudinal component of the study monitored death rates 
among a group of women in Philadelphia with and without asymptomatic 
infection and found no increased risk of death in the infected group. 
In the second arm of the study, a controlled clinical trial, women who 
were treated for asymptomatic infection had no significant differences 
in mortality compared with untreated women. Death rates were 13.8 per 
100,000 in the treated group and 15.1 per 100,000 for the group not 
treated.
    This study provides the strongest evidence to date against a link 
between asymptomatic bacteriuria and mortality, according to the 
study's principal investigator Dr. Elias Abrutyn. He suggests that on 
the strength of this effort, physicians rethink their approach in 
treating older women without symptoms. While women with symptoms (e.g., 
burning and increased frequency of urination) should be treated, older 
women with asymptomatic infection should not be subjected to 
unnecessary antibiotic therapy.
    According to the National Center for Health Statistics, in 1991 
there were nearly 1.5 million urinary tract infections diagnosed in 
women 65 and older.
    The research included women age 65 and older who were living at a 
geriatric center and 21 continuing care communities in the Philadelphia 
area. In this longitudinal study, 318 women with urinary tract 
infections were older and sicker than the 1,173 uninfected residents. 
The analysis showed, however, that higher death rates in the infected 
group were not linked to infection. Increased age and a poor self 
rating of health by the women were much stronger predictors of a higher 
risk of death. In the clinical trial, mortality in the 166 treated 
residents was comparable to that of the 192 untreated residents.
New Techniques for Managing Urinary Incontinence
    Urinary incontinence (UI) affects an estimated 10 million 
Americans. Because people who suffer from urinary incontinence UI often 
are too embarrassed to seek treatment, the actual number of people with 
the condition may far exceed this estimate. Urinary incontinence is a 
condition that can lead to social isolation and depression. It is a 
primary reason for nursing home admissions in the United States where 
more than half the residents suffer from UI at an annual cost to the 
Nation of approximately $3.3 billion.
    NIA scientists at the Gerontology Research Center in Baltimore, MD 
studied the benefits of a prompted voiding schedule on nursing home 
patients with UI. They also looked at how benefits could be maintained 
in a normal nursing home situation.
    The scientists studied 41 nursing home residents. Of the 18 men and 
23 women, 39 needed staff assistance to get to the bathroom, and all 
spent more than 50 percent of their day in a chair. For 2 weeks, 
researchers measured the participants' incontinence frequency and 
evaluated their demographic, psychological, function, and medical 
characteristics.
    In phase two of the study the participants were checked for 
incontinence every 2 hours for a 2-week period. Based on the data, 
researchers divided the participants into three groups. Group number 1 
was prompted every hour and then returned to a 2-hour schedule. Group 
number 2 was shifted to a 3-hour routine, and group number 3 remained 
on the 2-hour protocol for the duration of the study. For approximately 
2 months each patient, regardless of group assignment, was checked for 
wetness every 2 hours and monitored for liquid intake and voiding.
    Phase three returned the group to their original nursing home 
facility where researchers had trained the nursing staff in prompting 
voiding procedures. The study results showed that prompted voiding is 
an effective treatment for urinary incontinence and that management 
procedures developed by the research team can be successfully carried 
out by nursing home staff. The 3-hour schedule was superior to the 2-
hour schedule for some residents.
    A common problem for nursing home staff is the frequent and 
repetitive patient requests for assistance in toileting and other 
activities. A schedule of prompted voiding cut down the number of 
requests--an important step in helping nursing home care become less 
custodial and more rehabilitative
New Detection Method for Cancer Drugs and Environmental Toxins 
        Developed
    A highly sensitive detection method for cancer drugs and 
environmental toxins has been developed by Doctors Vilhelm Bohr and 
Nicholas J. Rampino at NIA's Gerontology Research Center in Baltimore.
    The scientists developed a very sensitive assay (or test), allowing 
them to measure specific activities on a DNA strand where toxic damage 
can occur. These activities are affected by various enzymes (called 
polymerases and exonucleases), which could be blocked by the 
chemotherapy drug cisplatin. Cisplatin is used to treat ovarian cancer, 
but is very toxic and difficult to tolerate for many patients. Failure 
to tolerate the drug is often accompanied by an acquired resistance to 
the drug. Previous assays have used a fairly high dosage of cisplatin 
in order to achieve verifiable results. The sensitivity of this new 
assay may enable researchers to better understand the mechanisms by 
which cisplatin acts on ovarian cancers and allow them to modify 
dosages for greater tolerance and lower toxicity of the drug.
    The investigators sought to find out which mechanisms of DNA damage 
and repair were responsible for making cisplatin toxic to tumor cells 
at doses that normal cells could tolerate. The methods developed here 
should be applicable to a broad variety of chemotherapy drugs and 
environmental toxins.
    Drs. Bohr and Rampino developed their assay by introducing 
cisplatin to ovarian cancer cells in a laboratory dish and by examining 
the effects of the drug on DNA repair activity. DNA is often called 
``the building-block of life'' and its structural integrity is crucial 
for the development of healthy new cells. When the structure of DNA is 
altered, lesions or deletions may occur that can lead to tumors and 
other harmful side effects, including age-associated diseases. The body 
has its own repair mechanisms for removing lesions, but sometimes 
repairs are not effective or may even introduce new ``errors'' into the 
DNA. The drug cisplatin apparently works by forming DNA lesions that 
significantly distort the structure of the DNA double helix and by 
doing so, enhances the effect of the drug on tumor cells.
    Additionally, Doctors Bohr and Rampino were measuring the DNA 
repair process in relation to cell cycle timing. Because timing is 
important to the aging process, where a defect in timing alters cell 
aging, understanding the principles involved in the regulation of 
timing is central to our understanding of aging. Moreover, a better 
understanding of this process could lead to better therapies for age-
associated diseases, such as cancer and less toxic drugs for treatment.
How Exercise Effects the Aging Heart
    The mechanisms of how the aging heart works while under the stress 
of exercise are now better understood due to research done by 
scientists at NIA's Gerontology Research Center. Dr. Edward G. Lakatta, 
Chief, Laboratory of Cardiovascular Science, and his research team 
examined men from their twenties to their seventies to study the 
effects of vigorous aerobic exercise on the heart and how aging changes 
these effects. This is one of the first studies to examine these 
effects in older people and helps expand our understanding of the aging 
heart.
    Dr. Lakatta's team studied the impact of age on a specific nerve 
receptor in the heart that controls heart rate and function during 
exercise. This receptor, the beta-adrenergic receptor, is responsible 
for the large increases in heart rate and pumping function that occur 
with vigorous exercise. Researchers often use drugs which block the 
beta-receptors, called ``beta-blockers,'' to study the importance of 
this receptor system in heart function. Using the beta blocking agent 
propranolol, the scientists studied the importance of the beta-
adrenergic receptor on heart performance in younger versus older men at 
rest and during exercise.
    Participants were chosen from the Baltimore Longitudinal Study of 
Aging. This long-term study begun by the NIA in 1958, is examining men 
and women for a large variety of physiological and psychological 
changes as they age. Men selected for the aging heart study were 
separated into control and test groups. They were studied at rest and 
during exhaustive exercise on a stationary bicycle. The participants 
were given the blocking drug, propranolol, before the start of 
exercise, and examined for the effect of the drug on their heart. 
Control participants exercised without the drug. The researchers 
measured heart rate, blood pressure, and several measures of cardiac 
size and performance.
    Scientists hypothesized that the deficits in cardiac performance 
observed during strenuous exercise in older adults were due to a 
lessened beta-adrenergic response. This study proves the hypothesis 
true. The effect of propranolol in reducing cardiac performance during 
exercise was greater in younger men than in older men as would be 
expected since older men usually have a lessened beta-adrenergic 
response to exercise. Thus, the blocking effect would not be expected 
to be as great as in their younger counterparts.
    Dr. Lakatta's team was particularly interested in the contraction 
function of the left ventricle of the heart. The left ventricle is the 
main pumping chamber of the heart. Contraction of its walls propels 
blood into the aorta and then on to the rest of the body. Inhibition of 
beta-adrenergic receptors by propranolol caused a decrease in left 
ventricle contractile ability. The inhibition of the left ventricle's 
contractile ability was also more prominent in younger than older men 
as would have been expected. This finding is of particular note due to 
the left ventricle's importance in the health and vitality of the human 
body, since it is the heart chamber most commonly affected by disease.
    These studies point the way for more extensive investigations into 
this phenomenon for the population as a whole.
Gene Mutation Doubles the Lifespan of Worms
    Longevity research moved a step forward with the finding that a 
mutated gene more than doubles the lifespan of a worm--the largest life 
extension yet reported in any organism. Dr. Cynthia Kenyon, and 
colleagues at the University of California at San Francisco found that 
a mutated form of the daf-2 gene enabled healthy, active worms to live 
more than 5 weeks, a dramatic contrast to their normal lifespan of 
about 2\1/2\ weeks.
    The daf-2 mutation affected aging as well as length of life. When 
all the worms without the mutation had died or become immobile, 90 
percent of the long-lived worms were still active, signifying a slower 
rate of aging.
    The finding adds a new clue to a string of findings in recent years 
concerning genes that affect longevity. Researchers have pinpointed 
more than a dozen such genes both in fruit flies and in the microscopic 
worms called Caenorhabditis elegans or C. elegans used in Kenyon's 
laboratory.
    How the daf-2 mutation extends lifespan is still a mystery. What 
scientists do know about the gene is that it helps regulate one stage 
of development in C. elegans. Normally the worm turns into an adult by 
passing through several larval stages. But in an unfriendly 
environment--where there is crowding or a good shortage--C. elegans 
pauses at one of the larval stages. This is where the daf-2 gene comes 
in, enabling the larva to enter a sort of holding pattern and become 
what is called a dauer. The dauer can live for months in this arrested 
state until conditions improve and the worm is able to continue 
developing into an adult.
    In Kenyon's study, however, the mutated daf-2 gene appeared to work 
outside the dauer state. The mutated form of the gene affected lifespan 
even though the long-lived worms had not spent time as a dauers. Thus 
daf-2 could have some effects other than those that regulate the 
pathway to becoming a dauer.
    Discovering what these effects are now is an important goal. So 
far, the researchers know that daf-2 is just one of many genes that 
regulate dauer formation. They have learned that it is a key gene, 
regulating many of the other genes that are activated later in the 
dauer formation process. One of these, daf-16, must also be active to 
bring about the doubled lifespans seen in this study.
    Findings to date raise the possibility that the longevity of the 
dauer is not simply a consequence of its arrested growth, according to 
Kenyon and her colleagues. Instead, they hypothesize, daf-2 and daf-16 
may be part of a regulated lifespan extension mechanism that can act 
independently of other aspects of dauer formation. Now underway are 
studies to learn more about that mechanism. The findings should lead to 
a deeper understanding of the basic biology of longevity and aging.
Older Americans at Risk of HIV Infection Take Few Precautions
    While human immunodeficiency virus (HIV) infection is present in an 
increasing proportion of Americans age 50 and older, many older people 
at high risk take few precautions against infection, according to a new 
study by scientists at the University of California at San Francisco 
(UCSF). Older Americans account for 10 percent of all acquired 
immunodeficiency syndrome (AIDS) cases nationwide. The proportion of 
cases attributed to heterosexual contact is among the highest of any 
age group. But there has been little research in behavioral risk among 
older people.
    A study supported by NIA and the National Institute of Mental 
Health (NIMH), found that older at-risk heterosexual individuals are 
one-sixth as likely to use condoms during sex and one-fifth as likely 
to have been tested for HIV when compared with a group of people in 
their twenties who take the same risks. The findings, say study 
scientists, point to the need for including at-risk older Americans in 
AIDS education programs and for improving communication between health 
care providers and patients about aging and sexuality.
    Doctors Ron Stall and Joe Catania of the Center for AIDS Prevention 
Studies at UCSF analyzed data from the National AIDS Behavioral Surveys 
taken in 1990 and 1991. The data are among the first to look at risk 
behaviors among those age 50 and older. Analysis shows that the most 
prevalent types of behavioral risks reported in this age group were 
having multiple sexual partners, having a partner with a known 
behavioral risk, and those who had a blood transfusion between 1979 and 
1985.

    Research Advances on Aging Supported and Conducted by Other NIH 
                               Institutes

                       national cancer institute
    A new study funded by the National Cancer Institute (NCI) 
evaluating the effect of age on a breast cancer prognosis has shown 
that younger women diagnosed with early stage breast cancer have a 
poorer prognosis than older women. This study involved 1,398 breast 
cancer patients who were diagnosed at being similar stages and were 
treated at one institution. Patients under age 35 had a worse prognosis 
than older patients in terms of overall recurrence, distant recurrence, 
and overall survival. Researchers also studied whether certain 
pathologic features could explain the worsened prognosis for younger 
women. While younger patients more frequently demonstrated poor 
prognostic factors (such as estrogen receptor negativity) than older 
patients, age had an effect on disease outcome independent of these 
factors. The researchers suggest that these results may indicate that 
the aggressive disease in younger women may have a different biological 
basis than the disease of older women. Additional research is necessary 
to identify the genetic defects responsible for breast cancer and to 
determine how such factors differ between young and older women.
    Over the past three decades, large numbers of women have used 
estrogen therapy to relieve menopausal symptoms. In recent years, long-
term use of estrogen replacement therapy has been advocated for its 
beneficial effects in preventing osteoporosis and coronary heart 
disease. Since breast cancer appears to be influenced by the length of 
exposure to endogenous ovarian hormones, exposure to exogenous hormones 
may also increase breast cancer risk. An NCI-supported collaboration 
with Swedish investigators has shown when the combination therapy of 
estrogen and progestin was used the use of progestins did not appear to 
eliminate the risks associated with estrogen. Moreover, there is some 
indication that use of the combined therapy might be more harmful than 
using estrogen alone. Data from followup evaluations of participants in 
a large, NCI-funded multicenter breast screening program will further 
investigate this issue.
    Few advances have been made in recent years in the treatment of 
adult acute myelogenous leukemia (AML). While most patients achieve a 
complete remission--and intensive regimens can prolong disease-free and 
overall survival--50 to 70 percent of patients still relapse and die 
from the disease. A number of clinical trials are evaluating the use of 
biologic therapies as adjuncts to standard regimens. Several recently 
completed trials have evaluated hematopoietic growth factors in the 
treatment of older AMA patients. One trial suggested that myeloid 
growth factors reduce the toxicity of conventional chemotherapy and 
prolong time of remission and overall survival. This observation was 
not confirmed by a second study, but the promising results will be 
pursued in future research.
    Rhabdomyosarcoma is a solid tumor of striated muscle that usually 
occurs during childhood, but occasionally presents in adults. Adults 
with rhabdomyosarcoma seem to have a poorer prognosis than children and 
adolescents with the disease. A recent analysis of medical records was 
done on a broad age range of patients with rhabdcomyosarcoma to learn 
if age exerts an effect on survival independent of known prognostic 
factors including tumor stage, therapeutic intensity, or histologic 
subtype. Results suggest age is an important, independent predictor of 
survival. This was especially true for people with invasive but 
nonmetastatic tumors who were considered at intermediate risk for 
recurrence. The biologic determinants underlying the effect of age on 
survival are still unknown, but establishing age as a useful prognostic 
factor will aid in the clinical management of disease.
                 national center for research resources
    Studies of the normal aging process conducted by the National 
Center for Research Resources (NCRR) include research at the Regional 
Primate Research Centers (RPRCs) nationwide. Diagnostics such as 
positron emission topography (PET) and metabolic tracers are used to 
identify regional cerebral metabolic rates for glucose in older 
monkeys. Insulin responses to intravenous glucose challenge are lower 
in aged animals. Tentative observations support the thesis that 
deficits in cerebral glucose metabolism occur in older animals in some 
brain regions, especially the temporal cortex, while other brain 
regions appear to be spared. The effects of aging on a wide variety of 
physiological functions have also been examined. Scientists are 
correlating declines in T-cell function with adrenal steroid hormone 
(DHEA) levels to determine if DHEA reverses aging's adverse effects and 
prevents increases in blood cholesterol, lipoproteins and other lipids. 
Characterizing the aging process in older monkeys is being assessed 
relative to body composition, food and water intake and other 
physiological parameters. Moderate food restriction will not only 
reduce the incidence and slow the onset of age-related diseases, but 
also slows the rate of aging and prolongs the lifespan of primates. 
Finally, investigators have found that exposure to dioxin places 
monkeys at greater risk for developing endometriosis as they age.
                         national eye institute
    The mission of the National Eye Institute (NEI) is to conduct and 
support research, training, health information dissemination, and other 
programs with respect to blinding eye diseases, visual disorders, 
mechanisms of visual function, preservation of sight, and the special 
health problems and requirements of the blind. Many diseases of the eye 
and visual pathway that result in blindness or reduced vision are 
directly related to aging.
Age-Related Macular Degeneration (AMD)
    Age-related macular degeneration (AMD) is a deterioration or 
degeneration of the macula, the area of the retina responsible for 
sharp central vision. It is the leading cause of blindness in Americans 
age 65 and older. Although NEI-supported research has demonstrated the 
effectiveness of laser treatment for the neovascular or wet form of 
AMD, there is no proven way either to prevent or to treat the vast 
majority of people who have the dry form of the disease. The major goal 
of the NEI research AMD is to prevent or delay its progression. In a 
large NEI-supported epidemiologic study of neovascular AMD, scientist 
found an increased risk was associated with cigarette smoking and 
higher levels of serum cholesterol, and a decreased risk was associated 
with postmenopausal use of estrogens and higher levels of serum 
carotenoids. These results are consistent with a hypothesis linking 
risk factors for cardiovascular disease with AMD.
Cataract
    Cataract, the third leading cause of blindness in the United 
States, is an opacity of the normally transparent lens that interferes 
with vision. It is three to four times more prevalent in the diabetic 
population than in the nondiabetic population. As the American 
population ages, the prevalence of the disease will increase.
    The Framingham Offspring Eye Study (FOES) was designed to examine 
familial relationships for age-related cataract and age-related macular 
degeneration, among 1,086 parents examined in the Framingham Eye Study 
(1973-75) and 896 of their children examined from 1989-91. Strong 
statistical associations were found between siblings for nuclear and 
posterior subcapsular opacities, suggesting that there is clustering of 
lens opacities within families. The clustering may be due to genetic or 
environmental factors.
    Researchers conducting the Italian-American Natural History Study 
of Age-Related Cataract have estimated the incidence and progression of 
cortical, nuclear, and posterior subcapsular opacities in a large 
follow-up study. The 3-year cumulative incidence for persons age 65-74 
years (the largest group studied) was 18 percent, 6 percent, and 6 
percent for cortical, nuclear, and posterior subcapsular opacities. 
Progression was much higher than incidence for each type of opacity. 
The study suggested that patient age, baseline lens status, cataract 
grading system, definition of change, and analytic methodology may have 
important effects on estimates of cataract incidence and progression.
Diabetic Retinopathy
    Diabetes affects a number of ocular tissues, but exerts its most 
harmful effects on the retina where it causes progressive breakdown of 
the normal vascular system, a condition called diabetic retinopathy. 
Diabetic retinopathy accounts for approximately 12 percent of new cases 
of blindness each year among persons age 20-74 years in the United 
States. Diabetes increases the risk of blindness 25-fold over that of 
the general population, and it is estimated that 24,000 Americans 
become blind each year as a result of diabetic retinopathy.
    The Wisconsin Epidemiologic Study of Diabetic Retinopathy (WESDR) 
is a population-based epidemiologic study of the incidence and 
progression of diabetic retinopathy that was conducted in southern 
Wisconsin. The study focused on insulin-taking diabetics who were 
diagnosed with the disease before age 30. Among those initially free of 
retinopathy, 59 percent developed the disease by the 4-year visit, and 
11 percent of the 713 individuals initially free of proliferative 
retinopathy developed this severe disease by the 4-year visit. Overall, 
41 percent of the 996 diabetics surveyed showed a deterioration of 
retinopathy. Increased blood pressure was shown to almost double the 
risk of developing retinopathy. Other important risk factors were 
higher levels of an altered form of the oxygen-carrying molecule 
hemoglobin (glycosylated hemoglobin) and a longer duration of diabetes. 
These data provide important information regarding the eye health care 
needs of patients with diabetes and emphasize the need for adequate 
control of hypertension.
Glaucoma
    Glaucoma is a heterogeneous group of disorders characterized by a 
distinct type of optic nerve damage that can lead to blindness. In the 
United States about 2 million people have glaucoma, but because of the 
insidious nature of the disease, many are unaware of its presence. 
Additionally, about 5 million Americans, some of whom will develop 
glaucoma, have elevated intraocular pressure (IOP). Primary open angle 
glaucoma (PAOG) is the most severe form of the disease and is most 
common in people over the age of 60. Approximately 80,000 people with 
this form of the disease will become blind this year.
    The mechanism by which the optic nerve is damaged by glaucoma is 
unknown. The relative influence of genetic and environmental factors is 
also unclear. However, there is some hope for understanding the cause 
of the disease since juvenile onset glaucoma, a form of the disease 
characterized by early adulthood onset and elevated IOP, displays an 
autosomal dominant pattern of inheritance. Several NEI-supported 
scientists have identified a number of families with sufficient 
individuals with glaucoma that make it now possible to perform genetic 
linkage studies. Recently, one disease-associated gene has been mapped 
by linkage analysis to chromosome 1. Corroborating data from different 
laboratories using different families have confirmed this location. 
Linkage analysis has placed the gene to within approximately a 20-80 
gene region on the chromosome. Isolation and characterization of the 
gene responsible for one form of glaucoma is a significant step in 
identifying a least one causal factor of this disease and holds great 
promise for eventually understanding, treating, and preventing age-
related and other forms of glaucoma.
               national heart, lung, and blood institute
    A recent report from the National Heart, Lung, and Blood Institute 
(NHLBI) report6s on risk factors for cardiovascular disease (CVD), the 
leading cause of death in older people. An important public health/
medical paradox results from improved survival for younger individuals 
with CVD, which increases the population of older persons at high risk 
for heart attack or stroke, both associated with substantial disability 
and morbidity. The report emphasizes primary prevention, especially 
risk factor reduction as the major focus of CVD prevention and 
research. Research on lifestyle changes in older persons in needed to 
evaluate interventions for risk factor modifications and their effects 
on functional impairment and quality of life. Related issues for the 
elderly include identification of determinants and precursors of CVD, 
and the relationships of systolic blood pressure to vascular disease 
and risk of stroke and heart attack.
    Heart failure, a frequent consequence of ischemic heart disease, 
represents a major disturbance in the heart's function to collect 
venous blood, deliver it to the lungs for oxygenation, and pump 
oxygenated blood throughout the body. It is both more prevalent and 
more severe in the elderly. The NHLBI Task Force on Research in Heart 
Failure examined the state of the science and research opportunities 
for treatment and prevention of heart failure. Its recently published 
report describes ``. . . the great potential for preventing heart 
failure through early and vigorous treatment of hypertension, 
prevention of myocardial infarction, and limitation of infarct size by 
restoring blood flow early.'' Among the ways cited to achieve this 
objective, the report advise that ``. . . research should be undertaken 
to provide a better understanding of the molecular effects of age on 
the heart.''
    Magnetic resonance imaging can detect cerebral abnormalities, 
including those of unknown significance. A report from the NHLBI 
Cardiovascular Health Study (CHS) describes prevalence and correlates 
of such abnormalities in 303 men and women aged 65-95 years. Measures 
of cerebral atrophy increase with age and are greater in men than in 
women. In the CHS, cerebral atrophy and white matter hyperintensity, 
common in the elderly, correlate with advanced age, prior stroke, and 
known cardiovascular risk factors. However, their wide variability and 
associations with CVD do not support the suggestion that they represent 
normal aging, but do emphasize the need to identify modifiable risk 
factors for these abnormalities.
    The Systolic Hypertension in the Elderly Program (SHEP), a 
randomized clinical trial, reports the results of medical treatment 
compared to placebo for systolic hypertension in older adults. SHEP 
investigators describe the effects of treatment on progression of 
carotid stenosis, an arterial obstruction associated with increased 
risk of stroke. Measurement of changes in carotid blood flow velocity 
ratios are reported for 129 study participants. Stenosis progression 
was found in 22 percent (28/129) of patients and regression in 16 
percent (8/49) of a subgroup. Progression was significantly more 
frequent in the placebo group than in those treated (31 percent versus 
14 percent). All of the patients with regression received active 
treatment. The study shows that treatment of systolic hypertension 
slows progression of carotid stenosis, and similar effects on 
intracranial vessels may account for the substantial decrease in stroke 
observed in SHEP participants assigned to active treatment.
                national institute for nursing research
    The National Institute for Nursing Research (NINR) funds research 
directed toward the development of strategies that help older people 
maintain optimum health, the highest functioning ability, and best 
quality of life.
Sensory Organization Test
    With the rising occurrence of falls in older people, it is 
important that health care providers use the best balance test 
available to clinically identify those at risk for falling. Balance 
problems associated with a decline in the sensory or motor systems must 
be distinguished from those associated with specific pathological 
processes. Dr. Jean F. Wyman and colleagues at the Virginia 
Commonwealth University in Richmond, Virginia, found that the Sensory 
Organization Test--which uses a computerized force platform and loss-
of-balance episodes--performed well overall (ICC .66) and over time. 
The percent of agreement for loss of balance in all protocol 
conditions, and over time, was 77 to 100 percent. Participants were, 
age 65 and over, without hip or knee replacement and walking without a 
quad cane or walker.
    The test is administered with a computerized system using a movable 
forceplate and a movable visual screen. The volunteers are evaluated on 
visual, vestibular, and proprioceptive ability. The results showed that 
the instrument appropriately measures postural control and performs in 
a consistent pattern over time with the same client. The test can help 
clinicians detect instability in older adults identify conditions 
placing them at risk of falling. The scientists recommend modifying the 
current scoring on the test to incorporate a weighted score to further 
improve the test's usefulness.
Hospital Discharge Planning
    The quality of hospital discharge planning available for people age 
65 and older has been rated very poor by a national panel of experts. 
In addition, increasing pressure to contain costs raises serious 
concerns about the continued access to older patients to the quality of 
care they need. Interventions are needed to facilitate the discharge of 
older people from hospitals to their homes in a way that prevents poor 
outcomes and reduces health care costs.
    A study was conducted to compare the effectiveness of a 
comprehensive discharge planning protocol design specifically for older 
people. Cardiac patients in medical and surgical DRG groups were 
included in the experimental and control groups. The protocol was 
implemented by gerontological nurse specialists (GNS). The protocol was 
compared to routine hospital discharge planning on the outcomes for the 
patients and caregivers and to the costs of the care.
    From the initial hospital discharge to 6 weeks after discharge, 
patients in the experimental group had fewer readmissions, fewer total 
days rehospitalized, lower readmission charges, and lower charges for 
health care services after discharge than the control group. When the 
investigators controlled for the rate of post-surgical infections, the 
readmission rate for the experimental group was half of the rate for 
the control group. Studies are continuing to determine if additional 
interventions by the GNSs, including home visits, can further improve 
the outcomes in these chronically ill older people.
 national institute of arthritis and musculoskeletal and skin diseases
    The National Institute of Arthritis and Musculoskeletal and Skin 
Diseases (NIAMS) has had a landmark year of research achievements 
related to aging. These activities have included the announcement of a 
major genetic finding related to osteoporosis, leadership of two NIH 
consensus development conferences--one on optimal calcium intake and 
the other on total hip replacement--and establishment of a national 
resource center on osteoporosis.
    Osteoporosis is a bone disease characterized by low bone density 
and an increase in bone fragility. It is a leading cause of fractures 
in postmenopausal women and older adults. NIAMS-funded scientists 
report that a variation in a single gene may account for a large part 
of the total genetic effect on bone density. The gene codes for the 
vitamin D receptor, a protein that enables vitamin D to exert its 
actions on bone and on calcium metabolism. The prospect of a genetic 
marker of bone loss that may help to identify, early in life, 
individuals at high risk for osteoporosis may foster early intervention 
to prevent the disease.
    Calcium is an essential nutrient for developing and maintaining 
strong bones and reducing the incidence of fractures due to 
osteoporotic bone loss. At an NIH Consensus Development Conference in 
June 1994, panelists made recommendations for calcium intake at each 
stage of life, confirming previously recommended levels for older women 
and putting new emphasis on calcium intake for adolescent females and 
older men.
    Total hip replacement is most commonly performed in men age 65 to 
74 and women 75 to 84, many of whom suffer from advanced arthritis. The 
current state of practice and technology was the subject of a September 
1994 NIH Consensus Development Conference on Total Hip Replacement. The 
consensus panel concluded that hip replacement is one of the most 
successful and cost-effective surgical procedures performed today. The 
panel also highlighted the effectiveness of the combination of a 
cemented femoral (thigh) component and a porous-coated pelvic 
component.
    To accelerate the pace at which new research information reaches 
the public, patients, and health professionals, the NIAMS established a 
National Resource Center for Osteoporosis and Related Bone Diseases. 
The center will include materials on such topics as Paget's disease, a 
chronic disorder of older persons and the second most common bone 
disorder after osteoporosis.
                 national institute of dental research
    One of the highest priorities of the National Institute of Dental 
Research (NIDR) is to preserve the oral health of older adults. This 
commitment reflects the results from the National Survey of the Oral 
Health of U.S. Adults, a 1985-86 study supported by NIDR that 
identifies people age 65 and over as those most prone to severe oral 
health problems.
    Responding to this survey data, NIDR began a number of initiatives, 
which include funding for the Research Centers on Oral Health in Aging. 
Currently the center at the University of Texas Health Science Center 
at San Antonio, will conduct five studies aimed at understanding and 
diminishing the causes of poor oral health in older people. One study 
will include a focus on the oral health of Hispanics of varying 
socioeconomic and educational backgrounds. Researchers at another 
center, located at the University of Iowa, will conduct basic and 
epidemiological studies of mouth diseases that affect older people, 
including candida infections, human papilloma virus infections, and 
oral cancer.
    At the University of Washington in Seattle, researchers are trying 
to improve the oral health of low-income Caucasian and minority older 
people who receive care in dental public health clinics. Initial 
results suggest that some of the observed ethnic differences in risk 
for oral health problems may be accounted for by different patterns of 
systemic illness and medication use. For example, low-income, older 
African Americans use blood pressure drugs that cause dry mouth more 
frequently than those in other ethnic groups.
    NIDR also funds a longitudinal study at the University of 
Washington, examining the cost-effectiveness of preventive dental 
regimens for high risk older people. The regimens range from 
behavioral/educational interventions to administration of mouthwashes 
alone and in combination with a fluoride varnish, to scaling and 
curettage. Comparisons are being made between men and women and across 
ethnics groups. Of the 250 participants, over one-third are minorities. 
Preliminary results show African Americans and Asians had a higher risk 
for periodontal disease and tooth loss than whites and Hispanics. The 
risk of cavities, on the other hand, was not related to ethnicity. Data 
on the time and costs involved in delivering the interventions are 
being collected and will be entered into the calculation of the 
effectiveness of each of the preventive methods.
    Results are encouraging from a randomized controlled trial of a 
group oral hygiene intervention for older periodontal patients enrolled 
in a group health insurance program serving the northwestern states. 
Researchers found that the intervention is practical and acceptable for 
older patients and results in positive health and behavioral effects, 
even after 3- and 12-month followups.
    national institute of diabetes and digestive and kidney diseases
    The National Institute of Diabetes and Digestive and Kidney 
Diseases (NIDDK) conducts and supports research on several diseases 
affecting middle-age or older adults. One of these is benign prostatic 
hyperplasia (BPH), or prostate enlargement--a common disorder affecting 
older men, with symptoms usually occurring in men over age 40. 
Approximately 75 percent of men over 50 have some symptoms of BPH, and 
20 percent of all men will require surgery for this disease by the time 
they reach 80. BPH is the second leading cause of surgery in men. The 
NIDDK funds research to understand the processes of normal development 
and abnormal prostate growth and to develop effective therapies. For 
example, the NIDDK has begun the pilot phase of a randomized clinical 
trial that will study the role of new drugs in delaying the progression 
of BPH symptoms.
    A recent advance in prostate research is the finding that 
estradiol, a female sex hormone, is involved in regulating prostate 
growth. This finding may help researchers solve the long-standing 
puzzle as to why BPH increases in prevalence as men age, at the stage 
in life when plasma androgens are decreasing. The investigators present 
data showing that estradiol--acting in concert with other chemicals--
produces an increase in the intracellular accumulation of cyclic AMP. 
This demonstrates the cell-specific, powerful effect of estradiol on 
the human prostate.
    Non-Insulin-Dependent Diabetes Mellitus (NIDDM) is another disease 
that affects a large segment of older Americans. The incidence of NIDDM 
increases rapidly with age. It affects almost one in five people age 
65. About one-third of diabetics from age 65 to 74 are hospitalized 
each year. The diagnosis of people with diabetes who are over age 65 is 
expected to increase 44 percent during the next 20 years, to 3.9 
million. Also, minority populations (including blacks, Hispanics, 
Native Americans, Hawaiians, and Alaskans) are disproportionately 
affected by this form of diabetes and its enormous cost burden.
    NIDDK-funded researchers, reporting on clinical trials that studied 
the effect of varying carbohydrate contents of diets in patients with 
NIDDM. They found diets high in carbohydrates caused a persistent 
deterioration of the control of blood sugar, as well as increased 
levels of fat in the blood stream, effects which may not be desirable.
    NIDDK also supports research on urinary tract infections (UTIs), 
which affect many postmenopausal women. Institute grantees report the 
results of a study of 93 postmenopausal women showing that recurrent 
UTIs could be prevented with the intravaginal administration of 
estradiol, a form of estrogen.
          national institute of environmental health sciences
    The National Institute of Environmental Health Sciences (NIEHS) 
conducts and supports research investigating the environmental 
contribution of diseases or conditions of older people, basic research 
on the mechanisms of aging, and the effect of environmental agents on 
the aging process.
A Gene for Breast Cancer
    NIEHS intramural scientists and colleagues at the University of 
Utah were the first to isolate and sequence a breast cancer 
susceptibility gene known as BRCA1. Inheritance of a mutated form of 
this gene is implicated in 5 to 10 percent of all breast cancer cases 
and 85 percent of women who inherit it will develop breast cancer. The 
gene in its normal form is thought to be a tumor suppressor gene whose 
normal function is to regulate the growth of breast tissue. The mutated 
form of this gene functions abnormally thus allowing the uncontrolled 
growth found in cancer. The gene is associated with the early onset 
breast cancer. Its role in postmenopausal breast cancer is currently 
under investigation.
    The next step is to develop a screening test enabling physicians to 
identify women with the mutated form of the gene. This test could be 
done at an early age to detect the cancer when it is more easily and 
effectively treated.
The Role of Cadmium in Bone Loss
    In another NIEHS-funded study, scientists are investigating the 
mechanism by which cadmium (Cd) causes bone loss in ovariectomized 
laboratory animals and the relevance of these findings to humans 
exposed to Cd. So far, researchers have found Cd increases calcium loss 
from bone at levels well within reported ranges for humans exposed to 
Cd in cigarettes or industrial settings. Additional analyses will 
determine whether Cd influences bone indirectly by causing decreases in 
the gastrointestinal absorption of calcium, kidney dysfunction, or 
changes in the adrenal or pituitary glands. Results indicate that 
pregnant, nursing, and postmenopausal women have an increased 
sensitivity to Cd. Determining the mechanism by which Cd increases bone 
loss in ovariectomized animals may provide insight into mechanisms that 
control increased bone loss in postmenopausal women.
Cancer and Aging
    Cancer remains one of the major health problems associated with 
aging, yet the specific interaction between aging process and cancer 
remains uncertain. To better understand the interaction, NIEHS 
intramural scientists have been studying aging at the molecular level 
using cellular models of aging. Cellular senescence is a state of 
irreversible cell damage in which normal cells fail to enter DNA 
synthesis following stimulation. The NIEHS team has shown that defects 
in the senescence program of cells can be corrected in the laboratory 
by introducing normal human chromosomes into immortalized cells. These 
studies mapped senescence genes to nearly 10 chromosomes. These genes 
have been shown to control different pathways that regulate the 
senescence programs in cells. Studies were also conducted to determine 
whether proteins required for single cell cycle progression were 
irreversibly down-regulated in senescent cells in culture. Significant 
extensions of life-span were seen in cells that expressed two 
transfected genes, suggesting that multiple gene products may be 
important in controlling the life-span of cells.
                  national institute of mental health
    The National Institute of Mental Health (NIMH) conducts a broad 
program of research on mental disorders and behavioral dysfunction that 
often occurs in later life. NIMH encourages research in the areas of 
Alzheimer's disease and related dementias (see the Alzheimer's disease 
section of this report), psychotic disorders and schizophrenia; mood, 
anxiety, and personality disorders; suicide; sleep disorders; and the 
interaction between physical illness and mental disorders.
    The following are some recent research advances from NIMH:
          Using combined pharmacotherapy and psychotherapy, researchers 
        found that treatment of consecutive episodes of major 
        depression in older patients is as successful in late-life as 
        in mid-life patients. Ninety percent of people finishing 
        treatment had a remission of depressive symptoms.
          Older patients, with a ``reversible'' dementia have nearly 
        five times greater risk of developing true dementia at followup 
        as compared to cognitively intact, depressed patients.
          The complex relationships between depression and physical 
        disability in older patients appears to be primarily 
        unidirectional--depression causes disability more often than 
        disability causes depression. This suggests that treatment of 
        depression may prevent disability.
          Neuroleptic induced tardive dyskinesia (TD), is a major 
        iatrogenic disorder that is especially prevalent among older 
        patients (cumulative 3-year incidence of 60 percent). This is 
        five to six times higher than the incidence in younger adults. 
        Significant risk factors are cumulative amount of high potency 
        neuroleptics, history of alcohol abuse/dependence, borderline 
        neurimuscular disorder and tremor at baseline.
          Bright light suppresses melatonin output in humans and 
        results in significant phase-shifting of the circadian system, 
        or the ``biological clock.'' Timed exposure to bright light has 
        been demonstrated to be effective in alleviating age-related 
        insomnia and other sleep and behavioral problems.
           national institute on alcohol abuse and alcoholism
    The National Institute on Alcohol Abuse and Alcoholism (NIAAA) 
conducts and supports biomedical and behaviorial research on the 
causes, consequences, treatment, and prevention of alcohol-related 
problems. NIAAA is particularly interested in studying how to reduce 
alcohol-related problems among older people. These problems include 
difficulties resulting from the reduced tolerance to alcohol that 
accomplishes aging, medication interactions, falls, accidents, fires, 
social isolation, negative affect, and reduced quality of life from 
cognitive impairment.
    A research center devoted exclusively to the study of alcohol and 
aging processes is supported by NIAAA at the Univerisity of Michigan. 
This center, and other NIAAA-funded research, explores the interaction 
between age-related changes and the effects of alcohol on the central 
nervous system, the immune system, cognitive, affective states, and 
various organs. The effects of the chronic use of alcohol on the 
cerebellum and frontal lobes have been identified and associated with 
specific functional deficits. Current evidence suggests that the 
greater physiological and functional deficits experienced by older 
alcoholics occur because age renders them more vulnerable to the 
effects of alcohol. The center developed and evaluated an alcohol 
screening test specifically for older adults, called the Michigan 
Alcohol Screening Test-Geriatric Version (MAST-G). This instrument is 
easily administered, and will provide valuable for future research and 
for clinical practice in preventing for treating alcohol problems in 
older adults.
    NIAAA researchers are also investigating patterns of alcohol use in 
the older population, predictors of change, and age-specific 
treatments. Alcohol consumption does not appear to be stable in this 
group, and patterns of drinking may change over time. The Institute's 
ongoing epidemiologic study will provide more information.
    national institute on deafness and other communication disorders
    The National Institute on Deafness and Other Communication 
Disorders (NIDCD) conducts and supports research and research training 
in hearing, balance, smell, taste, voice, speech, and language. Each of 
these areas of human communication is affected by the physiological 
changes that occur with aging.
    Of the 1.5 million individuals with Parkinson's disease, a 
progressive neurodegenerative disorder, at least 75 percent have a 
breakdown in their ability to communicate orally. Several NIDCD-
supported scientists are focusing on therapy for the deteriorating 
voice and speech disorders associated with Parkinson's disease. One 
clinical investigation examines the voice characteristic in patients 
before and after voice therapy. The long-term goals are to evaluate the 
efficacy of a model of voice treatment for these patients and explore 
the physiologic and neural mechanisms underlying voice and speech 
changes related to the treatment and speech changes related to the 
treatment and the progression of the disease.
    In another study, a number of patients with Parkinson's disease 
were evaluated on different aspects of the physiology of speech 
production before and after voice treatment. The researchers found that 
all dimensions of speech were improved, and the patient's vocal 
loudness and speech intelligibility increased significantly after 
treatment. In most cases improvements lasted 1 to 2 years without 
additional therapy. After voice treatment, patients reported that they 
spoke more often and had more confidence that their speech was 
understood. These findings show that Parkinson's disease patients can 
make physiological changes in their speech production mechanisms with 
voice treatment that will improve their ability to communicate.
    In the United States, more than 10 million older people are hearing 
aids. Currently hearing aids are designed to amplify sound. In a noisy 
environment a hearing aid will increase all sounds including background 
noise, thus increasing the difficulty of understanding speech. NIDCD-
supported scientists have discovered how the loudness of the sounds 
humans are capable of hearing is perceived.
    This new finding shows that two mechanisms, rather than one, help 
determine variations in loudness. This discovery promises to improve 
the design and function of prosthetic hearing devices such as hearing 
aids. By designing devices that present high- and low-pitched sounds 
differently to the hearing nerve, the capabilities of these devices 
could be improved.

                          alzheimer's disease

    Alzheimer's disease (AD) is the most common cause of dementia, or 
mental deterioration, among people age 65 and older. A slowly 
degenerative brain disease, AD is marked by changes in behavior and 
personality and by an irreversible decline in intellectual abilities. 
It impairs thinking, memory, and judgment, advancing in stages that 
range from mild forgetfulness to severe dementia. The course of the 
disease varies from person to person, as does the rate of decline. The 
average duration of AD is from 4 to 8 years.
    People with this disease may forget how to do simple tasks, like 
brushing their teeth or combing their hair. Often, they are unable to 
think clearly or remember the right names of familiar objects or 
people. Eventually, they become completely dependent on others for 
their care.
    Risk for AD increases with advancing age. After age 65, the 
percentage of people who suffer from AD or other dementias doubles with 
every decade of life However, AD is not a part of normal aging. AD and 
other dementing disorders of old age are caused by specific diseases. 
Without disease, the human brain continues to function well, often into 
the tenth decade of life.
Prevalence and Costs of Alzheimer's Disease
    Currently, an estimated 4 million Americans suffer from AD. In 
addition, the lives of countless caregivers are affected by this 
devastating illness. Families experience emotional, physical, and 
financial stress. They watch their loved ones become increasingly 
forgetful, agitated, and confused. Many caregivers, most of them women, 
juggle child care and jobs while caring at home for relatives with AD 
who cannot function on their own. As the disease progresses and the 
abilities of people with AD steadily decline, family members face 
painful decisions about the long-term care of their loved ones.
    Moreover, AD puts a heavy economic burden on society. A recent 
study estimated that the cost of caring for one person with AD is more 
than $47,000 a year, whether the patient lives at home or in a nursing 
home. For a disease that can range in duration from 2 to 20 years, the 
overall costs of AD to families and to society are staggering.
    Others factors in our changing society compound the problem of AD. 
Life expectancy has been increasing since the turn of the last century. 
During the past three decades, improvements in public health measures, 
diet, and health behavior have brought about dramatic demographic 
changes, including a lower birthrate. Thus, today in most 
industrialized countries, the 85+ age group is the fastest growing 
segment of the population. In addition, the challenge of paying for 
health care for all Americans has yet to be tackled.
    In light of these issues, AD, which primarily affects older people, 
represents a major health concern and expense for the United States. 
Until researchers find a way to cure or prevent AD, the number of 
people living to very old age (85+) and at risk for AD will continue to 
increase dramatically. Providing and financing the care of a growing 
older population present special challenges for our health care system.
Research Directions
    AD research falls into three broad, overlapping areas of emphasis: 
cause(s)/risk factors, diagnosis, and treatment/caregiving. Research 
into the basic neurobiology of aging is critical to understanding what 
goes wrong in the brain affected by AD. Understanding the mechanisms by 
which nerve cells lose their ability to communicate with each other and 
the reasons for selective nerve cell death is at the heart of the 
worldwide scientific effort to discover the cause, or causes, of AD. 
Epidemiology is an important research tool in determining risk factors 
and identifying potential interactions between genetic and nongenetic 
factors. Recent discoveries about the possible roles of inherited 
traits and education as risk factors for AD have taken researchers in 
new directions in their search for answers. In addition, researchers 
are looking for better ways to diagnose and treat AD, improve a 
patient's ability to function, and support the caregivers of people 
with AD.
    The NIA has primary responsibility for research aimed at finding 
ways to prevent, treat, and cure AD.
    This section of the report highlights recent progress in AD 
research conducted or supported by the NIA and other components of the 
NIH, including the:
          National Institute of Diabetes and Digestive and Kidney 
        Diseases
          National Institute of Neurological Disorders and Stroke
          National Institute of Arthritis and Musculoskeletal and Skin 
        Diseases
          National Institute on Deafness and Other Communication 
        Disorders
          National Institute of Mental Health
          National Center for Research Resources
          National Eye Institute
          National Institute of Allergy and Infectious Diseases
    Additional AD research projects, which are not summarized in this 
report, are supported by the: National Cancer Institute; National 
Heart, Lung, and Blood Institute; National Institute of Dental 
Research; National Institute of Child Health and Human Development; 
National Institute of Environmental Health Sciences; National Institute 
of Nursing Research; National Center for Human Genome Research; and 
Fogarty International Center.
                the structure and function of the brain
    The brain integrates, regulates, and controls functions for the 
whole body, governing cognition, personality, and the senses. We are 
able to speak, move, and remember because of complex chemical processes 
that take place in the brain. The brain also regulates (controls) body 
functions that occur without our knowledge or direction, such as our 
heartrate and breathing.
    The human brain is made up of billions of nerve cells, called 
neurons, which communicate with one another through a large array of 
biological and chemical signals. Even more numerous are glial cells, 
which surround, support, and nourish neurons. Each neuron has a cell 
body, an axon, and dendrites. The nucleus within the cell body controls 
the cell's activities. The axon, which emanates from the cell body, 
transmits messages to other neurons. Dendrites receive messages from 
axons of other nerve cells or from specialized sense organs.
    Communications between neurons and other organs are transmitted 
through synthesis and release of chemicals. When a nerve impulse 
reaches the end of the neuron, the signal triggers the release of 
chemicals. The chemicals reach other nearby neurons and trigger them to 
send signals. Each neuron connects with many other neurons in the brain 
and may connect with neurons in the peripheral nervous system. A 
synapse is the place where the nerve impulse moves from one neuron to 
another. Neurotransmitters are chemicals that carry messages from the 
axons of nerve cells across the synapse to the dendrites of other 
neurons. In this way, signals can travel back and forth across the 
brain in a fraction of a second. And millions of signals flash through 
the brain every moment. Moreover, groups of neurons in the brain have 
certain jobs. For example, the cerebral cortex is a collection of 
neurons involved in thinking, learning, remembering, and planning.
    Survival of nerve cells in the brain depends on the proper 
functioning of many interrelated systems that normally work in harmony. 
These systems control nerve cell activity related to communication, 
metabolism, and repair, The first system, communication between nerve 
cells, is described above. The loss or absence of any of several 
chemical messengers disrupts cell-to-cell communication and interferes 
with normal brain function.
    The second system, metabolism, refers to the process whereby cells 
and molecules break down substances (chemicals and nutrients) into 
energy. Efficient metabolism in nerve cells depends on blood 
circulation to supply the cells with important nutrients, such as 
oxygen and glucose (a sugar). A sustained reduction in the supply of 
these nutrients can lead to nerve cell death.
    The third system repairs and cleans up nerve cells. Unlike most 
other body cells, neurons live a long time. When neurons die, they 
cannot grow back or be replaced. Instead, living neurons constantly 
remodel themselves. Any disruption in cell cleanup and repair can have 
disastrous consequences for cell functioning. Research shows that the 
damage seen in AD is associated with changes in all three systems: 
communication, metabolism, and repair.
Communication Breakdown in Alzheimer's Disease
    In AD, the intricate process of communication between nerve cells 
breaks down. The destructive forces involved in AD ultimately cause 
nerve cell dysfunction, loss of connections between nerve cells, and 
death of some nerve cells. Death of neurons in key parts of the AD 
brain severely affects memory, cognition, and behavior.
    AD destroys neurons in parts of the brain involved with cognition, 
especially the hippocampus (a structure deep in the brain that plays an 
important role in memory encoding). As the hippocampal nerve cells 
degenerate, short-term memory falters, and often, the ability to 
perform familiar tasks begins to decline as well. AD also attacks the 
cerebral cortex (the outer layer of the brain). The greatest damage 
occurs in areas of the cerebral cortex responsible for functions such 
as language and reasoning. Here, AD begins to take away language and 
change a person's judgment. Emotional outbursts and disturbing 
behaviors, such as wandering and agitation, appear with increasing 
frequency as the disease progresses.
    In the final stages, AD wipes out the affected person's ability to 
recognize close family members or communicate in any way; the person 
becomes totally dependent on others for care. People with AD live for 
years, ultimately succumbing to a number of other diseases, but most 
often pneumonia.
               plaques and tangles in alzheimer's disease
    Two abnormal structures are found in the AD brain--amyloid plaques 
and neurofibrillary tangles. Located outside and around neurons, 
plaques contain dense deposits of an amyloid protein and other 
associated proteins. Neurofibrillary tangles are twisted fibers inside 
neurons. Progress has been made in determining the makeup of amyloid 
plaques and neurofibrillary tangles and in proposing mechanisms that 
could account for their buildup in AD.
Amyloid Plaques
    In AD, plaques develop in areas of the brain related to memory. 
These plaques consist of beta-amyloid mixed with dendritic debris from 
surrounding cells. Beta-amyloid is a protein fragment clipped from a 
larger protein (amyloid precursor protein) during metabolism. However, 
researchers do not know whether amyloid plaques cause AD or result from 
it.
    Amyloid precursor protein (APP) is a member of a larger gene family 
of membrane proteins. During metabolism, APP pokes through the nerve 
cell membrane (wall), part inside the cell, part outside. Pausing there 
only briefly, it is replaced by new APP molecules being produced in the 
cell. While APP is embedded in the membrane, enzymes called proteases 
split APP in two. Only when the splitting occurs at a particular spot 
on APP is beta-amyloid the substance that is set free.
    After the splitting, how the beta-amyloid segment moves through or 
around the nerve cells is less clear. However, in the final stages of 
its journey, it is known to join up with other beta-amyloid filaments 
and fragments of dead and dying dendrites. Together, these form the 
dense and insoluble plaques that characterize AD.
    Large numbers of beta-amyloid deposits in the brain can occur in 
older humans and some other mammals without surrounding nerve cell 
changes. This finding suggests that beta-amyloid initiates and/or is 
only an early disordered product in a slow, multi-step process that 
ultimately leads to brain cell malfunction.
    Several studies have centered on how beta-amyloid is processed and 
how APP is broken down by enzymes. Other investigations are seeking 
clues in beta-amyloid's environment. For example, substances near beta-
amyloid may bind to it normally and thus keep it in solution. But in 
AD, according to one theory, something causes the beta-amyloid to drop 
out of solution and form insoluble plaques. Another candidate for the 
role of keeping beta-amyloid in solution is a form of a protein called 
apolipoprotein E (ApoE).
    Other areas of research center on how beta-amyloid affects neurons. 
In one laboratory study, hippocampal neurons died when beta-amyloid was 
added to the cell culture, suggesting that the protein is toxic to 
neurons. Results of another recent study suggest that beta-amyloid 
breaks into fragments, releasing free radicals that attack neurons. 
Free radicals are unstable molecules that can do damage in the body. In 
AD a buildup of oxygen free radicals, leading to breakdown of nerve 
cell membranes, is thought to play a role in cell death.
    The precise mechanism by which beta-amyloid may cause nerve cell 
death is a mystery. However, one recent finding suggests that beta-
amyloid forms small channels in neuron membranes. These channels may 
allow excess amounts of calcium to enter the nerve cell, a lethal 
event.
    Other recent studies indicate that beta-amyloid disrupts potassium 
channels, which also could affect calcium levels. Yet another study 
links beta-amyloid to reduced choline levels in nerve cells. Since 
choline is an essential component of acetylcholine, a neurotransmitter; 
this finding suggests a link between beta-amyloid and acetylcholine.
    Beta-amyloid is not the only protein implicated in AD. Not long 
after the discovery of beta-amyloid, scientists found the protein that 
is the principal component of neurofibrillary tangles, the other 
hallmark of AD.
Neurofibrillary Tangles
    Neurofibrillary tangles are abnormal collections of twisted threads 
found inside nerve cell bodies. They are the remains of the neuron's 
microtubules, the cell's internal support structures. The chief 
component of tangles is a protein called A68, a form of tau.
    In healthy neurons, microtubules are formed like train tracks, long 
parallel rails with crosspieces, that guide nutrients from the bodies 
of the cells down the ends of the axons. In cells affected by AD, these 
structures collapse. Tau normally forms the crosspieces of the 
microtubules, but in AD it twists into paired helical filaments, two 
threads wound around each other. These paired helical filaments are the 
major component of neurofibrillary tangles. No one has discovered yet 
why the microtubules collapse, but according to one theory, it may be 
due to the presence of a gene product called ApoE4.
    The collapse of nerve cell supports may result in the breakdown of 
communication between nerve cells and finally cause neurons to die. 
Still unknown, however, is whether abnormal processing causes tau to 
come away from the nerve cell supports or whether abnormal processing 
is the result of tau being gathered into the paired helical filaments. 
In addition, abnormal tau processing may simply indicate problems with 
metabolism of other, as yet unknown, nerve cell proteins. Sustained 
triggering of a single enzyme may disrupt other normal body functions 
that affect the survival of brain cells. To determine why some nerve 
cells are vulnerable to AD and others are not, researchers first must 
understand the causes of abnormal processing and the regulation of 
certain enzymes.
    Scientists may be able to develop animal models using mice that 
produce excess enzymes involved in tau processing. Further clues may 
lie in recent research using ``knockout'' mice (mice in which the 
regulation of an enzyme that helps process tau is altered). These and 
other routes could lead to an animal model for use in testing drugs to 
reverse or limit early brain cell damage caused by AD.
 advances in identifying potential risk factors for alzheimer's disease
    Although healthy aging does not result in dementia or AD, aging 
remains the most strongly associated risk factor for AD. Family history 
is another important risk factor. A history of AD in a parent or 
sibling increases the odds of developing AD by three to four times. 
Researchers believe that genetic (inherited) factors may be involved in 
more than half of the cases of AD. In addition, a severe head injury 
that leads to a brief loss of consciousness doubles the risk of 
developing AD later on in life. These three risk factors--age, family 
history, and head injury--meet the accepted epidemiologic criteria for 
causal factors: they provide a plausible biological explanation, and 
their effects are strong and consistent.
    Other risk factors that do not meet the above criteria have been 
studied, including exposure to environmental toxins (such as aluminum) 
or to chemicals (such as benzene and toluene). The detection of 
aluminum, zinc, and other metals in the brain tissue of people with AD 
is being studied to see whether such deposits influence the disease 
process or whether they are the result of disrupted brain structures. 
In addition, gender may play a role in the disease. Further research is 
needed to confirm recent data showing higher rates of AD among women. 
This finding may only reflect the effects of age, since women live 
longer, on average, than men.
    It is becoming clear that the cause of AD is not a single factor, 
but a host of factors that interact differently in different people. In 
most cases, genetic factors alone are not enough to bring on AD. 
Genetic indicators have been found in some patients with the disease 
and in their relatives who do not yet show signs of impairment. Other 
risk factors may combine with a person's genetic makeup to increase the 
chances of developing AD.
    Researchers studying the incidence and prevalence of AD and related 
dementias in later life seek to identify specific risk factors for AD 
and to show how and why AD develops. Incidence refers to the rate at 
which new cases of a disease occur. Prevalence is the percentage of the 
entire population with the disease at a given time. By studying people 
in different ethnic, racial, and social groups, scientists may discover 
additional risk factors for AD. These risk factors, in turn, may 
suggest new theories that can be tested regarding the disease's origin.
    In the past year, researchers have examined risk factors that may 
speed up or slow down the onset of AD and increase or decrease a 
person's risk of AD. They focused on determining whether ApoE, 
education and occupation levels, a gene on chromosome 14, or zinc, 
aluminum, and other metals are related to AD. Their findings eventually 
may lead to treatment and prevention strategies.
The Link Between Alzheimer's Disease and ApoE
    A gene is the biologic unit of heredity that has a precise location 
on a chromosome. Chromosomes are structures in the nucleus of cells 
that transmit hereditary information using a molecule called DNA. Genes 
direct the manufacture of every enzyme, hormone, growth factor, and 
other protein in the body. They help determine a person's traits, for 
example, what he or she looks like. Genes are made up of four 
chemicals, or bases, arranged in various patterns within the DNA. Each 
gene has a different sequence of bases, and each one directs the 
manufacture of a different protein. Even slight alterations in the DNA 
code of a gene can produce a faulty protein. And a faulty protein can 
lead to cell malfunction and eventually disease.
    Genetic research has turned up evidence of three gene alterations 
that are more common in AD patients than in the general population. 
One, the ApoE4 gene on chromosome 19, has been linked to the most 
common form of AD, called late-onset AD, which appears in older people. 
Researchers also have found genes on chromosomes 14 and 21 that are 
more common among people who develop AD earlier, in middle age.
    Everyone has ApoE, which helps transport cholesterol in the blood 
throughout the body. The gene for ApoE occurs in three versions: ApoE2, 
ApoE3, and ApoE4. Every person inherits two ApoE genes, one from each 
parent. Scientists are studying people with different versions of this 
gene. ApoE3 is the most common one found in the general population. 
However, ApoE4 occurs in about two-thirds of all late-onset AD patients 
and is not limited to people with a family history of AD.
    Collaborating researchers at the Duke University General Clinical 
Research Center and the Joseph and Kathleen Bryan Alzheimer's Disease 
Research Center in Durham, North Carolina, studied the relationship 
between ApoE4 and AD. Their research was supported by the NIA and the 
National Center for Research Resources (NCRR). These scientists found 
that the risk for AD in people with the gene for ApoE4 is three times 
greater than that for other people. For example, a 78-year-old person 
with two copies of the gene for ApoE4 has a 98 percent chance of having 
the disease, with one copy a 60 percent chance, and with no copies a 25 
percent chance.
    In addition, their data show that the presence of ApoE4 also lowers 
the age of onset of AD. On average, people with two copies of the gene 
for ApoE4 start showing AD symptoms before age 70 and are eight times 
more likely to develop AD than those who have two copies of the more 
common ApoE3 version. For those with no copies of ApoE4, the average 
age of onset is older than 85 years. According to these scientists, AD 
risk increased because the age of onset decreased. In some unknown way, 
ApoE4 may speed up the AD process.
    These researchers also found that ApoE is localized in the senile 
plaques and neurofibrillary tangles found in AD. Moreover, Duke 
University researchers now believe that ApoE is located in all neurons 
in both healthy and AD brains.
    Researchers at the Mayo Clinic in Rochester, Minnesota, followed 71 
older patients with mild memory impairment. Almost half had clinical 
dementia after 3 years. Over two-thirds of those with clinical dementia 
with a copy of the gene for ApoE4 continued to decline, and ApoE4 best 
predicted who would decline. ApoE4 appears to mark susceptibility to 
AD. However, the presence of ApoE4 in a blood sample does not predict 
AD. A person can have ApoE4 and not get the disease, and a person can 
get AD without having ApoE4.
    The relatively rare protein ApoE2 may protect people against the 
disease; it seems to lower the risk for AD and increase the age of 
onset. For instance, people with one ApoE2 gene and one ApoE3 gene have 
only one-fourth the risk of developing AD as people with two ApoE3 
genes.
    Some researchers supported by the NIA and NCRR exploring the 
function of the protein product of ApoE4 point to beta-amyloid. While 
the ApoE4 protein binds rapidly and tightly to beta-amyloid, the ApoE3 
protein does not. Normally, beta-amyloid is soluble, but when the ApoE4 
protein latches on to it, the amyloid becomes insoluble. This may mean 
that it is more likely to be deposited in plaques. Studies of brain 
tissue suggest that ApoE4 increases deposits of beta-amyloid and that 
it directly regulates APP.
    Other researchers believe that the presence of ApoE in neurons may 
affect certain cell processes and how synapses function. Also, 
scientists conducting test tube studies found marked differences in the 
rates at which ApoE3 and ApoE4 bind to tau protein and to a similar 
protein found in dendrites. One hypothesis suggests that the ApoE4 
product allows the microtubule structure to come undone in some way, 
leading to the neurofibrillary tangles.
    While still controversial and far from proven, the hypotheses 
surrounding ApoE4 are driving new research. One next step is to see how 
tau and beta-amyloid react with ApoE in its several forms in living 
cells. Other experiments will be designed to determine the actions and 
role of ApoE. Once these are clear, it should be easier to understand 
how ApoE's function might be affected by drugs. For instance, if ApoE2 
turns out to be beneficial, then substances that mimic its effects 
might be developed to help slow or prevent the progress of AD.
    Theories surrounding ApoE4 are not confined to the proteins. Its 
effect on dendrites intrigues some scientists, because of findings that 
dendrites in patients with the ApoE4 gene are shorter, pruned back 
apparently by some unknown agent. The result may be that, compared to 
normal dendrites, these pruned dendrites cannot form as many 
connections with other nerve cells. Although this pruning also can 
occur in people without the ApoE4 gene, it happens 20 to 30 years 
earlier in people with ApoE4.
    In addition, environmental factors may interact with genetic 
factors. Researchers at the Neurological Institute in New York City 
believe that repeated head injuries do not increase the risk of 
developing AD without ApoE4. However, when ApoE4 is present, these 
scientists found that repeated head injuries increase risk for AD by 10 
times.
    With ApoE, scientists have a biological indicator for AD for the 
first time. ApoE can be used by researchers to sort populations and 
follow the subgroups with the hope of finding other risk factors. 
Scientists still must learn how ApoE and its various genes function in 
the brain and relate to other risk factors for AD. Larger population-
based studies are needed to clarify the link between ApoE4 and AD, and 
to confirm the protective effect of ApoE2. Further explanation of 
preliminary findings may lead to ways to reduce the effects of ApoE4, 
develop drugs to treat or prevent AD, and ultimately, decrease the 
occurrence of AD. Moreover, some scientists suggest that testing for 
the ApoE4 gene someday may help in the diagnosis of AD.
Genes in Early-Onset Alzheimer's Disease
    AD can strike early and often in some families--often enough to be 
singled out as a separate form of the disease, called early-onset 
familial AD (FAD). Combing through the DNA of some of these early-onset 
FAD families, researchers have found an abnormality in one gene on 
chromosome 21 that is common to a few of the families. And they have 
mapped another gene, which occurs in a much larger portion of early-
onset families, to a region on chromosome 14.
    The gene on chromosome 21 carries the code for an abnormal form of 
APP, the parent protein for beta-amyloid. The discovery of this gene 
supports the theory that beta-amyloid plays a central role in some 
forms of AD, although it has been found only in about 5 percent of 
early-onset FAD families. In addition, the gene on chromosome 21 is the 
gene involved in Down syndrome. Down syndrome is similar to AD in one 
respect. People with Down syndrome have an extra version of chromosome 
21, and, as they grow older, usually develop plaques and tangles like 
those found in AD.
    Compared to the chromosome 21 gene, the gene on chromosome 14 
occurs more often in people with FAD. However, so far, no one knows 
exactly what gene it is. The gene has been tracked to a specific region 
on chromosome 14. Scientists still are trying to find the gene among 
the 10,000 or so DNA bases in this region.
Lower Educational and Occupational Levels Associated With Alzheimer's 
        Disease
    Scientists at Columbia University in New York City have established 
a relationship between increased risk for AD and lower educational and 
occupational levels. The researchers found that people with either 
lower educational or occupational levels have at least twice the risk 
for developing AD, compared to those who have had 6 to 8 or more years 
of schooling. The risk is three times greater when low occupation and 
low education occur together.
    For 4 years, researchers administered yearly neuropsychologic tests 
to 593 people age 60 and older to see if any of them began to show 
signs of dementia. The results were analyzed based on educational level 
(kindergarten through college) and occupational level. A low level of 
education was set at 8 years of schooling, and occupational levels were 
based on U.S. Census categories. At the study's end, over 25 percent of 
the participants showed some sign of dementia.
    These researchers do not know why low occupation and education are 
linked with AD. They believe that higher occupational and educational 
backgrounds may allow people to cope better with the effects of AD for 
a longer time before symptoms occur. People with more education may 
develop a protective reserve of brain cells or synapses. Also, 
increased mental capacity may allow these people to find additional 
ways to do daily activities. Or, education may be related to another 
factor, such as socioeconomic or nutritional status, which may be the 
reason for increased risk.
    This study adds information about psychosocial factors related to 
AD. Investigators and caregivers now have another factor to consider 
when evaluating whether failing memory and confusion are signs of AD or 
some other, possibly treatable, problem. If some aspects of life 
experience can delay the onset of AD for even a short time, the overall 
prevalence, and costs, of the disease will be reduced significantly. 
This also could enhance the quality of life for many people.
Environmental Suspects
    Certain environmental factors, such as metals and poisons carried 
in foods, may play a role in the development of AD. The most studied of 
these factors are aluminum and zinc. Researchers continue to study 
whether some metals are related to the development of disease markers 
such as plaques and tangles in brain tissue of AD patients. To date, no 
conclusive evidence links metals such as zinc or aluminum to AD.
    One of the most publicized and controversial hypothesis in AD 
research concerns aluminum. This aluminum theory goes back to the 
1970's, when researchers found traces of aluminum in the brains of AD 
patients. Many studies since then have either not been able to confirm 
this finding or have produced questionable results.
    Aluminum does turn up in higher-than-normal amounts in some, but 
not all, autopsy studies of AD patients. Further doubt about the 
importance of aluminum comes from the possibility that the aluminum 
found in some studies did not all come from the brain tissues being 
studied. Instead, some could have come from the special substances used 
in the laboratory to study brain tissue.
    Other studies have shown that groups of people exposed to unusually 
high levels of aluminum have no increased risk of AD. Moreover, 
aluminum in cooking utensils does not get into food, and the aluminum 
that does occur naturally in some foods, such as potatoes, is not 
absorbed well by the body. On the whole, most scientists now believe 
that there is little chance that exposure to aluminum causes AD.
    Zinc has been implicated in AD in two ways, some reports suggesting 
that too little zinc is a problem, others that too much zinc is at 
fault. Too little zinc was suggested by autopsies that found low levels 
of zinc in the brains of AD patients, especially in the hippocampus. 
There is some evidence that zinc deficiency can add to the symptoms of 
AD.
    On the other hand, results of a recent study suggest that too much 
zinc might be the problem. In this laboratory experiment, zinc caused 
soluble beta-amyloid from cerebrospinal fluid to form clumps similar to 
the plaques of AD. Current experiments with zinc are pursuing this lead 
in laboratory tests that more closely mimic conditions in the brain.
               advances in diagnosing alzheimer's disease
    A definitive diagnosis of AD is based on the presence of plaques 
and tangles in the brain. Plaques and tangles can be found only by 
examining brain tissue, and this procedure usually is done only as part 
of an autopsy (or brain biopsy).
    Currently, no definitive test exists to diagnose AD. However, a 
probable diagnosis of AD can be made based on the patient's medical 
history, a physical examination, and tests of mental ability. Several 
other conditions, some of which are treatable, also may cause memory or 
other cognitive deficits and must be ruled out. These include thyroid 
gland problems, drug reactions, depression, brain tumors, and dementia 
cause by blood vessel disease in the brain.
    A patient history includes a review of present and past medical 
problems, as well as an examination of current ability to carry out 
daily activities. Clinical analyses used to decide whether a person has 
AD or another disease include tests of blood and urine samples and an 
examination of a small sample of cerebrospinal fluid.
    Neuropsychological tests are used to evaluate a person's mental 
abilities in many areas, including memory, problem solving, attention, 
calculation, and language. Brain imaging also may be used to detect 
abnormalities in the brain. The results of all tests and the patient's 
medical history help the doctor determine if symptoms are caused by AD 
or by another condition.
    Early and accurate diagnosis of AD has a major affect on the 
progress of research on dementia and is of utmost concern to patients 
and their families. Although the early and accurate diagnosis of AD is 
difficult, a reliable diagnosis with 80 to 90 percent accuracy (when 
compared to autopsy findings) can be obtained in many specialized 
centers.
    Improving the diagnosis of AD using various procedures would allow 
patients and their families to know what stage of the illness they are 
dealing with and help them plan for the future. It also would improve 
the planning and design of drug trials, because drugs may work more 
effectively to alter the course of disease in patients with less severe 
illness. These methods would help identify patients early in the course 
of the illness when they have experienced the smallest degree of nerve 
cell damage and cognitive loss. The earlier and more accurate the 
diagnosis, the greater the gain in managing the clinical course of the 
illness, determining its natural history, and providing information 
about its causes and treatment.
    The NIA supports research to identify dementia indicators; develop 
tests and methods related to differential diagnosis, screening, 
etiology (the study of the causes of the disease), risk factors, and 
family history; improve research designs; and refine diagnostic 
criteria.
    One goal of current research is to develop an accurate test for AD. 
The search continues for a biological indicator that can identify AD 
cases very early in the course of the disease, when treatment still 
could be effective. Neuropsychologic tests are needed that pinpoint the 
stages of AD. These tests would separate people who are in the earliest 
stages of AD from people who have cognitive deficits that are related 
to healthy aging. Brief cognitive screening tools are proliferating. 
However, the relationship of the results of one test to another, to 
careful clinical diagnosis of abnormalities, and ultimately to brain 
cell death remains unknown.
    Experimental technology for imaging the brain continues to develop 
rapidly. New procedures include positron emission tomography (PET), 
single photon emission computed tomography (SPECT), magnetic resonance 
imaging (MRI), and magnetic resonance spectroscopy imaging (MRSI). MRI 
provides high-resolution images of the brain. MRSI allows observation 
of various metabolites in the brain without the use of radioactive 
tracers. Metabolites are substances that are produced when energy is 
made available for cell use. Scientists are working to learn how 
metabolites change with aging and with AD and how to relate these 
changes to cognitive impairment. MRSI may offer a way to establish 
early diagnosis, determine prognosis, monitor patients, and evaluate 
treatment efficacy.
    Researchers have yet to understand the relationship between the 
results of various brain imaging methods and the person's clinical 
condition. In addition, methods used to analyze imaging results need to 
be standardized. In the future, researchers hope to put information 
from imaging techniques that evaluate structure and those that analyze 
function together into a unified diagnostic summary.
Research on an Eye Test for Diagnosing Alzheimer's Disease
    Researchers at the Harvard Medical School in Boston, Massachusetts, 
are working on developing a simple eye test for detecting the presence 
of AD. Eventually this test may help diagnose patients with AD. 
Preliminary results suggest that monitoring pupil dilation (expansion) 
after exposure to certain eye drops may one day be the basis of an 
easy, accurate way to diagnose AD.
    Data in this study suggest that the pupils of healthy people or 
those with non-AD dementia dilated about 5 percent after receiving the 
eye drops. The pupils of people with AD dilated 23 percent. This test 
pointed to Ad in 18 of 19 people believed to have AD. Furthermore, 
pupils seemed to be sensitive to the chemical very early in the course 
of the disease, when emerging treatments are likely to be most 
effective. This test now must be studied in many more people to 
determine whether it holds up in different types of people with 
different types of AD, and distinguishes AD from other neurologic 
illnesses.
Changes in Immediate Visual Memory Predict Cognitive Impairment
    NIA researchers have found that changes occurring over 6 years in 
immediate visual memory performance, assessed by the Benton Visual 
Retention Test (BVRT), predict AD before the onset of cognitive 
symptoms. Immediate visual memory refers to the ability to remember and 
name, within seconds, things seen. The BVRT requires subjects to 
reproduce geometric designs from memory after study them for 10 
seconds. Each test consists of 10 separate designs with 1 or more 
figures, and the score is the total number of errors made in 
reproducing the designs.
    Researchers in the NIA's Baltimore Longitudinal Study of Aging 
examined data for 254 men and 117 women, who were administered 
cognitive, neuropsychologic, and neurologic tests between 1986 and 
1992. These people were generally healthy and ranged in age from 55 to 
95 at the initial testing. Six of them had probable AD, and one had 
definite AD.
    Compared to those without AD, subjects with the disease had larger 
changes in the numbers of errors in immediate memory performance over 
the 6 years prior to the onset of AD. This finding implies that AD may 
be identified by changes in memory performance sooner than other 
changes can be detected by clinical evaluation. Six-year change in 
immediate visual memory performance also predicted cognitive 
performance from 6 to 15 years and from 16 to 22 years later. This was 
true even after adjusting for the influences of age, general ability, 
and initial immediate memory.
    In addition, these results suggest that change in recent memory 
performance, a critical component in diagnosing AD, may be an important 
precursor of the development of the disease. Recent memory performance 
generally refers to recall after a short delay, such as 20 minutes.
    The results show the value of longitudinal studies because 
predictions of risk for subsequent disease are possible only when 
baseline and followup data are gathered before the onset of disease. 
This is particularly important for AD, because little is known about 
the earliest stages of AD. However, this period is likely to be when 
the disease is most responsive to treatment.
        advances in treating and preventing alzheimer's disease
    There currently is no effective way to treat or prevent AD. 
However, several substances are being tested to see if they can slow or 
reverse the decline in those behavioral and cognitive skills that are 
impaired by AD. Pharmacologic and behavioral treatments for the 
noncognitive behavioral symptoms related to AD also are being studied. 
These symptoms include aggression, agitation, wandering, depression, 
sleep disturbances, and delusions.
    The drug tacrine (also known as THA or Cognex) may temporarily slow 
the rate of decline in memory and thinking ability in some patients who 
are in the mild and moderate stages of the disease. Experimental drug 
treatments may be available to AD patients through clinical trials 
conducted at large teaching hospitals and universities. Several of 
these experimental drugs have shown promise in easing symptoms in some 
patients.
    Moreover, medications may help control behavioral symptoms, thereby 
making some patients more comfortable and making their management 
easier for caregivers. For example, several drugs now in use may 
improve sleep patterns, reduce agitation and wandering, or ease anxiety 
and depression.
    Scientists studying drug and nondrug treatments seek to reduce 
disruptive behaviors, allow patients to live in the least restrictive 
manner possible while maximizing their dignity and independence, reduce 
caregiver stress, and keep or re-establish patients' self-care 
abilities. In addition, effective treatments would decrease 
significantly the economic costs to families and society by reducing 
the need to institutionalize patients. Overall, these research efforts 
are designed to increase the intellectual, emotional, and social well-
being of patients, families, and caregivers.
    In September 1994, the NIA funded a 5-year study to screen for 
potential toxic effects of new drugs to treat AD. The data gathered 
will be used to file Investigational New Drug requests with the Food 
and Drug Administration so that compounds can be taken quickly from 
animal testing into human clinical trials.
    Thirty-five sites in the Alzheimer's Disease Cooperative Study Unit 
(ADCSU) are located primarily at the Alzheimer's Disease Research 
Centers and Alzheimer's Disease Core Centers. The ADCSU is conducting 
trials of deprenyl and vitamin E, drugs used to treat agitation, an 
anti-inflammatory agent, and estrogen. In addition, the ADCSU is 
testing neuropsychologic instruments in the areas of cognitive change, 
behavioral change, global assessment, and activities of daily living. 
The ADCSU also is adapting instruments for use with people who are 
severely impaired and with those who do not speak English. Future ADCSU 
work will be to design trials to evaluate whether a substance can 
prevent AD.
    In addition, postmenopausal estrogen replacement therapy, long-term 
use of anti-inflammatory drugs, and cigarette smoking have been 
implicated as having a protective effect against AD. These all need to 
be confirmed by further and more careful studies.
Inverse Association of Anti-Inflammatory Drugs and Alzheimer's Disease
    Anti-inflammatory drugs are used to ease symptoms of arthritis or 
related conditions. Recently, they have been proposed as a means of 
slowing the progression of AD symptoms. Studies of twins show how 
environmental factors, such as the use of anti-inflammatory agents, may 
relate to the etiology and prevention of AD.
    NIA-funded researchers at the Duke University Medical Center and 
Johns Hopkins University School of Hygiene and Public Health studied 50 
sets of older twins with AD. They found a lower incidence of AD among 
those who had used anti-inflammatory drugs to treat arthritis. These 
findings suggest that inflammatory mechanisms may be involved in the 
development of AD. They also indicate that anti-inflammatory agents may 
prevent or delay the onset of AD symptoms.
Estrogen
    Preliminary data from previous animal and human studies suggest 
that estrogen may protect older women against AD. However, recent 
research has generated some conflicting results. Initial results from 
one study by researchers at the University of Washington, Seattle, 
provide no evidence that post-menopausal estrogen replacement therapy 
influenced the risk of AD in women. Using computerized pharmacy data, 
these researchers compared use of estrogen replacement therapy by 107 
women with AD and 120 women without AD. Estrogen use was not associated 
with AD.
    Other NIA-funded researchers at the University of Southern 
California School of Medicine, Los Angeles, analyzed data for 138 older 
women who had died and whose death certificates listed AD or related 
dementias. Their results suggest that risk of AD and related dementia 
was lower in estrogen users than in non-users. Risk of AD decreased 
significantly with increasing estrogen dose and with increasing 
duration of estrogen use. Risk of AD also was associated with variables 
related to estrogen levels produced naturally in women. Data also 
suggest that risk of AD increased with increasing age at the onset of 
menstruation and decreased with increasing weight.
    This study suggests that the increased incidence of AD in older 
women who have undergone menopause may be due to estrogen deficiency. 
Further research is needed to determine whether estrogen replacement 
therapy can slow down AD-related nerve cell death, and delay the onset 
of AD or prevent it altogether. Additional studies will allow 
researchers to analyze how and why these and other studies have 
conflicting results.
Research on Dementia Special Care Units
    Another line of AD research sponsored by the NIA concerns the 
effectiveness of special care units (SCU's) across the Nation. These 
units provide services in long-term care settings to patients with AD 
and related dementias. The results of these studies may provide ways to 
improve care for these patients.
    Dementia SCU's are long-term care settings designed to meet the 
needs of people with AD and related mental impairments. SCU's emerged 
in the 1980's as a care option for patients with AD. Forces creating a 
demand for specialized care include the growing numbers of older 
people, the recognition that the care needs of people with dementia 
differ from those of physically frail people, and the widespread 
concern that standard nursing home care has been unresponsive to the 
special needs of people with AD and related disorders, their families, 
and caregivers.
    Since their beginnings, SCU's have proliferated rapidly and grown 
in diversity. The 1990-91 National Survey of Special Care Units in 
Nursing Homes found that of the Nation's 15,555 licensed nursing homes, 
9.6 percent (1,497 nursing homes) had SCU's, with an estimated capacity 
of about 47,878 SCU residents. While most nursing homes with SCU's 
present some features considered important for SCU's, only 647 met all 
of them. Projections from this survey suggest that 16.7 percent of all 
nursing homes will offer SCU's in 1995.
    To explore the effectiveness of SCU's, the NIA funded a 5-year 
multi-center Special Care Unit Initiative, beginning in 1991. Under 
this program, the NIA financed 10 research projects to examine SCU's 
throughout the United States.
    Several research issues have emerged since 1991. There is a lack of 
standardization about what constitutes an SCU versus a non-SCU. Use of 
uniform descriptive data is critical because SCU's vary in size, age of 
patients, and whether or not patients are segregated from the general 
nursing home population. SCU's also can differ in how they recruit 
residents for participation in studies. Research studies need to 
establish the diagnosis and cognitive level of residents to identify a 
sample group for study.
    The proliferation of SCU's means that for the first time in the 
United States, administrators and staff members in numerous nursing 
homes are developing methods of care specifically for their residents 
with dementia. Better methods of care cannot be realized without formal 
research to describe, compare, and evaluate the various methods being 
used. There still is a need for more research on classification, design 
characteristics, costs, and effectiveness of SCU's. For public policy 
purposes, the most important research questions pertain to the 
effectiveness of SCU's for their residents, the residents' families, 
and the unit staff members and the impact of SCU's on residents with 
and without dementia in nonspecialized nursing home units.
    Further research will provide a better idea of what constitutes 
``special care'' and identify which features of SCU's are most 
important in terms of environment, staffing, activities, care planning, 
admission policies, size, and patient segregation. Additional studies 
will determine whether effective SCU's cost more than traditional 
nursing home units. Eventually, the results of these studies will 
enable caregivers and health care insurers to compare options when 
shopping for long-term care facilities.
Alzheimer's Disease Centers Program
    The NIA funds 28 Alzheimer's Disease Centers (ADC's) at major 
medical institutions across the Nation. The centers conduct a wide 
range of research, including studies on the causes of AD and 
investigations aimed at diagnosing, treating, and managing the symptoms 
of the disease. The ADC Program promotes research, training, and 
education, technology sharing, and multi-center and cooperative studies 
of diagnosis and treatment. Each ADC has administrative, clinical, 
neuropathology, and education and information-sharing cores, or 
sections. Some ADC's include additional cores, such as neuroimaging and 
data analysis.
    Fifteen comprehensive ADC's have fully-funded basic, clinical, and 
behavioral research projects. Areas of study range from the basic 
mechanisms of AD to managing the symptoms and helping families cope 
with the effects of the disease. The other 13 ADC's are Alzheimer's 
Disease Core Centers, which provide resources and knowledge to AD 
researchers.
    A program was initiated in 1990 to add satellite clinics linked to 
the ADC's. Currently, 27 satellite clinics at 21 ADC's offer diagnostic 
and treatment services and collect research data in underserved, rural, 
and minority communities. These programs allow members of culturally 
and ethnically diverse communities to take part in research and 
clinical drug trials associated with parent ADC's.
    Much of the success of AD research in this country during the last 
10 years can be attributed to resources provided at the ADC's, 
including the recent discovery of the importance of chromosome 14 in 
FAD and the identification of inherited risk factors related to ApoE. 
The ADC's enhance AD research by providing a network for sharing new 
ideas as well as research results.
    Other initiatives funded by the NIA depend on the ADC's, including 
regular research grants, the Consortium to Establish a Registry for 
Alzheimer's Disease, and the Alzheimer's Disease Cooperative Study 
Unit. The ADC's provide resources for these efforts, such as patient 
data, brain and other tissue samples, and molecular probes.

  Research Advances on Alzheimer's Disease Supported and Conducted by 
                          Other NIH Institutes

    national institute of diabetes and digestive and kidney diseases
    National Institute of Diabetes and Digestive and Kidney Diseases 
(NIDDK) research that relates to AD generally falls within two areas. 
The first focuses on mechanisms involved in abnormal metabolic 
processes. The second concerns the molecular and biochemical mechanisms 
of cells, including the roles of neurotrans-mitters and ion channels.
    This year, NIDDK grantees reported progress in understanding the 
metabolic processes leading to the formation of abnormal amyloid 
protein (AAP), a major component of plaques in the brain. Although the 
ultimate cause of neuronal cell death remains undetermined, some 
evidence suggests that the buildup of AAP may be involved in this 
process.
    One goal of NIDDK-supported research is to understand the 
biochemical mechanisms underlying amyloid diseases. Researchers are 
learning how AAP, a normally soluble protein, is transformed into the 
insoluble fibers that build up in AD plaques. This work focuses on a 
form of AAP that has been implicated in amyloid polyneuropathy, a 
neurologic disease. This form of AAP is similar but not identical to 
the form found in AD. These researchers identified a gene mutation that 
alters an intermediate step in the formation of amyloid and appears to 
be related to AAP production. The findings suggest that certain gene 
mutations may have metabolic effects that determine the development of 
amyloid disease.
        national institute of neurological disorders and stroke
    The National Institute of Neurological Disorders and Stroke (NINDS) 
is the principal source of support for neurological research in the 
United States and a major participant in the study of AD. Basic studies 
are aimed at determining the underlying causes of AD with the ultimate 
goal of prevention. Clinical research seeks to improve the diagnosis 
and treatment of patients.
    Scientists at the NINDS and the NIA have discovered that adding 
beta-amyloid to normal skin cells causes them to undergo the same type 
of failure at the molecular level previously shown in skin cells of 
patients with AD. By placing a solution with low levels of beta-amyloid 
in culture with normal human skin cells, the scientists produced 
changes in potassium channel function similar to those seen in skin 
cells from AD patients. Beta-amyloid is the main component of plaques 
found in brain tissue in AD. This finding suggests that beta-amyloid 
may cause the abnormal process that leads to memory loss even before it 
congeals into plaques. This research may lead to alternative 
explanations of the causes of memory loss, one of the earliest and most 
common symptoms of the disease.
    Last year, researchers in the same laboratory showed that skin 
cells from people with AD have defects that interfere with the cell's 
ability to regulate its concentrations of potassium and calcium ions. 
The flow of potassium and consequent uptake of calcium are especially 
critical in cells responsible for memory formation and information 
storage. Results of current research suggest that after treating one 
group of the cells with soluble beta-amyloid for 48 hours, a specific 
potassium channel was absent in all but one of the cells. However, a 
functional potassium channel was present in 94 percent of untreated 
cells. Results of further testing suggest that beta-amyloid selectively 
targets this specific potassium channel, which had been absent in skin 
cells of AD patients.
    These researchers now are working to see if similar potassium 
channel dysfunction occurs in central nervous system neurons. The 
scientists have discovered similar defects in nerve cells of the 
olfactory system (related to the sense of smell) suggesting that such 
defects may be present in brain cells.
 national institute of arthritis and musculoskeletal and skin diseases
    Researchers at the National Institute of Arthritis and 
Musculoskeletal and Skin Diseases have made strides in finding a 
treatment for amyloidosis (a buildup of amyloid protein in various body 
tissues). This research may lead to a possible treatment for AD, 
because a major feature of AD is brain deposits of amyloid or amyloid-
like material.
    Some forms of amyloidosis are inherited. One of these forms, 
familial amyloid polyneuropathy (FAP), is caused by a mutation of the 
transthyertin (TTR) protein. Scientists have developed a method for 
separating normal and mutant TTR in bodily fluids, allowing rapid 
screening and diagnosis. This method also allows the ration of normal 
to mutant TTR to be measured over time.
    These researchers also have reported on liver transplants in 
patients with FAP. Almost all normal and abnormal TTR is produced in 
the liver. Patients undergoing liver transplants for advanced disease 
showed important improvements in their conditions. The amount of mutant 
TTR present after the transplant was reduced markedly. After surgery, 
patients and only normal TTR. This is the first successful therapy in 
patients with FAP.
    national institute on deafness and other communication disorders
    The National Institute on Deafness and Other Communication 
Disorders (NIDCD) studies the normal and disordered processes of 
balance, smell, taste, voice, speech, hearing, and language. The 
NIDCD's chemosensory (smell and taste) research program includes 
studies of the olfactory receptor cell (a nerve cell in the part of the 
nose that senses smell). Normally, these nerve cells are replaced 
continually in the body. An important aspect of this research is the 
potential for developing new strategies to treat nerve cell loss caused 
by aging, injury, and diseases, such as AD.
    Scientists supported by the NIDCD recently examined the development 
of human olfactory neurons transplanted into the brains of animals. 
They studied the interaction of these transplanted neurons with other 
brain cells. The transplanted neurons not only survived, but developed 
and grew nerve fibers that entered and mingled with the animal's other 
nerve cells. The fact that donor olfactory neurons developed and 
integrated with other nerve cells means that the possibility exists of 
forming new neuronal connections.
    The capacity of transplanted olfactory neurons to produce new nerve 
cells is of wide interest not only with respect to chemosensory 
function, but also as a model for studying neuron replacement. Further 
research on transplanted neurons may mean that biological repair of 
nerve damage from neurodegenerative diseases, including AD, is 
possible.
                  national institute of mental health
    National Institute of Mental Health (NIMH) research on AD spans 
from the genetics and molecular biology of the disease to the 
psychosocial stresses faced by family members.
    The NIMH Diagnostic Centers for Psychiatric Linkage Studies of 
Alzheimer's Disease identify siblings with and without AD for ongoing 
studies. Their goal is to establish a national resource of cell lines 
and clinical data from people with AD and their key relatives.
    Advances in the molecular genetic study of AD may show how the 
disorder develops and offer ways to identify those at risk for the 
purposes of early intervention. Neurofibrillary tangles found in the AD 
brain largely consist of abnormal forms of the cellular protein tau. In 
the normal brain, tau binds to microtubules (cylindrical formations) 
that provide structural support for cells, including neurons. In AD, 
tau takes the form of twisted fibers and does not bind to microtubules.
    Using techniques from molecular genetics, NIMH researchers have 
identified tissue at risk for AD and other neurodegenerative processes. 
They also have developed a new probe, an antibody that identifies and 
interacts exclusively with neurons that are vulnerable to the disease. 
Antibodies are immune system molecules. Antigens stimulate the 
production of antibodies. Each antibody has a unique amino acid 
sequence that allows it to interact with only a certain antigen. The 
above antibody probe stains for a different antigen than expected. This 
finding suggests that a host of unknown pathologic indicators or gene 
products may occur in AD.
    In test tube studies, NIMH scientists have been able to grow 
neuroblasts (immature nerve cells), which were taken from inside the 
noses of AD patients and healthy people. They have found that AD 
neuroblasts have increased levels of APP fragments. These fragments are 
thought to include the toxic protein beta-amyloid. The amount of 
fragments decreases when theophylline is added to the cells, suggesting 
toxicity and a potential therapeutic intervention.
    Recent advances in basic neuroscience research link brain 
structures and functions involved in AD and help explain some AD 
symptoms. Using animal models, NIMH-supported researchers have found a 
connection between two areas of the brain, one of which allows people 
to forget an emotion-linked memory that no longer is useful. When this 
part of the brain is damaged, it may fail to erase an emotional memory 
or prevent an emotional response. This research may bear on AD 
patients' inappropriate emotional responses or inability to remember 
emotionally significant information.
    NIMH researchers strive to reduce problematic symptoms of AD and 
help families care for these patients. They are studying the 
relationship between disturbed sleep, altered sleep-wake cycles, 
episodes of stopped breathing, daytime sleepiness, and sundowning (or 
nighttime confusion). By doing so, NIMH-funded researchers hope to 
decrease sleep problems and confusion and reduce some disability in AD 
patients. Preliminary studies of patients with dementia and normal 
breathing during sleep show they have less confusion in the morning or 
the same amount of confusion as during the previous night. This finding 
suggests that increased confusion related to a decrease in the amount 
of oxygen breathed in during sleep may represent an early phase of 
sundowning. Studies also are being done of the clinical efficacy of 
several medications commonly used for sundowning.
    An NIMH-supported program for caregiving spouses of AD patients 
delayed nursing home placements up to 6 months. This program offered 
individual and family counseling and a caregiver support group. 
Compared to other caregivers not in the program, the supported spouses 
showed less decline in their own mental and physical health and derived 
more satisfaction from their social support networks. Results suggest 
that psychosocial interventions may relieve some burdens of long-term 
caregiving for chronically impaired older adults. This relief may 
translate into major cost reductions for health care delivery systems. 
These findings are important, given the high cost of nursing home care 
and the increasing number of people with AD.
    NIMH-funded research indicates that caregiving stress negatively 
affects the caregiver's mental health (increased depression), immune 
system function, and physical health. These studies show that AD 
caregivers perform lower on measures of their bodies' ability to fight 
diseases and have more infectious disease episodes than do non-
caregivers. Older, caregiving spouses' immune functions fail to return 
to the level of controls over a sustained period. Caregivers also show 
a lower antibody buildup in response to influenza vaccination.
    Male caregivers may be at risk for the cardiovascular effects of 
caregiving stresses. Higher levels of triglycerides (``bad'' 
cholesterol) and lower levels of high-density lipoproteins (``good'' 
cholesterol) have been found among male caregivers. Male caregivers 
also have higher levels of anger, coronary-prone behavior, and use of 
avoidance when coping. These results provide the foundation for more 
targeted interventions with caregivers who can be identified as more or 
less at risk for mental health and physical health problems.
    Although most older Americans lead healthy lives unaffected by 
significant mental disorder, up to 12 percent of people age 65 or older 
experience an anxiety disorder, depression, or some form of dementia, 
Mental disorders in late life are not an outcome of normal aging. 
Instead, they are illnesses that result in significant disability, 
dependency, and early death. Sleep problems can lead to inappropriate 
use of sleeping pills, fatigue, and disorientation, which in turn 
reduce quality of life and increase the chances of illness. Of the 5 
percent of older Americans in nursing homes, up to one-fifth suffer 
from some form of unnecessary depression, which increases the risk of 
mortality.
    Mental disorders in older people often occur along with physical 
illness and pain symptoms. Older people are less likely to seek mental 
health services, and many seek assistance from primary care physicians 
when faced with mental illness. Unfortunately, mental disorders in 
older people typically go undetected, and many do not receive available 
treatments. This is particularly tragic for depressed older people who 
commit suicide. More than 70 percent of older men (the highest risk 
group for suicide in this country) visit their primary care physicians 
within 1 month before their suicides.
    Safe and effective treatments are available for depression, 
anxiety, and sleep disorders. Efforts to refine treatments include 
studies of how people metabolize psychotropic medications (drugs that 
act on the mind) with and without other medications for physical 
disorders. Research on psychosocial treatments alone and in combination 
with medications over long periods are providing important data for 
recommended treatment practices. Like other diseases, it appears that 
many mental disorders require long-term treatments.
                 national center for research resources
    Through its national network of clinical, animal, and other 
research resource centers, the NCRR supports studies to advance 
understanding and treatment of AD and other disorders affecting older 
Americans.
    In addition to research at Duke University on ApoE, the NCRR 
supports several potential therapies for AD at Regional Primate 
Research Centers (RPRC's). Researchers at the University of Washington 
RPRC have used a compound (leupeptin) that accelerates brain aging in 
rats to stimulate an effect similar to AD in aged monkeys.
    At the California RPRC, scientists found that age-related neuron 
weakening in part of the brain can be prevented by adding nerve growth 
factor (NGF) in primates. A NGF is a protein that fosters development 
of nerve cells and may protect certain nerve cells from damage. It 
supports cells that produce the vital neurotransmitter, acetylcholine. 
Other neurotrophic factors (components that help maintain body tissues 
and are regulated by nervous functions) also may be useful in therapy 
for this degeneration. Using gene therapy techniques, researchers have 
found that NGF-producing fibroblasts (cells that are part of the tissue 
that binds together and supports the various body structures) survive 
up to 6 months in the adult primate brain.
    At the Wisconsin RPRC, scientists are mapping the distribution of 
neurotrophins and their receptors. This work will help identify growth 
factors that may allow rescue of neurons in brain centers affected by 
AD.
                         national eye institute
    The National Eye Institute continues to support a study of human 
binocular vision and motion perception. Binocular vision is the merging 
of images from both eyes into a single image perceived by the visual 
cortex of the brain. Motion perception is the ability to perceive 
clearly the direction and speed of a moving object. This research 
focuses on interactions among the neurological mechanisms underlying 
these aspects of vision and stereopsis. Stereopsis is the ability to 
combine the images of two pictures of an object seen from slightly 
different viewpoints. It refers to how people see something as both a 
solid and three-dimensional object. These study areas may provide 
important clues about the perceptual consequences of neurologic 
dysfunctions in AD.
    Specific areas under study are: (1) the coexistence of stereopsis 
and binocular competition; (2) the regions in the brain associated with 
binocular suppression (relative to the analysis of motion information) 
and visual attention; (3) interactions between stereopsis and depth 
perception in specifying structure from motion; and (4) motion 
perception and stereopsis in AD patients.
         national institute of allergy and infectious diseases
    Studies conducted by the National Institute of Allergy and 
Infectious Diseases (NIAID) with the greatest relevance to aging and AD 
involve research to develop a drug to prevent scrapie. Scrapie is an 
infectious, neurodegenerative disease of sheep and goats. Scrapie is 
similar to AD in that accumulations of abnormal protein from anyloid 
plaques in the brain. One advantage of scrapie research is that, unlike 
AD research, animal and cell culture models already exist in which to 
study amyloid formation and therapeutic strategies. Current NIAID 
research on scrapie offers potential for understanding the clinical 
development of AD.
    The agent that causes scrapie is an unusual infectious particle 
that contains no nucleic acid and consists of a single protein, called 
Prp-res. NIAID scientists found that when a normal protein typically 
found in the brain (Prp-sen) interacts with an altered form of itself, 
the altered form is converted to Prp-res. When Prp-res builds up in the 
brain, amyloid plaques form. Although the major proteins forming 
plaques differ in scrapie and AD, an understanding of how amyloid is 
formed in scrapie may provide insights about plaque formation in the AD 
brain.
    NIAID intramural scientists have found that Congo red, a chemical 
dye, can delay the onset of scrapie in mice by preventing the buildup 
of PrP-res in the brain infected with scrapie. The fact that Congo red 
shows some efficacy in preventing the development of scrapie in 
laboratory animals suggests that a similar substance might be useful in 
preventing the development of AD in humans.
    NIAID scientists also are conducting test tube studies related to 
aging. Using a new technique, NIAID researchers have isolated almost 
all classes of stem cells (the earliest development form of blood 
cells) from mouse bone marrow. This isolation process does not appear 
to alter the cells' normal behavior, suggesting that stem cells are 
reliable for studying normal blood cell development. Isolated stem 
cells now can be used to evaluate the effects of the aging process on 
blood cell development.

                                Outlook

    Scientists have learned a great deal about AD in the past year. 
Projects in 1995 will seek to identify the gene on chromosome 14 
responsible for one form of early-onset AD and to understand better how 
ApoE works as a risk factor for AD. More specifically, researchers are 
interested I learning how ApoE relates to plaques and tangles. 
Scientists also will look for ways to enhance the use of imaging 
techniques, especially MRI, as early diagnostic tools for AD. Improved 
MRI technology is expected to allow researchers to identify initial 
changes in the hippocampus in AD. Clinical studies of estrogen and 
anti-inflammatory agents will build on evidence gained from previous 
epidemiologic studies. Another important area of research in the next 
few years will focus on behavioral interventions for patients and 
training programs for caregivers. Taken together, these avenues of 
research will help scientists to understand the causes of AD to 
diagnose the disease earlier, and to improve treatment and caregiving 
strategies.
    The breadth of the selected scientific findings in this report 
demonstrates NIH's success in implementing its research agenda. The 
achievements by NIH scientists provide information needed by physicians 
to better treat their older patients. The various NIH components--
including NIA as the lead Federal agency responsible for conducting 
health research on older adults--are achieving rapid progress on 
several fronts. Scientists are clarifying the differences between 
normal againg processes and disease states; they are identifying the 
basic biological mechanisms that control aging; and they are training 
geriatricians as research scientists and physicians. With an increasing 
body of scientific knowledge and more doctors trained in geriatrics, a 
better quality of health care will be available to older people in 
decades ahead as ever larger numbers of Americans reach and surpass age 
65.


                     SOCIAL SECURITY ADMINISTRATION

  Programs Administered by the Social Security Administration--Fiscal 
                               Year 1994

    The Social Security Administration (SSA) administers the Federal 
old-age, survivors, and disability insurance (OASDI) program (title II 
of the Social Security Act). OASDI is the basic program in the United 
States that provides income to individuals and families when workers 
retire, become disabled, or die. The basic idea of the cash benefits 
program is that, while they are working, employees and their employers 
pay Social Security taxes; the self-employed also are taxed on their 
net earnings. Then, when earnings stop or are reduced because of 
retirement in old-age, death, or disability, cash benefits are paid to 
partially replace the earnings that were lost. Social Security taxes 
are deposited to the Social Security trust funds and are used only to 
pay Social Security benefits and administrative expenses of the 
program. Amounts not currently needed for these purposes are invested 
in interest bearing obligations of the United States. Thus, current 
workers help to pay current benefits and, at the same time, establish 
rights to future benefits.
    SSA also administers the Supplemental Security Income (SSI) program 
for needy aged, blind, and disabled people (title XVI of the Social 
Security Act). SSI provides a federally financed floor of income for 
eligible individuals with limited income and resources. SSI benefits 
are financed from general revenues. In about 49 percent of the cases, 
SSI is reduced due to individuals having countable income from other 
sources, including Social Security benefits.
    SSA shares responsibility for the black lung program with the 
Department of Labor. SSA is responsible, under the Federal Coal Mine 
Health and Safety Act, for payment of black lung benefits to coal 
miners and their families who applied for those benefits prior to July 
1973 and for payment of black lung benefits to certain survivors of 
miners.
    Local Social Security offices process applications for entitlement 
to the Medicare program and assist individuals with questions 
concerning Medicare benefits. Overall Federal administrative 
responsibility for the Medicare program rests with the Health Care 
Financing Administration, HHS.
    Following is a summary of beneficiary data and selected 
administrative activities for Fiscal Year 1994.

                  I. OASDI Benefits and Beneficiaries

    At the beginning of 1994, about 95 percent of all jobs were covered 
under the Social Security program. It is expected that, under the 
present law, this percentage of jobs will increase slightly through the 
end of the century. The major groups of workers not covered under 
Social Security are Federal workers hired before January 1, 1984 and 
State and local government employees covered under a retirement system 
for whom the State has not elected Social Security coverage.
    At the end of September 1994, 42.7 million people were receiving 
monthly Social Security cash benefits, compared to 42.1 million in 
September 1993. Of these beneficiaries, 26.3 million were retired 
workers, 3.5 million were dependents of retired workers, 5.5 million 
were disabled workers and their dependents, 7.4 million were survivors 
of deceased workers and about 1,800 were persons receiving special 
benefits for uninsured individuals who reached age 72 some years ago.
    The monthly amount of benefits being paid at the end of September 
1994 was $26 billion, compared to $24.9 billion at the end of September 
1993. Of this amount, $19 billion was payable to retired workers and 
their dependents, $2.8 billion was payable to disabled workers and 
their dependents, $4.2 billion was payable to survivors, and $0.3 
million was payable to uninsured persons who reached age 72 in the 
past. (The cost of these special benefits for aged uninsured persons is 
financed from general revenues, not from the Social Security trust 
funds.)
    Retired workers were receiving an average benefit at the end of 
September 1994 of $677 (up from $655 in September 1993), and disabled 
workers received an average benefit of $642 (up from $625 in September 
1993).
    During the 12 months ending September 1994, $313 billion in Social 
Security cash benefits were paid, compared to $298 billion for the same 
period last year. Of that total, retired workers and their dependents 
received $213 billion, disabled workers and their dependents received 
$36.8 billion, survivors received $63.5 billion, and uninsured 
beneficiaries over age 72 received $4.3 million.
    Monthly Social Security benefits were increased by 2.6 percent for 
December 1993 (payable beginning January 1994) to reflect a 
corresponding increase in the Consumer Price Index (CPI).
    Monthly Social Security benefits increase by 2.8 percent for 
December 1994 (payable beginning January 1995) to reflect a 
corresponding increase in the CPI.

      II. Supplemental Security Income Benefits and Beneficiaries

    In January 1994, SSI payment levels (like Social Security benefit 
amounts) were automatically adjusted to reflect a 2.6 percent increase 
in the CPI. From January through December 1994, the maximum monthly 
Federal SSI payment level for an individual was $446. The maximum 
monthly benefit for a married couple, both of whom were eligible for 
SSI, was $669. In January 1995, these monthly rates increase to $458 
for an individual and $687 for a couple, to reflect a 2.8 percent 
increase in the CPI.
    As of September 1994, 6.3 million aged, blind, or disabled people 
received Federal SSI or federally administered State supplementary 
payments. Of the 6.3 million recipients on the rolls during September 
1994, about 2.1 million were aged 65 or older. Of the recipients aged 
65 or older, about 650,000 were eligible to receive benefits based on 
blindness or disability. About 4.2 million recipients were blind or 
disabled and under age 65. During September 1994, Federal SSI benefits 
and federally administered State supplementary payments totaling 
slightly over $2.2 billion were paid.
    For fiscal year 1994, an estimated $27.7 billion in benefits 
(consisting of $24.5 billion in Federal funds and $3.2 billion in 
federally administered State supplementary payments) were paid.

               III. Black Lung Benefits and Beneficiaries

    Although responsibility for new black lung miner claims shifted to 
the Department of Labor (DOL) in July 1973, SSA continues to pay black 
lung benefits to a significant, but gradually declining, number of 
miners and survivors. (While DOL administers new claims taken by SSA 
under part C of the Federal Coal Mine Health and Safety Act, SSA is 
still responsible for administering part B of the Act.)
    As of September 1994, about 157,000 individuals (126,000 age 65 or 
older) were receiving $61 million in black lung benefits which were 
administered by the Social Security Administration. These benefits are 
financed from general revenues. Of these individuals, 28,000 miners 
were receiving $12 million, 98,000 widows were receiving $43 million, 
and 31,000 dependents and survivors other than widows were receiving $6 
million. During fiscal year 1994 SSA paid out black lung payments in 
the amount of $764 million. About 28,000 miners and 97,000 widows and 
wives were age 65 or older.
    Black lung benefits increased by 2.2 percent effective January 1994 
due to special legislation enacted to increase black lung benefits 
because there was no general Federal pay increase for 1994. The monthly 
payment to a coal miner disabled by black lung disease increased from 
$418.20 to $427.40. The monthly benefit for a miner or widow with one 
dependent increased from $627.30 to $641.10 and with two dependents 
from $731.90 to $748.00. The maximum monthly benefit payable when there 
are three or more dependents increased from $836.40 to $854.80. In 
action on the FY 1995 appropriations bill for the Departments of Labor, 
HHS, Education and Related Agencies, the Congress approved a general 
provision to authorize continuation of the January 1994 benefit rate 
into FY 1995.

                     IV. Communication and Services

    SSA's public information initiatives are aimed at more than 43 
million Social Security beneficiaries, 6 million SSI recipients and 
about 137 million workers currently paying into the system. SSA seeks 
to ensure that current and future recipients are aware of programs, 
services, and their rights and responsibilities.
    In 1994, SSA planned public information outreach activities to help 
restore confidence in Social Security, especially among younger working 
Americans. The principal messages supporting this theme are that Social 
Security will be there for them; people get their money's worth from 
Social Security; the agency is striving to provide world-class service; 
and the disability benefits application and decision processes are 
being redesigned to provide better service.
    These messages were placed in the form of news releases, radio and 
TV public service announcements, and publications such as the Social 
Security Courier, a newsletter distributed to national organizations. 
Messages were also placed on the agency's new Internet information 
server, which is accessible to Internet users world wide.
    SSA produces a wide range of publications on all Social Security 
programs. About 50 consumer booklets and fact sheets keep the public 
informed about programs and policies affecting them. Many publications 
are also available in Spanish. In 1994, SSA added several publications 
to the inventory. One, a fact sheet called ``When You Retire from Your 
Own Business,'' explains to potential Social Security beneficiaries how 
the agency determines if they are retired from business. A booklet, 
``Putting Customers First,'' lists the agency's customer service 
standards. Another booklet, ``Social Security . . . What Every Woman 
Should Know,'' explains provisions of special interest to women, 
including those who work inside and outside the home. The Public 
Information Distribution Center provides materials directly to external 
groups and organizations; publications are listed in catalog form for 
easy ordering.
    The agency released several new videos designed to inform the 
public about Social Security. One, ``Changing Focus,'' highlights 
important points for people planning to retire. A second video, 
``Focusing on Service,'' details services provided to the public by 
SSA. In addition, a video was distributed about work incentives for 
disabled beneficiaries under the Supplemental Security Income program.
    In addition to these video products, SSA sends a package of radio 
public service announcements on Social Security themes to 5,000 radio 
stations twice a year.

            V. Summary of Legislation That Affects SSA, 1994

social security independence and program improvements act of 1994 (h.r. 
             4277), p.l. 103-296, signed on august 15, 1994
                           independent agency
    Establishes SSA as an independent agency, responsible for the 
administration of the old-age, survivors, and disability insurance 
(OASDI) and Supplemental Security Income (SSI) programs. SSA is also 
required to continue to perform its current functions in assisting in 
the administration of the Medicare program, the Black Lung program, and 
the Coal Industry Retirees Health Benefits Act.
    The independent SSA is to be headed by a Commissioner, appointed by 
the President within 60 days of enactment and subject to Senate 
confirmation, to serve a 6-year term, with the initial term of office 
ending January 19, 2001. The Commissioner exercises all powers and 
discharges all duties of SSA, and has authority and control over all 
SSA personnel and activities. The bill also provides for Presidential 
appointment and Senate confirmation of a Deputy Commissioner, whose 
duties and authority are to be prescribed by the Commissioner, to serve 
a 6-year term, with the initial term of office ending January 19, 2001.
    Establishes a position of Inspector General in the Social Security 
Administration (to be appointed by the President) and provides for the 
appointment of a Chief Financial Officer by the Commissioner.
    Establishes a seven-member, bipartisan Social Security Advisory 
Board, required to meet at least four times a year, to review and make 
recommendations to the Commissioner concerning matters of policy; the 
Board has no role with respect to SSA operations. Board members are to 
be appointed as follows: Three by the President (no more than two from 
the same political party), two by the Speaker of the House (with the 
advice of the Chairman and Ranking Minority Member of the Committee on 
Ways and Means), and two by the President pro tempore of the Senate 
(with the advice and consent of the Chairman and Ranking Minority 
Member of the Committee on Finance). Board members are to serve 
staggered 6-year terms. Eliminates the requirement of present law for 
the appointment of a quadrennial Advisory Council on Social Security 
after the current Advisory Council completes its work.
    Requires the Commissioner and the Secretary to develop a joint plan 
for the transfer of personnel and resources to the independent SSA. For 
1 year after the effective date all full-time or part-time permanent 
employees are protected against separation or reduction in grade or 
compensation if such action is caused solely as a result of transfer. 
Further, any employee who was not employed by SSA immediately prior to 
enactment will be exempt from directed reassignment for 1 year after 
the effective date; the exemption is limited to 6 months in the case of 
directed reassignments between Baltimore and Washington, D.C. duty 
stations.
    As an independent agency, SSA will continue to adjudicate Medicare 
appeals. Under this arrangement, the Secretary will maintain the 
ultimate authority for appeal decisions, but SSA's Administrative Law 
Judge corps will continue to conduct Medicare hearings until and unless 
such time as the Commissioner and the Secretary reach a different 
agreement.
    As required, the Secretary and Commissioner transmitted a report to 
the House Committee on Ways and Means and Senate Committee on Finance 
on October 31, 1994, regarding the progress made in developing the 
inter-agency transfer arrangement. The Secretary and the Commissioner 
have entered into a written inter-agency arrangement for the transfer 
of appropriate personnel and resources to the independent agency 
effective March 31, 1995, and on December 29, 1994, submitted the 
arrangement to the House Committee on Ways and Means, the Senate 
Committee on Finance, and the General Accounting Office (GAO). GAO is 
required to submit a report to the Committees evaluating the plan by 
February 15, 1995.
    The independent agency provision becomes effective on March 31, 
1995.
 restrictions on payment of benefits based on disability to substance 
                                abusers
    Places new restrictions on Social Security disability insurance 
(DI) and SSI benefit payments to individuals disabled by drug addiction 
and alcoholism (DA&A) and establishes barriers against a beneficiary's 
using Social Security or SSI benefits to support an addiction. The 
provisions are generally effective 180 days after enactment.

                           Payment Limitation

    Limits the payment of SSI benefits to 36 months for individuals 
whose substance abuse is material to their disability. Likewise limits 
the payment of DI benefits to 36 months but begins with the first month 
for which treatment is available. The 36-month DA&A payment 
restrictions sunset October 1, 2004. Medicare, dependents' benefits, 
and Medicaid (in most States) will continue as long as a terminated 
beneficiary continues to be disabled and otherwise eligible (i.e., 
except for the 36-month payment limit). The payment limit will not 
apply to individuals who are disabled independent of their alcoholism 
or drug addiction at the close of the 36-month period.

                     Suspension For Non-Compliance

    Provides for suspending benefits for non-compliance with treatment 
for both DI and SSI substance abusers, beginning the month after SSA 
sends notification of non-compliance. Once benefits are suspended for 
non-compliance, they may be reinstated only after demonstrated 
compliance with treatment requirements for specified periods--a minimum 
of 2 months, 3 months, and 6 months, respectively, for the first, 
second, third, and additional instances of non-compliance. Suspension 
of benefits for 12 consecutive months for non-compliance will result in 
termination of benefits.

                         Treatment Requirement

    Extends the treatment participation requirement, which now applies 
only to SSI recipients, to DI beneficiaries whose substance abuse is 
material to their disability determination. The provision is to be 
implemented beginning with newly adjudicated cases and DI beneficiaries 
already on the rolls with a primary diagnosis of DA&A, and extending to 
other applicable beneficiaries as quickly as possible.

                        Referral and Monitoring

    Requires the establishment of Referral and Monitoring Agency (RMA) 
contracts in each State and the issuance of regulations defining 
appropriate treatment for substance abusers.

                          Retroactive Benefits

    Requires gradual payment of retroactive DI and SSI benefits to 
substance abusers, except for beneficiaries who have outstanding debts 
related to housing and are at high risk of homelessness. Retroactive 
benefits due an individual whose entitlement terminates will continue 
in prorated amounts until they are fully paid. In addition, if a 
beneficiary dies without having received all retroactive benefits, the 
unpaid amount becomes an underpayment.

                         Representative Payment

    Extends the representative payee requirement, which now applies 
only to SSI beneficiaries, to DI beneficiaries whose drug addiction or 
alcoholism is material to a finding of disability.
    Requires SSA to give preference to the appointment of Social 
Service Agencies or to Federal, State, or local government agencies as 
representative payees for DI and SSI substance abusers, unless SSA 
determines that a family member would be a more appropriate payee.
    Permits organizations that meet the requirements and serve as 
representative payees for substance abusers to retain, as compensation 
for their services, the lesser of 10 percent of the monthly benefit or 
$50, indexed to the Consumer Price Index (CPI). Also, indexes to the 
CPI the maximum payee services fee ($25) for other beneficiaries with a 
qualified organizational payee.

                          Studies and Reports

    Requires the following DA&A studies and reports:
          A study of: (1) The feasibility, cost, and equity of 
        requiring representative payees for all DI and SSI 
        beneficiaries who suffer from drug addiction or alcoholism, 
        regardless of whether their addiction is material to their 
        disability; (2) the feasibility, cost, and equity of providing 
        non-cash benefits; (3) the extent of substance abuse among 
        child recipients and ways of addressing such afflictions; and 
        (4) the extent to which children's representative payees are 
        substance abusers and how to identify those that are. A report 
        on the studies is due to the House Committee on Ways and Means 
        and the Senate Committee on Finance by December 31, 1995.
          A report on the Secretary's activities relating to the 
        monitoring and testing of Social Security and SSI DA&A 
        beneficiaries. The report is due to the House Committee on Ways 
        and Means and the Senate Committee on Finance by December 31, 
        1996.
          Demonstration projects designed to explore innovative 
        referral, monitoring, and treatment approaches with respect to 
        Social Security and SSI DA&A beneficiaries who are subject to a 
        treatment requirement. A report on the demonstration projects 
        is due to the House Committee on Ways and Means and the Senate 
        Committee on Finance by December 31, 1997.
    issuance of physical documents in the form of bonds, notes, or 
            certificates to the social security trust funds
    Requires each obligation issued by the Department of the Treasury 
for purchase by the Social Security trust funds (including those 
already issued) to be evidenced by a physical document in the form of a 
bond, note, or certificate of indebtedness, rather than simply by an 
accounting entry. Requires interest payments and proceeds from the sale 
or redemption of trust fund holdings to be paid by checks drawn on the 
general fund of the Treasury. The provision is effective 60 days after 
enactment.
  gao study regarding telephone access to local offices of the social 
                        security administration.
    Requires GAO to assess SSA's use of innovative technology to 
increase public telephone access to local Social Security offices (both 
phase I and II) and to report to the House Committee on Ways and Means 
and the Senate Committee on Finance no later than January 31, 1996.
 expansion of state option to exclude service of election officials or 
                     election workers from coverage
    Increases from $100 to $1,000 a year the amount an election worker 
must be paid for the earnings to be covered under Social Security of 
Medicare. Beginning in the 2000, the coverage threshold increases 
automatically as wage levels rise. The provision is effective January 
1, 1995.
       use of social security numbers for jury selection purposes
    Allows State and local governments and Federal district courts to 
use Social Security numbers to eliminate duplicate names and convicted 
felons from jury selection lists. The provision is effective upon 
enactment.
  authorization for all states to extend coverage to state and local 
  police officers and firefighters under existing coverage agreements
    Gives all States, rather than only those now specifically 
authorized to do so, the option to extend Social Security coverage to 
police officers and firefighters who are under a retirement system. The 
provision is effective upon enactment.
 limited exemption for canadian ministers from certain self-employment 
                             tax liability
    Exempts certain ministers who were American citizens and residents 
of Canada from liability for unpaid Social Security taxes and related 
penalties for 1979 through 1984. The provision is effective with 
respect to individuals who file a certificate with the Internal Revenue 
Service within 180 days after it issues implementing regulations.
exclusion of totalization benefits from the application of the windfall 
                         elimination provision
    Disregards the windfall elimination provision in computing (1) the 
regular U.S. benefit of a person who receives a foreign totalization 
benefit that includes U.S. employment, provided they receive no other 
pension based on noncovered employment; and (2) any U.S. totalization 
benefit. The provision is effective for benefits for months after 
December 1994.
  exclusion of military reservists from application of the government 
         pension offset and the windfall elimination provisions
    Excludes from the application of both the government pension offset 
and windfall elimination provisions military pensions that are based, 
at least in part, on noncovered military reserve duty after 1956 and 
before 1988. The provision is effective for benefits for months after 
December 1994.
              repeal of the facility-of-payment provision
    Repeals the facility-of-payment provision, under which deductions 
are not now imposed against the benefits of an auxiliary beneficiary to 
whom they otherwise would apply if the maximum family benefit would 
continue to be payable to other auxiliaries living in the same 
household. Following repeal, deductions will be made for the 
beneficiary to whom they apply, and the benefits withheld will be 
redistributed to other entitled auxiliaries living in the same 
household as the auxiliary who is subject to deductions. The provision 
is effective for benefits payable for months after December 1995.
               maximum family benefits in guarantee cases
    Uses the maximum family benefit in effect in the last month of a 
worker's prior entitlement to disability benefits for the purpose of 
determining the maximum family benefit under a subsequent period of 
entitlement. The provision is effective for beneficiaries who become 
reentitled after December 1995, and for survivors of beneficiaries who 
die after December 1995 after previously having been entitled.
authorization for disclosure of ssa information for purposes of public 
            or private epidemiological and similar research
    Requires SSA, on a reimbursable basis, to disclose information 
showing whether an individual is alive or deceased, if it is needed for 
epidemiological or similar research that the Secretary of Health and 
Human Services determines has reasonable promise of contributing to 
national health interests. Requestors must agree to safeguard and to 
limit re-release of the information. The provision is effective upon 
enactment.
 misuse of symbols, emblems, or names in reference to social security 
 administration (ssa) or department of health and human services (hhs)
    Broadens present-law deterrents against misleading mailings about 
Social Security and Medicare by:
          Requiring specific written authorization from SSA or HHS for 
        a person to reproduce, reprint, or distribute for a fee any SSA 
        or HHS form, application, or other SSA or HHS publication;
          Providing that a disclaimer on a mailing does not provide a 
        defense against misleading mailing violations;
          Providing that each piece of mail in an illegal mass mailing 
        constitutes a violation;
          Adding names, letters, symbols, and emblems of SSA, HCFA, 
        SSI, and HHS to the items protected by the misleading 
        advertising prohibitions;
          Removing the $100,000 annual cap on civil penalties that may 
        be imposed for misleading advertising activities, and providing 
        that penalties SSA collects are to be deposited in the OASI 
        Trust Fund; and
          Requiring the Secretary and the Commissioner to report on the 
        operation and enforcement of this provision to the Senate 
        Committee on Finance and the House Committee on Ways and Means. 
        The reports are due to the committees by December 1 of 1995, 
        1997, and 1999.
    The provision is effective for violations occurring after March 31, 
1995.
  increased penalties for unauthorized disclosure of social security 
                              information
    Makes unauthorized disclosure of information and fraudulent 
attempts to obtain personal information under the Social Security Act a 
felony. Each violation is punishable by a fine of up to $10,000, 
imprisonment for up to 5 years, or both. The provision is effective 
upon enactment.
  increase in authorized period for extension of time to file annual 
                            earnings report
    Extends from 3 months to 4 months the additional time that an 
individual may be granted to file an annual earnings report. The 
provision is effective with respect to reports of earnings for taxable 
years ending on or after December 31, 1994.
    extension of disability insurance program demonstration project 
                               authority
    Extends for 3 years (through June 10, 1996) authority to waive 
Social Security or Medicare benefit requirements in connection with 
demonstration projects and studies designed to promote the objectives 
or facilitate the administration of the Social Security disability 
insurance program and encourage disabled beneficiaries to return to 
work. A final report is due no later than October 1, 1996. The 
provision is effective upon enactment.
   cross-matching of social security account number information and 
employer identification number information maintained by the department 
                             of agriculture
    Permits the Department of Agriculture to disclose retail operators' 
names, Social Security numbers, and Employer Identification numbers to 
other Federal agencies for the purpose of investigating food stamp 
fraud and violations of other Federal laws. The provision is effective 
upon enactment.
    certain transfers to railroad retirement account made permanent
    Makes permanent the provision that proceeds from the income 
taxation of railroad retirement tier 2 benefits be deposited in the 
railroad retirement account, rather than the General Fund of the 
Treasury. The change is effective for income taxes on tier 2 benefits 
received after September 30, 1992 (when the authority for depositing 
the proceeds from these income taxes in the railroad retirement account 
was last applicable).
  authorize the department of labor to use social security numbers as 
                      claim identification numbers
    Permits the Department of Labor to use Social Security numbers as 
claim identification numbers for workers' compensation claims. THe 
provision is effective upon enactment.
  coverage under fica of federal employees transferred temporarily to 
                      international organizations
    Continues the Social Security coverage of Federal civilian 
employees temporarily assigned to an international organization, 
regardless of whether the international organization is within or 
outside the United States. Employees are to pay their share of the 
Social Security tax on their earnings and the loaning agency is to pay 
the employer's share of the tax. The provision is effective for 
services performed after the calendar quarter following the calendar 
quarter of the date of enactment.
extend the fica tax exemption and certain tax rules to individuals who 
enter the united states under a visa issued under section 101(a)(15)(q) 
                 of the immigration and nationality act
    Excludes from Social Security coverage aliens who enter the United 
States as part of a cultural exchange program. The provision is 
effective with the calendar quarter following the date of enactment.
     elimination of rounding distortion in the calculation of the 
     contribution and benefit base and earnings test exempt amounts
    Designates 1994 as the base year to be used in calculating 
increases in the OASDI contribution and benefit base and earnings test 
exempt amounts for all years after 1994. (Increases in these amounts 
will no longer be based on the rounded amounts applicable in the 
previous year, which can distort the base and exempt amounts over 
time.) The provision is effective for the contribution and benefit base 
beginning in 1995 and for earnings test exempt amounts for taxable 
years ending after 1994.
                   commission on childhood disability
    Requires the Secretary to appoint, by January 1, 1995, not less 
than 9 nor more than 15 experts to a Commission on the ``Evaluation of 
Disability in Children.'' The Commission, in consultation with the 
National Academy of Sciences, is to conduct a study on the effect of 
the current Supplemental Security Income definition of disability as it 
applies to children under the age of 18 and their receipt of services, 
including the appropriateness of an alternative definition. The 
Commission also is to examine the feasibility of providing non-cash 
benefits to children; the feasibility of prorating Zebley lump sum 
retroactive benefits or holding them in trust; the extent to which SSA 
can involve private organizations to increase social services, 
education, and vocational instruction aimed at promoting independence 
and the ability to engage in substantial gainful activity (SGA); and 
the desirability and methods of increasing the extent to which benefits 
are used to help a child achieve independence and engage in SGA.
    The Commission is required to report its results and any 
recommendations to the House Committee on Ways and Means and the Senate 
Committee on Finance by November 30, 1995.
 regulations regarding completion of plans for achieving self-support 
                      (pass) under the ssi program
    Requires SSA to revise its regulations to take the needs of an 
individual into account in determining the time necessary for 
completion of a PASS. The provision is effective January 1, 1995.
             gao report on plans for achieving self-support
    Although the conference did not agree to a House-passed provision 
to deem plans for achieving self-support (PASS) approved if they are 
not disapproved within 60 days, the conferees instructed the GAO to 
study the PASS provision. GAO's study would include data for the past 5 
years on the number and characteristics of individuals who have applied 
for PASS, the kinds and durations of PASS approved and completed, and 
the extent to which individuals' PASS have led to their economic self-
sufficiency. GAO would include any recommendation for improvements in 
the PASS provision in its report to the House Committee on Ways and 
Means and the Senate Committee on Finance.
            ssi eligibility for students temporarily abroad
    Allows individuals who leave the United States temporarily as part 
of an educational program that is not available in the United States, 
that is designed for gainful employment, and that is sponsored by a 
school in the United States to continue receiving SSI benefits for up 
to 1 year if they were eligible for SSI the month they left the 
country. The provision is effective January 1, 1995.
  disregard of cost-of-living increases for continued eligibility for 
                            work incentives
    Continues Medicaid under section 1619(b) for an individual whose 
Social Security cost-of-living increase otherwise would make them 
ineligible because of excess unearned income. The provision is 
effective for eligibility determinations for months after December 
1994.
            provisions to combat oasdi and ssi program fraud
    Strengthens present law in deterring fraud and abuse in the OASDI 
and SSI programs by:
          Requiring that third-party translators certify under oath the 
        accuracy of their translations, whether they are acting as the 
        applicant's legal representative, and their relationship to the 
        applicant.
          Authorizing civil penalties to be imposed against third 
        parties, medical professionals, and OASDI beneficiaries and SSI 
        recipients who engage in fraudulent schemes to enroll 
        ineligible individuals in the OASDI and SSI programs. In 
        addition, medical professionals may be barred from 
        participation in Medicare and Medicaid.
          Treating SSI fraud as a felony.
          Clarifying SSA's authority to reopen OASDI and SSI cases 
        where there is reason to believe that an application or 
        supporting documents are fraudulent, and to terminate benefits 
        expeditiously in cases where SSA determines that there is 
        insufficient reliable evidence of disability.
          Requiring the Inspector General to immediately notify SSA 
        about OASDI and SSI cases under investigation for fraud, and 
        requiring SSA to immediately reopen such cases where there is 
        reason to believe that an application or supporting documents 
        are fraudulent, unless the U.S. Attorney or equivalent State 
        prosecutor determines that doing so would jeopardize criminal 
        prosecution of the parties involved.
          Requiring SSA to obtain and utilize, to the extent it is 
        useful, pre-admission immigrant and refugee medical 
        information, identification information, and employment history 
        compiled by the Immigration and Naturalization Service or the 
        Centers for Disease Control when developing SSI claims for 
        aliens.
          Requiring SSA to submit an annual report to the House 
        Committee on Ways and Means and the Senate Committee on Finance 
        on the extent to which it has reviewed OASDI and SSI cases, 
        including the extent to which the cases reviewed involved a 
        high likelihood or probability of fraud.
    The provisions are effective October 1, 1994.
                 disability reviews for ssi recipients
    Requires SSA, in each of fiscal years 1996, 1997, and 1998, to 
perform CDRs for a minimum of 100,000 SSI recipients and one-third of 
all childhood SSI recipients who are between age 18 and age 19. The 
latter provision applies to individuals who attain age 18 in or after 
the 9th month after enactment. Requires SSA to report its findings on 
these two provisions to the House Committee on Ways and Means and the 
Senate Committee on Finance no later than October 1, 1998.
          exemption from adjustment in passalong requirements
    Allows States the option of exempting Zebley-related retroactive 
State supplementary payments from the annual supplementary payments 
expenditure amount that a State must maintain in the following year in 
order to meet the passalong requirement. Effective before, on, and 
after date of enactment.
labor, hhs and education appropriations, fy 1995 (h.r. 4606), p.l. 103-
                   333, signed on september 30, 1994
    Provides FY 1995 funding for SSA's Limitation on Administrative 
Expenses (LAE) account of $5.577 billion, including disability 
investment funding of $320 million and automation investment funding of 
$97 million.
    In addition, the overall appropriations Act reduces SSA's funding 
for 1995 for procurement reform, rent savings and performance awards. 
These reductions total about $37 million for SSA, reducing the total 
appropriations to $5.540 million.

                                Reports

    Directs SSA to prepare a report by February 1, 1995, addressing 
concerns raised by Appropriations Committee members and to include 
information on short and long term costs and performance goals of 
planned automation initiatives.
    Urges SSA to consider establishing a Chronic Fatigue Syndrome (CFS) 
Surveillance advisory committee and to provide a report to the 
Committee on this project, including the Agency's efforts to 
investigate the obstacles to disability benefits for persons with CFS.
  social security domestic employment reform act of 1994 (h.r. 4278), 
                p.l. 103-387, signed on october 22, 1994
         simplification of employment taxes on domestic service
    Raises the threshold for coverage of domestic employees' earnings 
paid per employer from $50 per calendar quarter to $1,000 for calendar 
year 1994. In calendar years after 1995, this amount will increase in 
$100 increments as average wages increase.
          In cases where domestic employees were paid $50 or more but 
        less than $1,000 in 1994, their employers must report the 
        earnings on form W-2 and the employees will receive credit 
        under Social Security for the wages. (However, no Social 
        Security taxes are payable on these wages.) If total earnings 
        on the worker's record equal $620 or more, but less than 
        $1,000, only one quarter of coverage is credited.
          Instead of being treated as agricultural employees, domestic 
        employees no farms operated for profit are treated like other 
        domestic employees and their earnings are subject to the new 
        threshold instead of the threshold applicable to agricultural 
        employees. (Effective in 1994.)
          Beginning with calendar year 1995, domestic employees will no 
        longer be covered under Social Security in any year in which 
        they are under age 18 unless their principal occupation is 
        household employment.
          In cases where the employer has only domestic employees, 
        wages paid to those employees will be reported annually, rather 
        than quarterly, on the employer's personal income tax return, 
        and Social Security employer and employee taxes will be subject 
        to quarterly estimated tax payment requirements. (Effective 
        January 1995.)
        allocations to the disability insurance (di) trust fund
    Allocates a greater portion of the OASDI tax rate (0.94 percent 
instead of 0.60 percent) to the DI Trust Fund for 1994 through 1996. 
For 1997 through 1999, the DI reallocation will be increased from the 
currently scheduled 0.60 percent to 0.85 percent. Beginning with 2000, 
the DI Trust Fund allocation will be 0.90 percent instead of the 
currently scheduled 0.71 percent.
    These provisions are effective with respect to wages paid after 
December 31, 1993, and self-employment income for taxable years 
beginning after such date.
  nonpayment of benefits to individuals found not guilty by reason of 
                                insanity
    Extends the current prisoner nonpayment provision to all 
individuals confined to a jail, prison, or other penal institution or 
correctional facility pursuant to a conviction of a crime punishable by 
imprisonment for more than 1 year (regardless of the actual sentence 
imposed). Suspension will also apply to beneficiaries confined by court 
order in an institution at public expense in connection with a finding 
that the individual is: guilty but insane, with respect to an offense 
punishable by imprisonment for more than 1 year; not guilty of such an 
offense by reason of insanity or by reason of similar factors (such as 
a mental disease, a mental defect, or mental incompetence); or 
incompetent to stand trial for such an offense.
    Also provides that an individual shall not be considered to be 
confined in a jail, prison, or other penal institution or correctional 
facility if he is residing outside the institution at no expense (other 
than the cost of monitoring) to the institution or the penal system or 
to any agency to which the penal system has transferred jurisdiction 
over the individual.
    These provisions are effective with respect to benefits for months 
beginning after 90 days after enactment.
                  additional debt collection practices
    Authorizes SSA to use certain delinquent debt collection procedures 
available to other Federal agencies, but not to SSA, under the Debt 
Collection Act of 1982. The procedures include reporting delinquent 
debtors to credit agencies, contracting with private debt collection 
agencies, and recovering debts by administrative offset of other 
Federal payments to which the debtor may be entitled. The procedures 
may be applied only if the overpayment was paid to a person after he or 
she attained age 18, the debt is not recoverable by other means 
provided by the Social Security Act, and the debtor is no longer a 
beneficiary.
    The provision is effective with respect to collection activities 
begun on or after enactment and before October 1, 1999.
                       nursing home notification
    Requires nursing homes to notify SSA within 2 weeks after they 
admit SSI recipients (effective October 1, 1995).

                                 Report

    Requires SSA to conduct a study on the rising costs payable from 
the Disability Insurance (DI) trust fund. In conducting the study, SSA 
must determine the relative importance of the increased number of 
applications, higher allowance rates and decreased benefit termination 
rates in increasing the DI program costs. The results of the study must 
be reported to the House Committee on Ways and Means by October 1, 
1995.
social security act amendments of 1994 (h.r. 5252) p.l. 103-432, signed 
                          on october 31, 1994
   definition of disability for children under age 18 applied to all 
                        individuals under age 18
    Provides that the criteria used for determining disability of 
children who are under age 18 would apply to any individual who is 
under age 18 (i.e., individuals who do not meet the SSI definition of a 
child because they are married or the head of a household). Effective 
for determinations made on or after October 31, 1994.
                qualified medicare beneficiary outreach
    Requires the Secretary of HHS to establish and implement within one 
year after date of enactment a method for obtaining information from 
newly eligible Medicare beneficiaries that may be used to determine 
whether they may be eligible as Qualified Medicare Beneficiaries and 
for transmitting this information to the States in which they live.
         indicators/predictors of dependency on welfare receipt
    Requires the Secretary of HHS to develop (1) indicators of the rate 
at which and degree to which families depend on welfare receipt and (2) 
predictors of welfare to assess the data needed to report annually on 
the indicators and predictors, to provide an interim report to 
congressional committees by October 31, 1996, on conclusions resulting 
from such development and assessments, and to report annually 
thereafter, covering AFDC, SSI, food stamps, and general assistance 
programs administered by State and local governments.
                   minor and technical ssi provisions
    Makes a number of technical corrections in previously enacted 
legislation.
     voluntary income tax withholding from social security benefits
    Permits a person to request voluntary withholding from certain 
Federal payments, including Social Security benefits, for income tax 
purposes. Withholding will be in accordance with specified percentages 
as permitted by the IRS and requested by the person. Effective with 
respect to payments made after December 31, 1996.
                  tax on nonresident alien individuals
    Increases from 50 to 85 percent the amount of Social Security 
benefits which are subject to mandatory Federal income tax withholding 
because they are paid to nonresident aliens. Applies to benefits paid 
in taxable ending after December 31, 1994.
   taxpayer identification number (tin) required to claim dependency 
                               exemption
    Requires that, in order to claim a dependency exemption for Federal 
income tax purposes, a taxpayer must include the TIN/SSN for that 
dependent on his or her return, regardless of age. (Current law 
requires the TIN/SSN for claimed dependents who are at least 1 year 
old). Effective for taxable years beginning after December 31, 1994; 
with the exception that it does not apply to returns for taxable years 
beginning in 1995 with regard to individuals born after October 31, 
1995, or to returns for taxable years beginning in 1996 for individuals 
born after November 30, 1996.
       modification of maximum guarantee for disability benefits
    Amends the Employee Retirement Income Security Act of 1974 by 
modifying the maximum guaranteed pension benefit payable in disability 
cases to participants in terminated employee pension benefit plans, 
i.e., plans which have been terminated and whose participants are 
receiving payments from the Pension Benefit Guaranty Corporation. Under 
this provision, the maximum guaranteed benefit shall not be reduced 
because of the age of the participant if the participant demonstrates 
that SSA has determined that he/she meets the definition in the Social 
Security Act.

          ITEM 7. DEPARTMENT OF HOUSING AND URBAN DEVELOPMENT

             U.S. HOUSING FOR THE ELDERLY--FISCAL YEAR 1994

    The Department of Housing and Urban Development is committed to 
providing America's elderly with decent affordable housing appropriate 
to their needs. The elderly, who are the fastest growing segment of our 
nation's population, are often frail and in need of supportive services 
to help them remain in their homes. The Department's goal is to provide 
a variety of approaches so that older Americans may be able to maintain 
their independence, remain as part of the community, have access to 
supportive services, and live their lives with dignity and grace. To 
meet this goal, HUD has sought to expand its ability to link housing 
and appropriate services for the elderly.

                               I. Housing

a. section 202 capital advances for supportive housing for the elderly 
    and section 811 supportive housing for persons with disabilities
    The National Affordable Housing Act of 1990 authorized a 
restructured Section 202 program while separating out and creating the 
new Section 811 program for Housing for Persons with Disabilities. 
Funding for both programs is provided by a combination of interest-free 
capital advances and project rental assistance. Project rental 
assistance replaces Section 8 rent subsidies. The annual project rental 
assistance contract amount is based on the cost of operating the 
project. The 30 percent maximum tenant contribution remains unchanged.
    Since the passage of the National Affordable Housing Act of 1990, 
there have been 29,317 units approved under the Section 202 program and 
8,686 units approved under the Section 811 program. Of those amounts 
7,819 Section 202 units and 2,783 Section 811 were approved in Fiscal 
Year 1994.
     b. section 231 mortgage insurance for housing for the elderly
    Section 231 of the National Housing Act authorized HUD to insure 
lenders against losses on mortgages used for construction or 
rehabilitation of market rate rental accommodations for persons age 62 
years or older, married or single. Nonprofit as well as profit-
motivated sponsors are eligible under this program. The program is 
largely inactive since most sponsors and lenders prefer to use the 
Section 221(d)(3) and 221(d)(4) programs.

     c. section 221(d) (3) and (4) mortgage insurance program for 
                          multifamily housing

    Sections 221(d) (3) and (4) authorized the Department to provide 
insurance to finance the construction or rehabilitation of market rate 
rental or cooperative projects. The programs are available to nonprofit 
and profit-motivated mortgagors as alternatives to the Section 231 
program. While most projects under the programs have been developed for 
families, projects insured under Section 221 may be designed for 
occupancy wholly or partially for the elderly, and the mobility 
impaired of any age.
d. section 232 mortgage insurance for nursing homes, intermediate care 
  facilities, and board and care homes, and assisted living facilities
    The primary object of the Section 232 program is to assist and 
promote the construction and rehabilitation (or purchase or refinance 
of existing projects) of nursing homes, intermediate care facilities, 
board and care homes, and assisted living facilities by providing 
insurance to finance these facilities. The vast majority of the 
residents of such facilities are elderly.
                     e. service coordinator program
    The National Affordable Housing Act authorized funding for the 
service coordinator program under the Section 202 program in 1990. 
Eligibility was expanded to cover Sections 8, 221(d)(3) and 236 
projects in 1992.
    A service coordinator is a social service staff person who is part 
of the project's management team. That individual is responsible for 
ensuring that the residents of the project are linked with the 
supportive services they need from agencies in the community to assure 
that they can remain independently in their homes and avoid premature 
and unnecessary institutionalization as long as possible.
    In FY 1994 HUD awarded two rounds of grants, using both FY 1993 and 
FY 1994 dollars. The Department awarded about $57.1 million to about 
350 Section 202 projects and 99 221(d)(3) and 236 projects. Earlier 
funding (FY 1992) covered an additional 128 202 projects for about 
$13.2 million.
               f. the congregate housing services program
    The Congregate Housing Services Program (CHSP), initially 
authorized in 1978 and revised in 1990, provides direct grants to 
States, Indian tribes, units of general local government and local 
nonprofit housing sponsors to provide case management, meals, personal 
assistance, housekeeping and other appropriate supportive services to 
frail elderly and non-elderly disabled residents of HUD public and 
assisted housing, and for the residents of section 515/8 projects under 
the Department of Agriculture's Rural Housing and Community Department 
Service.
    In 1994 HUD made 28 grants for approximately $6.4 million to serve 
an estimated 900 additional frail elderly and non-elderly disabled 
residents of eligible housing. The program covers 115 grantees, which 
serve about 5,000 people.
    g. flexible subsidy and loan management set aside (lmsa) funding
    The Flexible Subsidy Program provides funding to correct the 
financial and physical health of HUD subsidized properties, including 
those which house the elderly. Flexible Subsidy provides funds for 
projects insured under Section 221(d)(3), Section 236, and funding 
under the 202 program (once they have reached 15 years old).
    The Loan Management Set Aside (LMSA) Program provides Project-based 
Section 8 funding to HUD-Insured and HUD-Held projects and projects 
funded under the 202 Program which need additional financial assistance 
to preserve the long-term fiscal health of the project.
                       h. manufactured home parks
    The Housing and Urban-Rural Recovery Act (HURRA) of 1983 amended 
Section 207 of the National Housing Act to permit mortgage insurance 
for manufactured home parks exclusively for the elderly. The program 
has been operational since the March 1984 publication of a final rule 
implementing the legislation, although HUD insures very few 
manufactured home parks.
             i. title i property improvement loan insurance
    Title I of the National Housing Act authorizes HUD to insure 
lenders against loss on property improvement loans made from their own 
funds to creditworthy borrowers. The loan proceeds are to be used to 
make alterations and repairs that substantially protect or improve the 
basic livability or utility of the property. There are no age or income 
requirements to qualify for a Title I loan.
              j. title i manufactured home loan insurance
    Title I of the National Housing Act authorizes HUD to insure 
lenders against loss on manufactured home loans made from their own 
funds to creditworthy borrowers. The loan proceeds may be used to 
purchase or refinance a manufactured home, a developed lot on which to 
place a manufactured home, or a manufactured home and lot in 
combination. The home must be used as the principal residence of the 
borrower. There are no age or income requirements to qualify for a 
Title I loan.
       k. home equity conversion mortgage insurance demonstration
    The Department has implemented a pilot program to insure Home 
Equity Conversion Mortgages (HECM), commonly known as ``reverse 
mortgages.'' The program is designed to enable persons aged 62 years or 
older to convert the equity in their homes to monthly streams of income 
and/or lines of credit.
    As of Fiscal Year end September 30, 1994, the Department insured 
3,362 loans for HECM borrowers. The cumulative number of active insured 
loans reached 7,800 with a potential maximum claim amount of 
$787,355,882 million. Approximately 2,000 loans are in the endorsement 
pipeline with an average of 300 loans being endorsed per month.
    One-third of the borrowers are single with an average age of 76. 
They have lower incomes and higher house values than the general 
population of elderly homeowners. The median principal limit or the 
amount that can be made available to the borrower is approximately 
$46,836.
    The Department is publishing final regulations on the HECM program 
that simplify processing of loans by permitting the use of the Direct 
Endorsement program. The volume of loans is expected to significantly 
increase as more lenders and the general population become more aware 
of the HECM program.

                     II. Public and Indian Housing

    The Low-Income Public Housing program may be the largest single 
resource for housing for the elderly in the United States today.
          a. section 8 rental certificates and rental vouchers
    Section 8 of the U.S. Housing Act of 1937 authorizes housing 
assistance payments to aid low-income families in renting decent, safe, 
and sanitary housing that is available in the existing housing market.
    PIH estimates that about 20 percent of Section 8 certificate and 
voucher recipients are elderly. This equates to 350,000 units.
    The following statistics are provided for the elderly low income 
population of public and Indian housing:

Public and Indian Housing...............................         283,406
Public Housing residents................................         279,108
Indian housing..........................................           4,298
                b. elderly/disabled service coordinators
    Section 673 of the Housing and Community Development Act of 1992 
authorized the Department to fund services coordinators in public 
housing developments to assure the elderly and non-elderly disabled 
residents have access to the services they need to live independently. 
The Department published a NOFA on February 27, 1995 to announce the 
availability of approximately $46 million in FY 1994 and 1995 funds for 
public housing authorities to submit applications to hire services 
coordinators for their elderly and non-elderly disabled residents to 
provide case management and link these needy residents to other 
supportive services.

    (Note: there is no available information on actual number of 
residents served because the program has not yet begun, but we estimate 
it could serve approximately 60,000 elderly and non elderly disabled 
residents.)
                     c. tenant opportunity program
    Section 20 of the U.S. Housing Act of 1937 authorized the Tenant 
Opportunity Program. This program provides training and technical 
assistance to resident entities to organize their communities and to 
establish various resident managed initiatives. The program began in 
1988 and to date has funded about 550 resident groups. Public and 
Indian housing developments with elderly residents are eligible to 
participate and we would estimate a small portion, perhaps, 5 percent 
are in fact primarily elderly grantees.
                 d. public housing development program
    The Public Housing Development Program was authorized by Sections 5 
and 23 of the United States Housing Act of 1937 to provide adequate 
shelter in a decent environment for families that cannot afford such 
housing in the private market.
    The program has funds for 612 units of elderly housing. These units 
equal $98.4 million worth of elderly housing. Presently, including the 
612 units, there are 2,598 units of elderly housing under construction.
                             e. set-asides
    Hope for Elderly Independence Grants: $7.7 million assigned in FY 
94.
    Hope for Elderly Independence Vouchers: $32.1 million (1,186 units) 
assigned in FY 94.

                III. Community Planning and Development

        a. community development block grant entitlement program
    The Community Development Block Grant (CDBG) Entitlement Program is 
HUD's major source of funding to large cities and urban counties. The 
activities funded by it help low- and moderate-income persons and 
households, eliminate slums or blight, or meet other urgent community 
development needs. The CDBG program made more than $3.1 billion 
available to States and communities in the most recent year for which 
complete information is available on use of CDBG funds. Approximately 
$2.2 billion was available to 757 metropolitan cities and 125 urban 
counties by entitlement, with individual grants determined by formula.
    Entitlement communities implemented a wide range of eligible 
activities in which elderly residents may benefit either directly or 
indirectly. HUD does not require local communities to collect 
information and report to HUD on the age of program beneficiaries. For 
this reason, it is difficult to determine all of the CDBG funds that 
directly address the needs of the elderly. However, Entitlement 
communities did spend $49.5 million in the most recent program year for 
which complete data are available on senior centers ($22.3 million) and 
for public services for the elderly ($27.2 million). $35 million of 
that was spent by metropolitan cities and $14.5 million by urban 
counties.
    Entitlement grantees spent the most money on housing-related 
activities which are primarily rehabilitation of housing. They spent 
$985 million or 37.8 percent of all program expenditures on these 
activities. Housing rehabilitation includes major renovations, minor 
home repairs, and weatherization activities to owner- and tenant-
occupied structures. Many local communities directed a portion of the 
funding for these activities to the elderly.
    Significant amounts of CDBG Entitlement spending for neighborhood 
improvements, public services, and other public works either directly 
or indirectly benefited the elderly. CDBG Entitlement grantees spent 
$65.5 million for improvements to and the operation of neighborhood 
facilities. They also spent $19.7 million for the removal of 
architectural barriers and $10.7 million for centers for the disabled. 
These activities provided important benefits to the elderly.
                 b. cdbg state and small cities program
    The State Community Development Block Grant and HUD-Administered 
Small Cities programs are HUD's principal vehicles for assisting 
communities with less than 50,000 in population that are not central 
cities. States and small cities use the CDBG funds to undertake a broad 
range of activities and structure their programs to give priority to 
eligible activities that they wish to emphasize.
    As in the CDBG Entitlement program, States are not required to 
report to HUD the ages of individuals who benefit from the recipients' 
activities. Consequently, the level of benefits to the elderly cannot 
be estimated with certainty. The States and the Commonwealth of Puerto 
Rico allocated approximately $922 million of State CDBG funds to local 
governments during Fiscal Year 1992, the latest year for which data on 
program use are available. Approximately $247 million or 27 percent of 
that portion of funds which are obligated supported housing-related 
activities such as the rehabilitation of private properties and 
weatherization services. Some local governments target some of these 
activities to benefit elderly homeowners and tenants. Approximately $44 
million or 5 percent of State Small Cities CDBG obligated funds 
assisted community centers and public services. Many local governments 
use the programs to assist senior citizens.
                 c. home investment partnership program
    Title II of the National Affordable Housing Act of 1990 created of 
HOME Investment Partnerships Program to provide States and local 
governments with a flexible vehicle to expand the supply of safe and 
affordable housing. The HOME Program provides annual formula-based 
allocations to more than 500 participating jurisdictions to assist low-
income families and create homeownership and rental housing 
opportunities. Eligible activities include: acquisition, 
rehabilitation, new construction, and tenant-based rental assistance.
    Since Fiscal Year 1992, the first year for which appropriations 
were made participating jurisdictions have committed $1.6 billion in 
HOME funds to projects for 93,713 affordable units. In Fiscal Year 1994 
alone, $1.2 billion was committed for 67,546 affordable units.

                            OTHER ACTIVITIES

               Fair Housing and Equal Opportunity (FHEO)

                        a. the fair housing act
    The Fair Housing Act prohibits discrimination in housing based on 
race, color, religion, sex, national origin, handicap, or familial 
status. The Act provides an exemption from the requirement of 
nondiscrimination on the basis of familial status in circumstances 
where a housing provider offers ``housing for older persons.'' Such 
housing is exempt under the law if it is intended for and solely 
occupied by residents 62 years of age and older, or if (a) 80 percent 
of the units are occupied by at least one person 55 years of age and 
older, (b) there exist significant services and facilities specifically 
designed to meet the physical or social needs of older persons, and the 
housing is marketed to persons 55 years of age and older.
    Section 919 of the Housing and Community Development Act of 1992 
required the Secretary of HUD to issue regulations defining 
``significant facilities and services.'' The regulations were issued on 
July 7, 1994. During an extended comment period on the regulations, HUD 
conducted five public hearings. The comments, both at the hearings and 
those received in writing, were strongly against the proposed rule. 
Accordingly, in December 1994 HUD withdrew the rule and announced its 
intention to issue a new proposed rule early in 1995.
    During Fiscal Year 1994 familial status was alleged as a basis of 
discrimination in 1,088 complaints filed with the Department pursuant 
to the Act. This represents 22.2 percent of all HUD complaints (4,841) 
filed during the period. Many of these complaints were filed against 
housing providers who claimed the ``housing for older persons'' 
exemption. All such complaints are investigated and resolved in 
accordance with the procedures set forth in the Act and the 
implementing regulations.
                       b. age discrimination act
    During Fiscal Year 1994, the Department received 13 complaints 
alleging age discrimination in federally-assisted programs. It appears 
that five of these complaints were filed by persons over 62 years of 
age. (Age discrimination complaints may be filed by persons of any 
age.)

               Office of Policy Development and Research

                       a. american housing survey
    The American Housing Survey for the United States, Current Housing 
Reports H. 150, and the Supplement to the American Housing Survey for 
the United States, Current Housing Report H. 151, for the years 1985, 
1987, 1989 and 1991, contain special tabulations on the housing 
situations of elderly households in the United States. (Data for 1993 
will be available in Spring 1995.) Chapter 7 of the regular report and 
Chapter 6 of the supplemental report for each year provide detailed 
demographic and economic characteristics of elderly households, 
detailed physical and quality characteristics of their housing units 
and neighborhoods and the previous housing of recent movers, and their 
opinions about their house and neighborhood. The data are displayed for 
the four census regions, and for central cities, suburbs, and 
nonmetropolitan areas, and by urban and rural classification. The non-
elderly chapters (total occupied, owner, renter, Black, Hispanic, 
central cities, suburbs, and outside MSAs) as well as the publications 
for the 44 largest metropolitan areas individually surveyed over a 4-
year cycle, Current Housing Reports H. 170, also contain data on the 
elderly.
    An elderly household is defined as one where the householder, who 
may live alone or head a larger household, is age 65 years or more. 
Special information in these publications is provided on households in 
physically inadequate housing or with excessive cost burdens, and on 
households in poverty. The supplemental report provides general 
housing, household, financial characteristics and housing quality 
measures by family or household type, and neighborhood quality and 
journey to work by tenure, selected housing characteristics, selected 
household characteristics, and type of geographic location.
   b. evaluation of the hope for elderly independence demonstration 
                                program
    The HOPE for Elderly Independence Demonstration Program (HOPE IV) 
evaluation studies the design, implementation, and impact of the HOPE 
IV Program. HOPE IV combines Section 8 housing assistance, service 
coordination, and supportive services to help low-income frail elderly 
persons remain in their homes and avoid unnecessary 
institutionalization.
    The evaluation focuses on the first round HOPE IV Program sites. 
Information comes from applications, surveys of grantees, service 
coordinators, professional assessment committee representatives, and 
program participants. In addition, the program participants will be 
compared with a group of frail elderly who are receiving the Section 8 
assistance but are not receiving case management and coordinated 
services. The evaluation began in July 1993 and will be completed in 
July 1998. Westat is the contractor conducting the evaluation.
    The first interim report (now in draft) presents preliminary 
findings on the Program's first year operation. There are several 
policy relevant findings.
          Successful program start-up depends on how quickly the public 
        housing agencies (PHAs) can form partnerships with the various 
        State and local service agencies and programs. The State and 
        local agencies help the PHAs prepare program applications, 
        provide matching funds, and contract for service delivery, 
        including service coordination and professional assessments.
          Recruiting participants for the Program has been difficult 
        since Section 8 waiting lists had few eligible applicants. 
        Although the PHAs advertised for applicants and the State and 
        local agencies referred their clients, the Section 8 program is 
        difficult for the frail elderly to use without substantial 
        assistance from the PHA staff and others. The program requires 
        the frail elderly to process a great deal of paperwork and has 
        required in some cases (40 percent of the cases in the FY 1994) 
        locating units which meet the housing quality standards.
    The Demonstration is not likely to receive additional funding as of 
FY 1995.
        c. evaluation of the congregate housing services program
    The Congregate Housing Services Program (CHSP) evaluation will 
provide a comprehensive picture of the new Program. The evaluation will 
study CHSP implementation and compare its effectiveness in maintaining 
the independence of the frail elderly with the HOPE for Elderly 
independence Program.
    The evaluation focuses on the first round CHSP grantees. 
Information comes from applications, annual financial reports, and 
census data as well as surveys of grantees, service coordinators, 
professional assessment committee representatives, and residents. The 
evaluation began in October 1993 and will be completed in October 1998. 
Research Triangle Institute is the contractor conducting the 
evaluation.
    As of December 1994, 8 of 44 projects have not yet enrolled the 
number of residents they plan to serve in the facility during the first 
year of operation and some grantees have not started delivering 
services to residents. The first interim report was submitted in 
January 1995.
               d. service coordinator program evaluation
    The Office of Policy Development and Research began an evaluation 
of the Service Coordinator Program in the Fall 1994. The objectives of 
this study are to assess the processes by which the Service Coordinator 
program is established and implemented. More specifically, this 1-year 
study will describe the start-up and implementation of the program and 
assess what service coordinators are doing to facilitate service 
delivery to the elderly residents. Additionally, the study will focus 
on measuring resident satisfaction with nonhousing services. Data will 
be gathered through site visits, focus group interviews, and 
application reviews.

                   ITEM 8. DEPARTMENT OF THE INTERIOR

               DEPARTMENTAL OFFICE FOR EQUAL OPPORTUNITY

                              Introduction

    The Department of the Interior (DOI) diligently seeks to improve 
its services and programs for senior citizens and their families by 
making DOI managed parks, historical sites, wildlife refuges, prairie 
lands, recreational areas, offices and other facilities more open and 
easily accessible, and by improving accommodations at these facilities 
and areas for the older population and for DOI's own senior employees. 
To assist the Department in meeting its goals for seniors, the 
Departmental Office for Equal Opportunity (OEO) takes the lead in 
managing all federally conducted and federally assisted civil rights 
programs, activities, and functions within DOI. These activities 
encompass the coordination and management of both DOI employee 
activities and general public activities associated with the 
elimination of age related discrimination in DOI employment and the 
elimination of age discrimination affecting the general public.
            training equal employment opportunity counselors
    In furtherance of these goals, newly appointed DOI Equal Employment 
Opportunity (EEO) Counselors are given initial training on how to be 
aware of and sensitive to the needs of older people. All counselors 
receive pertinent training in order to understand and accurately apply 
regulations which are related to the issues of age discrimination and 
its elimination. When age related regulations are up-dated or modified, 
both newly appointed and experienced EEO Counselors receive briefings, 
training, or information designed to keep them fully informed about the 
changes which affect senior citizens. Educational and training texts 
and classroom materials are specifically designed to reflect and 
explain all new changes which impact the well-being and health of 
senior citizens. In regards to complaints about age discrimination, all 
offices and bureaus have been given EEO Counselor's Guidebooks and 
recently up-dated EEO materials which explain the rights of Federal 
employees, particularly those who are over 40 and who thus have 
employment rights against age discrimination based upon their age.
                    inter-agency information sharing
    To further the exchange of information on issues related to senior 
citizens and issues concerning age discrimination, DOI regularly 
prepares and transmits quarterly and annual reports to the Department 
of Justice, the Equal Employment Opportunity Commission, and the 
Department of Health and Human Services.
                decreased age related complaints in 1994
    During Fiscal Year 1994 (FY-94) the number of Federal equal 
employment complaints filed with DOI in which age discrimination was 
alleged to be a factor decreased by 19 percent over the number filed in 
FY-93 (222 cases were filed in FY-94 compared to 265 filed in FY-93). 
This decrease in cases in FY-94 reverses a trend stated in FY-93 in 
which age related cases increased 34 percent. This change, in part, may 
be attributable to a continued emphasis within DOI on training and 
counseling which has helped to improve the working environment and 
morale of older DOI employees.
              improved information on complaint processing
    With respect to age discrimination matters, OEO has provided 
refresher training and up-dated information for EEO specialists 
throughout DOI on such subjects as the implementation of guidance in 
the Code of Federal Regulations (29 CFR 1614). OEO has developed, 
printed, and distributed a brochure, You and the Federal Sector 
Employment Discrimination Complaints Process which has proven to be 
helpful in explaining in a simple, uncomplicated manner the new EEOC 
regulations to older employees and to older job applicants.
                 federal financial assistance programs
    In relation to DOI's Federal Financial Assistance Programs, OEO 
provided leadership and direction for approximately 5,000 civil rights 
compliance reviews of its federally assisted programs and activities to 
determine, among other issues, whether they are in compliance with 
Federal age discrimination requirements. State and local recreation 
programs, as well as State fish and wildlife activities, were evaluated 
for inappropriate age distinctions. OEO also provided technical 
assistance to DOI bureaus and offices and State and local governments 
regarding the applicability of DOI Federal assistance age 
discrimination policies. OEO processed numerous inquiries from Federal, 
State, and local government agencies, private organizations, and 
citizens regarding DOI polities against age discrimination. During FY-
94, OEO processed eight civil rights complaints from the general public 
that alleged discrimination on the basis of age in programs and 
activities to which DOI provided Federal financial assistance.

                     ITEM 9. DEPARTMENT OF JUSTICE

                       OFFICE OF JUSTICE PROGRAMS

    The Office of Justice Programs (OJP) works to form partnerships 
among Federal, State, and local government officials to address crime 
and related problems in communities throughout the Nation. OJP is 
comprised of five major program bureaus: The Bureau of Justice 
Assistance (BJA); the Bureau of Justice Statistics (BJS); the National 
Institute of Justice (NIJ); the Office of Juvenile Justice and 
Delinquency Prevention (OJJDP); and the Office for Victims of Crime 
(OVC). These five program bureaus:
          Support national, State, and local programs to prevent and 
        control crime and improve the criminal justice system;
          Collect and analyze statistical justice-related data;
          Conduct research to identify emerging criminal justice 
        issues, develop and test promising approaches to address these 
        issues, evaluate program results, and disseminate research 
        findings;
          Sponsor research and demonstration programs to test effective 
        methods for preventing and treating juvenile delinquency and 
        improving the juvenile justice system; and
          Lead efforts to improve the Nation's response to crime 
        victims and their families.

                      State Formula Grant Programs

    Most OJP funding is awarded to State governments through formula or 
``block'' grant programs. The largest such program is the Edward Byrne 
Memorial State and Local Law Enforcement Assistance Program, which is 
administered by BJA. States may use Byrne funds to support a variety of 
criminal justice programs that affect elderly citizens, including 
projects to protect senior citizens from physical and mental abuse, 
prevent consumer fraud directed at them, promote community awareness 
and crime prevention among the elderly, and provide assistance for 
elderly victims of crime.
    For example, Massachusetts uses Byrne formula funds to support a 
project by the Massachusetts Attorney General that provides specialized 
training to police officers to assist them in preventing, reporting, 
and responding to cases of elder abuse and to protect older citizens 
from neglect and financial exploitation. The program involves 
cooperation among law enforcement, prosecutors, and protective service 
agencies. Its curriculum covers such issues as the myths and facts 
about aging, elder abuse reporting law, domestic violence and the 
elderly, mental health, and police response to missing persons with 
Alzheimer's disease.
    OVC also awards funds to the States under two programs authorized 
by the Victims of Crime Act (VOCA) of 1984. The VOCA programs are 
funded, not by Congressional appropriations, but by the Crime Victims 
Fund in the U.S. Treasury. The Fund is comprised of fines and penalties 
assessed on convicted Federal offenders.
    OVC's Victim Assistance Program provides funds to States to support 
programs that provide direct services for crime victims, such as rape 
crisis centers, battered women's shelters, and counseling services. 
States are required to set aside 10 percent of these funds for 
previously underserved victims of violent crime. A number of States 
have identified elder abuse victims as a previously underserved group 
for which they provide additional programs and services. Other States 
and territories award subgrants from VOCA victim assistance funds to 
local victim services agencies that aid elderly victims of abuse and 
crime.
    OVC's Victim Compensation Grant Program awards grants to states to 
support State programs that reimburse violent crime victims and their 
survivors for expenses related to their victimization. These include 
medical expenses, including mental health counseling and care, funeral 
expenses, lost wages, and other costs associated with the crime.

              National Citizens' Crime Prevention Campaign

    OJP's bureaus also directly support a number of innovative 
initiatives relating to the elderly. These include the National 
Citizens' Crime Prevention Campaign, which is supported by BJA in 
cooperation with the National Crime Prevention Council (NCPC), the 
Advertising Council, Inc., and the Crime Prevention Coalition, which 
includes such organizations as the American Association of Retired 
Persons (AARP).
    Among other activities, the Campaign provides crime prevention and 
personal safety information to elderly and other citizens throughout 
the Nation. The Campaign features ``McGruff, the Crime Dog,'' who asks 
Americans to help ``Take A Bite Out Of Crime'' by taking simple 
precautions, by reporting suspicious activity to the police, and by 
working with their neighbors, community leaders, law enforcement 
officials, and others to keep their communities safe from crime and 
drugs.
    Information packets developed by the Campaign and distributed 
across the country include special crime prevention tips for senior 
citizens and focus on the special needs, concerns, and vulnerabilities 
of elderly citizens with regard to crime and victimization. Recent 
material includes a booklet developed by NCPC and the General 
Federation of Women's Clubs on crimes against the elderly, as well as 
several reproducible brochures.
    The Campaign also works to enlist senior citizens in the fight 
against crime and drugs, recognizing them as a valuable resource for 
community crime prevention programs. Its informational materials and 
public service advertising encourage older Americans to participate in 
crime prevention activities in their communities.

                                 Triad

    BJA, NIJ, and OVC support Triad, a program sponsored by three 
national organizations--the American Association of Retired Persons, 
the International Association of Chiefs of Police, and the National 
Sheriffs' Association. These organizations encourage Triad agreements 
at the State and local level and monitor the programs' progress.
    Under Triad, teams of local law enforcement personnel, elderly 
volunteers, and victim-service providers work together to prevent crime 
against senior citizens. Communities implementing Triad have formed 
senior advisory councils, sometime known as SALT (Seniors and Lawmen 
Together) Councils, to ensure dialog between the chief executive 
officers of law enforcement agencies and the senior citizen community.
    In Illinois, a State-level Triad program involves a cooperative 
effort of the Attorney General's office, the Department of Aging, and 
Adult Protective Services targeting fraud against the elderly in the 
financial and health care sectors.
    In Orange County, Florida, senior safety seminars offer information 
on scams, as well as tips on traffic safety and side effects of some 
over-the-counter and prescription drugs. The seminars also feature an 
exhibit by the mobile crime prevention unit, a tractor-trailer 
renovated by an elder by volunteer that displays home safety devices. 
In addition, senior volunteers provide support for storefront police 
operations, court services, and crime prevention activities.
    In Georgia's Adopt-A-Senior Program, a law enforcement officer 
visits an individual weekly to assess that person's needs and pass on 
information to the appropriate service agencies.
    With NIJ's support, the sponsoring organizations have published and 
distributed newsletters on Triad and completed a manual to help 
sheriffs, police chiefs, and senior leaders implement Triad in their 
communities. In addition, a videotape describing the program has been 
produced and distributed to communities seeking to establish their own 
Triad programs.

                   Alzheimer's Patient Alert Program

    As directed by Congress, OJJDP's Missing Children Program is 
providing the third year of funding for the National Alzheimer's 
Patient Alert Program's ``Safe Return'' project. Safe Return is 
designed to facilitate the identification and safe return of missing 
persons afflicted with Alzheimer's disease and related disorders.
    The project supports a national registry of computerized 
information on memory-impaired persons and a toll-free telephone line 
to access the registry. It communicates vital information to 
appropriate law enforcement agencies and has developed an 
identification system using jewelry and clothing labels with unique 
numbers to aid in locating and returning missing persons affected by 
Alzheimer's disease or other memory loss.
    During its third year of operation, the program will assist local 
Area Resource Centers to provide more hands-on services to families and 
work with law enforcement and emergency service personnel. It also will 
launch a national public awareness campaign and expand its information 
and educational materials to include translations into other languages.

                  Understanding Crime and the Elderly

    As the primary justice statistical agency in the Nation, BJS 
collects, analyzes, publishes, and disseminates statistical information 
on crime, criminal offenders, victims of crime, and the operations of 
criminal justice systems at all levels of government. In March 1994, 
BJS released Elderly Crime Victims, which reports data from a special 
analysis of its National Crime Victimization Survey (NCVS). NCVS 
interviews approximately 100,000 people every 6 months about the crimes 
they sustained. This includes the violent crimes of rape, robbery, and 
assault; personal theft; and the household crimes of burglary, 
household larceny, and motor vehicle theft. Persons age 65 or older 
comprise about 14 percent of people age 12 or older interviewed in the 
NCVS. However, the elderly report less than 2 percent of all 
victimizations. Among the report's findings:
          In 1992, people age 65 or older experienced about 2.1 million 
        criminal victimizations.
          People age 65 or older are the least likely of all age groups 
        in the Nation to experience crime.
          The elderly appear to be particularly susceptible to crimes 
        motivated by economic gain, such as robbery and personal theft, 
        as well as the household crimes of larceny, burglary, and motor 
        vehicle theft. Like the general population, the elderly are 
        most susceptible to household crimes and least susceptible to 
        violent crimes.
          Injured elderly victims of violent crime are more likely than 
        younger victims to suffer a serious injury. Violent offenders 
        injure about a third of all victims. Among the violent crime 
        victims age 65 and older, 9 percent suffer serious injuries 
        such as broken bones and loss of consciousness. By comparison, 
        5 percent of younger victims suffer serious injuries.
          Elderly violent crime victims are more likely than younger 
        victims to face assailants who are strangers.
          Elderly victims of violent crime are almost twice as likely 
        as young victims to be raped, robbed, or assaulted at or near 
        their home. Half of the elderly victims of violence and a 
        quarter of those under age 65 are victimized at or near their 
        home.
          About 38 percent of elderly victims of violent crime and 35 
        percent of younger victims report facing an armed offender.
    Among the elderly, certain groups were generally more likely to 
experience a crime than others:
          Elderly men generally have higher victimization rates than 
        elderly women. Elderly women, however, have higher rates of 
        personal larceny with contact such as purse snatching.
          The elderly age 65 to 74 have higher rates of victimization 
        than those age 75 or older.
          Elderly blacks are more likely than elderly whites to be 
        crime victims. However, rates of personal larceny that did not 
        involve contact between the victim and offender were greater 
        for whites.
          Elderly with the lowest incomes experienced higher violence 
        rates than those elderly with higher family incomes. Those 
        elderly with the highest family income have the highest rates 
        of personal theft or household crime.
    BJS also analyzes data collected through its 1992 National 
Corrections Reporting Program. These data show that among offenders 
entering prison, older offenders are more likely than younger offenders 
to have been convicted of a violent offense.
    Of the total persons age 55 of older entering prison, 43.7 percent 
were convicted of violent offenses, compared to 26 percent for 25-29 
year olds and 24.5 percent for 30-34 year olds. Of the total persons 
age 55 or older entering prison, the survey found that 7.4 percent were 
convicted of rape and 17.8 percent were convicted for other sexual 
assault.
    Another BJS survey, the 1992 National Judicial Reporting Program, 
found that 3 percent of persons convicted of felonies in state courts 
were age 50-59. One percent was age 60 or older. Three percent of all 
persons convicted of violent felonies were age 50-59, while 2 percent 
were age 60 or older.
    NIJ supported Research on Managing Elderly Offenders begun in late 
1993 by Northwestern University. The study is examining management, 
supervision, and treatment of elderly inmate populations in the 
Nation's prisons and jails. Researchers will conduct a comprehensive 
literature review on related topics such as management issues 
concerning elderly inmates, elderly offender needs and problems, and 
existing programs for elderly offenders. A survey of State and Federal 
prison systems, as well as local jails, will be conducted to compile 
information on their current policies, programs, management strategies, 
housing, classification, and medical services. Researchers will also 
conduct site visits to jurisdictions to document promising programs and 
practices.
    Early results from the study indicate that, among three states 
(Georgia, Illinois, and Michigan) that have studied elderly inmates in 
their systems, findings are strikingly similar:
            Most older inmates are serving time for violent or sex 
        crimes.
            Most elderly offenders are classified as medium security 
        inmates or less.
            Elderly inmates have few disciplinary problems.
    The study also found that in Georgia, 1 in 5 elderly offenders had 
major medical problems. Michigan categorized about 20 percent of its 
elderly inmates as having bad health. In Illinois, the cost of care for 
geriatric inmates is estimated at $24,000 annually, compared with 
$16,000 for inmates in the general population.

                   Training and Technical Assistance

    OVC uses a small but growing share of the Crime Victims Fund to 
award grants to eligible crime victim assistance programs for training 
and technical assistance services. OVC's national-scope training and 
technical assistance programs have focused on providing training for 
criminal justice personnel, volunteers, professionals, clergy and other 
service providers who play a critical role in responding to victims of 
crime.
    During 1994, OVC completed a project with the Police Executive 
Research Forum that developed a curriculum on elder abuse for law 
enforcement agencies. The curriculum is designed to provide law 
enforcement policymakers and officers information on the most effective 
procedures and policies for responding to incidents of family violence 
involving elderly people. OVC, NIJ, and BJA are working with AARP, the 
National Sheriffs' Association, and the Department of Health and Human 
Services' Administration on Aging to sponsor regional training seminars 
using the curriculum.
    Grant and program information is available by calling the 
Department of Justice Response Center at 1-800-421-6770. Copies of 
research and statistical reports and other information published by the 
Office of Justice Programs is available by calling the National 
Criminal Justice Reference Service toll-free on 1-800-851-3420. From 
metropolitan Washington, D.C., and Maryland, call 301-251-5500.
    Other inquiries should be addressed to the: Office of Congressional 
and Public Affairs, Office of Justice Programs, 633 Indiana Ave., N.W., 
Washington, D.C. 20531, Telephone: 202-307-0703.

                      ITEM 10. DEPARTMENT OF LABOR

    The welfare of our Nation's older citizens is a matter of 
substantial concern to the Department of Labor. The Department of Labor 
is therefore pleased to provide this summary of the programs it 
administers which can provide helpful assistance to older citizens. 
These include--job training and related assistance, disclosed worker 
assistance, and other employment service assistance, under programs 
administered by the Department of Labor's Employment and Training 
Administration; a public information and assistance program on matters 
relating to certain pension and welfare plans, under programs 
administered by the Pension and Welfare Benefits Administration; 
statistical programs providing employment and unemployment data for 
older persons, under programs administered by the Bureau of Labor 
Statistics; protection for certain employees to take unpaid, job-
protected leave to provide care for sick, elderly parents, under a 
program administered by the Employment Standards Administration; and, a 
Clearinghouse which provides information and resources to employees and 
employers interested in developing or implementing family friendly 
policies such as elder care and child care, under a program 
administered by the Women's Bureau. These matters are addressed more 
fully in the following discussion.

                 EMPLOYMENT AND TRAINING ADMINISTRATION

                              introduction
    The Department of Labor's Employment and Training Administration 
(ETA) provided a variety of training, employment and related services 
for the Nation's older individuals during Program Year 1993 (July 1, 
1993-June 30, 1994) through the following programs and activities: the 
Senior Community Service Employment Program (SCSEP); programs 
authorized under the Job Training Partnership Act (JTPA); and the 
Federal-State Employment Service system.

              Senior Community Service Employment Program

    The Senior Community Service Employment Program (SCSEP), authorized 
by Title V of the Older Americans Act, employs low-income persons age 
55 or older in a wide variety of part-time community service activities 
such as health care, nutrition, home repair and weatherization 
programs, and in beautification, child care, conservation, and 
restoration efforts. Program participants work an average of 20 hours 
per week in schools, hospitals, parks, community centers, and in other 
government and private, nonprofit facilities. Participants also receive 
personal and job-related counseling, annual physical examinations, job 
training, and in many cases referral to regular jobs in the competitive 
labor market.
    Over 66 percent of the participants were age 60 or older, and over 
37 percent were age 65 or older. Over two-thirds were female; about 
one-third had not completed high school. All participants met low-
income guidelines.
    Table 1 below shows SCSEP enrollment and participant 
characteristics for the program year July 1, 1993, to June 30, 1994.

 TABLE 1.--Senior Community Service Employment Program (SCSEP): Current 
 Enrollment and Participant Characteristics--Program Year July 1, 1993, 
                            to June 30, 1994

Enrollment:
    Authorized positions established..........................    65,107
    Unsubsidized placements...................................    17,776
Characteristics Cumulative Starts (Percent):
    Sex:
        Male..................................................        33
        Female................................................        67
    Educational status:*
        8th grade and less....................................      15.3
        9th grade through 11th grade..........................      17.5
        High School graduate or equivalent....................      40.2
        1-3 years of college..................................      18.3
        4 years of college or more............................       8.6
    Veterans..................................................        16
    Ethnic Groups:*
        White.................................................      62.6
        Black.................................................      22.4
        Hispanic..............................................       9.7
        American Indian/Alaskan Native........................       1.7
        Asian/Pacific Island..................................       3.5
    Economically disadvantaged................................       100
    Poverty level or less.....................................      77.5
    Age groups:*
        55-59.................................................      33.8
        60-64.................................................      28.8
        65-69.................................................      20.9
        70-74.................................................      11.3
        75 and over...........................................       5.1

* Figures do not add to 100% due to rounding.

Source: U.S. Department of Labor, Employment and Training Administration 
(Preliminary Data).

              Job Training Partnership Act (JDTA) Programs

    The Job Training Partnership Act (JTPA) provides job training and 
related assistance to economically disadvantaged individuals, 
dislocated workers, and others who face significant employment 
barriers. The ultimate goal of JTPA is to move program participants 
into permanent, self-sustaining employment. Under JTPA, Governors have 
the approval authority over locally developed plans and are responsible 
for monitoring local program compliance with the Act. JTPA functions 
through a public/private partnership which plans, designs and delivers 
training and other services. Private Industry Councils (PICs), in 
partnership with local governments in each Service Delivery Area (SDA), 
are responsible for providing guidance for and oversight of job 
training activities in the area.
    JTPA was amended most recently in 1992, to target program services 
to those with serious skill deficiencies; and individualize and 
intensify the quality of services provided. Five percent of the funds 
appropriated for the new adult program (Title II-A) must be used by 
States in partnership with SDAs for older workers. The Governors must 
ensure that services under the adult program are provided to older 
workers on an equitable basis.

                           Basic JTPA Grants

    Title II-A of JTPA authorizes a wide range of training activities 
to prepare economically disadvantaged youth and adults for employment. 
Training services available to eligible older individuals through the 
basic Title II-A grant program include vocational counseling, jobs 
skills training (either in classroom or on-the-job), literacy and basic 
skill training, job search assistance, and job development and 
placement. Table 2 below shows the number of persons 55 years of age 
and over who terminated from the Title II-A program during the period 
July 1, 1993 through June 30, 1994. (The data do not include the 5 
percent set-aside for older individuals, which is discussed 
separately.)

          TABLE 2--JTPA ENROLLMENT JULY 1, 1993--JUNE 30, 1994          
                              [Title II-A]                              
------------------------------------------------------------------------
                                                     Number             
                       Item                          Served     Percent 
------------------------------------------------------------------------
Total Adult Terminees:                                                  
  (22 and older).................................    210,640       100  
  55 years and over..............................      5,088         2.4
    Entered Unsubsidized Employment..............      2,393     (\1\)  
    Received Training............................      2,517     (\1\)  
------------------------------------------------------------------------
\1\ N/A.                                                                
                                                                        
Source: U.S. Department of Labor, Employment and Training Administration
  (December, 1994 Preliminary Data).                                    

                         Section 124 Set-Aside

    Section 124 of JTPA mandates that 5 percent of the Title II-A 
allotment of each State be made available for the training and 
placement of older individuals in private sector jobs. Only 
economically disadvantaged individuals who are 55 years of age or older 
are eligible for services under this set-aside.
    Governors have wide discretion regarding use of the JTPA 5 percent 
set-aside. Two basic patterns have evolved. One is adding set-aside 
resources to Title II-A to ensure that a specific portion of older 
persons participates in the basic Title II-A program. The other is 
using the resources to establish specific projects targeted to older 
individuals which operate independently of the basic program. Likewise, 
States are required to provide ``equitable services to older 
individuals throughout the State, taking into consideration the 
incidence of such workers in the population.'' Some States distribute 
all or part of the 5 percent set-aside by formula to local SDAs; other 
States retain the resources for State administration and/or model 
programs.
    In keeping with the requirements of the amendments, Governors are 
expected to coordinate services as much as possible with the services 
provided under Title V of the Older Americans Act--Senior Community 
Service Employment Program. There are two separate provisions for older 
individual programs as they relate to Title V of the Older Americans 
Act. Under the Title II-A program, up to 10 percent of the participants 
may be individuals who are not economically disadvantaged; under this 
10 percent ``window,'' those who meet Title V criteria and have a 
serious barrier to employment may qualify. In addition, when an SDA and 
Title V sponsor establish joint projects, individuals eligible under 
Title V of the Older Americans Act ``shall be deemed to satisfy the 
requirements'' of JTPA. SDAs may enter into joint programs with Title V 
programs, including co-enrollment of Title V participants in Title II-
A. Joint programs must have a written agreement, which may be financial 
or nonfinancial in nature, and may include a broad range of activities. 
For Program Year 1993 (July 1, 1993, through June 30, 1994) preliminary 
data indicate that over 16,846 terminees went through the set-aside 
program for economically disadvantaged individuals 55 years of age and 
older.

                    Programs For Dislocated Workers

    Title III of JTPA authorizes a State and locally-administered 
dislocated worker program which provides training and related 
employment assistance to workers who have been, or have received notice 
that they are going to be, laid off from their jobs, and are unlikely 
to return to their previous industries or occupations. This includes 
workers who lose their jobs because of a permanent closing of a plant 
or facility or mass layoffs; long-term unemployed with little prospect 
for local employment or reemployment; and farmers, ranchers, and other 
self-employed persons who become unemployed due to general economic 
conditions.
    Those older workers eligible for the program may receive such 
services as job search assistance, retraining, pre-layoff assistance 
and relocation assistance. During the period July 1, 1993, through June 
30, 1994, approximately 13,000 individuals 55 years of age and over 
completed their participation in the program (8 percent of the program 
terminations), based on preliminary data.

              The Federal-State Employment Service System

    The State-operated public employment service offices (ES) offer 
employment assistance to all jobseekers, including middle-aged and 
older persons. A full range of basic labor exchange services are 
provided, including counseling, testing, job development, job search 
assistance and job placement. In addition, labor market information and 
referral to relevant training and employment programs are also 
available.
    Federal reporting requirements for State employment service 
agencies (SESAs) were revised effective July 1, 1992, to capture 
additional information on applicant characteristics, including data on 
the age of all ES applicants and those placed in employment. During the 
period July 1, 1993, through June 30, 1994, over 1,300,000 ES 
applicants were age 55 and over. Approximately 97,500 of the ES 
applicants age 55 and over were placed in jobs during this period.

              PENSION AND WELFARE BENEFITS ADMINISTRATION

                              Introduction

    The Pension and Welfare Benefits Administration (PWBA) is 
responsible for enforcing the Employee Retirement Income Security Act 
(ERISA). PWBA's primary responsibilities are for the reporting, 
disclosure, and fiduciary provisions of the law.
    Employee benefit plans maintained by employers and/or unions 
generally must meet certain standards, set forth in ERISA, designed to 
ensure that employees actually receive promised benefits. Employee 
benefit plans exempt from ERISA include church and Government plans.
    The requirements of ERISA differ depending on whether the benefit 
plan is a pension plan or a welfare plan. Pension plans provide 
retirement benefits, and welfare plans provide a variety of benefits, 
such as employment-based health insurance and disability and death 
benefits. Both types of plans must comply with provisions governing 
reporting and disclosure to the Government and to participants (Title 
I, Part 1) and fiduciary responsibility (Title I, Part 4). Pension 
plans must comply with additional ERISA standards (contained in both 
Title I, Parts 2 and 3, and Title II), which govern--membership in a 
plan (participation); nonforfeitability of a participant's right to a 
benefit (vesting); and financing of benefits offered under the plan 
(funding). Welfare plans providing medical care must comply with ERISA 
continuation of coverage requirements and medical child support orders 
(Title I, Part 6).
    The Departments of Labor and the Treasury have responsibility for 
administering the provisions of Title I and Title II, respectively, of 
ERISA. The Pension Benefit Guaranty Corporation (PBGC) is responsible 
for administering Title IV, which established an insurance program for 
certain benefits provided by specified ERISA pension plans. On a 
regular basis, PWBA meets and coordinates closely with the Internal 
Revenue Service (IRS) and the PBGC on matters concerning pension 
issues.
    In FY 1994, PWBA participated in legislative efforts for 
comprehensive reform of America's health care system. No legislation 
was enacted, but problems in this area are expected to demand PWBA's 
continuing attention.
    PWBA also supported enactment of a Congressional proposal to make 
remedies available to former participants and beneficiaries under 
certain pension plans that had purchased annuity contracts from 
Executive Life Insurance Company and several other insolvent insurers. 
The ``Pension Annuitants Protection Act of 1994'' was signed into law 
as Public Law 103-401 on October 22, 1994. PWBA had sought broader 
legislation to restore the full range of potential remedies to 
participants and beneficiaries who sue third parties that knowingly and 
actively assist fiduciaries in breaching their duties under ERISA, and 
to give standing to former participants to sue wrongdoers for actions 
taken while they were active participants. As enacted, Public Law 103-
401 provides standing and fuller remedies for participants who lose 
benefits due to improper purchases of pension annuities, but not for 
other violations of ERISA.
    PWBA also supported the ``Retirement Protection Act of 1994,'' a 
bill to strengthen funding in underfunded pension plans. Legislation 
based on the Administration's bill was enacted as part of Public Law 
103-465 on December 8, 1994. Public Law 103-465 also modified and 
extended provisions which allow the transfer of excess pension assets 
to pay for retiree health expenses.
    The 100th Congress amended ERISA to impose penalties of up to 
$1,000 per day for filing late or deficient annual reports. Because 
these penalties could impose substantial burdens, the Department 
provided plan administrators a ``grace period'' ending December 31, 
1993. Plan administrators filing overdue annual reports in the grace 
period were assessed $1,000 regardless of how many days the report was 
actually in arrears. During this grace period, over 41,000 filings were 
submitted to bring plans into compliance with ERISA. The Department 
collected over $35 million in penalty fees from the grace period.
    PWBA published an interpretive bulletin on fiduciary standards for 
proxy voting on July 29, 1994, with guidance on the responsibilities of 
ERISA plan fiduciaries in voting shares held by the plan, and 
encouraged plan officials to adopt written statements of investment 
policy. An interpretive bulletin on economically targeted investments 
was published June 23, 1994. This bulletin clarified the DOL position 
on ERISA's fiduciary standards for investing plan assets in 
economically targeted investments with risk-adjusted returns no lower 
than alternative investments. To make previous guidance widely 
available in the code of Federal Regulations, the bulletin reiterated 
positions taken in earlier DOL advisory letters. The bulletin stresses 
that any ETI must be made for the exclusive benefit of participants and 
beneficiaries, and all other ERISA requirements must be satisfied.
    In fiscal year 1994 PWBA continued its program of research directed 
toward improving the understanding of the employment-based pension and 
health benefit systems. The key component of this program is the 
project with the National Academy of Sciences to improve retirement 
income modeling. PWBA sponsored a conference on this important work on 
September 29-30, 1994. The agency also published ``Pension and Health 
Benefits of American Workers'' in fiscal year 1994, with findings and 
data from the Census Bureau's April 1993 survey of 30,000 households on 
employee benefits; and ``Pension Coverage Issues for the 90's,'' 
containing articles on new studies in this area.

                               Inquiries

    PWBA publishes literature and audio-visual materials which, in some 
depth, explain provisions of ERISA, procedures for plans to ensure 
compliance with the Act and the rights and protections afforded 
participants and beneficiaries under the law. In addition, PWBA 
maintains a public information and assistance program, which responds 
to many inquiries from older workers and retirees seeking assistance in 
collecting benefits and obtaining information about ERISA. Among the 
publications disseminated, the following are designed exclusively to 
assist the public in understanding the law and how their pension and 
health plans operate:

          Health Benefits Under the Consolidated Omnibus Budget 
        Reconciliation Act (COBRA); What You Should Know About the 
        Pension and Welfare Law; Know Your Pension Plan; How to File a 
        Claim for Benefits; and Often Asked Questions About ERISA;
          How to Obtain Employee Benefits Documents From the Labor 
        Department; and
          Simplified Employee Pensions: What Small Business Needs to 
        Know.

                       BUREAU OF LABOR STATISTICS

    The Department of Labor's Bureau of Labor Statistics (BLS) 
regularly issues a wide variety of statistics on employment and 
unemployment, prices and consumer expenditures, compensation including 
wages and benefits, productivity, economic growth, and occupational 
safety and health. Data on the labor force status of the population, by 
age, are prepared and issued on a monthly basis. Data on consumer 
expenditures, classified by age groupings, are published annually. In 
1994 BLS published the first results of the redesigned survey of 
occupational injuries and illnesses; these data will now be available 
by age, race, and gender, providing important new information on this 
aspect of the labor market experiences of older Americans. In addition 
to regularly recurring statistical series, BLS undertakes special 
studies as resources permit. In May 1994 BLS published a report on an 
experimental Consumer Price Index for older Americans. This report 
updates a portion of a study originally performed by BLS in response to 
the Older Americans Act Amendments of 1987.

                             WOMEN'S BUREAU

    The Women's Bureau Clearinghouse, established in 1989, is a 
computerized database and resource center responsive to dependent care 
and women's employment issues. Services help employers and employees 
make informed decisions about which programs and services best serve 
their needs. The Clearinghouse offers information and guidance in five 
broad option areas for child care and elder care services: direct 
services, information services, financial assistance, flexible leave 
policies, and public-private partnerships. The Clearinghouse has also 
been expanded to include information on the Family and Medical Leave 
Act (FMLA), pregnancy discrimination, and sexual harassment. Within 
each of these areas customers can be provided with model programs from 
other companies, implementation guides, national and State information 
sources and bibliographic references.
    In 1994, the Clearinghouse continues to receive requests for 
information on worksite elder care program options. Information 
provided included flexible work schedules, respite care services, 
information and referral, adult day care, parent seminars, case 
management, as well as transportation services.
    The Clearinghouse can be accessed through 1-800-827-5335.

                  EMPLOYMENT STANDARDS ADMINISTRATION

    The Family and Medical Leave Act of 1993 became effective on August 
5, 1993, for most employers. This statute provides potential benefit to 
the elderly in that it empowers eligible employees of covered employers 
to take up to 12 weeks of unpaid, job-protected leave in any 12-month 
period to provide care for a parent who has a serious health condition. 
In the past, the employee had to make a decision in many instances of 
whether or not to give up their job to provide care to a sick, elderly 
parent.

                      ITEM 11. DEPARTMENT OF STATE

  SUMMARY OF PROGRAMS FOR CIVIL SERVICE EMPLOYEES AND FOREIGN SERVICE 
                               PERSONNEL

    Dependent Parents Residing at Post.--A number of Foreign Service 
personnel choose to have elderly family members accompany them on 
overseas assignments. The Department of State will place parents who 
qualify as ``dependents'' on the employee's travel orders. To qualify, 
a parent must be at least 51 percent financially dependent upon either 
the employee or his/her spouse. The parent then becomes eligible: to 
travel on a diplomatic passport; for official travel to post at 
government expense; for criminal, civil and administrative immunity in 
the country of assignment; and to evacuation in times of civil unrest 
or natural disaster. In addition, the family may qualify for larger 
housing due to increased family size. The one benefit for which older 
family members are not automatically eligible is medical benefits; 
accompanying parents are urged to carry private insurance to cover 
their medical expenses, including coverage in case of a medical 
evacuation. The Employee Consultation Service (ECS), a confidential 
counseling service in the Office of Medical services, provides 
information to departing employees regarding insurance. (Medicare does 
not cover overseas expenses and very few private companies will protect 
those over the age of 70.) Only if no adequate care is available in the 
host country will the medical unit at post attempt to meet the needs of 
an older relative. If these medical needs are more than routine, 
however, it may be difficult for post medical personnel to provide that 
care.
    Dependent Parents Unable to Reside at Post.--Because of assignment 
to an unaccompanied post, medical concerns, or personal need, a 
dependent parent may decide not to reside at the employee's post of 
assignment. If the parent has previously accompanied the employee on an 
overseas assignment, s/he may request to be placed on a Separate 
Maintenance Allowance, a special allowance which alleviates some of the 
additional expenses of maintaining two households. When parents suffer 
a health crisis in the United States, the Employee Consultation Service 
provides a resource locator service for Foreign Service employees 
abroad. This service researches and identifies the best medical and 
support services in the parent's community. In addition, ECS staff 
members will visit nursing homes, hospices, and hospitals in the 
Washington area, if requested, to assess the degree of care being 
provided. This service is now limited, however, due to down-sizing.
    Parents Not Residing at Post.--Most parents do not qualify as 
dependents and do not accompany their Foreign Service family members on 
overseas assignments. When personnel are assigned abroad the issue of 
caring for elderly parents can be particularly challenging. Long-
distance decisionmaking is difficult at best, impossible at times. The 
ECS resource locator service is available to Foreign Service employees 
and staff members will visit care providers as described in the 
previous section. Finally, ECS provides individual counseling for those 
dealing with eldercare concerns. A paper entitled ``Caring for Elderly 
Parents,'' prepared by the Family Liaison Office (FLO), is available to 
all employees and family members, and several books on eldercare have 
been provided to embassies and consulates by FLO. In the case of a 
life-threatening illness or the death of a parent, visitation travel at 
government expense is permitted for either the employee or a family 
member.
    Retirement Programs.--The Department is committed to assisting 
employees as they make the transition to retirement. A 1-week seminar 
followed by a 30-day (Civil Service) or 90-day (Foreign Service) job-
search program with full pay is available to every employee. Topics 
covered in the seminar include financial planning, estate planning, 
retirement living, long-term healthcare, nursing home insurance, and 
more. Spouses often attend this seminar along with the employee and the 
Overseas Briefing Center offers a 2-day course specifically tailored to 
spousal concerns. The course, entitled ``Life After the Foreign 
Service,'' is professionally-led and provides discussion, papers, and a 
reading list on issues facing older Americans.
    Retired Employees.--The Department of State's commitment to assist 
Foreign Service employees does not end at retirement. The Employee 
Consultation Service will consult with former employees and family 
members to provide guidance on medical and mental health alternatives 
which are available to them.
    American Foreign Service Protective Association (AFSPA).--AFSPA 
offers medical insurance to all Foreign Service personnel and their 
family members. Recently they initiated a long-term care policy 
(LTCare) which will assist older members to meet their need for 
additional care. Parents under the age of 80 at the time of enrollment 
may be included on a member's policy.
    Programming for Civil Service Employees and Foreign Service 
Personnel Assigned to Washington.--The Employee Consultation Service 
provides both programs and services to assist older Americans and their 
families. For 5 years ECS has offered weekly support groups for those 
providing care for elderly relatives. In addition, they counsel 
employees on retirement options in the Washington area and throughout 
the United States, they consult with parents experiencing difficulty 
when family members move overseas, they meet with managers concerned 
about workplace performance of elderly employees, and they provide 
private short-term counseling.
    Programs for older Americans are vitally important; I am pleased to 
have this opportunity to inform you of those offered by the Department 
of State.
    I hope this report is useful to you. Please do not hesitate to 
contact me if we can be of further assistance.
            Sincerely,
                                          Wendy R. Sherman,
                           Assistant Secretary Legislative Affairs.

                 ITEM 12. DEPARTMENT OF TRANSPORTATION

   SUMMARY OF ACTIVITIES TO IMPROVE TRANSPORTATION SERVICES FOR THE 
                              ELDERLY \1\

                              Introduction

    The following is a summary of significant actions taken by the U.S. 
Department of Transportation during calendar year 1994 to improve 
transportation for elderly persons.\2\
---------------------------------------------------------------------------
    \1\ ``Prepared for the U.S. Senate Special Committee on Aging--
December 1994.
    \2\ Many of the activities highlighted in this report are directed 
toward the needs of handicapped persons. However, one-third of the 
elderly are handicapped and thus will be major beneficiaries of these 
activities.
---------------------------------------------------------------------------

                                Policies

                 federal railroad administration (fra)
    The National Railroad Passenger Corporation (Amtrak) continued 
throughout calendar year 1994 to provide elderly and disabled 
passengers with discounted fares, accessible accommodations, and 
special services, including assistance in arranging travel. These 
passengers continue to represent a substantial part of Amtrak's 
ridership--in recent years, 28 percent of long-distance passengers were 
62 or older.
    Discounted Fares.--Amtrak has a systemwide policy of offering to 
elderly persons and persons with disabilities a 25 percent discount on 
one-way ticket purchases. This 25 percent discount to senior citizens 
and passengers with disabilities cannot be combined with any other 
discounts.
    Accessible Accommodations.--Amtrak provides accommodations that are 
accessible to elderly and disabled passengers, including those using 
wheelchairs, on nearly all of its trains. Long-distance trains include 
accessible sleeping rooms. Short-distance trains, including Northeast 
Corridor trains, have accessible seating and bathrooms in food service 
cars. Many existing cars are being modified to provide more accessible 
accommodations and all new cars will provide enhanced accessibility for 
passengers with mobility and other types of disabilities.
    Mechanical lifts operated by train or station staff provide 
passengers with access to single-level trains from stations with low 
platforms and short plate ramps provide access to bi-level equipment. 
An increasing number of Amtrak stations are fully accessible, 
particularly among key intermodal stations that provide access to 
commuter trains and other forms of transportation.
    Special On-Board Services.--Amtrak continues to provide special on-
board services to elderly and disabled passengers needing such 
assistance, including aid in boarding and deboarding, special food 
service, special equipment handling, and provisions for wheelchairs. 
Amtrak has also improved training of its employees to better enable 
them to respond knowledgeably to passengers with special needs. It is 
always advisable for passengers to advise Amtrak of any special needs 
they may have.
    Assistance in Making Travel Arrangements.--Persons may request 
special services by contacting the reservations office at 1-800-USA-
RAIL. This office is equipped with facilities for taking reservations 
from hearing impaired persons. To ensure that passengers receive the 
assistance they need, Amtrak maintains a Special Services Desk which 
supports its reservations agents 7 days a week. This desk completed 
successful responses to nearly 100,000 requests for special services 
last year. Passengers may also inform their travel agent or the station 
ticket agent of their special needs when making travel reservations.
                  federal transit administration (fta)
    The Federal Transit Administration is the lead agency in an 
interdepartmental working relationship between the Department of 
Transportation (DOT) and the Department of Health and Human Services 
(DHHS). Under the terms of the interagency agreement, a staff working 
group has been established, and a formal executive level DOT/DHHS 
Transportation Coordinating Council has been formed. The council, which 
meets quarterly, has directed that regional initiatives be undertaken 
in each Federal region. Federal regional staff from both departments 
have worked with state program administrators to identify barriers to 
coordination in Federally supported programs and to encourage State and 
local efforts to coordinate funding for specialized transportation 
services. Liaison between these two departments will increase the 
mobility of elderly Americans by improving the coordination and 
effective use of transportation resources of both departments. The FTA 
and DHHS are negotiating with the Departments of Housing and Urban 
Development, Labor, Education, and Agriculture and the Veterans 
Administration to join the council.
    In a continuing project of the council, the Administration on Aging 
and FTA have developed a Volunteer Van Transportation Program in the 
State of Oklahoma for Native Americans who do not live on reservations. 
This joint program provides vans, insurance, and maintenance for a 
period of 4 years to develop a community-based transportation program 
where no public transportation exists. The project is currently 
purchasing additional vans to enhance the expansion of this project. A 
significant segment of those being served by this program is elderly.

                    Capital and Operating Assistance

                     federal transit administration
    Under 49 USC 5310 (formerly Section 16 of the Federal Transit Act, 
as amended), the FTA provides assistance to private nonprofit 
organizations and certain public bodies for the provision of 
transportation services for elderly persons and persons with 
disabilities. In FY 1994, over $58.6 million was used to assist in the 
purchase of 1,895 vehicles for the provision of transportation services 
for the elderly and individuals with disabilities. Besides providing 
transportation service, vehicles purchased with these funds may also be 
used for meal delivery to the homebound, as long as this purpose does 
not interfere with the primary purpose of the vehicles.
    Under 49 USC 5211 (formerly Section 18 of the Federal Transit Act, 
as amended), the FTA obligated $137.1 million to States in FY 1994. 
These funds were used for capital, operating, and administrative 
expenditures by State and local agencies, nonprofit organizations and 
operators of transportation systems to provide public transportation 
services in rural and small urban areas under 50,000 population. The 
rural program funds are also used for intercity bus service to link 
these areas to larger urban areas and other modes of transportation. An 
estimated 36 percent of the ridership of nonurbanized systems is 
elderly, which represents nearly three times their proportion of the 
rural population.
    Under Section 9 of the Federal Transit Act, as amended, the FTA 
obligated $2.3 billion in 1994. These funds were used for capital and 
operating expenditures by transit agencies to provide public 
transportation services in urbanized areas. While these services must 
be open to the general public, a significant number of passengers 
served are elderly.

                   Research and Technical Assistance

                 federal aviation administration (faa)
    Over the past year, the Office of Aviation Medicine's Civil 
Aeromedical Institute has contributed to the following research related 
to the needs/concerns of the aging population in aviation 
transportation.
    Cataract Therapy Implications for Airmen.--The prevalence of 
aphakia (no natural lens in the eye) and the use of operatively placed 
intraocular lenses by pilots was determined; concurrently, the aircraft 
accident rate associated with the aphakic condition was determined. 
Although not all intraocular lens implants are necessitated by 
conditions directly related to age, many are carried out because of the 
development of senile cataracts, which are typically related to age. 
Thus the findings of the research assist aeromedical certification 
personnel and pilots in assessing both the need for the efficacy of 
surgical correction for a category of visual defect increasingly 
prevalent in the aging pilot.
    Aircraft Evacuation Study.--The influence of age on evacuation 
performance was studied. Test subjects were divided into two groups, 
age 40 and under and over age 40, and asked to perform a simulated 
emergency evacuation from a single-aisle airliner through the overwing 
exits. The more elderly group was found to take significantly longer to 
evacuate the passenger cabin in simulated emergency conditions. In 
1994, the data were analyzed, and relationships correlating age and 
evacuation speed were developed and presented to a scientific meeting.
    Cognitive Function Test.--An automated cognitive function test was 
developed to permit the more sensitive and specific evaluation of 
pilots after brain injury or disease. This test was not specifically 
developed to assess fitness to perform flying duties in relation to the 
age of the subject being evaluated. However, this screening test was 
proven useful in assisting both aeromedical certification personnel and 
the involved pilot in assessing the level of cognitive capability for 
tasks proven to be key components in the job of piloting an aircraft; 
and since some cognitive loss is related to age, this test helps to 
assess if the degree of loss (independent of brain injury and disease) 
has progressed to levels usually associated with brain disease or 
injury. Thus, this test has been incorporated in batteries of tests 
used by some employers, as a part of EEOC settlements, to permit 
certain categories of commercial pilots to fly past age 60.
    ``Age 60 Rule''.--The ``Age 60'' Rule of the Federal Aviation 
Regulations, Part 121, prohibits any person who has reached the age of 
60 from serving as a pilot in air carrier operations. This rule has 
generated controversy since its adoption by the FAA in 1959. The rule 
has been challenged in court. Both Federal and private organizations 
have been tasked with developing specialized informational reports 
concerning the issue, and Congress has sought to develop specialized 
legislation. Recent challenges call into question the validity of the 
rule. In 1990, a contract was awarded to Hilton Systems, Inc. Under the 
contract, Hilton Systems conducted a statistical analysis on historical 
data to investigate the relationship between pilot age and accident 
rates. The results present a converging body of evidence which fails to 
support a hypothesis that the pilots of scheduled air carriers had 
increased accident rates as they neared the age of 60. Analyses give a 
hint, and a hint only, of an increase in the accident rate for medical 
Class III (private) pilots older than 63 years of age. Additional 
research will continue on this issue.
                 federal highway administration (fhwa)
    The following FHWA supported studies have been completed in fiscal 
year 1994:
    Relative Visibility of Increased Legend Size vs. Brighter Materials 
studied the effects of highly retroreflective sheeting on current 
stroke-width standards; compared older driver responses to these 
brighter signs, as compared with their response to larger signs; and 
evaluated other legend characteristics (font, spacing, and 
capitalization). Findings show that sign material did not have a 
significant effect on legibility, and imply that increases in letter 
height beyond 16 inches may not produce expected increases in 
legibility distance.
    Older Driver Perception-Reaction Time for Intersection Sight 
Distance and Object Detection evaluated the perception-reaction time of 
older drivers in a variety of intersection, stopping, and decision 
sight-distance situations. Alternate models for intersection sight 
distance were identified and evaluated. Findings show that in most 
cases, older drivers are not significantly slower than their younger 
counterparts, although the distributions of reaction time do appear to 
vary for different age groups.
    Symbol Signing Design for Older Drivers investigated the use of 
symbol signs for older drivers, made recommendations on changes to 
current signs, and developed guidelines for design of future symbol 
signs. Findings show that mechanisms exist to optimize symbol signs, 
particularly the application of Fourier analyses during sign design.
    Traffic Operations Control for Older Drivers investigated many 
operational aspects of intersections in light of older driver and 
pedestrian capabilities. Findings show that pedestrians do not often 
read educational placards and that older drivers are more likely than 
younger drivers to stop on the amber phase of a signal. Overall, 
drivers do not show adequate comprehension of the protected/permissive 
left turn signal, and older drivers in particular tended to interpret 
the permissive phase as giving them right-of-way.
    Design Characteristics of Older Adult Pedestrians used analytical 
and empirical methods to determine the capabilities and limitations of 
older pedestrians and to recommend changes in design to accommodate the 
population. Findings show that vehicles making a right turn on red are 
considered particularly hazardous by older pedestrians, and that 
pedestrians tend to walk faster when a pedestrian signal is present.
    Older and Younger Drivers' Reactions to Emergency Events was 
conducted on the HYSIM (Highway Driving Simulator) to investigate the 
driving performance of older and younger drivers. During the test 
session, subjects performed four evasive emergency maneuvers. Findings 
show no significant difference in older and younger drivers response 
times to emergency events, but do show that older drivers tend to drive 
further to the right in their lanes.
    Design Characteristics of Older Pedestrians developed walking speed 
distributions for pedestrians 65 and older as compared with walking 
speed distributions for pedestrians less than 65 years old. The 
comparisons are intended for use in highway design and operations.
                     ongoing fhwa supported studies
    Pavement Markings and Delineation for Older Drivers is using 
simulator and field techniques to investigate the use of improved 
pavement marking and delineation systems to enhance their value for 
older drivers. Preliminary findings show that delineation treatments 
that include both an edgeline and an off-road element (post mounted 
delineators, chevron signs) have the best recognition distance, for 
both older and younger drivers.
    Intersection Geometric Design for Older Drivers and Pedestrians is 
using laboratory and field methodologies to investigate the geometric 
needs of older road users at intersections, an area where older drivers 
experience a large number of accidents.
    Investigation of Older Driver Freeway Needs and Capabilities is a 
preliminary investigation to assess the extent of older driver usage 
of, and difficulties with, freeways.
    Traffic Control Device Design and Placement to Aid the Older Driver 
is investigating, in predominantly field settings, issues related to 
the design and placement of signs to aid older drivers in terms of 
detection, comprehension, recognition, and response time. This study is 
being conducted under the auspices of the National Cooperative Highway 
Research Program.
    Synthesis of Research Findings on Older Drivers will review and 
synthesize all the research findings in the High Priority National Area 
for older driver research, as well as other relevant research, in a 
format compatible for later inclusion in a driver handbook. 
Implementation plans will be developed and future research needs 
identified.
    Delineation of Hazards for Older Drivers is evaluating the utility 
of object markers in terms of conspicuity, recognizability, and 
comprehension through a series of laboratory and field studies.
    Human Factors Study of Traffic Control in Construction and 
Maintenance Zones is the subject of a projected 1995 FHWA supported 
study that will evaluate, through laboratory studies and field 
verification, the traffic control devices and operational aspects of 
construction and maintenance zones. Drivers of all ages will be 
studied, but older driver needs and capabilities will be emphasized. 
Specific problems will be identified, followed by the development and 
testing of countermeasures.
         national highway traffic safety administration (nhtsa)
    The agency continues its on-going research and programs designed to 
improve the safety and mobility of older persons. During 1993, the 
agency updated its long-term research and development program, 
published as the Traffic Safety Plan for Older Persons. Geared toward 
enhancing older person safety on the nation's streets and highways, it 
includes cooperative research between the private and public sectors on 
older drivers, vehicle occupants, and pedestrians.
    Older Driver Safety.--Analyses continue to show that older people 
are increasingly dependent on driving for their mobility, and that this 
mobility is essential for maintaining quality of life. Analyses also 
show that older drivers have fewer crashes per vehicle mile driven than 
do other drivers, but, due to their physical frailty, are more likely 
to die when involved in a crash than a younger person involved in the 
same crash.
    Research currently underway is refining the impact of specific 
medical conditions and functional ability on driving patterns and crash 
involvement. Early findings indicate that most older drivers with 
functional disabilities curtail or limit their driving and pedestrian 
practices in urban and rural areas, with a concurrent reduction in 
their ability to meet their transportation needs. More recent findings 
seem to indicate that those with arthritis are more likely to continue 
to drive and those with low back pain who take non-steroidal 
medications may be at higher risk of having a crash.
    A Cooperative Agreement currently in place with the State of 
California is developing driver license assessment techniques that will 
identify older drivers who have dementia or other unsafe cognitive 
conditions. Results from this work are not yet available.
    A study was also initiated in 1994 to understand the difficulties 
older drivers have in negotiating intersections--an area where they are 
over-involved in crashes. Studies have also been undertaken to evaluate 
the mobility consequences of stopping driving and to determine how 
society can assist older people to better regulate their driving. In 
addition, two projects have been initiated to update the medical 
condition/functional assessment guidelines for use by State motor 
vehicle administrators. The results of this work would also provide 
guidelines for license examiners in spotting driver license applicants 
who need more extensive examination before being granted a license.
    The Transportation Research Board's Committee on the Safety and 
Mobility of Older Persons, chaired by a NHTSA employee, continues to 
provide coordination of research and development activities across the 
private and public sectors. It serves a multi-disciplinary 
constituency, directing research attention to those areas most in need, 
helping to avoid unnecessary duplication of effort, and disseminating 
information about the latest findings in the field. It's chair also 
serves as an advisor on the Administration on Aging's Eldercare 
Institute on Transportation.
    Occupant Protection.--As people age, their vulnerability to 
injuries and fatality increases dramatically. NHTSA is continuing two 
major activities begun in 1993 that will better understand and increase 
the survivability of older vehicle occupants who are involved in a 
crash. Work is continuing under a grant awarded to the William Lehman 
Injury Research Center at the Ryder Trauma Center, Jackson Memorial 
Hospital in Miami, Florida. This will develop an Automobile Trauma Care 
and Research Facility, and establish an information system that will 
advance both the delivery of trauma care and the detailed data for 
research on automobile injuries, treatments, outcomes, and costs. The 
availability of an older population of automobile injury victims in the 
Miami area is providing information on the prevention of restrained 
occupant injuries that will be of increasing national importance as the 
population ages and the use of occupant restraints (air bags and 
automatic and manual belts) grows.
    NHTSA is also continuing research with the Transportation Systems 
Center using computer simulation and experimental work to improve belt/
air bag systems for vehicle occupants. Particular attention is being 
paid to possible approaches to improving alternate restraint designs or 
requirements for elderly vehicle occupants. It is expected that this 
work will be of particular value to older vehicle occupants and to 
women who, due to their more fragile bone structure, can benefit most 
from improved belt/air bag designs.
    In addition, NHTSA's new side impact standard provides a higher 
level of protection to older occupants in vehicles meeting the 
standard. The new standard is based on a dynamic crash test which 
incorporated age effects for the first time and, thus, will provide 
better protection to older vehicle occupants. Manufacturers are 
required to incrementally apply the standard to 25 percent of cars 
manufactured after September 1, 1994, 40 percent after September 1, 
1995, and 100 percent after September 1, 1996.
    Vehicle Design Practices to Enhance Older Driver Crash Avoidance.--
NHTSA's crash avoidance research program on the older driver will 
emphasize the evaluation of vehicle design practices--e.g., instrument 
panel features, forward lighting, collision warning systems--that 
influence driving safety. NHTSA will analyze the traffic crash 
experience of older drivers, assess their capabilities and limitations 
as drivers, and identify vehicle design features that will ensure 
safety while accommodating mobility needs.
    Such design features may be conventional vehicle components, such 
as lights and mirrors, which can be modified to enhance older driver 
performance. Or, they can be advanced technology countermeasure systems 
such as those under study as part of NHTSA's Intelligent Vehicle 
Highway System (IVHS) research program. Indeed, a major goal in NHTSA's 
IVHS program is to determine the safety improvements (and, hence, 
mobility-enhancements) that IVHS technologies can provide to the older 
driver.
    It is recognized that IVHS may be a ``double-edged sword'' for the 
older driver. Selected IVHS technologies clearly provide opportunities 
for safety improvements. However, other IVHS applications have the 
potential to further degrade older driver safety by confusing or 
distracting the older driver with an overload of information or 
decision-making workload. The types and amounts of information and the 
methods of presenting it must be carefully studied to ensure that older 
driver safety and mobility are enhanced rather than degraded.
    Whether the focus is on conventional or high-technology solutions, 
NHTSA addresses the older driver issue in two fundamental, mutually-
reinforcing ways. First, NHTSA considers the older driver in the 
context of virtually all ongoing research on specific driver-vehicle 
interaction issues (e.g., crash types, proposed countermeasures, safety 
concerns regarding mobility-enhancing systems). Here, the older driver 
is treated as part of the overall distribution of driver traits and 
behaviors. For example, a new study on Head-Up Displays (HUDs)--small 
windshield projected displays of information that might otherwise show 
on a dashboard--is assessing any potential distraction that might 
effect driver performance. In this case questions are being examined 
about whether the HUDs might adversely impact driver performance by 
distracting driver attention, particularly older driver attention, away 
from the driving task.
    Secondly, crash avoidance and the older driver is being addressed 
specifically to identify vehicle design practices likely to enhance (or 
degrade) the driving safety performance of older drivers. In 1994 the 
agency completed an assessment of research needs and targets of 
opportunity relating to older driver traffic safety, with emphasis on 
vehicle design practices and potential countermeasures. Based upon the 
results of this work, the agency will further refine work on the effect 
of vehicle design and older driver crash involvement, and will identify 
recommended vehicle design practices, including crash avoidance 
countermeasures, of benefit to the older driver.
    Pedestrian Safety.--NHTSA and FHWA are continuing field research 
aimed at preventing older pedestrian accidents. The work is ongoing in 
Phoenix and Chicago, and involves a demonstration program of behavioral 
safety information combined with traffic engineering applications in 
selected ``zones'' of the cities that have been shown to have a high 
incidence of older pedestrian accidents. Elderly pedestrian safety will 
also be addressed in NHTSA's ``Pedestrian Safety Awareness'' Project. 
There is little awareness of the dangers faced by the walking public 
and older adults are more likely to be killed in pedestrian accidents 
than any other age group. This project seeks to form a public/private 
coalition to develop and initiate a national awareness campaign.
                     federal transit administration
    In FY 1994, under FTA's University Research and Training Program, 
the University of Kentucky completed a research project to examine the 
travel behavior and transportation needs of the elderly in rural areas. 
The major objective of the project is to evaluate existing systems of 
transport and to suggest how these systems may be managed, modified, 
reorganized, and/or enhanced to improve mobility and provide better 
service to the elderly. The draft project report suggests that an 
organized, institutional volunteer system might be considered to assist 
in meeting the transportation needs of the elderly in the rural 
Kentucky community in which the study was conducted. The final report 
on this project will be provided to FTA by the end of December 1994.
    A project by the University of Arizona was undertaken in FY 1994 to 
draw together and synthesize operating experiences of American and 
European transit operators who have implemented, provided, or evaluated 
service routes, deviation on fixed route services, group services, and 
accessible feeder services. The study will focus primarily on how each 
of these service options is synchronized with current system 
operational patterns, in conformity with requirements of the Americans 
with Disabilities Act of 1990 (ADA), and consistent with the system's 
ADA eligibility criteria and screening processes. Based on preliminary 
data collected from paratransit providers, it is estimated that 
approximately 50 percent of ADA paratransit riders are elderly. The 
final report will be submitted to FTA by March 1995.
    The Rural Transit Assistance Program (RTAP), in its seventh year, 
obligated $5.2 million in FY 1994. The program provides funding for 
training, technical assistance and research, and related support 
activities in rural areas. The RTAP National Program supports, among 
other initiatives, a National RTAP Resource Center, an Electronic 
Bulletin Board, regional outreach initiatives, and the development of 
training modules for use by rural transit operators. The RTAP National 
Program produces a wide range of initiatives for the elderly and 
individuals with disabilities living in rural areas.
    The National Easter Seal Society's Project ACTION (Accessible 
Community Transportation in Our Nation) is a $2 million research and 
demonstration grant program. National and local organizations 
representing public transit operators, the transit industry, and 
persons with disabilities are involved with the development and 
demonstration grant program now in the final implementation phase. 
National and local organizations representing public transit operators, 
the transit industry, and persons with disabilities are involved with 
the development and demonstration of workable approaches to promote 
access to public transportation services for persons with disabilities. 
A large number of elderly persons with disabilities will benefit from 
this project. Project ACTION has identified the following six priority 
areas through a Request for Proposal process, has completed 57 projects 
in the six priority areas.
         1. Clarify disability problems in the community;
         2. Outreach and marketing strategies for people with 
        disabilities;
         3. Training programs for transit providers;
         4. Training programs for persons with disabilities;
         5. Technology to solve critical barriers to transportation and 
        accessibility; and
         6. Development of a Resource Center on Transit Access 
        Activity.
    Project ACTION also assists in the implementation of the Americans 
with Disabilities Act by investigating what training is necessary to 
sensitize transit drivers to the needs of people with various 
disabilities. Tie-down and securement difficulties, especially for the 
three-wheeled motorize wheelchairs, have been identified for research. 
Project ACTION has also targeted other model projects to be refined and 
replicated throughout the Country. Congress mandated an additional $2 
million per year to continue this program for the next 3 years.
          research and special programs administration (rspa)
    Several schools participating in the Department of Transportation 
University Transportation Centers Program are conducting research that 
relate to improving mobility of older Americans. Title and summaries of 
the most relevant projects are as follows:
    Accommodating the Elderly to Accellerative Forces in Transit 
Vehicles takes into consideration that public transportation vehicles 
must meet tight schedules. Boarding and exiting vehicles can pose 
significant risks to elderly persons, giving rise to the perception 
that public transit is hazardous, and thus reducing the frequency of 
usage. Large accelerative and decelerative forces are present in public 
transit vehicles, especially buses, shortly before and after stops. The 
elderly, because of decreased motor strength, motor coordination, 
sensory capabilities, and increased skeletal brittleness, are at far 
higher risk for serious injury than younger transit users in response 
to these forces. Possibly, the fear of this hazard deters many from 
taking full use of public transit. This project will measure the 
magnitude of accelerating forces in buses in a typical urban transit 
system during the boarding and exiting epochs. During these epochs, 
transit users who are manifestly old, will be observed during the times 
they are not seated, to correlate measured accelerative forces with the 
associated duration of exposure.
    Design of Communications Network to Support Mobile Health System 
was identified as a need in a study by the Mack-Blackwell 
Transportation Center. In that study concept of the integration of a 
mobile health system to deliver routine medical care to patients living 
in the rural areas was analyzed. The mobile health system was 
envisioned as hospital based and provided medical services, chronic and 
short term, acute care on an outpatient basis. For a mobile medical 
facility to operate effectively, the ability to transmit/receive 
patient information between doctors at the hospital and the medical 
personnel at the mobile unit is a requirement that must be addressed. A 
study is being conducted that will analyze the design of communication 
networks to support a mobil health system.
    A Feasibility Study for the Application of Advanced Public 
Transportation System Technology will study the use of advanced 
communications equipment in paratransit service. Specifically, the 
project will determine whether an investment in this technology is cost 
effective. The project will also involve a study of the state-of-the-
art in current communications and automatic vehicle location AVL 
technology that would be appropriate for paratransit operations, 
develop a test methodology and protocol, undertake pilot and field 
tests to measure the changes in service as a result of the use of 
communications technology, do post test analysis, and document the 
results for managers to make decisions on the implementation of this 
technology for regular operations.
    Development of Transportable Wheelchair Standard is an important 
objective because providing occupant protection for persons seated in 
wheelchairs during travel in motor vehicles is a system problem that 
involves the wheelchair securement equipment, the occupant restraints, 
the wheelchair, the occupant, and the vehicle. Failure to adequately 
deal with and consider each of these system components can result in 
ineffective occupant protection. A study is underway that will develop 
a standard on ``Wheelchairs and Transportation'' that will provide 
general design guidelines and will specify test conditions and 
performance requirements for wheelchairs that can be considered to 
offer safe and effective seating to occupants of motor vehicles.
    Optimum Size of an Effective and Efficient Transit Agency in Rural 
or Non-Metropolitan Areas is important because one of the principal 
customer groups for rural transit services is elderly rural residents. 
Providing transit services in the most cost-effective manner while 
increasing the quantity and improving the quality of service is a long-
term goal of the U.S. Department of Transportation and the Department 
of Health and Human Services. Several studies have attempted to measure 
the effectiveness and efficiency of transit agencies. However, no 
studies have indicated the optimum size a transit system should be in 
order to operate in the most cost-efficient and effective manner within 
the rural and non-metropolitan regions. A study is underway that will 
investigate the optimum size a rural or non-metropolitan transit system 
should reach in order to maximize efficiency and effectiveness.
    Paratransit and Land Use: Facility Siting Considerations will use 
10 to 15 local-area (e.g., city or county) case studies to describe the 
types of facilities that are major attractors and producers of 
paratransit trips and to describe the types of transportation services 
provided to the clients of these facilities. The decisionmaking process 
for the location of these facilities will also be described. These 
facilities include sheltered workshops, congregate dining facilities, 
and senior centers, among others. Often these types of facilities are 
located without regard to the service areas and patterns of local 
transit and paratransit services, which can result in poor public 
transportation service to the facilities and/or substantially increased 
costs for the providers of service. When facilities are located in 
areas easily served by paratransit or on existing transit routes, and 
when complementary facilities and services are located next to each 
other so that one trip can meet more than one need, the efficiency of 
public transportation services is increased. This study will develop a 
classification methodology for these types of facilities that will 
describe their relative dependence on paratransit services and the 
relative impacts of transportation considerations on their location 
decisions.
    Potential for Advance in-Vehicle Systems to Increase the Mobility 
of Elderly Drivers will assess the feasibility of applying advanced in-
vehicle information and warning devices for increasing the mobility of 
the elderly. Such devices have the potential, if specifically designed 
to enhance the weaknesses of the elderly driver, to allow the elderly 
to drive more efficiently, comfortable, and safely for a longer period 
of time. The criticality of exploring methods to maintain the mobility 
of older drivers cannot be over emphasized, particularly given the 
changing demographics of the population in the United States. The 
elderly populations of the United States could benefit greatly from the 
development of such systems.
    The Role of Transportation in Service Access for Rural Elderly is 
the title of a study that focuses on improving transportation access to 
health services in rural areas. The project will provide the knowledge 
base to examine this conclusion and suggest methods for improving 
health care access for rural elderly within the state of Arkansas. The 
rural nature of the State of Arkansas combined with the relatively high 
numbers of elderly within the State, present a special challenge in the 
provision of health care and other formal services essential in the 
maintenance of personal independence. At 15 percent, the percentage of 
the population over the age of 65 years is higher than the 12.2 percent 
national average. A majority of the elderly of the State live in rural 
counties where transportation limitations hinder their access to 
medical and other needed services.
    Transportation and the Elderly: Coping with Loss of Mobility is an 
important study because the population of elderly people in the United 
States is growing, and most of this growth is occurring in suburban 
areas. Because private automobiles are the number one source of 
transportation for the suburban elderly, it is important to understand 
the effects of mobility restrictions when they face the loss of access 
to private automobiles. The main objective of a study entitled is to 
examine the process of adaptation that occurs during the transition 
from autonomy through private automobile use to dependency on public 
transit and other sources of transportation. Although planners and 
designers have focused on issues concerning the elderly for some time, 
the psychological adaptation process to mobility loss is important yet 
little studied.

                       Information Dissemination

                    federal railroad administration
    Information about Amtrak special services and accessible stations 
is available to senior citizens and passengers with disabilities in a 
brochure entitled ``Amtrak Travel Planner'' which can be obtained in 
stations, local sales offices, and through travel agencies. Amtrak also 
works directly with a number of organizations each year on large 
special moves of passengers needing assistance.
             national highway traffic safety administration
    In 1993, NHTSA completed production on a video ``Walking Through 
the Years.'' The video illustrates the problems facing older 
pedestrians and presents safety advice for preventing pedestrian 
crashes. The American Automobile Association has adapted ``Walking 
Through the Years'' materials as a program to help older adults 
recognize pedestrian hazards and safer walking behaviors. They have 
agreed to market a flyer, brochure and scripted slide presentation 
through its network of 1,000 clubs. To ensure that this effective 
material reaches the widest audience possible, the video presentation 
is being distributed through the National Safety Council.
    In an effort to address the elderly pedestrian problem in the 
Hispanic communities, NHTSA is preparing an Hispanic version of 
``Walking Through the Years.'' A focus group will assist in the 
translation of the program, with attention given to distinct cultural 
factors that may affect Hispanic behavior.
    NHTSA and FHWA recently revised the ``Walk Alert Manual,'' a 
national pedestrian safety concept. Special attention is given to 
elderly pedestrian issues in this program. A marketing plan, centered 
around the ``Walk Alert'' concept, is being developed to increase 
community leaders' awareness of pedestrian safety issues and problems.
              research and special programs administration
    Because of continuing interest in State and local governments and 
throughout the transportation community, the following products dealing 
with mobility of the elderly were distributed through RSPA's Technology 
Sharing program.
    Improving Bus Accessibility.--RSPA and the Federal Transit 
Administration (FTA) cooperated in distributing the report ``Improving 
Bus Accessibility Systems for Persons with Sensory and Cognitive 
Impairments.'' This study, conducted by the Transportation Research 
Institute of Oregon State University, focused on meeting the 
transportation needs of the visually-impaired, the hearing-impaired, 
and cognitive problems resulting from age, heredity, or injury.
    Vehicle Emergency Response.--RSPA and FTA cooperated in 
distributing the report ``Evacuating Elderly and Disabled Passengers 
from Public Transportation Vehicle Emergencies'' (DOT-T-94-16). This 
training package, developed by Senior Services of Snohomish County 
under FTA funding, is a detailed overview of evacuation techniques 
which can be used to extricate people with mobility limitations from 
transit vehicles involved in breakdown, accident, or fire situations.
    Advance Public Transportation Systems (APTS).--Applications of 
advanced electronics and computer technology to bus routing, 
scheduling, and operations hold the promise of making transit easier 
for a variety of groups, including the elderly, to use. RSPA and FTA 
collaborated on making the following products on the potential of the 
technology available to the transit industry and transportation 
decision-makers:
          ``Advanced Public Transportation Systems: The State of Art, 
        Update'' '94 (DOT-T-94-09)
          ``Advanced Public Transportation Systems: Evaluation 
        Guidelines'' (DOT-T-94-10)
          ``Advanced Vehicle Monitoring and Communication Systems for 
        Bus Transit: Benefits and Economic Feasibility'' (DOT-T-94-03)
    Telecommuniting Programs.--Although the link between telecommuting 
activities and the elderly has not been highlighted, the availability 
of telecommuting programs will enable many of the elderly to continue 
productive lives by working at home connected to their workplace 
electronically. RSPA and the Office of the Secretary issued the 
following two publications describing the potential of the technology:
          Orientation to Telecommuting
          Implementing Telecommuting

                  ITEM 13. DEPARTMENT OF THE TREASURY

       Treasury Activities in Fiscal Year 1994 Affecting the Aged

    The Treasury Department recognizes the importance and the special 
concerns of older Americans, a group that will comprise an increasing 
proportion of the population in decades ahead.
    The Secretary of the Treasury is Managing Trustee of the social 
security trust funds. The short- and long-run financial status of these 
trust funds is presented in annual reports issued by the Trustees. The 
1994 reports concluded that combined Old-Age and Survivors Insurance 
and Disability Insurance (OASDI) benefits can be paid on time well into 
the next century. Legislation enacted in 1994 resolved the impending 
exhaustion of the DI Trust Fund. As reflected in the past several 
reports, the financial outlook for Medicare, in particular Hospital 
Insurance (HI), will become troublesome shortly after the turn of the 
century. Although legislation enacted in 1993 has provided additional 
breathing space for the HI Trust Fund, further action may be required 
before the end of the century. During 1994, the OASDI cost-of-living 
increase was 2.6 percent. The taxable base for OASDI was increased to 
$60,600 for 1994 and the HI taxable base was changed to include all 
earnings. The amount a 65- to 69-year-old beneficiary could earn before 
his or her OASDI benefits were reduced was $11,160 per year.
    With respect to the personal income tax, in 1994 the width of the 
income tax brackets and the sizes of personal exemptions and of the 
standard deductions were increased by approximately 3.1 percent to 
reflect the effects of inflation which occurred during the preceding 
year. The personal exemption increased by $100 to $2,450 for each 
taxpayer and dependent.
    Taxpayers aged 65 or over (and taxpayers who are blind) are 
entitled to larger standard deductions than other taxpayers. For 1994, 
each taxpayer who is single and who is at least 65 years old is 
entitled to an extra $950 standard deduction. Each married taxpayer 
aged 65 or over is entitled to an extra $750 so that a married couple, 
both of whom are over age 65, are entitled to an extra $1,500. 
Including these extra standard deduction amounts and the basic standard 
deduction amounts, taxpayers over age 65 are entitled to the following 
standard deductions for tax year 1994: $4,750 for a ``single'' 
taxpayer; $6,550 for a taxpayer entitled to claim ``unmarried head of 
household'' status; $7,100 for a married couple filing a joint tax 
return, only one of whom is 65 or older; and $7,850 for a married 
couple filing jointly if both are age 65 or older. The corresponding 
amounts for tax year 1993 were: $4,600 for a ``single'' taxpayer; 
$6,350 for a taxpayer entitled to claim ``unmarried head of household'' 
status; $6,900 for a married couple filing a joint tax return, only one 
of whom was 65 or older; and $7,600 for a married couple filing jointly 
if both were age 65 or older.
    Two other special provisions for the elderly continue: the tax 
credit for the elderly (and permanently disabled); and the one-time 
exclusion of the first $125,000 of profit from the sale of the personal 
residence of a taxpayer age 55 or older.
    As the result of the Omnibus Reconciliation Act of 1993 (OBRA 
1993), the taxation of social security benefits and the portion of Tier 
1 of Railroad Retirement benefits treated as social security benefits 
changes for 1994. Prior to 1994, taxpayers with Modified Adjusted Gross 
Income (AGI) exceeding threshold amounts were required to include in 
AGI the lesser of 50 percent of social security benefits or 50 percent 
of the amount by which Modified AGI exceeded the threshold. Modified 
AGI is the sum of items of income included in AGI (except any 
includable social security benefits) plus tax-exempt state and local 
bond interest plus one-half of social security benefits. The Modified 
AGI threshold was $25,000 for single taxpayers and $32,000 for married 
taxpayers filing joint returns. Taxpayers with Modified AGI below these 
thresholds do not pay taxes on any of their social security benefits. 
For 1994 and future years, a second Modified AGI threshold was added: 
$34,000 for single taxpayers and $44,000 for married taxpayers filing 
joint returns. Fro those with Modified AGI below these new, secondary 
thresholds, the taxation of social security benefits did not change at 
all. Beginning in 1994, taxpayers with Modified AGI over the secondary 
threshold are required to include in AGI the lesser of 85 percent of 
social security benefits or the sum of $4,500 ($6,000 on a joint 
return) and 85 percent of the amount by which Modified AGI exceeds the 
secondary threshold. All of the revenue from the additional taxation of 
social security benefits is allocated to the Hospital Insurance (HI) 
trust fund.
         internal revenue service activities affecting the aged
    The Internal Revenue Service (IRS) recognizes the importance and 
special concerns of older Americans, a group that will comprise an 
increasing proportion of the population in the years ahead. Major 
programs and initiatives of the Office of the Assistant Commissioner 
(Taxpayer Services) and the Office of Strategic Planning and 
Communications that are of interest to older Americans and to others 
are described below.
    The following publications, revised on an annual basis, are 
directed to older Americans:
          Publication 523, Selling Your Home, sets forth the rules 
        regarding the once in a lifetime exclusion of $125,000 of the 
        gain on the sale of a personal residence of a person 55 years 
        of age or older.
          Publication 524, Credit for the Elderly or the Disabled, 
        explains that individuals 65 and older may be able to take the 
        Credit for the Elderly or Disabled, reducing taxes owed. In 
        addition, individuals under 65 who retire with a permanent and 
        total disability and receive taxable disability income from a 
        public or private employer because of that disability may be 
        eligible for the credit.
          Publication 554, Tax Information for Older Americans, 
        explains that single taxpayers aged 65 or older are generally 
        not required to file a federal income tax return unless their 
        gross income for 1994 is $7,200 or more (as compared to $6,250 
        for single taxpayers under age 65). Married taxpayers who can 
        file a joint return are generally not required to file unless 
        their joint gross income for 1994 is $12,000 or more if one of 
        the spouses is 65 or over, or $12,750 if both spouses are 65 or 
        older.
          Publication 721, Tax Guide to U.S. Civil Service Retirement 
        Benefits, and Publication 575, Pension and Annuity Income, 
        provide information on the tax treatment of retirement income.
          Publication 907, Tax Highlights for Persons with 
        Disabilities, covers tax issues of particular interest to 
        persons with handicaps or disabilities and to taxpayers with 
        disabled dependents.
          Publication 915, Social Security Benefits and Equivalent 
        Railroad Retirement Benefits, assists taxpayers in determining 
        the taxability, if any, of benefits received from Social 
        Security and Tier I Railroad Retirement.
    All publications are available free of charge. They can be obtained 
by using the order forms found in the tax forms packages or by calling 
1-800-TAX-FORM (1-800-829-3676). Many libraries, banks and post offices 
stock the most frequently requested forms, schedules, instructions and 
publications for taxpayers to pick up. Also, many libraries stock a 
reference set of IRS publications and a set of reproducible tax forms.
    Most forms and some publications are on CD-ROM, available in some 
larger libraries and on sale to the general public through the 
Government Printing Office's Superintendent of Documents. Information 
about ordering can be obtained by calling (202) 512-1800. Also, most 
forms and some publications may be downloaded through the FedWorld 
electronic bulletin board system. FedWorld can be reached by modem 
(dial-up) at (703) 321-8020, or by Internet (Telnet to fedworld.gov 
(192.239.93.3)).
    Outreach and taxpayer education programs include:
    The Tax Counseling for the Elderly (TCE) Program, which provides 
free tax assistance to persons 60 and older. The IRS enters into 
cooperative agreements with public and private nonprofit organizations 
(sponsors) whose members will be trained by IRS to act as volunteer tax 
assistors at selected sites identified by the sponsors. Sponsors also 
now have the option to operate telephone answering sites to assist the 
elderly with tax questions, help with forms, or schedule appointments. 
IRS assistance to older Americans through the TCE program has been 
growing since the program began in 1980. Some 35,000 volunteers helped 
1.6 million persons during the past filing period.
    The Volunteer Income Tax Assistance (VITA) Program provides tax 
assistance to targeted groups including low income persons, non-English 
speaking persons, and the elderly. The IRS trains volunteers who offer 
their services to taxpayers needing assistance. This service is free 
and many VITA volunteers also help the elderly in preparing their State 
and local returns and answering their questions. In addition, 
volunteers helped elderly taxpayers compute their estimated tax for the 
current tax year. The training that is available was developed in 
response to a study that included evaluations by educational 
authorities and surveys of volunteers and IRS employees involved in 
VITA and TCE. In fiscal year 1994, over 51,000 volunteers assisted over 
1.5 million taxpayers through the VITA Program.
    The Small Business Tax Education (STEP) Program provides 
information about business taxes and the responsibilities of operating 
a small business. Through a partnership between IRS and over 1,600 
community colleges, universities, and business associations, small 
business owners and other self-employed persons have an opportunity to 
learn what they need to know about business taxes. Assistance is 
offered at convenient community locations and times. Many elderly 
persons, such as those beginning second careers, avail themselves of 
this program.
    As part of the Banks, Post Offices, and Libraries (BPOL) Programs, 
the IRS supplies 12,000 libraries with free tax aids such as 
reproducible tax forms, reference publications, and audio-visual 
materials that can assist older Americans in preparing Forms 1040EZ, 
1040A, 1040 and related schedules. Also, banks and post offices 
distribute the Form 1040 family and other forms.
    The Community Outreach Tax Education Program provides individuals 
with group income tax return preparation assistance and tax education 
seminars. IRS employees and trained volunteers conduct these seminars, 
which address a variety of topics. They are tailored for groups and 
individuals with common tax interests, such as groups of older 
Americans. These seminars are conducted at convenient community 
locations.
    The 1990 tax year was the first year older Americans could use the 
expanded Form 1040A to report income from pensions and annuities, as 
well as other items applicable to older Americans such as estimated tax 
payments and the credit for the elderly or the disabled. More than half 
of the potential filing population eligible to use this simpler, 
shorter form rather than the much longer Form 1040 made the switch.
    Responding to requests from the public for such a product, the Tax 
Forms and Publications Division developed large-print versions of the 
Form 1040 and Form 1040A packages earmarked for older Americans. These 
packages (designated as Publications 1614 and 1615, respectively) are 
newspaper-size and contain both the instructions and the forms (for use 
only as worksheets, with the amounts to be transferred to regular-size 
forms for filing).
    The Tax Forms and Publications Division reviews Protecting Older 
Americans Against Overpayment of Income Taxes, a publication from the 
Senate Special Committee on Aging.
              other treasury activities affecting the aged
    Other agencies of the Treasury also have an impact on the elderly 
as part of their specific functions. Developments during 1994 are 
summarized below.
                      financial management service
    The Financial Management Service makes over 600 million Social 
Security, Supplemental Security Income, and Veteran payments annually. 
Nearly half of these payments are made via paper checks, which are 
mailed. There are certain vulnerabilities associated with checks, such 
as the possibility of forgery, theft and loss. We have several 
initiatives which will significantly improve the certainty of the 
payments reaching the intended recipients on a timely basis, and 
improves the ability of recipients to use those payments safely and 
conveniently.
    FMS continues to support the development of a nationwide program to 
make Electronic Benefit Transfer (EBT) a viable payment mechanism. 
Geared toward those individuals without a bank account or who choose 
not to use Direct Deposit, EBT is an electronic benefit delivery 
mechanism that enables recipients to use plastic debt cards to access 
their benefits at automated teller machines or point-of-sale terminals. 
There are currently 8 operating projects delivering State benefits 
(e.g., Food Stamps, Aid to Families with Dependent Children, and 
General Assistance) and 1 project in Texas delivering direct Federal 
benefits (e.g., Social Security and Supplemental Security Income). 
Twenty-eight other States are currently planning an EBT project or 
investigating the possibility of using EBT.
    The direct Federal pilot project, begun in April 1992, in the 
Houston, Texas, areas, was extended to Dallas/Fort Worth in November 
1993, and is ready to be implemented on a statewide basis. The pilot is 
targeted to recipients who receive their monthly benefit by check. 
Currently, over 8,500 recipients of Social Security, Supplemental 
Social Security Income, Railroad Retirement, Civil Service Retirement, 
and Veteran's Pension and Compensation use an EBT card to receive their 
benefits.
    FMS also provides direct support as one of the key agencies active 
in the Federal EBT Task Force, including the Office of Management and 
Budget and the Departments of Agriculture and Health and Human 
Services, to create a nationwide integrated Federal/State EBT program. 
FMS is currently working with the EBT Task Force and seven southern 
States to design and implement an integrated Federal/State EBT system. 
FMS is also preparing to acquire Federal and State EBT services 
nationwide. The objective is to have nationwide EBT for Federal and 
State benefits by 1999.
                      u.s. savings bonds division
    During Fiscal Year 1994 the U.S. Savings Bonds Division continued 
to provide information about Bonds to the public, including older 
Americans. The Division recognized the importance of maturing Series E 
Savings Bonds for older Americans by producing information bank 
leaflets, publicity, and public service advertising promoting the 
exchange privileges for Series HH Savings Bonds. Series HH Bonds allow 
the accrued interest of Series E and EE Savings Bonds to be tax-
deferred for up to an additional 20 years while earning interest that 
is treated as current income for the owner.
    Public service advertising incorporated closed captioning for the 
hearing impaired and promotional print materials will be designed to be 
enlarged for the visually impaired.
    With respect to the education tax benefits of Savings Bonds used to 
pay for higher education tuition and fees at qualifying institutions, 
older Americans were informed of ways to purchase Bonds for the benefit 
of their adult child's or grandchildren's college education.
    The Division continued to promote the sale and retention of Savings 
Bonds to the public, including older Americans, through news media, 
financial institutions, employers and major national organizations.
                       bureau of the public debt
    The Bureau of the Public Debt continued to make improvements in 
programs to better serve all investors. The Bureau's efforts to 
streamline and simplify access to Treasury securities are of particular 
benefit to elderly investors.

                           Savings Securities

    Customer Service.--In compliance with Executive Order 12862, dated 
September 11, 1993, setting customer service standards, we are taking 
steps to formalize and enhance our existing commitment to customer 
satisfaction. The elderly compose a very important part of our customer 
base, making up an estimated 28 percent of the nearly 11 million 
Americans who purchase savings bonds each year. In addition, persons 
over the age of 55 represent 48 percent of adults owning savings bonds 
worth more than $10,000. Consequently, our efforts to improve service 
to our customers will undoubtedly have a positive effect on many older 
people. We have established standards to ensure the timely delivery of 
savings bonds, the accuracy of inscribed bonds, and courtesy extended 
to our customers. In addition, we continually modify internal processes 
to improve efficiency and simplify the purchasing procedure. Finally, 
we actively promote savings bonds as an investment for retirement 
through advertisement and informative brochures.
    Matured Bonds.--We have two programs that provide better service to 
owners of current income bonds. The first involves contacting owners of 
current income bonds, many of them elderly, whose bonds have matured. 
We advise owners of bonds that are no longer earning interest to redeem 
or reinvest them. The second initiative consists of a new automated 
telephone system. It expedites business by allowing a caller to speak 
directly to a customer service representative rather than leaving a 
message and waiting for a return call.
    Automated Clearing House.--Owners of all current income bonds may 
have their semi-annual interest payments deposited immediately to their 
bank accounts. The Automated Clearing House (AC) method eliminates any 
worry about lost, stolen, or delayed interest checks, provides 
assurance that the money is on deposit and available to use on the 
payment date, and eliminates the item and expense of special trips to 
deposit interest checks. We now make nearly half of all such interest 
payments through ACH.
    Public Information.--Our Division of Transactions and Rulings has 
the most contact with the public and, therefore, the elderly. It tries 
to write its forms and letters to be easily read and understood by 
persons of all ages. It gives special attention to those having 
difficulty understanding by amending forms as much as possible and 
writing clearly.

                         Marketable Securities

    Book-Entry Conversion.--Public Debt continues to encourage owners 
of registered and bearer securities to convert these paper certificates 
to book-entry form. Holding Treasury securities in book-entry form 
provides a much safer and more convenient method than holding them in 
definitive form. The maintenance of book-entry accounts is more cost 
effective for the Federal Government and therefore the taxpayer.
    Public Debt's Smart Exchange program is an excellent way for 
investors to hear about, and convert to, book-entry holdings. The Smart 
Exchange begins with a mailer, included with interest payments made by 
check to holders of paper certificates. The mailer suggests the 
investor call the 1-800 number to talk with a Bureau representative 
about the advantages of converting to book-entry. Specific information 
regarding the streamlined procedures for converting are shared with the 
investor and needed materials are sent quickly.
    Since April 10, 1992, more than 10,000 investors have called about 
Smart Exchange, with conversions exceeding 30 percent.
    Consumer Information Center.--Public Debt makes two brochures 
available through the Consumer Information Center in Pueblo, Colorado.
          Buying Treasury Securities provides basic information on 
        purchasing marketable securities.
          Make the Smart Exchange informs interested investors about 
        converting their marketable Treasury securities held in 
        definitive form to book-entry accounts in the Treasury Direct 
        system.
               office of the comptroller of the currency
    During 1994, the Office of the Comptroller of the Currency (OCC) 
continued its active liaison with national organizations representing 
bank customers, including the American Association of Retired Persons, 
to share information about banking-related issues. Comptroller Eugene 
Ludwig met monthly with representatives from these national 
organizations at informal meetings held at the OCC. The Comptroller met 
with local consumer and community representatives from each of the 
OCC's six districts. The purpose of the meetings was to share 
information about affordable housing for low- and moderate-income and 
elderly persons and families, community development lending, and small 
business and economic development. These meetings were held in Dallas, 
Omaha, Salt Lake City, Chicago, San Francisco and Atlanta.
    OCC district offices continued their outreach programs for purposes 
of contacting and meeting with local consumer and community groups to 
share information about banking-related issues. Organizations 
representing the elderly were among those contacted. The OCC also 
distributed 7 banking issuances to over 1,400 consumer and community 
groups throughout the United States including those representing the 
elderly.
    Throughout the year, the OCC provided copies of its publications, 
including its quarterly newsletter Community Developments to national 
banks, bank trade associations and bank customer groups, including 
those representing the elderly. Affordable housing for all citizens, 
including the elderly, continues to be an issue voiced by consumer and 
community groups in meeting with the OCC. The publications provided by 
the OCC provide guidance to bankers on innovative programs banks can 
utilize in partnership with community organizations, as well as 
federal, state and local governments, to finance low- and moderate-
income housing and other community economic development programs. The 
objective of these programs is to increase the affordable housing and 
economic opportunities for low- and moderate-income persons, including 
the elderly.
    The OCC also is responsible for resolving complaints against 
national banks. Through the first 11 months of 1994, the OCC received 
14,884 written complaints. Older Americans seek OCC's assistance in 
resolving problems with their bank.
                             secret service
    The Secret Service continued to protect elderly recipients of 
Government payments. During Fiscal Year 1994, the Secret Service closed 
16,108 Social Security check investigations. In addition, the Secret 
Service closed 1,976 check investigations involving Veterans' benefits, 
408 involving Railroad Management checks and 931 involving Office of 
Personnel Management checks. The majority of these checks were issued 
to retirees.
    The Secret Service also conducted 1,757 investigations involving 
attempts by individuals to illegally divert funds during the direct 
deposit/electronic funds transfer process. Elderly Americans have been 
encouraged to utilize the electronic transfer process as a matter of 
convenience and as a safeguard against the loss of funds.
                    bureau of engraving and printing
    The Bureau of Engraving and Printing (BEP) continued to recognize 
the special needs of aging citizens during 1994.
    Bureau of Engraving and Printing Tour.--The BEP Tour is one of the 
Treasury Reinvention Laboratories. The implementation of this 
laboratory will include several changes to make the Tour more customer 
friendly, which will help Seniors as well as the other tourists that 
visit the Bureau. Some of the changes include: (1) a sidewalk along the 
building so the seniors will no longer walk on the alleyway road; (2) 
better signage that will direct the visitors along the tour and how to 
return to the buses; (3) more and improved exhibits that explain the 
Bureau's mission; (4) a canopy over the pathway from 15th Street to 
14th Street to protect visitors from the inclement weather and the heat 
of the summer; (5) better ventilation on the tour; (6) opening up 
narrow walkways so the areas will be less confining; (7) allowing fewer 
people through the tour each 15 minute period to make it more 
comfortable and less crowded for each group going through; and (8) 
providing guides for each group going through the tour and eliminating 
self-guided tours.
    The operation of the BEP tour is managed by an ``8a'' firm, a 
minority-owned business under the SBA 8(a) program, which employs 
retired individuals as tour guides.
    The Bureau provides CPR training on an ongoing basis to its tour, 
medical, and police units in the event that an emergency should occur.
    The Bureau has wheelchairs available for senior citizens touring 
the facility, as well as tour guides trained to assist senior citizens 
with special needs.
    The Bureau has ramps, wide entrances, and restrooms designed to 
accommodate persons using wheelchairs or walkers.
    Programs for Bureau Employees.--The Bureau periodically conducts a 
Pre-retirement Program for employees 50 years of age and over. The 
program, also available to spouses, emphasizes the importance of 
planning for retirement in advance. It is offered to employees who are 
planning to retire within the next 5 years, and covers areas such as 
calculation of benefits, financial planning, discovering hidden 
talents, legal affairs, relationships and health.
    Other Assistance.--The Office of Equal Employment Opportunity and 
Employee Counseling Services works with older employees who have 
experienced problems with housing, finance, health, or energy 
conservation requirements. The Office also provides assistance to 
employees who are part of the ``sandwich'' generation, who are 
responsible for providing care for both older and younger generations. 
In addition to providing for their children, they often are the primary 
caregivers for elderly parents or relatives who must have adult day 
care or require nursing home placement. The Office also maintains 
information on referral services available to older employees or to 
employees who are providing for older parents or relatives.
    The Bureau's on-site medical staff provides life-style counseling 
for employees who are senior citizens. The emphasis is on wellness and 
prevention of disease, and include advice on nutrition and weight 
control, testing of blood pressure and cholesterol levels, and 
examination of possible vision and hearing deficiencies.
    An assessment of our facilities, including the tour areas, has been 
completed in accordance with the Americans with Disabilities Act (ADA), 
and we will be incorporating recommended modifications.
    The BEP is contracting with the National Academy of Sciences to 
conduct a study, with the cooperation of the American Counsel for the 
Blind, to determine ways to assist the blind and partially sighted with 
handling currency.
                          u.s. customs service
    The U.S. Customs Service does not specifically target any group of 
individuals, including the aged, for expedited Customs processing. 
However, the aged are included among those who are entitled to request 
special treatment when they arrive from abroad. This group not only 
includes the elderly, but also persons who are handicapped or ill and 
are unable to wait in line, persons returning home for emergency 
reasons such as a death in the family, and a parent arriving with 
several infants. Travelers meeting any of the aforementioned criteria 
may request to speak with a Customs supervisor as soon as he or she 
arrives in the Customs processing area of the airport or other Customs 
port of entry. The supervisor will provide all possible assistance 
within his or her means to facilitate the traveler's Customs clearance 
without compromising Customs enforcement responsibilities.
    In addition, Customs works with government and private architects 
to ensure that federal inspection facilities, including restrooms, 
permit the unrestricted movement of those individuals who must rely on 
a wheelchair or walker.
    The U.S. Customs Service places a high priority on professionalism 
and the courteous treatment of travelers. Our policy of professional 
pride, image, and attitude is not only limited to our treatment of the 
elderly, but to all travelers to this country.
                               u.s. mint
    The U.S. Mint continues to consider the special needs and concerns 
of senior citizens in it programs and services.
    Special accommodations for elderly visitors are available at the 
Philadelphia Mint, Denver Mint, and San Francisco Old Mint Museum which 
offer public tour programs. Most significant of these services during 
Fiscal Year 1994 was the continuing improved accessibility project at 
the Denver Mint. The second phase of this project includes 
accessibility for physically challenged visitors via a motorized chair 
lift to the Sales & Exhibit Center from the sidewalk along one side of 
the building. We expect to have this phase of the project completed by 
February 1995.
                bureau of alcohol, tobacco and firearms
    The Bureau of Alcohol, Tobacco and Firearms (ATF) began a program 
called Project Outreach in May 1990. This is a public awareness program 
which informs citizens of the growing threat of street gang violence. 
The information is presented to civic groups as well as local community 
anti-drug educational organizations.
    The American Association of Retired Persons (AARP) has been used by 
Compliance Operations of ATF to fill clerical positions in areas 
offices in the past. Currently, Compliance Operations is consulting 
with AARP to determine if they can supply us with people to perform 
clerical tasks in the Technical Services in Cincinnati. We continue to 
urge our various offices to explore these and other possibilities to 
fill needed positions.
    Program for Employees.--ATF supports its Health Improvement Program 
and encourages persons of all ages, especially those over 50 years of 
age, to participate frequently.
    ATF offers pre-retirement seminars to all of its employees who are 
eligible to retire within 5 years or less. These seminars cover 
financial planning, retirement benefits, and health and legal affairs.
    ATF has an ongoing Employee Assistance Program and encourages 
elderly employees to seek help in any area where they feel there is a 
need.
    Under the Quality of Worklife Program, ATF is developing an 
Eldercare program to provide information, counseling, and support to 
elder employees and employees with older relatives.

                  ITEM 14. COMMISSION ON CIVIL RIGHTS

    During FY 1994, the Commission continued to process complaints 
received from individuals alleging denials of their civil rights. 
Specifically, 33 complaints alleging discrimination on the basis of age 
were received by the Commission and referred to the appropriate agency 
for resolution.

              ITEM 15. CONSUMER PRODUCT SAFETY COMMISSION

       Report on Activities to Improve Safety for Older Consumers

    Each year, according to estimates by the U.S. Consumer Product 
Safety Commission (CPSC), nearly 1 million people over age 65 are 
treated in hospital emergency rooms for injuries associated with 
products they live with and use everyday. The death rate for older 
people is approximately five times that of the younger population for 
unintentional injuries involving consumer products, including motor 
vehicles. Specifically, there are 60 deaths per 100,000 persons 65 and 
older, while there are about 12 deaths per 100,000 persons under 65.
    Slips and falls are the main source of injury for older people in 
the home. Older consumers can slip in the bathroom, especially in the 
bathtub. Falls can happen on stairs, stepstools, and floors with loose 
carpets. When older people fall, their risk of serious injury or death 
is much higher than that of the general population. CPSC recommends the 
use of grabbars and non-slip mats by the bathtub; handrails on both 
sides of the stairs; and slip-resistant carpets and rugs.
    Burns occur from hot tap water and from open flame fires in the 
home and are an important source of injury to older Americans. CPSC 
recommends the installation and maintenance of smoke detectors on every 
floor of the home. Older consumers should look for nightwear that would 
resist flames, such as a heavy weight fabric, tightly woven fabrics 
such as polyester, modacrylics, or wood. CPSC also recommends that 
consumers turn down the temperature of their water heater to 120 
degrees Fahrenheit to help prevent scalds.
    As part of the Home Electrical System Fires project, CPSC is 
conducting studies to investigate new technology to address electrical 
wiring fires in older homes, and to identify less destructive and 
costly means of updating the wiring. This is particularly important to 
the elderly since they often live in the older homes.
    CPSC is also looking to new technology to address range cooking 
fires. Studies are being conducted to develop technology to sense fire 
conditions and shut the burner or oven off. Older consumers are often 
involved in kitchen fires when they forget food is on the range.
    CPSC is investigating fires involving both upholstered furniture, 
and mattresses and bedding to determine how the fires start and the age 
of consumers involved. Older consumers are a part of the focus because 
they have a slowed response time. If the flammability of furniture and 
bedding is reduced, the elderly have a chance to react and get out.
    In 1994, CPSC distributed more than 60,000 copies of the ``Home 
Safety Checklist for Older Consumers'' (English and Spanish). The 
``Home Safety Checklist'' is a room-by-room check of the home, 
identifying hazards and recommending ways to avoid injury. Consumers 
may order a free copy by sending a postcard to ``Home Safety 
Checklist,'' CPSC, Washington, D.C. 20207.
    Another publication to which CPSC contributed is ``What Smart 
Shoppers Know About Nightwear Safety.'' This brochure was developed by 
a group of experts in apparel flammability and distributed by the 
American Association of Retired Persons (AARP). The brochure encourages 
older consumers to look for sleepwear that is flame resistant. 
Consumers may request a copy by sending a postcard to AARP, 601 E 
Street, N.W., Washington, D.C. 20049.
    The Chairman has invited manufacturers and retailers of nightwear 
for older consumers to come to the CPSC to discuss the flammability 
hazard with nightwear. Elderly consumers have been involved in a number 
of incidents in which loose fitting, long hanging nightwear has caught 
fire while the consumer was cooking. The Chairman is holding this 
meeting in order to explore ways with industry to address the hazard.
    Older consumers are involved in the childhood poisoning issue 
because many young children are poisoned when they swallow 
grandparents' medicine. In October 1990, the Commission proposed 
changing the test protocol for child-resistant packages under the 
Poison Prevention Packaging Act to make it easier for all adults to use 
child-resistant packages. CPSC has data estimating that the widespread 
use of child-resistant closures on aspirin and oral prescription 
medicines saved the lives of at least 700 children under age 5 since 
1972. However, many adults (particularly older consumers) do not use 
child-resistant packaging because they find it physically difficult to 
use. To make it easier for all adults, especially older ones, to use 
child-resistant packaging, CPSC proposed to change the regulation by 
requiring that the adults on the test panel be 60 to 75 years of age 
rather than 18 to 45 years old. This is expected to increase the use of 
child-resistant packaging by all adults.
    In 1995, CPSC plans to decide whether to finalize these changes in 
the test protocol for child-resistant packaging. If made final, these 
changes will encourage industry to develop innovative closures that 
appeal to older people's ``cognitive skills'' instead of their physical 
strength. In addition, CPSC reminds all adults to keep medicines out of 
the reach of children who can be poisoned if they swallow medicines or 
household chemicals.
    Older consumers are the focus in the development of revised CPSC 
regulations for special packaging of prescription and nonprescription 
medicines and household chemical products. Older adults often find it 
difficult to open current child-resistant packaging and may not replace 
caps--thereby exposing young children to potential poisonings. The 
Commission is reviewing a final rule for Poison Prevention Packaging 
Act (PPPA) protocol revisions which specifically include older 
consumers in testing to determine if the elderly can open the packaging 
without young children opening it.
    In a new innovation this year the Chairman, Ann Brown, has given 
commendations to two companies for safety innovations. They are Procter 
and Gamble for senior friendly and child-resistant caps on mouthwash 
and to Sunbeam Plastics for an entire line of senior friendly and 
child-resistant closures.
    Finally, CPSC is currently working with the Food and Drug 
Administration (FDA), to issue a joint safety release on heating pads. 
CPSC receives reports of 6 to 10 deaths each year associated with 
heating pads; most of these deaths involve fires with victims over 65 
years of age. In addition, CPSC estimates that there are about 1,500 
injuries associated with heating pads treated each year in hospital 
emergency rooms; most of these injuries involve burns with an estimated 
40 percent of the victims over 65 years of age.

        ITEM 16. CORPORATION FOR NATIONAL AND COMMUNITY SERVICE

                     NATIONAL SENIOR SERVICE CORPS

    On September 21, 1993, the President signed into law the National 
and Community Service Trust Act, which created the Corporation for 
National and Community Service (Corporation). The Corporation's mission 
is to engage Americans of all ages and backgrounds in community-based 
service. This service addresses the Nation's unmet education, public 
safety, human and environmental needs to achieve direct and 
demonstrable results. This commitment to ``get things done'' is honored 
by the Corporation's three national service initiatives: National 
Senior Service Corps (NSSC), AmeriCorps, and Learn and Serve America.
    NSSC, also known as the Senior Corps, is comprised of three 
seasoned programs previously supported by the Federal agency ACTION: 
The Retired and Senior Volunteer Program (RSVP), the Foster Grandparent 
Program (FGP), and the Senior Companion Program (SCP).
    In 1994, the Senior Corps utilized the skills of half a million 
volunteers to fulfill the Corporation's mission. A sample of 
accomplishments follows.
                           human needs forum
    On April 20, 1994, the Senior Corps participated in an 
intergenerational event focused on independent living hosted by First 
Lady Hillary Clinton at the White House to honor outstanding service 
leaders and organizations.
    This event reflected the First Lady's commitment to health care 
reform and her support of the role that community-based organizations 
play in improving the quality of life for Americans. While this event 
placed particular emphasis on the Senior Companion Program's dedication 
to serving the frail elderly and enabling them to remain independent in 
their own homes, all three Senior Corps programs were showcased because 
of their ability to mobilize the vast resources of senior volunteers in 
support of independent living.
    Thirteen Senior Corps volunteers from around the country were 
selected to participate from over 30 nominees. Ranging in age from 65 
to 100 and representing a variety of backgrounds, these seniors have 
collectively contributed over 70 years of service through the Senior 
Corps to individuals and communities nationwide.
    Two of the thirteen volunteers gave brief presentations on the 
support they have provided to their peers over the years. For example, 
Senior Companion Alta Nuzman, 76, spoke of her 4-year commitment to the 
frail elderly and their independence. The remainder of volunteers were 
individually recognized for similar contributions.
                         summer of safety (sos)
    In June 1994, the Senior Corps launched the Senior Summer Corps 
(SSC) as part of the Corporation's Summer of Safety demonstration 
initiative. Twenty grants were awarded to the sponsors of 20 Senior 
Corps projects to develop flexible program models appropriate to 
specific local public safety problems. Over an 8-12 week period, SSC 
drew upon the accumulated life experience of 2,400 seniors in 
implementing and testing program models to reduce violence, drug abuse, 
fraud, vandalism, and the fear associated with these pervasive 
problems.
    For example, volunteers created neighborhood watch organizations, 
offered victim assistance, taught conflict resolution and established 
safe havens where children could play without fear. As of October, 2 
out of every 5 volunteer positions funded by SSC were sustained beyond 
the summer, an indication that grantees were able to transition their 
projects from demonstration to long-term initiatives.
     leadership roundtable: a vision for senior service in america
    On September 29 and 30, 1994, the Corporation participated with 
selected public and private organizations involved in the fields of 
aging and voluntarism to explore issues and areas for collaboration and 
partnership around senior service. Participating organizations 
included: the University of Maryland's Center of Aging, American 
Association of Retired Persons (AARP), Administration on Aging (AOA), 
Save Our Security, Public/Private Ventures, Johns Hopkins Health 
Institutes, the Retirement Research Foundation, Generations United and 
the National Directors Associations for FGP, SCP and RSVP, to name a 
few.
    Over this 2-day period, attendees discussed possible strategies for 
developing a senior service movement of substantial proportions and 
impact, one that would help communities and community-based 
organizations dramatically enhance the service opportunities currently 
available to older Americans. The Corporation expects to play a 
significant role in moving senior service to this next level of 
significance and is in the process of clarifying the roles of other key 
organizations and sectors. Future gatherings similar to the Roundtable 
have been tentatively arranged to continue the development of this 
service movement.
   national training institutes for leadership in senior voluntarism
    Four National Training Institutes for Leadership in Senior 
Voluntarism, co-sponsored with the University of Maryland, were held in 
Washington, DC; Atlanta, Georgia; Denver, Colorado; and Minneapolis, 
Minnesota. The Corporation sponsored 80 participants, including select 
project directors from FGP, SCP and RSVP, Corporation staff, State 
Commissions and Executive Directors of sponsoring organizations. The 
training was designed to develop a core set of leadership skills for 
current or potential leaders in community-based organizations having a 
mission in voluntarism and aging.

                  RETIRED AND SENIOR VOLUNTEER PROGRAM

    In fiscal year 1994, with a budget of $34.4 million, the Retired 
and Senior Volunteer Program (RSVP) completed its 23rd successful year. 
There were 746 Corporation funded projects and 445,500 volunteers 
assigned to 60,000 community agencies nationwide, providing over 80 
million hours of service. RSVP volunteers served in courts, schools, 
museums, libraries, hospices, hospitals, nursing homes and a wide range 
of other public and private nonprofit organizations. Volunteers serve 
without compensation, but may be reimbursed for, or provided with, 
transportation and other out-of-pocket expenses. All volunteers are 
covered by appropriate accident and liability insurance coverage.
    The RSVP continues to match its resources to the diverse needs of 
hundreds of American communities by providing increased and diversified 
opportunities for persons 55 years of age and older to serve on a 
regular basis in a variety of settings.
    RSVP, in partnership with the National Association of RSVP 
Directors, conducted a National Training Conference entitled 
``Experienced Partners in National Service.'' Almost 1,000 RSVP Project 
Directors and staff, Project Sponsor staff and Corporation staff 
attended the Conference at three decentralized locations. The core 
curriculum included sessions on the Corporation mission and priorities 
in relation to senior service, the new AmeriCorps programs, national 
societal trends resulting from the graying of America, thinking 
strategically and bringing the national senior service agenda home to 
local communities.
    A total of 19 projects received ``Programs of National Significance 
Awards'' totalling $103,000. These awards support on additional 545 
volunteers in 15 specific program areas. New areas include public 
safety, environment, apprenticeship programs and assistance to State 
and local governments.

                      Public/Private Partnerships

    A continuing effort to maximize partnerships with other public and 
private entities resulted in the following:
          The Environmental Alliance for Senior Involvement (EASI) was 
        formed by 15 Federal agencies and national organizations to 
        increase involvement of senior volunteers with local 
        environmental improvement efforts. RSVP, as the Nation's 
        largest senior volunteer network, was one of the lead programs 
        in the formulations of EASI, joining with the American 
        Association of Retired Persons, the Environmental Protection 
        Agency (EPA), and components of the Departments of Agriculture 
        and Interior. EASI sponsored its second national conference in 
        September 1994. As a result of funding provided by EPA, a 
        number of RSVP projects received small grants to initiate or 
        expand ground water protection efforts.
          Through the Intergenerational Alliance, RSVP extended 13 RSVP 
        projects participating in inter-generational activities with 
        local youth service agencies. A grant to Generations United was 
        awarded to provide training and technical assistance to those 
        projects to facilitate linkages and encourage participation 
        among all networks involved in intergenerational programming.
          Volunteers from RSVP are serving effectively in partnerships 
        with a growing number of State Health Insurance Counseling 
        Programs, administered by State Office on Aging and State 
        Insurance Departments. These State programs have been fostered 
        by the Office of Beneficiary Services (OBS) of the Health Care 
        Financing Administration. For more than 5 years, the OBS has 
        provided training materials to all RSVP projects to assist 
        volunteers who counsel Medicare/Medicaid beneficiaries 
        regarding Health Insurance and related topics such as selecting 
        the most appropriate HMO and choosing a nursing home. In some 
        States, State Insurance Departments are contracting directly 
        the RSVP projects through the Senior Health Insurance Benefits 
        Advisors Program. In other cases, RSVP is contracted through 
        local Administration on Aging (AoA) offices, and training and 
        funding support is subcontracted by local agreements. In 
        Maryland, for example, seven of the nine RSVP projects receive 
        support funds for transportation and travel expenses, and 
        training ranging from $2,000 to $12,000 per project. Other 
        States which are just starting counseling programs are eager to 
        use RSVP volunteers when possible.

                          Non-Federal Support

    Projects have successfully generated non-Federal resources to help 
expand and improve volunteer services. RSVP sponsors, their advisory 
councils and staff, have used imaginative and varied approaches to 
attract cash and in-kind contributions. RSVP's total non-Federal 
support totaled over $36.7 million in FY 1994. Non-Federal support was 
52 percent of the total funding for RSVP.

                            Project Examples

                          green bay, wisconsin
    Many volunteer opportunities are available for active older people, 
but what about the frail or homebound seniors? RSVP of Brown County has 
identified ``stay at home'' volunteer opportunities for seniors who are 
unable to get around so that they can continue to offer something to 
their communities and feel needed. These volunteers not only do more 
traditional ``stay at home'' work like knitting warm hats and mittens 
for the homeless, telephone reassurance calls to other elderly people, 
and making dolls and teddy bears for hospitalized children, but are 
also engaged in more creative projects. For example, a growing number 
of RSVP volunteers are working with the Einstein Project to improve 
science education in the schools. Volunteers develop special kits for 
students to do hands-on science projects that the students will 
particularly enjoy, making science infinitely more interesting. Since 
the Einstein Project works with all grade levels in all the school 
districts in Brown County, the volunteers are making a major impact in 
the lives of many students, while contributing to their communities, 
despite being limited in their ability to get around.
                             denison, texas
    When the County Health Department reported that only 35 percent of 
the children in the Denison area had received the vaccinations 
recommended by the American Academy of Pediatrics, the Denison RSVP and 
its volunteers decided to do something to alleviate this problem. Many 
parents are unaware of recommended vaccination schedules or that free 
or low-cost immunizations are available. So in the phase one, RSVP 
volunteers visit new mothers in local hospitals, providing information 
on the importance of vaccinating children on a regular schedule. Then, 
the volunteers work with the health department to contact parents in 
writing and by telephone to both remind them of the vaccination 
schedule and help set up appointments to complete vaccinations.
    The goal is for children by age 2 to have all the recommended 
vaccinations rather than waiting until the mandated school age. By 
eliminating these vulnerable, unvaccinated years, many disabling and 
crippling diseases can be avoided and much suffering relieved.
                          seattle, washington
    Since 1986, the King County RSVP in Seattle as been providing 
consultation services to a broad spectrum of nonprofit agencies through 
its Retired Executive Volunteers (REV) program. This group of retired 
professionals and business managers have applied their various skills, 
to assist a nonprofit adult day center do long-range planning; a 
nonprofit child care agency to strengthen their board structure and 
participation; a program serving at-risk youth to develop personnel 
policies; and a County probation office to restructure.

                   Characteristics of RSVP Volunteers

                                                                 Percent
Distribution by Gender:
    Female........................................................    76
    Male..........................................................    24
Distribution by Age:
    55-59.........................................................     3
    60-69.........................................................    28
    70-79.........................................................    46
    80-84.........................................................    15
    85+...........................................................     8
Distribution by Ethnic Group:
    White.........................................................    84
    Black.........................................................    10
    Hispanic......................................................     4
    Asian/Pacific Islanders.......................................     1
    American Indian or Alaskan Native.............................     1

                       FOSTER GRANDPARENT PROGRAM

    The Foster Grandparent Program (FGP) is one of the most successful 
and respected volunteer efforts in the United States. Through FGP, 
income eligible persons, aged 60 and older, provide person-to-person 
service to children with special or exceptional needs.
    In FY 1994 there were 262 Corporation-funded FGP projects in all 50 
States, the District of Columbia, Puerto Rico, and the Virgin Islands. 
In addition, there were 14 projects totally supported by non-Federal 
funds, bringing the total number of FGP projects to 276.
    Nearly 23,800 volunteers contributed about 21.7 million hours 
assisting children with special or exceptional needs, such as mental 
retardation, autism, and physical disabilities. Children with special 
needs also include those who have been abused and neglected, children 
of single teenage mothers, runaway youth, juvenile delinquents, as well 
as those in need of protective intervention.
    Foster Grandparents assist over 80,000 children everyday. They 
usually serve 4 hours a day, 5 days a week. The Program provides 
certain direct benefits to these income eligible volunteers, including 
a modest stipend, transportation and meal assistance when needed, 
insurance protection and an annual physical examination. Foster 
Grandparent services are provided through designated volunteer stations 
in private nonprofit organizations and public agencies. They include 
schools, hospitals, juvenile detention centers, Head Start programs, 
shelters for abused or neglected children, State schools for the 
mentally retarded, and drug abuse rehabilitation centers.
    During FY 1994, the Corporation for National and Community Service, 
under Subtitle H, continued an agreement initially funded by the 
Commission on National and Community Service intended to stimulate 
greater FGP involvement with Head Start Parent Child Centers.

                            Project Examples

                           new york, new york
    The FGP Family Mentor Program is funded by the New York City 
Department of Aging in collaboration with the Child Welfare 
Administration and serves all five boroughs. There are 77 Foster 
Grandparent volunteers assigned as mentors to work in the homes of 
``high-risk'' families who have been reported for abuse and/or neglect, 
as an alternative to removing the children from their families and 
placing them into foster care.
    The Foster Grandparents are assigned to two or three families 
having no more than two children under 18 years of age. The Foster 
Grandparents provide love and attention to the children; act as role 
models for good parenting skills; reinforce guidance to parents on 
child management; introduce families to available community sources of 
support; and expose children and their families to cultural activities 
in order to alleviate the stresses that lead to abuse and/or neglect.
    The Family Mentors Field Workers work closely with the Family 
Mentor Coordinator on the monitoring and supervision of the Foster 
Grandparents. Foster Grandparents regularly meet with the Field Worker 
at the host site to discuss issues and concerns pertaining to each 
family in order to enhance their effectiveness. In this fashion, the 
volunteers take an active role in family care management and enable 
them to make valuable contributions to the families' successful 
development.
                            portland, maine
    Youth Alternatives Emergency Boy's Shelter is a safe haven for boys 
ages 7 to 17 years of age. The boys are allowed to stay at the shelter 
for a maximum of 28 days. Some of these boys are homeless, some are 
runaways and some are in between placements having just been released 
from the Maine Youth Center, a correctional facility, or waiting for a 
foster home. This transition time can be very stressful for the boys 
and their Foster Grandmother is there to nurture and lend an ear. For 
many of them, she is the only adult who makes an ``extra effort.'' She 
provides support by helping them with their homework or writing 
letters, plays games, models good manners and helps them prepare meals 
and eats with them. She encourages them to complete their chores and 
always goes that ``extra mile'' by being willing to volunteer evenings 
and weekends when they need her most. One boy who happened to forget 
the Foster Grandparent's name asked her ``can I just call you nice 
lady?''
    In April 1994 Foster Grandparents were assigned to a program called 
Sentencing Options, a nonprofit agency that works with the courts in 
developing alternative sentences for youth who have committed 
nonviolent crimes. A Foster Grandfather has been successfully matched 
as a mentor with young men helping them to develop goals and the steps 
needed to accomplish them. He encourages them to attend substance abuse 
support groups, often accompanying them to make meetings easier to 
attend. If his assigned children are incarcerated, the mentor will 
visit them to assure support so that upon leaving the correctional 
facility they have someone to talk to that will assist them in making 
good choices about employment, housing, financial needs, and social 
interactions. Making this contact with a mentor upon release can lead 
to the youth making good choices and reducing their chances of 
returning to prison for lack of community connections.

                          Non-Federal Funding

    Non-Federal funding for the Foster Grandparent Program increased by 
approximately $900,000 in FY 1994. Approximately, $30.7 million in non-
Federal funding was contributed to support FGP projects nationwide. A 
major portion of these funds came from State governments, either 
through direct appropriations or contributions from State-funded 
agencies. The balance came from local governments and private sources. 
Non-Federal funds matched approximately 46 percent of the Federal 
appropriation for FGP in 1994.
    Fourteen non-federally-funded FGP projects are operating in the 
country today--seven in Michigan, one in New York, one in Wisconsin, 
three in New Mexico, and two in Georgia.

                   Characteristics of FGP Volunteers

Distribution by Gender:                                          Percent
    Female........................................................    90
    Male..........................................................    10
Distribution by Age:
    60-69.........................................................    34
    70-79.........................................................    50
    80-84.........................................................    12
    85 +..........................................................     4
Distribution by Ethnic Group:
    White.........................................................    49
    Black.........................................................    37
    Hispanic......................................................    10
    Asian/Pacific Islanders.......................................     2
    American Indian or Alaskan Native.............................     2
Ages of Children Served:
    0-5...........................................................    38
    6-14..........................................................    42
    15-20.........................................................    16
    21 +..........................................................     4

                        SENIOR COMPANION PROGRAM

    The Senior Companion Program (SCP) offers volunteer service 
opportunities to income eligible Americans 60 years of age and older. 
Senior Companions provide person-to-person non-medical assistance and 
peer support to adults, primarily the frail elderly who experience 
difficulties with activities of daily living. The clients served by the 
Senior Companion are chronically homebound with physical, emotional, 
and mental health limitations that place them at risk of being placed 
in very costly institutionalized care facilities. Companions help 
strengthen their clients' capacity to live independently in the 
community.
    In FY 1994, with a budget for the Senior Companion Program of $29.8 
million, 147 Corporation-funded Senior Companion projects were funded. 
In addition, 40 projects were non-federally funded, bringing the total 
to 187 projects. These projects supported approximately 13,200 
volunteers, contributing over 11 millon hours of service. Through the 
projects, community agencies such as home health care agencies, day 
care centers, residential institutions, hospitals and hospices match 
volunteers to about 33,000 clients, primarily the frail elderly. The 
majority of the Senior Companions provide in-home care to their 
clients.
    A national conference was held to celebrate the 20th anniversary of 
the Senior Companion Program and explore new avenues for expanding 
SCP's role in addressing the emerging health and social service needs 
of the growing older American population. Examples of two new avenues 
for program development explored were the Health Care Financing 
Administration's (HCFA) Medicaid waiver program and public/private 
partnerships through the insurance industry. Approximatley seven 
projects are supporting volunteers under the Medicaid home and 
community-based waiver program. A second publc/private partnership 
grant with the Visiting Nurse Associatiosn of America (VNAA) extended 
``best practices learned'' into a new initiative involving four 
projects and a future search technology conference with selected public 
and private organizations. Funds supported public relations marketing 
activities to give SCP greater visibility.
    A sum of $225,000 was awarded to support Programs of National 
Significance grants to 18 projects with a total of 59 additional 
service years funded to both Corporation and non-federally funded SCP 
projects.

                            Project Examples

                         hot springs, arkansas
    Loneliness had cause a 69 year old man who had once been the ``life 
of the party'' to become a hermit and his ``social drinking'' had lead 
him to become an alcoholic. When the hospital could do no more for his 
damaged stomach, he was sent home to die unless he drastically changed 
his ways. He made up his mind to quit drinking but was too weak and 
depressed to take care of himself. He was assigned a Senior Companion 
volunteer to help him. She is a very cheerful and kind person and her 
good cooking soon enticed him to eat. She has helped him with his house 
work and assists in helping him keep his clothes and bedding clean and 
has helped encouraged him with his personal cleanliness. Her patience 
and positive attitude has given him hope. He is now strong enough to 
get out of his apartment on short trips. He continues to get stronger 
and is enjoying life like he never thought possible 1 year ago. He is 
the first to admit he wouldn't even be alive this year without his 
Senior Companion.
                           tazewell, virginia
    Working with the terminally ill is not usually a happy assignment. 
however, when Helen was assigned to work with a terminal cancer patient 
as her first client, she found that it was necessary that she faced the 
assignment with a ``can do'' philosophy. Because of this attitude, she 
feels that she was able to make a difference in the comfort of her 
client. She not only did housekeeping duties her client was unable to 
do for herself any longer; but she helped to arrange for Meals On 
Wheels to provide meals to help out when she could not be with her 
client. She contacted the health department and local home health group 
to arrange professional bathing and other needed services and looked 
for any any other possible assistance. When her client went into the 
last stages of her illness, she continued to assist her by relieving 
the family at her bedside in the hospital and was with her client when 
she died. She took care of her client's physical needs and became her 
friend. If you ask her why she did so much, she will answer that, ``Its 
just part of my job. You can't be around someone in need and not help 
them.''
                          birmingham, alabama
    Ms. Dorothy Cates, age 70, has been a Senior Companion since March 
1990 and has helped take care of her 92 year old neighbor. She assists 
her with taking a bath, preparing meals, reads her mail and helps 
balance her checkbook. All these activities are normally performed by 
most Senior Companions but Ms. Cates has consistently gone beyond the 
call of duty. When her client fell and fractured her ankle, Ms. Cates 
called the paramedics, stayed at the hospital and spent the first night 
with her. On another occasion when Ms. Cates came to care for her 
client, she found that she had fallen again but she could not get in to 
the house to help her. She had to call the fire department for 
assistance in getting the door opened. Again she stayed with her client 
in the emergency room so that she could be available if her client 
needed any assistance. Ms. Cates loves to do for people, to make them 
happy. Her volunteer work far exceeds her volunteer hours. But Ms. 
Cates is only one example of a typical Senior Companion.
    The project was recently chosen to be one of four agencies featured 
in the United Way of Central Alabama Campaign. United Way knows Senior 
Companions, too many of our frail elderly would be institutionalized 
earlier than necessary.

                          Non-Federal Funding

    In 1994, $17.8 million in non-Federal funding was contributed to 
support SCP projects, including 40 projects that were totally non-
federally funded. The source of most of these funds is State 
governments, either through direct appropriations or contributions from 
State-funded agencies. County/city governmental and private community 
sources make up the balance. These projects are operating nationwide 
with New Mexico, California, Michigan, and Illinois having the greatest 
number of non-Federal projects.

                   Characteristics of SCP Volunteers

Distribution by Gender:                                          Percent
    Female........................................................    85
    Male..........................................................    15
Distribution by Age:
    60-69.........................................................    40
    70-79.........................................................    49
    80-84.........................................................     9
    85+...........................................................     2
Distribution by Ethnic Group:
    White.........................................................    51
    Black.........................................................    33
    Hispanic......................................................    10
    Asian/Pacific Islanders.......................................     3
    American Indian or Alaskan Native.............................     3
Ages of Clients Served:
    22-45.........................................................     5
    46-59.........................................................     5
    60-74.........................................................    27
    75-84.........................................................    37
    85+...........................................................    26

                ITEM 17. ENVIRONMENTAL PROTECTION AGENCY

     Environmental Protection Agency 1994 Accomplishments on Aging

    The U.S. Environmental Protection Agency conducts a research 
program to improve our understanding of the effects of environmental 
exposures on human health to reduce the uncertainty in Agency health 
risk assessments. Our research programs addressing issues associated 
with aging focus on the following questions: (1) Do physiological 
changes in the body normally associated with aging increase the 
susceptibility of aged individuals to the effects from environmental 
pollution? and (2) What role do environmental factors play in the aging 
process?
    The 1993 WHO report on Principles for Evaluating Chemical Effects 
on the Aged Population (Environmental Health Criteria 144) concluded 
that the aged population is likely to be more susceptible to the 
harmful effects of environmental chemicals. Results from two recent EPA 
research projects support this conclusion. In the first study, aged 
male rats appear to be more susceptible to the toxic effects of carbon 
tetrachloride, a model liver toxicant whose toxicity is mediated by 
reactive metabolites rather than by the parent compound. Research is 
underway to examine the underlying mechanisms responsible for the 
enhanced hepatotoxicity in the aged rat. The second study conducted in 
collaboration with Health and Welfare Canada, determined that aged rats 
were found to be more sensitive and to show more individual variability 
of response to inhaled ozone than young rats; current work is 
investigating possible mechanisms of the increased sensitivity. These 
animal models provide data which suggest that aging may be a 
significant factor in susceptibility to environmental contaminants.
    Another research study involving human subjects ranging from 19 to 
70 years of age was initiated to determine the variability in lung 
deposition of air pollutants as a function of age and lung disease. 
Results from this study will be available in 1996.
    Collaborative research with Duke University has shown that less 
oxygen is taken up into tissues of old rats and that there are large 
differences in tissue antioxidants (vitamins C and E, glutathione, 
antioxidant enzymes) in old versus young rats. Similar results in 
another species have been obtained in collaborative research with NCTR 
(National Center for Toxicological Research), i.e., oxygen uptake is 
less in old mice than in young mice. The role of oxidation in aging is 
being studied in a laboratory animal model (fruit fly mutants) 
deficient in antioxidant enzymes (catalase, superoxide dismutase, 
etc.), the goal of this collaborative research with NIEHS is to 
determine the correlation between longevity and oxygen uptake into 
tissue.
    Neurotoxicological results emphasize the need to conduct 
longitudinal research to detect effects of early exposure of chemicals 
on the aging process. It has been postulated that sublethal exposure of 
brain cells to toxicants could cause changes which render the cells 
susceptible to premature aging and death. While models of accelerated 
aging have been postulated, there are few experimental data 
demonstrating that such a phenomenon actually exists. Recent research 
in an animal model has shown that exposure to a neurotoxicant, triethyl 
tin, during development accelerated cognitive dysfunction and changes 
in neuroanatomical markers normally associated with senescence.

            ITEM 18. EQUAL EMPLOYMENT OPPORTUNITY COMMISSION

                      OFFICE OF PROGRAM OPERATIONS

                              Introduction

    The Office of Program Operations (OPO), established in 1982, 
provides direction to EEOC's administrative enforcement program and 
activities. Through management of the Commission's headquarters program 
components and the field establishment, OPO ensures that EEOC's charge 
resolution responsibility is accomplished in accordance with its 
legislative mandate and mission statement. Utilizing definitive 
principles of leadership, consistent program objectives, a single 
charge resolution management system, and a dedicated national staff, 
OPO has consistently contributed to the accomplishment of agencywide 
program and administrative goals at the optimal level.
    The Director of the Office of Program Operations serves as a 
principal advisor to the Chairman in matters of equal employment 
opportunity and administrative enforcement. The Director exercises 
overall supervisory, managerial, and fiscal responsibility for all OPO 
activities. At headquarters, the Director carries out the mission of 
OPO with an organization consisting of four staffed program areas and 
an administrative unit. OPO field staff conduct EEOC law enforcement 
activities in 50 offices which are organized into 1 field office and 23 
district office jurisdictions to which the remaining 26 area and local 
offices are assigned. OPO staff at headquarters and in the field are 
charged with the efficient and effective implementation of EEOC's 
program responsibilities.
    In FY 1993, OPO continued its efforts to enforce Federal 
legislation prohibiting employment discrimination in an environment of 
reduced resources and increased demand on agency services. Dramatic 
increases in the workload resulted from implementation of the Americans 
with Disabilities Act and economic conditions. Field office 
productivity increased in private sector charge resolutions as well as 
in Federal sector hearings findings, continuing the upward trend of the 
last five years. OPO launched new programmatic and management 
initiatives aimed at improving customer service in charge resolution 
activities. Seeking alternative methods for resolving charges in less 
time, OPO piloted a new approach to charge resolution through 
mediation. This method was intended to take less time and fewer 
resources, while continuing to provide quality charge resolution 
services to the public. Efforts were undertaken to improve and better 
coordinate technical assistance and communications services to the 
public.

                                OVERVIEW

                      Office of the Director (OD)

    Provides overall direction, coordination, leadership, and 
administrative support to OPO program areas. Retains supervisory and 
fiscal responsibility for the Office of Program Operations.

            Field Management Programs (East and West) (FMP)

    Ensures effective and efficient operation of field offices through 
operational oversight and monitoring of program implementation, 
evaluation of performance, and provision of technical assistance and 
administrative services.
    Field Management Programs, East and West, provide headquarters 
oversight and management of EEOC's fifty field offices. Each field 
office is assigned a jurisdiction based on specific geographic 
boundaries. Within its jurisdiction, each field office is charged with 
accomplishing the statutory enforcement responsibilities of the 
Commission through investigation, conciliation, and litigation of 
charges filed. The operational mandate given to each field office is to 
achieve timely and appropriate resolution of discrimination charges 
through efficient administration and effective implementation of 
systematic case development and case management practices.

           Systemic Investigations and Review Programs (SIRP)

    Develops and recommends charge resolution procedures; provides 
technical and administrative support systems for systemic and 
individual charge investigations; and develops intermittent 
instructions which assist field staff in the timely investigation of 
Title VII, EPA, ADA and ADEA charges. SIRP investigates class and 
pattern and practice systemic charges in headquarters units and 
provides technical assistance to district offices as they accomplish 
pattern and practice charge investigative responsibilities.

            Operations Research and Planning Programs (ORPP)

    Produces summary statistical reports of data required by OPO in 
planning and carrying out its functions; designs and conducts national 
surveys of employment sectors; analyzes data from employment sectors 
and from OPO field and headquarters offices; produces research and 
analytical reports based on employment sector data; conducts reviews 
and issues reports on effective field office investigative strategies; 
and provides long- and short-range planning systems from which OPO 
decisions regarding operational plans and goals, resource and staffing 
determinations, and workload distribution may be made on a national and 
office-specific basis.
    Develops the procedural guidance for enforcement through Volume I 
of the Compliance Manual and other guidance materials. Refines and 
develops charge resolution policies and procedures. Provides program 
development and support for the field technical assistance function.

              Charge Resolution and Review Program (CRRP)

    Reviews both EEOC and FEPA charge files as a quality control 
function in coordination with Field Management Programs' oversight of 
field operations. In addition to reviewing FEPA charge files, CRRP's 
state and local responsibilities include oversight of worksharing 
agreements with FEPAs as well as conducting on-site audits for the 
purpose of enhancing FEPA charge-handling capabilities and improving 
the quality of their product.

              Administrative Support Services Staff (ADM)

    Provides administrative and technical support services to all OPO 
components. In addition, conducts comparative analyses of financial 
transactions and monitors their impact on budget allocations, 
administers the OPO management reporting system, and conducts special 
studies and evaluations on specific program office units.

                            ACCOMPLISHMENTS

                       Field Management Programs

    In FY 1993, Field Management Programs (FMP) and field office 
managers addressed problems related to the workload, implementation of 
a new statute, the Americans with Disabilities Act (ADA), and a new 
180-day time limit for the Federal sector hearings process. Initiatives 
to enhance the agency's technical assistance and communications 
programs were also implemented.
    This section discusses the workload and staffing challenges 
confronting OPO managers; the response in terms of productivity; 
caseload management and quality indicators; individual district 
achievements and significant resolutions; and litigation and Federal 
sector activities.
                         workload and staffing
    EEOC's incoming workload has grown significantly in the last four 
years, up by 46.1 percent from 63,085 to 92,136 in FY 1993. Incoming 
workload includes charges filed with EEOC offices and net charge 
transfers from State and local agencies. FY 1993's 87,942 charge 
receipts were 48 percent (28,516) charges) higher than FY 1990's. 
During the same period, net transfers into EEOC's workload from State 
and local agencies grew by 14.6 percent. The greatest 1-year increase 
in receipts was 24.9 percent (17,543 charges) from FY 1992 to FY 1993, 
reflecting ADA implementation.
    However, since EEOC did not receive additional resources, the 
number of investigators available to resolve charges did not keep pace, 
declining by 3.1 percent from 762.2 investigators in FY 1990 to 738.3 
in FY 1993. Consequently, there was a sharp increase in the number of 
open charges awaiting resolution, up by 74.2 percent from 41,987 at the 
end of FY 1990 to 73,124 at the end of FY 1993. This unprecedented jump 
in pending inventory, which occurred despite historically high 
productivity in FY 1993 (97.1 charges per investigator), represented a 
major turnabout. Prior to FY 1991, pending inventory had steadily 
declined and was approaching a long-sought goal, measured in the time 
required to complete all pending cases, of 6 months. Instead, months of 
pending inventory, which had dropped to 7.9 months in FY 1990, reached 
12.2 months in FY 1993.
    As a result, the average caseload carried per investigator grew by 
41.5 cases or 80.9 percent from 51.3 in FY 1990 to 92.8 in FY 1993. 
Caseloads ranged from 61.3 in the district office with the lowest, to 
131.7 cases per investigator in the district office with the highest 
caseload. Attempting to meet this challenge, FMP managers continually 
monitored the workload for each office, redistributing charges to 
minimize caseload imbalances nationwide. In FY 1993, FMP also continued 
efforts to consolidate and coordinate investigations between districts 
to make the most efficient use of resources; as well as to ensure 
consistent application of remedies when investigations against an 
employer were ongoing in different offices at the same time. These 
efforts reduced duplication of effort, saving time and resources.
    With only two more investigators available nationwide in FY 1993 
than in FY 1992, FMP managers also responded to ADA-generated workload 
increases by initiating computerized oversight of field staffing 
vacancies, identifying critical needs and shifting limited resources 
where possible. Both FMP and field office managers implemented case 
resolution efficiencies that led to improved productivity. EEOC 
resolved 71,716 charges in FY 1993, 4.9 percent (3,350 charges) more 
than in FY 1992. Productivity, at 88.4 resolutions per investigator in 
FY 1990, rose from 92.8 in FY 1992 to an historical agency high of 97.1 
in FY 1993. Productivity by district ranged from an average of 83.2 to 
118.7 resolutions per investigator in FY 1993.

              WORKLOAD, RESOLUTIONS, INVENTORY FY 1990-1993             
------------------------------------------------------------------------
                                              Fiscal year               
                             -------------------------------------------
                                 1990       1991       1992       1993  
------------------------------------------------------------------------
Receipts to process.........     59,426     62,806     70,399     87,942
Net trans (f/FEPAs).........      3,659      4,703      4,798      4,194
Total inc work..............     63,085     67,509     75,197     92,136
Inventory available.........      762.2      727.1      736.3      738.3
Productivity................       88.4       88.5       92.8       97.1
Resolutions.................     67,145     64,342     68,366     71,716
Pending inventory...........     41,987     45,717     52,856     73,124
Caseload/Investigator.......       51.3       58.7       67.6       92.8
Months pending inventory....        7.9        9.0       10.4       12.2
------------------------------------------------------------------------

                       charge resolution quality
    Equally important to FMP as managing the size of the national 
caseload, was its responsibility to monitor and assure high quality 
standards for the charge resolution process. FMP conducted on-site 
quality reviews to assess field office effectiveness in investigative 
quality, procedural consistency, and case management/case tracking. FMP 
completed on-site quality reviews of 37 field offices in FY 1993. With 
input from the Charge Resolution Review Program's review of enforcement 
files and charge data information, FMP issued special reports to 
district offices on their case management and development efforts. FMP 
also conducted joint reviews with the Office of General Counsel to 
assess the quality of legal/enforcement interaction in field offices. 
Indicators of quality in the charge process include:
    Timely Charge Processing.--FMP managers and field office were 
successful in maintaining timely processing of the workload at close to 
FY 1992 levels, despite the rapid growth in charge receipts. FY 1993 
average charge processing time was 294 days, only 2 days higher than in 
FY 1992. Likewise, the average age of open charges in EEOC's inventory 
increased by 3 days to 201 days in FY 1993. The percentage of charges 
in the workload over 270 days old increased from 16.3 percent in FY 
1992 to 20.4 percent in FY 1993. This increase was lower than the 24.9 
percent increase in receipts, indicating that field offices were 
continuing to resolve charges on a first come, first serve basis.
    Merit Resolutions.--Merit resolutions are charges with outcomes 
favorable to charging parties. They include negotiated settlements, 
withdrawals with benefits, successful conciliations, and unsuccessful 
conciliations. FY 1993 merit resolutions were 15.7 percent of total 
resolutions, 0.2 percentage points higher than in FY 1992.
    Determinations on the Merits.--Determinations on the merits are 
charges resolved after full investigation with findings that 
discrimination did or did not occur. FY 1993 determinations on the 
merits (42, 148) included 40,183 no reasonable cause (95.3 percent) and 
1,965 reasonable cause (4.7 percent) findings. Reasonable cause 
determinations resulted in 589 successful conciliations and 1,376 
unsuccessful conciliations. Determinations on the merits were 58.7 
percent of total resolutions in FY 1993, down 4.7 percentage points 
from FY 1992. This decline was due primarily to an increase in 
administrative resolutions from FY 1992 to FY 1993. Charges resolved 
administratively are resolved prior to full investigation. In FY 1993, 
administrative resolutions comprised 28.3 percent of all resolutions. 
Implementation of the Civil Rights Act of 1991, which offers potential 
punitive and compensatory damages, contributed to the growth in 
administrative resolutions by triggering charging parties' requests for 
issuance of notices of right-to-sue (RTS), enabling them to file suit 
without waiting for the completion of the charge resolution process. 
RTS's accounted for 75 percent of the increase in administrative 
resolutions in FY 1993. Also, administrative resolutions occurring 
after EEOC attempts to conciliate charges under Section 7(d) of the 
ADEA increased in FY 1993.
    Benefits to Charging Parties.--In FY 1993 monetary benefits 
resulting from enforcement and systemic unit efforts were $126.8 
million dollars, up 7.7 percent from FY 1992's $117.7 million, and 54.6 
percent higher than FY 1990. Average monetary benefits ($14,823 for all 
charges) were highest for ADEA resolutions at $22,409, while ADA 
resolutions were a close second at $20,471. Also, 19,528 individuals 
received non-monetary benefits. FMP implemented a management initiative 
to ensure the consistency of nationwide punitive and compensatory 
damages awarded under the Civil Rights Act of 1991. (See individual 
field office case resolution activity below for a sampling of benefits 
obtained in specific cases.)
                         litigation activities
    In each district office, litigation units carry out necessary legal 
actions within their jurisdictions. These units submit litigation to 
the Office of General Counsel recommending that the Commission approve 
or disapprove litigation on reasonable cause cases. A total of 825 
presentation memoranda (702 positive and 123 negative) were submitted 
to the Commission in FY 1993, up from 665 in FY 1992. Litigation units 
also took other legal actions related to the administrative charge 
process, such as enforcing subpoenas. The increase in presentation 
memoranda reflects improved coordination between district office 
enforcement and legal units in the development of cases for litigation.
                       federal sector activities
    District offices are responsible for administration and enforcement 
of antidiscrimination laws in the Federal government. This includes the 
hearings function, which examines complaints filed by employees against 
Federal agencies; and the Federal Affirmative Action (FAA) program, 
which approves and monitors Federal affirmative employment plans, and 
provides technical assistance to agencies.
                                hearings
    During FY 1993, hearings units received 8,882 new complaints, an 
increase of 28.6 percent over FY 1992's 6,907 receipts. This was 
largely the result of revisions to Section 1614 of the CFR which went 
into effect on October 1, 1992, imposing a mandatory 180-day processing 
limit both for agencies investigating EEO charges and EEOC's hearings 
on the resolution of those charges. In response, and to substantially 
reduce the number of 180-day-old complaints in the inventory, FMP 
redistributed hearings workload among field offices and temporarily 
detailed field office staff from other functions to hearings units.
    Administrative judges (AJs) increased their annual productivity 
rate by 11.1 percent from 113.5 to 126.1 resolutions. Consequently, 
complaints were resolved on a one-to-one basis with receipts in FY 
1993, up from 0.88 in FY 1992.
    AJs available increased by 16.8, up 31.2 percent from FY 1992. Due 
to increases in both available AJs and the annual productivity rate, 
resolutions in FY 1993 (8,906) increased 46 percent from FY 1992 
(6,100).
    In spite of the increase in resolutions, pending inventory remained 
virtually unchanged (3,991 on 9/30/93 compared to 3,977 on 9/30/92). 
Open complaints more than 180 days old constituted 13.3 percent of 
pending inventory. Average processing time declined 10 days to 183 
days.

                            HEARINGS OVERVIEW                           
------------------------------------------------------------------------
                                   Fiscal year                          
                             ----------------------   Change    Percent 
                                 1992       1993                  Diff  
------------------------------------------------------------------------
Receipts....................      6,907      8,882      1,975       28.6
Resolutions.................      6,100      8,906      2,806       46.0
Pending inventory...........      3,977      3,991         14        0.4
AJs available...............       53.8       70.6       16.8       31.2
Adjusted prod/AJ............      113.5      126.1       12.6       11.1
Average days................        193        183       (10)      (5.2)
180-day inventory \1\.......        N/A        530        N/A        N/A
Percent 180-day inventory                                               
 \1\........................        N/A       13.3        N/A        N/A
------------------------------------------------------------------------
\1\ 180-Day inventory not tracked in fiscal year 1992.                  

    Significant Hearings Resolutions.--Examples of significant hearings 
resolutions follow:
    The Birmingham District Office resolved by negotiated settlement an 
ADEA charge filed by a 50-year-old branch manager against a financial 
lending institution. The charging party alleged that he had been 
demoted and subsequently forced to resign due to his age. Under the 
terms of the settlement, the charging party elected to take early 
retirement in lieu of reinstatement. He received monetary benefits 
totalling $92,121 which included retirement annuities, a lump sum 
payment, and other benefits, a significant benefit for an individual 
charging party.
    The Charlotte District Office found reasonable cause to believe 
that a manufacturer violated the ADEA by failing to consider for 
employment two job applicants over 40 years of age. The case was 
expanded to include the ADEA violations which were discovered during 
the course of a Title VII race discrimination investigation. In the 
Title VII case, a 25-year-old secretary who alleged race discrimination 
when she was fired after she put a picture of her biracial child on her 
desk. Her charge was resolved via withdrawal with benefits ($1,000). In 
gathering evidence related to the charging party's allegation, the 
investigator contacted the employment agency that had referred her to 
the company. An official of the agency testified that prior to hiring 
the 25-year-old secretary, the company had turned down two of the 
agency's referrals, ages 41 and 44, because the company wanted 
``someone young who wore heels and a short skirt.'' The Charlotte 
District Office entered into a conciliation agreement with the company 
under the terms of which the two older job applicants received a total 
of $1,750 in backpay. Both of the applicants had found other jobs and 
were no longer interested in employment with the company.
    The Cleveland District Office resolved by negotiated settlement a 
charge filed by a conversion manager against a computer service. The 
charging party alleged that he had been discharged due to his age. 
Under the terms of the settlement, the charging party was reinstated in 
his conversion manager job at his annual salary of $31,000 along with 
full seniority and fringe benefits.
    The Milwaukee District Office found reasonable cause to believe 
that an employer had engaged in a pattern and practice of discharging 
older employees due to their age. The parties entered into a 
conciliation agreement resulting in significant benefits for each class 
member. It provided $2,649,595 in monetary benefits paid to seventeen 
class members who had been employed in various salaries jobs including 
engineer, buyer, expeditor, cost estimator, dispatcher, and a 
scheduler.
    The New York District Office found reasonable cause to believe that 
a securities brokerage firm had violated the ADEA by discharging an 
employee due to his age. The parties agreed to enter into a 
conciliation agreement which provided $500,000 in monetary benefits to 
the charging party. The $500,000 included $300,000 in backpay, $150,000 
in compensatory damages, and $50,000 in attorney's fees. This 
resolution provided a significant monetary benefit for a single 
individual.
    The Newark Area Office in the Philadelphia District resolved by 
negotiated settlement a charge filed by a vice president of a 
reinsurance company who alleged that her employer had discriminated 
against her on the basis of sex and age. Specifically, the respondent 
allegedly discriminated against the charging party by changing her job 
assignments and then denying her salary increases. In addition, after 
she filed her initial charge, the respondent denied her a promotion as 
well as additional salary increases. Under the terms of the settlement 
agreement, the charging party received a significant lump sum 
settlement of $344,822 plus $18,578 in backpay, for a total of $363,400 
in monetary benefits.
    The Phoenix District Office found reasonable cause to believe that 
a public employer demoted a fleet manager over 40 years of age due to 
his age. The parties entered into a conciliation agreement which 
provided $35,000 in backpay. The agreement also mandated the training 
of all managers on the ADEA and the posting of a notice informing all 
employees of the prohibitions against age discrimination.
    The Seattle District Office found reasonable cause to believe that 
a beverage distributor discharged an employee because of his age and 
replaced him with a younger employee. The parties entered into a 
conciliation agreement which provided $73,000 in backpay to the 
charging party. The agreement also mandated the training of all of the 
company's employees with respect to the provisions of the ADEA.
    The St. Louis District Office issued a reasonable cause finding 
against an aerospace firm which had engaged in a pattern and practice 
of laying off workers 55 years of age and older due to their age. After 
conciliation efforts failed, EEOC filed suit. This case was resolved by 
a consent decree which provided for the reemployment of 216 class 
members and the payment of monetary benefits totaling $20.1 million to 
950 class members. This is one of the single largest dollar amounts 
obtained by the Commission through its own litigation efforts.
    The resolutions above are examples of the 11,248 merit factor 
resolutions which constituted 15.7 percent of all resolutions in FY 
1993. Merit factor resolutions are those with outcomes favorable to the 
charging party and include negotiated settlements, withdrawals with 
benefits, successful conciliations, and unsuccessful conciliations.
              systemic investigations and review programs
                          systemic activities
    In FY 1993, Systemic Investigations and Review Programs (SIRP) 
continued the level of program activity sustained over the last 4 
years. The Commission approved 69 case actions for headquarters and 
field office systemic activities. This total included 28 new 
Commissioner charges, and 41 resolutions, of which 32 were decisions on 
the merits. Of the 28 new charges, one was filed under Title VII/ADEA 
and four were filed under the ADA. The remaining 23 were filed under 
Title VII. There were two ADEA directed resolutions and two Title VII/
ADEA resolutions. Thirty-seven other resolutions were filed under Title 
VII. Of the 41 resolutions, in 36 there was reasonable cause to believe 
that discrimination had occurred. Of these, 17 settlement and 
conciliation agreements generated $1,326,639 in monetary benefits for 
290 persons. In 19 other resolutions, although the Commission found 
reasonable cause to believe that discrimination occurred, subsequent 
efforts to conciliate the cases failed and they were referred to the 
Office of General Counsel and field office legal units for litigation.
                            pending charges
    The systemic case docket included 80 active cases in various 
processing stages at yearend. Three of the pending charges were filed 
under Title VII/ADEA and four were filed under the ADA. The remaining 
73 charges were filed under Title VII. Of the 80 pending charges, 95 
percent were less than 3 years old, compared to only 74.9 percent that 
were less than 3 years old in FY 1990. In FY 1993, SIRP continued to 
reduce the age of its workload by resolving the four remaining charges 
in its inventory initiated prior to FY 1988.
    The 80 systemic charges pending at the end of FY 1993 included 
charges filed against employers in varied industries, including service 
providers (30), manufacturing (17), retail establishments (14), 
wholesale establishments (7), and 12 companies in other categories, 
including four financial institutions. Of the charges filed against 
employers in the service industry, 14 were against companies providing 
business services. Seven of the 14 retail establishments were 
restaurants, one of them a national chain.
    During FY 1993, SIRP implemented a system for streamlined 
processing of proposed Commissioner charges involving per se violations 
of the ADA. SIRP also developed guidance encouraging joint 
investigations across district boundaries. The prototype for this 
effort was coordination between the Birmingham and Memphis offices in 
the investigation and conciliation of charges filed against a company 
with locations in both jurisdictions. As a result, staff and funds 
required to investigate the charges were reduced and consistent 
company-wide remedies were obtained. SIRP also improved the 
coordination of headquarters and field office systemic investigations 
by linking headquarters investigations, regionally or nationally, with 
field efforts in order to ensure more effective use of resources. 
During FY 1993, SIRP developed new methods for accelerating 
investigations, including deposition taking during investigations. Two 
new nationwide or multi-district charges were approved by the 
Commission and two were resolved.

                Charge Resolution Review Program (CRRP)

                   state and local programs division
    Fair Employment Practices Agency (FEPA) Workload Increases. In FY 
1993, FEPA charge receipts (61,289) increased by 13.3 percent over FY 
1992, primarily due to receipt of 9,552 new ADA charges. This increase 
occurred at a time when most FEPAs were affected by continuing revenue 
and budget reductions for State and local governments. The increase in 
receipts was accompanied by a 3.3 percent decrease in resolutions. 
Consequently, FEPA pending inventory increased by 13.1 percent in FY 
1993.

                                             FEPA CHARGE PROCESSING                                             
----------------------------------------------------------------------------------------------------------------
                                                                      Fiscal year              Fiscal year  1992-
                                                        --------------------------------------   93  difference 
                                                                                                   (percent)    
                                                                1992               1993                         
----------------------------------------------------------------------------------------------------------------
Receipts to process....................................             54,080             61,289               13.3
Net Transfers to EEOC..................................              4,798              4,194              -12.6
Resolutions............................................             49,791             48,166               -3.3
Pending Inventory......................................             66,590             75,289               13.1
----------------------------------------------------------------------------------------------------------------
 AAAFiscal year 1992 FEPA resolutions include 33 more charges added to the database since publication of the    
  fiscal year 1992 OPO Annual Report. Fiscal year 1993 FEPA resolutions include 1,840 bankruptcy and NRTS       
  administrative resolutions not previously reported.                                                           

    Initiatives to Assist FEPAs.--To respond to declining FEPA budget 
resources, the State and Local Programs Division (SLPD) explored 
methods for increasing the agencies' capacity to resolve more charges 
with fewer resources, enhancing charge-handling capabilities, and 
improving the quality of their charge resolutions. EEOC initiatives 
implemented in FY 1993 included:
          Facilitating the delivery of the EEOC-developed Automated 
        Intake System to FEPAs to speed the FEPA charge intake process 
        by streamlining the entry of charge receipt data in the Charge 
        Data System (CDS).
           Ensuring that FEPAs were provided access to the EEOC 
        Compliance Manual via a computerized bulletin board system. The 
        manual specifies policy and procedures for conducting 
        investigations.
           Developing surveys for use by EEOC district offices and 
        Tribal Employment Rights Organizations (TEROs) to obtain 
        recommendations that would enhance the TERO program.
    Annual EEOC-FEPA Training Conference.--The SLPD held the annual 
EEOC-FEPA conference, focusing on management strategies for effective 
and timely charge resolution. Workshops were conducted on implementing 
effective worksharing arrangements under contracts; on EEOC's ADA 
charge processing policies and procedures in preparation for 
contracting with FEP agencies to resolve ADA charges in FY 1994; on 
procedures for ensuring automated data integrity; and on current charge 
resolution issues impacting the capacity of FEPA's to reduce pending 
inventories.
                     determinations review division
    Charge Resolution Quality Control Reviews.--The Determinations 
Review Division (DRD) reviewed the files for more than 2,600 field 
office charge resolutions in FY 1993 and conducted on-site reviews with 
FMP analysts to assess the quality of investigations and compliance 
with agency policies and procedures.
    Charge Investigation Project.--During fourth quarter FY 1993, as 
part of an OPO-wide initiative to explore new alternatives for 
balancing the national field office workload, DRD received 399 charges 
from a district office for investigation and resolution. This 
redistribution of workload reduced the caseload of each investigator in 
the district office to a more manageable level. By the end of FY 1993, 
DRD had completed several on-site investigations and had resolved a 
number of the charges. The project was continued into FY 1994.
    Charges Against Elected Officials.--In FY 1993, DRD attempted to 
resolve 20 charges filed against elected State and local government 
officials under Section 321 of the Civil Rights Act of 1991. Section 
321 requires a new process for which the Commission is developing 
procedures. Attempts were made to settle these charges through 
mediation. One charge was resolved with benefits totalling $66,887.

            Operations Research and Planning Programs (ORPP)

                 program research and surveys division
    Survey Processing.--The 1992 Employer Information Report (EEO-1) 
survey data file, for 38,372 employers, included the highest employment 
number (42,113,681) and EEO-1 establishments (158,230) in the history 
of the survey. Also, in FY 1993, several large employers that had not 
been filing reports were brought into the EEO-1 filing system. The 
Surveys Division developed on-line access to the Apprenticeship 
Information Report (EEO-2) survey database enabling retrieval of the 
latest available employer data. Major revisions to computer programs 
used to aggregate the Higher Education Staff Report (EEO-6) survey data 
were completed. Over 1,150 requests for survey data from members of the 
public were processed, resulting in distribution of approximately 
21,000 reports. Data aggregated by industry and various geographical 
areas are used by private employers to design individual affirmative 
employment programs. The number of unions not responding to EEOC 
requirements for survey data was reduced significantly, from 343 to 49.
    Research.--Three research efforts were initiated. One report, ``The 
Glass Ceiling for Women and Minorities: An Employment Issue of the 
1990s,'' included data by industry for women, Blacks, Hispanics, 
Asians, and American Indians. A second report, ``Sexual Harassment in 
Charge Receipts and Resolutions,'' examined the agency's resolution of 
sexual harassment charges. The third report, ``Congressional Oversight 
Hearings on the Equal Employment Opportunity Commission by the U.S. 
Senate and U.S. House of Representatives, 1982 to 1992,'' addressed 
Congressional consideration of the agency's general administration and 
specific program areas.
    In addition, two updated reports were prepared and released in FY 
1993. The first, ``Equal Employment Opportunity (EEO) Profile of the 
Private and Public Employers Surveyed by the Commission,'' compared the 
employment participation rates of minorities and women in the various 
sectors of the economy. The second, ``Indicators of Equal Employment 
Opportunity--Status and Trends,'' provided employment and salary status 
trends of minorities and women in the labor force.
    Technical Assistance.--The Surveys Division provided labor force 
availability statistics, census data, employment trends for particular 
companies/industries, and occupational analyses of targeted companies 
for headquarters systemic investigations and field office systemic and 
individual investigations. In addition, the 1992 JURIS System was 
distributed to all district offices to provide linkage between the EEO-
1 employment database and charges filed against private employers. The 
system also provided support in identifying and contacting employers to 
notify them of Technical Assistance Program Seminars.
                 program planning and analysis division
    Planning.--The Program Planning and Analysis Division automated the 
development of quarterly field office performance expectations used for 
annual national workload planning. Performance rating guides for field 
managers were revised to reflect requirements of the Civil Rights Act 
of 1991 and CFR Section 1614 regulations which mandate a 180-day 
maximum time frame for hearings processing. Workload and staffing 
projections were developed for EEOC's FY 1993 and FY 1994 budget 
justifications. Analyses identifying emerging workload trends and their 
impact on agency charge processing capabilities were prepared. Reports 
and analyses were developed in response to issues raised by government 
agencies and the public.
    Data Analysis and Dissemination.--Graphics were developed depicting 
trends in selected issues, including sexual harassment and pregnancy, 
and for each statute enforced by EEOC. Graphics presentations were 
developed for EEOC planning meetings and EEOC/FEPA management 
conferences as well as for public briefings and speeches. 
Implementation of the ADA in its first full year was closely tracked 
with issuance of numerous statistical summaries providing an up-to-date 
account of the new statute's enforcement. Analyses of litigation 
recommendations by district and the relationship between productivity 
and performance ratings were also developed during FY 1993. Each 
quarter ``fact sheets'' on key charge processing statistics and 
detailed summary data reports were produced as were analyses of 
significant enforcement trends for the Commissioners and program 
directors. This information was used to identify workload imbalances, 
to support agency resource requests, and to provide field directors and 
others speaking to the public with accurate and timely information 
regarding charge trends. The FY 1992 annual report of OPO 
accomplishments was prepared for dissemination to the public. The 
Planning Division also prepared this report on FY 1993 OPO 
accomplishments.
    Data Integrity.--The capability to produce computerized summaries 
of various indicators of data integrity was developed, makimg possible 
timely identification and correction of data discrepancies in the 
national database. Quarterly guidance was prepared to assist field 
offices in more accurately reporting charge processing actions. A 
concerted effort was made to assure that national charge data 
information issued from OPO and other sources within the agency was 
consistent and accurate.
         program development and technical assistance division
    In FY 1993, the Program Development and Technical Assistance 
Division (PDTAD) provided training, technical assistance, and 
procedural guidance for the administrative charge resolution process, 
with emphasis placed on clarifying the complex, unprecedented issues 
presented by the ADA.
    ADA Training.--In FY 1993, the Disability Rights Education and 
Defense Fund (DREDF), under contract, provided refresher training, 
support, and technical assistance to a cadre of people with disability 
to serve as community-based resources with expertise on the ADA. DREDF 
also conducted advanced mediation training on ADA employment issues. In 
addition, DREDF developed a directory of ADA Training and 
Implementation Network participants for publication by EEOC as a 
resource for the public.
    ADA Technical Assistance.--To respond to questions raised by the 
novel issues presented by ADA, technical assistance was provided to 
EEOC headquarters and field offices, Congressional offices, the media, 
disability groups, employers, regional Disability and Business 
Technical Assistance Centers, and others.
    Other ADA Implementation Actions.--Staff reviewed ADA charges 
resolved during the first six months after the July 26, 1992 effective 
date of Title I of the Act. Results of the review served as the basis 
for additional training of EEOC investigators on making an initial 
determination as to whether charging parties are ``individuals with 
disabilities'' and for revising CDS disability basis codes.
    Extensive revisions to Volume I of EEOC's Compliance Manual were 
made to incorporate requirements of the ADA and the Civil Rights Act of 
1991. Other sections were consolidated and revised to reflect new 
statutes enacted and changes in Federal government or agency policy. 
These changes included revising investigative procedures to incorporate 
ADA provisions, the Family and Medical Leave Act, procedures for 
calculating benefits pursuant to the requirements of the Civil Rights 
Act of 1991, and recent court decisions.

                           Office of Director

             americans with disabilities act implementation
    In FY 1993, the first full year of ADA implementation, the Office 
of the Director coordinated a variety of activities executed by OPO 
program areas to ensure the effective administration of the ADA 
including.
          Supplemental training to the public and EEOC staff in ADA 
        policy and operational issues.
          Review of ADA charges and affidavits to identify issues and 
        trends regarding EEOC's initial experience with the statute.
          Adjustment of systemic processing methods to ensure that 
        charging parties' rights under the ADA were protected.
          Issuance to the public of an ADA Training and Implementation 
        Network participants directory.
    Sexual Harassment Training.--Approximately 30 sexual harassment 
seminars were conducted nationwide on a cost reimbursable basis for 
approximately 900 managers of the Resolution Trust Corporation--one of 
EEOC's first efforts under the newly established reimbursable Revolving 
Fund.
    GAO Audit.--During FY 1993, GAO audited EEOC's management of the 
ADEA and the overall charge resolution process. The Office of the 
Director provided in-depth analyses of charge data that facilitated 
GAO's completion of the audit and provided additional analyses for 
GAO's testimony before the House Select Committee on Education and 
Civil Rights. This input provided GAO with a clear picture of the 
constraints on agency management caused by the lack of sufficient 
resources.
    Alternative Dispute Resolution Program.--The Office of the Director 
developed this initiative to explore alternative approaches to the 
current charge resolution process. When the program pilot was 
implemented, the Office of the Director participated in the selection 
of the contractor to provide mediation services, and monitored the 
progress of the program with the contractor and field office managers 
throughout the year. The program was piloted in four field offices and 
was extended through mid-FY 1994. Of the charges entering the pilot 
program, nearly 50 percent were settled with charging parties receiving 
over $194,000 in monetary benefits.
    Technical Assistance Program.--Staff developed and participated in 
the implementation of a program to achieve a coordinated approach for 
delivering educational services, technical assistance and training 
services to the public by creating a new position dedicated to 
technical assistance activities focused on identifying and providing 
enhanced services to the public with an emphasis on under-served 
groups.
    The Administrative Support Services Staff in the Office of the 
Director administered OPO's management reporting systems as indicated 
below.
          Administration. The administrative staff monitored the OPO 
        budget of over $26 million for six accounts, ensuring that no 
        activity exceeded its allocation. The staff has responded to 
        numerous requests for management reviews.
          Document Tracking. In FY 1993, over 6,000 items were 
        monitored for timeliness and accuracy through the OPO-ADM 
        tracking system. Among these items, the most significant were 
        730 Congressional inquires, primarily regarding charges filed. 
        The unit also monitored 616 requests for information from the 
        Chairman. More than 2,400 headquarters and field personnel 
        actions were tracked, as well as 1,400 financial documents and 
        management reports.

           COMMUNICATION, EDUCATION, AND TECHNICAL ASSISTANCE

    In FY 1993 the Commission strengthened its efforts to enhance 
public awareness about EEOC and laws prohibiting employment 
discrimination. The Commission's outreach efforts included Technical 
Assistance Program Seminars (TAPS) implemented through the agency's 
Technical Assistance and Training Institute Revolving Fund, and other 
appearances in which EEOC representatives addressed members of the 
public. Every district office held at least one TAPS seminar and all 
but two held two seminars in FY 1993.
    Technical Assistance Program Seminars.--EEOC district offices 
conducted 46 TAPS in FY 1993. Over four thousand managers, human 
resources specialists, union representatives, and others attended the 
seminars which provided information regarding the rights and 
obligations of employers and unions under Federal laws prohibiting 
discrimination in employment. Seminar fees, paid into the Revolving 
Fund, were used to finance the cost of the seminars.
    Most seminar attendees were from medium- to large-sized employers, 
and most were managers, supervisors, or human resource management 
personnel. The seminars were generally well attended.
    Sexual Harassment Training.--During FY 1993, the Revolving Fund 
also sponsored several projects responsive to the needs of both the 
private and public sectors. As noted above, in one project, staff from 
the Office of the Director developed and conducted training sessions on 
sexual harassment issues for managers and supervisors of a Federal 
agency.
    Technical Assistance and Education Program.--In FY 1993, six field 
offices tested a program designed to increase the effectiveness of the 
Commission's outreach and education programs by ensuring a more 
coordinated and standardized approach. A new staff position dedicated 
to this function was created. Combining responsibility for training, 
outreach, education, public relations, and other agency special 
programs activities in a single staff position reporting directly to 
the office director produced better results in reaching all affected 
groups, especially those historically under-served.
    Outreach Activities.--Field offices reached the largest audiences 
with information about EEOC's policy and program through their outreach 
activities--public presentations made at the request of outside 
organizations. In FY 1993, agency staff provided information to over 
94,000 people who attended 1,694 presentations made in a variety of 
settings--including workshops, conferences, and on radio and 
television. Field office representatives communicated with a variety of 
audiences, including associations and advocacy groups (38.1 percent), 
respondent and educational organizations (37.4 percent), and 
representatives of other Federal and State governments (24.5 percent).
    The topic most often addressed was general EEOC information (816). 
Presentations on these EEOC topics (48.2 percent of the total) included 
those covering more than one statute, the Civil Rights Act of 1991, and 
other issues of concern. The ADA was the topic addressed next most 
frequently (31.6 percent) while sexual harassment was the topic of 
discussion in 18.6 percent of the presentations. The percentage of 
presentations made concerning the ADA decreased from 49.2 percent last 
year when the employment prohibitions of the ADA first went into 
effect. The remainder of the presentations (1.6 percent concerned Title 
VII and ADEA issues.
    EEOC field office staff at all levels participated in these 
presentations. Of the 1,694 public appearances made, office directors 
represented EEOC on 373 occasions (22.1 percent); managers and 
supervisors represented EEOC on 707 occasions (41.7 percent); and other 
staff addressed public gatherings on 614 occasions (36.2 percent). 
Nonsupervisory staff accounted for 67 more public appearances than last 
year.
    Examples of outreach presentations included:
          Managers from the Baltimore District Office addressed 500 
        employees of the Social Security Administration on Federal EEO 
        matters.
          The Charlotte District Office Regional Attorney addressed 200 
        managers on EEOC laws in a seminar held by a employers' 
        association.
          Management officials from the Nashville Area Office addressed 
        700 employees of a public utility on sexual harassment.
          The Atlanta District Office Deputy Director made a 
        presentation to 250 members of a city police department on 
        sexual harassment.
          Staff of the Milwaukee District Office addressed 550 members 
        of an employers' association on the topic of sexual harassment.
          Management officials from the Denver District Office 
        addressed 100 members of a statewide disability advocacy group, 
        providing information on the ADA.
          The Director and staff of the Houston District Office 
        addressed 370 people while participating in panel discussions 
        on the ADA sponsored by an advocacy group.
          Management staff from the Albuquerque Area Office made a 
        presentation on the ADA to 230 staff members of an employer.
          Headquarters OPO Activities.--The Director and his staff also 
        took part in more than 25 speaking engagements in FY 1993. In 
        addition, headquarters OPO program managers made numerous 
        presentations to a variety of audiences nationwide.

                       OFFICE OF GENERAL COUNSEL

    This report highlights the accomplishments of the Equal Employment 
Opportunity Commission's Office of General Counsel from October 1992 
through September 1993.

   I. Current Structure and Function of the Office of General Counsel

                 a. the mission of the general counsel
    The Office of General Counsel was established by the Equal 
Employment Opportunity Act of 1972, which amended Title VII of the 
Civil Rights Act of 1964 to provide for a General Counsel, appointed by 
the President and confirmed by the Senate, with responsibility for 
conducting the Commission's litigation. Following transfer of 
enforcement functions from the U.S. Department of Labor to the 
Commission in 1979, the General Counsel was also vested with 
responsibility to conduct Commission litigation under the Equal Pay Act 
and the Age Discrimination in Employment Act. With the enactment of the 
Americans with Disabilities Act, the General Counsel was granted 
responsibility for Commission litigation under that statute as well.

 Title VII Provides for a General Counsel, Appointed by the President, 
                 to Conduct the Commission's Litigation

                       b. organization structure
    The Office of General Counsel is divided into nine organizational 
units: (1) the District Office Legal Units; (2) Litigation Management 
Services; (3) Research and Analytic Services Staff; (4) Litigation 
Advisory Services; (5) Systemic Litigation Services (6) Appellate 
Services; (7) Administrative and Technical Services Staff; (8) the 
General Counsel's immediate staff; and (9) the Deputy General Counsel's 
immediate staff.
    The District Office Legal Units are located in the Commission's 23 
District Offices. Each legal unit is responsible for prosecuting 
enforcement litigation which has been approved by the Commission. In 
addition to their prosecutorial function, legal unit attorneys provide 
legal advice to enforcement units, which are responsible for 
investigating charges of discrimination. The legal advice function 
includes, among other things, completing written reviews of all 
proposed ``reasonable cause'' findings to ensure uniformity with legal 
standards, drafting determinations for the District Director on 
objections to administrative subpoenas, and making determinations on 
Freedom of Information Act requests.

  The 23 District Legal Units Prosecute the EEOC's Field Enforcement 
                               Litigation

    Each District Office legal unit is under the direction of a 
Regional Attorney who is appointed by the General Counsel and the 
Chairman of the Commission. The Regional Attorney manages the legal 
staff of the District Office under the legal direction of the General 
Counsel. In addition, many Regional Attorneys supervise a Hearings 
Unit, which is composed of administrative judges who conduct hearings 
and render decisions on claims of discrimination in federal employment.
    Litigation Management Services is one of the three headquarters 
prosecutorial divisions of the Office of General Counsel. Formed in 
November 1991, as part of a reorganization of the former Trial Services 
Division, Litigation Management Services is managed by an Associate 
General Counsel under the supervision of the Deputy General Counsel. 
Litigation Management Services performs the following functions, 
pursuant to a delegation of authority from the General Counsel: (1) 
manages and oversees the Commission's litigation enforcement program in 
the 23 District Offices of the Commission; and (2) in conjunction with 
the Office of Program Operations, oversees the integration and 
interaction of District Office legal units into the administrative 
enforcement structure of the District Office.

  Litigation Management Services Oversees All EEOC Field Enforcement 
                               Litigation

    To accomplish its mission, Litigation Management Services is 
divided into two units staffed by three Assistant General Counsels. The 
Litigation Oversight Unit within Litigation Management Services 
oversees all litigation conducted by the District office legal units, 
and monitors the effectiveness of the legal units' interaction with 
administrative enforcement units. The Expert Services Unit is 
responsible for identifying and monitoring complex District Office 
litigation. This unit evaluates District Office suit recommendations in 
complex cases, drafts OGC litigation recommendations, monitors expert 
procurements, and evaluates case prosecutions and settlements.
    Appellate Services of the Office of General Counsel is managed by 
an Associate General Counsel who reports through the Deputy General 
Counsel to the General Counsel. Organized into three divisions of staff 
attorneys who are supervised by three Assistant General Counsels, 
Appellate Services is responsible for conducting all appellate 
litigation where the Commission is a party or where the Commission 
participates as amicus curiae, usually in cases involving novel issues. 
Appellate Services also represents the Commission in the United States 
Supreme Court through the Solicitor General of the United States.

 Appellate Services Conducts the EEOC's Appellate Litigation and Files 
                             Amicus Briefs

    Appellate Services is responsible for reviewing every case in which 
the Commission receives an adverse judgment. The attorneys of Appellate 
Services then prepare written recommendations analyzing the facts and 
legal issues in the case for review by the General Counsel, who makes 
the final decision on whether to appeal. In amicus cases, Appellate 
Services drafts memoranda recommending Commission participation which, 
if approved by the General Counsel, is submitted to the Commission for 
authorization.
    Appellate Services is also responsible for reviewing and, with 
General Counsel approval, making appeal recommendations to the 
Department of Justice in cases which are referred to the Commission and 
which involve certain employment discrimination issues arising in 
litigation against other federal agencies. In addition, Appellate 
Services reviews EEOC policy matters, such as proposed policy 
statements and regulations, from the Office of Legal Counsel, to 
determine the effect of such proposals on litigation.

   Systemic Litigation Services Conducts Complex Class and Systemic 
                               Litigation

    Systemic Litigation Services, located in the EEOC's Washington, DC 
headquarters office, operates under the supervision of an Associate 
General Counsel who reports through the Deputy General Counsel to the 
General Counsel. Staffed by two Assistant General Counsels who oversee 
two units of line attorneys, Systemic Litigation Services conducts 
litigation on behalf of the Commission in certain complex cases 
alleging patterns or practices of employment discrimination or 
involving complex legal or factual issues. The responsibilities of 
Systemic Litigation Services include evaluating and preparing 
litigation recommendations in certain complex cases for Commission 
consideration and, upon Commission approval, prosecuting those cases. 
Further, Systemic Litigation Services provides legal advice to systemic 
Investigations and Individual Compliance Programs within the Office of 
Program Operations during the investigation and conciliation of 
systemic charges. In addition, the General Counsel has delegated to 
Systemic Litigation Services the responsibility for coordinating the 
representation of the Commission in bankruptcy proceedings nationwide.
    Litigation Advisory Services was established in the January 1993 
realignment and is composed of two Assistant General Counsels who 
report directly to the Deputy General Counsel and who are responsible 
for the daily operations of litigation Advisory Services Division I and 
II. The Divisions of Litigation Advisory Services review and prepare 
recommendations to the Commission from the General Counsel on certain 
litigation recommendations submitted from the 23 District Office by the 
Regional Attorneys.
    The Commission authorizes litigation by a majority vote of the 
Commissioners. Under EEOC's Enforcement Policy, the Commissioners 
consider for litigation all cases where reasonable cause determinations 
were issued and conciliation efforts failed. The District Office legal 
units, as well as Systemic Litigation Services, submit all such cases 
for consideration by the Commissioners in a standardized ``Presentation 
memorandum'' format. The Office of General Counsel reviews certain 
presentation memoranda, and advises the Commissioners whether 
litigation should be authorized.
    Litigation Advisory Services has the responsibility of performing 
these review and advice services for the Office of General Counsel. Its 
primary function is to prepare a ``Transmittal Memorandum,'' reviewing 
and recommending approval or disapproval of litigation in every ``non-
certified'' case submitted by the field. Non-certified cases requiring 
independent headquarters review include, for example, cases that 
involve complex or novel legal issues, rely on a disparate impact 
theory of discrimination, involve a pattern or practice of employment 
discrimination, or propose intervention in a pending private suit. 
``Certified cases,'' which are initially submitted to the Commission 
without a recommendation from the Office of General Counsel, generally 
raise only individual claims of disparate treatment or involve 
Department of Justice referrals for litigation under Title VII.

 Litigation Advisory Services Prepares Litigation Recommendations for 
                        Commission Consideration

    The other major function of Litigation Advisory Services is to 
respond to Commissioner inquiries in cases under consideration for 
litigation. In responding to these inquiries, Litigation Advisory 
Services also acts as the Office of General Counsel's liaison and 
contact point between the Commissioners and the field legal units or 
Systemic Litigation Services. In addition, Litigation Advisory Services 
represents the General Counsel in Commission meetings where litigation 
recommendations are considered. Litigation Advisory Services also 
conducts audits, training, investigations, projects, and other special 
assignments for the Office of General Counsel.
    The Research and Analytic Services Staff was established in 
December 1986, and reports directly to the Deputy General Counsel. The 
Research and Analytic Services Staff is the principal source within the 
EEOC of expert and analytical services for cases under investigation as 
well as cases in litigation. The Research and Analytic Services Staff 
has a professional staff of experts in the fields of the social 
sciences, economics, statistics, and psychology as well as a technical 
staff of research and statistical assistants. The Office of General 
counsel has estimated that the Research and Analytic Services Staff 
saves the Commission nearly two million dollars per year in expert 
service costs and other types of contract costs.
    The essential function of the Research and Analytic Services Staff 
is to provide expert services for class action cases in litigation. 
These expert services include providing support during discovery, 
obtaining information, computerizing data, conducting analyses, 
producing reports (declarations or affidavits), generating exhibits, 
being deposed, and testifying at trial. The Research and Analytic 
Services Staff secondarily provides expert and analytic support to 
charges under investigation in the administrative process and to 
special research projects within the Agency.

  The Research and Analytic Services Staff Provide Expert Services in 
                             Complex Cases

    Other primary functions of the Research and Analytic Services Staff 
include providing expert and technical advice in implementing UGESP; 
creating and making EEO-1 data bases available to headquarters and 
field staff; developing and maintaining special Census files by 
geography, race, ethnicity, and sex, and detailed occupations; 
developing labor market availability estimates; constructing large 
employer personnel data files and work history records by coding and 
converting paper records into computer files; conducting statistical 
analyses of complex employment practices; and assisting in the 
retention of outside experts, when necessary.
    Finally, the Research and Analytic Services Staff conduct training 
sessions for both attorneys and investigators, on such topics as the 
use of various statistical analysis software packages, and basic 
concepts in statistics, economics and psychology as they relate to 
Title VII, ADEA and EPA cases and charges.
    The Administrative and Technical Services Staff is the central 
control unit for the Office of General Counsel and is responsible for 
providing administrative and technical services to all components of 
the Office, including the 23 field legal units.

 The Administrative and Technical Services Staff Handles Procurement, 
   Budget, Finance and Litigation Tracking Systems for the Office of 
                            General Counsel

    The Administrative unit acts as the liaison between the Office of 
General Counsel and the Office of Management on financial concerns and 
staffing matters. It provides information to managers within the Office 
of General Counsel on procurement, budgetary, and financial matters 
based on policies, procedures, and guidelines contained in EEOC 
Directives, Federal Acquisition Regulations, and other sources. This 
unit also assists managers within the Office of General Counsel on 
personnel matters. In addition, the unit is responsible for preparing 
budget projections and monthly reconciliation reports for the allowance 
holders within the Office of General Counsel. The Administrative unit 
also reviews and processes expert witness procurement requests from 
Systemic Litigation Services and the 23 field legal units to insure 
that they are in compliance with applicable rules, regulations, and 
guidelines pertaining to procurement.
    The Technical unit of the Administrative and Technical Services 
Staff maintains computerized systems for tracking Presentation 
Memoranda, and litigation filed by the Commission. These systems 
maintain the most current and accurate source of data available for 
describing the Commission's litigation activity. The Technical unit 
ensures the accuracy of the data by working closely with Litigation 
Management Services, Litigation Advisory Services, and the 23 District 
Office legal units.
    To facilitate assessments of nationwide litigation activity, the 
Technical unit periodically prepares reports analyzing the Commission's 
litigation. Additionally, the Technical unit provides information to 
respond to inquiries from members of Congress, managers within the 
Office of General Counsel, other offices within EEOC, other 
governmental agencies, and the media.
                        c. litigation highlights

                              1. Generally

    In fiscal year 1993, the Office of General Counsel prosecuted 1,029 
cases on behalf of the Commission. Also in this fiscal year, the 
Commission filed a total of 481 lawsuits, including 398 direct suits 
and interventions, 64 subpoena enforcement actions, and 19 cases 
alleging recordkeeping or reporting violations. Among the direct suits 
and interventions, 260 were filed under Title VII, 115 under the ADEA, 
two under the EPA, three under the Americans with Disabilities Act, and 
18 were filed concurrently either under Title VII and the ADEA or under 
Title VII and the EPA.
    The Office of General Counsel resolved 427 cases in this fiscal 
year, including 362 substantive cases, 56 subpoena enforcement actions, 
six lawsuits alleging reporting and recordkeeping violations, and three 
actions for temporary restraining orders.
    The Commission won its first case even filed under the Americans 
with Disabilities Act and in other areas focused on cases involving 
stereotypes that limit opportunities for women, discriminatory pilot 
age rules and class wide discrimination against Blacks and Hispanics in 
hiring. Other significant cases in this fiscal year involved 
discrimination based on English-Only rules, sexual harassment, a 
discriminatory seniority system, disparate wages paid to women, and the 
exclusion of older workers from jobs and benefits because of their age.
Appellate Litigation
    In fiscal year 1993, Appellate Services filed the largest number of 
appellate briefs in at least a decade--101 total briefs, 50 as a party 
and 51 as amicus curiae. Of the briefs filed, 55 were under Title VII, 
38 under the ADEA, four under both Title VII and the ADEA, one under 
the EPA, two under the ADA, and one under the Freedom of Information 
Act. Additionally, many cases briefed by Appellate Services were 
decided during the fiscal year. (See Sec. IV for a brief description of 
the cases.)
Supreme Court Litigation
    The Supreme Court issued critical decisions in two employment 
discrimination cases during fiscal year 1993. In St. Mary's Honor 
Center v. Hicks, No. 92-602 (June 25, 1993), the Commission had filed a 
brief as amicus curiae along with the Solicitor General's Office, 
arguing that the plaintiff was entitled to judgment as a matter of law 
once he had established a prima facie case and had shown that all the 
defendant's nondiscriminatory reasons for the adverse action in issue 
where unworthy of credence. The Supreme Court held, however, that 
although a finding of pretext may support an inference of 
discrimination, such a conclusion is not mandatory.

Supreme Court Adopts EEOC Position on Willfulness in Hazen Paper Co. v. 
                                Biggins

    In the second case, Hazen Paper Co. v. Biggins, No. 91-1600 (April 
20, 1993), the Commission had filed an amicus brief jointly with the 
Office of the Solicitor General during fiscal year 1992. Adopting the 
position urged by the Commission on the standard of willfulness, the 
Court issued its opinion in fiscal year 1993, holding that the Thurston 
standard of ``knowing or reckless disregard'' should be applied to 
cases of individual disparate treatment under the ADEA. The Court, 
however, found that the court of appeals had relied improperly on 
evidence that the defendant discharged the plaintiff because his 
pension was about to vest, ruling that an adverse action based on an 
age-linked characteristic does not in itself constitute a violation of 
the Act.
    In several other cases pending before the Supreme Court, the 
Commission participated as amicus curiae during fiscal year 1993. In 
two companion cases, Rivers v. Roadway Express, No. 92-757, and 
Landgraf v. USI Film Products, No. 92-938 the Commission and the 
Solicitor General argued that the Civil Rights Act of 1991 should be 
applied retroactively. The Commission contended that because two 
sections of the Act explicitly limit the retroactive effect of 
particular provisions, and a general provision expressly states that 
``except as otherwise specifically provided, this Act . . . shall take 
effect upon enactment,'' Congress intended the other provisions of the 
Act to apply retroactively.

  EEOC Filed Amicus Briefs in Three Cases Before the Supreme Court in 
                            Fiscal Year 1993

    In a significant case in the area of sexual harassment, Harris v. 
Forklift Systems, Inc., No. 92-1168, the Commission and the Solicitor 
General argued that an employee establishes hostile environment sexual 
harassment by showing that the objectionable work place conduct is 
sufficiently severe or pervasive to interfere with the job performance 
of a reasonable person. The Commission contended that the Court should 
therefore reverse the lower courts' decisions that an employee 
subjected to the offensive conduct must show that he or she suffered 
psychological injury.
Commission Wins Its First Case Under the Americans with Disabilities 
        Act
    In the first case ever brought by the Commission to endorse the 
Americans with Disabilities Act, EEOC v. AIC Security Investigations, 
Ltd., et al., No. 92-C-7330 (N.D. Ill.), the Chicago legal unit won a 
major jury verdict on the issue of liability, and a magistrate awarded 
the charging party $222,000 in back pay, and in punitive and 
compensatory damages. The Commission successfully contended that the 
defendants had discharged the charging party because he had brain 
cancer, even though he had continued to perform the essential functions 
of his position as Executive Director of the company.
EEOC Obtains $20 Million Consent Decree in Major Reduction-in-Force 
        Case
    The St. Louis legal unit successfully resolved a major class case 
under the ADEA, alleging that the defendant had forced employees age 50 
or older to retire during two reductions-in-force. See EEOC v. 
McDonnell Douglas Corporation No. 4:93CV00526 (E.D. Mo.). Under the 
consent decree resolving this case, the defendant is required to 
reimburse approximately 940 class members $20,100,000 in back pay and 
enhanced pension benefits.
Other Significant Class Cases
    In this class case on behalf of more than 3000 class members, the 
EEOC alleged that the defendant referral agency had discriminated 
against the class on the basis of race, sex, national origin and age in 
failing to refer for employment and in failing to hire. See EEOC v. 
Transworld Placement, Inc. d/b/a Interplace, No. C-91-0694-SAW (N.D. 
Cal.). The San Francisco legal unit successfully resolved this case 
through a consent decree providing for a $2,000,000 settlement fund, 
which includes an estimated $1,420,000 in back pay to 3271 class 
members, $35,000 in back pay and liquidated damages for two 
individuals, and $100,000 in compensatory damages for a class of 
African Americans represented by a private intervenor.
    In EEOC v. United Airlines, Inc., No. 73-C-972 (N.D. Ill.), the 
Commission alleged that the defendant discriminated against the class 
based on race (Black), sex (female), and national origin (Hispanic, 
Asian, and Native American) in its failure to hire for pilot positions. 
Systemic Litigation Services reached a partial settlement with the 
defendant airline, which will pay $404,000 in back pay to 20 
individuals. This settlement is a follow-up to a consent decree entered 
in 1976, which obligated the defendant to hire qualified minorities and 
women at two times their application rate until 1,200 pilots had been 
hired.
                         6. age discrimination
EEOC Obtains $1.66 Million in Pilot Hiring Case
    In another major class case, the Commission alleged that the 
defendant airline company refused to hire pilot applicants who were age 
50 or older. See EEOC v. Southwest Airlines Company, No. 3:89-CV-2238-P 
(N. D. Tex.). The Dallas legal unit resolved this case through a 
consent decree providing for $1.25 million in back pay for 29 class 
members and $415,000 in back pay and attorney's fees for the charging 
party. The defendant also agreed that all its future hiring practices 
will be conducted in accordance with the ADEA.

Consent Decree Removes Threat of Lost Health Benefits for Older Workers

    In EEOC v. Quail Creek Country Club, No. 90-119-FTM-99 (M.D. Fla.), 
the Miami legal unit obtained a consent decree which resolved the 
charging party's claim that he was discharged after resisting his 
employer's attempt to remove him from its health insurance policy and 
require him to accept Medicare at age 65. The decree provides for 
$42,500 in back pay and liquidated damages as well as reinstatement. In 
addition, the employer has agreed that all employees 65 or older have 
the right to elect voluntarily to accept Medicare coverage or to remain 
on the employer's health plan.
EEOC Wins Trial on Insurance Coverage for Seventy-Year-Old Driver
    In EEOC v. Pro Transport and Leasing, Inc., No. A2-91-186 (D.N.D.), 
the Commission alleged that the defendant had discharged the 70-year-
old charging party from a temporary over-the-road truck driving 
position because of his age. After being told by its insurance carrier 
that the carrier did not insure individuals over age 65, the defendant 
had discharged the charging party the same day he was hired. During a 
2-day trial litigated by the Denver legal unit, the Commission 
demonstrated that there were risk pool policies available that would 
have covered the charging party and that the defendant had purchased 
such a policy approximately three weeks after the charging party's 
discharge. The jury returned a verdict for the EEOC and awarded the 
charging party three months of back pay. In addition, the court ordered 
the defendant to maintain insurance that covers drivers 40 or older.
Court Invalidates State Law Requiring Older Workers to Pass Medical 
        Examinations
    Striking down a State law that required employees age 70 or older 
to pass a medical examination, the court of appeals for the First 
Circuit reversed the district court's grant of summary judgment for the 
defendants and remanded the case to the district court with 
instructions to enter summary judgment for the Commission. See EEOC v. 
Commonwealth of Massachusetts, No. 92-1696 (1st Cir.). The court held 
that the State law and the ADEA are in conflict and, under the 
preemption doctrine, the State law is preempted because it is a 
physical impossibility to comply with both statutes. The court also 
held that the State statute was not based on a reasonable factor other 
than age and was not part of a bona fide employee benefit plan.
    In EEOC v. Watergate at Landmark Condominium, No. 92-1224-A (E.D. 
Va.), the Commission alleged that because of the charging party's age, 
63, the defendant discharged her from the position of Director/Tennis 
Pro of its tennis club and failed to hire her as Manager of the club. 
Following a 1-day trial, the jury returned a verdict for the 
Commission. The Commission's evidence showed that charging party, who 
had worked for the defendant as Director/Tennis Pro for 13 years, was 
the most qualified applicant for the newly created Manager position, 
and that residents of the condominium, who played a significant role in 
the tennis club, had stated that the charging party was too old to run 
the tennis club. The jury found that the defendant's violation of the 
ADEA was willful and awarded the charging party $63,820 in back pay and 
an equal amount as liquidated damages. The court awarded the charging 
party an additional $93,011 in front pay and $6,104 in attorney's fees.
ADEA Preempts State Law That Revoked Tenure of Older Teachers
    Challenging an Illinois State law that revoked the tenure of public 
school teachers and placed them on annual contracts when they reached 
age 70, the Commission won a major victory for older workers in this 
case litigated by the Chicago legal unit. See EEOC v. State of Illinois 
and Bourbonnais Elementary Board of Education, No. 88-CV-2261 (C.D. 
Ill.). The court granted summary judgment in EEOC's favor on liability, 
finding that changing the teachers's status to employees at will 
violated the ADEA and that the ADEA preempted the State law. The court 
also found that the State's violation was willful because the State was 
aware by March 23, 1988, that it was in violation of the ADEA, but made 
no effort to repeal the statute until January 1, 1989.
Court Strikes Down Annuity Program Requiring Older Workers to Forfeit 
        Employer Contributions
    Ruling that the employer's violation was willful under the ADEA, 
the district court struck down the defendant's annuity investment 
program, which required employees who worked past age 65 to forfeit 
some or all of the employer's contributions to the plan. See EEOC v. 
Jefferson County Board of Education, No. 91-C-1248-S (N.D. Ala.) In 
this case litigated by the Birmingham legal unit, the court granted 
summary judgment on liability to the Commission, finding that the 
investment program on its face violated section 4(i) of the ADEA. The 
court also determined that the program could not survive under the 
exemption in section 4(f)(2) for bona fide employee benefit plans 
either. First, the court found that the program constituted a 
subterfuge to evade the purposes of the ADEA because a purpose of the 
plan was to replace older workers with younger workers. In addition, 
the court held that the program encouraged the involuntary retirement 
of older workers.
Consent Decree Requires Employer to Pay Retroactive Pension 
        Contributions
    The Dallas legal unit obtained a favorable consent decree requiring 
an employer to maker retroactive retirement contributions to the 
pension plans of four individuals who alleged they were fired because 
they were over age 50. See EEOC v. Schindler Elevator Corporation, et 
al., No. 3:90-CV-1407-P (N.D. Tex.). The decree provides for 
$218,763.73 in relief, including back pay, interest and the additional 
pension contributions.
EEOC Resolves Case Alleging Forced Retirement of NFL Game Officials
    Successfully resolving allegations that the National Football 
League unlawfully transferred game officials to off-field positions and 
forced them to retire at age 60, the New York legal unit obtained a 
consent decree providing $235,000 in back pay for three individuals. 
See EEOC v. National Football League, No. 91-CIV-5447 (S.D.N.Y.).
    Similarly, in fiscal year 1992, 33.3 percent of suits filed under 
the ADEA alleged discriminatory discharge, 23.3 percent alleged hiring 
discrimination, 5.8 percent alleged discrimination in promotions, and 
8.3 percent alleged layoff or recall discrimination.
    Thirty cases of national origin discrimination and 15 cases of 
religious discrimination were brought in fiscal year 1993, compared 
with 24 cases of national origin and 13 cases of religious 
discrimination filed in fiscal year 1992. Predominant among the claims 
made in fiscal year 1993 national origin discrimination cases were 
discharge, at over 53 percent of claims; hiring, at 7 percent of 
claims; harassment based on national origin at over 11 percent of 
claims; and terms and conditions of employment, at slightly more than 9 
percent of claims. (See Table 12, below.)

    TABLE 12. FREQUENCY OF UNLAWFUL PRACTICES ALLEGED IN FY 1993 AGE    
                                LAWSUITS                                
------------------------------------------------------------------------
             Practice                      No.              Percent     
------------------------------------------------------------------------
Discharge.........................                 58               42.0
Hiring............................                 26               18.8
Layoff............................                 13                9.4
Retirement........................                 11                8.0
Promotion.........................                  6                4.3
Benefits..........................                  2                1.4
Demotion..........................                  1                0.7
Recall............................                  1                0.7
Other.............................                 20               14.5
    Total.........................                138              100.0
------------------------------------------------------------------------
Total exceeds total age discrimination suits filed because suits often  
  contain multiple claims.                                              

                         IV. Appellate Services

             a. summary of selected appellate briefs filed
    Baker & EEOC v. Delta, 9th Cir. Nos. 92-55044, 92-55048, 92-55049 
Brief as Appellant Filed 11/15/92
    Eight former Delta pilots filed an ADEA action in the district 
court alleging that Delta discriminated on the basis of age because it 
required its flight crew to retire at age 60 and prohibited captains 
from downbidding to flight engineer positions. The pilots also argued 
that Delta was a successor to their former employer, Western, and 
therefore was bound by a pre-existing injunction to honor downbids that 
had been granted prior to Delta's merger with Western. The EEOC 
intervened. To defend its treatment of the age 60 pilots, Delta argued 
that age 60 was a bona fide occupational qualification necessary to the 
safe operation of its aircrafts and that its rejection of the pilots' 
downbids was because its company policy prohibited two-step downbidding 
and therefore was justified by a reasonable factor other than age. The 
jury rendered a verdict against Delta on the BFOQ defense and in its 
favor on the RFOA defense.
    Argued: The district court abused its discretion when it excluded 
relevant evidence that was pertinent to the plaintiffs' contention that 
Delta's policy against two-step downbidding could not be a reasonable 
factor other than age. Exclusion of the evidence adversely affected 
plaintiffs' right to show that age was a determining factor in the 
formulation of the policy and that Delta's alleged safety concerns were 
pretextual. Alternatively, if the district court properly excluded 
plaintiffs' evidence, then the district court's admission of an earlier 
Delta brief was an abuse of discretion. The brief raised matters that 
had no direct bearing on the issue in the case and its admission 
prejudiced plaintiffs' substantive rights because the brief was Delta's 
only evidence that the policy against two-step downbidding existed, 
which was critical to Delta's RFOA defense. Finally, the district court 
failed to properly analyze the successorship question and to apply 
controlling law.
    Tindall v. Doe Run Investment Holding Corp., Burch v. Doe Run 
Investment Holding Corp., E.D. Mo. Nos. 4:93-CV-00831 & 4:93-CV-00759 
(ELF) Brief as Amicus Curiae Filed 8/2/93
    These are cases challenging a companywide reduction-in-force 
undertaken in 1991 by the Doe Run Investment Holding Corp. The 
plaintiffs allege that they were selected for discharge on the basis of 
their age. The defendants have moved for summary judgment in both 
cases, arguing that waivers executed by the plaintiffs of their ADEA 
rights bar their claims. The defendants did not provide the information 
required by the Older Workers' Benefit Protection Act for waivers in 
conjunction with ``employment termination programs.'' 20 U.S.C. 
Sec. 6269(1)(H). The defendants argue that subsection (H) does not 
apply to involuntary reductions, but only to retirement and other exit 
incentives in which employees are given the choice whether to leave, 
and an inducement to do so.
    Argued: The language of Sec. 626(f)(1)(H) on its face applies to 
``exit incentive[s] or other employment termination program[s] offered 
to a group or class of employees.'' Here, Doe Run offered a standard 
severance benefit to employees subject to the RIF, and required them to 
execute a waiver of claims in exchange. The legislative history is 
specific and explicit that subsection (H) applies to both exit 
incentives and involuntary reductions, and the congressional purpose, 
to give employees subject to a mass downsizing the information 
necessary to determine whether they might have an ADEA claim, applies 
with equal force in both contexts. Doe Run's argument would nullify the 
intent of Congress in an entire class of cases.
    Gately v. Massachusetts, 1st Cir. No. 92-2485 Brief as Amicus 
Curiae Filed 2/12/93
    Until 1991, Massachusetts had four separate units of State law 
enforcement officers: the State police, with a mandatory retirement age 
of 50, and three smaller units, with a mandatory retirement age of 65. 
In the mid-'80s the First Circuit twice upheld the State police age-50 
policy as a BFOQ. In 1991, the State reorganized these four units into 
one department of State police, with a mandatory retirement age of 55. 
Some members of the three smaller units brought this action, claiming 
that the State violated the ADEA when it lowered the requirement age 
applicable to them from 65 to 55. The district court granted 
preliminary injunctive relief, and the State appealed. The State argued 
that plaintiffs' claim was barred on two grounds: first, that the First 
Circuit's earlier decisions upholding the age-50 policy precluded this 
challenge on stare decisis grounds; and second, that section 4(j) of 
the ADEA authorizes them to apply a retirement age as low as 50 to 
State police.
    Argued: The earlier decisions upholding the age-50 policy cannot 
bar this challenge because the State itself, by raising the age, has 
admitted that the facts supporting those earlier holdings have since 
changed. Further, section 4(j) does not allow a State to lower the age 
at which it requires a class of employees to retire.
               b. summary of selected appellate decisions

                                2. ADEA

    Hazen Paper Co. v. Biggins, 113 S. Ct. 1701 (1993)
    The Supreme Court vacated and remanded the case to the court of 
appeals for the First Circuit for reconsideration of whether the 
evidence showed that the employer discriminated against Walter Biggins 
on the basis of his age. The Court found that the court of appeals had 
relied improperly on evidence that Hazen Paper Co. discharged Biggins 
because his pension was about to vest. The Court did not adopt a 
blanket rule against reliance on so-called ``age proxies'' as evidence 
of age discrimination, but it did say that reliance on an age-linked 
characteristic does not itself constitute a violation of the ADEA. It 
did not reach the question of whether a disparate impact claim could be 
raised under the ADEA, and if so, whether use of an ``age proxy'' could 
be a neutral rule with a disparate impact on the basis of age. The 
Court reaffirmed the standard for willfulness it adopted in Trans World 
Airlines, Inc. v. Thurston, 469 U.S. 111 (1985), and applied the 
``knowing or reckless disregard'' standard to cases of individual 
disparate treatment. The United States and the EEOC participated in the 
case as amicus curiae.
    EEOC v. Local 350, Plumbers and Pipefitters, 982 F.2d 1305 (9th 
Cir.), amended 998 F.2d 641 (1992)
    The Ninth Circuit reversed the district court's grant of summary 
judgment for Local 350 and invalidated the union's policy of refusing 
to allow retired members to seek work through its hiring hall while 
they were receiving pension benefits. The court held that the ADEA is 
violated when there is ``a very close connection between age and the 
factor on which discrimination is based,'' in this case, retirement 
status. In rejecting Local 350's argument that the cause of the 
discrimination was not age, but the individual's choice to retire, the 
court stated that it was ``unwilling to draw so fire a line when 
determining causation.'' The court also held that it was discriminatory 
to require any older workers to choose between alternative sources of 
income and using the hiring hall while not requiring younger workers to 
make that choice. Also, the court rejected Local 350's view that the 
policy was based on a reasonable factor other than age, inasmuch as the 
justification ``rests on retirement, a status closely related to age.''
    EEOC v. Commonwealth of Massachusetts, 987 F.2d 64 (1st Cir. 1993)
    The First Circuit reversed the district court's grant of summary 
judgment for the defendants and remanded the case to the district court 
with instructions to enter summary judgment for the EEOC. The court of 
appeals rejected the district court's reliance on Gregory v. Ashcroft, 
holding that absent an ambiguity in the language of the ADEA, 
traditional preemption standards should apply. Because the state law, 
requiring medical exams as a condition of continued employment for 
employees age 70 and older, conflicts with the ADEA, the state law is 
preempted. The court also held that the state statute was not exempt 
from ADEA coverage because it was not based on a reasonable factor 
other than age and it was not part of a bona fide employee benefit 
plan.
    Baker & EEOC v. Delta Air Lines, Inc., 6 F.3d 632 (9th Cir. 1993)
    In a unanimous decision, the Ninth Circuit reversed in part and 
affirmed in part the district court's rulings, and remanded this ADEA 
case for retrial. Reversing the district court, the Ninth Circuit held 
that Delta was a successor to Western Air Lines and therefore bound by 
the Criswell I injunction imposed against Western that would have 
permitted appellants, former Western pilots Baker and Stunz, to fly as 
second officers beyond age 60. The court also held that the district 
court abused its discretion when it refused to admit exhibits that 
constituted ``the only documentary evidence establishing Appellants' 
claim that the two-step downbidding rule never existed and that, if the 
policy did exit, it was based on age.'' The court affirmed the district 
court, holding that other exhibits regarding one-step downbidding were 
properly excluded on relevancy and confusion grounds and that Delta's 
exhibit 692, the FAA brief expressing safety concerns about 
downbidding, was properly admitted. The court reversed the district 
court's denial of JNOV on the finding that Delta's age-60 rule 
constituted a willful violation, reasoning that Delta acted in good 
faith when it relied on a case affirming a jury's finding that Delta's 
age-60 policy was lawful.
    Gately v. Massachusetts, 2 F.3d 1221 (1st Cir. 1993)
    This ADEA action challenges a 1991 Massachusetts statute that 
consolidated four units of State law enforcement officers into one 
Department of State Police, and lowered the mandatory retirement age 
applicable to the members of the three smaller units from 65 to 55. The 
district court granted a preliminary injunction prohibiting 
Massachusetts from enforcing the latter provision. The First Circuit 
affirmed the district court's order in a decision that agreed with the 
position advanced by the EEOC as amicus curiae. The court of appeals 
held that plaintiffs' challenge to the 1991 act was not barred by the 
stare decisis effect of Mahoney v. Trabucco, 738 F.2d 35 (1st Cir. 
1984), because the BFOQ finding in the earlier case was ``fact-
intensive,'' and plaintiffs here had submitted evidence of changed 
circumstances. Nor, the court held, was plaintiffs' challenge barred by 
Sec. 4(j) of the ADEA, the temporary exemption for state law 
enforcement officers. While that section allows states to enforce 
mandatory retirement ages in effect in 1983, it prohibits reducing 
them. The court also affirmed the district court's finding of 
irreparable harm, rejecting Massachusetts' argument that plaintiffs had 
to meet the higher standard enunciated in Sampson v. Murray, 415 U.S. 
61 (1974).
    EEOC v. Fond du Lac Band of Lake Chippewa 986 F.2d 246 (8th Cir. 
1993)
    A divided panel of the Eighth Circuit affirmed the district court's 
decision holding that the ADEA does not apply to an Indian tribe 
employer. The EEOC sought relief for an elderly member of Fond du Lac, 
who was denied employment with a construction company owned and 
operated by Fond du Lac, in favor of a much younger, caucasian worker. 
The panel majority acknowledged that the broad terms of the Act could 
extend to tribal employees and that there was no specific treaty right 
that would be abrogated by applying the ADEA in this case. However, the 
majority ruled that Fond du Lac retained inherent rights of self-
government that would be infringed if it were subject to the ADEA. The 
court held that there was not a sufficiently clear indication of 
congressional intent to overrule tribal rights.

  V. Field Office Litigation--Selected Suits Filed and Selected Suits 
                                Resolved

                        atlanta district office
    Atlanta filed 22 lawsuits, including 8 subpoena enforcement 
actions, in fiscal year 1993; all suits filed on the merits were on 
behalf of an individual or individuals.
    Of the suits filed on the merits, 9 were filed under Title VII and 
5 under the ADEA.
    Atlanta resolved 7 lawsuits, including 3 subpoena enforcement 
actions, in addition to 1 presuit settlement, in fiscal year 1993, and 
recovered $94,000 in monetary benefits for victims of employment 
discrimination.

                              Suits Filed

B. ADEA
    Atlanta Dairies, Inc. No. 1:93-CV-1038-HTW (N.D. Ga. filed May 13, 
1993)--age (62); involuntary retirement.
    Atlantic Southeast Airlines No. 1:93-CV2110-RHH (N.D. Ga. filed 
September 16, 1993)--age (60); involuntary retirement.
    Freuhauf Trailer Corporation No. 1:93-CV-0430-GET (N.D. Ga. filed 
February 24, 1993)--age (63); discharge.
    Ringier America, Inc. No. CV 193-011 (S.D. Ga. filed January 13, 
1993)--age (61); layoff, failure to reinstate.
    United Dominion Industries, Inc. No. 1:93-CV-1667-MHS (N.D. Ga. 
filed July 23, 1993)--age (63); discharge.
                       baltimore district office
    Baltimore filed 39 lawsuits, including 5 subpoena enforcement 
actions and 12 reporting/recordkeeping violations in fiscal year 1993. 
Of the suits filed on the merits, 20 were on behalf of an individual or 
individuals, and 2 on behalf of a class.
    Of the suits filed on the merits, 17 were filed under Title VII, 4 
under the ADEA, and 1 under the Equal Pay Act.
    Baltimore resolved 20 lawsuits in fiscal year 1993, and recovered 
$600,655.49 in monetary benefits for victims of employment 
discrimination.

                              Suits Filed

B. ADEA
    Central Virginia Area Agency on Aging No. 93-0047-L (W.D. Va. filed 
June 14, 1993)--age (54); failure to hire.
    General Electric and Martin Marietta Corporation, as a successor 
No. 2:93-CV-809 (E.D. Va. filed August 9, 1993)--age (61); failure to 
hire.
    Mayor and City Council of Cumberland, Maryland No. MJG-92-3293 (D. 
Md. Filed November 20, 1992)--age (64); discharge.
    Westinghouse Electric Corporation No. MJG-93-1004 (D. Md. Filed 
April 2, 1993)--class; age (over 40); lay-off, involuntary retirement.

                             Suits Resolved

B. ADEA
    Bowie State University No. HAR-92-2137 (D. Md. filed July 31, 
1992)--age (60 or over); failure to reclassify to a higher position, 
discharge; March 15, 1993 settlement agreement in which defendant 
agreed that it would not violate the ADEA by discriminating against 
employees over 40, would not retaliate against charging party or any 
other persons who communicated with the Commission, and will consider 
charging party for future employment.
    National Car Rental Systems, Inc. No. WN-89-3223 and S-89-2504 (D. 
Md. filed November 21, 1989)--age (56); discharge; June 28, 1993 
settlement agreement providing $175,000 in back pay for six individuals 
and notice posting.
    Pan American Development Foundation No. 90-2392-HHG (D.D.C. filed 
September 28, 1990)--age (66), retaliation; constructive discharge; 
February 24, 1993 consent decree providing $7,500 in back pay and 
interest for one individual and notice posting.
    S & G Concrete Company No. HAR-92-2265 (D. Md. filed August 13, 
1992)--age (58); discharge; February 17, 1993 settlement agreement 
providing $30,000 in back pay for one individual.
    Temporary Living Communities Corporation, a division of National 
Loan Service Center f/k/a Comprehensive Marketing Systems, Inc. No. 92-
0739 (D.D.C. filed March 26, 1992)--age (62); constructive discharge; 
September 13, 1993 consent decree providing $30,000 in back pay for one 
individual and notice posting.
    Watergate at Landmark Condominium No. 92-1224-A (E.D. Va. filed 
August 27, 1992)--age (63); discharge, failure to hire; April 29, 1993 
jury verdict awarding $220,651 in front pay, back pay, and liquidated 
damages.
                       birmingham district office
    Birmingham filed 13 lawsuits, including 1 subpoena enforcement 
action, in fiscal year 1993; of the suits filed on the merits, 10 were 
on behalf of an individual or individuals, and 2 on behalf of a class.
    Of the suits filed on the merits, 9 were filed under Title VII and 
3 under the ADEA.
    Birmingham resolved 19 lawsuits, including 1 subpoena enforcement 
action, in addition to 2 presuit settlements, in fiscal year 1993, and 
recovered $448,070.95 in monetary benefits for victims of employment 
discrimination.

                              Suits Filed

B. ADEA
    International Systems, Inc. No. 93-0148-CB-C (S.D. Ala. filed 
February 26, 1993)--age (51); failure to rehire.
    The Kent Corporation No. CV-92-P-2659-S (N.D. Ala. filed 
November12, 1992)--age (70); transfer, reassignment.
    Millard Refrigerated Services Atlanta, Inc. No. CV93-AR-0993-M 
(N.D. Ala. filed May 18, 1993)--age (62); failure to hire, discharge.

                             Suits Resolved

B. ADEA
    John C. Calhoun Community College No. CV-90-H-00397-HE (N.D. Ala. 
filed March 6, 1990)--age (63), retaliation; discharge; November 24, 
1992 consent decree providing $20,000 in back pay and liquidated 
damages for one individual, reinstatement and notice posting.
    Fountain Construction, Inc. No. J91-0727(W)(C) (S.D. Miss. filed 
December 12, 1991)--age (64); failure to hire; November 5, 1992 
settlement agreement providing total relief of $7,000 for one 
individual and notice posting. (Charging party received an additional 
$7,000 through private settlement with respondent).
    The Kent Corporation No. CV-92-P-2659-S (N.D. Ala. filed November 
12, 1992)--age (70); transfer, reassignment; August 25, 1993 consent 
decree providing front pay in the amount of $14,345 for one individual.
    See also, below, Community Convalescent Center.
D. Title VII/ADEA
    Community Convalescent Center No. 92-0449-AHC (S.D. Ala. filed June 
1, 1992)--breach of negotiated settlement agreement age (62), race 
(white); discharge, terms and conditions of employment; March 31, 1993 
consent decree providing $450 in back pay for one individual.
                       charlotte district office
    Charlotte filed 28 lawsuits, including 5 subpoena enforcements 
actions, in fiscal year 1993; of the suits filed on the merits, 19 were 
on behalf of an individual or individuals, and 4 on behalf of a class.
    Of the suits filed on the merits, 19 were filed under Title VII, 
and 4 under the ADEA.
    Charlotte resolved 28 lawsuits, including 9 subpoena enforcement 
actions and 1 temporary restraining order, in fiscal year 1993 and 
recovered $273,505.78 in monetary benefits for victims of employment 
discrimination.

                              Suits Filed

B. ADEA
    City of Gastonia No. 3:93CV307-MU (W.D.N.C. filed September 15, 
1993)--age (61), retaliation; demotion.
    Burnham Service Company, Inc. No. 3:92-CV-369-P (W.D.N.C. filed 
October 2, 1992)--class; age (52 and 59); failure to recall.
    Shelby City Schools No. 4:93CV63 (W.D.N.C. filed April 30, 1993)--
age (62); job assignment, wages.
    U.S. Textiles Corporation No. 1:93CV154 (W.D.N.C. filed August 12, 
1993)--age (40, 51, 52 and 53); failure to hire.

                             Suits Resolved

B. ADEA
    Burnham Services Company, Inc. No. 3-92-CV-369-P (W.D.N.C. filed 
October 2, 1992)--class; age (50 and 59); failure to recall; July 29, 
1993 settlement agreement providing $6,000 in back pay and liquidated 
damages for one individual.
    North Carolina Department of Human Resources, a division of Youth 
Services No. 91-491-CIV-5-BO (E.D.N.C. filed July 29, 1991)--age (54); 
discharge, failure to rehire; October 15, 1992 settlement agreement 
providing $22,000 in back and front pay for one individual.
    Thomasville City Schools, Thomasville, North Carolina No. C-90-122-
S (M.D.N.C. filed March 5, 1990)--age (62); failure to hire; June 3, 
1993 settlement agreement providing $13,500 in back pay for one 
individual.
                        chicago district office
    Chicago filed 31 lawsuits, including 4 subpoena enforcement actions 
and 1 reporting/recordkeeping violation, in fiscal year 1993; of the 
suits filed on the merits, 21 were on behalf of an individual or 
individuals, and 5 on behalf of a class.
    Of the suits filed on the merits, 15 were filed under Title VII, 1 
under the Americans with Disabilities Act, 7 under the ADEA, 1 under 
the Equal Pay Act, 1 under Title VII and the ADEA, and 1 under Title 
VII and the Equal Pay Act.
    Chicago resolved 33 lawsuits, including 7 subpoena enforcement 
actions, in fiscal year 1993, and recovered $1,371,154.21 in monetary 
benefits for victims of employment discrimination.

                              Suits Filed

B. ADEA
    City of Des Plaines and City of Des Plaines Fire Department No. 92-
C-7328 (N.D. Ill-ED filed November 5, 1992)-age (65); involuntary 
retirement.
    Dukane Corporation No. 92-C-8279 (N.D. Ill.-ED filed December 22, 
1992)--age (59); discharge.
    Egg Store, Inc. No. 93-C-1950 (N.D. Ill.-ED filed April 1, 1993)--
age (62); discharge.
    Graham Hospital Association No. 93-1348 (C.D. Ill. filed September 
13, 1993)--age (over 65); benefits.
    Landau and Heyman, Inc. No. 93-C-5411 (N.D. Ill.-ED filed September 
2, 1993)--age (64), retaliation; terms and conditions of employment, 
discharge.
    Lea-Ronal, Inc. No. 93-C-2950 (N.D. Ill.-ED filed May 14, 1993)--
age (59); failure to hire.
E. Title VII/ADEA
    William Rainey Harper College No. 93-C-4914 (N.D. Ill.-ED Filed 
August 13, 1993)--age (40), national origin (non-Hispanic); failure to 
hire.

                             Suits Resolved

B. ADEA
    Deere & Company No. 92-C-4036 (C.D. Ill.-RD filed May 11, 1992)--
retaliation; failure to rehire; December 17, 1992 consent decree 
providing $28,700 in back pay for one individual.
    Francis W. Parker School No. 91-C-4674 (N.D. Ill. filed July 25, 
1991)--age (40 and over); failure to hire; July 25, 1992 unfavorable 
court order.
    G-K-C, Inc., et al. No. 89 C 8693 (N.D. Ill. filed December 21, 
1989)--age (70); discharge; November 10, 1992 order of dismissal.
    State of Illinois No. 86-C-7214 (N.D. Ill. filed September 24, 
1986)--age (40 and over); failure to hire; October 2, 1992 settlement 
agreement providing $25,000 in back pay for five individuals.
    Dukane Corporation No. 92-C-8279 (N.D. Ill.-ED filed December 22, 
1992)--age (59); discharge; May 26, 1993 consent decree providing 
$52,500 in back pay and liquidated damages for one individual.
    State of Illinois and Fraternal Order of Police, Troopers Lodge No. 
41 No. 92-C-2108 (/f/ 92-C-2883, N.D. Ill.) C.D. Ill. filed May 21, 
1990)--class; age (60); involuntary retirement; February 16, 1993 
unfavorable court order.
    Spiegel, Inc., and Otto Versand GMBH No. 90-C-6363 (N.D. Ill.-ED 
filed October 31, 1990)--class; age (over 40); discharge; May 14, 1993 
settlement agreement providing $52,262 in back pay for nine 
individuals.
    Spiegel, Inc., and Otto Versand GMBH No. 90-C-4208 (N.D. Ill.-ED 
filed July 24, 1990)--class; age (over 40); discharge; June 14, 1993 
order of dismissal, no monetary relief.
                       cleveland district office
    Cleveland filed 22 lawsuits in fiscal year 1993; all suits were 
filed on the merits--20 were filed on behalf of an individual or 
individuals, and 2 were filed on behalf of a class.
    Of these, 11 were filed under Title VII, 10 under the ADEA, and 1 
under Title VII and the Equal Pay Act.
    Cleveland resolved 16 lawsuits in fiscal year 1993, and recovered 
$288,062.20 in monetary benefits for victims of employment 
discrimination.

                              Suits Filed

B. ADEA
    B & P Wrecking Company, Inc. and Paxton Equipment Company, Inc. No. 
3:92CV7649 (N.D. Ohio filed November 20, 1992)--age (59 and 62); 
layoff.
    Electronic Control Systems, Inc. No. 1:93-CV-525 (N.D. Ohio filed 
March 9, 1993)--age (70); involuntary retirement.
    Frontier Fruit & Nut Company No. 5:92CV2469 (N.D. Ohio filed 
November 19, 1992)--age (42); failure to hire.
    Hupp Industries, Inc. No. 1:93CV-1107 (N.D. Ohio filed May 25, 
1993)--age (58); permanent layoff.
    Libbey-Owens-Ford Company No. 3:93CV7540 (N.D. Ohio filed September 
27, 1993)--age (58); failure to hire.
    Odgen Services Corporation No. 3:92CV7657 (N.D. Ohio filed November 
24, 1992)--age (51); discharge.
    Rochester Midland Corporation No. 1:93-CV-0148 (N.D. Ohio filed 
January 21, 1993)--age (63); discharge.
    The Marsh Foundation No. 3:93CV7547 (N.D. Ohio filed September 29, 
1993)--age (58); discharge.
    The Rickelman Masonry Company, Inc. No. 1:92CV-2312 (N.D. Ohio 
filed November 2, 1992)--age (53); layoff.
    VME Americas, Inc. No. 1:92CV2470 (N.D. Ohio filed November 19, 
1992)--age (62); layoff.

                             Suits Resolved

B. ADEA
    B&C Machine Company No. 5:91CV2270 (N.D. Ohio filed November 8, 
1991)--age (54); failure to recall; December 29, 1992 settlement 
agreement providing $9,000 in back pay and interest for one individual.
    TMK Corporation d/b/a Frontier Fruit & Nut Company No. 5:92CV2469 
(N.D. Ohio filed November 19, 1992)--age (42); failure to hire; 
September 13, 1993 consent decree providing $1,750 in back pay for one 
individual.
    State of Ohio Rehabilitation Services Commission No. C2-91-726 
(S.D. Ohio filed September 6, 1991)--age (52); failure to hire; July 9, 
1993 summary judgment in favor of defendant.
    The Rickelman Masonry Company, Inc. No. 1:92CV-2312 (N.D. Ohio 
filed November 2, 1992)--age (53); layoff; December 21, 1992 consent 
decree providing $5,693.12 in back pay for two individuals.
    Rochester Midland Corporation No. 1:93-CV-0148 (N.D. Ohio filed 
January 21, 1993)--age (63); discharge; August 30, 1993 dismissal/
settlement agreement providing $19,671.79 in back pay for one 
individual.
                         dallas district office
    Dallas filed 17 lawsuits, including 3 subpoena enforcement actions, 
in fiscal year 1993; of the suits filed on the merits, 12 were on 
behalf of an individual or individuals, and 2 on behalf of a class.
    Of the suits filed on the merits, 10 were filed under Title VII and 
4 under the ADEA.
    Dallas resolved 19 lawsuits, including 4 subpoena enforcement 
actions, in addition to 2 presuit settlements, in fiscal year 1993 and 
recovered $3,232,550.96 in monetary benefits for victims of employment 
discrimination.

                              Suits Filed

B. ADEA
    American Airlines, Inc. No. 4-93CV-203-A (N.D. Tex. filed March 26, 
1993)--class; age (over 40); failure to hire.
    Raudin McCormick, Inc. No. 3-93-CV1819-D (N.D. Tex. filed September 
10, 1993)--age (69 and 72); failure to hire.
    Tecc Corporation No. 3-93CV0602-G (N.D. Tex. filed March 25, 
1993)--age (69); discharge.
    Woodcraft Furniture No. 93-C-828E (N.D. Okla. filed September 13, 
1993)--age (63), recordkeeping violation; failure.

                             Suits Resolved

B. ADEA
    City of Tulsa No. 92-C-468-E (N.D. Okla. filed May 23, 1992)--age 
(64); failure to hire; November 3, 1992 consent decree providing 
$107,500 in back pay and injunctive relief for one individual.
    Enserch Corporation No. CA3-90-2412-X (N.D. Tex. filed October 17, 
1990)--age (58); failure to hire; October 30, 1992 settlement agreement 
providing $21,500 in back pay for one individual.
    Manville Sales Corporation and Manville Corporation No. 4:88CV0905-
K (N.D. Tex. filed December 14, 1988)--age (55); discharge; November 
24, 1992 adverse jury verdict.
    Schindler Elevator Corporation, et al. No. 3:90-CV-1407-P (N.D. 
Tex. filed June 14, 1990)--age (over 50); discharge; April 2, 1993 
consent decree providing $218,763.73 in back pay, interest and 
retroactive retirement contributions for four individuals.
    Southwest Airlines Company No. 3:89-CV-2238-P (N.D. Tex. filed 
October 5, 1990)--class; age (53); failure to hire; September 3, 1993 
consent decree providing $1,665,000 in back pay for charging party and 
29 class members.
    Thomson Newspaper Inc. d/b/a Marshall News Messenger No. 2-92-CV028 
(E.D. Tex. filed March 6, 1992)--age (50); discharge; March 2, 1993 
settlement agreement providing $218,200 in back pay and front pay for 
one individual.
    West Texas Printing Company No. 692CV0001-W (N.D. Tex. filed 
January 3, 1992)--age (57); discharge; December 8, 1992 consent decree 
providing $11,000 in back pay for one individual.
C. Title VII/ADEA
    Recognition Equipment, Inc. No CA3-90-0491-G (N.D. Tex. filed June 
29, 1990)--age (43); sex (female), race (black), retaliation; layoff, 
discharge; October 1, 1992 settlement agreement providing $52,500 in 
back pay for one individual.
                         denver district office
    Denver filed 8 lawsuits, including 1 subpoena enforcement action, 
in fiscal year 1993; of the suits filed on the merits, 6 were on behalf 
of an individual or individuals, and 1 on behalf of a class.
    Of the suits filed on the merits, 4 were filed under Title VII, 1 
under the ADEA, 1 under Title VII and the ADEA, and 1 under Title VII 
and the Equal Pay Act.
    Denver resolved 6 lawsuits, including 1 subpoena enforcement 
action, in addition to 1 presuit settlement, in fiscal year 1993 and 
recovered $95,510.35 in monetary benefits for victims of employment 
discrimination.

                              Suits Filed

    Merchants Association d/b/a Westminister Mall Company.
C. Title VII/ADEA
    Westminister Mall Merchants Association d/b/a Westminister Mall 
Company No. 93-M-333 (D. Colo. filed February 11, 1993)--age (72), 
national origin (Hispanic), recordkeeping violation; discharge.

                             Suits Resolved

B. ADEA
    N.P. Dodge Management Company No. CV-90-O-354 (D. Neb. filed May 
25, 1990)--age (60); discharge; October 23, 1992 settlement agreement 
providing $10,000 in back pay for one individual.
    Pro Transport and Leasing, Inc. No. A2-91-186 (D.N.D. filed 
November 7, 1991)--age (70); discharge; June 8, 1993 judgment providing 
$4,536 in back pay for one individual.
                        detroit district office
    Detroit filed 21 lawsuits, including 2 subpoena enforcement 
actions, in fiscal year 1993; all suits filed on the merits were on 
behalf of an individual or individuals.
    Of the suits filed on the merits, 11 were filed under Title VII, 1 
under the Americans with Disabilities Act, and 7 under ADEA.
    Detroit resolved 21 lawsuits, including 3 subpoena enforcement 
actions and 1 reporting violation, in fiscal year 1993, and recovered 
$95,002.05 in monetary benefits for victims of employment 
discrimination.

                              Suits Filed

B. ADEA
    American Telephone & Telegraph Company, a New York Corporation, and 
Communications Workers of America No. 92CV76754DT (E.D. Mich. filed 
November 20, 1992)--age (55); denied training, reassigned to another 
position.
    Dana Commercial Credit Corporation No. 92CV76272DT (E.D. Mich. 
filed October 23, 1992)--age (45); discharge.
    Kalwall Corporation No. 92CV40510FL (E.D. Mich. filed October 26, 
1992)--age (61); discharge.
    National Delivery Service, Inc. No. 93CV73577DT (E.D. Mich. filed 
August 24, 1993)--retaliation; discharge.
    Regency Oakbrook Ltd. f/k/a Regency Windsor Management, Inc. No. 
1:93CV361 (W.D. Mich. filed May 10, 1993)--age (62); discharge.
    Regional Group, Inc. d/b/a WGRD Radio No. 1:93-CV-691 (W.D. Mich. 
filed August 27, 1993)--age (52); discharge.
    Roberta's, Inc. No. 93-74058 (E.D. Mich. filed September 27, 
1993)--age (62); discharge.
C. Americans with Disabilities Act
    H. Hirsch Sons Company d/b/a Hirschfield Steel Center No. 
93CV10259BC (E.D. Mich. filed September 3, 1993)--disability 
(degenerative disc disease); discharge.

                             Suits Resolved

B. ADEA
    Bob Maxey Lincoln-Mercury Sales, Inc. No. 91-CV-72625 DT (E.D. 
Mich. filed May 31, 1991)--class; age (51); failure to hire, 
advertising violation; November 5, 1992 consent decree providing $500 
in back pay for one individual.
    Dana Commercial Credit Corporation No. 92CV76272DT (E.D. Mich. 
filed October 23, 1992)--age (45); discharge; February 24, 1993 order 
of dismissal with prejudice.
    Kalwall Corporation No. 92-CV-40510-FL (E.D. Mich. filed October 
26, 1992)--age (61); discharge; November 30, 1992 order of dismissal.
    Transition Mold Corporation and Superior Plastic, Inc., a successor 
corporation No. 91CV71784 DT (E.D. Mich. filed April 22, 1992)--age 
(54); layoff; October 26, 1992 consent decree providing $9,500 in back 
pay for one individual.
                        houston district office
    Houston filed 16 lawsuits in fiscal year 1993; all suits were filed 
on the merits--14 were filed on behalf of an individual or individuals, 
and 2 were filed on behalf of a class.
    Of these, 14 were filed under Title VII, and 2 under the ADEA.
    Houston resolved 14 lawsuits in fiscal year 1993 and recovered 
$229,936.01 in monetary benefits for victims of employment 
discrimination.

                              Suits Filed

B. ADEA
    Ford Motor Credit Company No. H-93-2190 (S.D. Tex. filed July 20, 
1993)--age (45); failure to hire.
    North Star Steel Texas, Inc. No. 1:93CV432 (E.D. Tex. filed 
September 3, 1993)--age (73); terms and conditions of employment.

                             Suits Resolved

B. ADEA
    Aristech Chemical Corporation No. H-91-3565 (S.D. Tex. filed 
December 5, 1991)--age (61); discharge; March 5, 1993 consent decree 
providing $27,500 in back pay and liquidated damages for one individual 
and notice posting.
    Loral Space Information Systems No. H-92-1255 (S.D. Tex. filed 
April 22, 1992)--age (52); failure to hire; August 26, 1993 dismissal 
without prejudice, no monetary relief.
    See also, below, Fina Oil and Chemical Co.
C. Title VII/ADEA
    Fina Oil and Chemical Co. No. 1:91CV901 (E.D. Tex. filed November 
13, 1991)--age (56), national origin (Hispanic); continuous denial of 
training, transfer of job responsibilities, discharge; August 31, 1993 
consent decree providing $40,000 in back pay for one individual.
                      indianapolis district office
    Indianapolis filed 13 lawsuits in fiscal year 1993; all suits were 
filed on the merits--9 were filed on behalf of an individual or 
individuals, and 4 were filed on behalf of a class.
    Of these, 3 were filed under Title VII, 6 under the ADEA, and 4 
under Title VII and the Equal Pay Act.
    Indianapolis resolved 120 lawsuits, including 1 subpoena 
enforcement action, in fiscal year 1993 and recovered $211,263.83 in 
monetary benefits for victims of employment discrimination.

                              Suits Filed

B. ADEA
    Crown Point Community School Corporation, Board of Trustees of the 
Crown Point Community School Corporation and Crown Point Education 
Association No. 2:93-CV-RL (N.D. Ind. filed August 16, 1993)--class; 
age (61 or over); benefits.
    Ellas Construction Company, Inc. No. H93-53 (N.D. Ind. filed 
February 19, 1993)--age (60); discharge.
    Regency Windsor Management, Inc. No. IP92-1692C (S.D. Inc. filed 
December 7, 1992)--age (56); discharge.
    The Town of New Chicago and the Board of Metropolitan Police 
Commissioners of the Town of New Chicago. No. 2:93CV-107-JM (N.D. Ind. 
filed April 1, 1993)--age (71); involuntary retirement.
    Trade Winds Rehabilitation Center, Inc. No. H92-0372 (N.D. Ind. 
filed November 16, 1993)--age (61); discharge.
    Waffle House Lebanon, Inc. No. IP93-251C (S.D. Ind. filed February 
24, 1993)--age (53); discharge.

                             Suits Resolved

B. ADEA
    Regency Windsor Management, Inc. No. IP92-1692C (S.D. Ind. filed 
December 7, 1992)--age (56); discharge; July 21, 1993 consent decree 
providing $4,000 in damages for one individual, favorable letter of 
reference, and notice posting.
                      los angeles district office
    Los Angeles filed 10 lawsuits, including 1 temporary retraining 
order, in fiscal year 1993; of the suits filed on the merits, 6 were on 
behalf of an individual or individuals, and 3 on behalf of a class.
    Of the suits filed on the merits, 5 were filed under Title VII, and 
4 were filed under the ADEA.
    Los Angeles resolved 10 lawsuits, including 1 temporary restraining 
order, in fiscal year 1993 and recovered $276,936.73 in monetary 
benefits for victims of employment discrimination.

                              Suits Filed

B. ADEA
    KCAL TV, Inc. No. CV 93-2926 RMT (CTx) (C.D. Cal. Filed May 20, 
1993)--age (49); discharge.
    Ginsburg, Stephan, Oringher & Richman No. CV 93 3799 (LGB) (Bx) 
(C.D. Cal. filed June 28, 1993)--age (67); failure to hire.
    Southwestern Cable Television No. CV 92-1639B (CM) (C.D. Cal. filed 
October 23, 1992)--class; age (40 and over); failure to hire.
    Housing Resources Management, Inc. No. CV 92-7003 ER (SRX) (C.D. 
Cal. filed November 24, 1992)--age (59); failure to promote.

                             Suits Resolved

B. ADEA
    Housing Resources Management, Inc. No. CV 92 7003 ER (JRX) (C.D. 
Cal. filed November 24, 1992)--age (58 and 59); failure to promote; 
April 19, 1993 settlement agreement providing $7,541.89 in back pay for 
two individuals.
                        memphis district office
    Memphis filed 23 lawsuits, including 1 subpoena enforcement action, 
in fiscal year 1993; of the suits filed on the merits, 18 were on 
behalf of an individual or individuals, and 4 on behalf of a class.
    Of the suits filed on the merits, 15 were filed under Title VII, 5 
under the ADEA, and 2 under Title VII and the Equal Pay Act.
    Memphis resolved 18 lawsuits, including 1 subpoena enforcement 
action and 1 temporary restraining order, in fiscal year 1993 and 
recovered $1,268,840.21 in monetary benefits for victims of employment 
discrimination.

                              Suits Filed

B. ADEA
    Allen Petroleum d/b/a Okee Dokee No. 18 No. CIV-2-93-46 (E.D. Tenn. 
filed February 5, 1993)--age (54); discharge.
    Hendrix College No. LRC-93-529 (E.D. Ark. filed July 28, 1993)--age 
(56), recordkeeping violation; failure to retain records.
    Labinal Components and Systems, Inc. and Northern Technologies 
Manufacturing Corporation No. J-C-92-296 (E.D. Ark filed November 12, 
1992)--class; age (40 and over); failure to hire.
    Whithall School District #27 No. PBC-C-92-709 (E.D. Ark filed 
November 12, 1992)--age (49), retaliation; failure to hire.
    Union County, Arkansas No. 92-1150 (W.D. Ark filed November 18, 
1992)--age (46, 59, 63 and 69); constructive discharge.

                             Suits Resolved

B. ADEA
    Airport Properties, Inc. No. 3-92-0299 (M.D. Tenn. filed March 30, 
1992)--age (53); discharge; January 28, 1993 consent decree providing 
$15,906.65 in back pay, interest and liquidated damages for one 
individual, injunction prohibiting age discrimination.
    Commerical Management d/b/a McMahon Properties, Inc. No. 92-2056 
(W.D. Ark. filed March 18, 1992)--age (60); failure to promote; June 
25, 1993 consent decree providing $13,290 in back pay for one 
individual, injunction prohibiting discrimination on the basis of age.
    Harvey Industries, Inc. d/b/a Harve Engineering and Manufacturing 
Corporation No. 92-6003 (W.D. Ark. filed January 9, 1992)--age (61), 
retaliation; failure to hire; November 5, 1992 consent decree awarding 
$47,127.40 in back pay for one individual.
                         miami district office
    Miami filed 26 lawsuits, including 9 subpoena enforcement actions, 
in fiscal year 1993; of the suits filed on the merits, 13 were on 
behalf of an individual or individuals, and 4 on behalf of a class.
    Of the suits filed on the merits, 12 were filed under Title VII and 
5 under the ADEA.
    Miami resolved 18 lawsuits, including 5 subpoena enforcement 
actions, in addition to 1 presuit settlement, in fiscal year 1993 and 
recovered $924,531.93 in monetary benefits for victims of employment 
discrimination.

                              Suits Filed

B. ADEA
    ABC Liquors, Inc. No. 93-679-CIV-ORL-22 (M.D. Fla. filed August 17, 
1993)--age (72); discharge.
    H.I. Development Corporation, Inc. No. 92-2797-CIV-MOORE (S.D. Fla. 
filed December 9, 1992)--age (62); discharge.
    Humana Inc., d/b/a Humana Hospital-Daytona Beach No. 93-168-CIV-
ORL-18 (M.D. Fla. filed March 9, 1993)--age (64); constructive 
discharge.
    Ironhorse No. 93-8504-CIV-ZLOCH (S.D. Fla. filed September 30, 
1993)--age (58); advertising, failure to hire.
    Oil, Chemical and Atomic Workers International Union No. 93-464-
CIV-ORL-22 (M.D. Fla. filed June 15, 1993)--class; age (68); denied 
opportunity to seek elective office in union.

                             Suits Resolved

B. ADEA
    Aircraft Services International, Inc. No. 92-8063-CIV-ZLOCH (S.D. 
Fla. filed February 5, 1992)--breach of conciliation agreement; October 
26, 1992 settlement agreement providing $5,000 in back pay for one 
individual and notice posting.
    E.M.I. Entertainment World, Inc., a Delaware Corporation, f/k/a SBK 
Entertainment World, Inc. No. 90-1764-CIV-MARCUS (S.D. Fla. filed June 
25, 1990)--age (64); discharge; April 15, 1993 consent decree and 
settlement agreement providing $500,000 in back pay and liquidated 
damages for one individual.
    Newham Plastering, Inc. No. 90-942-CIV-ORL-18 (M.D. Fla. filed 
December 17, 1990)--age (64); discharge; October 22, 1992 judgment 
providing $254,445.87 in back pay, interest and liquidated damages for 
one individual.
    Quail Creek Country Club, Inc. No. 90-119-CIV-FTM-99 (M.D. Fla. 
filed May 2, 1990)--retaliation; discharge; November 20, 1992 consent 
decree providing $42,500 in back pay and liquidated damages for one 
individual, reinstatement, injunction against retaliation, reporting 
requirements, and notice posting.
    Steinmart, Inc. No. 92-93-CIV-ORL-22 (M.D. Fla. filed January 27, 
1992)--age (53); failure to hire; February 4, 1993 adverse jury 
verdict.
                       milwaukee district office
    Milwaukee filed 15 lawsuits in fiscal year 1993; all suits were 
filed on the merits--13 were filed on behalf of an individual or 
individuals, and 2 were filed on behalf of a class.
    Of these, 9 were filed under Title VII, 6 were filed under the 
ADEA.
    Milwaukee resolved 17 lawsuits in fiscal year 1993 and recovered 
$464,288.92 in monetary benefits for victims of employment 
discrimination.

                              Suits Filed

B. ADEA
    Hartz Foods, Inc. No. 4-93-476 (D. Minn. filed May 10, 1993)--age 
(59); discharge.
    K-Mart Apparel Corporation No. 3-92-727 (D. Minn. filed October 27, 
1992)--age (44), retaliation; failure to promote.
    Northwest Airlines, Inc. and Airline Pilots Association, 
International (Rule 19 defendant) No. 3-93-547 (D. Minn. filed August 
19, 1993)--class; age (50 and over); failure to hire.
    Royal Insurance Company No. 4-92-CV1030 (D. Minn. filed October 22, 
1992)--age (58); transfer, discharge.
    Svedala Industries, Inc. f/k/a Boliden Allis, Inc. and d/b/a 
Svedala, Inc. or Mineral Processing Systems, and Svedala, Inc. No. 93-
C-1095 (E.D. Wis. filed June 2, 1993)--intervention; class; age (54 and 
older); involuntary retirement, constructive discharge.
    Wendell's Inc. No. 4-92-1170 (D. Minn. filed December 2, 1992)--age 
(56); discharge.

                             Suits Resolved

B. ADEA
    City of Minneapolis No. 4-92-84 (D. Minn. filed January 27, 1992)--
age (59), retaliation; harassment, hostile working environment; April 
6, 1993 consent decree providing $3,221.84 in back pay and compensatory 
damages for one individual.
    LaCrescent School District No. 300 No. 4-91-861 (D. Minn. filed 
October 29, 1991)--age (55); failure to hire; May 20, 1993 consent 
decree providing injunctive relief.
    Northome/Industrial Independent School District No. 363 No. 5-92-19 
(D. Minn. filed February 3, 1992)--age (60), retaliation; failure to 
hire; April 8, 1993 consent decree providing $30,000 in full back pay 
for one individual.
    Wendell's Inc. No. 4-92-1170 (D. Minn. filed December 2, 1992)--age 
(56); discharge; February 9, 1993 consent decree providing $40,000 in 
back pay, interest and liquidated damages for one individual.
C. Title VII/ADEA
    White Castle System, Inc. No. 4-9-973 (D. Minn. filed December 10, 
1991)--age (41), retaliation; failure to hire; December 21, 1992 
consent decree providing $4,000 in back pay for one individual.
                      new orleans district office
    New Orleans filed 15 lawsuits, including 6 subpoena enforcement 
actions and 5 recordkeeping/reporting violations, in fiscal year 1993; 
of the suits filed on the merits, 3 were on behalf of an individual or 
individuals, and 1 was on behalf of a class.
    All suits on the merits were filed under Title VII.
    New Orleans resolved 13 lawsuits, including 4 subpoena enforcement 
actions and 3 reporting violations, in fiscal year 1993 and recovered 
$37,363.67 in monetary benefits for victims of employment 
discrimination.
                        new york district office
    New York filed 28 lawsuits, including 4 subpoena enforcement 
actions, in fiscal year 1993; of the suits filed on the merits, 19 were 
on behalf of an individual or individuals, and 5 on behalf of a class.
    Of the suits filed on the merits, 11 were filed under Title VII, 1 
under the Americans with Disabilities Act, and 12 were filed under the 
ADEA.
    New York resolved 28 lawsuits, including 4 subpoena enforcement 
actions, in fiscal year 1993 and recovered $1,349,235.09 in monetary 
benefits for victims of employment discrimination.

                              Suits Filed

B. ADEA
    American International Group and Morefare Estates No. 93-CV-6390 
(S.D.N.Y. filed September 13, 1993)--age (45 and 54); discharge.
    Amherst Central School District No. 93-CIV-0326 (W.D.N.Y. filed 
April 12, 1993)--age (46); failure to hire.
    Commonwealth of Massachusetts No. 92-12622Y (D. Mass. filed 
November 2, 1992)--class; age (over 60); discharge.
    Doremus & Company No. 93-CIV-3169 (S.D.N.Y. filed May 11, 1993)--
age (58); discharge.
    Ethan Allen, Inc., Ethan Allen Furniture Orleans Division No. 92-
327 (D. Vt. filed October 26, 1992)--age (64); discharge.
    HMK Enterprises, Inc. No. 92-12583 (D. Mass. filed October 27, 
1992)--age (54); discharge.
    Jack Sherman Toyota, Inc. No. 93-CV-807 TJM (N.D.N.Y. filed June 
21, 1993)--age (58); discharge.
    Johnson & Higgins, Inc. No. 93-CV-5481 (S.D.N.Y. filed August 5, 
1993)--class; age (60 and 62); mandatory retirement.
    Kidder Peabody & Company Inc. No. 92-9243 (S.D.N.Y. filed December 
23, 1992)--class; age (over 40); discharge.
    New York State; New York State Division of State Police No. 93-CV-
0477A (W.D.N.Y. filed June 1, 1993)--class; age (over 40); failure to 
permit taking of examination.
    New York City Health & Hospitals Corporation No. 93-CV-6818 
(S.D.N.Y. filed September 29, 1993)--age (59); discharge.
    The New York Cherokee Corporation No. 92-CIV-8800 (S.D.N.Y. filed 
December 8, 1992)--age (56, 73 and 75), retaliation; discharge.

                             Suits Resolved

A. Title VII
B. ADEA
    AMF, Inc. and Minstar, Inc. No. 88-1050 (W.D.N.Y. filed September 
29, 1988)--age (45); layoff; December 21, 1992 settlement agreement 
providing $125,000 in back pay for one individual.
    City of Medford Department of Public Works No. 91-12824K (D. Mass 
filed October 30, 1991)--age (65 and 66); advertising, failure to hire; 
March 11, 1993 consent decree providing $83,610.05 in back pay for two 
individuals, reinstatement and posting of corrective notices.
    Consolidated Edison Company No. 92-CIV-5951 (S.D.N.Y. filed August 
7, 1992)--class; age (49); terms and conditions of employment; March 5, 
1993 settlement agreement whereby defendant ceased policy of requiring 
medical exams (stress test) as condition of employment for individuals 
age 40 and above.
    First Northern Mortgage Corporation No. CV-91-3925 (E.D.N.Y. filed 
October 8, 1991)--age (61), retaliation; discharge; March 29, 1993 
default judgment providing $24,108.79 in back pay for one individual.
    Monroe County, Office of County Attorney No. CV-90-0652L (W.D.N.Y. 
filed June 25, 1990--age (53); discharge; May 5, 1993 consent decrees 
providing $10,000 in back pay for an individual.
    National Football League (NFL) No. 91-CIV-5447 (91-C-1289 and 91-C-
2135) (S.D.N.Y. filed August 13, 1991)--class; age (60); terms and 
conditions of employment, demotion, involuntary transfer, involuntary 
retirement; February 18, 1993 consent decree providing $235,000 for 
three individuals.
    Plymouth Lamston Stores Corporation No. 92-CIV-2793 (S.D.N.Y. filed 
April 17, 1992)--age (65); transfer, discharge; February 8, 1993 court 
order upheld by bankruptcy court providing $168,566.38 in back pay for 
one individual.
    The Institute of Electrical and Electronics Engineers, Inc. No. 92-
CIV-0867 (S.D.N.Y. filed February 4, 1992)--age (63); discharge; May 
12, 1993 consent decree providing $62,500 in back pay for one 
individual.
C. Title VII/ADEA
    Async Corporation No. 92-CIV-2790 (S.D.N.Y. filed April 20, 1992)--
age (42), race (black); failure to hire; May 4, 1993 consent decree 
providing $55,000 in back pay for one individual.
                      philadelphia district office
    Philadelphia filed 40 lawsuits, including 9 subpoena enforcement 
actions in fiscal year 1993; of the suits filed on the merits, 29 were 
on behalf of an individual or individuals, and 2 on behalf of a class.
    Of the suits filed on the merits, 16 were filed under Title VII, 14 
under the ADEA and 1 under Title VII and the Equal Pay Act.
    Philadelphia resolved 28 lawsuits, including 8 subpoena enforcement 
actions, in addition to 1 presuit settlement, in fiscal year 1993, and 
recovered $538,529.65 in monetary benefits for victims of employment 
discrimination.

                              Suits Filed

B. ADEA
    Braddock Medical Center No. 93-0990 (W.D. Pa. filed June 23, 
1993)--retaliation; denial of reinstatement, failure to rehire.
    Children's Hospital No. 93-1613 (W.D. Pa. filed September 30, 
1993)--class; age (65 and over); terms and conditions of employment.
    CIC Corporation/Runyon Music, Inc. No. 93-1524 (WGB) (D.N.J. filed 
April 7, 1993)--class; age (70 and 79); involuntary retirement, 
discharge.
    Citizens First National Bank of New Jersey No. 93-1229 (D.N.J. 
filed March 22, 1993)--age (61); discharge.
    Equitable Resources No. 93-1478 (W.D. Pa. filed September 3, 
1993)--age (53); failure to promote.
    Famous Supply Company a/k/a The Famous Manufacturing Company No. 
93-0698 (W.D. Pa. filed May 7, 1993)--age (62); discharge.
    Insurance Company of North America (Cigna Companies) No. 93-CV-3476 
(E.D. Pa. filed June 29, 1993)--age (48); layoff, failure to rehire.
    M.H. Detrick Company No. 93-1569 (MTB) (D.N.J. filed April 13, 
1993)--age (49); discharge.
    Martin Oil Company No. 93-72J (W.D. Pa. filed March 8, 1993)--age 
(43); permanent layoff.
    MECO International, Inc. No. 93-1319 (W.D. Pa. filed August 10, 
1993)--age (47); discharge.
    Medical Center of Ocean County No. 92-4352 (CSF) (D.N.J. filed 
October 8, 1992)--retaliation; discharge.
    Neward Board of Education No. 93-4360 (MTB) (D.N.J. filed September 
30, 1993)--age (52); harassment.
    The Equitable Life Assurance Society of the United States No. 92-
CV-5215 (JHR) (D.N.J. filed December 4, 1992)--retaliation; discharge.
    Westinghouse Electric Corporation No. 93-0581 (W.D. Pa. filed April 
13, 1993)--age (60); involuntary retirement.

                             Suits Resolved

B. ADEA
    Concurrent Computer Corporation No. 92-219 (MLP) (D.N.J. filed 
January 10, 1992)--age (47); discharge; August 17, 1993 summary 
judgment in favor of defendant.
    General Electric Company No. 92-CV-1120 (E.D. Pa. filed February 
25, 1992)--age (57); discharge; September 9, 1993 settlement agreement 
providing reinstatement for one individual.
    Hugin Sweda, Inc. No. 90-2648 (JAP) (D.N.J. filed July 5, 1990)--
age (40 and 53); layoff; October 8, 1992 settlement agreement providing 
$200,000 in back pay for two individuals.
    ITT Avionics Division, ITT Corporation No. 92-793 (MTB) (D.N.J. 
filed February 20, 1992)--age (60); discharge; July 10, 1993 order 
granting summary judgment to defendant.
    Pope & Talbot WIS, Inc. No. 3:CV-92-1122 (M.D. Pa. filed August 18, 
1992)--age (62); failure to hire; January 22, 1993 settlement agreement 
providing $17,690.14 in back pay for one individual.
    Southeastern Pennsylvania Transportation Authority No. 92-CV-3927 
(E.D. Pa. filed July 7, 1992)--class; age (40 and over); failure to 
hire; July 26, 1993 settlement agreement providing $37,500 in back pay 
and reinstatement for one individual.
    The Equitable Life Assurance Society of the United States No. 92-
CV-5215 (JHR) (D.N.J. filed December 4, 1992)--retaliation; discharge; 
August 9, 1993 settlement agreement providing $12,500 in back pay for 
one individual.
                        phoenix district office
    Phoenix filed 26 lawsuits, including 2 subpoena enforcement 
actions, in fiscal year 1993; of the suits filed on the merits, 17 were 
on behalf of an individual or individuals, and 7 on behalf of a class.
    Of the suits filed on the merits, 19 were filed under Title VII, 3 
under the ADEA, and 2 under Title VII and the ADEA.
    Phoenix resolved 19 lawsuits, including 4 subpoena enforcement 
actions, in addition to 3 presuit settlements, in fiscal year 1993 and 
recovered $251,157.89 in monetary benefits for victims of employment 
discrimination.

                              Suits Filed

B. ADEA
    California Micro Devices Corporation No. 93-1024 PHX SMM (D. Ariz. 
filed June 1, 1993)--age (62); layoff, discharge.
    T&J Jewelry, Inc. No. CIV92-1948 PHX EHC (D. Ariz. filed October 
19, 1992)--age (65 and 68); wages, discharge.
    Bell Gas, Inc. No. CIV92-1320 JP (D.N.M. filed November 18, 1992)--
age (69); discharge.
C. Title VII/ADEA
    JB's Restaurants, Inc. No. 93-0773-S-C (D.N.M. filed June 24, 
1993)--age (60), race (black); failure to promote, terms and conditions 
of employment, constructive discharge.
    SER, Jobs for Progress, Inc. No. CIV92-0968 HB (D.N.M. filed August 
24, 1993)--age (63), sex (female); failure to promote.

                             Suits Resolved

B. ADEA
    Albuquerque Publishing Company No. 90-0258 M (D.N.M. filed March 
14, 1990)--age (67); discharge; July 13, 1993 settlement agreement 
providing $15,000 in back pay and interest for three individuals.
    Bell Gas, Inc. No. CIV-92-1320 JP (D.N.M. filed November 18, 
1992)--age (69); discharge; June 11, 1993 consent decree providing 
$10,482.73 in back pay and interest for one individual and notice 
posting.
    T&J Jewelry, Inc. No. CIV-92-1948 PHX EHC (D. Ariz. filed October 
19, 1992)--age (65 and 68); wages, discharge; July 30, 1993 consent 
decree providing $15,250 in back pay and interest for two individuals.
                      san antonio district office
    San Antonio filed 21 lawsuits in fiscal year 1993; all suits were 
filed on the merits--18 were filed on behalf of an individual or 
individuals, and 3 were filed on behalf of a class.
    Fourteen cases were filed under Title VII, 5 under the ADEA, 1 
under Title VII and the ADEA, and 1 under Title VII and the Equal Pay 
Act.
    San Antonio resolved 13 lawsuits in fiscal year 1993 and recovered 
$91,332.51 in monetary benefits for victims of employment 
discrimination.
B. ADEA
    Conquest Airlines Corporation No. A-93-CA-402JN (W.D. Tex. filed 
July 7, 1993)--age (46); failure to hire, recordkeeping violation.
    Electrolux Corporation/Electrolux, Inc. No. EP-92-CA-342(B) 
(consolidated with No. EP-92-CA-144(B) filed May 8, 1992) (W.D. Tex. 
filed November 6, 1992)--age (63); layoff.
    KGBT-TV, L.P. NO. B-93-177 (S.D. Tex. filed August 31, 1993)--age 
(67), retaliation; discharge.
    Union Carbide Chemicals & Plastics Company, Inc. No. V-92-058 (S.D. 
Tex. filed November 12, 1992)--age (49); failure to hire.
    Winns Stores, Inc. No. SA-892-CA-1210 (W.D. Tex. filed December 31, 
1992)--age (74); harassment, constructive discharge.
    Electrolux Inc./Electrolux Corporation Nos. EP-92-CA-144(B) and EP-
92-CA-342(B) (W.D. Tex. filed May 8, 1992 and November 6, 1992)--age 
(62); terms and conditions of employment, layoff; March 1, 1993 consent 
decree providing $22,500 in back pay for one individual.
    County of Hidalgo No. M-92-078 (S.D. Tex. filed April 7, 1992)--age 
(66); discharge; October 22, 1992 consent decree providing $9,000 in 
back pay for one individual.
    Winn's Stores, Inc. No. SA-92-CA-1210 (W.D. Tex. filed December 2, 
1992)--age (74); constructive discharge; March 22, 1993 consent decree 
providing $134.79 in back pay for one individual.
                     san francisco district office
    San Francisco filed 10 lawsuits in fiscal year 1993; all suits were 
filed on the merits - 8 were filed on behalf of an individual or 
individuals, and 2 were filed on behalf of a class.
    Eight cases were filed under Title VII, 1 under the ADEA, and 1 
under Title VII and the Equal Pay Act.
    San Francisco resolved 14 lawsuits, in addition to 1 presuit 
settlement, in fiscal year 1993 and recovered $1,866,179.24 in monetary 
benefits for victims of employment discrimination.

                              Suits Filed

B. ADEA
    Naismith Dental Corporation No. C-93-0134-WHO (N.D. Cal. Filed 
January 13, 1993)--age (70); discharge.
    American Airlines, Inc. No. C-92-20477-SW (N.D. Cal. Filed July 28, 
1992)--age (59); failure to hire; April 21, 1993 settlement agreement 
providing $15,000 in back pay and liquidated damages for one 
individual.
    Grumman Systems Support Corporation No. C-92-2273MHP (N.D. Cal. 
Filed June 17, 1992)--age (52); failure to hire; February 24, 1993 
consent decree providing $60,000 in back pay and liquidated damages for 
one individual.
    Loftin Associates, Inc. d/b/a Ormsby House Hotel/Casino No. CV-N-90 
593-H DM (D. Nev. filed December 21, 1990)--age (62); discharge, 
failure to rehire; November 13, 1992 consent decree providing $30,000 
in back pay for one individual.
    Naismith Dental Corporation No. C-93-0134 WHO (N.D. Cal. filed 
January 13, 1993)--age (70); discharge; May 18, 1993 settlement 
agreement providing $32,500 in back pay and liquidated damages for one 
individual.
    See also, below, Transworld Placement, Inc. d/b/a Interplace.
C. Title VII/ADEA
    Transworld Placement, Inc. d/b/a Interplace No C-91-0694-SAW (N.D. 
Ca. filed March 11, 1991)--class; race, sex, national origin, age; 
recordkeeping violation; failure to refer for employment, failure to 
hire; October 5, 1992 consent decree providing comprehensive injunctive 
relief with recordkeeping and reporting requirements, $2,000,000 
settlement fund which includes a back pay distribution of an estimated 
$1,420,000 to 3,271 class members, $35,000 in back pay and liquidated 
damages for two individuals, and $100,000 in compensatory damages for 
members of a class of African Americans represented by a private 
intervenor.
    Aeronautical Radio, Inc. and ARINC Inc. No. 92-00364 SPK (D. Hawaii 
filed June 8, 1992)--age (59); sex (male); failure to promote; May 24, 
1993 settlement agreement providing $35,556 in back pay for one 
individual.
                        seattle district office
    Seattle filed 15 lawsuits in fiscal year 1993; all suits were filed 
on the merits--14 were filed on behalf of an individual or individuals, 
and 1 was filed on behalf of a class.
    Fourteen cases were filed under Title VII and 1 under the ADEA.
    Seattle resolved 18 lawsuits in fiscal year 1993 and recovered 
$590,182.16 in monetary benefits for victims of employment 
discrimination.

                              Suits Filed

B. ADEA
    Pape' Lift, Inc. d/b/a Hyster Sales Company No. 93-11RE (D. Or. 
filed January 4, 1993)--age (60); discharge.
    Cashmere Valley Bank No. CS-92-0136-WFN (E.D. Wash. filed March 30, 
1992)--age (65); mandatory retirement; October 19, 1992 consent decree 
providing $50,000 in back pay, interest, benefits and liquidated 
damages for one individual, as well as posting, internal complaint 
procedure, management training and reports for three years on training 
and compliance.
    Ratelco Properties Corp. d/b/a Ratelco, Inc. No. 92-636-WD (W.D. 
Wash. filed April 15, 1992)--age (59); failure to hire; January 25, 
1993 settlement agreement providing $30,000 in back pay for one 
individual, establishment of policy prohibiting age discrimination, 
internal complaint procedure, supervisory training and notice posting.
    Wyeth-Ayerst Laboratories No. C91-1620 Z (W.D. Wash. filed November 
20, 1991)--age (57); terms and conditions of employment; June 23, 1993 
consent decree providing $17,500 in back pay for one individual.
                       st. louis district office
    St. Louis filed 22 lawsuits, including 3 subpoena enforcement 
actions and 1 reporting/recordkeeping violation, in fiscal year 1993; 
of the suits filed on the merits, 12 were on behalf of an individual or 
individuals, and 6 on behalf of a class.
    Of the suits filed on the merits, 11 were filed under Title VII, 6 
under the ADEA, and 1 under Title VII and Equal Pay Act.
    St. Louis resolved 21 lawsuits, including 1 subpoena enforcement 
action, in addition to 4 presuit settlements, in fiscal year 1993 and 
recovered $20,997,108.40 in monetary benefits for victims of employment 
discrimination.

                              Suits Filed

B. ADEA
    ANR Freight Systems, Inc. No. 4:92CV002041GFG (E.D. Mo. filed 
October 8, 1992)--age (59); discharge, failure to rehire.
    Hettich Manufacturing, L.P. No. 93-0517-CV-W-1 (E.D. Mo. filed May 
26, 1993)--age (54 and 58); failure to reassign, layoff.
    McDonnell Douglas Corporation No. 4:93CV00526 (E.D. Mo. filed March 
1, 1993)--class; age (55 and over); layoff, involuntary retirement.
    Normandy School District No. 4:93CV001413-ELF (E.D. Mo. filed June 
16, 1993)--age (52); discharge, failure to rehire.
    Pea Ridge Iron Ore Company, Inc. No. 4:93CV001413-ELF (E.D. Mo. 
filed June 16, 1993)--age (52); discharge, failure to rehire.
    Synergy Gas Corporation No. 93-0758-CV-W-3 (W.D. Mo. filed August 
10, 1993)--age (61); discharge.
C. Title VII/Equal Pay Act
    Signet Graphic Products, Inc. No. 4:92CV002373ELF (E.D. Mo. filed 
November 25, 1992)--class; sex (female); wages.
B. ADEA
    Caruthersville Shipyard, Inc. No. 4:92CV01008 (E.D. Mo. filed May 
27, 1992)--age (72); discharge; May 28, 1993 settlement agreement 
providing $35,000 in back pay and interest for three individuals.
    City of St. Louis Employee Retirement System Board of Trustees, et 
al. No. 91-2003-C-7 (E.D. Mo. filed September 30, 1991)--class; age (60 
and over); pension benefits; February 1, 1993 consent decree providing 
$443,355.68 in back pay and pension enhancement for 38 individuals.
    Golf Discount of St. Louis, Inc. No. 4:92CV00767 (E.D. Mo. filed 
April 23, 1992)--age (54); failure to hire, recordkeeping violations; 
November 25, 1992 consent decree providing $13,008.45 in back pay, pre-
judgment interest and liquidated damages.
    Hettich Manufacturing, L.P. No. 93-0517-CV-W-1 (W.D. Mo. filed May 
26, 1993--age (54 and 58); failure to reassign, layoff; September 15, 
1993 consent decree providing $160,000 in back pay, front pay, and 
liquidated damages for two individuals.
    McDonnell Douglas Corporation No. 4:93CV00526 (E.D. Mo. filed March 
1, 1993)--class; age (55 and over); layoff, involuntary retirement; 
August 12, 1993 consent decree providing $20,100,000 in back pay and 
pension enhancement for approximately 940 class members.
    Normandy School District No. 4:93CV01433 JCH (E.D. Mo. filed June 
17, 1993)--age (59); failure to promote; August 16, 1993 consent decree 
providing $14,044.62 in back pay and liquidated damages for one 
individual.
    Plattner's Modern Department Stores, Inc. No. 4:92CV00836 (E.D. Mo. 
filed April 30, 1992)--age (40 and 56), retaliation; reduced severance 
benefits, discharge; January 22, 1993 consent decree providing $14,500 
in back pay and liquidated damages for three individuals.

               ITEM 19. FEDERAL COMMUNICATIONS COMMISSION

    We are pleased to report that we have expanded our outreach to 
recruitment activities. Through our contacts within organizations such 
as Forty Plus of Greater Washington we have been successful in 
employing several individuals who have brought great breadth of 
experience to the FCC.

                   ITEM 20. FEDERAL TRADE COMMISSION

 STAFF SUMMARY OF FEDERAL TRADE COMMISSION ACTIVITIES AFFECTING OLDER 
                         AMERICANS--1994 REPORT

    This report discusses the Federal Trade Commission's activities of 
particular significance for older consumers in fiscal year 1994. The 
first section of the report describes activities relating to the health 
concerns of older consumers. Older consumers in general experience more 
health problems and therefore may be more vulnerable to injury from 
anticompetitive conduct in health care markets or from misleading 
claims made about the health related benefits of a product or service. 
The second section discusses Commission law enforcement activities of 
particular importance to older consumers in other areas. The final 
section of the report addresses the Commission's relevant consumer 
education initiatives that may benefit the elderly. The report also 
includes discussion of some calendar year 1994 developments that fall 
within fiscal year 1995.

                       Health Related Activities

    While health care is a subject of concern for all of our citizens, 
it is of disproportionate concern to the aging. A substantial portion 
of the Commission's antitrust law enforcement activity is aimed at 
ensuring that competition among providers of health care goods and 
services is not unlawfully impaired. This activity contributes both to 
cost containment and to the maintenance of quality in health care. 
Similarly, a significant portion of the Commission's consumer 
protection work helps to ensure that consumers are not harmed by false 
or deceptive claims for health related benefits of various products or 
services.
                  antitrust guidance to private actors
    Last year's report noted that the rapid evolution of health care 
markets, in response to pressures for cost containment, had created 
concerns that uncertainty about the impact of antitrust enforcement in 
this sector might impede efficient, procompetitive combinations and 
collaborations. In response to these concerns, the Commission and the 
Department of Justice Antitrust Division had jointly issued, in 
September 1993, their Statements of Antitrust Enforcement Policy in the 
Health Care Area. These statements defined ``antitrust safety zones'' 
for health care activity in various areas; these ``safety zones'' 
identified conduct that will not be challenged, absent extraordinary 
circumstances, by the agencies. Additionally, for conduct falling 
outside these ``safety zones,'' the statements explained how the 
agencies will analyze the conduct to determine its legality. Finally, 
the statements highlighted the availability of Commission advisory 
opinion and Justice Department Antitrust Division business review 
procedures and, for the first time, adopted time limits for agency 
answers to most health industry requests.
    Subsequently, in September 1994, the Commission and the Antitrust 
Division issued updated and expended Statements of Enforcement Policy. 
The new statements include policies covering three new areas, and 
expand the ``antitrust safety zones'' for several others. As with the 
1993 statements, the new and updated policy guidelines are intended to 
clarify what health care providers can do together with little or no 
antitrust risk.
    One of the new statements describes a rule-of-reason framework for 
analyzing hospital joint ventures formed to provide specialized 
clinical or other expensive health care services such as open-heart 
surgery. This statement does not include an antitrust safety zone 
because the agencies felt they did not yet have enough experience with 
such joint ventures to define one.
    Another new statement covers the collective provision of fee 
related information by health care providers to purchasers of health 
care services. A safety zone is available if: (1) The collection of the 
information is managed by a third party; (2) any information that is 
shared among competing providers is at least 3 months old--although 
information provided only to purchasers may be current; and (3) 
information shared among the providers aggregates data for at least 
five providers, with no individual provider's data representing more 
than 25 percent of the reported statistic on a weighted basis, and the 
aggregation of data is such that recipients cannot identify the prices 
charged by any individual provider.
    The third new statement covers multiprovider networks, which may 
include providers that otherwise compete, as well as providers offering 
complementary or unrelated services. One example is a physician-
hospital organization. A wide variety of such networks are beginning to 
appear, and they may present vertical as well as horizontal antitrust 
issues. Because such organizations are relatively new, again the 
agencies determined that they lack the experience needed to define a 
safety zone. Therefore, the policy statement is limited to a 
description of the framework within which such ventures will be 
analyzed.
    The new statements also broaden the safety zone for physician 
network joint ventures that are nonexclusive, because they are less 
likely to foreclose competition than exclusive joint ventures, and 
broaden some other provisions as well. In the attempt to flush out the 
policy statements in the context of concrete facts, Commission staff 
has provided substantial guidance in the form of advisory opinions 
analyzing proposed ventures on a case-by-case basis.
                         health care regulation
    The staff of the Commission continued in 1994 to monitor restraints 
imposed by existing or proposed regulations and actions that could 
raise costs to consumers by reducing competition in the health care 
industry without providing countervailing benefits to consumers. As 
part of the Commission's competition advocacy program,\1\ Omission 
staff testified before the Vermont legislature on a proposal to exempt 
certain cooperative agreements among health care providers from 
antitrust oversight. Staff testified that such a proposal runs a risk 
of encouraging or permitting agreements that could reduce choices of 
and raise prices for health care services.
---------------------------------------------------------------------------
    \1\ Staff advocacy comments and testimony are authorized by the 
Commission but are not substantively approved by the Commission and do 
not necessarily reflect the views of the Commission or any individual 
Commissioner.
---------------------------------------------------------------------------
  antitrust law enforcement in the health care sector hospital mergers
    As in other industries, the Commission challenges only those 
mergers that it has reason to believe are likely to have 
anticompetitive results, and it seeks a remedy that is carefully 
tailored to eliminate only the anticompetitive part of the transaction 
while allowing the remainder to proceed.
    In 1994, the Commission initiated new enforcement actions against 
eight hospital mergers. The Commission authorized the staff to seek a 
preliminary injunction against four: Sisters of Charity Health Care 
Systems/Parkview Episcopal Medical Center; HealthTrust Inc./Holy Cross 
Health Services of Utah; Lee Memorial Hospital/Cape Coral Hospital; and 
Port Huron Hospital/Mercy Hospital. The Sisters of Charity/Parkview 
transaction was abandoned, and no complaint was filed. The HealthTrust/
Holy Cross transaction was resolved with a consent agreement before a 
complaint was filed. With respect to Lee Memorial, the Commission 
challenged the acquisition by a municipal hospital of its only 
significant competitor. The parties claimed that the acquisition was 
immunized under the State action doctrine by a State statute that 
permitted the hospital to acquire property. Although the district court 
and a panel of the Eleventh Circuit Court of Appeals accepted that 
argument, the transaction was abandoned and the hospital was purchased 
by an entity that did not raise competitive problems. The Port Huron 
case is still pending resolution at this time.
    In addition, the Commission issued a final consent order involving 
Columbia Healthcare Corporation's acquisition of HCA Hospital 
Corporation of America. This case in particular demonstrated the 
Commission's sharply focused approach to antitrust remedies. These two 
multi-hospital chains owned 87 and 72 hospitals respectively. When they 
proposed to merge, the Commission, after surveying some 17 local 
overlaps, remained concerned only about the overlap in the area of 
Augusta, Georgia. As part of a settlement agreement the two firms 
agreed to divest the HCA hospital in that market. The Commission did 
not challenge other aspects of the merger.
    The Commission also accepted and made final a consent order in 
connection with Columbia/HCA Healthcare Corp.'s subsequent acquisition 
of Medical Care America, Inc. The consent order requires the 
divestiture of an outpatient surgical center in Anchorage, Alaska.
    Near the end of 1994, the Commission accepted for public comment 
two more consent agreements in hospital merger cases. In Charter 
Medical Corporation's acquisition of National Medical Enterprise's 
psychiatric facilities, Charter agreed to modify its purchase agreement 
to delete acquisition of the NME facilities in four geographic 
markets--Atlanta, Memphis, Orlando, and Richmond--in which the 
Commission alleged that the acquisition would substantially lessen 
competition in the psychiatric care market. The second such consent 
agreement held particular significance for aging citizens. In the 
merger of HEALTHSOUTH Rehabilitation Corporation, the Nation's leading 
operator of rehabilitation hospitals and other rehabilitation 
facilities, totaling about 240 in 34 States, with ReLife Inc., which 
operates more than 40 rehabilitation facilities in 12 States, 
HEALTHSOUTH agreed to divest a hospital in one market and to terminate 
management contracts to operate rehabilitation units at hospitals in 
two other markets. The Commission alleged that competition in 
rehabilitation services would otherwise be substantially reduced in 
these markets.
    Finally, in Adventist Health System, a case that was litigated 
before the Commission and discussed initially in last year's report, 
the Commission heard the matter on appeal from a decision by an 
administrative law judge and dismissed the complaint after finding that 
the evidence developed at trial did not support complaint counsel's 
geographic market definition.
                           physician conduct
    During 1994, the Commission accepted one consent agreement for 
public comment and issued one final consent order in cases alleging 
anticompetitive joint conduct by physicians. The Commission accepted 
and made final a consent order with Trauma Associates of North Broward, 
Inc., and 10 surgeons in Broward County, Florida, settling charges that 
they illegally conspired to fix the fees they were paid for their 
services at the trauma centers at two area hospitals. The Commission 
alleged that when the North Broward Hospital District refused to meet 
the group's unlawful joint demands, the surgeons staged a walkout, 
forcing one of the centers to close. The order requires the dissolution 
of Trauma Associates within 180 days, and, prior to its dissolution, 
Trauma Associates is required to give copies of the settlement to any 
entity with whom it has entered into contract negotiations for trauma 
surgical services since its inception. In addition, the order prohibits 
the surgeons from entering into any agreements of the type at issue in 
the future.
    In the other case, the Commission accepted an agreement with the 
medical staff of Good Samaritan Regional Medical Center in Phoenix, 
Arizona. The agreement was to settle charges that the staff members 
conspired to boycott, or threaten to boycott, the hospital, to include 
it to end its ownership interest in the Samaritan Physicians Center, a 
multi-specialty physicians' clinic that would have competed with the 
medical staff. Under the agreement, members of the medical staff would 
be prohibited from agreeing, or attempting to agree, to prevent or 
restrict the services offered by Good Samaritan, the Samaritan 
Physicians Center, or any other health care provider.
mergers in manufacture and distribution of pharmaceuticals and medical 
                                devices
    It has been reported that the roughly 13 percent of our population 
over the age of 65 consumes more than a third of all prescription drugs 
dispensed, and that this percentage is increasing. This report confirms 
that the pharmaceutical and medical device industries have 
disproportionate impact on older citizens. The Commission was quite 
active during 1994 in the role of protecting competition in this area, 
focusing on oversight of merger activity in both the manufacturing and 
distribution sectors.
    In the manufacturing sector, Roche Holding Ltd.'s proposed 
acquisition of Snytex Corp. raised concerns in the market for drug 
abuse testing products. A consent order issued in 1994 requires Roche 
to divest the Syntex subsidiary engaged in that market. The Commission 
also took action in 1994 regarding the acquisition of Rugby-Darby Group 
by Marion Merrell Dow, Inc., which eliminated competition between the 
only two FDA-approved producers of dicyclomine, a medication used in 
the treatment of irritable bowel syndrome. The final consent order 
requires Marion to license its dicyclomine formulations and production 
technology to a third party. In addition, the consent order requires 
Marion to contract-manufacture dicyclomine for that third party while 
that party awaits FDA approval to sell its own dicyclomine.
    The Commission accepted for comment a consent agreement with the 
American Home Products Corporation (AHP), settling charges that its 
$9.7 billion acquisition of American Cyanamid Company (Cyanamid) could 
substantially lessen competition in the U.S. market for tetanus and 
diptheria vaccines, for certain biotechnology drugs used in treating 
cancer, and for research for a vaccine to treat rotavirus, a diarrheal 
disease that causes thousands of children's deaths annually. Under the 
agreement, AHP would divest its tetanus and diptheria vaccine business 
to a Commission-approved buyer, and manufacture the vaccines for the 
buyer, under contract, while the buyer awaits Food and Drug 
Administration approval to manufacture them. In addition, AHP would 
license Cyanamid's rotavirus vaccine research to a Commission-approved 
licensee and provide the licensee with certain technical assistance. 
The order would also require that AHP change a previously-established 
licensing agreement to assure that it does not obtain competitively-
sensitive data about a class of drugs used in chemotherapy.
    In early December, the Commission accepted for comment a consent 
agreement with Wright Medical Technology, Inc., to settle charges that 
Wright's proposed acquisition of Orthomet, Inc., would eliminate 
potential competition in the market for the sale of orthopaedic 
implants used in human hands. In addition, the Commission alleged that 
actual competition between the companies in research and development 
for such implants would be eliminated. The proposed settlement would 
restore competition by requiring Wright to transfer to the Mayo 
Foundation, the licensor of the implant technology to Orthomet, a 
complete copy of all assets relating to Orthomet's business of 
researching and developing these implants, enabling the Mayo Foundation 
either to find another nonexclusive license in addition to Wright, or 
to grant an exclusive license to an entity other than Wright.
    Also, in late December, the Commission accepted for comment a 
consent agreement to settle charges arising from the planned 
acquisition of Zenith Laboratories by IVAX Corporation. The two 
companies are the only marketers of a generic drug used to treat 
patients with chronic cardiac conditions--verapamil in the extended-
release form--in the U.S. market. Under the agreement, IVAX would be 
prohibited from acquiring any rights to market or sell the drug 
pursuant to Zenith's exclusive distribution agreement with G.D. Searle 
& Co. Separately, Zenith and Searle have terminated their agreement and 
Zenith has agreed to transfer its customers to Searle, or to a firm 
that Searle designates. The settlement would help to ensure that two 
independent competitors will remain in the market.
    In November 1994, the Commission accepted for comment a consent 
agreement affecting competition at both the production and distribution 
levels of the pharmaceutical industry. Eli Lilly and Company agreed to 
settle Commission charges that its approximately $4 billion acquisition 
of McKesson Corporation and its prescription management business, PCS 
Health Systems, Inc., would substantially lessen competition in the 
manufacture and distribution of pharmaceuticals. The settlement would 
require Lilly to take steps, including the establishment of an open 
formulary, to ensure that Lilly drugs are not given unwarranted 
preference over those of its competitors in connection with the 
pharmacy-benefit management services Lilly will provide to health 
insurers and others as a result of the acquisition. Lilly also agreed 
to build a ``fire wall'' between its pharmaceutical sales business and 
PCS's pharmacy benefits management business to ensure that one division 
of the company does not gain access to sensitive information about 
competitors' drugs from another division.
    The Commission challenged three mergers at the retail level to 
protect competition in the prescription pharmaceutical industry. In 
August, the Commission issued a final consent order in connection the 
TCH Corp.'s acquisition of the PayLess drug store chain. TCH already 
owned the Thrifty and Bi-Mart drug store chains. To resolve its 
competitive concerns, the Commission required the divestiture of drug 
stores in six towns. In the second case of that type, the Commission 
issued a final consent order in connection with Revco D.S., Inc.'s 
acquisition of Hook-SupeRx, Inc. That consent order required 
divestitures in three geographic markets. In the third such case, the 
Commission accepted for public comment a consent order that would 
resolve concerns over Rite Aid Corporation's acquisition of 
LaVerdiere's Enterprises, Inc. The consent order would require the 
divestiture of retail pharmacy assets in three towns.
      consumer protection in health related matters--hearing aids
    In 1994, the Commission filed order-enforcement actions against two 
of the largest hearing-aid manufacturers in the United States. On 
January 25, 1994, the Commission filed a complaint charging Dahlberg, 
Inc., maker of the ``Miracle-Ear'' brand of hearing aids, with 
violating a 1976 FTC order by making numerous allegedly false and 
unsubstantiated claims about its Miracle-Ear ``Clarifier,'' purportedly 
a ``noise-suppression'' hearing aid. These claims included assertions 
that the Clarifier focuses its amplification on sounds the user wants 
to hear, such as speech, and reduces all unwanted background noise. The 
action against Dahlberg currently is in litigation. The Commission also 
obtained an $825,000 civil penalty as part of a settlement with Beltone 
Electronics Corporation, filed in court on December 20, 1994, resolving 
alleged violations of a 1976 FTC order. The alleged violations included 
false and unsubstantiated claims that Beltone's ClearVoice and Voice 
Enhancer hearing aids focus amplification on sounds the user wants to 
hear, such as speech, and do not amplify background noise.
             health claims for food and dietary supplements
    Consumers rely on the truthfulness of health claims for food and 
dietary supplements when making purchasing decisions. Senior citizens, 
because of special dietary requirements or other health concerns, may 
be particularly vulnerable to misleading claims for such products. The 
Commission continues to be active in this area, and, since last year, 
it has taken several important steps.
    In the administrative litigation against Stouffer Foods, the 
Commission upheld an administrative law judge's finding in 1993 that 
Stouffer's low sodium claims in advertisements for its ``Lean Cuisine'' 
line of frozen-food entrees were false and misleading. The Commission 
also approved final consent orders against Eggland's Best, Inc. 
(alleged claims that Eggland's eggs will not increase consumers' serum 
cholesterol, and that they are superior to regular eggs in this 
respect); Haagen-Dazs Company, Inc. (alleged low-fat and calorie claims 
for frozen yogurt products); and, Presto Food Products, Inc. (alleged 
misrepresentations about the amount of total fat or saturated fat in 
Mocha Mix and Mocha Mix Lite liquid nondairy creamer products). In 
addition, the Commission staff is actively investigating approximately 
20 possible deceptive food advertisements.
    In addition, in 1994, the Commission issued a food advertising 
enforcement policy statement which explained how the Commission would 
apply its laws to food advertising in light of the Nutritional Labeling 
and Education Act of 1990 and the food labeling regulations promulgated 
by the Food and Drug Administration (FDA) and the Department of 
Agriculture to implement that legislation. The enforcement policy 
statement describes how the Commission will harmonize its advertising 
enforcement policy with the requirements of other agencies responsible 
for food labeling in order to provide a consistent Federal approach to 
food advertising and labeling regulation.
    In the area of dietary supplements, the Commission filed an 
administrative complaint against Metagenics, Inc., challenging 
allegedly exaggerated osteoporosis prevention and bone rebuilding 
claims for its calcium supplement; entered a settlement with RN 
Nutrition regarding similar claims for the same product; and accepted a 
consent agreement with Bee-Sweet, Inc., regarding advertising claims 
that the company's bee pollen products could treat several physical 
ailments including anemia, allergies, arthritis, and arteriosclerosis, 
as well as weight problems. Litigation with Schering Corporation over 
allegedly unsubstantiated weight loss and health benefit claims for its 
fiber supplement was also resolved through settlement. The Commission's 
complaint against National Dietary Research, challenging claims for 
purported weight loss and cholesterol reduction products, was withdrawn 
from adjudication pending approval of a consent agreement with the 
company.
    In 1994, the Commission also charged General Nutrition Corporation 
(GNC), the largest retailer of nutritional supplements in the United 
States, with violating two previous Commission cease and desist orders 
by failing to substantiate claims of health benefits for more than 40 
products. Included among the challenged representations were claims 
that GNC's nutritional supplements could cure, treat, prevent, or 
reduce the risk of developing diseases (including arthritis); would be 
of benefit in the prevention, relief or treatment of tiredness, 
listlessness, or fatigue; would assist in weight loss; or would prevent 
or retard hair loss. The Commission accepted a $2.4 million civil 
penalty (the largest ever obtained in a Commission advertising case) in 
a settlement with GNC. The GNC case was closely followed by a $1.4 
million settlement with L & S Research Corp. for allegedly deceptive 
claims regarding weight-loss and muscle-building products.
    The Dietary Supplement Health and Education Act of 1994 was enacted 
in October. As with the Nutrition Labeling and Education Act of 1990, 
this law applies only to the labeling, not advertising of supplements. 
Within its own statutory mandate, however, the FTC will maintain a 
consistent enforcement policy, just as it has done in the area of food 
advertising.
               over-the-counter drugs and medical devices
    Senior citizens rely heavily on the truthfulness of advertising 
claims for over-the-counter (OTC) drugs and medical devices. While the 
Commission has primary responsibility for ensuring that advertising for 
these products is truthful and nondeceptive, the FDA exercises primary 
jurisdiction with respect to the labeling of such products and their 
safety.
    Pursuant to a stipulated permanent injunction involving vision-
improvement claims for ``pinhole'' eyeglasses, including claims that 
wearing Vision Clear Glasses can effectively cure or correct any vision 
problem, a consumer redress program has made $425,000 available to 
purchasers of these devices. The Commission has also accepted a consent 
agreement with Olsen Laboratories settling charges regarding arthritis-
treatment claims made in infomericials for a product entitled ``Eez-
Away Relief.'' During the last year the Commission issued a final 
consent order against the remaining individual respondent in 
Synchronal, Corp., which was charged with making unsubstantiated claims 
in infomercials for a baldness remedy and a cellulite reduction 
product. A redress program in the Synchronal case has made $3.5 million 
available to consumers who purchased these products.
    Finally, FTC staff has worked closely with the staff of the FDA in 
considering the nature of appropriate claims for drugs that may be 
``switched'' from prescription to OTC status. The FDA is in the process 
of evaluating certain drugs that have been available only with a 
prescription to determined whether they are appropriate for OTC 
availability--for consumers to use without the supervision of a health 
care professional. As the switch of such drugs is approved and they 
become available to consumers without a prescription, the FTC assumes 
primary responsibility for ensuring the accuracy of their advertising. 
In order to maximize the Commission staff's ability to evaluate claims 
for switched products, a few FTC employees have been designated to 
attend both public and non-public FDA advisory committee meetings on 
drugs being considered for switch to OTC status.
               diet and weight loss products and services
    Older consumers invest heavily in the weight loss industry. The 
Commission has continued to be active in this area, and has taken 
numerous actions involving weight loss clinics or programs. These cases 
include the settlements mentioned above with Schering Corp., GNC, L & S 
Research Corp., and Bee-Sweet, Inc., and the proposed consent agreement 
with National Dietary Research, all of which included purported weight 
loss products. The Commission has also obtained a permanent injunction 
against Silueta Distributors, which had advertised its cream and 
tablets through Spanish language commercials, claiming that the 
products would break down or eliminate cellulite or fat. Silueta also 
will pay $169,339 in consumer redress to purchasers of these products.
    Many older consumers purchase services from diet clinics. In 1994, 
the Commission continued its investigations of national and regional 
weight loss programs, focussing on the extent to which these firms may 
have made unsubstantiated claims about the safety and success of their 
programs. In fiscal year 1994, the Commission issued final consent 
orders against three marketers of commercial low-calorie diet programs 
(Nutri/System, Diet Center, Inc, and Physicians Weight Loss Centers). 
These orders are in addition to six consent orders with very-low-
calorie diet programs that the Commission issued in 1992 and 1993. In 
addition, the Commission filed for comment and later issued as final 
consent orders in three additional matters involving marketers of low-
calorie diet programs (Doctors Medical Weight Loss Centers, Quick 
Weight Loss Centers, and Doctors Weight Loss Centers--Texas). The 
Commission's administrative complaints against Weight Watchers and 
Jenny Craig issued in 1993 remain in litigation.
    The weight loss orders the Commission issued and each of the 
agreements accepted for comment set out detailed requirements for 
substantiation and disclosure when weight loss and weight loss 
maintenance success claims are made. The core requirements of these 
orders contain the obligation, when claims of successful maintenance 
are made, to include--factural disclosures of the average weight loss 
maintained; how long program participants have maintained the loss; the 
representatives of the successful participants in terms of the overall 
participant population; and a statement that ``For many dieters, weight 
loss is temporary.'' In addition, the orders with the very-low-calorie 
diet companies contain requirements that safety claims be accompanied 
by a disclosure that physician monitoring is necessary to minimize the 
potential for health risks.
    Furthermore, many of these orders contain additional requirements 
that the companies warn customers about the importance of adhering to 
the diet protocol and consuming all of the food prescribed to avoid 
health consequences associated with rapid weight loss; that 
testimonials used in advertising for these programs either be 
representative of the results generally realized from participation in 
the program or, if not, be properly qualified in a clear and prominent 
manner as to the limited applicability of the experience of the 
consumer used in the testimonial; and that claims as to the price of 
these programs not fail to reveal any other mandatory costs.

                     Non-Health Related Activities

                            funeral services
    The Commission's Funeral Rule increases consumer access to accurate 
information about prices, options, and legal requirements before 
consumers make funeral arrangements. The Commission has filed 42 
enforcement actions charging violations of the rule since the rule 
became effective in 1984. The Commission filed four such actions during 
fiscal year 1994. In one case involving a Houston, Texas, company that 
markets insurance-funded, pre-need funeral arrangement plans 
nationwide, the Commission alleged violations of both the Funeral Rule 
and of the FTC's Cooling Off Rule, which applies to door-to-door sales. 
In this instance, the FTC alleged that the company failed to provide 
consumers with general price lists and itemized statements of funeral 
goods and services selected, both of which are required by the Funeral 
Rule. In addition, the company typically made the sales presentation in 
the consumer's home but allegedly failed to provide consumers with a 
written notice regarding their cancellation rights, thus violating the 
FTC's Cooling Off Rule.
    In addition to prohibitions against future violations of the rule, 
the consent agreements reached in most of these cases require payment 
of a civil penalty. The Commission obtained $178,000 in civil penalties 
paid pursuant to consent agreements files during 1994.
    The Funeral Rule required the Commission to begin a reevaluation of 
the rule no later than 4 years after its effective date. That 
proceeding was completed in 1994, and the Commission promulgated an 
amended rule that: (1) retains the rule's primary itemization, price 
and other disclosure requirements, with only minor modifications; (2) 
expressly prohibits the imposition of any nondeclinable fees (such as 
so-called ``casket handling fees'' that sometimes have been charged 
when a casket is not purchased from the funeral director but instead 
from a third-party) in addition to the already permitted nondeclinable 
fee for basic services of funeral director and staff; (3) deletes the 
affirmative telephone disclosure that required funeral directors, in 
certain circumstances, to inform telephone callers that price 
information is available over the phone, while retaining the rule's 
existing obligation to give price and other information over the 
telephone to consumers who request it; and (4) makes a series of 
corrective changes designed to facilitate compliance and consumers' 
understanding of their rights under the rule. The amended rule became 
effective on July 19, 1994.
    A funeral directors' group filed a petition for review of the 
amended Commission rule, challenging the most controversial amendment 
that prohibits providers from charging any nondeclinable fee in 
addition to the nondeclinable fee for services of funeral director and 
staff already permitted by the rule. That provision was designed to 
preclude so-called ``casket handling fees'' charged only to consumers 
who purchased caskets from third parties, such as cemeteries that sell 
caskets in competition with funeral homes, rather than from the funeral 
home. The amendment is important, because ``casket handling'' fees were 
being used by funeral directors to impede competition wherever third-
party casket sellers tried to enter a market. The Third Circuit Court 
of Appeals upheld the amendment on October 17, 1994, and no further 
review of the decision was sought.
    The Commission continues to review mergers and acquisitions in 
order to maintain competition in the funeral services and cemetery 
industry. Recently, the Commission accepted for public comment a 
consent agreement with Service Corporation International, the largest 
owner and operator of funeral homes and cemeteries in North America, to 
settle charges that SCI's proposed acquisition of Uniservice 
Corporation, the parent company of a group of funeral homes and 
cemeteries in Oregon and Washington, would substantially lessen 
competition for funerals and perpetual care cemetery services in and 
around Medford, Oregon. Under the settlement agreement, SCI would be 
permitted to acquire Uniservice but must keep all of the assets and 
operations of Uniservice's Medford facilities--two funeral homes, a 
cemetery, and a crematory--separate from its own until they can be sold 
to a buyer approved by the Commission. In addition, the proposed 
settlement would require SCI, for 10 years, to obtain FTC approval 
before acquiring any interest in funeral homes or cemeteries in Jackson 
County, Oregon.
    Commission staff submitted comments on a Louisiana proposal that 
would prohibit removal of the body of a deceased person from the State 
unless it was first embalmed (or cremated). Staff concluded that the 
proposal would limit consumer choice and impair competition by 
requiring consumers to purchase services they neither need nor want and 
could increase the costs borne by residents of other States arranging 
funerals for their relatives who die in Louisiana. Staff also submitted 
comments to the Pennsylvania legislature on a bill that would require 
deposit into a trust fund of all or nearly all of the proceeds of pre-
need sales of funeral and cemetery goods and services. Cautioning the 
legislature about the proposal, the staff of the Commission suggested 
allowing pre-need sellers to post a performance bond, under which a 
third-party guarantor would agree to pay the contract amount if the 
seller did not deliver at the time of need.
                  mail or telephone order merchandise
    The Commission's Mail Order Rule requires sellers to make timely 
shipment of orders; give options to consumers to cancel an order and 
receive a prompt refund or to consent to any delay in delivery; have a 
reasonable basis for any promised shipping dates (the rule presumes a 
30-day shipping date when no date is promised in an advertisement); and 
make prompt refunds. In issuing the original Mail Order Rule in 1975, 
the Commission noted that those consumers with mobility problems, 
including older consumers, frequently order by mail. During the 
proceeding to amend the rule to cover telephone sales, the American 
Association of Retired Persons (AARP) provided evidence indicating that 
a significant percentage of persons age 65 and older order products and 
services by telephone and, therefore, that the amendment would benefit 
its members. Amendments extending coverage of the rule to telephone 
sales became effective on March 1, 1994.
    The Commission staff works closely with industry members and trade 
associations to obtain compliance with the rule, and it initiates law 
enforcement actions where appropriate. During 1994, the courts entered 
four consent decrees resolving alleged rule violations, resulting in 
judgments for civil penalties totalling $216,000.
    In one of these cases, the Commission charged that the Haband 
Company, which directed advertising to older Americans in such 
publications as American Legion, Modern Maturity, and Saving Social 
Security, substituted merchandise materially different from that 
ordered without obtaining the consumers' prior consent, in violation of 
the rule. Although the company permitted consumers to return the 
merchandise at no cost, the company's substitution practices could be 
especially different for elderly consumers, who might be less willing 
or able to make returns than younger persons. The consent decree 
prohibits unauthorized substitutions and required the company to pay a 
$49,000 civil penalty.
                             used car sales
    The Used Car Rule requires that used car dealers display ``Buyers 
Guides'' on the windows of their cars to tell consumers whether the 
vehicle comes with a warranty or is sold ``as is.'' These warranty 
disclosure requirements can be of particular benefit to older 
consumers, who may be on fixed incomes and therefore need to purchase 
less expensive used cars and who also may be less able to meet sudden, 
unexpected repair expenses. In 1994, the Commission entered a consent 
decree against one used car dealer for rule violations, obtaining 
$20,000 in civil penalties. Investigations of other dealers are 
ongoing.
    As part of its systematic review of all current Commission 
regulations and guides, the Commission requested public comments in 
1994 on, among other things, the economic impact of and the continuing 
need for the rule; possible conflict between the rule and State, local 
or other Federal laws; and the effect on the rule of any technological, 
economic, or other industry changes. At the same time, the Commission 
also solicited comments on the impact of the rule on small businesses, 
as mandated by the Regulatory Flexibility Act, 5 U.S.C. Sec. 601 et 
seq. The Commission will determine whether it should propose any 
changes to the rule following review of the comments that were 
received.
                           door-to-door sales
    The Cooling-Off Rule requires that consumers be given a 3-day right 
to cancel certain sales occurring away from the seller's place of 
business (often known as ``door-to-door sales''). In addition, the 
Commission, in some administrative cease and desist orders against 
companies engaged in door-to-door sales, has required companies to 
allow consumers the right to cancel purchases. The rule and these 
orders can particularly benefit older Americans who are retired and at 
home and who may be exposed more frequently to high pressure sales 
tactics by door-to-door or other sellers.
    In December 1993, the court issued a consent order and judgment for 
a civil penalty of $10,000, against Lonnie Divine (doing business as 
Union Circulation Company), a national clearinghouse and a door-to-door 
seller of magazine subscriptions, to resolve alleged violations of the 
Cooling-Off Rule. In addition, the Commission is conducting litigation 
against Budget Marketing, Inc., a nationwide telemarketer of magazines, 
for alleged violations of an existing cease and desist order. The 
litigation arose from many complaints from elderly citizens who 
believed that they had been tricked into paying hundreds of dollars for 
multi-year magazine subscriptions. Other investigations are ongoing.
    As part of its systematic review of all current Commission 
regulations and guides, the Commission requested public comments in 
1994 on, among other things, the economic impact of and the continuing 
need for the Cooling-Off Rule; possible conflict between the rule and 
State, local or other Federal laws; and the effect on the rule of any 
technological, economic, or other industry changes. Comments from both 
buyers and sellers' representatives were submitted. All of the comments 
stated that the rule provides important protections for consumers and 
favored retaining the rule. AARP commented that the rule is especially 
needed to protect older consumers who are most vulnerable to 
unscrupulous door-to-door sellers. The Commission will determine 
whether it should propose any changes to the rule following its 
complete review of the comments that were received.
                              energy costs
    The cost of heating and cooling one's home can be especially 
burdensome to older consumers. Retired individuals, who tend to spend 
more time at home than working individuals, may have less opportunity 
to lower their home heating or cooling requirements during the day. In 
addition, the elderly, being more susceptible to hypothermia, are often 
counselled to maintain a higher temperature in their homes than younger 
persons might comfortably tolerate. Those on fixed incomes also may 
face greater relative economic burdens in meeting energy costs.
    Property insulated homes can maintain more constant temperatures 
and can save consumers substantial amounts on heating and cooling 
costs. The Commission's R-value Rule assists consumers by requiring 
that sellers of insulation accurately disclose the ``R-value,'' or 
insulating effectiveness, of such products. The rule also requires 
installers and new home sellers to give consumers a written disclosure 
of the type and R-value of the insulation installed; requires retailers 
to make specific information available at the point-of-sale to 
consumers who purchase insulation for do-it-yourself installation; and 
requires advertisers to include important disclosures in advertisements 
that contain specific claims. This rule will be reviewed during 1995, 
and its economic and other impact examined. Public comment will be 
sought.
    The Commission also has investigated the accuracy of claims of the 
insulating effectiveness, known as ``U-value,'' of windows and doors 
used in homes. Insulating effectiveness of such products is often 
determined by independent laboratories following government-approved 
test methods. State and local governments then use the U-value test 
results to determine if windows and doors comply with State and local 
building codes. The Commission filed a consent decree in Federal court 
in 1994, settling charges that an organization that sets test 
standards, including energy efficiency or U-value standards for 
windows, sliding glass doors skylights and similar products, had 
deceptively accredited a testing laboratory to test the energy 
efficiency of windows and similar products.
    The Commission's Appliance Labeling Rule also enables consumers to 
reduce energy costs by requiring sellers to disclose the energy usage 
of major household appliances. The rule requires disclosure, based on 
standardized tests, of specific energy consumption, efficiency, or cost 
information for covered products in catalogs. It also requires 
information at the point-of-sale in the form of an ``EnergyGuide'' 
label or fact sheet, or in an industry directory. The labels include 
the energy consumption or efficiency figure, a range showing the 
highest and lowest energy consumption or efficiencies for all similar 
appliance models, and, at the bottom of the label for some products, 
the estimated annual operating cost of the appliance based on specified 
assumptions. Because energy-efficient appliances cost less to run over 
the life of the product, the rule enables those elderly consumers who 
may be on limited incomes to keep down monthly expenses for running 
major home appliances. Compliance with the rule is generally high, and 
the industry is largely self-policing through certification programs 
maintained by the several large trade associations that represent most 
manufacturers.
    On October 1993, pursuant to the Energy Policy Act of 1992 (``EPA 
92''), the Commission amended the Appliance Labeling Rule to include 
four plumbing products: showerheads, kitchen and lavatory faucets, 
water closets (toilets), and urinals. The amended rule requires sellers 
to disclose the water-usage of these products in terms of both gallons 
and liters per flush, minute or cycle (except where the size of the 
product would make it impractical to include the metric measure). The 
information must be displayed both on the products themselves and on 
their packaging and labeling, as well as in catalog advertising point-
of-sale promotional materials for them. The amendments took effect on 
October 25, 1994. The disclosures will assist purchasers in selecting 
replacement plumbing products that save money by reducing water 
consumption.
    In May 1994, pursuant to EPA 92, the Commission also amended the 
Appliance Labeling Rule to include three categories of lamp products 
(light bulbs or tubes) in the rule--general service fluorescent, medium 
base compact fluorescent, and general services incandescent (including 
spot lights and flood lights). For the lamp products types most 
commonly used in the home, general service incandescent light bulbs and 
medium base compact fluorescent tubes, the rule requires that package 
labels clearly and conspicuously disclose: (1) light output, in lumens; 
(2) energy used, in watts; (3) design volts (if different from 120 
volts); (4) average life, in hours; (5) the number of bulbs or tubes in 
the package; and (6) an Advisory Statement explaining how to select the 
most energy efficient lamp that meets the purchaser's needs. The 
purpose of these disclosures is to give consumers information they need 
to purchase the most energy efficient lamps that meet their needs. 
Although energy used in residences for lighting is relatively small in 
comparison to that used for heating and cooling, saving on unnecessary 
energy costs by using more efficient lighting products can be 
particularly important to those who are on fixed incomes. The 
amendments become effective in May 1995.
    The Commission also has conducted investigations under its Fuel 
Rating Rule (formerly known as the Octane Rule), which establishes 
standard procedures for determining, certifying, and posting octane 
ratings on gasoline pumps. Accurate certification and posting of octane 
ratings deter distributors and retailers from deceptively selling lower 
octane fuel as higher octane fuel. This rule may benefit retired 
persons who have the time for leisure activities involving car travel, 
but who also may be on limited budgets. In 1994, the Commission 
obtained four consent decrees resolving alleged Fuel Rating Rule 
violations, which included a total of $287,500 in civil penalties. The 
Commission also continues to monitor performance claims for gasoline of 
a particular octane rating. In 1994, it approved a final consent 
agreement with Unocal Corp., and its advertising agency, Leo Burnett 
Co., requiring the company to mail a corrective notice to all Unocal 
credit card customers who had received bill inserts with challenged 
performance claims. Staff is investigating other marketers of gasoline 
as well, with regard to performance and environmental benefit claims.
    Amendments to the Fuel Rating Rule, issued pursuant to EPA 92, 
became effective on October 25, 1993. The Commission adopted the 
amendments to include alternative liquid automotive fuels such as 
methanol and ethanol, among others. The amended rule requires sellers 
of alternative liquid automotive fuels to determine, certify, and post 
an ``automotive fuel rating'' consisting of the common name of the fuel 
along with a disclosure of the amount, expressed as a minimum 
percentage by volume, of the principal component of the fuel. Sellers 
are permitted to disclose other components, if they desire.
                              credit fraud
    Credit fraud continues to affect consumers of all ages and walks of 
life. However, it is particularly harmful to the elderly who generally 
live on fixed incomes, may be using credit to augment their income, and 
therefore, are more likely to be susceptible to credit scams.
    Among other things, the Commission has taken action against 
fraudulent marketers of secured credit cards. In May 1993, the 
Commission filed a complaint charging American Standard Credit Systems 
and its officers with deceptively marketing secured Visa and MasterCard 
credit cards. According to the complaint, American Standard Credit 
Systems ran advertisements in Sunday newspapers throughout the country 
stating that anyone could receive a Visa or MasterCard credit card by 
calling ``900'' telephone numbers at a cost of $10 per call. However, 
the company failed to tell consumers that an application fee of $65 to 
$80 was required, that not everyone would be approved to receive a 
credit card, and if approved, each consumer would have to deposit at 
least $300 with the card issuer. As a result, the complaint alleged, 
many consumers who called the advertised ``900'' number either did not 
bother to apply for a credit card or were denied credit. Last year, the 
Commission's litigation ended successfully when the court granted 
summary judgment in favor of the Commission, and the individual 
defendants agreed to a $2 million judgment.
    In December 1994, the Commission filed an action against 10 
companies and four individuals for unfair practices in the selling of 
credit card numbers. The Commission charged these defendants with 
selling lists of consumers' credit card numbers to direct marketers, 
who in turn billed consumers' accounts without authorization. In 
January the court entered consent decrees banning these defendants from 
providing confidential credit card account information to third parties 
and requiring them to ensure that future clients for other credit-
related lists do not engage in the same or similar practices. In 
addition, the defendants are required to pay a total of $292,000 in 
consumer redress.
    In the past few years, the Commission also has worked closely with 
Federal and State law enforcement agencies to combat ``advance-fee 
loan'' scams. In these scams, companies ``guarantee'' loans to 
consumers in exchange for an advance fee, typically ranging from $100 
to several hundred dollars. After taking consumers' money, the 
companies frequently disappear. In August 1994, the Commission filed a 
complaint against Southland Consultants alleging that the company 
promised that consumers who paid $189 were guaranteed to receive a 
loan, whereas in fact, numerous consumers neither received the promised 
loans nor were given refunds. In January of this year, the defendants 
agreed to pay up to $100,000 in consumer redress to settle the 
Commission's charges.
    The Commission continues to bring enforcement actions against 
credit repair companies that promise to ``clean up'' consumers' bad 
credit histories. In addition, in November 1994, the Commission hosted 
a Credit Repair Summit with Federal, State, and local law enforcement 
agencies, credit bureau representatives, and public interest groups to 
invigorate local law enforcement efforts and find alternatives to case-
by-case enforcement by the Federal Government against the countless 
small operators in the field.
                            debt collection
    Each year the Commission receives thousands of consumer complaints 
regarding harassing and abusive behavior by debt collectors. Often 
these letters come from the elderly. In March of this year, Payco 
American Corporation (``Payco''), one of the Nation's largest debt 
collection agencies, agreed to pay a $500,000 civil penalty to settle 
allegations that it violated the Fair Debt Collection Practices Act 
(``FDCPA''). The Commission's lawsuit, filed in August 1993, charged, 
among other things, that Payco illegally revealed consumer debts to 
third parties; used obscene or profane language; telephoned debtors at 
times and places known to be inconvenient to the consumers being 
contacted; and made several misrepresentations to consumers. In 
addition to the $500,000 civil penalty, the settlement prohibits Payco 
from violating the FDCPA in the future, and requires the company to 
give notice to all employees who are responsible for debt collection 
that they may be held liable individually if they are found to be 
violating the FDCPA.
                            investment fraud
    Investment frauds frequently victimize the public through false 
promises of large returns on ``safe'' investments. While these frauds 
harm all investors, they can also particularly hurt older investors, 
who are vulnerable to fraudulent operators and often ill-prepared to 
recoup the losses. Some investment fraud firms have bilked individual 
consumers of $5,000 to $20,000 or much more by promising large returns 
for investments in art works, motion picture film cels, gold mines, 
gemstones, precious metals, rare coins, oil and gas leases, cellular 
telephone licenses, or wireless cable licenses and partnerships. These 
firms usually employ telephone room salespersons who use high-pressure, 
polished sales pitches.
    In fiscal year 1994, the Commission filed eight cases in Federal 
district court involving such schemes. In all of these cases, the 
Commission secured preliminary or permanent orders halting the 
challenged conduct.
    In addition to the cases filed, the NAAG-FTC Telemarketing 
Complaint System, which is maintained by the Commission, has been used 
by Federal and State law enforcement agencies to identify potential 
scams and file actions against fraudulent telemarketers. For example, 
the data base has been cited as the source of information used to 
obtain the criminal indictment of 42 individuals and companies by the 
Postal Inspection Service and the U.S. Attorney in Pittsburgh, 
Pennsylvania. The charges involved gemstone investment scams, many of 
which were directed to the elderly, individuals and entities located 
outside the United States but selling to U.S. citizens.
                       other telemarketing fraud
    The Commission continues its enforcement actions against fraudulent 
telemarketers. Many of these cases involved the sale of goods and 
services of special interest to older consumers, including prize 
contests, credit opportunities, health products, deceptive charity 
solicitations, and various home products.
    The Commission also combines its efforts with those of various 
State and other Federal agencies to combat telemarketing fraud. The 
Commission has worked closely with State attorneys general, the U.S. 
Postal Service, the FBI, and other law enforcement agencies in bringing 
actions against fraudulent telemarketers. Another example of this 
concerted Federal/State effort is the series of regional conferences on 
telemarketing fraud which the Commission began in 1993. During 1994 
regional conferences were held in Atlanta, Chicago, Dallas, Boston, 
Cleveland, Seattle, and Los Angeles. These conferences included city 
and State prosecutors, State attorneys general, regional Postal 
Inspectors, offices of the regional U.S. Attorneys, the Federal Bureau 
of Investigation, and others. Each of the meetings produced a specific 
agenda for organized and coordinated approaches to investigating and 
prosecuting Telemarketing in the region.
    Because many of the telemarketers that target American consumers 
are actually located in other countries, the Commission has begun to 
address the globalization of telemarketing fraud. For example, in 
September 1994, the Commission and Canada's Bureau of Competition 
Policy co-sponsored a conference in Ottawa for officials at the 
Federal, provincial, and local levels who are concerned with fraudulent 
telemarketing in North America.
                            prize promotions
    The elderly frequently are victimized by prize promotion schemes, 
where telemarketers either make unsolicited calls or mail notification 
cards to consumers stating that they have won a valuable prize, such as 
a vacation, car, cash, or jewelry. Promotional sweepstakes are the most 
numerous single category of complaints in the NAAG/FTC Telemarketing 
Fraud Database.
    Last year, the Commission filed suit in district court against Gem 
Merchandising Corporation and its principals. The Commission charged 
Gem with operating a nationwide telemarketing operation that sells a 
medical alert system and other merchandise by fraudulently promising to 
consumers that they would receive an award such as a $10,000 cashier's 
check, a ``vacation,'' a big screen television, or a $2,500 cashier's 
check if they purchased the product. In fact, Gem allegedly 
misrepresented the value of the prizes and the likelihood that 
consumers would receive a particular prize. In addition, the promised 
``vacation'' was actually a vacation voucher that required the consumer 
to pay substantial sums to purchase minimum stays at selected hotels 
and pay additional surcharges if they wanted to travel during peak or 
holiday seasons. The case is still in litigation.
    The Commission also obtained settlements in the lawsuits that had 
been filed early in 1993 against other clusters of telemarketing 
companies. Sierra Pacific Marketing, Inc., and S.E.C. Enterprises, 
Inc., as well as their principals and related companies, had been 
charged with falsely representing to consumers that they had won 
valuable prizes, and then using a variety of misrepresentations to 
persuade the consumers to purchase vitamins, ``environmentally safe'' 
cleaning products, water purifiers, and other products. The defendants 
allegedly used techniques particularly successful with elderly 
consumers. These techniques included placing repeated calls to those 
who initially declined to purchase. In some cases, calls were made on a 
daily or weekly basis or even several times in an hour. Moreover, 
consumers allegedly were threatened with legal action when they tried 
to cancel an order. In February 1994, the Commission obtained $1 
million in redress from Sierra Pacific and in April, another $900,000 
from S.E.C. Enterprises. In addition, several of the principals were 
permanently banned from participating in, or assisting others to run, 
prize promotion businesses.
    In 1994, the Commission also filed suit against Nishika, Ltd., a 
Nevada telemarketing firm charged with operating a deceptive prize 
promotion scheme, in which consumers were ``guaranteed'' to win a 
valuable prize, such as a new car, $1,250 or more in cash, a 
television/stereo system, or a vacation travel package. However, in 
order to receive the prize, the consumer had to authorize a ``one 
time'' charge of up to $700 on their credit cards. Consumers later 
received merchandise that was often of limited value, along with their 
prize, which in almost all cases, was a vacation voucher that contained 
a number of onerous conditions and additional costs. Nishika allegedly 
misrepresented the value of the merchandise and prizes, as well as the 
likelihood that the consumer would receive a specific prize. The case 
is still in litigation.
                      ``recovery room'' operations
    The past year has also seen an increase in ``recovery room'' scams. 
These so-called recovery rooms contact consumers who have been victims 
of prior telemarketing scams, most often sweepstakes schemes which 
particularly target the elderly. The pitch typically used by recovery 
room telemarketers makes reference to the consumer's prior 
victimization, sympathetically warns the consumer not to fall for 
unscrupulous telemarketing schemes again, and then falsely represents 
that, for an upfront fee, the recovery room will assist the consumer in 
obtaining a refund of the amount the consumer initially lost. In fact, 
the recovery room is simply bilking consumers one more time and will 
not engage in any such ``recovery'' efforts on their behalf.
    During 1994, the Commission filed several cases involving such 
recovery rooms. For example, in October 1994, the Commission filed a 
case in federal district court against Refund Information Services, a 
Nevada-based telemarketing company that allegedly preyed on elderly 
consumers who had previously lost money to fraudulent sweepstakes or 
prize-promotion promoters. The company and its principals were charged 
with misrepresenting that they could recover lost money for consumers 
and that they had a successful record in recovering money for 
consumers. The defendants also were charged with misrepresenting a 
connection with Government authorities, such as the Federal Trade 
Commission. Consumers paid fees ranging from $200 to as much as $800 
for the defendants' services, but allegedly got nothing of value in 
return. The case is still in litigation.
                         ``telefunding'' scams
    Another increasingly popular fraudulent scheme that strikes the 
elderly is deceptive ``telefunding.'' Legitimate telefunders raise 
funds for bona fide charities through telephone solicitation campaigns. 
Fraudulent or deceptive telefunders, however, raise funds for 
themselves or for nonexistent or phony charities, although sometimes 
they may use the names of bona fide charities in their solicitations. 
The Commission has brought a number of cases in Federal district court 
challenging allegedly deceptive telefunding. In these cases, often the 
telemarketers entice consumers with the promise of extravagant prizes 
in return for a donation to the purported charity.
    In one case, consumers throughout the country donated as much as 
$3,500 each in response to a ``telefunding'' scheme operated by 
Regeneration & Renewing, Inc. d/d/a AWARE, and 18 other defendants 
based primarily in Las Vegas. The FTC complaint alleged that the 
defendants combined false statements that consumers would receive 
valuable prizes with falsehoods about the charitable activities the 
donations would support. The defendants also allegedly misrepresented 
the need to make a donation in order to receive a prize and the tax 
deductibility of the contributions. The case is still pending.
    The case involving AWARE illustrates the Commission's ``root'' 
approach to combating telemarketing fraud, in which the FTC maximizes 
its resources by targeting not only boilerrooms, but also by charging 
the ``root'' defendants who provide the support network that supplies 
products, prize inducements, proven deceptive sales pitches, lists of 
consumers, and access to a credit-card payment system or some other 
similar means of obtaining payment. In the AWARE investigation, the 
compliant also named several defendants who allegedly helped promote 
the scheme by providing donor leads, customer service support or cheap 
prizes.
    In another telefunding case, Heritage Publishing Company, an 
Arkansas for-profit company that raises funds on behalf of charitable 
organizations, agreed to pay $200,000 to settle FTC charges that it 
misrepresented the percentage of donations that go to nonprofit 
entities and misrepresented that funds would be earmarked for 
activities in the donors' own localities.
                          work-at-home schemes
    Many consumers, including the elderly, are looking for 
opportunities to increase their income, often by working at home. 
During 1994, the Commission brought a number of cases involving 
companies that misrepresented the amount of income consumers could 
expect to earn. In one action, the FTC filed suit in Federal district 
court against an Illinois company, Pase Corporation, alleging that the 
company and its principals had used deceptive advertisements and 
mailings in connection with several of their work-at-home business 
opportunities. Among those business opportunities were a program that 
offered consumers payment for tabulating and forwarding to the company 
responses to classified ads in local papers, a program promising to pay 
for compiling and typing names and addresses, and a program offering 
payment for responses to postcards mailed on behalf of the defendants. 
In early 1995, two of the individual defendants agreed to pay $16,400 
collectively to settle the FTC charges. The case is still pending 
against the remaining defendants.
                            ``900'' numbers
    The Telephone Disclosure and Dispute Resolution Act of 1992 
directed the Commission to promulgate rules governing the advertising 
and operating of 900-number (or pay-per-call) services, as well as 
billing and collection procedures for these services. The FTC's 900-
Number Rule became effective on November 1, 1993. The rule requires 
cost and other disclosures in advertisements for 900 numbers and in 
preambles to pay-per-call services costing more than $2. Callers who 
hang up within 3 seconds of a signal or tone indicating the conclusion 
of the preamble cannot be charged for the call. The rule prohibits the 
use of 800 numbers (or other toll-free numbers) for pay-per-call 
services. In addition, the rule requires certain disclosures for 
billing statements for 900-number calls and establishes procedures for 
the correction of billing errors.
    Since the rule became effective, the Commission staff has closely 
monitored compliance with its requirements. In 1994, the Commission 
brought its first action alleging violations of the 900-Number Rule. 
The complaint alleged that American TelNet, Inc., illegally used 800 
numbers for pay-per-call services, then billed unwary consumers and 
businesses for calls made from their phones to psychic and sex lines. 
The FTC also charged that American TelNet illegally referred callers to 
800 numbers to international or 900 numbers without making proper price 
disclosures. American TelNet agreed to pay $2.5 million as part of the 
settlement agreement.
                   proposed telemarketing sales rule
    In August 1994, Congress passed the Telemarketing and Consumer 
Fraud and Abuse Prevention Act, 15 U.S.C. Sec. 1601 et seq. This Act 
requires the Commission to promulgate regulations: (1) defining and 
prohibiting deceptive and abusive telemarketing acts or practices; (2) 
prohibiting telemarketers from engaging in a pattern of unsolicited 
telephone calls that a reasonable consumer would consider coercive or 
an invasion of privacy; (3) restricting the hours of the day and night 
when unsolicited telephone calls may be made to consumers; and (4) 
requiring disclosure of the nature of the call at the start of an 
unsolicited call made to sell goods or services. The statute expressly 
authorizes the Commission to include within the rule's coverage 
entities that ``assist or facilitate'' deceptive telemarketing 
practices, including credit card laundering. Moreover, the statute 
authorizes State law enforcement officials to enforce the rules issued 
by the Commission. The Act requires the Commission to finalize the 
Telemarketing Rule by August 16, 1995.
        Consumer Education Activities Affecting Older Consumers
    The Commission, through its Office of Consumer and Business 
Education, is involved in preparing and distributing a variety of 
consumer publications and broadcast materials. Many of the subjects are 
of significant interest to older consumers.
                       1994 education activities
    In 1994, the Commission in conjunction with the National 
Association of Attorneys General (NAAG) and the American Association of 
Retired Persons (AARP) conducted a multi-media campaign on Telephone 
Scams and Older Consumers. The campaign describes some common telephone 
scams, tells consumers what they can do to protect themselves, and 
where to go for more help and information. The television audience for 
this campaign was projected at 3 million, and the radio audience was 
estimated to be 21 million. The Commission distributed 72,000 copies of 
the brochure in the last 3 months of FY 1994.
    Another brochure, ``Telemarketing: Reloading and Double-Scamming 
Frauds,'' was prepared in cooperation with Call For Action (CFA), an 
international, nonprofit consumer hotline which operates in conjunction 
with radio and television broadcasters. The brochure explains that 
consumers who have lost money to a fraudulent telemarketer can expect 
to have that same or another telemarketer try to take advantage of them 
again. It also explains how such scams work, what precautions consumers 
can take to avoid becoming a victim, and where to go with a complaint 
about a telemarketer. More than 45,000 copies of the brochure were 
distributed in 1994.
    The FTC, in cooperation with the Direct Marketing Association and 
AARP, updated ``Shopping by Phone or Mail'' to reflect revisions to the 
FTC Mail or Telephone Order Merchandise Rule. The brochure explains how 
the rule covers goods ordered by mail, telephone, computer, and fax 
machine. It also explains consumer protections under the Fair Credit 
Billing Act when consumers pay by credit card. Since its original 
release in 1975, more than 344,000 copies of the brochure have been 
requested.
    In 1994, the Commission also produced ``Invention Promotion 
Firms.'' The brochure tells consumers how to spot some common signs of 
trouble, how to protect themselves, and what to do if they are 
victimized by an unscrupulous invention promotion firm. More than 
55,000 requests for this publication have been filled.
    The FTC worked with the American Academy of Ophthalmology, the 
National Association of Optometrists and Opticians, and the Opticians 
Association of America to produce a brochure called, ``Eye Wear.'' It 
explains consumer rights under the Prescription Release Rule and 
provides information about various types of eye care professionals. It 
also gives some suggestions about selecting an eye care specialist and 
shopping for eye exams, eyeglasses, and contact lenses. The FTC 
distributed 27,000 copies of the brochure in 1994.
    The Commission, in cooperation with the American Bar Association's 
Public Education Division, produced ``Credit and Divorce.'' This 
brochure explains what action consumers who have recently been through 
a divorce, or are contemplating one, may want to take concerning credit 
issues. It specifically discusses individual and joint accounts and 
users on accounts, listing the advantages and disadvantages of each. 
More than 21,000 copies of the publication were requested in 1994.
    ``Varicose Vein Treatments'' was prepared with technical assistance 
from the American Venous Forum. The brochure defines varicose and 
spider veins, who gets them, what causes them, and the available 
treatments to eliminate them. More than 63,000 copies of the brochure 
have been distributed by the Commission.
      ongoing efforts against telemarketing scams and other frauds
    ``Sweepstakes Scams: When Winners Lose Money,'' warns consumers 
about fraudulent telemarketers who pose as representatives of major 
sweepstakes. The brochure advises consumers to use caution if they are 
told to pay money before delivery of an item, or provide a credit card 
number to claim a prize. The brochure stresses that legitimate 
sweepstakes do not require consumers to pay anything to collect a 
prize. The FTC has distributed more than 55,000 copies of the 
publication since its release in late 1993.
    ``900 Numbers: New Rule Helps Consumers'' describes the legal 
protections consumers have under the Telephone Disclosure and Dispute 
Resolution Act and the FTC 900-Number Rule. The brochure also tells 
what to watch for in 900 numbers and what consumers should do if caught 
in a 900-number scam. In 1994, the publication was translated into 
Spanish. Nearly 70,000 copies of the English and Spanish versions were 
distributed in 1994.
    ``Telephone Investment Fraud'' explains how this type of fraud 
works, describes a typical sales pitch, and offers tips to help 
consumers avoid losing their money. The brochure also lists government 
agencies and business organizations that register, investigate, or 
monitor companies and individuals who offer investment opportunities. 
Since its release in 1987, the Commission has filled more than a 
quarter of a million requests for the publication in English and 
Spanish.
    ``Prize Offers,'' produced in cooperation with Call for Action, 
discusses promotions that use deceptively-advertised prizes, advises 
consumers how to avoid being victimized, and suggests how to handle 
complaints. Since its release in 1983, the Commission has distributed 
nearly 358,000 copies of the brochure.
    The FTC also continued to distribute existing brochures concerning 
various aspects of telemarketing fraud. Over the past 6 years, for 
example, the Commission has filled requests for more than half a 
million copies of publications, such as ``Magazine Telephone Scams,'' 
``Scams by Phone,'' and ``Telemarketing Travel Fraud.''
         information about other consumer services and products
    The Commission also continues its efforts to provide information 
about other kinds of marketplace services and products that could be of 
special importance to older consumers.
    ``Personal Emergency Response Systems (PERS),'' prepared in 
cooperation with AARP, explains the electronic device that assists 
persons in summoning help in an emergency. The publication describes 
how a PERS works and what to consider when shopping for a system. The 
brochure also discusses purchasing, renting, and leasing options. The 
FTC has distributed nearly 18,000 copies of the brochure since its 
release in 1993.
    ``How to Take the Scare Out of Auto Repair'' is the print component 
of a multi-media education campaign conducted by the Commission in 
conjunction with NAAG and the American Automobile Association (AAA). 
The booklet provides tips on selecting a good technician, helps 
consumers ask the right questions, identifies common vehicle troubles, 
and explains how consumers can better handle any problem that might 
arise with their autos. NAAG, AAA and the FTC are distributing the 
booklet, and the Commission alone has distributed more than 76,000 
copies of the publication since its release in late 1993. This campaign 
also included the production and distribution of a video news release 
by satellite to television stations, and radio public service 
announcements to 425 radio stations nationwide.
    ``Fire Detectors'' explains two types of detectors--smoke detectors 
and heat detectors--and briefly discusses home sprinkler systems. 
``Negative Option Plans for Books, Records, Videos . . .'' describes 
how negative option plans work, explains consumers' rights under the 
FTC's Negative Option Rule, and suggests things to consider before 
consumers subscribe to such plans. The Commission has filled more than 
100,000 orders for these two publications since their release in 1991.
                                funerals
    During 1994, the Commission continued its educational efforts with 
regard to funeral goods and services. ``Caskets and Burial Vaults'' 
discusses the uses of these items and protective claims that may be 
made about them. It mentions the option of pre-planning a funeral and 
lists organizations to contact for additional information. Consumers 
have requested more than 42,000 copies of the brochure since 1992.
    ``Funerals: A Consumer Guide'' continues to be a popular brochure. 
It explains the Funeral Rule and lists business, professional, and 
consumer groups that provide information on how to make funeral 
arrangements and the available options. During 1994, the FTC filled 
requests for 29,000 copies of the brochure, bringing total distribution 
since 1984 to more than half a million copies.
                                 health
    ``Facts About Weight Loss Products and Programs'' is the print 
component to a cooperative multi-media effort with NAAG and the Food 
and Drug Administration. The brochure provides information to help 
consumers avoid weight-loss scams, encourages consideration of the 
costs and consequences to dieting decisions, and offers sensible weight 
maintenance tips. Since its release in 1992, the Commission has filled 
more than 87,000 consumer requests. The joint effort also sponsored a 
video news release, sent to television stations by satellite, and radio 
public service announcements, sent to 500 radio stations and networks 
nationwide.
    ``Food Advertising Claims'' provides information to help consumers 
interpret fat, ``no'' or ``low'' cholesterol, and ``light'' claims in 
food advertising and labeling. The publication was translated into 
Spanish in 1994. Nearly 14,000 copies of the English and Spanish 
versions were distributed in 1994.
    During 1994, the Commission continued its distribution of two 
health-related publications produced in cooperation with AARP. 
``Hearing Aids'' describes the two basic types of hearing loss: 
conductive an sensorineural. It also offers purchase suggestions for 
hearing aids and outlines Federal and State standards for their sale. 
``Healthy Questions'' explains how to select and use the services of 
health care professionals. The Commission filled more than 22,000 
requests for these publications in 1994.
    The Commission's own consumer brochure, ``Health Claims: Separating 
Fact from Fiction,'' addresses specific aspects of health fraud. The 
FTC has distributed more than 200,000 copies of this brochure in 
English and Spanish since its release in 1986.
                                housing
    ``Getting a Loan: Your Home as Security'' explains the ``right of 
rescission'' under the Federal Truth in Lending Act. The right of 
rescission gives consumers 3 business days to reconsider personal loan 
agreements when they use their principal home as security. Since its 
release in 1981, the FTC has filled nearly 200,000 requests.
    The Commission continues to distribute other housing-related 
brochures that may be of special interest to older consumers: ``Real 
Estate Brokers'' and ``How to Buy a Manufactured Home,'' produced with 
the Manufactured Housing Institute.
              education about credit and financial matters
    ``Secured Credit Card Marketing Scams'' explains the differences 
between a secured and unsecured credit card, describes how marketing 
scams are used to sell secured credit cards, and tells how to recognize 
and avoid deceptive credit card offers. It also lists some 
organizations that offer additional consumer credit information and 
assistance. More than 45,000 consumers have requested the publication 
since its release in late 1993.
    During 1994, the Commission continued to distribute credit 
publications that may be especially useful to widows and older persons 
who may have difficulty obtaining credit. ``Women and Credit 
Histories'' explains two Federal laws--the Equal Credit Opportunity Act 
(ECOA) and the Fair Credit Reporting Act--that give consumers specific 
rights to help protect their credit histories and make it easier to get 
credit. Since the brochure was released in 1978, nearly 423,000 copies 
have been distributed.
    ``Credit and Older Americans,'' produced in 1987, explains the 
anti-age-discrimination provisions of the ECOA. Since its release, 
nearly a quarter of a million copies have been distributed.
    ``Credit Repair Scams,'' a brochure and video news release produced 
by the FTC in cooperation with NAAG, warns consumers about fraudulent 
credit repair companies that claim, for a fee, they can erase bad 
credit and remove bankruptcy and liens from credit files. The brochure 
and video tell consumers how to spot credit repair scams, what 
information is in a credit report, and how consumers can correct 
mistakes themselves. The FTC has filled nearly 180,000 requests for 
this publication in English and Spanish.
    Other credit publications that may be useful to the elderly 
include: ``Fix Your Own Credit Problems,'' ``Lost or Stolen: Credit and 
ATM Cards,'' and ``Buying and Borrowing: Cash in on the Facts.'' ``Fix 
Your Own Credit Problem'' is a how-to publication that also cautions 
consumers about credit repair clinics. The FTC has distributed more 
than half a million copies of this publication in English and Spanish 
during the last seven years. ``Lost or Stolen: Credit and ATM Cards,'' 
which discusses card-holder liability in the event of such loss, has 
been distributed to more than 290,000 consumers since 1987. ``Buying 
and Borrowing,'' a summery of information about buying on credit, 
layaway, and by phone and mail, has been distributed to more than 
135,000 consumers over the past 7 years.
    During 1994, the Commission continued its print education campaign 
on financial issues. ``Reverse Mortgage,'' prepared in cooperation with 
AARP and the National Center for Home Equity Conversion, explains how 
reverse mortgages work for consumers who are house-rich and cash-poor. 
More than 155,000 copies of this publication have been disseminated 
since its release in 1991.
    In 1990, the FTC and AARP produced ``Facts About Financial 
Planners.'' This booklet provides information to help consumers decide 
if they need a financial planner and offers guidelines for selecting a 
good planner. The publication also lists sample questions to ask a 
planner during the initial interview. Nearly 198,000 copies of the 
booklet have been distributed.
    The FTC and AARP also developed ``Money Matters.'' This booklet 
explains how to select and use the professional services of lawyers, 
accountants, financial planners, real estate brokers, and tax 
preparers. The Commission has filled more than 80,000 requests for the 
publication since its release in 1986.
                               Conclusion
    This report reviews Commission programs that may be of particular 
concern to older consumers and their families. Through the combination 
of law enforcement and consumer education described above, the 
Commission strives to ensure a vigorous, fair, and competitive 
marketplace for all consumers.

                  ITEM 21.--GENERAL ACCOUNTING OFFICE

    GAO's work in aging reflects the continuing importance of Federal 
programs for older Americans. The Census Bureau has estimated that 
there are over 33 million older Americans today, and, by the year 2020, 
that number will exceed 53 million. Because the elderly are one of the 
fastest growing segments of today's society, the Congress faces many 
issues involving income security and health policy in which the Federal 
Government will play an important role. These issues range from 
demographic changes affecting the traditional structure and role of the 
family to financing and provision of health care, long-term care, 
Social Security, and pensions.
    Our work during fiscal year 1994 covered a range of issues, 
including Federal Government activities in employment, health care, 
housing, income security, and veterans' issues. Some Federal programs 
such as Social Security and Medicare are directed primarily at older 
Americans. Other Federal programs target older Americans as one of 
several groups served, such as Medicaid or Federal housing programs. We 
have organized the summaries of our fiscal year 1994 reports and 
related products accordingly.
    In the appendixes, we describe four types of GAO activities that 
relate to older Americans:
          Reports on policies and programs directed primarily at older 
        Americans (see app. I),
          Reports on policies and programs that affect older Americans 
        as one of several target groups (see app. II),
          Congressional testimonies on issues related to older 
        Americans (see app. III), and
          Ongoing work on issues related to older Americans (see app. 
        IV).
    The issues addressed by these products and ongoing work are 
presented in table 1. The table shows that health and income security 
were the leading issues addressed among reports focused primarily on 
older Americans. Health and veterans were the leading issues that 
affected both older Americans and other groups.

                       TABLE 1: GAO ACTIVITIES RELATING TO THE ELDERLY IN FISCAL YEAR 1994                      
----------------------------------------------------------------------------------------------------------------
                                                                   Reports with                                 
                                                      Reports     elderly as one                   Ongoing work 
                      Issue                       focused on the    of several      Testimonies    as of 9/30/94
                                                      elderly      target groups                                
----------------------------------------------------------------------------------------------------------------
Employment......................................               0               2               0               0
Health..........................................              16              20              13              26
Housing.........................................               0               7               1               0
Income Security.................................              10               6               8               8
Social Services.................................               3               1               0               0
Veterans........................................               0              17               5              21
Other...........................................               1               6               1               0
                                                 ---------------------------------------------------------------
    Total.......................................              30              59              28              55
----------------------------------------------------------------------------------------------------------------

    Appendix I provides summaries of 30 issued reports on policies and 
programs directed primarily at older Americans. We include in this 
section reviews of health, income security, social services, and other 
issues.
    Appendix II provides summaries of 59 reports in which older 
Americans were one of several target groups for specific Federal 
policies. Many of these policies are generally financed in conjunction 
with services to other populations. For example, Medicaid finances 
nursing homes and other types of long-term care, as well as medical 
care for poor persons of all ages.
    Appendix III describes 28 testimonies given during fiscal year 1994 
on subjects focused on older Americans. We testified most often on 
health issues.
    In appendix IV, we have listed 55 studies related to older 
Americans that were ongoing as of September 30, 1994.

APPENDIX I--FISCAL YEAR 1994 GAO REPORTS ON ISSUES PRIMARILY AFFECTING 
                            OLDER AMERICANS

    During Fiscal Year 1994, GAO issued 30 reports on issues primarily 
affecting older Americans. Of these, 16 were on health, 10 on income 
security, 3 on social services, and 1 on other issues.

                             Health Issues

Health Insurance for the Elderly: Owning Duplicate Policies Is Costly 
        and Unnecessary (GAO/HEHS-94-185, Aug. 3, 1994)
    Owning multiple health insurance policies to supplement Medicare is 
both costly and unnecessary. GAO estimated that about 3 million elderly 
Medicare beneficiaries paid about $1.8 billion in 1991 for policies 
that probably involved duplicate coverage. Many of these people had 
supplemental coverage through employer-sponsored plans. About 500,000 
other Medicare beneficiaries who were also eligible for Medicaid 
because of limited incomes spent about $190 million on unnecessary 
supplemental insurance. Although retirees with employer-sponsored 
coverage generally do not need to buy a Medigap policy, many employers 
with retiree health plans are increasing cost-sharing or tightening 
eligibility requirements. Such changes may make an employer-sponsored 
plan less attractive. In addition, the employer may terminate the plan. 
Federal Medigap requirements provide a one-time ``open season'' for 
people to buy Medigap insurance, regardless of health status, within 6 
months of enrolling in Medicare part B. If a retiree's employee-
sponsored plan is changed or canceled after the open season, the 
retiree has lost the guaranteed access to a Medigap plan. To alleviate 
this potential problem, the Congress would have to revise the law.
Long-Term Care Reform: States' Views on Key Elements of Well-Designed 
        Programs for the Elderly (GAO/HEHS-94-227, Sept. 6, 1994)
    The state agencies agree widely on the key components of well-
designed programs for the elderly. State agencies believe that an 
elderly person's ability to perform activities of daily living is the 
best way to identify persons with the greatest need for services, 
although states do not uniformly define such activities. To determine 
service needs, state agencies generally agree that case/care 
management, a standard assessment instrument, and involvement of the 
elderly person in the process are most useful. State agencies report 
that the largest number of severely disabled elderly persons need 
nonmedical services, such as personal care. State agencies agree that a 
variety of cost control methods are effective, although there is less 
consensus about which specific methods work best. Regarding the 
private-sector role in long-term care, state agencies believe that the 
private-sector role could probably reduce government costs, and 
government interventions might spur private-sector activity.
Long-Term Care: Other Countries Tighten Budgets While Seeking Better 
        Access (GAO/HEHS-94-154, Aug. 30, 1994)
    In the United States, the number of people age 65 and older will 
exceed 20 percent of the total population by the year 2030, up from 
12.5 percent in 1990. Public and private spending for long-term care 
has risen dramatically during the past decade--exceeding $100 billion 
for fiscal year 1993--and is projected to continue this upward trend. 
At the same time, there is considerable consumer dissatisfaction with 
the cost of and access to this care. To varying degrees, other 
countries also face aging populations, cost pressures, and service 
delivery problems. This report reviews the provision of long-term care 
in Canada, Germany, Sweden, and the United Kingdom. GAO examines (1) 
the financing and cost-containment measures these countries use to 
control public spending for long-term care and (2) administrative and 
delivery approaches the countries use to expand the range of and access 
to services.
Long-Term Care: Private Sector Elder Care Could Yield Multiple Benefits 
        (GAO/HEHS-94-60, Jan. 31, 1994)
    Today, about 6 million older Americans need help living at home 
because of their disabilities. The demand for this kind of assistance 
is expected to increase significantly in the future, with upwards of 10 
million persons needing help by 2020. Most disabled elderly receive 
this care from family members and friends, primarily women. Yet greater 
geographic dispersion of families, smaller family sizes, and the large 
numbers of women who work outside the home are straining the ability of 
caregivers. Some companies are responding to the needs of their workers 
with policies and programs, known as ``elder care,'' to help ease work 
and caregiving conflicts. This report evaluates (1) the extent and 
nature of company practices now offered to help employees who look 
after the elderly, (2) planned changes in these practices, and (3) the 
potential of company practices to further support informal caregivers.
Long-Term Care: Status of Quality Assurance and Measurement in Home and 
        Community-Based Services (GAO/PEMD-94-19, Mar. 31, 1994)
    This report examines how quality is ensured and measured in home 
and community-based long-term care services for elderly persons with 
disabilities. These services range from skilled nursing services to 
help with activities such as bathing, dressing, shopping, and meal 
preparation. GAO answers the following questions: How is ``quality'' 
defined for home and community-based long-term care services? What 
measures are now being used to monitor or ensure quality?
Long-Term Care: Support for Elder Care Could Benefit the Government 
        Workplace and the Elderly (GAO/HEHS-94-64, Mar. 4, 1994)
    Today, about 6 million older Americans living at home need help 
with day-to-day activities, such as eating, bathing, shopping, and 
house cleaning. Most disabled elderly get all their care informally, 
from family members and friends, mainly women. Greater geographic 
dispersion of families, small families, and more women working outside 
the home are straining the ability of informal caregiving. Some private 
and public-sector employers are now providing assistance known as 
``elder care'' to alleviate work and caregiving conflicts. This 
assistance may include leave policies, alternative work schedules, and 
referral services to help employees care for their elderly relatives. 
Little is known nationwide about the extent and content of elder care 
generally--and even less is known about elder care in government, which 
employs 18 million people or 15 percent of the workforce. This report 
evaluates (1) the extent and nature of government practices 
facilitating elder care; (2) planned changes in these practices; and 
(3) their potential to further support informal caregivers.
Medicare and Medicaid: Many Eligible People Not Enrolled in Qualified 
        Medicare Beneficiary Program (GAO/HEHS-94-52 Jan. 20. 1994)
    The Qualified Medicare Beneficiary Program pays many out-of-pocket 
expenses for Medicare recipients whose incomes are not quite low enough 
to qualify them for regular Medicaid benefits. The number of people 
enrolled has steadily increased since the program began in 1989, but a 
substantial portion of those eligible has yet to sign up--despite 
repeated efforts by government and advocacy groups to publicize the 
program. Many believe that people have not enrolled because of the 
perceived welfare stigma associated with means-tested programs and 
because of the complicated application process. Many also believe that 
authorizing the Social Security Administration (SSA) to make program 
eligibility determinations would help overcome these factors and boost 
enrollment. Although SSA might be able to increase enrollment, GAO 
believes that this concept should be tested before it is generally 
adopted. Finally, some State part A buy-in practices delay or preclude 
enrollment of Qualified Medicare Beneficiary Program and regular 
Medicaid beneficiaries in part A. This, in turn, can place some 
beneficiaries at a disadvantage relative to beneficiaries in other 
States.
Medicare: Beneficiary Liability for Certain Paramedic Services May Be 
        Substantial (GAO/HEHS-94-122BR, Apr. 15, 1994)
    Volunteer ambulance companies often transport Medicare patients to 
hospitals. In some cases, the patient may require the services of a 
paramedic trained in advanced life support services. GAO found that 
Medicare contractors rely on States to certify ambulance companies for 
participation in the Medicare program, and States set their own 
certification requirements. Most volunteer ambulance companies do not 
charge for their services or have their own paramedics. Medicare does 
not pay separately for paramedics, who are covered only if they are an 
integral part of the ambulance service. Although data are limited, GAO 
believes that the potential liability of Medicare beneficiaries for 
paramedic services may be substantial. For example, two providers of 
paramedic services in Connecticut charged Medicare patients in excess 
of $600,000. The Health Care Financing Administration (HCFA) has tried 
to minimize this liability by allowing ambulance companies to submit a 
single bill to Medicare for both the ambulance and paramedic services. 
Because volunteer ambulance companies seldom bill for services, 
however, this arrangement may not help patients minimize their 
liability. HCFA officials have agreed to reexamine their policy but as 
of March 1994 had not yet reached a decision on this matter.
Medicare: Better Guidance Is Needed to Preclude Inappropriate General 
        and Administrative Charges (GAO/NSIAD-94-13, Oct. 15, 1993)
    GAO found that $1.1 million of $2.6 million in administrative 
expenses claimed by the Hospital Corporation of America (HCA) in its 
Medicare cost report was either unallowable, questionable, or 
unsupported. In a recently completed review of administrative expenses 
and employee fringe benefit costs claimed by hospitals and corporate 
offices in their Medicare cost reports, the Inspector General at the 
Department of Health and Human Services found more than $50 million in 
unallowable and questionable expenses. He concluded that a lack of 
explicit guidance in Medicare cost principles was at least a 
contributing factor to this problem. Similarly, the general nature of 
the Medicare cost principles was a major reason why HCA included 
inappropriate costs in its report. Medicare cost principles, for 
example, do not specifically address many of the costs that GAO 
questioned, such as liquor, flowers, gifts, entertainment, Christmas 
parties, and scholarships for employee children. In GAO's view, the 
cost principles contained in the Federal Acquisition Regulation and in 
Office of Management and Budget Circular A-21 provide useful guidance 
on allowable general and administrative expenses.
Medicare: Changes to HMO Rate Setting Method Are Needed to Reduce 
        Program Costs (GAO/HEHS-94-119, Sept. 2, 1994)
    During the 1980s, the per capita costs of providing health care to 
the elderly under Medicare increased 59 percent, even after adjusting 
for inflation. To slow this cost spiral, the Congress allowed Medicare 
to contract with health maintenance organizations (HMO) under an 
alternative payment system. Medicare's traditional fee-for-service 
payment method created incentives for overuse of medical care because 
providers could boost their incomes by encouraging greater use of 
services. By contrast, HMOs receive an up-front fixed monthly fee for 
each patient's care instead of a fee for each service. Government 
researchers and outside analysts, however, have claimed that HMOs can 
be more expensive than fee-for-service care. These analysts argue that 
beneficiaries enrolled in Medicare HMOs are healthier (and less costly 
to care for) than beneficiaries in the fee-for-service sector and that 
Medicare payments to HMOs do not fully reflect these differences in 
costs. In addition to this problem, industry representatives and other 
analysts claim that Medicare payment rates are too low in some areas 
and show unjustifiably wide variation across geographic boundaries. 
This report examines Medicare's HMO rate setting methodology to 
determine the existence and the magnitude of these problems and to 
review proposed solutions. Specifically, GAO discusses the impact of 
favorable selection and rate variation on the ability of the Medicare 
risk contract program to yield cost savings.
Medicare: Greater Investment in Claims Review Would Save Millions (GAO/
        HEHS-94-35, Mar. 2, 1994)
    Given soaring U.S. health care costs and shrinking budgets for many 
government programs, the Congress is concerned that Medicare pay only 
for appropriate medical services without compromising the quality of 
care provided to beneficiaries. One of the several ways that Medicare 
ensures proper payments is through the medical review function 
performed by contractors--called carriers--who process and pay claims 
for physician services, diagnostic tests, and other Medicare part B 
services. Review activities are designated to prevent spending on 
inappropriate, medically unnecessary, or excessive services. This 
report assesses a HCFA demonstration that involves medical review 
operations at five carriers: three of these were given added management 
flexibility and funding to enhance their medical review function and 
two served as comparisons. This report discusses whether (1) the 
improved medical review activities at the demonstration carriers 
produced measurable savings or benefits to the claims process; (2) more 
medical review funding for other carriers would be cost-effective; and 
(3) HCFA's medical review oversight needs improvement.
Medicare: HCFA's Contracting Authority for Processing Medicare Claims 
        (GAO/HEHS-94-171, Aug. 2, 1994)
    Since 1966, HCFA has awarded most contracts to process claims under 
Medicare parts A and B without competition, has renewed them annually, 
and has compensated contractors on a cost-reimbursement basis. 
Periodically, the Congress has directed HCFA to experiment with other 
types of contracts to reduce administrative costs. Earlier experiments 
had mixed results, but current experiments indicate that different 
types of contracts may reduce costs. While HCFA's current authority 
provides opportunities to achieve administrative efficiencies, it may 
be useful for the Congress to direct HCFA to evaluate new approaches 
that could lead to a more competitive environment. Any changes, 
however, should avoid problems that have occurred in the past. The role 
that the Blue Cross and Blue Shield Association (the national trade 
association for independent Blue plans) plays in coordinating part A 
contracting activities with individual Blues plans may limit the need 
for HCFA resources to perform these activities. However, HCFA has not 
evaluated the Association's performance since 1989, even though HCFA 
paid the Association over $21 million during that period. In GAO's 
view, HCFA needs to regularly assess the Association's performance, 
just as it does for other contractors, to ensure that the Medicare 
program is being managed efficiently.
Medicare: Impact of OBRA-90's Dialysis Provisions on Providers and 
        Beneficiaries (GAO/HEHS-94-65, Apr. 25, 1994)
    To control soaring Medicare costs, the Congress has required that, 
in some cases, employer-sponsored group health plans covering Medicare 
beneficiaries pay medical claims before Medicare begins to foot the 
bill. Since 1981, such a requirement has been in place for patients 
with advanced kidney disease, which requires regular dialysis or a 
kidney transplant. The Omnibus Budget Reconciliation Act of 1990 (OBRA-
90) extended the period during which these plans must pay before 
Medicare kicks in. The OBRA extension of the plans' obligation as 
primary payers has increased the amount that providers received for 
dialysis by an estimated $41 million per year. This increase occurred 
because employer-sponsored plans generally paid dialysis providers more 
than the cost-based Medicare rates. Although the additional revenue is 
relatively small when viewed in the aggregate, boosting total provider 
revenues for dialysis by amount 1.8 percent, it represents pure profit 
for providers. The extension should not affect most kidney patients' 
out-of-pocket expenses because provisions insulate patients with dual 
coverage from being singled out for increased out-of-pocket 
expenditures.
Medicare: Inadequate Review of Claims Payments Limits Ability to 
        Control Spending (GAO/HEHS-94-42 Apr. 28, 1994)
    Medicare overpayments of millions of dollars are being made because 
of inadequate safeguards by contractors who process Medicare claims and 
inattention by HCFA. Carriers use inaccurate or incomplete data in 
compiling statistical reports profiling doctors and other providers. 
Their focused reviews to identify irregular billing patterns and 
unusual spending trends suffer from HCFA's failure to spell out 
appropriate analysis methods and outcome measures. As a result, HCFA 
cannot be sure that Medicare carriers are systematically targeting 
providers or services that most warrant attention. Shortcomings in 
carriers' claims review activities exist, in part, because HCFA lacks 
meaningful requirements for--and the data needed to measure--carriers' 
postpayment review performance. Shortcomings also persist because funds 
earmarked for postpayment review have not kept pace with the growth in 
Medicare claims or as a percentage of the carriers' overall 
administrative budget.
Medicare: Shared System Conversion Led to Disruptions in Processing 
        Maryland Claims (GAO/HEHS-94-66, May 23, 1994)
    Since 1989, HCFA has tried to reduce administrative costs by urging 
Medicare contractors to share claims processing system software and 
hardware with other contractors. In October 1991, Blue Cross and Blue 
Shield of Maryland began using claims processing software developed by 
another contractor. For more than a year after the system conversion, 
Medicare payments to Maryland physicians were frequently late and often 
contained errors, resulting in unanticipated costs of more than $5 
million. The Maryland contractor has yet to realize any of the 
anticipated annual savings of more than $600,000 in administrative 
costs. Poor management by Blue Cross and Blue Shield of Maryland and 
poor decisions by HCFA contributed to the contractor's costly and 
turbulent shared system conversion. In particular, HCFA and the 
Maryland contractors did not allow enough time to plan the effort and 
scheduled the conversion during a period of Medicare program changes 
requiring major computer system modifications. The Maryland 
contractor's experience provides valuable lessons for the future, 
especially given HCFA's plan to convert the 14 systems that the 
contractor now uses to a single automated claims processing system. 
HCFA needs to ensure that planning and testing time for major system 
changes are adequate and not compromised by its desire to achieve 
administrative savings.
Medigap Insurance: Insurers' Compliance With Federal Minimum Loss Ratio 
        Standards, 1988-91 (GAO/HEHS-94-47, Feb. 7, 1994)
    From 1988 through 1991, the market for Medicare supplemental 
insurance--commonly called Medigap--grew by more than 50 percent; 
premiums rose from about $7 billion to $11 billion. In the first half 
of this period, Medigap insurers' loss ratios rose, and the 1991 
aggregate loss ratios were about at their 1988 levels--80 percent for 
policies sold to individuals and 90 percent for group policies. The 
loss ratios for individual policies represent a dramatic improvement 
from the early 1980's when the Federal minimum standards became 
effective and aggregate loss ratios were about 60 percent. The premiums 
associated with companies whose aggregate loss ratios did not meet the 
Federal minimum standards fell from $388 million in 1988 to $206 
million 3 years later. Although this decline suggests that insurers' 
compliance with the loss ratio standards improved during the 4-year 
period, some companies did not meet the minimum loss ratio standards in 
every State in which they did business. The premiums collected by these 
companies steadily declined during the period, from $126 million in 
1988 to $35 million in 1991.

                         Income Security Issues

D.C. Pension Benefits: Comparison With Selected State and Local 
        Government Pension Plans (GAO/HRD-94-18, Nov. 4, 1993)
    After surveying 40 public employee retirement plans, GAO concludes 
that the District of Columbia's retirement plans for police officers, 
firefighters, teachers, and judges generally provide benefits that are 
comparable to those offered by other public retirement plans. District 
police officers and firefighters receive pensions that are slightly 
higher (as a percent of final salary) than the average provided by 
similar plans, while District teachers' pensions are slightly lower. 
District judges' pensions are higher than the average of other plans. 
Any comparison of public pension plan benefits in complicated, however, 
because survivor benefits, disability benefits, and cost-of-living 
adjustment provisions vary among plans. The District's cost-of-living 
adjustment provision--retirement annuities are increased twice yearly 
by the full amount of the rise in the consumer price index--is more 
generous than provisions of other plans.
District's Workforce: Annual Report Required by the District of 
        Columbia Retirement Reform Act (GAO/GGD-94-64, Mar. 31, 1994)
    The Federal Government makes annual payments to the District of 
Columbia retirement fund for police officers and firefighters. To 
encourage the District government to control disability retirement 
costs, these payments must be reduced when the disability retirement 
rate exceeds a certain limit. GAO concludes that no reduction is 
required in the fiscal year 1995 payment to the fund.
Insurance Ratings: Comparison of Private Agency Ratings for Life/Health 
        Insurers (GAO/GGD-94-204BR, Sept. 29, 1994)
    Private rating agencies can play an important role in providing 
consumers with information about insurers' financial health. Concerns 
have arisen, however, about the usefulness of these ratings to 
consumers. This report (1) compares the rating systems of the five 
major raters of life/health insurers--A.M. Best, Duff & Phelps, 
Moody's, Standard and Poor's, and Weiss Research--over the period 
August 1989 to June 1992 and (2) determines which raters were first to 
report the vulnerability of financially impaired or insolvent insurers.
Pension Plans: Stronger Labor ERISA Enforcement Should Better Protect 
        Plan Participants (GAO/HEHS-94-157, Aug. 8, 1994)
    The Department of Labor's Pension and Welfare Benefits 
Administration (PWBA) is responsible for enforcing provisions of the 
Employee Retirement Income Security Act of 1974 (ERISA), the Federal 
program to protect an estimated 200 million participants and 
beneficiaries of private pension and welfare plans, as well as the $2.5 
trillion in assets held by those plans. A review of Labor's enforcement 
program shows improvements since 1986, but also the need to strengthen 
enforcement by taking steps to ensure maximum use of investigative 
resources. PWBA has never evaluated its current enforcement strategy; 
such an evaluation is needed to determine whether PWBA is focusing on 
the right issues and whether the strategy produces the greatest 
results. In addition, PWBA has done little to assess the effectiveness 
of computer targeting programs developed to systematically select 
pension and welfare plans for investigation of potential fiduciary 
violations. The enforcement program also can be strengthened by 
increasing the use of penalties authorized by ERISA to deter plans from 
violating the law.
Proposal to Strengthen H.R. 3396 (GAO/HEHS-94-181R, June 24, 1994)
    Pursuant to a congressional request, GAO provided information on 
options that would strengthen H.R. 3396. GAO noted that (1) H.R. 3396 
would improve funding for many underfunded pension plans, (2) H.R. 3396 
should be strengthened so that sponsors of poorly funded plans are 
required to contribute more than the ERISA minimum requirements, (3) 
the Pension Benefit Guaranty Corporation (PBGC) needs to determine what 
threshold defines a poorly funded plan so that the risks of benefit 
loss are reduced and plan contributions are increased, (4) PBGC 
believes that strengthening H.R. 3396 is unnecessary and that the 
minimum ERISA contribution will be sufficient to move plans to full 
funding, (5) funding mechanisms are needed to ensure that a plan's 
funding ratio will not fall too low because hidden liabilities can 
deteriorate a plan's funding rapidly, and (6) a reasonable threshold to 
define a underfunded plan would be 75 to 85 percent.
Social Security Administration: Risks Associated With Information 
        Technology Investment Continue (GAO/AIMD-94-143, Sept. 19, 
        1994)
    SSA's proposed acquisition of intelligent workstations, that is, 
personal computers and local area networks, has not been driven by 
plans to identify how and where SSA can best use its new technology and 
other resources to handle increasing workloads and improve public 
service. SSA ultimately plans to introduce a system of more than 90,000 
personal computers and 27,000 local area networks at a cost of billions 
of dollars. GAO has encouraged and supported recent SSA efforts to 
reengineer its disability determination process and set overall service 
delivery goals because they are important steps in identifying future 
resource needs. However, national implementation of intelligent 
workstations and local area networks is proceeding independently of 
these initiatives and at risk because SSA has not adequately defined 
its technology needs.
Social Security Disability: Most of Gender Difference Explained (GAO/
        HEHS-94-94, May 27, 1994)
    Under the Social Security Disability Insurance Program, older women 
are allowed benefits at a lower rate than are older men. For example, 
in 1988, 39 percent of female applicants aged 55 to 64--compared with 
50 percent of the male applicants of the same age--were allowed 
benefits. However, GAO found that this difference does not necessarily 
point to bias in the system. Rather, most of the difference could be 
explained by gender difference in impairments and demographic 
characteristics and by the rules for determining disability.
Social Security Retirement Accounts (GAO/HEHS-94-226R, Aug. 12, 1994)
    Pursuant to a congressional request, GAO reviewed proposed 
legislation to create a system of individual Social Security retirement 
accounts (ISSRA), focusing on the (1) implications of H.R. 306 on the 
retirement income of individuals and (2) key differences between H.R. 
306 and the 1990 proposal. GAO noted that (1) ISSRA could be integrated 
with the Social Security benefit structure and, given favorable market 
conditions, could improve retirement incomes; (2) although both 
proposals include a 2-percent payroll tax diversion, H.R. 306 would 
deplete Social Security trust fund contingency reserves; (3) under the 
1990 proposal, the ISSRA program would end when the projected Old Age 
and Survivors Insurance (OASI) cost rate would rise to equal the income 
rate, except for the accumulation and payment of interest; (4) H.R. 306 
proposes a permanent ISSRA scheme that would require future payroll tax 
increases or benefit reductions; (5) since H.R. 306 does not provide 
for benefit reductions to account for the diversion of payroll tax 
revenues, individuals will generally receive a higher total retirement 
income; and (6) under H.R. 306, the ISSRA program would effectively 
become a mandatory defined contribution supplement to Social Security.
Social Security: Sustained Effort Needed to Improve Management and 
        Prepare for the Future (GAO/HRD-94-22, Oct. 27, 1993)
    Failure to meet the SSA's management challenges could have serious 
consequences. SSA provides benefits to about 47 million people today, 
and it will have to provide benefits and services to many more people 
in the future. The baby boomers are aging, and, beginning in 1995, 
Social Security earning and benefits statements will be required for 
all workers. SSA is already seeing the effects of a significant rise in 
disability cases, an area already plagued by major processing delays. 
This third in a series of GAO reports examines SSA's current operations 
and its preparations for the future. GAO concludes that if SSA cannot 
establish the necessary long-range plans, efficiently manage computer-
systems modernization, address workforce needs, and control its 
finances, it risks significant deterioration in its ability to serve 
the public efficiently and effectively. GAO summarized this report in 
testimony before the Congress; see Social Security Administration: SSA 
Needs to Act Now to Assure World-Class Service, by Jane L. Ross, 
Associate Director for Income Security Issues, before the Subcommittee 
on Social Security, House Committee on Ways and Means (GAO/T-HRD-94-46, 
Oct. 28, 1993).
Social Security: Trust Funds Can Be More Accurately Funded (GAO/HEHS-
        94-48, Sept. 2, 1994)
    Each year, the Social Security trust funds are credited with 
revenues derived from income taxes paid on Social Security benefits. 
But do they get the right amount? GAO reports that the Social Security 
trust fund's revenues could be increased by recognizing additional 
taxes identified through the Internal Revenue Service's (IRA) efforts 
to locate underreported taxable income and through better detection of 
underreported tax-exempt interest. Recognizing additional taxes 
identified by IRS could have boosted the trust funds by more than $200 
million in tax revenue and investment income for tax years 1984 to 
1989. Further, data from the Federal Reserve and the Investment Company 
Institute indicate that taxpayers may have underreported an estimated 
$7.2 billion in tax-exempt income on their 1989 tax returns.

                         Social Services Issues

Older Americans Act: Title III Funds Not Distributed According to 
        Statute (GAO/HEHS-94-37, Jan. 18, 1994)
    The Administration on Aging's (AOA) method of allocating funds 
under title III of the Older Americans Act is inconsistent with the 
law's basic requirement that funds be distributed to states in a manner 
proportionate to their elderly populations. Funds must be allotted 
proportionally among the States except that no State is to receive less 
than the minimum set by law. AOA's current method of computing 
allotments ensures that the minimums are met but in a way that fails to 
achieve proportionality among States not subject to the minimum grant 
requirements. Among the distorting effects of AOA's method are that the 
amounts allotted per elderly person are not equal in similarly 
populated States, and States with more rapidly growing elderly 
populations are underfunded. The required method avoids or minimizes 
both effects.
Older Americans Act: The National Eldercare Campaign (GAO/PEMD-94-7, 
        Feb. 23, 1994)
    In April, 1991, AOA launched a multiyear initiative called the 
National Eldercare Campaign. AOA used about $14 million of $26 million 
in title IV discretionary funds to support the campaign's various 
components. The largest portion of these funds went to a new community 
outreach effort, Project CARE. Under this national coalition-building 
demonstration program, each state was required to establish three local 
coalitions. At the end of 15 months, virtually all States had three 
local coalitions in place. A majority of coalitions had generated some 
resources, and about 70 percent of the coalitions were providing a 
service to the elderly. The campaign differs from earlier AOA 
initiatives in that it seeks to expand not only the Aging Network but 
also the resources available to them. Usually, AOA initiatives were of 
12- to 24-months duration and limited to research, demonstration, and 
technical assistance. By the end of fiscal year 1992, about 200 
coalitions had joined the Aging Network and had developed programs and 
services for the elderly. Although this is a significant change in both 
the mission and structure of the Aging Network, the success of this 
campaign ultimately depends upon the coalitions' ability to sustain 
themselves beyond the 3-year funding period.
Older Americans Act: Funding Formula Could Better Reflect State Needs 
        (GAO/HEHS-94-41, May 12, 1994)
    In response to congressional concerns that current title III 
allocations do not fully reflect indicators of states' needs, GAO 
examined the interstate funding formula of the current Older Americans 
Act of 1965. This formula allocated more than $770 million in Federal 
title III dollars in fiscal year 1993 among the 50 States and the 
District of Columbia. GAO concludes that the Congress should modify the 
formula for distributing title III money to better target those elderly 
persons with the greatest social and economic needs. In this report, 
GAO (1) develops equity standards appropriate to evaluating the 
allocation of title III assistance to the States, (2) uses these 
standards to create alternative formulas under which funds might be 
distributed more equitably, (3) shows how each of the alternatives 
would redistribute funding among the States, and (4) explores ways of 
phasing in a new formula to moderate the degrees of funding changes in 
a single year.

                              Other Issues

Aging Issues: Related GAO Reports and Activities in Fiscal Year 1993 
        (GAO/HRD-94-73, Dec. 22, 1993)
    GAO's work on aging issues reflects the continuing importance of 
Federal programs for older Americans. The 1990 Census reported more 
than 31 million older Americans, and that number is expected to top 53 
million by 2020. A multitude of public policy issues are linked to the 
graying of America. GAO's reports and testimony during 1993 addressed 
many of these subjects, including Federal programs relating to 
employment, health care, housing, income security, and veterans 
affairs. This handy reference guide summarizes issued reports and 
testimony and lists jobs that were ongoing as of September 1993.

  APPENDIX II--FISCAL YEAR 1994 GAO REPORTS ON ISSUES AFFECTING OLDER 
                          AMERICANS AND OTHERS

    GAO issued 59 reports in fiscal year 1994 on policies and programs 
in which older Americans were one of several groups. Of these, 2 were 
on employment, 20 on health, 7 on housing, 6 on income security, 1 on 
social services, 17 on veterans, and 6 on other issues.

                           Employment Issues

EEOC's Expanding Workload: Increases in Age Discrimination and Other 
        Charges Call for New Approach (GAO/HEHS-94-32, Feb. 9, 1994)
    The amount of time a person may have to wait for the Equal 
Employment Opportunity Commission (EEOC) to process a discrimination 
charge under the nondiscrimination laws could more than double and 
approach 21 months by fiscal year 1996. The current trend of a steadily 
increasing workload without commensurate increases in resources is 
expected to continue. Former and current EEOC officials and civil 
rights experts have suggested several options that they believe could 
improve the Federal Government's ability to enforce employment 
nondiscrimination laws. The one mentioned most often is increased use 
of alternative dispute resolution approaches, such as mediation. GAO 
recommends that the Congress convene a panel of experts to review this 
and other options for improvement. Because resources are scarce, EEOC 
officials doubt that EEOC will initiate substantially more systemic 
charges or litigate significantly under the nondiscrimination laws.
Employment Discrimination: How Registered Representatives Fare in 
        Discrimination Disputes (GAO/HEHS-94-17, Mar. 30, 1994)
    To work in the security industry, registered representatives--
mainly stockbrokers--must agree to submit any employment controversy, 
including discrimination disputes, to arbitration panels composed of 
neutral third parties. In recent years, the number of discrimination 
cases filed by registered representatives for arbitration at the New 
York Stock Exchange (NYSE) and the National Association of Securities 
Dealers (NASD) has remained low and relatively constant. Six 
discrimination cases were filed for arbitration with NYSE in 1990 and 
14 in both 1991 and 1992. Between August 1990 and December 1992, NASD's 
New York Office and NYSE decided 18 discrimination cases. In 4 of the 
10 cases involving financial awards, the monetary compensation was 
directly linked to discriminatory practices. Sex and age discrimination 
were cited most often in such cases. Some NYSE and NASD procedures for 
selecting arbiters need improvement. For example, NASD lacks written 
criteria for excluding potential arbiters with a history of 
disciplinary actions or regulatory infractions while working in the 
securities industry. In addition, NYSE and NASD differ in their 
requirements for arbiter disclosure of criminal convictions. The 
Securities and Exchange Commission's (SEC) oversight of arbitration 
programs focuses on customer-firm disputes rather than on employee-
employer disputes. Because SEC does not review discrimination cases 
during its inspection of arbitration programs, it does not know the 
extent to which discrimination cases are filed and whether the industry 
has fairly and impartially resolved them. In addition, SEC has not 
established a formal inspection cycle--a set time for conducting 
inspections of securities' arbitration programs--to ensure that all 
programs are inspected regularly. SEC also does not know whether the 
securities industry corrects problems flagged by its inspections.

                             Health Issues

Blue Cross and Blue Shield: Experiences of Weak Plans Underscore the 
        Role of Effective State Oversight (GAO/HEHS-94-71, Apr. 14, 
        1994)
    The 1990 failure of Blue Cross and Blue Shield of West Virginia 
left thousands of people and many health care providers with millions 
of dollars in unpaid claims. More recently, congressional investigators 
uncovered serious financial problems as well as mismanagement at three 
other ``Blues'' plans and raised questions about the oversight of these 
plans by their boards of directors and State regulators. GAO found that 
53 of 64 Blues plans are rated in fair to excellent condition by Weiss 
Research, Inc.--the only insurance rating agency doing such evaluations 
of Blues plans. The remaining 11 plans, which insure about one-quarter 
of all Blues subscribers, are rated as weak to very weak financially. 
Some plans were slow to respond to changing market conditions or made 
poor investment decisions, while others were put at a competitive 
disadvantage by rate-setting constraints and coverage requirements 
applicable only to Blues plans. In addition, weaknesses in oversight by 
plan boards of directors and State regulators allowed plans' financial 
problems to persist. The Blue Cross and Blue Shield Association, 
individual plans, and States have tried to remedy the problems of 
financially troubled plans, but it is too soon to tell how successful 
these efforts will be. Under health care reform, the role of State 
insurance regulators in monitoring the financial solvency of Blues 
plans and protecting subscribers' and providers' interest will become 
increasingly important and challenging. It is essential that State 
insurance regulators have the tools necessary to enforce new 
requirements on Blues plans and other health insurers. -Subformat:
Cancer Survival: an International Comparison of Outcomes (GAO/PEMD-94-
        5, Mar. 7, 1994)
    In comparing United States and Canadian survival rates for lung 
cancer, colon cancer, Hodgkin's disease, and breast cancer, GAO found 
that breast cancer patients lived longer after diagnosis in the United 
States than in Canada. The outcomes were mixed for the other types of 
cancer studied. Nine to 10 years after cancer was detected, the 
survival rates for U.S. patients were indistinguishable from (in the 
cases of colon cancer and Hodgkin's disease) or lower (in the case of 
lung cancer) than survival rates in Canada. One possible interpretation 
of these findings is that quality of care for breast cancer patients is 
better in the United States than in Canada and that for the three other 
cancers it is about the same. Other interpretations focus on 
differences in detection.
Early Retiree Health: Health Security Act Would Shift Billions in Costs 
        to Federal Government (GAO/HEHS-94-203FS, July 21, 1994)
    The President's proposed Health Security Act would relieve private 
industry of much of the financial burden of providing health insurance 
to early retirees. This would shift billions of dollars in costs each 
year to the Federal Government. Today, about 9 million private-sector 
retirees and one-third of all private-sector workers are in company 
health plans with coverage for health care between retirement and age 
65--when Medicare kicks in. If the Health Security Act is enacted, the 
Federal Government, beginning in 1998, would not only pick up the tab 
for early retirees' share of their health costs but would also pay the 
major portion of company costs. The Federal Government's share would be 
$6 billion in the first year, growing to nearly three times that amount 
3 years later. At the same time, companies would save $11 billion in 
the first 3 years and would ultimately save over $130 billion after 10 
years.
Health Care in Hawaii: Implications for National Reform (GAO/HEHS-94-
        68, Feb. 11, 1994)
    For nearly 20 years, Hawaii has been a leader in the effort to 
achieve universal access to health insurance. It is the only State that 
requires employers to provide a minimum level of health insurance 
benefits to employees, and its public programs cover many residents 
lacking employment-based insurance. GAO makes several points. First, 
Hawaii's employer mandate did not have a harmful effect on small 
businesses. Second, although Hawaii's system of near-universal access 
has lowered health premiums, its per capita health care costs have 
risen at a rate similar to the national average. Third, Hawaii's 
experience suggests that an employer mandate by itself will not 
necessarily result in universal access to health care. GAO summarized 
this report in testimony before the Congress; see Health Care in 
Hawaii: Implications for National Reform, by Mark V. Nadel, Associate 
Director for National and Public Health Issues, before the House 
Committee on Small Business (GAO/T-HEHS-94-123, Mar. 16, 1994).
Health Care Reform: ``Report Cards'' Are Useful but Significant Issues 
        Need to Be Addressed (GAO/HEHS-94-219, Sept. 29, 1994)
    As part of the debate over health care reform, the Congress is 
considering requiring health plans to provide prospective purchasers 
with information on the quality of care they furnish. Presumably, 
purchasers will use such ``report cards'' to compare health plans and 
choose one that provides the desired level of quality and price. 
Although report cards that compare the performance of competing health 
care plans could be a positive step in preserving quality and lowering 
costs, experts disagree about the type and amount of information to be 
published because such data may not be reliable or valid. Some experts 
believe that usable report cards can be produced within 2 to 5 years if 
the indicators are limited to those known to be valid and reliable. 
Others believe that it will be as long as 15 years before highly 
reliable and valid measures are developed. Several States and groups 
such as United HealthCare Corporation and Kaiser Permanente Northern 
California Region have already issued report cards on the care they 
furnish, but no studies have been done on the cards' validity or 
reliability. To overcome obstacles to using report cards, most experts 
recommend that (1) the Federal Government standardize indicators and 
the formulas for calculating results and (2) an independent third party 
verify data before they are published.
Health Care Reform: Proposals Have Potential to Reduce Administrative 
        Costs (GAO/HEHS-94-158, May 31, 1994)
    Americans today receive health insurance from a multitude of 
sources, including more than 1,200 commercial insurers; 550 health 
maintenance organizations, 69 Blue Cross and Blue Shield plans; 
thousands of self-insured plans run by private employers; and 
government programs, such as Medicaid and Medicare. Many believe that 
the complexity of this insurance system contributes to the Nation's 
high per capita health care costs. One of the aims of health care 
reform is to enhance administrative efficiency. To the extent that 
reform simplifies insurance administration, it may be able to cut 
costs. Any savings in administrative expenses could be applied to other 
valuable ends, such as expanding access and improving quality. This 
report examines the administrative cost implications of alternative 
reform proposals, including a single-payer plan and three managed 
competition plans, and compares their administrative cost savings 
potential.
Health Care Reform: Potential Difficulties in Determining Eligibility 
        for Low-Income People (GAO/HEHS-94-176, July 11, 1994)
    To obtain basic health care, more than 30 million people depended 
on Medicare in fiscal year 1992. Federal and State governments spent 
nearly $120 billion to provide services to these people. However, 
millions of people with income below the poverty line are not now 
covered by Medicaid. Many of these who are potentially eligible do not 
apply, and many who apply are denied enrollment and remain uninsured. 
Because health care reform may expand coverage to many of the 
uninsured, some form of means testing may be required to determine 
eligibility. This report identifies the (1) reasons why people who may 
be potentially eligible for Medicaid are not being enrolled, (2) 
incentives hospitals have to facilitate enrollment of their patients in 
Medicaid, and (3) implications for eligibility determinations if health 
care reform is enacted.
Health Care: Antitrust Enforcement Under Maryland's Hospital All-Payer 
        System (GAO/HEHS-94-81, Apr. 27, 1994)
    One issue being raised in the debate over health care reform is how 
antitrust law should be applied to health care providers. Federal and 
State antitrust law seeks to prevent price fixing and predatory pricing 
and to ensure access to and quality of goods and services for 
consumers. Since 1974, Maryland has operated a rate-setting program 
that sets how much hospitals can charge for their services. Also, 
health care facilities operating in Maryland must obtain a certificate 
of need if they wish to change the type of services they provide or to 
make major capital expenditures. Because Maryland regulates hospital 
prices similar to the way in which public utilities are regulated, 
State antitrust concerns about hospital pricing are not an issue, and 
Planning Commission-approved mergers and joint actions by hospitals are 
exempt from the State's antitrust law. Also, to the extent that the 
State actively regulates hospitals, Federal antitrust enforcement 
concerning such regulated activities may not be relevant under the 
Supreme Court's State action immunity doctrine. Other concerns about 
anticompetitive conduct and its possible harmful effect on the public 
may still be relevant and covered by Federal or State antitrust law.
Health Care: Federal and State Antitrust Actions Concerning the Health 
        Care Industry (GAO/HEHS-94-220, Aug. 5, 1994)
    In response to a request to review antitrust enforcement actions 
involving hospitals by the Department of Justice and the Federal Trade 
Commission (FTC), GAO found that of 397 acute care hospital mergers 
reviewed by Justice and the FTC in the 13-year period of fiscal year 
1981 through fiscal year 1993, less than 4 percent were challenged. For 
an additional 13 percent of these mergers, Justice or the FTC conducted 
a preliminary investigation and then allowed the mergers to go forward. 
The remaining 83 percent of cases involved no more than the required 
initial filing of notice of proposed merger. Neither Justice nor the 
FTC has ever challenged a hospital joint venture. GAO also found that 
the hospital industry has actively sought enactment of State laws that 
would confer antitrust immunity to collaborative actions by hospitals, 
such as mergers, joint ventures, and sharing of patients and equipment. 
Since 1992, 18 States have enacted regulatory programs of State 
approval of hospital activities that can fall under antitrust statutes. 
Such State laws are sought because under the State action immunity 
doctrine established by the Supreme Court, certain anticompetitive 
conduct regulated by the States may be immune from Federal antitrust 
enforcement action.
Health Insurance: California Public Employees' Alliance Has Reduced 
        Recent Premium Growth (GAO/HRD-94-40, Nov. 22, 1993)
    As part of the ongoing debate over health care reform, policymakers 
have been weighing the pros and cons of alternative ways to purchase 
care. The administration's health care reform package and other recent 
reform proposals call for purchasing cooperatives to manage competition 
among health care plans. One frequently cited example of a successful 
purchasing cooperative is the California Public Employees' Retirement 
System (CalPERS), which negotiates health premiums for many public 
employees in California. This report analyzes CalPERS' effectiveness in 
controlling health care costs for its members. GAO (1) examines 
CalPERS' cost-containment record, (2) identifies factors that have 
contributed to the trend in its premium rates, (3) assesses the impact 
of CalPERS' cost-containment efforts on its members' benefits, and (4) 
discusses the applicability of its Health Benefits Program as a model 
of managed competition--a system under which large purchasing 
cooperatives contract with a variety of competing health plans on 
behalf of employers and individuals.
Health Professions Education: Role of Title VII/VIII Programs in 
        Improving Access to Care Is Unclear (GAO/HEHS-94-164, July 8, 
        1994)
    During the past decade, the supply of nearly all health 
professionals has increased faster than has the population. For most 
health professions, however, data are unavailable to show whether this 
increased supply has meant more access to care in rural and underserved 
areas. For the two professions with the most data available--primary 
care physicians and general dentists--supply has increased in many 
rural areas but not in those urban and rural areas with the greatest 
shortages. GAO's findings are similar for minority recruitment: 
Although the number of minorities in the health professions is 
increasing, data are inconclusive about whether further increases will 
improve access to health care for underserved populations. Although 
nearly $2 billion has been provided to 30 Title VII and VIII programs 
during the last 10 years, evaluations have not shown that these 
programs have had a significant effect on changes in the supply, 
distribution, and minority representation of health professionals.
Medicaid Long-Term Care: Successful State Efforts to Expand Home 
        Services While Limiting Costs (GAO/HEHS-94-167, Aug. 11, 1994)
    Because nearly one-third of the Nation's Medicaid expenditures are 
now spent on long-term care ($42 billion in 1993), GAO was asked to 
review the experience of States in expanding government-funded home and 
community-based services. GAO's review focused on Oregon, Washington, 
and Wisconsin. These three States have expanded home and community-
based long-term care in part as a strategy to help control rapidly 
increasing Medicaid expenditures for institutional care. As they 
expanded home and community-based care, the three States restricted how 
large most of the programs can grow. Some restrictions were mandated by 
the Federal Government which approves capacity limits on programs 
operated under Medicaid waivers. Other restrictions result from 
constrained State budgets. Despite these deliberate limits on program 
size, one impact of the shift to home and community-based care is that 
the three States have been able to provide services to more people with 
the dollars available, primarily because home and community-based care 
is less expensive per person than institutional care.
Medicaid: Changes in Best Price for Outpatient Drugs Purchased by HMOs 
        and Hospitals (GAO/HEHS-94-194FS, Aug. 5, 1994)
    The Congress has tried to reduce Medicaid prescription drug costs 
by requiring drug manufacturers to give State Medicaid programs rebates 
for outpatient drugs. The rebates were based on the lowest or ``best'' 
prices that drug manufacturers charged other purchasers, such as health 
maintenance organizations (HMO) and hospitals. Concerns have been 
raised in the Congress that drug manufacturers might try to minimize 
the rebates to State Medicaid programs by increasing best prices and 
cutting best price discounts for drugs purchased by HMOs and others. 
This fact sheet (1) determines the changes in the best prices for the 
drugs bought by the HMOs and group purchasing organizations GAO 
studied; (2) determines the changes in the difference between the 
drugs' best prices and their average prices, known as the ``best price 
discount;'' and (3) compares the changes in the best prices with the 
changes in prices paid by the HMOs and the group purchasing 
organizations.
Medicaid: States Use Illusory Approaches to Shift Program Costs to 
        Federal Government (GAO/HEHS-94-133, Aug. 1, 1994)
    Medicaid, which provides health insurance for qualified low-income 
persons, is jointly funded by the Federal Government and the states. 
Because of soaring health care costs during the past decade, States 
have been searching for new ways to help finance the $125 billion 
Medicaid program. Some States are now using dubious financial 
arrangements to collect Federal funds without committing their own 
matching amounts, thus increasing the share of Medicaid costs borne by 
the Federal Government. This report (1) examines the financial 
arrangements used by states to inflate the Federal share of Medicaid 
program expenditures, (2) describes the various techniques that States 
use to obtain Federal funds for their basic Medicaid and 
disproportionate share hospital programs, and (3) looks into whether 
States are using their Federal matching funds to provide medical 
services to Medicaid patients.
Medical Malpractice: Maine's Use of Practice Guidelines to Reduce Cost 
        (GAO/HRD-94-8, Oct. 25, 1994)
    As part of a larger goal of reducing health care costs and 
improving medical care, Maine is testing an innovative medical 
malpractice reform initiative. Maine has incorporated into State law 20 
practice guidelines for four specialties; anesthesiology, emergency 
medicine, obstetrics and gynecology, and radiology. This effort seeks 
to resolve malpractice claims by eliminating the need to litigate to 
establish the standard of care. Maine officials expect that the 
practice guidelines will decrease doctors' motivation to do medically 
unnecessary tests and will lower health care costs. Maine was able to 
incorporate the practice guidelines into law by (1) gaining broad 
involvement of those affected by the guidelines, (2) ensuring that 
those developing and choosing the guidelines were accountable to the 
public, and (3) protecting the physicians who use the guidelines in 
their practice. Specifically, the project was developed and is overseen 
by health care providers, payers, and consumers. To persuade Maine's 
doctors to participate in the project once it was developed, the 
project provides physicians complying with the guidelines a defense in 
future malpractice lawsuits. With these components, the majority of 
eligible doctors opted to participate in the project.
Medicare/Medicaid: Data Bank Unlikely to Increase Collections From 
        Other Insurers (GAO/HEHS-94-147, May 6, 1994)
    The Department of Health and Human Services has been directed to 
establish a data bank, beginning in February 1995, that would contain 
information on all workers, spouses, and dependents who are covered by 
employer-provided health insurance. The goal is to save millions by 
strengthening processes to (1) identify the approximately 7 million 
Medicare and Medicaid beneficiaries who have other health insurance 
coverage that should pay medical bills before Medicare and Medicaid 
kicks in and (2) ensure that this insurance is appropriately applied to 
reduce Medicare and Medicaid costs. In GAO's view, however, the data 
bank will end up costing millions and likely achieve little savings. 
GAO believes that changes and improvements to existing activities would 
be a much easier, less costly, and thus preferable alternative to the 
data bank. This is largely because the data bank will result in an 
enormous amount of added paperwork for both the Health Care Financing 
Administration (HCFA) and the Nation's employers. GAO summarized this 
report in testimony before the Congress; see Medicare/Medicaid: Data 
Bank Unlikely to Increase Collections From Other Insurers, by Leslie G. 
Aronovitz, Associate Director for Health Financing Issues, before the 
Senate Committee on Governmental Affairs (GAO/T-HEHS-94-162, May 6, 
1994).
Medicare: Graduate Medical Education Payment Policy Needs to Be 
        Reexamined (GAO/HEHS-94-33, May 5, 1994)
    It is widely held that the United States is not training enough 
primary care physicians relative to types of physicians. In 1961, about 
half of all doctors were in primary care practice; if current trends 
continue, that number could drop to about 26 percent by 2020. At the 
same time, if health care reform establishes a delivery system that 
incorporates managed care, the need for primary care physicians will 
increase. The Medicare program is the primary vehicle through which the 
Federal Government helps finance physician training and education. 
Although data are limited, some researchers argue that hospitals are 
using Medicare funds to disproportionately underwrite the training of 
nonprimary care physicians at a time when more primary care physicians 
are needed. This report (1) describes how Medicare compensates 
hospitals for the costs of graduate medical education and (2) 
determines the extent of Medicare support for the graduate medical 
education of primary and nonprimary care physicians.
Medicare: Technology Assessment and Medical Coverage Decisions (GAO/
        HEHS-94-195FS, July 20, 1994)
    Thousands of medical procedures, devices, and drugs are available 
for patient care in this country. Each year, public and private health 
care insurers make coverage decisions for these medical technologies. 
To make these decisions, insurers increasingly rely on formal 
technology assessments, which evaluate a technology's safety and 
effectiveness. In this fact sheet, GAO provides general information 
about the technology assessment resources and activities of the Public 
Health Service's (PHS) Agency for Health Care Policy and Research, 
HCFA's resources and processes for making Medicare coverage decisions, 
and HCFA's process for making hospital payments that account for the 
use of new technologies.
Prescription Drugs: Companies Typically Charge More in the United 
        States Than in the United Kingdom (GAO/HEHS-94-29, Jan. 12, 
        1994)
    Drug manufacturers charge 60 percent more for 77 commonly 
prescribed, brand-name drugs in the United States than for the same 
medications in the United Kingdom. A total of 66 of the drugs were 
priced higher in the United States than in the United Kingdom; 47 of 
these were priced more than twice as high. Most of the differences in 
prescription drug prices between countries cannot be attributed to 
differences in manufacturers' costs. Instead, U.S.-U.K. drug price 
differences are mainly due to the lack of regulatory constraints in the 
United States. In the United Kingdom, the government health system--
virtually the sole payer for prescription drugs--has an agreement with 
drug manufacturers that limits the profits that drug companies can earn 
on sales in the British Isles. Other factors may also work to lower 
drug prices in the United Kingdom. Pharmaceutical information is more 
widely available in the United Kingdom than in the United States, 
possibly enhancing price competition among drug manufacturers in the 
United Kingdom. U.K. doctors receive information on their own 
prescribing patterns and on the comparative prices and efficacy of 
drugs. The government can remove drugs from its list of reimbursable 
products if the manufacturers' prices for those drugs are considered 
excessive. Wholesalers and retailers can import brand-name drugs into 
the United Kingdom from elsewhere in Europe where drugs are cheaper.
Public Health Services: Agencies Use Different Approaches to Protect 
        Public Against Disease and Injury (GAO/HEHS-94-85BR, Apr. 29, 
        1994)
    The PHS conducts or supports national programs of health services 
delivery, disease prevention, health promotion, and biomedical research 
through eight agencies. Because agencies' programs often address the 
same diseases or conditions, the potential exists for duplication of 
effort. Congressional concerns have also been raised about the 
expansion of funding for the Centers for Disease Control and Prevention 
(CDC), which rose from $587 million to about $1.5 billion between 
fiscal years 1987 and 1992. Concerns have likewise been raised that the 
scope of CDC's programs and activities today extends well beyond the 
agency's early focus on communicable disease. GAO found that no PHS 
agency was duplicating another agency's public health activities in the 
programs GAO reviewed. Also, CDC's programs were appropriate 
considering the agency's legislative authority and its history of 
prevention and control efforts regarding chronic diseases and other 
health conditions. Public health experts GAO consulted support CDC's 
activities.

                             Housing Issues

Efforts to Assist the Homeless in San Antonio (GAO/RCED-94-238R, July 
        11, 1994)
    Pursuant to a congressional request, GAO reviewed the role of 
McKinney Act programs in assisting the homeless in San Antonio. GAO 
noted that (1) although the homeless have had access to a range of low-
income assistance programs since 1970, most of these programs were not 
targeted specifically toward the homeless; (2) before McKinney Act 
programs became available, emergency shelters were established by 
charitable organizations and health care was available through county 
facilities; (3) McKinney program funding has played a small but 
important role in San Antonio's homeless assistance efforts since 1987; 
(4) McKinney programs have improved existing emergency food and shelter 
programs, funded transitional housing, expanded health care services, 
helped link adult education programs with shelters, established mobile 
outreach services for the mentally ill and employment assistance for 
veterans, and improved coordination between local organizations and 
providers; (5) local service providers believe that their current 
resources are not sufficient to meet the special needs of the homeless; 
(6) service providers believe that San Antonio needs to increase the 
amount of transitional housing, employment training, literacy 
education, prenatal care for youths, substance abuse treatment, 
homeless prevention efforts, affordable housing for low-income persons, 
and high-paying jobs; and (7) San Antonio should seek new and creative 
ways to provide low-income housing, since affordable housing shortages 
contribute to homelessness in San Antonio.
Efforts to Assist the Homeless in Seattle (GAO/RCED-94-237R, July 11, 
        1994)
    Pursuant to a congressional request, GAO reviewed the role of 
McKinney Act programs in assisting the homeless in Seattle. GAO noted 
that (1) homeless social service programs and emergency services have 
been available in Seattle for many years and are funded by local and 
state governments and private sources; (2) McKinney program funding has 
played an important role in Seattle's homeless assistance efforts since 
1987; (3) McKinney programs have supplemented existing food and 
emergency shelter services, expanded employment and education programs, 
and funded transitional housing, health care services shelters, and 
mentally ill outreach programs; (4) although McKinney funds are 
provided to cities for food, shelter, health care, education, and 
employment programs targeted to the homeless, the current resources 
available are not meeting service demands; (5) service providers 
believe that without McKinney program funds, health care outreach 
services, transitional housing, and education programs would be greatly 
reduced or discontinued; (6) local service providers believe that 
Seattle needs to increase the amount of affordable housing for low-
income persons, funds for substance abuse programs, services targeted 
to youths, and its employment training, education, and homeless 
prevention efforts; and (7) Seattle should seek new and creative ways 
to provide low-income housing, since affordable housing shortages 
contribute to homelessness in Seattle.
Efforts to Assist the Homeless in Baltimore. (GAO/RCED-94-239R, July 
        11, 1994)
    Pursuant to a congressional request, GAO reviewed the role of 
McKinney Act programs in assisting the homeless in Baltimore, GAO noted 
that (1) homeless emergency services have been available in Baltimore 
since the 19th century; (2) before McKinney Act programs became 
available, churches, missions, and private groups provided food and 
shelter services for the homeless; (3) since 1987, McKinney program 
funding has played an important role in Baltimore's efforts to assist 
the homeless; (4) McKinney programs have supplemented existing 
emergency food and shelter services, funded transitional housing and 
education programs for adults and children, expanded health care 
services, and established mobile outreach services for the mentally ill 
and a research demonstration project for homeless people with chronic 
mental illnesses and substance abuse problems; (5) service providers 
believe that without McKinney program funds, case management and health 
care outreach services, transitional housing, and adult education 
programs would be greatly reduced or discontinued; (6) local service 
providers believe that their current resources are not sufficient to 
meet the special needs of the homeless and that Baltimore needs to 
increase the amount of affordable housing, funds for substance abuse 
programs, and its homeless education and prevention efforts; and (7) 
Baltimore should seek new and creative ways to provide low-income 
housing, since affordable housing shortages contribute to homelessness 
in Baltimore.
Homelessness: McKinney Act Programs Provide Assistance but Are Not 
        Designed to Be the Solution (GAO/RCED-94-37, May 31, 1994)
    The Stewart B. McKinney Homeless Assistance Act of 1987 established 
emergency food and shelter programs; programs providing longer term 
housing and supportive services; and programs designed to demonstrate 
effective approaches for providing the homeless with other services, 
such as physical and mental health, education, and job training. GAO 
evaluated the act's impact in Baltimore, Maryland; San Antonio, Texas; 
Seattle, Washington; and St. Louis, Missouri. This report discusses (1) 
what difference the McKinney Act programs have made in these cities' 
efforts to help the homeless, (2) what problems the cities have 
experienced with McKinney Act programs, and (3) what directions the 
cities' programs for the homeless are taking and what gaps the McKinney 
Act programs may fill.
Homelessness: McKinney Act Programs and Funding Through Fiscal Year 
        1993 (GAO/RCED-94-107, June 29, 1994)
    GAO is required to report annually to the Congress on the status of 
programs authorized under the McKinney Act. This report provides 
updated program and funding information for fiscal years 1992 and 1993. 
It also provides information on the third reauthorization of the Act. 
GAO discusses the legislative history of the act; describes each 
McKinney Act program, and identifies the funding provided under each 
program by State. GAO also briefly describes newly authorized 
assistance programs for the homeless and significant changes to 
existing McKinney Act programs that occurred during these two fiscal 
years.
Rental Housing: Use of Smaller Market Areas to Set Rent Subsidy Levels 
        Has Drawbacks (GAO/RCED-94-112, June 24, 1994)
    To ensure that needy families can live in adequate housing, the 
Department of Housing and Urban Development (HUD) provides rent 
subsidies to low-income households. This program, known as the Section 
8 program, served more than 1 million households at a cost of about $7 
billion in 1992. The amount of rental assistance that a household 
receives varies depending on the household's market area. The size and 
nature of a market area can vary greatly: Entire States, large 
metropolitan areas, and medium-sized cities can all be considered 
market areas. In response to congressional concerns that these market 
areas are too broadly defined to permit rental assistance payments that 
reflect true market rents, this report determines (1) the effects of 
basing rent subsidy payments on smaller market areas, including any 
effects that doing so would have on recipient households' access to 
education and employment and (2) the extent to which payments made 
under the current program have an inflationary effect on the rental 
rates in surrounding areas. GAO also provides information on where 
Section 8 recipients lived and their proximity to key services and 
businesses. GAO based its analysis on the following four market areas: 
Oklahoma City, Oklahoma; Seattle, Washington; Washington, D.C.; and 
Wilmington, Delaware.
Section 8 Rental Housing: Merging Assistance Programs Has Benefits but 
        Raises Implementation Issues (GAO/RCED-94-95, May 27, 1994)
    HUD runs two similar rental housing subsidy programs for low-income 
households--the section 8 certificate and voucher programs. These two 
programs, which local and State housing agencies operate for HUD, 
enable 1.3 million poor families to live in decent, affordable, 
privately owned housing. Although these programs are in many ways 
similar, several statutory and administrative differences can affect 
the housing subsidy that households receive. Over the past several 
years, GAO, the Vice President's National Performance Review, and 
others have urged that the two programs be combined; legislation now 
before the Congress would accomplish that goal. This report examines 
(1) the benefits of a merger, (2) the major program differences that 
would need to be reconciled, (3) the effect of a merger on HUD's 
budgeting and financial management, and (4) the effort needed to merger 
the two programs.

                         Income Security Issues

Social Security Disability: SSA Quality Assurance Improvements Can 
        Produce More Accurate Payments (GAO/HEHS-94-107, June 3, 1994)
    In 1993, the Social Security Administration's (SSA) Disability 
insurance program provided nearly $35 million to 5.3 million disabled 
workers and their dependents and the Supplemental Security Income (SSI) 
program provided about $24 billion to 6 million recipients. Although 
SSA runs these programs, State agencies determine whether claimants are 
disabled according to program rules. In recent years, disability 
benefit claims have soared, and the two programs have been unable to 
keep up with the high rate of claims submitted. In response to 
congressional concerns about the increasing workload pressures on the 
quality of disability determinations, this report evaluates (1) the 
reliability of SSA's reported accuracy rates and (2) how well SSA's 
quality assurance mechanism ensures the accuracy and consistency of 
State agencies' disability determinations and minimizes erroneous 
payments.
Social Security: Disability Rolls Keep Growing, While Explanations 
        Remain Elusive (GAO/HEHS-94-34, Feb. 8, 1994)
    More people are applying for and being awarded Social Security 
disability benefits than ever before, and these beneficiaries are 
remaining on the disability rolls for longer periods of time. As a 
result, disability payments have burgeoned. Changes in beneficiary 
characteristics have accompanied this growth: the average age of new 
beneficiaries is now below 50, mental impairment awards to younger 
workers have risen substantially, and more and more new beneficiaries 
receive such low disability insurance (DI) benefits that they get 
additional income from SSI. These low benefit levels suggest that the 
new beneficiaries had limited work histories. Higher unemployment 
probably contributes to increasing applications, and policy changes 
have produced changes in the numbers and types of beneficiaries. 
Quantitative data on the impact of these factors are lacking, however, 
and important questions remain. The upshot is that SSA's ability to 
predict future growth and change in the rolls is limited. Better 
information would also help SSA to determine whether improvements in 
program management are needed.
Social Security: Increasing Number of Disability Claims and 
        Deteriorating Service (GAO/HRD-94-11, Nov. 10, 1993)
    The administration SSA's disability programs has reached a crisis 
stage; service is poor and billions of dollars in payments will end up 
going to ineligible persons unless mandated continuing disability 
reviews are resumed. Claim backlogs and processing times for SSA's DI 
and SSI programs hit an all-time high in fiscal year 1992. The two 
programs have been unable to keep up with the high rate of claims for 
benefits, a trend that has continued into fiscal year 1993. Processing 
times have increased nearly 50 percent in recent years, and some States 
take more than 5 months to process claims. SSA has undertaken many 
short-term initiatives to keep up with claims--most significantly, the 
funding of overtime for disability determination services. According to 
administrators, staff are overworked and overtime is at record levels. 
SSA has also diverted staff from doing continuing disability reviews to 
program benefits at a cost of at least $1.4 billion. These short-term 
initiatives have only slightly reduced pending claims and processing 
times. SSA also has several long-term initiatives under way to improve 
its disability programs; exactly how, when, and to what extent these 
initiatives will improve service is unknown at this point, however.
Social Security: Major Changes Needed for Disability Benefits for 
        Addicts (GAO/HEHS-94-128, May 13, 1994)
    The number of addicts receiving disability benefits has grown 
substantially during the last 5 years--from fewer than 100,000 to about 
250,000 today. The annual cost of providing benefits to addicts is 
about $1.4 billion. The vast majority of addicts receiving disability 
benefits are either not in treatment of their treatment status is 
unknown. About 100,000 addicts have not been assigned a third-party or 
representative payee to manage their benefits. Consequently, SSA has no 
guarantee that these persons are not using their benefit checks to buy 
drugs or alcohol. Even in cases when payees have been assigned, their 
control over benefit payments is questionable; most of these payees are 
friends or relatives. Because addicts may abuse, threaten, and pressure 
their payees, GAO believes that organizations would make better payees 
for addicts than friends or relatives. SSA needs to ensure that all 
disability benefit recipients are in treatment and that all addicts 
have a third-party or representative payee. Also, the Congress needs to 
consider expanding the treatment requirement to all addicts and 
restructuring the program to improve the payoff from treatment. GAO 
summarized this report in testimony before the Congress, Social 
Security: Disability Benefits for Drug Addicts and Alcoholics Are Out 
of Control, by Jane L. Ross, Director of Income Security Issues (GAO/T-
HEHS-94-101, Feb. 10, 1994).
Social Security: Most Social Security Death Information Accurate but 
        Improvements Possible (GAO/HEHS-94-211, Aug. 29, 1994)
    Nearly all the information based on reports of death that the SSA 
shares with other Federal agencies is accurate. The accuracy of this 
information, which is provided to such agencies as the Departments of 
Defense, Veterans Affairs, and Labor, is essential to prevent or 
identify millions of dollars in overpayments by Federal agencies to 
deceased persons and to avoid the erroneous termination of benefits. 
Fewer than 1 percent of the nearly 350,000 recorded deaths GAO reviewed 
were inaccurate. SSA can make its information more useful by taking 
action in four areas: the handling of cases erroneously terminated, 
processing of rejected death reports, providing information on 
nonbeneficiaries, and using feedback based on agency investigations of 
deaths.
Social Security: New Continuing Disability Review Process Could Be 
        Enhanced (GAO/HEHS-94-118, June 27, 1994)
    SSA's new process for conducting continuing disability reviews 
relies on computer profiling and beneficiary self-reported data. 
Beneficiary self-reported data, when used with other key information 
SSA has, appear reliable for making decisions about when to do full 
medical examinations of beneficiaries scheduled for reviews. SSA has 
also taken steps to further assess the reliability of the self-reported 
data and plans to continually refine its use of computerized 
beneficiary data to better predict medical improvements and likely 
benefit terminations. The mailer process appears to be a significant 
step by SSA to make the review process more efficient and cost-
effective. SSA needs to send out more mailers and conduct more full 
medical reviews of program beneficiaries. As SSA gains more experience 
with the mailer process and improves its ability to accurately identify 
beneficiaries with the greatest potential for medical improvement, it 
should do more full medical reviews of those persons to achieve the 
most effective use of agency resources. By focusing on beneficiaries 
with the greatest likelihood of improvement, SSA can save taxpayers 
millions of dollars each year and help preserve the programs' integrity 
by removing ineligible persons from the rolls.

                         Social Services Issues

Americans With Disabilities Act: Challenges Faced by Transit Agencies 
        in Complying With the Act's Requirements (GAO/RCED-94-58, Mar. 
        11, 1994)
    The Americans With Disabilities Act prohibits discrimination on the 
basis of disability. The law requires transit systems to gradually make 
their buses and rail systems accessible to the disabled, including 
wheelchair users, and provide alternative transportation to those 
unable to use the transit systems' fixed-route service. Alternative 
transportation, called paratransit or door-to-door service, is 
generally provided by vans, minibuses, or taxis. This report (1) 
reviews the early experiences of transit agencies in phasing in the 
act's paratransit requirements and notes challenges to successful 
implementation, (2) provides information on transit agencies' 
projections of costs and time periods to implement the act's 
paratransit requirements, and (3) identifies variables affecting the 
reliability of projections and the magnitude of potential costs.

                            Veterans Issues

Disabled Veterans Programs: U.S. Eligibility and Benefit Types Compared 
        With Five Other Countries (GAO/HRD-94-6, Nov. 24, 1993)
    The United States offers benefits specifically for disabled 
veterans and their survivors in more program areas than any of the five 
other nations GAO studied--Australia, Canada, Finland, Germany, and the 
United Kingdom. Major differences exist, however, in the kinds of 
benefits offered, the eligibility requirements for benefits, and the 
methods used to compute benefits. Countries without special programs 
for disabled veterans often help these men and women through programs 
that serve the general population. In fact, Germany and the United 
Kingdom run most of their special veterans programs through general 
social service agencies rather than a separate veterans agency as in 
the United States, Australia, Canada, and Finland. Countries differ in 
the extent to which a veteran's disability must be service connected 
for the veteran to receive benefits. Most foreign countries require 
that a disability be closely related to the performance of military 
duty to qualify for disability benefits; no such link is required in 
the United States. The upshot is that the United States provides 
benefits for some disabilities that other countries do not. In a July 
1989 report (GAO/HRD-89-60), GAO recommended that the Congress consider 
tightening the U.S. criteria.
Health Security Act: Analysis of Veterans' Health Care Provisions (GAO/
        HEHS-94-205FS, July 15, 1994)
    Reform of the Nation's health care system to reduce the number of 
Americans who lack coverage of basic acute health care services could 
significantly reduce demand for such services in facilities 
administered by the Department of Veterans Affairs (VA). GAO reported 
in 1992 that if changes were not made in the VA health care system as 
part of health reform, VA hospitals could lose about 50 percent of 
their acute hospital workload and 44 percent of their outpatient 
workload. To assist the congressional Veterans' Affairs Committees, 
which will be considering legislation to fundamentally reform the VA 
health care system and veterans' health benefits, GAO prepared this 
fact sheet, which analyzes the veterans affairs provisions of the 
administration's proposed Health Security Act.
Homelessness: Demand for Services to Homeless Veterans Exceeds VA 
        Program Capacity (GAO/HEHS-94-98, Feb. 23, 1994)
    Veterans are generally believed to be about one-third of the 
homeless population in the United States; on any given night, up to 
250,000 of an estimated 600,000 homeless persons living on the streets 
or in shelters may be veterans. Virtually all of these veterans are 
men, many of whom suffer from mental illness or drug and alcohol 
problems. The capacity of VA programs to serve these homeless veterans, 
however, falls far short of the demand of such services. Further VA 
services for homeless veterans are nonexistent in many areas of the 
country. Every VA medical center is required to assess the needs of 
homeless veterans, determine the availability of VA and other services 
in its area, and establish plans to meet those needs in coordination 
with public and private providers. VA has not done these assessments 
and has yet to set specific targets dates. If VA is to address the 
medical and social needs to homeless veterans nationwide, existing 
substance abuse, mental health, and housing programs will need to be 
substantially expanded and enhanced. VA may need to open new beds, hire 
more staff, contract with private providers of health care/housing, and 
either renovate buildings or allow private homeless groups to do so to 
provide temporary housing. In an era of tight Federal budgets, however, 
increasing services for the homeless could force cutbacks in services 
to other veterans.
VA and the Health Security Act (GAO/HEHS-94-159R, May 9, 1994)
    Pursuant to a congressional request, GAO reviewed the proposed 
Health Security Act, focusing on (1) the provisions that pertain 
directly to VA; (2) other provisions of the Health Security Act that 
pertains to veterans' health care; and (3) a comparison of the health 
care services that would be covered under the Health Security Act with 
the health care services currently available to veterans. GAO noted 
that (1) the comprehensive benefits package under the proposed Health 
Security Act and the scope of care currently available to veterans are 
very extensive; (2) current VA benefits of mental health care, 
substance abuse treatment, dental treatment of children, and optometric 
treatment for children are more generous than those benefits proposed 
under the comprehensive benefits package; (3) VA currently provides for 
respite care and domiciliary care while the proposed Health Security 
Act does not; (4) the board array of VA benefits is affected by 
complicated VA edibility criteria; and (5) the proposed Health Security 
Act is more generous in regard to the broad category of outpatient 
services since it includes no limitations on outpatient care.
VA Health Care: A Profile of Veterans Using VA Medical Facilities in 
        1991 (GAO/HEHS-94-113FS, Mar. 29, 1994)
    In 1993, the President proposed a major overhaul of the Nation's 
health care system that would guarantee universal coverage to all 
Americans. For many veterans, this reform would allow them, for the 
first time, to choose between VA medical centers and other health care 
providers. Employment status and income levels are expected to be major 
factors affecting veterans' decisions. This fact sheet profiles 
veterans who, during 1991, used VA medical centers. It describes 
veterans' income, age, marital status, usage rates, disability status, 
employment, family size, and other characteristics. GAO collected this 
information using VA patient records and Internal Revenue Service tax 
records.
VA Health Care: Delays in Awarding Major Construction Contracts (GAO/
        HEMS-94-170, June 17, 1994).
    For major construction projects costing $3 million or more, the VA 
is required to award (1) construction document contracts by September 
30 of the fiscal year in which funds are appropriated and (2) 
construction contracts by September 30 of the following fiscal year. VA 
is required to report to the Congress and to GAO on the projects that 
did not meet these time limits. VA's January 1994 letter to the 
Congress and GAO correctly identifies 15 projects that were required to 
but did not have construction document contracts or construction 
contracts awarded by September 30, 1993. GAO believes that the 
contracting delays for these projects do not constitute impoundments of 
budget authority under the Impoundment Control Act. In GAO's view, VA 
has shown no intent to refrain from using the funds appropriated. 
Information VA provided to GAO indicates that programmatic 
considerations caused the contracting delays. The reason cited most 
often for delays was changes in project scope or design. VA expects to 
award 13 of the 17 required contracts for these 15 projects by 
September 30, 1994.
VA Health Care: Labor Management and Quality-of-Care Issues at the 
        Salem VA Medical Center (GAO/HRD-93-108 Sept. 23, 1994)
    In April 1993, the bodies of two patients were found on the grounds 
of the VA Medical Center in Salem, Virginia, and allegations were made 
about poor quality patient care due to nursing shortages, employees' 
stress, and poor staff morale, GAO found that the center's new medical 
director is restoring both staff and public confidence in the 
facility's management and has started to deal with quality-of-care 
issues. He has addressed many of the labor-management issues 
confronting the facility and is trying to overcome nurse staffing 
shortages that have harmed the quality of care being provided. But more 
needs to be done. Nurse staffing shortages continue, medical records 
are incomplete, some psychiatrists are not seeing their patients 
regularly, and some psychiatrists and nurses are shirking essential 
duties, such as taking patient histories upon admission, assessing 
patient needs, and providing discharge planning before a patient is 
released. In addition, the center's quality assurance program could 
stand improvement. Management should ensure that this program 
objectively and systematically monitors and continuously improves the 
quality and appropriateness of services delivered.
VA Health Care: Medical Care Cost Recovery Activities Improperly Funded 
        (GAO/HRD-94-2, Oct. 12, 1993)
    Before 1990, the 158 medical centers run by the VA used medical 
care appropriations to finance the recovery of health care costs from 
veterans or third parties. In November 1990, the Congress established a 
Medical-Care Cost Recovery Fund to finance all recovery expenses 
related to collecting the cost of medical care and services provided by 
VA. This report examines whether medical centers were using only the 
fund to underwrite cost recovery activities. GAO also reviews VA 
efforts to improve the efficiency of its recovery activities.
VA Health Care: Restructuring Ambulatory Care System Would Improve 
        Services to Veterans (GAO/HRD-94-4, Oct. 15, 1994)
    Veterans are experiencing lengthy delays when receiving medical 
care at the approximately 200 outpatient facilities run by the VA. 
Veterans often wait up to 3 hours before being examined by a doctor in 
VA's emergency/screening clinics. In addition, veterans wait an average 
of 8 to 9 weeks for an appointment in specialty clinics, such as those 
for cardiology or orthopedics. Inefficient operating procedures are the 
main cause of these delays. President Clinton has called for VA to 
compete with other providers in meeting the health care needs of 
veterans. To be a viable competitor, VA needs to quickly restructure 
its outpatient care delivery system to provide more timely ambulatory 
services. The establishment of telephone assistance networks and 
appointment scheduling systems, for example, would help in the case of 
veterans with nonurgent conditions. GAO summarized this report in 
testimony before the Congress; see Veterans Affairs: Service Delays at 
VA Outpatient Facilities, by David P. Baine, Director of Federal Health 
Care Delivery Issues, before the Subcommittee on Oversight and 
Investigations, House Committee on Veterans Affairs (GAO/T-HRD-94-5, 
Oct. 27, 1993).
VA Health Care: Tuberculosis Controls Receiving Greater Emphasis at VA 
        Medical Centers (GAO/HRD-94-5, Nov. 9, 1993)
    Lax infection-control practices and inadequate isolation rooms were 
behind the tuberculosis outbreak at the VA medical center in East 
Orange, New Jersey. Medical center staff did not consistently use 
appropriate procedures for isolating suspected or known tuberculosis 
patients. The center lacked a comprehensive employee-testing program to 
monitor the staff's exposure to active tuberculosis. Isolation rooms 
did not have proper airflow, and air exhausted from these rooms may 
have contaminated other areas in the medical center. Since the 
outbreak, the center has made major improvements in its infection-
control practices, and VA plans to construct 19 isolation rooms at the 
center. VA has also tried to beef up tuberculosis controls at its other 
medical centers and is giving greater scrutiny to centers' 
tuberculosis-control programs and practices. According to a December 
1992 VA survey, 10 medical centers each had more than 20 cases of 
tuberculosis; 6 of the 10 also had the highest numbers of AIDS cases.
VA Health Care: VA Medical Centers Need to Improve Monitoring of High-
        Risk Patients (GAO/HRD-94-27, Dec. 10, 1993)
    After two patients were found dead on the grounds of a VA medical 
center, GAO investigated and found that ``high-risk'' patients--those 
unable to care for themselves--who wander away are a significant 
problem at 39 of 158 VA medical centers. In a recent 2-year period, 
more than 100 searches were conducted for high-risk patients at 20 VA 
medical centers. Patients leave their treatment settings without staff 
knowledge primarily when medical center staff (1) underestimate the 
potential for these patients to wander off without authorization or (2) 
fail to closely watch all high-risk patients while they are in the 
facility or on its grounds. During the same 2-year period, about 7,000 
searches were conducted throughout the VA system for high-risk patients 
who were reported missing. About 99 percent of these patients were 
ultimately found unharmed; 34 were found dead and 19 injured. VA is 
working to develop search procedures for these high-risk patients who 
disappear without staff knowledge and approval. The goal is to find 
these persons before they leave the medical center grounds. But VA also 
needs to do a better job of monitoring high-risk patients to prevent 
unauthorized departures in the first place. Further, VA can do more to 
locate unaccounted for patients.
Veterans Benefits: Redirected Modernization Shows Promise (GAO/AIMD-94-
        26, Dec. 9, 1993)
    In December 1992, the VA awarded the first of its planned three-
stage modernization procurements. This 8-year contract was awarded to 
Federal Data Corporation with a maximum value of $300 million. In 
response to congressional concerns about the benefits expected from 
this contract, this report discusses (1) the status of VA's business 
process redesign and its service improvement goals, (2) the validity of 
VA's cost estimates for the modernization, and (3) VA's contention that 
existing computer equipment failures were frequent and caused severe 
benefit service problems. In June 1993, VA and the Office of Management 
and Budget (OMB) agreed to redirect VA's modernization effort. This 
report also comments on the VA-OMB agreement.
Veterans' Benefits: Lack of Timeliness, Poor Communication Cause 
        Customer Dissatisfaction (GAO/HEHS-94-179, Sept. 20, 1994)
    In fiscal year 1993, the VA provided nearly $19 billion in 
nonmedical benefits to veterans and their families. In 1993, GAO 
surveyed 1,400 recent applicants for VA nonmedical benefits nationwide. 
Although most applicants were satisfied with VA's services, more than 
one-third were unhappy with VA's handling of their claims. The time it 
takes VA to process claims was by far the greatest source of 
applicants' dissatisfaction. Communication with VA was another major 
concern for applicants. Many customers said that they were 
dissatisfied, whether the communications were by mail, by phone, or in 
person. For example, 40 percent of those who visited a VA office said 
that they did not get the information they needed. The need to resubmit 
documents to VA also inconvenienced applicants. GAO's study pointed out 
two other factors that may hold significant implications for VA's 
efforts to improve customer satisfaction. First, applicants whose 
claims were denied represented a significant portion--36 percent--of 
VA's customers. VA knows very little about who those applicants are, 
why their claims were denied, or what it could do to help these people. 
Second, 60 percent of VA customers received service from sources over 
which VA has no authority, such as State and county veterans offices 
and veterans service organizations.
Veterans' Benefits: Status of Claims Processing Initiative in VA's New 
        York Regional Office (GAO/HEHS-94-183BR June 17, 1994)
    The VA recognizes slow claims processing and poor customer service 
as critical concerns. Claims processing time is increasing as are 
claims backlogs. In 1993, more than 500,000 claims were pending in VA 
regional offices nationwide. One of the most highly publicized 
initiatives to reduce claims processing time and improve service to 
veterans and their families is the restructuring of the claims 
processing system in VA's New York Regional Office. In May 1993, the 
regional office began processing a quarter of its claims in a prototype 
unit. This new unit differs substantially from the traditional 
``assembly line'' organization used by the rest of the New York office 
and most other VA regional offices. This briefing report determines (1) 
how the operation of the prototype unit differs from the traditional 
operation in New York, (2) how VA is assessing the effectiveness of the 
prototype and how the prototype's performance compares to the rest of 
the New York office's, and (3) what plans New York has for expanding 
the use of the prototype.
Veterans' Health Care: A Profile of Married Veterans Using VA Medical 
        Centers in 1991 (GAO/HEHS-94-223FS, Aug. 26, 1994)
    In a March 1994 report (GAO/HEHS-94-113FS), GAO profiled veterans 
who used medical centers run by the VA. That report focused on 
veterans' family incomes and showed how family income varied in 
relation to a range of characteristics, including employment status. 
This fact sheet examines married veterans, analyzing the percentage of 
family income attributable to veterans and spouses and comparing 
married veterans' incomes with those of single veterans. In addition, 
this fact sheet further refines veterans' employment status to 
differentiate between veterans receiving employee compensation and 
those with self-employment income.
Veterans' Health Care: Implications of Other Countries' Reforms for the 
        United States (GAO/HEHS-94-210BR, Sept. 27, 1994)
    Reform of the Nation's health care system would have a major impact 
on the VA health care system, one of the Nation's largest direct 
delivery systems. Health care reform would give many uninsured and poor 
veterans the freedom to choose between VA and other health care 
providers. This would likely cause many veterans to leave the system 
unless it changes or VA benefits change to encourage those now in the 
system to stay or those outside the system to start using VA 
facilities. Without such changes, VA would likely lose nearly 50 
percent of its acute hospital workload. This report studies changes in 
veterans health care systems and benefits in other countries that 
implemented universal health care systems. GAO limited its review to 
four countries--Australia, Canada, Finland, and the United Kingdom--
that ran separate direct delivery systems for veterans when they 
instituted universal health care.
Veterans' Health Care: Most Care Provided Through Non-VA Programs (GAO/
        HEHS-94-104BR, Apr. 25, 1994)
    When the VA health care system was established in 1930, neither 
public nor private health insurance programs were available to American 
veterans. With the subsequent growth of public and private health 
insurance programs, most veterans today have alternatives to VA health 
care. National health care reform could further reduce the number of 
veterans lacking health insurance. This briefing report determines (1) 
how many veterans are receiving services under other federal health 
programs and the cost of providing those services and (2) how many 
veterans using VA services are eligible to receive care under other 
Federal programs.

                              Other Issues

Americans With Disabilities Act: Effects of the Law on Access to Goods 
        and Services (GAO/PEMD-94-14, June 21, 1994)
    This report looks at the extent to which the Americans With 
Disabilities Act has improved the access for persons with disabilities 
to goods and services provided by businesses and State and local 
governments. Overall, GAO found steady improvement in both 
accessibility and awareness during the initial 15 months that the act 
was in effect. However, enough areas of concern remain to suggest a 
need for continuing educational outreach and technical assistance to 
business and Government agencies covered by the act, as well as 
continued monitoring by the Congress.
Budget Policy: Issues in Capping Mandatory Spending (GAO/AIMD-94-155, 
        July 18, 1994)
    GAO examined whether implementation of a budgetary cap on mandatory 
entitlement spending is a practical way to control growth in mandatory 
programs. Although a spending cap on mandatory spending for Federal 
entitlement programs would yield savings, a cap would have little, if 
any, effect on the long-term growth of these programs until the issues 
of eligibility and benefits, which drive up spending, are addressed.
FDA User Fee: Current Measures Not Sufficient for Evaluating Effect on 
        Public Health (GAO/PEMD-94-26, July 22, 1994)
    The Congress passed legislation in 1992 requiring the Food and Drug 
Administration (FDA) to charge fees for reviewing new drug applications 
to determine whether the drugs can be marketed in the United States. 
The fees collected are to be used to augment FDA resources devoted to 
reviewing new drug applications. This increase in resources, in turn, 
is intended to speed drug review and approval. GAO reviewed whether the 
data mandated by the law will be sufficient to evaluate how well the 
law has achieved its goal of getting drugs to patients sooner. GAO 
found that the existing reporting requirements of the user fee act, if 
satisfied, will provide detailed information on one aspect of the drug 
review and approval process--the timeliness of FDA performance. 
However, because FDA performance is not the sole determinant of how 
long the process takes, these data alone will not be enough to evaluate 
how long it takes for drugs to become publicly available, and more data 
are needed.
Federal Aid: Revising Poverty Statistics Affects Fairness of Allocation 
        Formulas (GAO/HEHS-94-165, May 20, 1994)
    Concerns have been raised in the Congress that revising counts of 
people in poverty by adjusting the official poverty line for geographic 
differences in the cost of living could significantly alter the 
allocation of Federal aid to State and local governments. This report 
presents GAO's views on how such a revision could affect the fairness 
of the distribution of Federal formula grants if such an adjustment 
were made. GAO concludes that adjusting poverty counts to reflect 
differences in the cost of living, if proven feasible, would bolster 
the Federal Government's ability to target Federal aid to places with 
the greatest needs. GAO also believes that such a change should not be 
implemented in Federal allocation formulas without first assessing the 
impact of the change on the fairness with which Federal funding is 
allocated to States and localities. In a formula lacking an indicator 
of States' own funding capabilities, such a change by itself could 
increase inequities. In formulas that already adequately reflect 
States' funding capabilities, such a change would improve fairness.
Health, Education, Employment, Social Security, Welfare, and Veterans 
        Reports (GAO/HEHS-94-233W, Sept. 1994)
    This booklet lists GAO documents issued on government programs 
related to health, education, employment, Social Security, welfare,and 
veterans issues, which are primarily run by the Departments of Health 
and Human Services, Labor, Education, and Veterans Affairs. One section 
identifies reports and testimonies issued in the 2 months prior to 
September 1994 and summarizes key products. Another section lists all 
documents published during the past 2 years, organized chronologically 
by subject. Order forms are included.
Status of Open Recommendations: Improving Operations of Federal 
        Departments and Agencies (GAO/OP-94-1, Jan. 14, 1994)
    In fiscal year 1993, GAO made more than 1,600 recommendations. This 
yearly report highlights the impact of GAO's work on everything from 
health care to transportation to international affairs. It also 
summarizes the key recommendations that have yet to be fully acted 
upon. For the first time, computer disks are being automatically 
included with the printed report. This hypertext software, which 
provides greater detail on all open recommendations, contains menu 
options that allow users to locate information easily.

APPENDIX III--FISCAL YEAR 1994 TESTIMONIES RELATING TO ISSUES AFFECTING 
                            OLDER AMERICANS

    GAO testified 28 times before congressional committees during 
fiscal year 1994 on issues relating to older Americans. Of the 
testimonies, 13 were on health, 1 on housing, 8 on income security, 5 
on veterans, and 1 on other issues.

                             HEALTH ISSUES

Health Care in Hawaii: Implications for National Reform (GAO/T-HEHS-94-
        123, Mar. 16, 1994)
    For nearly 20 years, Hawaii has been a leader in the effort to 
achieve universal access to health insurance. It is the only State that 
requires employers to provide a minimum level of health insurance 
benefits to employees, and its public programs cover many residents 
lacking employment-based insurance. GAO makes several points. First, 
Hawaii's employer mandate did not have a harmful effect on small 
businesses. Second, although Hawaii's system of near-universal access 
has lowered health premiums, its per capita health care costs have 
risen at a rate similar to the national average. Third, Hawaii's 
experience suggests that an employer mandate by itself will not 
necessarily result in universal access to health care.
Health Care Reform: Supplemental and Long-Term Care Insurance (GAO/T-
        HRD-94-58, Nov. 9, 1993)
    Provisions of the Clinton administration's Health Security Act that 
deal with private long-term care insurance and supplemental health 
insurance address many of the problems that GAO has pointed out in the 
past. The act has detailed sections governing the content and marketing 
of such insurance, including disclosure standards that protect 
consumers from deceptive marketing practices, grievance procedures that 
allow policyholders to contest insurance company decisions, and sales 
commission standards that discourage questionable sales practices. In 
general, GAO believes that the administration's proposal contains the 
kinds of consumer protections that GAO has long advocated. Some 
problems, however, are not addressed. Specifically, the act will not 
protect consumers from the sale of duplicate policies or high-pressure 
sales techniques. It also does not address other kinds of supplemental 
insurance that cover specific diseases or conditions requiring 
hospitalization. Because of their limited, narrow coverage, such 
insurance may be unnecessary for many consumers.
Health Care Reform: Implications of Geographic Boundaries for Proposed 
        Alliances (GAO/T-HEHS-94-108, Feb. 24, 1994)
    A common feature of many health reform bills is the creation of 
public or private health alliances that would seek to broaden coverage, 
pool risks, give consumers a choice of health care plans, and 
disseminate information on the costs and quality of plans. All the 
bills leave the establishment of alliance boundaries to the States. 
This testimony discusses (1) the provisions of major health reform 
bills concerning the configuration of alliance boundaries; (2) 
experiences of two States that have established entities similar to 
alliances; (3) features and procedures for creating a Metropolitan 
Statistical Area; and (4) issues relating to the potential effects of 
alliance boundaries on existing health markets, access to health care, 
and distribution of health care costs within a State. Concerns about 
the boundary provisions of the health reform proposals include the 
potential for gerrymandering, changing the provision and receipt of 
health care, segmenting high-risk groups, and isolating underserved 
areas.
Health Care Reform: How Proposals Address Fraud and Abuse (GAO/T-HEHS-
        94-124, Mar. 17, 1994)
    Weaknesses within the current health insurance system allow 
unscrupulous health care providers to cheat insurance companies and 
programs out of billions of dollars annually. Fraud and abuse flourish 
in a health care system that collects little information on provider 
practices, encourages high profits at the expense of cost-effective 
care, and has ineffective laws and enforcement mechanisms to punish and 
recover money from those abusing the system. This testimony makes 
several recommendations aimed at overcoming these problems. Recent 
legislative proposals to reform the health care system, including the 
administration's proposal, address each of these elements to some 
extent.
Long-Term Care Reform: Program Eligibility, States' Service Capacity, 
        and Federal Role in Reform Need More Consideration (GAO/T-HEHS-
        94-144, Apr. 14, 1994)
    Passage of any long-term care reform legislation is merely the 
first step in a long journey toward meeting the Nation's long-term care 
needs. Knowledge about determining long-term care needs and services, 
derived largely from the experience of innovative States suggests that 
State flexibility is the best way to meet the diverse needs of 
individuals and communities. This flexibility requires a new, different 
Federal role, largely one of partnership with the States in the design 
and management of programs. The administration's proposal would give 
states $38 billion in Federal funding each year for a new Federal-State 
program of home and community-based services, to be phased in from 1996 
to 2003. States will be given wide latitude to design and run programs 
to serve persons of all income ranges. The proposal would also 
liberalize Medicaid nursing home eligibility, provide tax credits to 
defray the costs of personal assistance for working persons with 
disabilities, and encourage and regulate private long-term care 
insurance. If the administration's proposal is to be the blueprint for 
long-term care reform, the new Federal role should be spelled out more 
clearly. More thought should also be given to developing State guidance 
on determining eligibility and to helping States with less capacity to 
use program funds wisely.
Long-Term Care: Demography, Dollars, and Dissatisfaction Drive Reform 
        (GAO/T-HEHS-94-140, Apr. 12, 1994)
    The long-term care system has evolved in a patchwork fashion and 
today comprises multiple programs that individuals find hard to access. 
Despite millions of dollars in outlays, the system often fails to meet 
the diverse needs of the disabled, and many believe that access to 
services could be improved with the same level of funding. This 
testimony focuses on three trends underlying the quest for reform. 
First, demographic changes make rising demand for long-term care 
inevitable across all ages, not just for the elderly. Second, spending 
will escalate sharply across all ages, not just for the elderly. Third, 
despite high costs, disabled persons are increasingly unhappy with 
available services and their ability to obtain them.
Long-Term Care: The Need for Geriatric Assessment in Publicly Funded 
        Home and Community-Based Programs (GAO/T-PEMD-94-20, Apr. 14, 
        1994)
    Because of advances in medicine and public health, Americans are 
living longer than ever before. Nearly one in every eight Americans was 
65 years of age or older in 1990; by 2020, this ratio is expected to 
rise to one in five. To maintain their independence, many elderly 
people need daily help with routine activities, such as bathing, 
dressing, shopping, and meal preparation. Home and community-based 
long-term care for the elderly is today financed and run through a host 
of Federal and State programs. This fragmentation can result in elderly 
persons being reevaluated every time they apply for a new program or 
pass a particular milestone, such as being discharged from a hospital. 
Despite this potential for redundancy, geriatric assessment is a 
potentially useful part of any program with frail elderly clients 
seeking community and home-based long-term care. This testimony 
discusses (1) what geriatric evaluation is and how it is used, (2) the 
extent to which it is available in public programs, (3) the 
professional requirements for persons who administer it, and (4) the 
pros and cons of standardizing the evaluation process.
Managed Health Care: Effect on Employers' Costs Difficult to Measure 
        (GAO/T-HEHS-94-91, Feb. 2, 1994)
    Although some ``managed care'' plans have the potential for 
delivering health care at lower cost, little empirical evidence exists 
showing that the use of these plans has contained employers' overall 
health care costs. Managed care refers to insurance plans that limit 
patients to a specific network of doctors and hospitals, control the 
use of services, and negotiate reimbursement with providers. Under this 
definition, about half of all insured workers are covered by managed 
care plans. GAO reviewed employers' experience with managed care and 
found that some managed care plans, by negotiating physician and 
hospital payments and controlling the use of services, can potentially 
hold down costs. Lower costs for these plans, however, may not 
translate into lower health care spending for employers due to enrollee 
differences and pricing policies. GAO also discovered that employees 
like many features of managed care plans but would rather not be 
limited in their choice of physicians.
Medicaid: A Program Highly Vulnerable to Fraud (GAO/T-HEHS-94-106, Feb. 
        25, 1994)
    The Medicaid program cost State and local governments more than 
$150 billion in 1993 for health services and supplies. It is highly 
vulnerable to fraud because of its size, structure, target population, 
and coverage. The ensuring drain on program funds is hard to gauge, but 
State Medicaid officials believe it may be as high as 10 percent of 
program expenditures. Prescription drugs are a very appealing target. 
Schemes include pharmacists routinely adding medications to customers' 
orders and clinics inappropriately giving Medicaid recipients completed 
prescription forms, or scrips, that can be sold on the street to the 
highest bidder. Some pills costing 50 cents at the pharmacy have been 
resold for as much as $85. Although States have been tackling Medicaid 
fraud with some success, the problem persists. Officials in many States 
say that most leads to unpursued, cases take too long to resolve, and 
penalties are light even for those convicted. Most say that a lack of 
resources hinders oversight, investigations, and prosecutions. GAO 
suggests that the Health Care Financing Administration (HCFA) take the 
lead and develop an overall strategy to guide States in their struggle 
against Medicaid fraud.
Medicare Part B: Inconsistent Denial Rates for Medical Necessity Across 
        Six Carriers (GAO/T-PEMD-94-17, Mar. 29, 1994)
    GAO discovered large disparities in a probe of how many Medicare 
claims are being rejected for medical reasons in different parts of the 
country. The study looked at six carriers: California Blue Shield, 
California-Occidental, Illinois Blue Shield, Wisconsin Physician 
Services, North Carolina-Connecticut General, and South Carolina Blue 
Shield. In Southern California, for example, the insurance carrier 
handling Medicare claims rejects as medically unnecessary 54 of every 
1,000 claims for mammograms. In contrast, in Northern California, only 
3 claims in 10,000 for the same procedure are turned down. GAO 
discovered (1) sizable differences among the carriers with respect to 
denial rates for the services screened for medical necessity; (2) that 
the number of services that carriers screened for medical necessity 
varied markedly; and (3) that the overall denial rate for medical 
necessity also differed among the six carriers reviewed. At one 
extreme, one carrier denied as few as 1 service per 1,00 allowed, while 
at the other extreme, another carrier denied 23 services per 1,000 
allowed. Medicare is a national program under which beneficiaries in 
different geographic areas should be receiving similar benefits. 
Although it may be essential for Medicare to allow for local 
determination of medical policy, GAO concludes that this allowance, 
left to itself, results in inconsistent treatment of beneficiaries and 
providers.
Medicare/Medicaid: Data Bank Unlikely to Increase Collections From 
        Other Insurers (GAO/T-HEHS-94-162, May 6, 1994)
    The Department of Health and Human Services has been directed to 
establish a data bank, beginning in February 1995, that would contain 
information on all workers, spouses, and dependents who are covered by 
employer-provided health insurance. The goal is to save millions by 
strengthening processes to (1) identify the approximately 7 million 
Medicare and Medicaid beneficiaries who have other health insurance 
coverage that should pay medical bills before Medicare and Medicaid 
kicks in and (2) ensure that this insurance is appropriately applied to 
reduce Medicare and Medicaid costs. In GAO's view, however, the data 
bank will end up costing millions and likely achieve little in the way 
of savings. GAO believes that changes and improvements to existing 
activities would be a much easier, less costly, and thus preferable 
alternative to the data bank. This is largely because the data bank 
will result in an enormous amount of added paperwork for both HCFA and 
the Nation's employers.
Medicare: Adequate Funding and Better Oversight Needed to Protect 
        Benefit Dollars (GAO/T-HRD-94-59, Nov. 12, 1993)
    Soaring expenditures for health care underscore the need for the 
government to fund and manage Medicare judiciously, but budget 
constraints have resulted in underfunding key program safeguards that 
control billions of dollars in benefit payments. In fiscal year 1993, 
Medicare cost $146 billion, covered about 35 million beneficiaries, and 
processed nearly 700 million claims. Medicare has delegated much of the 
responsibility for program safeguards to a national network of some 80 
claims processing and payment contractors. GAO testified that, given 
shortcomings in these safeguards, any cuts in Medicare's administration 
budgets should take into account their likely effect on benefit 
payments. During the past 5 years, Medicare's program safeguards 
budget, on a per claim basis, has declined dramatically. The upshot is 
that opportunities to curb unnecessary Medicare expenditures are being 
lost. Strong evidence exists that with an adequately funded and managed 
safeguard program, Medicare could avoid millions of dollars in 
unnecessary expenditures. GAO believes that the Congress should 
continue to pursue modifying budget procedures so that Medicare's 
safeguard funding could be boosted without cutting spending elsewhere. 
GAO also believes that HCFA needs to develop an effective strategy to 
manage contractors' payment safeguard activities.
1993 German Health Reforms: Initiatives Tighten Cost Controls (GAO/T-
        HRD-94-2, Oct. 13, 1993)
    Expensive new technologies, an aging population, administrative 
waste, structural inefficiencies, and unnecessary medical procedures 
have all fueled soaring health care costs in most industrialized 
nations. In 1993, Germany, concerned about sharp rises in health 
insurance premiums, began tightening its existing cost-control 
measures. The United States may find the German experience instructive 
because that Nation provides coverage of nearly all its residents, 
guarantees a generous benefit package, and, like the U.S. system, 
relies mainly on employment-based financing. This testimony, which 
draws on a July 1993 GAO report (GAO/HRD-93-103), provides an overview 
of the German health care system, discusses problems leading up to the 
1993 reforms, and presents some early results of these changes.

                             Housing Issues

Federally Assisted Housing: Condition of Some Properties Receiving 
        Section 8 Project-Based Assistance Is Below Housing Quality 
        Standards (GAO/T-RCED-94-273, July 26, 1994)
    Physical conditions in the Section 8 assisted properties GAO 
visited ranged from very good to very poor. The properties in good 
physical condition show that the Section 8 program can work. Conditions 
in some properties, however, clearly violate the Department of Housing 
and Urban Development's (HUD) housing quality standards. In the 
distressed properties, families lived in units with leaking toilets and 
sinks, exposed electrical wiring, holes in walls and ceilings, broken 
air conditioners and smoke detectors, damaged and missing kitchen 
cabinets, and roach and rat infestation. Moreover, the landlords for 
some of these distressed properties collected rents that were higher 
than those for well-maintained apartments nearby. Although HUD has 
various enforcement tools to ensure that properties comply with this 
housing quality standards, including barring or suspending landlords 
from further participation in Section 8 programs and terminating 
housing assistance contracts, HUD has used these tools sparingly and 
inconsistently.

                         Income Security issues

D.C. Pensions: Plans Consuming Growing Share of District Budget (GAO/T-
        HEHS-94-192, June 14, 1994)
    The District of Columbia's overall financial status is being 
affected by the increasing demand on city revenues from its underfunded 
pension plans for police and fire fighters, teachers, and judges. In 
1991 the District's contribution to these plans was about 8 percent of 
revenues, and unless remedial action is taken, the contribution could 
rise to about 15 percent of revenues by 2005. Pension costs are now 
running more than 50 percent of payroll and will grow to 70 percent 
after 2004. This testimony provides a brief historical overview of the 
unfunded liability in the District's Pension plans; outlines the plans' 
current funding provisions; and discusses the effects of H.R. 3728, the 
District of Columbia Pension Liability Funding Reform Act of 1994, 
which seeks to eliminate the District's financial liability for these 
plans, as well as the responsibilities of the Federal Government, the 
District, and the plans' participants.
Social Security Administration: Many Letters Difficult to Understand 
        (GAO/T-HEHS-94-126, Mar. 22, 1994)
    The Social Security Administration (SSA) each year sends letters to 
more than 44 million people. To accommodate this extremely high volume, 
virtually the entire process is automated, SSA relies on these letters 
to officially notify individuals about their eligibility for benefits 
or adjustments SSA is making to their benefits. SSA has had long-
standing problems communicating clearly in its letters. Although SSA's 
recently revised communication standards appear to be a positive step, 
they do not address problems such as illogically ordered information or 
missing details. GAO staff trained in accounting and the Social 
Security program examined a representative sample of 500 letters and 
found them hard to understand. GAO concludes that SSA needs to 
establish overall communication objectives, including identifying this 
customers' preferences and measuring progress toward achieving such 
objectives.
Social Security Administration Major: Changes in SSA's Business 
        Processes Are Imperative (GAO/T-AIMD-94-106, Apr. 14, 1994)
    SSA's current disability determination process is extremely 
stressed, burdened with increasing workloads and enormous backlog. SSA 
has turned to automation to improve operations, but these efforts have 
had only a minimal impact because they focused on automating existing 
processes that are inefficient, SSA's April 1994 proposal for 
redesigning the disability process is a credible proposal that would 
make the basic changes needed to realistically cope with disability 
determination workloads. The proposal, which combines top management 
leadership with the necessary staff and money, documents the existing 
disability determination problems and recommends a solution to 
dramatically change the process. As with any major reform, however, 
many implementation issues still need to be addressed, including new 
staffing and training demands, developing necessary automation 
requirements, and confronting the entrenched cultural barriers to 
changes.
Social Security: Continuing Disability Review Process Improved, but 
        More Targeted Reviews Needed (GAO/T-HEHS-94-121, Mar. 10, 1994)
    GAO is encouraged SSA's efforts to make the continuing disability 
review process more efficient and cost-effective through the use of 
computer profiling and beneficiary self-reported data. GAO is 
concerned, however, that SSA continues to do too few continuing 
disability reviews, particularly for beneficiaries with the greater 
likelihood of being removed from the disability rolls. In GAO's view, 
finding ways to provide SSA with more money to do the reviews is 
worthwhile.
Social Security: Disability Benefits for Drug Addicts and Alcoholics 
        Are Out of Control (GAO/T-HEHS-94-101, Feb. 10, 1994)
    The number of drug addicts receiving Social Security disability 
benefits has soared in recent years; about 250,000 addicts now receive 
disability benefits at an annual cost of $1.4 billion. Despite the fact 
that half of them qualify for benefits on the basis of their addiction 
alone, most addicts are not required to be in treatment. Finding 
qualified representative payees to manage addicts' benefits have been a 
long-standing problem for the SSA. Most payees are either friends or 
relatives. In the absence of tight controls, addicts are free to buy 
drugs and alcohol to maintain their addictions. GAO believes that 
organizational payees would be in a better position to provide the 
strict controls needed over benefit payments to addicts.
Social Security: GAO's Analysis of the Notice Issue (GAO/T-HEHS-94-236, 
        Sept. 16, 1994)
    GAO has been studying the ``notch'' issue for more than 8 years and 
has testified before the Congress many times. This testimony briefing 
covers the critical matters that GAO believes the Commission on the 
Social Security Notch Issue must deal with in addressing the notch 
issue in 1994. In summary, GAO concludes that retirees in the notch 
group who claim an inequity are comparing themselves to a group of 
retirees who received benefits based on an overgenerous formula. If the 
Congress chooses to pursue legislation, it should consider several 
factors, particularly the cost of financing any legislation.
Underfunded Pension Plans: Federal Government's Growing Exposure 
        Indicates Need for Stronger Funding Rules (GAO/T-HEHS-94-149, 
        Apr. 19, 1994)
    Sponsors of underfunded pensions are required by law to make 
additional contributions to their funds, but no evidence exists that 
the problem of underfunding has abated. The total underfunding in 
single-employer plans insured by the Pension Benefit Guaranty 
Corporation (PBGC) rose from $31 billion in 1990 to more than $50 
billion 1992. In a random sample of plans paying PBGC's variable rate 
premium, GAO discovered that only 40 percent of the plan sponsors 
subject to the law were making additional contributions in 1990, and 
the amount of additional contributions was less than 3 percent of the 
plans's underfunding. GAO found that the amounts sponsors were allowed 
to use to reduce their additional contributions were much larger than 
the unreduced additional contributions for some plans, suggesting that 
the design of the offset is flawed and needed to be changed. H.R. 3396 
contains provisions to improve funding in underfunded plans, including 
a measure to correct the design flaw in the offset. Although it 
believes that the bill is a step in the right direction, GAO believes 
that the provisions of H.R. 3396 should be strengthened to ensure that 
sponsors of a greater percentage of underfunded plans make additional 
contributions.
Underfunded Pension Plans: Stronger Funding Rules Needed to Reduce 
        Federal Government's Growing Exposure (GAO/T-HEHS-94-191, June 
        15, 1994)
    Although the majority of pension plans insured by the PBGC are well 
funded, a significant minority are underfunded, and the level of 
underfunding in these plans has been growing in recent years. This 
growth increases PBGC's exposure, which refers to the size of its 
potential claims. This testimony makes three main points. First, 
current rules designed to ensure that sponsors of underfunded plans 
make additional contributions to better fund their plans are not 
working well. Second, provisions in the administration's proposed 
pension reform bill--S. 1780, the Retirement Protection Act of 1993--
especially the revised offset design, should increase both the number 
of sponsors of underfunded plans that make additional contributions and 
the amount of those contributions. Third, GAO believes that the 
proposed funding provisions should be strengthened further to ensure 
that an even greater percentage of underfunded plan sponsors make 
additional contributions.

                            Veteran's Issues

VA Health Care for Women: In Need of Continued VA Attention (GAO/T-
        HEHS-94-114, Mar. 9, 1994)
    This testimony discusses the Department of Veterans Affairs' (VA) 
long-standing problems in meeting the health care needs of women 
veterans and the implications for VA's role in a reformed national 
health care system. VA has repeatedly stressed the need for delivering 
better service to women veterans and has issued guidance to its medical 
centers that responds to problems identified in a January 1992 GAO 
report. VA's greatest success has been in improving privacy for women 
veterans. VA has not, however, effectively monitored field facilities 
to ensure that they have actually improved service for women veterans. 
For example, even when medical centers submitted inadequate plans for 
improving breast cancer screenings, VA did not notify the medical 
centers of its findings. Under VA's health reform proposal, each 
veteran would be assigned a primary care physician. This step should 
improve the thoroughness of cancer screenings for women veterans. But 
real progress in improving service for women veterans depends on the 
leadership of individual VA medical center directors.
VA Health Care Reform: Financial Implications of the Proposed Health 
        Security Act (GAO/T-HEHS-94-148, May 5, 1994)
    This testimony discusses the financial and policy implications of 
the veterans' health care provisions in the administration's proposed 
Health Security Act. GAO focuses on (1) veterans health coverage under 
VA and other Federal programs; (2) factors that will likely affect the 
potential population of enrollees in VA health plans; (3) the potential 
costs associated with the expanded entitlement and supplemental 
benefits provisions of the Health Security Act; and (4) VA's ability to 
set realistic premiums and the implications of inaccurate premiums for 
cost, quality, and access to care for VA clients.
Veterans Affairs: Service Delays at VA Outpatient Facilities (GAO/T-
        HRD-94-5, Oct. 27, 1993)
    Veterans are experiencing lengthy delays when receiving medical 
care at the approximately 200 outpatient facilities run by the VA. 
Veterans often wait up to 3 hours before being examined by a doctor in 
VA's emergency/screening clinics. In addition, veterans wait an average 
of 8 to 9 weeks for an appointment in specialty clinics, such as those 
for cardiology or orthopedics. Inefficient operating procedures are the 
main cause of these delays. President Clinton has called for VA to 
compete with other providers in meeting the health care needs of 
veterans. To be a viable competitor, VA needs to quickly restructure 
its outpatient care delivery system to provide more timely ambulatory 
services. The establishment of telephone assistance networks and 
appointment scheduling systems, for example, would help in the case of 
veterans with nonurgent conditions.
Veterans' Health Care: Veterans' Perceptions of VA Services and Its 
        Role in Health Care Reform (GAO/T-HEHS-94-150, Apr. 20, 1994)
    GAO conducted a series of focus group meetings with veterans to 
explore their views on the current veterans health care system and the 
future role of the VA under health care reform. Among the topics 
discussed were the reasons and extent to which the veterans used VA 
health care services; their overall satisfaction with the care VA 
provides; the need to maintain a separate VA health care system; 
whether the VA health care system should be expanded to cover 
dependents; whether VA should set up managed care plans to compete with 
private-sector plans, and the potential competitiveness of VA plans; 
the factors they would consider in deciding whether to select a VA 
health plan; and improvements that would make VA a more competitive 
provider. The veterans expressed a wide range of opinions on these 
topics. Although their views may not be representative of the Nation's 
27 million veterans, many of the concerns expressed--such as the 
excessive waiting times and poor customer service--have been the focus 
of earlier GAO reports and congressional hearings.
Veterans' Health Care: Efforts to Make VA Competitive May Create 
        Significant Risks (GAO/T-HEHS-94-197, June 29, 1994)
    GAO is undertaking several studies of the potential effects of 
health care reform on the VA health care system and options for 
restructuring veterans' health benefits. This testimony draws on the 
preliminary work of one of those studies and discusses (1) legal and 
structural barriers that could limit VA's ability to restructure its 
health care facilities into managed care plans and compete with 
private-sector health plans, (2) the extent to which the Health 
Security Act would overcome these barriers, and (3) the potential risks 
associated with efforts to make VA competitive with private-sector 
managed care plans competitive with private-sector managed care plans.

                              Other Issues

Human Experimentation: An Overview on Cold War Era Programs (GAO/T-
        NSIAD-94-266, June 29, 1994)
    During World War II and the Cold War, the Defense Department (DOD) 
and other national security agencies conducted extensive radiological, 
chemical, and biological research programs. Precise information on the 
number of tests, experiments, and participants is unavailable and the 
exact numbers may never be known. However, GAO has identified hundreds 
of experiments in which hundreds of thousands of people were used as 
test subjects. These experiments often involved hazardous substances, 
such as radiation, blister and nerve agents, biological agents, and 
lysergic acid (LSD). In some cases, basic safeguards to protect people 
were either not in place or were not followed. Some tests and 
experiments were done in secret, and others involved the use of people 
without their knowledge or consent or their full knowledge of the risks 
involved. The effects of the experiments are hard to determine. 
Although some participants suffered immediate injuries, and some died, 
in other instances health problems did not surface until 20 or 30 years 
later. It has proven difficult for participants in Government 
experiments between 1940 and 1974 to pursue claims because little 
centralized information is available to provide participation or 
determine whether health problems resulted from the testing. Government 
experiments with human subjects continue today. For example, the Army 
uses volunteers to test new vaccines for malaria, hepatitis, and other 
exotic diseases. Since 1974, however, Federal regulations have required 
(1) the formation of institutional review boards and procedures and (2) 
researchers to obtain informed consent from human subjects and ensure 
that their participation is voluntary and based on knowledge of the 
potential risks and benefits.

  APPENDIX IV--ONGOING GAO WORK AS OF SEPTEMBER 30, 1994, RELATING TO 
                    ISSUES AFFECTING OLDER AMERICANS

    At the end of fiscal year 1994, GAO had 55 ongoing assignments that 
affected older Americans. Of these, 26 were on health, 8 were on income 
security, and 21 were on veterans issues.

                             Health Issues

    A Survey of Assessment Instruments in Medicaid Waiver Programs for 
Home and Community Based Long-Term Care
    Adult Immunization Under Medicare
    Assessing the Accuracy of Cholesterol Measurement
    Cost and Quality of Hospital Care
    Development of Formula and Program Alternatives to the Current 
Long-Term Care Component of Medicaid
    Disabled Medicare Beneficiaries' Ability to Obtain Durable Medical 
Equipment
    HCFA Management of Medicare Medical Policies
    Implementation of the ``Patient Self-Determination'' Provisions of 
OBRA '90
    Inappropriate Prescription Drug Use Among the Elderly
    Investigation of Inappropriate Medicare Billings for Rehabilitation 
Services to Nursing Home Residents
    Long-Term Care Financing
    Long-Term Care Populations
    Long-Term Care Services
    Loss Ratio Experience for MediGap Insurance in 1992
    Medicare Claim Denials and Appeals Across Six Carriers
    Medicare High Risk Report Follow-Up
    Medicare's Use of Data to Monitor Performance of HMO's
    Nursing Home Billing Abuses
    Quality Assurance in Home Care
    Recent Growth of Medicare Home Health Care
    Review of Billing and Payment Procedures for Medical Supplies
    Review of HUD's Hospital and Nursing Home Insurance Programs
    Safeguards Against Inappropriate Use of Drugs in Nursing Homes
    Study of Mergers and Alliances Between Pharmaceutical Manufacturers 
and Pharmacy Benefit Management Companies
    Supportive Services and Long-Term Care
    Time Charges to Medicare for Anesthesia Services

                         Income Security Issues

    Characteristics of 401(k) Plans and Their Participants
    Federal Options for Funding DC Pension Plans for Fire, Police, and 
Teachers
    HRA4: 1995 Update of Pension Benefit Guaranty Corporation High Risk 
Report
    Public Pension Public Fund
    Reasons for Caseload Growth in Supplemental Security Income
    Social Security Administration: SSA's Transition to Independence
    Social Security Administration: Office of Hearings and Appeals
    Social Security Administration: SSA Services Provided to Employees

                            Veterans Issues

    Adequacy of VA's Planning for the Reuse of the Orlando Naval 
Hospital
    Availability of VA Health Care in Community-Based Settings
    Evaluation of VA Direct Cost Comparison Studies
    Evaluation of VA Medical Centers' Discharge Planning
    Evaluation of VA Programs to Treat Veterans' Drug and Alcohol 
Dependency
    How Well Is the Current VA Structure Meeting Health Care Needs of 
Veterans?
    Nonveterans Use of VA Medical Centers
    Preventing Needle-Stick and Sharp Injuries in VA
    Prevention of Compensation and Pension Overpayments to Veterans and 
Their Survivors
    Quality of Care: Factors Influencing Consumers' Decisions
    Relationship Between Distance to VA Medical Centers and Use of VA 
Services
    Review of the Quality of Care Provided in VA Hospital Based Nursing 
Homes
    Review of VA's Selection of a Nursing Home Site in the Chesapeake 
Region
    Study of VA Survivor's Benefits Program
    Survey of Veterans Benefit Administration Interface with Other 
Entities
    Types of Services Used by Medicare-Eligible Veterans
    VA Albuquerque Medical Center's Lithotripsy Contracting Practices
    VA Process for Evaluating Physicians Performance
    Veterans' Compensation and Pension Claims Take Far Too Long to 
Process
    Veteran's Perceptions Under Health Care Reform
    What Barriers Could Affect VA's Plans to Implement a Managed Care 
Program?

             APPENDIX V--MAJOR CONTRIBUTORS TO THIS REPORT

    Cynthia A. Bascetta, Assistant Director, (202) 512-7207
    James C. Musslewhite, Assignment Manager
    Benjamin C. Ross, Evaluator-in-Charge
    Stephen F. Palincsar, Network Librarian

                  ITEM 22. LEGAL SERVICES CORPORATION

                          Service to the Aging

    In 1993, LSC funded programs served 153,955 Americans over the age 
of 60, with an additional 19,771 being served through private attorney 
pro bono referrals. Roughly one-third of these cases involved Social 
Security benefit or Medicare. The other cases fell into the categories 
indicated above.
    Also in 1993, LSC provided a one-time grant to Legal Counsel for 
the Elderly, in Washington, DC, to hold a National Conference on 
Utilizing Senior Volunteer Attorneys. The conference was attended by 
representatives from 20 LSC programs and was hailed as a great success. 
In fact, three of the programs involved are set to begin their own 
Senior Volunteer Attorney programs.
    For more information on activities taken on behalf of older 
Americans by the legal services community, I would suggest talking to 
the two individuals listed below.
    Wayne Moore, Executive Director, Legal Counsel for the Elderly, 601 
E Street, NW, 4th Floor, Washington, DC 20049, (202) 434-2120.
    Burton D. Fretz, Executive Director, National Senior Citizens Law 
Center, 1815 H Street, NW, Suite 700, Washington, DC 20006, (202) 887-
5280.
    Both should be able to provide you with more specific programmatic 
information than I.
                  national senior citizens law center
    Main Office: 1052 West 6th Street--Suite 700, Los Angeles, 
California 90017, (213) 482-3550.
    Branch Office: 1815 H Street, Northwest--Suite 700, Washington, DC 
20006, (202) 887-5280.
    The National Senior Citizens Law Center (NSCLC), a national support 
center, was awarded a $658,919 LSC grant in fiscal year 1992. Under the 
terms of its grant, the NSCLC provides a variety of services to LSC-
funded field programs, including legislative and administrative 
representation on behalf of the elderly poor. The Center also provides 
training for attorneys and paralegals, on such topics as age 
discrimination, Medicaid, Medicare, long-term disability, the Older 
Americans Act, pensions, Social Security/SSI, and disability. In 
addition to producing and distributing the Washington Weekly and the 
Nursing Home Law Letter, the Center processed approximately 1,824 
requests for assistance regarding elderly issues in calendar year 1991. 
The Center's Executive Director, Burton D. Fretz, can be contacted for 
further information at the DC office.
                     legal counsel for the elderly
    601 E Street, Northwest Building ``A'', 4th Floor, Washington, DC 
20049, (202) 434-2120.
    Legal Counsel for the Elderly (LCE) was awarded a $119,533 LSC 
supplemental field grant in fiscal year 1992. During calendar year 
1991, LCE processed over 339 requests for assistance from elderly 
clients, in such general areas as public benefits protection, 
protective services, consumer and probate. In addition, LCE, in 
conjunction with the American Association for Retired Persons (AARP), 
provides specific outreach to the homebound and the Hispanic 
communities of Washington, DC. The Program's Executive Director, Wayne 
Moore, can be contacted for further information.
                    legal services for new york city
    Main Office: 350 Broadway, Sixth Floor, New York, New York 10013-
9990, (212) 431-7200.
    Branch Office: Legal Services for the Elderly, 130 West 42nd 
Street, 17th Floor, New York, New York 10036-7803, (212) 391-0120.
    For fiscal year 1992, Legal Services for New York City (LSNYC) was 
awarded a $13,753,672 basic field grant and a $127,081 State support 
grant. A portion of the States support grant was given to an LSNYC 
branch office, Legal Services for the Elderly (LSE), which provides 
legal assistance exclusively to the elderly on such issues as pensions, 
age discrimination, Social Security and SSI.
    In calendar year 1991, LSE processed approximately 320 requests for 
legal assistance to the elderly. LSE's Director, Jonathan Weiss, can be 
contacted for further information.
    It is important to note, though, that while not all LSC programs 
have a special, elderly law unit, they all potentially provide services 
to the elderly. Most LSC programs are in the yellow pages of any given 
locale, usually listed under ``Legal Aid,'' or ``Legal Services.'' I 
don't know if that is something you want to include in your listings, 
but I thought I would let you know.

                ITEM 23. NATIONAL ENDOWMENT FOR THE ARTS

NATIONAL ENDOWMENT FOR THE ARTS SUMMARY OF ACTIVITIES RELATING TO OLDER 
                      AMERICANS--FISCAL YEAR 1994

                    The Endowment's Goals and Vision

    The National Endowment for the Arts is actively engaged in making 
the arts more accessible in the firm belief that the arts enhance the 
quality of life for everyone and serve as catalysts in bringing people 
of all ages closer together. This contact between generations 
contributes to the revitalization of communities. The arts offer 
exciting opportunities for self expression, and contribute to their 
vitality and well being of everyone. The expansion of people's 
longevity and time has led to a shift away from the over-emphasis on 
aging as a social problem and toward the recognition that later life 
contains positive potential for growth and enrichment.
    The Arts Endowment holds as one of its guiding principles that the 
arts belong to everyone. As we look to the future of the arts in 
America, this belief must be ever present in our vision. Americans 
deserve and should receive a life of learning through the arts from 
grade school through adulthood and into their later years. In its plans 
for the future, the Endowment seeks to promote three key elements to 
the arts in America, Excellence, Diversity, and Vitality. These goals 
are being achieved through a number of strategies, many of which should 
improve the quality of life for older citizens. They include:
    Addressing health concerns of artists, disseminating information to 
the field, and supporting President Clinton's goal of health coverage 
for all Americans.
    Funding and promoting inter-generational programs that include the 
passing down of traditional arts to younger generations.
    Supporting initiatives across the country to involve the arts in 
non-traditional venues such as community centers, nursing homes, 
substance abuse treatment centers, hospitals, and correctional 
facilities. It is in these settings that the arts can become a powerful 
tool to educate, rehabilitate, and heal.
    Advocating for the concept of Universal Design, a design process 
that makes structures, spaces, products, and programs accessible to 
people of all abilities, throughout their lifespan.
    Encouraging and supporting Lifelong Learning through our 
neighborhood centers, senior homes, hospitals, libraries, theaters, and 
local cultural events.
    Ensuring that the Endowment's funding strategies serve an 
aesthetically, economically, culturally, and racially diverse field.
    Advocating the use of state-of-the-art technologies to make 
cultural facilities and programming fully accessible to people with 
disabilities. Innovative access tools like Audio Description, Closed 
Captioning, and Universal Design will assist our grantees in becoming 
full accessible.
    Working with other Federal, State, and local agencies to develop 
innovative arts programming in areas previously not involved in the 
arts. Already the Endowment is working with Department of Housing and 
Urban Development and the Department of Justice to create programs that 
utilize the arts as a tool to prevent crime and improve public housing.
               art-21: art reaches into the 21st century
    On April 14-17, 1994, the Arts Endowment convened the first 
government sponsored national arts conference, ``ART-21: Art Reaches 
Into the 21st Century'', in Chicago. Over 1,100 artists, arts 
administrators, educators, foundation leaders and government policy 
makers at the Federal, State and local levels from across the country 
came together to discuss major trends, priorities, and new ideas in the 
arts as changes in resources, demographics, and technologies shape new 
directions for America.
    The nationwide forum featured breakout sessions on a variety of 
topics, all centered around moving the arts into the 21st century. One 
such session was entitled ``Reaching Special Constituencies'' and 
featured Rev. Sally S. Bailey, Director of Arts, at the Connecticut 
Hospice. Rev. Bailey discussed the Hospice's 20 year history of 
integrating the arts into the lives of people who are terminally ill. 
She gave examples of patients whose lives were transformed by music, 
poetry, and the visual arts, stressing the proposition that lifelong 
learning must encompass people with life threatening illnesses as well.
    Artist Eleanor Schrader, who works with Elders Share the Arts 
(ESTAR) in Brooklyn, New York, presented the wide variety of programs 
offered by her organization: ``Pearls of Wisdom'', a senior theater 
project; ``Discoveries'', a visual arts program that displays the work 
of older artists in museums and senior centers; and ``Living History'', 
a training series in living history theater techniques.
    Among the major themes that emerged for the conference sessions was 
``Access to the Arts'' that encompassed: the need to appreciate the 
cost and availability of the arts as America enters the high tech era; 
to fully integrate the arts in all aspects of the society; and to 
assure the availability of the arts to all segments of the community.
    This highly successful meeting was well received, and participants 
overwhelmingly registered the value of networking, exchanging ideas, 
sharing experiences, and envisioning the 21st Century.
                   office for special constituencies
    Since 1976, the Special Constituencies Office has served as the 
technical assistance and advocacy arm of the Arts Endowment for people 
who are older, disabled, or living in institutions such as nursing 
homes. This office works with Endowment staff and grantees, State and 
local arts organizations, other Federal agencies, and organizations 
that represent older and disabled persons to educate and advocate 
quality arts programming for these underserved segments of our 
population. The focus is inclusion, opening up existing programs, and 
outreach, taking the arts to people who would not otherwise have such 
opportunities.
    Older adults are currently participating in a vast array of 
Endowment supported programs across the country as artists, audiences, 
students, teachers, volunteers, supporters, and arts administrators. In 
addition, the Arts Endowment supports projects that target older 
adults. Many of these efforts are developed through our Special 
Constituencies Office.
         design for accessibility: an arts administrators guide
    The Arts Endowment produced the most comprehensive arts access 
guide to date, ``Design for Accessibility: An Arts Administrators 
Guide,'' in partnership with the National Assembly of State Arts 
Agencies (NASAA) to assist Endowment grantees in making their programs 
and facilities fully accessible to older adults and people with 
disabilities.
    We developed this first-time publication using a method that the 
Arts Endowment and NASAA recommend to our constituents: that is to 
provide for broad constituent involvement and to seek advice from older 
adults and people with disabilities. We worked with a 17 member Arts 
Access Task Force to compose the Guide as well as 18 additional 
artists, arts administrators, and accessibility experts who served as 
reviewers. The 700 page Guide contains a wide variety of information 
and resource materials that may be copied from its looseleaf format for 
even wider dissemination: for example: a checklist specifically 
designed for cultural groups; guidance on how to write and speak about 
people with disabilities and older adults; information on how to make 
historic properties accessible; and guidance on accommodations for 
people who are hard of hearing. Section IV of the Guide is for each 
organization's access documentation that may be designed to fit its 
particular needs.
    The book was premiered at a reception on July 28, 1994 in 
celebration of its release and the fourth anniversary of the Americans 
with Disabilities Act. This gala event was held at Arena Stage in 
Washington, DC, which is a model of accessibility in terms of opening 
its programs to older and disabled people. In my remarks, I said:
          We must widen the circle and welcome everyone into our 
        organizations, our institutions, our creative enterprise. It 
        may be that we must change our attitude, just as society has 
        had to overcome prejudice on the basis of race, creed, or 
        religion. There are financial barriers, programmatic barriers, 
        architectural and logistical barriers. According to surveys, 
        participation in the arts declines with age, so there may be 
        other hidden obstacles to overcome.
          Our focus is on inclusion--integration into the arts 
        mainstream for full and equal participation. I emphatically 
        reject the notion that special or different arts programs be 
        developed for older and disabled persons; rather, existing 
        programs of the highest quality should be opened to everyone. 
        It's the only way we know of to avoid creating double 
        standards, to avoid ghettoizing older and disabled persons.
    The Arts Endowment and NASAA are disseminating 3,500 free copies of 
the Guide to grantees through the 56 State arts agencies and 
territories, and it will be marketed to the public through NASAA.
                 access to the arts: beyond compliance
    The Arts Endowment worked with the Mid-America Arts Alliance to 
convene this six-State region's first access conference, ``Access to 
the Arts: Beyond Compliance,'' on July 25-27, 1994 at the Johnson 
County Community College in Overland Park, Kansas. Over 200 artists and 
arts administrators attended workshops that focused on design, 
performing and visual arts, new technology that make the media more 
accessible, outreach to people living in institutions including nursing 
homes, and public policy that affects older and disabled people. 
Kristine Gebbie, White House National AIDS Policy Coordinator, was one 
of the keynote speakers whose presentation included the impact that 
AIDS is having on older people in America.
    In the workshop concerned with outreach initiatives, Dr. William 
Guilford, Director of Oklahoma Arts and Older Adults Project, discussed 
his organization's extensive work to involve older people in a wide 
variety of arts forms. The Project is a joint effort between the 
Oklahoma Arts Council and the University of Oklahoma in Norman. Dr. 
Guilford highlighted: professional artists' work in a wide variety of 
settings including nursing homes with Alzheimer's patients; older 
students' artwork that is exhibited at the state capitol and other 
settings; and intergenerational arts programs in Day Care Centers where 
artists, children, and older adults create murals as well as life 
history stories and poetry. These successful programs involve artists 
of many disciplines--musicians, painters, storytellers, dancers, and 
theatre artists--and serve over 1,000 of Oklahoma's older citizens each 
year.
    The Director of the Mid-America Arts Alliance, Henry Moran, 
described the symposium as a landmark that has substantially assisted 
arts groups in the region to open up their programs in ways that 
promote dignity and independence. This effort represents the third in a 
series of regional conferences sponsored by the Arts Endowment.
                         aids and older adults
    The definition of a disabled person in both the Endowment's Section 
504 Regulations and the 1990 Americans with Disabilities Act includes 
people with life threatening illnesses, such as cancer and AIDS.
    This year, studies from the National Institutes of Health, the 
Centers for Disease Control, and the National Institutes on Aging 
reported dramatic increases in the number of older Americans testing 
positive for HIV, the virus that causes AIDS. While the number of new 
infections in citizens under the age of 30 dropped 3 percent last year, 
the number of newly infected people over the age of 65 leapt 17 
percent. Today, 1 in every 10 that reported cases of AIDS is an 
individual over the age of 50. As the virus continues to move beyond 
its original boundaries, older adults are being affected more and more. 
Arts programs such as Visual AIDS and Day Without Art can be highly 
effective tools in educating people of all ages to the dangers of the 
AIDS pandemic in our society.
    Further, the Endowment worked in partnership with the Dayton-Hudson 
Foundation to convene a forum on Health Insurance and the Arts on 
September 20, 1994. This all-day meeting was organized by the 
Endowment's AIDS Working Group, which consists of staff members from 
across the Endowment. The purpose of the meeting was to address the 
problem of Health Insurance coverage for artists who are living with 
catastrophic diseases such as AIDS. Over 30 prominent artists, arts 
administrators, private sector, and government officials took part in 
this landmark meeting, leading to the formation of strategies to help 
artists and arts organizations deal with the complexities of health 
care coverage in today's market. Proposed action steps include 
providing a source for information dissemination to artists in all 50 
States. To that end, funds are being sought from private sources to 
conduct research and provide information on insurance options for 
artists.
                    white house conference on aging
    The Endowment feels that it is important that the White House 
Conference on Aging (WHCoA) address how the arts enrich the lives of 
older Americans, and assign a high priority to the involvement of older 
adults in the arts. As first steps to address the arts in the White 
House Conference, the Endowment worked with Robert B. Blancato, 
Director of the WHCoA, to send information to hundreds of arts groups 
across the country encouraging them to highlight the importance and 
value of older adults' participation in and contributions to the arts.
                     lifelong learning in the arts
    The Arts Endowment is undertaking an extensive effort to extend the 
reach and resources of the arts to all Americans by working with other 
Federal agencies to: identify mutual interests and concerns; ensure 
that they employ the arts to achieve their goals; and create continuing 
connections, partnerships, and collaborations. To this end, the 
Endowment has organized a series of team efforts including the Lifelong 
Learning Team that is composed of nine Endowment staff and chaired by 
the Coordinator of our Special Constituencies Office. Staff are 
contacting the Administration on Aging, the Department of Educator's 
Rehabilitation Services Administration, the National Endowment for the 
Humanities and other Federal agencies to explore and identify ways in 
which the Endowment may work in partnership with them to achieve our 
common goals through the arts.

                         Arts Endowment Funding

    Endowment supported programs are aimed at benefiting all Americans 
including people of all ages. In addition, many of these projects 
specifically address older adults. For example:
    The Grass Roots Art and Community Effort (GRACE) located in West 
Glover, Vermont discovers, develops, and promotes visual art produced 
primarily by older self-taught artists in rural Vermont. Since 1975, 
GRACE has involved older adults in arts programs, many of whom are in 
nursing homes and other residential centers. Each week, GRACE holds 
eight art sessions across the State. Participants have the choice of 
working in small groups or individually and workshops are held in 
comfortable supportive atmospheres. Many of GRACE's artists sell their 
work and their art is displayed in galleries.
    Another exemplary organization is Elders Share the Arts (ESTAR) in 
Brooklyn, NY that produces a wide variety of arts programs for older 
adults including on-going living history arts workshops. These sessions 
involve older citizens in oral history interviewing, writing, sharing 
life stories, and learning creative arts skills. The workshop series 
culminates with a group arts project that often tours elementary 
schools. One of the most popular touring groups is the ``Pearls of 
Wisdom'', a group of older adult storytellers who spin original tales 
from their personal experiences. Other programs include inter-
generational workshops where participants discuss common interests with 
members of younger generations. For example, one group of older Puerto 
Rican women chose to look at games from their childhood and share them 
with children in grammar school. Each generation showed their version 
of the same game. One older citizen from Flushing, NY said ``I am glad 
I got to know the children. We are both learning a new language, 
English, at the same time.
                       challenge and advancement
    Dell'arte, Inc. in Blue Lake, CA is a theater organization that 
provides a full-time, 2 year training program which includes 
traditional theater forms of mime, mask, comedy, and physical styles 
from around the world. The grant helped to support remodeling and 
renovation of their theater in compliance with the 1990 Americans with 
Disabilities Act so that people with limited mobility may comfortably 
use the theater as audience members and as artists.
                                 dance
    Theatre Development Fund, Inc. in New York, NY encourages older 
people to take advantage of the performing arts in New York City by 
providing discounted tickets and working with theaters for increased 
access through its Theater Access Project. Efforts include maintaining 
a mailing list of older citizens on fixed incomes to notify them of 
discounted tickets to arts events, scheduling sign-interpreted 
performances each month, and offering assistive listening systems.
    Very Special Arts New Mexico in Albuquerque features the Buen Viaje 
Dancers, a modern dance troupe of all ages with multiple disabilities, 
which, since its founding in 1984, has performed original works and 
offered participatory workshops throughout the nation. This year they 
received a grant to produce, market, and distribute a videotape on 
working with individuals with disabilities in dance. This video will 
demonstrate improvisational dance technique and choreographic 
approaches for people with disabilities. Their goal is to encourage 
similar programs that stimulate creative growth and expression.
Fellowships
    The Dance Program awarded seven Choreographer fellowships and three 
Master Teacher Awards to older artists.
                             expansion arts
    National Institute of Art and Disabilities (NIAD) in Richmond, CA 
provides an ongoing, 40-hour week art program for adults with 
developmental disabilities, many of whom are older and are developing 
careers as visual artists. Participants' work is facilitated by Master 
artist teachers who are all practicing artists with MFA degrees or 
equivalent body of work and exhibition history. NIAD is currently 
developing a new gallery at San Francisco's Ghiradelli Square to 
display the work of their artists.
    City Lore, Inc. located in New York, NY selects activities that 
bring elementary students in contact with older individuals at senior 
centers on field trips. Through the Arts Partners Program, participants 
from different generations discuss their memories and experiences and 
work on arts projects together. For example, one project involved 
creating a ``Tradition Tree,'' a potted branch with crafted objects 
representing family traditions.
    Jamaica Center for the Performing and Visual Arts, Inc. (JAC) in 
Jamaica, NY is conducting several programs that target older Americans. 
Their Community workshop series features courses such as painting and 
drawing, which are scheduled during weekday mornings to specifically 
attract older adults from the community. People who are older receive a 
50% discount for JAC workshops, performances and memberships. Further, 
JAC presents a yearly series of traditional jazz and other live music 
at senior centers throughout Queens, NY.
    Senior Arts, Inc. Albuquerque, NM is in its eleventh year of 
sponsoring a unique program of art activities for older people that 
take place throughout the city. The program consists of performances 
and workshops in music, dance, theater, literature, and visual arts. 
Workshops include Spanish Tinworking, Polish Paper Cutting, and Pueblo 
Ceramic Sculpture. Local artists, representing traditional New Mexican 
folk arts (Hispanic and Native American) and contemporary forms, are 
employed to share their skills and artistic vision. Senior Arts brings 
its programs, free of charge, to all six of Albuquerque's major senior 
centers as well as 18 satellite and residential sites. Gwen Forrester, 
a participant in the classes remarked, ``Thanks to Senior Arts, I am 
learning the crafts of my Native-American ancestors.'' At the close of 
last year, Senior Arts mounted an exhibit displaying the artwork of 
older citizens and their instructors in a gallery at the South Broadway 
Cultural Center.
    Appalshop in Whitesburg, KY provides programs that seek to break 
down cultural stereotypes of the Appalachian people to acknowledge them 
as a community with a full and wonderful heritage in the arts. 
Appalshop has several programs that target older citizens, allowing 
them to share their Appalachian culture with others. For example: the 
Roadside Theater program draws together diverse groups to examine local 
heritage, identify community concerns, and bridge age barriers; school 
children and older citizens are brought together to share stories and 
pass on cultural traditions; and their community radio program features 
programs such as ``Deep in Tradition'', an old-time mountain music show 
very popular with older Appalachians.
    Lola Montes and Her Spanish Dancers in Hollywood, CA perform a 
program entitled ``California Heritage'' in senior centers across the 
state. Through the medium of dance, music and story telling, and with 
authentic costuming, the dancers explore Hispanic contributions to 
California.
    Center on Deafness in Northbrook, IL is dedicated to enhancing 
individual growth within the community of deaf and hard of hearing 
people of all ages. This year they received a grant to provide fully 
accessible theater experiences to people with disabilities including 
deaf and hard of hearing audiences. Their efforts include involving 
actors, directors, and stage crew who are deaf in their work, and 
working to preserve the cultural differences involved in sign language 
and deaf art including literature. The company utilizes ``reverse 
shadow interpretation'' where deaf actors use sign language, and the 
hearing cast (dressed in black and placed in the background) voice 
interpret for hearing audience members. This creates a blended 
experience that is carefully choreographed and well received by 
audiences.
    Fairmount theatre of the Deaf in Cleveland, OH is one of the few 
professional theater companies in the United States that produces shows 
using both deaf and hearing actors, and in July 1990. FTD conducts 
outreach programming as well as performing three local mainstage 
productions each year. This year's performances include: Neil Simon's 
``I Ought To Be In Pictures'', ``Children of a Lesser God'' and 
``Counterfeits'', a world premiere work by FTD's artistic director 
Shanny Mow.
    Theater by the Blind Corporation in New York, NY recruits and 
trains actors and writers of all ages who are blind. The group conducts 
workshops to develop the talents of blind artists, and outreach to 
cultivate audiences for their work. They will present two fully staged 
productions which explore a production style unique to them.
                               folk arts
    Appalshop in Whitesburg, KY will present performances that offer an 
opportunity for artists to pass along their skills and receive 
recognition for their art. This cultural center is dedicated to 
celebrating the artistic and cultural heritage of the Appalachian 
region, and reaches many local residents through programs that present 
traditional Appalachian artistry to the community. Appalshop believes 
in utilizing the artistic mastery of many of the region's older 
citizens, who serve as guides to a cultural legacy for younger 
generations. Their older artists are featured in Appalshop events such 
as the annual Seedtime and the Cumberland Festival.
Fellowships
    The Folk Arts Program awarded five National Heritage fellowships to 
older folk artists.
                               literature
    Elders Share the Arts in Brooklyn, NY received a grant to introduce 
a writing project to older adults in New York's inner-city community 
centers. Three African-American, Chinese, and Jewish writers conduct 
readings and discussions of their own work. In subsequent workshops, 
they teach older adults how to develop their own narratives through 
writing and taping which helps them to better understand the richness 
of their own heritage.
    Howard County Poetry and Literature Society, Inc. in Columbia, MD 
will sponsor a tour that brings poetry to underserved communities in 
their region, including people in retirement communities as well as 
non-resident senior centers. This fall they conducted five readings 
with a diverse group of poets and plan to hold four more in the Spring. 
Their goal is to reach at least 1,000 people through poetry this year.
Fellowships
    The Literature Program awarded one Creative Writing fellowship and 
two Translator fellowships to older adults.
                               media arts
    International Museum of Photography at George Eastman House in 
Rochester, NY presents matinees of restored films from its archives 
that target older people in the Greater Rochester area. They include 
American and foreign classics, independents and silent films with full 
orchestral accompaniment.
    The Washington, DC International Film Festival presents free films 
in their ``Cinema for Seniors'' program. In addition, international 
guest filmmakers participate in workshops, panels, and seminars with 
audience members. This festival brings classic films to the city which 
attracts hundreds of older residents.
    Ilene Segalove of Venice, CA received a grant to support the 
production of Handshake, a half-hour experimental radio drama using 
monologue, dramatic reenactment, and original music to explore the 
psychological and physiological aspects of aging in America.
                                 music
    Nevada Symphony Orchestra in Las Vegas, NV will sponsor the 
Saturday Morning Series consisting of six concerts, which provides 
convenient orchestral performances for older Americans. The concerts 
are performed in an informal setting and include commentary from the 
musical director or conductor. Special attention is given to Las Vegas' 
extensive retiree population through the sale of group tickets and by 
providing transportation.
    Queens Symphony Orchestra in Long Island City, NY presents musical 
repertoire and guest artists of international acclaim. In addition, 
they offer pre-concert talks, open rehearsals, family day, discounted 
tickets, and a transportation program, all related to their Masterworks 
series which reaches out to older people.
    The Saint Paul Chamber Orchestra in Saint Paul, MN provides ``The 
Morning Coffee Series''. This program, geared toward older people, is 
comprised of eight morning Baroque concerts opening with informative 
concert previews.
    Fredric R. Mann Music Center in Philadelphia, PA has an outreach 
program that provides free concert tickets to many older Philadelphians 
on fixed and low incomes. Blocks of tickets are set aside for regional 
nonprofit groups serving people who are disabled, on fixed or low 
incomes, or older.
    The Louisville Orchestra located in Louisville, KY offers the 
Cumberland Coffee Concerts, a nine-concert, morning series of classical 
programs. This program was specifically created to make symphonic music 
more accessible to older citizens.
    Other music groups that conduct audience development in the form of 
daytime concerts, discounted tickets, free concerts, attendance of 
final rehearsals, and/or concerts in healthcare facilities are:
          Bronx Arts Ensemble Inc., Bronx, NY.
          Caramoor Center for Music and the Arts, Inc., Katonah, NY.
          Chicago Symphony Chorus, Chicago, IL.
          The Columbus Symphony Orchestra, Columbus, OH.
          Fort Wayne Philharmonic Orchestra, Inc., Fort Wayne, IN.
          Eastern Connecticut Symphony, Inc., New London, CT.
          Evansville Philharmonic Orchestra Corp., Evansville, IN.
          Grand Rapids Symphony Society, Grand Rapids, MI.
          Lexington Philharmonic Orchestra, Lexington, KY.
          Los Angeles Chamber Orchestra Society, Los Angeles, CA.
          Memphis Orchestra Society, Memphis, TN.
          Mississippi Symphony Orchestra Association, Jackson, MS.
          Missouri Symphony Society, Columbia, MO.
          New York Chamber Ensemble, Inc., New York, NY.
          Northeastern Pennsylvania Philharmonic, Avoca, PA.
          Rockford Symphony Orchestra, Rockford, IL.
          South Carolina Orchestra Association, Columbia, SC.
Fellowships
    The Music Program awarded three American Jazz Masters Fellowships 
and one Special Projects Fellowship to older adults.
                      presenting and commissioning
    Onion River Arts Council in Montpelier, VT invites artists from 
many different cultures, including French-Canadian, Scottish, Irish, 
Italian, African, Hispanic, and Asian to participate in programs with 
older people where they discuss their work. In addition, they provide 
subsidized tickets to performances and present at least one program a 
year that involves performers with disabilities.
    Artswatch in Louisville, KY exposes older Kentuckians to the arts 
through its arts presenting programs that are held at senior centers, 
Kentucky School for the Blind, and AIDS support centers.
                                theater
    Deaf West Theatre Company, Inc. in Los Angeles, CA will produce 
``Medea'' with traditional fifth century Greek costumes. This unique 
theater serving the deaf community produces all of its plays with deaf 
actors of all ages. The company uses a unique infrared listening 
system, which allows hearing audience members to listen to the play via 
headsets. Last year their production of Marsha Norman's ``Night 
Mother'' opened to rave reviews.
    National Theatre of the Deaf in Chester, CT is a professional 
ensemble of deaf and hearing actors of all ages. This season's 
production of Eugene Labiche's ``An Italian Straw Hat,'' will be 
performed with a new translation from the French and an original 
percussion score.
Fellowships
    One fellowship was granted to an older writer in the category of 
Solo Theater Artist.
                          local arts agencies
    North Carolina Arts Council in Raleigh, NC provided three 1-day 
workshops on accessibility to the arts for people with disabilities and 
older adults. These workshops offered an opportunity for board, staff, 
and volunteers to learn first hand about the 1990 Americans with 
Disabilities Act and how compliance affects an organization's 
facilities and programs. The program included a keynote speaker and 
panelists who provided specific steps toward compliance with the ADA 
and included outreach strategies for including more older Americans in 
the arts.
                           state and regional
    Vermont Council on the Arts Inc. in Montpelier, VT brings 
individuals with specific knowledge about accessible facilities and 
programming to Vermont's cultural organizations. These groups, funded 
through the Council's general operating support program, will welcome 
site visits and receive direct technical assistance to help develop 
increased access to their programs and facilities.
    University of Massachusetts at Boston in Boston, MA presents a 
reading series sponsored by the Joiner Center for the Study of War and 
Social Consequences and the University's Creative Writing Program. 
During 3-day residencies, four poets give public readings and conduct 
workshops specifically geared toward veterans and other older Americans 
who lived through periods of war.
                             international
    Axis Dance Troupe in Oakland, CA received a grant to support a 
collaborative residency program in Siberia with the Novosibirsk 
Regional Disabled Sports Club. Axis introduced disability culture to 
the people of Siberia and established dance as a vital part of that 
culture. The troupe performed, taught, and shared their technique and 
philosophy with members of local Siberian dance companies and disabled 
members of local civic organizations, which includes older adults.
    Kansas Arts Commission in Topeka, KS provides grants through its 
Grassroots Cultural Development Program. Some of the projects they fund 
include a visual artists working in a group home of Alzheimers's 
patients. The patients' difficulty with organized thinking and actions 
has been addressed by the artist in her nonthreatening and encouraging 
approach. Also, they have developed annual juried exhibitions of two 
and three dimensional artworks by retirement and home care residents 
that are shown at the Kansas Museum of History, and a poetry festival 
during which the literary works by older citizens were recognized.
                              visual arts
    Visual AIDS in New York, NY presents several national programs to 
increase AIDS awareness in all generations. Programs include ``Day 
Without Art'' and ``Night Without Light'' and are supported by the 
organizations Red Ribbon program, which employs older adults to 
construct the thousands of ribbons needed each year.
Fellowships
    One Visual Arts fellowship in Photography was awarded to an older 
adult.

             ITEM 24. NATIONAL ENDOWMENT FOR THE HUMANITIES

 NATIONAL ENDOWMENT FOR THE HUMANITIES REPORT ON ACTIVITIES AFFECTING 
                        OLDER AMERICANS IN 1994

    Although the Endowment does not have programs specifically directed 
at aging, NEH actively supports books, lectures, exhibitions, programs 
for radio and television, and adult educational courses which help 
bring the humanities to seniors. In addition, each year a number of 
scholars, age 65 or older, receive NEH funding to conduct research in 
the humanities, while others assist the Endowment by serving on grant 
review panels or as expert evaluators.
    Older scholars compete for Endowment support on the same basis as 
all other similarly qualified applicants. No information regarding age 
is requested from applicants. Applications for funding are evaluated by 
peer panels and specialist reviewers, Endowment staff, the National 
Council for the Humanities, and the NEH Chairman. Only applicants whose 
proposals are judged likely to result in work of exemplary quality and 
central significance to the humanities receive support. However, anyone 
may apply for an NEH grant, and no one is barred from consideration by 
reason of age. In addition, each year numerous projects are funded that 
involve older persons as primary investigators, project personnel, or 
consultants.
    The Jefferson Lecture in the Humanities is the highest official 
award the Federal Government bestows for distinguished intellectual 
achievement in the humanities. Since its establishment in 1972, the 
lecture has provided an opportunity for 22 of the Nation's most highly 
regarded scholars to explore matters of broad concern in the 
humanities. Not coincidentally, many of the scholars so honored have 
been among the most senior members of their profession. Poet Gwendolyn 
Brooks, who delivered the 1994 Jefferson Lecture, historian and poet 
Robert Conquest, classicist Bernard Knox, historians Gertrude 
Himmelfarb and Bernard Lewis, and sociologist Robert Nisbet are among 
the recent Jefferson Lecturers who, though still active scholars, were 
beyond the traditional retirement age at the time they received this 
honor.
    The Endowment's Charles Frankel Prize, first awarded in 1989, 
honors distinguished individuals who have enriched our national life by 
sharing their understanding and appreciation of history, literature, 
philosophy, and other aspects of the humanities. Many of the 
interpreters and patrons of the humanities who have received a Frankel 
Prize have been 65 years of age or older, including in 1994 historian 
and bibliographer Dorothy Porter Wesley. In prior years the Endowment's 
Frankel Scholars have included such distinguished senior Americans as 
Puerto Rican historian, anthropologist, and folklorist Ricardo Alegria; 
historian John Hope Franklin; novelist Eudora Welty; Civil War 
historian and novelist Shelby Foote; University of Dallas English 
professor emeritus and co-founder of the Dallas Institute of Humanities 
and Culture Louise Cowan; author and folklorist Americo Paredes; 
philosopher, author, and originator of the Great Books Program Mortimer 
Adler; classicist and 1992 Jefferson Lecturer Bernard Knox; and, 
originator of Brooklyn College's highly regarded core curriculum, 
Ethyle Wolfe.
    Older scholars are particularly evident in several types of 
research and teaching projects supported by the Endowment's Fellowships 
and Seminars division and Research Programs division. Of course, this 
is a reflection of the depth and breadth of knowledge that many senior 
scholars bring to their work in the humanities. In a number of cases, 
older scholars are receiving NEH support to continue long-term, 
collaborative research projects that they have directed and sustained 
for many years.
    Older Americans also participated in NEH programs by serving as 
grant review panelists and specialist reviewers. In some cases, older 
Americans have contributed to Endowment-sponsored projects by providing 
invaluable information. For example, in 1994 an NEH sponsored 
collaborative research project directed by William Chafe of Duke 
University, ``Behind the Veil: Documenting African Life in the Jim Crow 
South,'' aims primarily at recording and analyzing the recollections of 
people, obviously seniors, who were eyewitnesses and participants in 
Southern society prior to the Civil Rights movement. Also in 1994 the 
Endowment supported a project to prepare a five-volume edition of the 
correspondence of Irish playwright Samuel Beckett (1906-89). Essential 
to the project are interviews conducted by the editors with Beckett's 
correspondents, most of them very elderly, in the United States, 
England, France, and Ireland. The recollections and reflections of 
these contemporaries of the writer are an invaluable source of 
information not only on the writer himself but also on early twentieth 
century culture in general.
    The Endowment achieves its greatest impact among older Americans 
when they read books, attend public programs, view television 
productions, or listen to radio broadcasts made possible by an NEH 
grant. Many humanities programs for the general public supported by the 
Endowment through our Division of Public Programs reach large numbers 
of older persons.

                      Humanities Projects in Media

    Television productions supported by the Endowment are ideal for 
older people who cannot or prefer not to leave their homes. Widely 
acclaimed programs such as the 18-hour historical documentary series, 
Baseball; the series of dramatic literary adaptations, American Short 
Story and Life on the Mississippi; the biographical documentary, Huey 
Long; and Voices and Visions; a 13-part series chronicling the 
achievements of American's outstanding contemporary poets, have been 
viewed by millions throughout the country. NEH-funded programs have 
included The Donner Party, an award-winning documentary film that 
chronicles the ordeal of a group of settlers stranded in the Sierra 
Nevada during the winter of 1846; D.W. Griffith, an examination of the 
life and work of the controversial film pioneer; several episodes of 
Dancing, an eight-part, multi-disciplinary exploration of world-wide 
dance tradition; and George Marshall and the American Century, a 90-
minute biographical documentary that places the general and statesman 
during the first half of the twentieth century.
    Elderly persons who have visual handicaps may find that Endowment-
sponsored radio programs best suit their needs. The NEH-supported 
Craven Street: Franklin in London 1770-75 was broadcast for the first 
time on National Public Radio. The 5-hour dramatic radio series 
portrays the role of Benjamin Franklin as colonial representative in 
London in the years just preceding the American Revolution.
    Information about NEH-sponsored media programs is routinely 
provided to organizations working for special groups, including the 
elderly. For many elderly people confronting problems such as impaired 
vision, reduced mobility, and isolation, Endowment-funded media 
programs not only provide individual access to the humanities but can 
also provide the context for stimulating group activities and 
discussions.

      Humanities Projects in Museums and Historical Organizations

    In this program, the Endowment encourages museums or historical 
organizations receiving federal funding to waive entrance fees for the 
general public on certain days, an effort that helps make cultural 
programming more accessible to retired persons living on a fixed 
income. In recent years, a number of the institutions that have 
received NEH support for interpretive exhibitions have begun to 
establish a continuing relationship with local senior centers.

             Humanities Projects in Libraries and Archives

    By sponsoring reading and discussion programs for adults in public 
libraries, this Endowment program is helping to make intellectually 
stimulating activities available to senior citizens in their local 
communities. Recently the Endowment has awarded $2.8 million for 
programs throughout the country that will offer adults, including 
persons over 65, opportunities to read and talk about important books 
and issues under the direction of a humanities scholar from a nearby 
college or university, and a great many more reading and discussion 
programs--more than 1,600--were supported by the State humanities 
councils. Additionally, these reading and discussion programs for 
seniors make available large print books and audio tapes.
    examples of neh grants specifically for or about older americans
    Since FY 1976, the Endowment has awarded approximately $5 million 
to the National Council on the Aging for its reading programs in senior 
centers and libraries. Throughout a network of over 1,500 senior 
centers and other sites participating in the NCOA's ``Discovery Through 
the Humanities'' program, volunteer leaders guide small groups of 
senior citizens through active, in depth discussions of the work of 
prose writers, poets, artists, philosophers, scholars and critics. 
Project staff prepare and distribute thematically organized anthologies 
and ancillary instructional materials and provide training and 
technical assistance to discussion leaders. Anthologies currently in 
use include: ``A Family Album, The American Family in Literature,'' 
``Image of Aging,'' ``Americans and the Land,'' ``The Remembered Past, 
1914-1945,'' ``Work and Life,'' ``The Search for Meaning,'' and ``Roll 
on, River: Rivers in the Lives of the American People.'' Each anthology 
is designed to stimulate the group participants to relate what they 
read to their own experience and to universal human issues. Ranging 
between 100 and 300 pages in length printed in large print-type, and 
attractively illustrated with paintings, sculpture, and photographs, 
each anthologizes material from history, philosophy, and literature.
    NEH grants to the National Council on the Aging have also supported 
several large-scale reading and discussion programs led by scholars 
rather than by nonacademic volunteers. For example, recently NCOA 
received $244,977 to conduct 60 8-week programs on the topic 
``Remembering World War II.'' The programs will be held in senior 
centers, nursing homes, veteran's hospitals, libraries, and other 
community centers throughout the country. The discussions at each site 
will be lead by a scholar, who will provide historical perspective to 
complement the participants' real life experiences. Specifically 
prepared anthologizes of readings--available in large-print format--
will cover a variety of topics related to the war and the home front 
and will include relevant documents such as letters, photographs, and 
memorabilia.
    The Federal/State Partnership of the Endowment makes grants to 
humanities councils based in the 50 States, Puerto Rico, Marianas, and 
Guam. These councils, in turn, competitively award grants for 
humanities projects to institutions and organizations within each 
State. State humanities councils have been authorized to support any 
type of project that is eligible for support from the Endowment, 
including educational and research projects and conferences. The 
special emphasis in State programs, however, is to make focused and 
coherent humanities education possible in places and by methods that 
are appropriate to adults.
    Example of projects for older Americans or about aging-related 
topics that received State council support during 1993 and 1994 are 
presented below.
Alaska
    The Alaska Humanities Forum awarded a grant to the Tanana Yukon 
Historical Society, Fairbanks, in support of their project, ``Faces of 
Alaska, Book III,''' to conduct interviews with 15 older Alaskans of 
diverse backgrounds. A glimpse of history will be gained through 
paintings, photographs, and oral histories provided by older residents 
of the State. The future publication, ``Faces of Alaska III'' will 
complete the series.
Florida
    The Florida Humanities Council awarded a grant to the Women's 
Studies Program at the University of Florida in conjunction with the 
Harn Museum of Art titled: ``Creativity! a Symposium on Gender and 
Age,'' to sponsor a symposium to celebrate the resiliency of older 
women through the creative merging of scholarly theory about women's 
role in society and topics ranging from aesthetics to social policy and 
health. The symposium will also examine stereotypes of age and gender 
in literature, film, the arts, in order to evaluate their implications 
in the lives of all women.
Illinois
    The Illinois Humanities Council awarded a grant to the Westside 
Health Authority in conjunction with the Austin Academy, Northwestern 
University, titled: ``History for the Present,'' to develop an 
intergenerational history project, which aims to record, interpret, and 
share the life histories and struggles of Westside residents. Through 
this project, the Westside Health Authority will create a forum for 
sharing life histories to help create a community from which young and 
old people can draw strength and models of struggle. The project will 
involve senior citizens and high school humanities students who will 
conduct group and individual interviews to collect the life stories of 
participants, covering a broad range of community residents. These 
stories will be interpreted and assembled to produce a humanities 
newsletter as a supplement to the humanities curriculum at Austin 
Academy; and the material will also be shared with other schools and 
community groups.
Maryland
    The Maryland Humanities Council supported ``The Annapolis I 
Remember,'' conducted by the Arundel Senior Assistance Project. Oral 
history interviews with 73 senior Annapolis citizens were recorded and 
over 800 historic photographs were collected to provide documentation 
for a six-character stage performance depicting an Eastport waterman, a 
Greek immigrant, and African-American businessmen, among other 
residents of the city during the period 1900-65.
Minnesota Humanities Commission
    The Minnesota Humanities Commission awarded a grant to the College 
of St. Scholastica-Emeritus College program in conjunction with the 
Virginia Public Library titled: ``Emeritus College,'' for 15 humanities 
courses for older adults in Duluth, Two Harbors, Virginia, and Grant 
Marais. Emeritus College has received grant funds from the Minnesota 
Humanities Commission since 1982; this ongoing support has enabled the 
program to increase the number of communities and persons served. 
Topics in the 1994 program series include natural history, 
international studies, and literary studies.
New York Council For The Humanities
    The New York Council for the Humanities awarded the LaGuardia 
Community College of Long Island City a grant to sponsor Speakers in 
the Humanities lectures. One such lecture by Susan Miller was titled: 
``Drama of Aging in Contemporary Theatre and Films.'' Another award was 
given to the Rockland Community College Senior Citizens Club of Suffern 
for a lecture given by Dr. Finnegan Alford-Cooper on the subject 
``Aging in Non-Western Societies: What Does It Mean for Us?
Ohio
    The Ohio Humanities Council, with a special grant from the Ohio 
Department of Aging, began planning humanities programs for rural 
senior centers. A pilot project will bring one-act plays by Harden 
Foote about small-town Texas life to the centers and allow senior 
citizens to participate in follow-up discussions with the actors and 
with participating scholars.
South Carolina
    The South Carolina Humanities Council sponsored a number of 
programs for seniors on public policy issues such as ``the value of the 
individual life'' and ``the need to understand the common humanities of 
older adults.'' Using a reader developed especially for this project, 
the participants read and discussed thematically related selections 
from writers ranging from Cicero to Hemingway.
Arizona
    The Arizona Humanities Council with additional funding from the 
Marshall Fund of Arizona, planned a series of town hall meetings and 
reading and discussion program on the issue of elderly suicide.
Connecticut
    The Connecticut Council for the Humanities supported a scholar-led 
discussions series for older adults on the history and cultural 
continuities of Native Americans, focusing especially on the role of 
elders and healers.
Georgia
    The Georgia Humanities Council began a series of interviews with 
outstanding creative older adults including former President Jimmy 
Carter, about the philosophical and cultural significance of creativity 
and its relationship to continuing self-esteem. The interviews will 
form the basis for a planned series of radio and television programs.

                  ITEM 25. NATIONAL SCIENCE FOUNDATION

      National Science Foundation Report for Developments in Aging

    The National Science Foundation, an independent agency of the 
Executive Branch, was established in 1950 to promote scientific 
progress in the United States. The Foundation fulfills this 
responsibility primarily by supporting basic and applied scientific 
research in the mathematical, physical, environmental, biological, 
social, and engineering sciences, and by encouraging and supporting 
improvements in science and engineering education. The Foundation does 
not support projects in clinical medicine, the arts and humanities, 
business areas, or social work. The National Science Foundation does 
not conduct laboratory research or carry out educational projects 
itself; rather, it provides support or assistance to grantees, 
typically associated with colleges and universities, who are the 
primary performers of the research.
    The National Science Foundation is organized generally along 
disciplinary lines. None of its programs has a principal focus on 
aging-related research; however, a substantial amount of research 
bearing a relationship to aging and the concerns of the elderly is 
supported across the broad spectrum of the Foundation's research 
programs. Virtually all of this work falls within the purview of the 
Directorate for Biological Sciences; the Directorate for Social, 
Behavioral, and Economic Sciences; and the Directorate for Engineering.
               directorate for biological sciences (bio)
    The research supported by the Directorate for Biological Sciences 
is devoted to understanding how living systems function. This includes 
studies on the structure, function, and interaction of biological 
molecules; processes by which organisms develop, grow, and function; 
and investigations on how organisms perceive their surroundings and 
interact with other organisms. Aging as a normal biological phenomenon 
is part of development and growth. Therefore, studying organisms during 
development and in response to environmental and physiological stresses 
is an aspect of aging studies. The research divisions comprising the 
Directorate for Biological Sciences in a sense all look at aging. The 
Division of Molecular and Cellular Biosciences looks at the genetic 
basis and regulation of life processes, the molecules that are 
synthesized, degraded, and altered quantitatively throughout life, as 
well as cellular processes associated with different stages of life. 
The Division of Integrative Biology and Neuroscience is concerned with 
how organisms develop, function, and interact. This includes studies of 
the nervous system which directs and regulates many of these processes. 
The Division of Environmental Biology looks at groups of organisms and 
how they exist within different environments and respond to changes 
therein.
    directorate for social, behavioral, and economic sciences (sbe)
    The Directorate for Social, Behavioral, and Economic Sciences 
supports research in a broad range of disciplines and interdisciplinary 
areas through its Division of Social, Behavioral, and Economic 
Research. For example, sociological research is being supported which 
examines how the labor force participation and earnings of older 
Americans have been affected by recent economic trends; how Americans 
in their 50's cope with the dual pressures of supporting aging parents 
and grown children; how income distribution differs between the ``young 
old'' and the ``old old,'' and how the degree of political activism of 
older Americans has changed over time in the twentieth century. 
Projects within anthropology are being supported to examine how 
economic development affects patterns of caring for dependent elderly, 
and with cognitive psychology to examine the extent to which knowledge 
acquired in youth is retained in later life.
    The SBE Directorate also supports several large-scale data 
gathering efforts which can be and have been used to study issues 
related to aging, although that is not their sole or even primary 
purpose. For example the Panel Study of Income Dynamics, which has been 
tracking a sample of more than 7,000 American families since 1968, 
provides information on changing household composition, labor force 
participation, income, assets, and consumption patterns as individual 
respondents grow older. The General Social Survey, which has carried 
out sample surveys of the U.S. adult population more or less annually 
since 1972, contains several attitudinal items dealing with the status 
of, and care for, the elderly. These surveys enable researchers to 
examine how attitudes toward the elderly have changed over time and how 
age groups differ across a wide range of opinion areas. The National 
Election Survey, which has studied American elections since 1952, 
provides information on how attitudes regarding candidates and issues 
vary across age groups. The SBE Directorate is also supporting a 
project that will make available to researchers in a consistent and 
readily usable form public use microdata from the U.S. censuses from 
1850 through 1990. When completed, this project will make it possible 
to examine how the status and family relationships of older Americans 
have changed over the course of a century and a half.
                   directorate for engineering (eng)
    The National Science Foundation's Directorate for Engineering seeks 
to enhance long-term economic strength, security, and quality of life 
for the Nation by fostering innovation, creativity, and excellence in 
engineering education and research. This is done by supporting projects 
across the entire range of engineering disciplines and by identifying 
and supporting special areas where results are expected to have timely 
and topical applications, such as biotechnology and materials 
processing.
    Aging-related research is primarily supported within the 
Directorate for Engineering through the Biomedical Engineering and 
Research to Aid Persons with Disabilities. Research funded in this 
program relates to issues of aging and the elderly due to the 
propensity for the elderly to develop physical disabilities. Projects 
recently supported by this program include the following studies:
          Musculoskeletal investigations to understand the process of 
        maintaining erect posture and stepping.
          Investigating the development of an electromagnetic device 
        for measuring bone condition.
          Computer assisted design of orthopedic surgeries involving 
        joint replacement, cementing techniques, and failure detection.
          Cardiovascular systems studies involving tissue engineering 
        for the replacement of arteries and veins.
          Research directed toward correcting hearing loss through 
        improved signal process techniques.
          Studies concerned with drug infusion and control techniques.
          Undergraduate projects by student engineers to construct 
        custom designed devices and software for disabled individuals.
    While these projects are not specifically directed toward problems 
of aging, all of these studies have potential for dealing with 
conditions prevalent among the elderly.

             ITEM 26. PENSION BENEFIT GUARANTY CORPORATION

                      EXECUTIVE DIRECTOR'S REPORT

    Twenty years ago, the enactment of the Employee Retirement Income 
Security Act opened a new era of pension security for American workers. 
Our Nation's working men and women acquired stronger rights to their 
hard-earned pensions, funding rules promised that their pensions would 
be paid, and PBGC was established to provide pension insurance. 
However, weaknesses in the law, and particularly the funding standards, 
undermined the promise of pension security. While the vast majority of 
single-employer pension plans are fully funded, underfunding in single-
employer plans has been chronic, persistent, and growing, reaching $71 
billion in the most recent report.
    With enactment of the Retirement Protection Act, we can now begin 
to reverse the trend. This carefully designed package of pension 
reforms renews ERISA's promise of retirement security. Pensions will be 
better funded, the pension insurance program will be financially 
secure, and companies with underfunded pension plans will pay their 
fair share to support the retirement system. Workers and their 
employers can now have greater confidence in a stronger pension system 
and in PBGC. They can be assured they will receive their hard-earned 
benefits.
    For PBGC and the working people it protects, 1994 was a year of 
great progress. Passage of the Administration's pension reforms, a 
landmark pension funding agreement with General Motors, and PBGC's 
first unqualified independent audit opinion on its financial statements 
stand out. The energy, ingenuity, and diligence of the people at PBGC 
led to a number of other important accomplishments.

                           Benefit Protection

    Through our early warning program, we are constantly on the lookout 
for corporate transactions or events that may be harmful to the 
pensions of workers or to PBGC. If circumstances warrant, we try to 
reach agreement with the plan sponsor before the transaction is 
consummated for additional protection that will strengthen the plan and 
keep it ongoing. During 1994, we negotiated 16 agreements totalling 
nearly $11 billion that provided increased protection for workers and 
retirees in underfunded plans and recoveries on losses from the 
underfunding.
    Our negotiations yielded the largest contribution ever made to a 
PBGC-insured plan when, in May, we reached a landmark $10 billion 
pension funding agreement with General Motors Corporation. At the time, 
GM's plans were reported to be underfunded by more than $20 billion, 
most of which was in one plan covering some 600,000 GM workers and 
retirees. GM's contribution of cash and stock will assure this plan a 
level of funding it would not otherwise have reached for almost a 
decade.
    In another noteworthy settlement, New Valley Corporation, once 
known as Western Union Corporation, had an ongoing pension plan for 
16,000 Western Union workers and retirees that was under-funded by 
nearly $400 million. PBGC's immediate action seeking a district court 
order to terminate and protect the plan and preserve our claims against 
Western Union led to an agreement that has kept the plan ongoing and 
funded by a financially strong company. This prevented any loss of 
benefits for the participants in the plan and a significant loss for 
the pension insurance program. In the words of one grateful Western 
Union pensioner. ``Without your presence and brilliant maneuvering . . 
. both the Taxpayers and Pensioners of Western Union would have gotten 
a raw deal.''

                            Customer Service

    The payment of benefits and service to those receiving these 
benefits are the central work of the Corporation. PBGC established 
customer service standards for our principal customers, the workers and 
retirees to whom we owe benefits. These standards represent our 
commitment to provide the best possible service to our customers. We 
want PBGC to be a model customer-driven agency.
    Over the years, PBGC has distinguished itself for its service to 
participants. It was most gratifying when Vice President Al Gore 
presented PBGC with a ``Hammer Award'' in recognition of our success in 
reinventing and expanding our participant locator program. This ongoing 
program enables PBGC to find workers and retirees owed benefits that 
cannot be paid for lack of a valid address. In 1994 alone, we were able 
to find addresses for 12,000 out of 15,000 missing people.
    There is always room for improvement. To this end, we moved ahead 
to reorganize our insurance operations to institute more efficient team 
processing of plan terminations and participant benefits. We also made 
progress in our optical imaging effort, converting 1.2 million 
participant documents to computerized images. Optical imaging will make 
these records more accessible and enable our staff to answer 
participant inquiries more quickly and accurately than in the past.
    We continued to upgrade our participant communications. We 
introduced a semiannual Pension Newsletter to keep retirees receiving 
pensions from PBGC informed about our services and important 
developments. We produced a new videotape entitled ``Your Guaranteed 
Pension'' to explain PBGC's guarantees to people in newly trusteed 
plans. In certain cases in which PBGC assumed pension plans, senior 
agency officials conducted townhall-type meetings to explain the PBGC 
program and protections.
    Our pilot information campaign, ``Know Your Pension,'' also proved 
successful. We initiated this effort as a way to inform workers and 
retirees with underfunded pension plans about their pensions and PBGC's 
guarantees. Targeted to parts of Ohio and Pennsylvania, the campaign's 
message was carried by radio stations and newspapers and over 100,000 
people took pamphlets from supermarket racks. We will be expanding the 
campaign in 1995 to cover six States.
    For its outreach efforts, PBGC received the Award of Excellence of 
the National Association of Government Communicators, which cited our 
raising public awareness about pensions and pension funding issues as 
``a prime example of the type of government communication NAGC strives 
to recognize.''

                               Management

    PBGC's extensive efforts to improve its financial management were 
rewarded in 1994 when the General Accounting Office issued the first 
unqualified opinion on PBGC's financial statements. GAO stated that it 
found PBGC's 1993 and 1992 statements of financial condition for both 
insurance programs ``reliable in all material respects.'' PBGC's 
significant progress in improving financial operations and reporting 
paved the way for last year's GAO opinion. We continued to sustain our 
high level of financial management in 1994 and we have again received 
an unqualified opinion from GAO on our 1994 financial statements.
    This year, PBGC's deficit decreased. This is a positive 
development, but it must be viewed with caution. The change in the 
deficit reflects a convergence of several factors arising from a strong 
economy. We sustained no major terminations this year; our negotiations 
resulted in the continuation of a significantly underfunded Western 
Union plan once considered probable for termination, reducing our 
evaluation of probable future claims; and our improved collection 
efforts produced the largest premium revenues in our history. However, 
the most important factor affecting the deficit was the rise in 
interest rates, which reduced the value of PBGC's benefit obligations 
but can fall again, with the opposite effect, in the future. Lasting 
progress on the deficit will come from the newly enacted pension 
reforms, which will improve funding of pension plans at risk and 
increase PBGC's premium revenues to offset the deficit.
    Although beneficial for PBGC's deficit, the rise in interest rates 
adversely affected investments. PBGC responded to changing market 
conditions by revising its investment policy to maximize long-term 
investment returns, with less risk to the agency, in order to reduce 
the deficit. We shortened the duration of fixed-income assets and 
increased investment in equities.
    In other areas, we continued our efforts to improve our automated 
information systems. We are completing the development of our new 
premium accounting system. The new system will enhance collection 
efforts that have netted approximately $85 million in previously unpaid 
amounts, including about $20 million in 1994. At the same time, we are 
continuing to work on integrating our various information systems and 
improving our controls over our data.
    We also instituted tighter controls on our contracts and 
contractors and expanded the number of audits we perform. For the year, 
we completed 21 contact audits and achieved savings of more than $3 
million.

                          PBGC, 20 Years Later

    In September we commemorated the 20th anniversary of ERISA's 
enactment, and we reflected on the intervening years. PBGC started with 
a small staff housed in temporary offices with borrowed equipment and 
no money. In those pioneering days, the agency faced an immediate 
backlog of plan terminations to be processed, and an almost immediate 
deficit. In contrast, we now collect almost $1 billion in premiums 
annually, a far cry from the $22 million collected the first year, and 
we are managing $8.7 billion in assets. We insure the benefits of more 
than 41 million Americans, with direct responsibility for the pensions 
of 372,000 people. We are paying nearly $65 million in benefits every 
month.
    PBGC has accomplished much in the last 20 years, and yet more 
remains to be done. Our first priority is to implement the reforms. We 
must close the gap in pension funding and make sure that pensions and 
PBGC are truly safe. The reforms give us the tools to do so. With 
continued hard work, we will build a future as memorable as our past.
                                  Martin Slate, Executive Director.

                     RETIREMENT PROTECTION REFORMS

    On December 8, 1994, President Clinton signed into law the 
Retirement Protection Act of 1994 as part of the General Agreement on 
Tariffs and Trade legislation passed by the Congress. With enactment of 
the pension reforms, the Administration and the Congress have acted to 
close the gap of pension underfunding that has troubled the defined 
benefit pension system for more than a decade. For many workers and 
retirees, the Retirement Protection Act makes retirement security a 
reality.
    During the year, the reforms were widely discussed and broadly 
supported. Secretary of Labor Robert Reich and PBGC Executive Director 
Martin Slate testified in support of the legislation during three 
Congressional hearings. Both the House Ways and Means Committee and the 
House Education and Labor Committee considered the legislation and 
unanimously reported it out for action by the full House. In addition, 
editorials supporting the pension reforms appeared in 85 newspapers 
across the country.
    The heart of the reforms is strengthened and accelerated funding 
for single-employer pension plans that are less than 90 percent funded. 
The reforms also provide PBGC with additional enforcement tools, 
improve information for workers and retirees in underfunded plans, and 
increase pension insurance premiums for the plans that pose the 
greatest risk. Companies with well-funded plans are not affected by 
these reforms.
    PBGC expects that, over a 15-year period, the reforms will reduce 
underfunding by more than two-thirds and put the Corporation on a sound 
financial basis by eliminating the deficit within 10 years.

                        Pension Funding Reforms

    For single-employer plans that are less than 90 percent funded, the 
reforms will strengthen funding by:
          Accelerating the funding formula so that new benefits are 
        funded over a shorter period, with the greatest effect being 
        felt by plans that are less than 60 percent funded--most 
        benefit increases for these plans will be funded over 5-7 
        years;
          Removing a loophole in prior law that allowed employers to 
        use certain credits or other offsets to lessen minimum funding 
        payments;
          Constraining the interest and mortality assumptions that may 
        be used for calculating minimum funding contributions by 
        specifying the appropriate mortality tables and gradually 
        narrowing the range of permissible interest rates; and
          Adding a new plan solvency rule to ensure plans have enough 
        cash and marketable securities to pay current benefits.
    Transition rules will ease the impact and enhance the affordability 
of the new requirements. The reforms also remove certain impediments to 
full funding by granting excise tax relief in some situations. They 
also eliminate requirements for quarterly contributions for fully 
funded plans.

                           Compliance Reforms

    The reforms enhance PBGC's compliance authority and early warning 
program by strengthening our ability to protect pensions through new 
reporting requirements that should assure PBGC will have adequate 
information with which to act. Employers with large pension 
underfunding are required to provide PBGC annually with detailed 
actuarial information on their plans and financial information on the 
sponsoring companies and their controlled group members. Privately held 
companies with plans that are, in the aggregate, less than 90 percent 
funded and underfunded by more than $50 million must provide PBGC with 
30 days' advance notice of significant corporate transactions that 
might threaten the future funding of pensions. PBGC already is able to 
monitor the transactions of publicly held companies through publicly 
available sources.
    PBGC is given express authority to enforce minimum funding 
requirements, and the reforms improve the agency's authority to file 
liens against employer assets for missed contributions. Finally, 
employers are prohibited from increasing benefits in underfunded plans 
during bankruptcy.

                     Participant Protection Reforms

    Workers and retirees need to know the financial condition of their 
pension plans, the consequences of underfunding on their promised 
benefits, the scope of PBGC's guarantees, and that they will receive 
their benefits even if they are unaware that their fully funded plan 
has terminated. The reforms broaden information requirements and 
provide other protection for workers and retirees. Employers whose 
plans are less than 90 percent funded must provide participants with an 
annual plain-language explanation of their plan's funding status and 
the limits on PBGC's guarantee. In addition, PBGC will serve as a 
clearinghouse for participants who cannot be located upon termination 
of a fully funded plan. The employer will have to either purchase an 
annuity contract covering such people or transfer sufficient assets to 
PBGC to pay the participants' benefits once the participants are found 
or they contact PBGC. Also, the reforms require employers, by the year 
2000, to use uniform interest and mortality assumptions in calculating 
minimum lump-sum payments of benefits.

                            Premium Reforms

    PBGC's annual insurance premium for single-employer plans includes 
a flat-rate charge of $19 per participant paid by all plans and an 
additional variable-rate charge of $9 per $1,000 of unfunded vested 
benefits paid only by underfunded plans. The variable-rate charge, 
however, had a maximum cap under prior law that limited premium 
obligations and weakened the funding incentive for the most seriously 
underfunded plans. Although plans affected by the cap accounted for 80 
percent of all the underfunding in single-employer plans, they paid 
only 25 percent of PBGC's total premium revenues. The reforms provide 
an incentive for funding pensions and bring balance to the premium 
structure by phasing out the current cap on the variable-rate charge 
over 3 years. With the premium reforms, PBGC expects the deficit to be 
eliminated within 10 years.

                           Bankruptcy Reforms

    The Congress also passed legislation during the year to amend the 
Bankruptcy Code. Signed into law by President Clinton on October 22, 
1994, one provision of the Bankruptcy Amendments of 1994 allows PBGC to 
be a member of creditors' committees with full voting rights. Under 
prior law, PBGC was not allowed to be a member of these committees, 
despite frequently being the largest creditor because of pension 
underfunding. The change in the Bankruptcy Code will enable PBGC to 
participate in bankruptcy reorganizations, to have full access to 
essential information, and to expedite reorganization proceedings for 
the benefit of all parties concerned.

                              ENFORCEMENT

    Vigilance and decisive action marked PBGC's enforcement activities 
during 1994. Through year-round monitoring of companies with 
substantially underfunded plans, combined with determined negotiations 
and litigation, PBGC achieved some of the biggest successes in its 
history.

                         Early Warning Program

    PBGC's early warning program played a vital role in the agency's 
efforts to prevent benefit losses for workers, retirees, and the 
insurance program. PBGC seeks to proactively identify and address 
concerns about large underfunded plans that will strengthen the plans 
and keep them ongoing. The Corporation tries to ensure that pensions 
are protected when companies restructure or otherwise engage in major 
transactions.
    During the year, in-house financial analysts and actuaries closely 
monitored more than 300 companies with significantly underfunded plans 
that represented over 80 percent of the total underfunding in PBGC-
insured single-employer plans. Through analysis of company financial 
statements, government reports, actuarial valuations, and public 
announcements of major transactions, the PBGC staff evaluated the risk 
of future plan terminations and identified transactions or events that 
could adversely affect a plan and its participants.
    This information enabled PBGC to negotiate key settlements valued 
at nearly $11 billion with 16 plan sponsors. This includes a major 
pension funding agreement with General Motors Corporation, and other 
settlements that provided more than $800 million in increased 
protection for participants of underfunded plans.
    General Motors Corporation. In May 1994, following months of 
negotiations, PBGC reached an agreement with GM for the company to 
contribute about $10 billion in cash and stock to its largest and most 
underfunded pension plan. At the time of the agreement, the total 
underfunding for all of GM's plans was reported to be approximately $20 
billion, most of which was in the plan covered by the agreement. That 
plan covers more than 600,000 GM workers and retirees.
    GM's contribution consists of $4 billion in cash and 177 million 
shares of GM Class E stock. The company agreed not to use the $10 
billion contribution to offset its annual required contributions until 
2003, except under certain circumstances. In return, PBGC agreed to 
release GM's information technology services subsidiary, Electronic 
Data Systems Corporation (EDS), from liability for GM's pensions, under 
certain circumstances, if EDS leaves the GM corporate group.
    New Valley Corporation (formerly Western Union Corporation).--
Throughout New Valley's bankruptcy proceedings, which began in November 
1991, PBGC actively sought an agreement that would ensure that New 
Valley's ongoing pension plan--the tenth most underfunded plan in the 
country--was adequately protected under any reorganization proposal. 
That plan, which is underfunded by about $400 million, covers 16,000 
Western Union workers and retirees.
    On September 23, 1994, the bankruptcy court approved, over PBGC's 
objections, a bid for Western Union Financial Services, Inc., New 
Valley's major asset, that did not include assumption of the pension 
plan. On October 17, PBGC sought a district court order terminating the 
plan before the sale could be finalized. PBGC took this action to 
preserve its pension claims against Western Union while it was still a 
member of New Valley's controlled group. In response, on October 19, 
New Valley and First Financial Management Corporation (FFMC), the 
prospective purchaser of Western Union, agreed that FFMC would assume 
responsibility for the pension plan as part of the sale of Western 
Union. The bankruptcy court subsequently confirmed New Valley's plan of 
reorganization, including the sale of Western Union. Because of this 
swift action, the plan will be kept ongoing and funded by a financially 
strong company, thus protecting the pensions of Western Union's workers 
and retirees and averting a potentially significant loss for the 
pension insurance program.
    Pan Am Corporation. PBGC reached a $110 million cash settlement of 
the defunct airline's liability for three terminated Pan Am pension 
plans, which the bankruptcy court approved after the year ended. PBGC 
had asserted claims in Pan Am's bankruptcy for more than $900 million 
of unfunded benefits. Although little was left in the Pan Am estate, 
PBGC recovered about a third of what was available. In return, PBGC 
relinquished all other claims against Pan Am and ended all its 
litigation with the airline.
    Armco, Inc.--In June 1994, PBGC and Armco reached a settlement 
worth $27.5 million that resolved Armco's liability for a terminated 
plan once sponsored by Armco's affiliate, Reserve Mining Company, and 
strengthened a separate ongoing Armco plan. The settlement ended a PBGC 
suit seeking to establish Armco's responsibility for the plan, which 
was underfunded by about $21 million when terminated in 1987. Under the 
agreement, Armco paid PBGC $10 million in cash to satisfy its liability 
for the plan's underfunding. Armco also contributed $17.5 million, in 
addition to its normal annual contributions, to its own ongoing plan 
for hourly employees. That plan, underfunded by nearly $300 million as 
of 1992, covers 20,000 workers and retirees. The $17.5 million 
contribution far exceeded the amounts Armco would have contributed to 
the plan over the next 2 years had the agreement not been reached.
    Harvard Industries, Inc.--Harvard Industries, with eight pension 
plans that were underfunded by at least $25 million, planned a $100 
million debt offering to retire existing bank and trade debt and a 
portion of its preferred stock. Concerned that collateralization of the 
new debt and other aspects of the transaction would increase PBGC's 
risk of long-run loss should the plans terminate in the future, PBGC 
reached an agreement with the company for advance funding of the plans. 
Under the agreement, Harvard Industries will contribute $24 million, 
over and above its required pension funding, to its underfunded plans 
over the next 3 years. The agreement includes additional protections 
for PBGC, including restrictions on preferred stock redemptions.
    Great American Management and Investment, Inc., (GAMI).--Shortly 
after the year ended, PBGC reached an agreement with GAMI that 
protected the pensions of 11,000 workers and retirees of companies 
under GAMI's control. The pension plans of GAMI and its subsidiaries 
are underfunded by more than $30 million.
    Most of GAMI's earnings are derived from an affiliated group of 
companies, the Falcon Group. Falcon was planning an initial public 
offering of stock that could have relieved the group of joint-and-
several liability for the GAMI pensions. Under the agreement with PBGC, 
each company in the Falcon Group will remain liable for the 
underfunding of any GAMI-affiliated pension plan that terminates in the 
next 5 years.
    Lone Star Industries, Inc.--Lone Star, which successfully emerged 
from bankruptcy in April 1994, has nine underfunded pension plans that 
will be better protected as a result of the company's settlement 
agreement with PBGC. The plans cover about 5,900 people and were 
underfunded, at the time, by about $73 million. Under the settlement, 
Lone Star agreed to keep the plans ongoing and to contribute about 
$12.3 million to them in addition to its required annual contributions. 
The company also gave PBGC a security interest in real property and a 
partnership with a value of at least $35 million as additional 
protection should the plans terminate in the future.
    American Cyanamid Corporation (ACY).--ACY, which had a single 
pension plan with 37,000 participants, proposed to break up its 
controlled group by spinning off a subsidiary, Cytec Industries, Inc., 
to its shareholders. As part of this transaction, ACY proposed to spin 
off the portion of the ACY plan relating to Cytec's 4,500 active 
employees. The plan being spun off had underfunding of about $100 
million. Because Cytec did not have the financial resources of ACY, 
PBGC sought protection from ACY for Cytec's pension obligations. ACY 
subsequently agreed to remain responsible for full termination 
liability should the Cytec plan terminate without enough money to pay 
all promised pension benefits.

                               Litigation

    PBGC prefers to negotiate settlements of pension issues with the 
responsible employers, but the agency will not hesitate to take legal 
action when necessary to protect its interests or those of workers and 
retirees. Its successful record in Federal courts across the country is 
an important incentive for employers to seek resolution of pension 
issues through negotiated settlements rather than litigation.
    At the end of the year, PBGC had 121 active cases in State and 
Federal courts and 638 bankruptcy cases.
    East Dayton Tool and Die Company, Inc.--PBGC won a significant 
victory when an appellate court applied PBGC's definition of a group of 
commonly controlled companies in finding that the members of the 
Roscommon Group were jointly and severally liable for the terminated 
East Dayton pension plan. The court upheld PBGC's determination that, 
under Federal pension law, a corporate group's responsibility for an 
underfunded pension plan is based on stock ownership of the plan 
sponsor rather than on ``actual'' control of the company. The Roscommon 
Group owned all of East Dayton's stock but had lost control of the 
company after defaulting on the loan through which the group obtained 
East Dayton. The court found that actual control of East Dayton on the 
date the pension plan terminated was irrelevant.
    CF&I Steel Corporation.--In a case with potentially broad 
ramifications for PBGC's recoveries in bankruptcies, PBGC continued to 
pursue its claims for a CF&I plan that was underfunded by about $220 
million when terminated in March 1992. Under CF&I's consensual plan of 
reorganization, which was confirmed in 1993, PBGC is to receive a share 
of liquidation proceeds that will include a limited partnership 
interest in the business that was transferred to new owners by an asset 
sale, and may include cash and other consideration. PBGC estimates the 
total value of the potential recovery at about $33 million. PBGC may 
recover additional amounts depending on the outcome of pending 
litigation on its claims.
    In a November 1994 ruling, a distinct court denied priority to most 
of PBGC's claims for minimum funding contributions owned CF&I's plan 
and for the plan's underfunding. The court also remanded the case to 
the bankruptcy court for reconsideration of the amount of PBGC's 
underfunding claim, ruling that the bankruptcy court erred in deferring 
to PBGC's interest rate assumption. PBGC is seeking leave to pursue an 
immediate appeal of this ruling.
    White Consolidated Industries, Inc.--White continued to contest 
PBGC's claims for the estimated $120 million underfunding in several 
pension plans that White transferred in a 1985 transaction with Blaw 
Knox corporation. PBGC is alleging that a principal purpose of White in 
entering into the transaction was to evade the pension liabilities. 
Within the past 3 years, PBGC has had to terminate all six Blaw Knox 
plans, because they either ran out of money or lacked sufficient funds 
to pay all benefits when due. The case remained pending before a 
district court at yearend.
    Collins v. PBGC; Page v. PBGC.--In these consolidated class-action 
suits, the plaintiffs--participants in plans that terminated before 
September 26, 1980, without having been amended to adopt ERISA's 
minimum vesting standards--sought a court ruling requiring PBGC to 
guarantee their benefits as if their plans had been amended. PBGC had 
determined at the time their plans terminated that only those benefits 
vested under the express terms of their plans were guaranteeable. PBGC 
and the plaintiffs continued to discuss a settlement throughout the 
year.

                               Rulemaking

    PBGC issued final rules shortly after the year ended that will 
strengthen the agency's debt collection powers. One set of rules has 
enabled PBGC to participate in the Internal Revenue Service's tax 
refund offset program and claim the tax refunds of companies to offset 
amounts owed to PBGC, particularly unpaid premiums. A separate program 
known as administrative offset will allow PBGC to claim money owed to 
its debtors by other Federal agencies. The offset programs will be 
triggered only when there is a failure to pay a legally enforceable 
debt already owed to PBGC.

                            CUSTOMER SERVICE

    In 1994, PBGC expanded its efforts to reach out to people covered 
by plans taken over by the agency and to reassure them about their 
retirement security. Changes are in process that are enhancing PBGC's 
ability to process plan terminations and serve the workers and retirees 
in terminated plans.

                           Benefit Processing

    PBGC's responsibility for benefit payments begins immediately upon 
becoming trustee of a terminated plan. Top priority is given to 
maintaining uninterrupted benefit payments to existing retirees and 
commencing payments to new retirees without delay. Concurrently, PBGC 
staff also begin intensive efforts to obtain essential data and records 
on each individual participant, a difficult task frequently complicated 
by inadequate plan and employer records.
    PBGC pays estimated benefits to retirees until it has confirmed all 
necessary participant data and valued plan assets and recoveries from 
the plan's sponsor. PBGC then calculates the actual benefit payable to 
each participant according to the specific terms of the participant's 
plan, statutory guarantee levels, and the funds available from plan 
assets and employer recoveries. These benefit calculations can be an 
intricate process since each trusteed plan is different and must be 
administered separately.
                             trusteed plans
    During 1994, PBGC became trustee of 105 single-employer plans, 
almost 40 percent more than in 1993. PBGC is in the process of 
trusteeing an additional 117 terminated single-employer plans, which, 
along with 10 multiemployer plans previously trusteed, will bring the 
cumulative number of trusteed plans to 1,971. This total also reflects 
the changed circumstances of one plan, which no longer required PBGC 
trusteeship.
                            benefit payments
    About 372,000 participants from single-employer and multiemployer 
plans rely on PBGC for current and future pension benefits. These 
include 174,200 retirees receiving pensions and about 200,000 
additional people who are entitled to receive benefits when they retire 
in the future. Another 71,000 participants are in plans that were 
considered likely to terminate but had not done so before the year 
ended. Benefit payments during 1994 totalled about $721 million.
                               we pledge
    As customers of PBGC, you deserve our best efforts. Our first goal, 
of course, is getting you your benefit check on time each month. We are 
also committed to always showing you courtesy and respect when you 
contact us. For 1995, we pledge that:
          In all communications with you, we will acknowledge your 
        inquiry within one week. If we cannot give you an immediate 
        answer, we will tell you when to expect it and we will give you 
        a specific point of contact at PBGC.
          If it will take us longer than expected to answer your 
        question, we will give you a status report and tell you a new 
        date when to expect an answer.
          If you are receiving a pension check, changes you request 
        (such as address change, direct deposit, tax change) will be 
        made within 30 days, if the request is received by the first of 
        the month. It will take another month if the request is 
        received after the first of the month.
                       customer service standards
    PBGC established Customer Service Standards to better serve our 
principal customers, the workers and retirees to whom we pay pension 
benefits. Publication of these standards as part of the National 
Performance Review report, ``Putting Customers First, Standards for 
Serving the American People,'' culminated a cooperative effort that 
involved frontline PBGC employees who deal directly with the 
participants, representatives of participants, and PBGC management.
    To implement the standards, PBGC is reviewing the processes that 
affect customer services to ensure they support this effort, providing 
customer service training to staff who deal directly with our 
customers, and identifying additional standards that may be needed. 
PBGC also will measure overall customer satisfaction through a periodic 
survey of the workers and retirees whose plans the agency has taken 
over.
                          participant outreach
    Overall communications with our customers took a major step forward 
as PBGC introduced the Pension Newsletter for retirees paid benefits by 
the agency. The semi-annual newsletter, which has met with an 
enthusiastic response from the retirees, keeps them abreast of 
developments at the agency and communicates important information about 
PBGC's customer services and benefit payment procedures. In addition, 
PBGC produced and issued a videotape entitled ``Your Guaranteed 
Pension'' to explain PBGC's guarantees and reassure participants in 
newly trusteed plans. The video has proven particularly useful in 
meetings PBGC conducts with participants of large, newly trusteed plans 
to allay their concerns about their pensions. In 1994, PBGC held 10 
such meetings in several locations across the country for plan 
terminations affecting about 15,000 people.
    During the year, PBGC conducted a pilot ``Know Your Pension'' 
information campaign targeted to parts of Ohio and Pennsylvania. The 
campaign sought to educate participants in ongoing underfunded plans 
about their pensions and PBGC's guarantees through newspaper articles, 
radio messages, posters, and readily accessible pamphlets. The results 
of the campaign far exceeded expectations. The radio messages were 
carried on about 40 stations reaching almost 2 million homes. The 
newspaper columns were carried by nearly 70 newspapers with more than 6 
million readers. More than 100,000 pamphlets were taken, generating 
over 32,000 requests for additional publications. The program will be 
expanded in 1995 to cover six States where there are 4,700 underfunded 
plans covering more than 2.4 million people.
    PBGC's missing participant program, through which PBGC tries to 
find workers and retirees who may be unaware they are entitled to 
benefits, generated successful results during the year. A Wall Street 
Journal article headlined ``Agency Reunites People and Their Pensions'' 
began: ``They're from the government, and they're here to help you. 
Really.'' \1\ The project enabled PBGC to locate addresses for 12,000 
out of 15,000 missing people, for which Vice President Gore presented 
PBGC with the National Performance Review's ``Hammer Award.''
---------------------------------------------------------------------------
    \1\ Excerpted from The Wall Street Journal, February 17, 1994, 
' Dow Jones & Company, Inc.
---------------------------------------------------------------------------
                          service improvements
    PBGC moved ahead with plans to reorganize its longstanding 
``assembly line'' method for processing plan terminations and 
participant benefits in order to streamline and strengthen the process. 
In place of the agency's previous sequential handling of the procedural 
steps, PBGC has put in place interdisciplinary teams combining the 
various actuarial, financial, and benefit processing skills needed to 
simultaneously complete these tasks. The teams will assure faster, more 
efficient, and more accurate results than are possible through the 
current procedures. Participants will receive individualized and direct 
service.
    PBGC has a range of actions underway to improve customer service. 
One project to expedite the calculation and communication of 
participant benefits resulted in the issuance of more than 25,500 
individual benefit determinations, nearly 25 percent more than were 
issued in 1993. In addition, PBGC established ``800'' telephone numbers 
at all 18 of its field benefit locations, assuring direct, toll-free 
services for the people paid through these local pension administration 
offices, and will soon establish this service at its headquarters 
location in Washington, D.C.
    The past year also saw significant progress in PBGC's optical 
imaging of plan and participant documents, a program initiated in 1993. 
Optical imaging provides enhanced computer-based document storage and 
retrieval capabilities through conversion of documents to computerized 
images. Optical imaging is critical to PBGC's ability to provide 
faster, better service to participants. During 1994, the agency imaged 
1.2 million separate participant documents. PBGC expects to complete 
imaging of all its plan and participant records during 1995.

                   Appeals of Benefit Determinations

    PBGC established its Appeals Board in 1979 to resolve appeals of 
certain initial PBGC determinations. Almost all of the appeals PBGC 
receives are from participants disputing PBGC's determination of their 
benefits. Approximately 2 percent of all determinations issued are 
actually appealed.
    Most appeals are closed without Appeals Board action because the 
appeals department and other PBGC staff are able to resolve the issue 
informally or the appellant simply needs a better explanation of PBGC's 
determination. In 1994, 63 of the 156 appeals decided by the Board 
required changes in participants' benefits, and those changes usually 
were due to new facts presented by the appellant or a different 
interpretation of plan provisions.
    PBGC's single-employer plan insurance program posted a significant 
financial gain for the year largely through the effect of rising 
interest rates on the program's benefit obligations, the low impact of 
plan terminations, including deterrence of the termination of a major 
underfunded plan, and stepped-up collection efforts. As a result, the 
program's deficit fell sharply by yearend. The separate insurance 
program for multiemployer plans, while still carrying a considerable 
surplus, recorded its first financial loss in 11 years.

                        Single-Employer Program

    The number of American workers and retirees with pensions insured 
under the single-employer program grew slightly, to nearly 33 million 
people, despite a continuing decline in the number of single-employer 
pension plans covered by PBGC. There are about 56,000 single-employer 
plans, based on the most recent data available, which is for 1992 when 
there were about 8,000 terminations of fully funded plans. The number 
of terminations each year has dropped considerably since then.
                            program finances
    A healthy economy buttressed the pension system. With no major plan 
terminations and rising interest rates, PBGC reported a $249 million 
reduction in its accumulated losses from actual and probable plan 
terminations. This reduction of losses contributed to PBGC's 
significantly increased underwriting income.
    As a result of stepped-up collection efforts and the continued 
growth in underfunding, PBGC's premium revenues increased by $65 
million to $955 million. Despite investment losses, PBGC also reported 
more than $400 million in financial income primarily due to actuarial 
credits reflecting the change in interest rates. The net result for the 
year was that the single-employer program's liabilities dropped to 
about $9.5 billion. Assets increased slightly to nearly $8.3 billion. 
By yearend, the single-employer program's deficit had fallen to about 
$1.2 billion.
                         standard terminations
    An employer may end a fully funded plan in a standard termination 
by annuitizing or paying lump sums to participants. Standard 
terminations are subject to legal requirements governing notifications 
to participants and PBGC and payment of the participants' benefits. 
PBGC may disallow any standard termination that does not comply with 
the requirements.
    There were considerably fewer standard terminations in 1994, 
continuing a decline from the historically high levels reported during 
the late 1980's. In 1994, PBGC received about 3,950 notices of standard 
terminations, about 25 percent fewer than were received in 1993 and 
one-third the number received annually in the years 1987-90. Including 
plans for which PBGC received notices before 1994, the Corporation 
permitted completion of about 4,060 standard terminations and returned 
or disallowed another 1,560 cases that were incomplete or failed to 
meet legal requirements. The agency processes its applications for 
standard terminations well within the 60-day statutory time period.
    PBGC audits a statistically significant number of completed 
terminations to confirm compliance with the law and proper payment of 
participants' benefits. These audits generally have found few and 
relatively small errors in benefit payments, which plan administrators 
are required to correct. Under prior law, certain situations involving 
distribution of assets could be corrected only by cancellation of the 
termination, which could prove harmful to plan participants. The new 
law allows PBGC to exercise other remedies, such as the imposition of a 
penalty, if the agency determines that cancelling a termination would 
be inconsistent with the interests of the plan's participants and 
beneficiaries.
                 distress and involuntary terminations
    Defined benefit plans that are not able to pay all promised 
benefits may be terminated either by the employer responsible for the 
plan or by PBGC. An employer wishing to terminate an underfunded plan 
generally may do so only if the employer is being liquidated or if the 
termination is necessary for the company's survival. The employer must 
first prove to PBGC, or to a bankruptcy court if appropriate, that it 
and each of its affiliated companies meets one of the financial 
distress criteria set by law.
    An underfunded plan also may be terminated involuntarily by PBGC 
when necessary to protect the interests of the participants or of the 
insurance program. PBGC must terminate any plan that has insufficient 
assets to pay current benefits.
    The number of underfunded plans requiring distress or involuntary 
termination increased in 1994. Terminations during the year included 
plans from Schwinn Bicycle Company; Avtex Fibers, a Virginia textile 
company; Washington Industries, a Tennessee clothing manufacturer; 
Heintz Corporation, a Philadelphia aeronautical parts manufacturer; 
Blaw Knox Corporation; and Sharon Steel, a Pennsylvania steel company. 
By yearend, PBGC had approved the termination of 114 underfunded plans, 
in contrast to the 88 plans in 1993. The actual termination date for 
many of these plans occurred in earlier years.
    Although more underfunded single-employer plans terminated in 1994 
than in the previous year, losses from underfunded plans dropped 
substantially. PBGC's annual losses from underfunded single-employer 
plans have been variable throughout its history, with net losses 
generally increasing since 1982.

                    Single-Employer Program Exposure

    The majority of single-employer plans insured by PBGC are fully 
funded. However, total underfunding in single-employer plans increased 
to $71 billion as of December 31, 1993, from the $53 billion reported 
for the end of 1992. These underfunded plans, which covered about 8 
million workers and retirees, had total assets of $316 billion and 
total liabilities for vested benefits of $387 billion.

                                  LOSS EXPERIENCE FROM SINGLE-EMPLOYER PLANS\1\                                 
                                              [Dollars in millions]                                             
----------------------------------------------------------------------------------------------------------------
                                                                                                        Average 
                                                                      Trust    Recoveries              net loss 
             Year of termination              Number of   Benefit      plan       from        Net         per   
                                                plans    liability    assets    employers    losses   terminated
                                                                                                         plan   
----------------------------------------------------------------------------------------------------------------
1975-1981...................................        824       $742       $295        $129       $317        $0.4
1982-1988...................................        781      3,058        922         203      1,932         2.5
1989-1994...................................        356      4,690      2,043         390      2,257         6.3
                                             -------------------------------------------------------------------
      Subtotal..............................      1,961      8,489      3,260         723      4,506  ..........
Probable....................................         39      2,699      1,201         333      1,166  ..........
                                             -------------------------------------------------------------------
      Total.................................      2,000     11,188      4,461       1,055      5,672  ..........
----------------------------------------------------------------------------------------------------------------
Note: Numbers may not add up to totals due to rounding.                                                         
                                                                                                                
\1\ Stated amounts are subject to change until PBGC finalizes values for liabilities, assets, and recoveries of 
  terminated plans. Amounts in this table are valued as of the date of each plan's termination and differ from  
  amounts reported in the Financial Statements and elsewhere in the Annual Report, which are valued as of the   
  end of the stated fiscal year.                                                                                

    This underfunding remains concentrated in a relatively small number 
of companies and industries. More than half of the underfunding is in 
large pension plans, primarily in the automobile, steel, industrial and 
commercial machinery, airline, and tire and rubber industries.
    Underfunding increased in 1993 primarily due to the historically 
low interest rates, but a hard core of underfunding has persisted since 
enactment of ERISA in 1974. Even if interest rates remained constant, 
there still would have been no significant improvement in underfunding, 
which has grown over the past decade.
    In order to measure how much of the current underfunding may result 
in future claims, PBGC categorizes underfunding into three loss 
contingency classifications that follow generally accepted accounting 
principles and are based on the financial condition of plan sponsors. 
The classifications are: probable, reasonably possible, and remote.
    Probable claims are those that are likely to occur. PBGC estimates 
and records them as liabilities as they are determined, as required by 
financial accounting standards.
    Approximately one-fourth of the $71 billion underfunding (about $18 
billion based on public information obtained from corporate annual 
reports) is in plans maintained by companies that had below-investment-
grade bond ratings as of September 30, 1994, and present a risk to the 
insurance program and to participants with nonguaranteed benefits. 
These plans are included in PBGC's reasonably possible claims.
    About three-fourths of the underfunding is in plans sponsored by 
financially sound firms. These are categorized as remote claims. 
Pension underfunding in these plans is not presently a risk to 
participants or PBGC.
    PBGC's estimate of underfunding in single-employer plans does not 
reflect increases in underfunding that typically occur in plans of 
troubled companies as they minimize their pension contributions and pay 
costly early retirement benefits that result from increased layoffs and 
plant shutdowns. In certain cases, the underfunding that PBGC is 
obligated to make up will have increased substantially by the time an 
underfunded plan is terminated.

                          Financial Forecasts

    ERISA requires that PBGC annually provide an actuarial evaluation 
of its expected operations and financial status over the next 5 years. 
PBGC historically has extended these forecasts to cover 10 years. As a 
result of passage of the Retirement Protection Act of 1994, the 
forecasts for PBGC's future have improved markedly.
    PBGC's forecasts are subject to significant uncertainty since the 
amount of PBGC's future claims depends on many factors, including 
current underfunding among insured plans, future changes in funding 
levels, bankruptcies among plan sponsors, and recoveries from these 
bankrupt sponsors. These factors are influenced by future economic 
conditions, investment results, and the legal environment that the 
Congress and the courts create for PBGC's insurance program. Over the 
longer term, PBGC also will be affected by labor force trends, global 
trade, and employers' preferences among the variety of pension plans 
available.
    PBGC's current methodology for the 10-year forecasts relies on an 
extrapolation of the agency's claims experience and the economic 
conditions for the past two decades. As a result, the forecasts do not 
reflect a full range of economic conditions and do not measure the high 
degree of uncertainty surrounding PBGC's future claims. To address the 
limitations of the forecast methodology, PBGC is developing a 
simulation model, called the Pension Insurance Management System 
(PIMS), to examine its financial condition under a full range of 
economic scenarios. Until PIMS is complete, PBGC is continuing to rely 
on its current methodology.
                           ten-year forecasts
    PBGC has prepared three 10-year forecasts of its single-employer 
program (A, B, and C) using its current methodology to give a long-term 
view of the expected status under different loss scenarios. PBGC 
expects its history of significant annual variations in losses to 
continue. These forecasts include the significant improvement in PBGC's 
financial condition expected as a result of the December 1994 enactment 
of the Retirement Protection Act.
    Forecast A is based on the average annual net claims over PBGC's 
entire history ($382 million per year) and assumes the lowest level of 
future losses. Forecast A projects steady net income resulting in 
gradual elimination of PBGC's deficit and a surplus of $5.1 billion at 
the end of 2004.
    Forecast B, which assumes the mid-level of future losses, is based 
upon the average annual net claims over the most recent 13 fiscal years 
($516 million per year). PBGC began incurring significantly larger 
claims in 1982. Forecast B projects lower net income levels than 
Forecast A that still lead to gradual elimination of PBGC's deficit and 
a surplus of $2.8 billion at the end of 2004.
    Forecast C is highly pessimistic and reflects the potential for 
heavy losses from the largest underfunded plans by assuming that the 
plans that represent reasonably possible losses will terminate 
uniformly over the next 10 years in addition to a modest number of 
lesser terminations each year. (Reasonably possible losses are 
discussed in Note 8 to the financial statements.) This forecast assumes 
$1.15 billion of net claims each year, resulting in steady growth of 
PBGCs deficit throughout the 10-year period of $7.8 billion.
    The methodology used to produce Forecast C was revised for this 
year to reflect the impact of the sharp increase in interest rates that 
has occurred since December 31, 1993. The value of assets and 
liabilities of plans that represent reasonably possible losses has been 
re-estimated consistent with the September 30, 1994, interest rate, 
mortality, and administrative expense assumptions used in Forecasts A 
and B. If Forecast C had been prepared consistent with the prior year's 
methodology, on the basis of the December 31, 1993, 5.65 percent 
interest rate assumption at which reasonably possible losses were 
initially valued, the forecasts would have reflected $1.72 billion of 
net claims each year and projected rapid growth of PBGC's deficit 
throughout the 10-year period to $17.2 billion.
    The 1994 forecasts share several assumptions. Projected claims are 
in 1994 dollars. The present value of future benefits is valued using 
actuarial assumptions consistent with assumptions used to value the 
present value of future benefits in the financial statements as of 
September 30, 1994. Assets are projected to grow at 7.81 percent 
annually. Benefits for plans terminating in the future are assumed to 
grow at 5.93 percent annually until termination. Plan funding ratios 
are assumed to increase at 1.5 percent per year from historical 
averages and recoveries from plan sponsors are assumed to be constant 
at 10 percent of plan underfunding. The number of participants in 
insured single-employer plans is assumed to remain constant. The flat-
rate portion of the single-employer premium is assumed to remain 
constant at $19 per participant. Receipts from the variable-rate 
portion of the premium are projected on the basis of a constant 30-year 
U.S. Treasury bond rate of 7.75 percent. Assumed administrative 
expenses through 1996 are consistent with PBGC's 1996 President's 
Budget submission and are projected to grow 5.93 percent each year 
thereafter.

                         Multiemployer Program

    The multiemployer program, which covers about 8.7 million 
participants in about 2,000 insured plans, is funded and administered 
separately from the single-employer program and differs from the 
single-employer program in several significant ways. The multiemployer 
program covers only collectively bargained plans involving more than 
one unrelated employer. For such plans, the event triggering PBGC's 
guarantee is the inability of a covered plan to pay benefits when due 
at the guaranteed level, rather than plan termination as required under 
the single-employer program. PBGC provides financial assistance through 
loans to insolvent plans to enable them to pay guaranteed benefits.
    The significant reforms enacted in 1980 created several safeguards 
for the program, including a requirement that employers that withdraw 
from a plan pay a proportional share of the plan's unfunded vested 
benefits. These safeguards have permitted PBGC to maintain 
multiemployer premiums at a constant, reasonably low level.
    The program continues in sound financial condition with assets of 
$378 million, liabilities totalling $181 million for future benefits 
and nonrecoverable future assistance, and a net surplus of $197 
million. During 1994, the program's assets, which are invested 
primarily in U.S. Government securities, declined in value for the 
first time since passage of the 1980 reforms because of the effect of 
rising interest rates on the securities. The combination of reduced 
assets and an increased allowance for nonrecoverable future assistance 
due to a new probable liability produced the first decline in the 
multiemployer program's financial condition in 11 years.
                           plan underfunding
    Based on data as of the beginning of 1992--the most recent 
information available--multiemployer plans had total assets of $189.3 
billion and liabilities of $177.5 billion. PBGC has determined that, of 
these plans, a small number were underfunded by a total of about $12 
billion.
                          financial assistance
    The multiemployer program has received relatively few requests for 
financial assistance. Since enactment of the reforms in 1980, PBGC has 
provided approximately $24 million in total assistance, net of repaid 
amounts, to only 13 of the 2,000 insured plans. Of this amount, about 
$4 million went to 8 plans in 1994. PBGC estimates that about $164 
million, at present value, will be required to make all nonrecoverable 
future payments to the 8 plans currently receiving assistance and to 
other plans expected to require assistance in the near future.
                        improved administration
    During 1994, the Corporation established a Multiemployer Working 
Group to coordinate all multiemployer program activities within PBGC. 
The working group identifies and monitors underfunded multiemployer 
plans to assure better administration of the multiemployer program and 
to minimize losses for plan participants and the program.
    PBGC also took steps to enhance its evaluation of the multiemployer 
program's exposure to losses for nonrecoverable financial assistance. 
The agency established a new automated multiemployer plan financial 
database with historical data that can be used to assess multiemployer 
plan financial trends. This database, in combination with better and 
more timely information on the universe of insured multiemployer plans 
and improved valuation procedures, enabled a more complete and reliable 
assessment of the program's exposure.

                          CORPORATE MANAGEMENT

    The efforts to address longstanding problems in the agency's 
financial operations and reporting resulted in the General Accounting 
Office issuing its first clean opinion on PBGC's 1993 financial 
statements, confirming the validity of the reported financial condition 
of both of PBGC's insurance programs. PBGC is developing and 
implementing a new automated premium accounting system. A revised 
investment strategy, designed to maximize long-term investment 
performance, reduced PBGC's investment losses in a bad year for the 
capital markets.

                          Systems Initiatives

    Modernization and integration of PBGC's information systems, many 
of which are more than 10 years old, remained a priority for the 
Corporation during 1994. At yearend, PBGC was well on the way to 
replacing several of its most critical systems. A state-of-the-art 
premium accounting system--one of the more advanced systems in 
government service--is being developed and will soon be operational. 
This new system will integrate the latest electronic processing 
capabilities, including optical scanning and computer imaging of 
documents, with PBGC's cash receipt and premium receivable systems. 
These features should reduce data entry cost by half while making much 
more accurate data available more quickly than in the past.
    PBGC also began developing the systems architecture that will link 
PBGC's various information systems and assure that systems and programs 
adopted in the future are consistent with existing systems. Systems 
integration will improve the quality of, and controls over, corporate 
data and permit more efficient delivery of information to corporate 
staff.

                          Financial Management

    PBGC's improved financial management enabled GAO to issue its first 
unqualified opinion on the financial condition of both the single-
employer and multiemployer programs. In its May 1994 report, GAO stated 
that it found PBGC's statements of financial condition for both 1993 
and 1992 ``reliable in all material respects.'' PBGC has also received 
an unqualified opinion from GAO on the 1994 financial statements. GAO 
further recognized PBGC's progress by removing the pension insurance 
program from its high-risk list.
    GAO's ability to reach its conclusions rested largely on PBGC's 
progress in strengthening its financial operations and reporting 
functions. PBGC continues to take corrective actions in specific 
financial and management information systems to remedy internal control 
weaknesses. Actions in 1994 included concentrating oversight of 
financial policies, procedures, and internal controls in one unit and 
centralizing the audit function to monitor and test all financial 
operations and supporting information systems; developing the new 
premium accounting system; and developing a systems integration 
strategy. PBGC's ``1994 Management Report on Internal Controls'' is 
included as part of GAO's audit report on PBGC's 1994 financial 
statements (GAO/AIMD-95-83).
    Another area of concern has been PBGC's assessment of the 
multiemployer program's liability for financial assistance. Measures 
targeted at the multiemployer program during the year included 
instituting an automated database on insured multiemployer plans and 
improved oversight of multiemployer plan cases.
    PBGC also made progress in addressing concerns about its 
participant data. The agency is instituting database system 
enhancements that will automatically check participant data and improve 
the valuing of the Corporation's benefit liabilities. PBGC also is 
computer-imaging plan and participant records to preserve the records, 
facilitate responses to participant inquiries, and improve operational 
efficiency.

                           Other Initiatives

    The agency made significant progress on a number of other 
initiatives. PBGC implemented contract planning and monitoring 
procedures, including a formal advance procurement planning process, 
and introduced ``electronic commerce'' technology, which uses 
nationwide electronic bulletin boards to increase competition and 
reduce costs for small procurements. The Corporation also continued 
developing and implementing agency program performance measurements, 
with the majority of the measures identified to date to be implemented 
by the end of 1995, well ahead of the schedule set by the Government 
Performance and Results Act for all Federal agencies. In addition, PBGC 
identified and initiated personnel reforms, including improved employee 
development programs and increased diversity of staff, and relocated 
the entire agency to a new building.

                              Investments

    The Corporation's approximately $8.2 billion of total assets 
available for investment consist of premium revenues held in the 
revolving funds and assets from terminated plans and their sponsors 
held in the trust funds. The revolving funds are required to be 
invested in Treasury securities and the trust funds are invested 
principally in high-quality stocks, with a small portion invested in 
real estate. PBGC uses major investment management firms to invest 
these assets subject to PBGC's policy of investing for long-term 
reduction of its deficit.
                           investment policy
    With the approval of the Board of Directors, PBGC implemented a 
strategic change in its investment program to maximize long-term 
investment return within acceptable levels of risk. PBGC's new 
investment strategy emphasizes long-term asset growth in order to 
reduce PBGC's deficit. As interest rates began to climb, PBGC shortened 
the duration of its bond portfolio from 16.4 years to 5 years. PBGC 
reset the target duration to 10 years near the end of the fiscal year. 
PBGC further enhanced its ability to diversify the portfolio and 
improve investment performance by establishing a new equity ceiling of 
up to 50 percent of the overall portfolio value, in line with other 
pension funds.
    Under the new strategy, PBGC increased its equity investment level 
from 17 percent at the beginning of the fiscal year to approximately 30 
percent at fiscal yearend. Given the relative size of PBGC's trust fund 
compared to the larger revolving fund, which must be invested in 
Treasury securities, PBGC's current 30 percent allocation to equities 
represents the maximum level that could be achieved in 1994. This 
diversification in the overall portfolio protected PBGC's assets and 
reduced potential investment losses in 1994.
                           investment profile
    As of September 30, 1994, the value of PBGC's total investments, 
including cash, was approximately $8.2 billion. The revolving fund 
value was $4.9 billion and the trust fund value was $3.3 billion.
    Cash and fixed-income securities decreased from 79 percent of 
investable assets at the beginning of the fiscal year to 69 percent at 
fiscal yearend. This reduction was offset by an increase in equity 
investment from 17 percent at the beginning of the year to 30 percent 
at yearend. The balance of the invested portfolio remains in real 
estate and other financial instruments.

                           INVESTMENT PROFILE                           
------------------------------------------------------------------------
                                              September 30,             
                               -----------------------------------------
                                        1994                 1993       
------------------------------------------------------------------------
Fixed-Income Assets:                                                    
    Average Quality...........               AAA                  AAA   
    Average Maturity (years)..                23.0                 22.7 
    Duration (years)..........                 9.9                 16.2 
    Yield to Maturity                                                   
     (percent)................                 7.8                  6.4 
Equity Assets:                                                          
    Average Price/Earnings                                              
     Ratio....................                18.3                 20.3 
    Dividend Yield (percent)..                 2.8                  2.7 
    Beta......................                 1.07                 1.04
------------------------------------------------------------------------

                           investment results
    The past year proved difficult for capital market investments. The 
broad stock market, as measured by the Wilshire 5000 Index, returned 
just 2.5 percent over 1994 while PBGC's equity investments returned 4.5 
percent. The segment of the bond market in which PBGC invested returned 
-11.2 percent. In comparison, the Lehman Brothers 20 Plus Treasury 
Index returned -11.6 percent and the Lehman Brothers Treasury Index 
returned -4.0 percent. Overall, the investment program, including 
fixed-income securities, equities, and real estate, returned -6.4 
percent. For the year, PBGC reported $74 million in income from equity 
investments and a loss of $536 million from fixed-income investments. 
Other investments, including real estate, produced $36 million in 
income, for a total investment loss of $426 million.

                                             INVESTMENT PERFORMANCE                                             
                                       [Annual rates of return in percent]                                      
----------------------------------------------------------------------------------------------------------------
                                                                     September 30,              Five Years Ended
                                                        --------------------------------------   September 30,  
                                                                1994               1993               1994      
----------------------------------------------------------------------------------------------------------------
Total Invested Funds...................................               -6.4               27.7                9.7
Equities...............................................                4.5               13.3                8.1
Fixed-Income...........................................              -11.2               32.8               11.5
Trust Funds............................................                1.6               15.7                8.3
Revolving Funds........................................              -11.2               37.7               11.6
Indices:                                                                                                        
    Wilshire 5000......................................                2.5               17.3                9.1
    S&P 500 Stock Index................................                3.7               13.0                9.1
    Lehman Brothers Treasury Index.....................               -4.0               11.1                8.2
    Lehman Brothers 20+ Year Treasury Index............              -11.6               21.5                8.6
----------------------------------------------------------------------------------------------------------------

    The change in investment strategy helped to mitigate the negative 
impact of rising interest rates on PBGC's fixed-income investments. 
Although PBGC experienced investment losses in 1994 due to poor 
performing capital markets, PBGC's combination of a shorter duration 
bond portfolio and increased equity investments prevented approximately 
$395 million in losses that would have otherwise occurred. The losses 
that did occur, however, were more than offset by the decline in PBGC's 
benefit liabilities attributable to the rising interest rates, which 
resulted in a decrease in the agency's overall deficit.

                 ITEM 27. UNITED STATES POSTAL SERVICE

                   PROGRAMS AFFECTING OLDER AMERICANS

                         Carrier Alert Program

    Carrier Alert is a voluntary community service provided by city and 
rural delivery letter carriers who watch participants' mailboxes for 
mail accumulations that might signal illness or injury. Accumulations 
of mail are reported by carriers to their supervisors, who then notify 
a sponsoring agency, through locally developed procedures, for follow-
up action. The program completed its Twelfth year of operation in 1994 
and continues to provide a lifeline to thousands of elderly citizens 
who live alone.

                        Delivery Service Policy

    The Postal Service has a long-standing policy of granting case-by-
case exceptions to delivery regulations based on hardship or special 
needs. This policy accommodates the special needs of the elderly, 
handicapped, or infirm customers who are unable to obtain mail from a 
receptacle located some distance from their home. Information on 
hardship exceptions to deliver receptacles can be obtained from local 
postmasters.

               Services Available From Your Rural Carrier

    Rural carriers continue to provide their customers with the retail 
services they have come to expect from the rural ``post office on 
wheels.'' Some of the retail services provided by rural carriers are 
registered and certified mail, accepting parcels for mailing, taking 
applications for money orders, and providing their customers with 
receipts for these services.
    Retail services are available to all customers served by rural 
carriers but are most beneficial to those individuals who are elderly 
or have a physical handicap which limits their ability to go to the 
post office for these important services. Rural carriers provide their 
customers with almost all retail services available from the post 
office 302 days per year.

                        Parcel Delivery Policies

    For customers who are unavailable to receive uninsured parcels, but 
who are normally at home, we automatically redeliver the article on the 
following day. Additionally, if the mailer requests, parcels are left 
at customers' homes or businesses provided there is reasonable 
protection from the weather and theft. Both of these policies make it 
easier for customers to receive mail, and minimize the need for trips 
to the post office.

                    Federal Accessibility Standards

    The Postal Service is subject to the Architectural Barriers Act of 
1968 which requires that most Federal buildings leased or constructed 
after 1968 meet applicable standards. In 1986, the Postal Service 
amended USPS Handbook RE4, Standards for Facility Accessibility by the 
Physically Handicapped, by adding a new section, ``Accessible 
Buildings: Leasing of Space in Existing Buildings.'' These standards 
established accessibility requirements for existing buildings leased on 
or after January 1, 1977, and provided the Postal Service with 
guidelines for accomplishing its Architectural Barriers Compliance 
Program.
    The scope of this program includes 26,000 facilities which were 
surveyed to identify deficiencies and possible solutions for those that 
were determined to be inaccessible. During FY 94, approximately 12,600 
alteration projects were in progress. The success of the program is 
often heard at the local level from the elderly and physically disabled 
members of the community when accessibility alterations are completed. 
Our commitment to barrier-free facilities is apparent as over $130 
million was funded to provide access in FY 94, including design for 
projects planned for FY 94. To date, the Postal Service has spent over 
$130 million on accessibility projects, including design for projects 
planned for FY 95. To date, the Postal Service has spent over $260 
million on accessibility projects. The Postal Service has an aggressive 
Architectural Barriers Compliance Program and is committed to making 
its facilities accessible to all its customers. The Postal Service 
values its elderly customers and feel they will benefit from our 
efforts to make facilities accessible.

                Mail Fraud and Mail Theft Investigations

    The Postal Inspection Service successfully collaborated with the 
American Association of Retired Persons (AARP) Bulletin and 
Publications Division on an article concerning telemarketing frauds 
against the elderly (``Tapes Reveal Cons Targeting Elderly,'' AARP 
Bulletin, March 1994). The circulation of the AARP Bulletin is 
approximately 23 million households. We also have provided other 
information of interest to the AARP on investigations conducted by 
postal inspectors with unusual or newsworthy aspects.
    In October, the Postal Inspection Service was invited to 
participate in a news conference hosted by the AARP at the National 
Press Building on the subject of sweepstakes fraud. We hope to form a 
lasting working relationship with the AARP which will help us publicize 
the various fraudulent promotions which target the elderly with 
alarming success.
    In an effort to alert the public to prevalent mail fraud schemes, 
the Postal Inspection Service has issued a variety of public service 
messages in the form of video news releases during the last 6 years. 
The releases have covered such topics as boiler room fraud, government 
look-a-like mail, 900 number frauds, medical quackery, and deceptive 
unclaimed tax refund notices, all of which target the elderly.
    We often receive complaints from individuals who have discovered 
their elderly parents or relatives have lost tens, or in some instances 
hundreds of thousands of dollars to a variety of old fashioned con 
games that find their victims through the mail or by telephone. This 
year we produced a video news release entitled ``Holiday Travelers: 
Scam-Proofing Your Older Relatives.'' The video and a corresponding 
press release were disseminated on December 21 with the target audience 
being individuals who would be visiting with their elderly relatives 
during the holidays.
    Each year, during National Consumers Week, the Postal Inspection 
Service seeks to draw attention to some facet of consumer fraud. This 
year we issued a national news release through the wire services, 
national news syndicates and through each of our 30 division offices 
concerning investment frauds that impact the elderly. We offered a 
number of prevention tips that would help prospective targets avoid 
being victimized.

                   Injunctions and Other Civil Powers

    In addition to the investigation of individuals or corporations for 
possible criminal violations, the Inspection Service can protect 
consumers from material misrepresentations through the use of several 
statutes. In less severe cases, operators of questionable promotions 
agree to a Voluntary Discontinuance. This is an informal promise to 
discontinue the operation of the promotion. Should the agreement be 
violated, formal action against the promoter could be initiated. In 
certain cases where a more formal action is better suited, a Consent 
Agreement is obtained. Generally, a promoter signs a Consent Agreement 
to discontinue the false representations or lottery charged in a 
complaint. If this agreement is violated, the Postal Service may 
withhold the promoter's mail pending additional administrative 
proceedings.
    The Postal Service (Judicial Officer) is empowered under 39 U.S.C. 
3005(b)(2) to issue a Cease and Desist (C&D) Order which requires any 
person conducting a scheme in violation of Section 3005 to immediately 
discontinue. C&D orders are issued as part of a False Representation 
order and, as a matter of course, are agreed to as a part of a Consent 
Agreement. Violators of C&D orders may be subject to civil penalties 
under 39 U.S.C. 3012. When more immediate relief to protect the 
consumer is warranted, the Postal Service has a number of effective 
enforcement options available. Title 39 U.S.C. 3003 and 3004 enables 
the Postal Service, upon determining that an individual is using a 
factitious, false, or assumed name, title, or address in conducting or 
assisting activity in violation of 18 U.S.C. Sections 1302 (Lottery), 
1341 or 1342 (Mail Fraud), to withhold mail until proper identification 
is provided and the person's right to receive mail is established.
    In those instances where a more permanent action is necessary, 39 
U.S.C. 3007 allows the Postal Service to seek a Temporary Restraining 
Order detaining mail. By withholding service to the suspected violator, 
the extent of victimization is limited while an impartial judge reviews 
the facts and makes a final determination. If the judge decides that 
all mail pertaining to the promotion should be returned, then a False 
Representation Order, authorized under 39 U.S.C. 3005 is issued. In 
addition, U.S. District Judges may hold a hearing on alleged fraudulent 
activity, and issue a permanent injunction regarding the operation 
pursuant to 18 U.S.C. 1345.
    By requesting the court to withhold mail while a case is argued, 
Postal Inspectors have been successful in many cases in limiting the 
extent of victimization. Action under these statutes does not preclude 
criminal charges against the same target.

                       Customer Advisory Councils

    In October 1988, the Postal Service introduced the concept of 
Customer Advisory Councils (CACs). The council concept was developed to 
encourage community interaction with local postal officials. CACs 
provide one more way for the Postal Service to listen to its customers. 
In 1994, the number of active councils grew to 1,719 nationwide, and 
802 additional councils are planned for implementation in Fiscal Year 
1995.
    CAC membership usually includes up to 10 individuals who are 
representative of their community; small business owners, local 
government officials, university/college students, homemakers, and 
retired persons. Retired persons play an integral role in many of the 
council efforts, including ``mystery shopping'' where members ``shop'' 
the various post offices, stations and branches to rate the cleanliness 
of the facility, clerk knowledge, courtesy, and other related aspects 
of our retail services. The valuable feedback received from councils is 
often used by local postal officials to improve service.

                           Postal Answer Line

    Postal Answer Line (PAL) is an automated telephone information 
service designated to provide recorded responses to common customer 
inquiries, including domestic parcel post rate calculations. Over 112 
million customers with touch-tone telephones in 81 metropolitan areas 
may access PAL 24 hours a day, 7 days a week, PAL handles an average of 
3.7 million calls per year for the Postal Service that would otherwise 
have been addressed directly to postal employees. First deployed in 
1988, the average annual cost avoidance for this system to date has 
been calculated at $4.7 million. PAL provides a viable alternative for 
customers who are unable to visit their local post office.
    The PAL system will soon be upgraded to take advantage of 
technological advancements which will serve more of our customers 
better. Preliminary improvements to the system will include the 
development of an interactive speech recognition system which will 
satisfy the needs of all Postal Service customers, opening the door to 
serving rotary dial telephone customers (38.5% of the population) and 
providing special text telephone modems which will allow PAL access via 
Telecommunications Device for the Deaf (TDD) equipment.

                        National Consumers Week

    The Postal Service has sponsored an annual Consumer Protection Week 
since 1977. Since 1980, the Postal Service has scheduled its observance 
to coincide with the National Consumers Week sponsored by the U.S. 
Office of Consumer Affairs. Postmasters and facility managers are urged 
to sponsor special activities to educate customers about postal 
products and services as well as Postal Inspection Service efforts to 
protect consumers from perpetrators of fraudulent schemes and other 
postal crimes. In conjunction with open houses and special gatherings 
scheduled during National Consumers Week, brochures are distributed to 
warn consumers about mail fraud and misrepresentations of products and 
services sold by mail. Helpful information about proper addressing of 
mail, packaging parcels correctly, temporary address changes, sending 
valuables through the mail, and how to report service problems are made 
widely available through planned events. As medical fraud and work-at-
home schemes have traditionally ranked at the top of fraudulent 
promotions, the focus of material distributed is frequently directed 
toward alerting senior citizens of these other schemes.

                Stamps by Automated Teller Machine (ATM)

    Stamps by ATM is one of the Easy Stamp Services and a convenient 
way to purchase stamps at a bank's automated teller machine. A 
specially designed sheetlet of 18 First-Class stamps is dispensed at 
the touch of a button. The cost is debited from your checking or 
savings account, treated like a cash withdrawal. Because many ATMs are 
accessible 24 hours a day, our customers are able to do banking and buy 
postage stamps at their convenience.

                             Stamps by Mail

    Stamps by Mail is another one of the Easy Stamp Services that 
allows postal customers to purchase postal products such as booklets, 
sheets, coils, postal cards, and stamped envelopes, by ordering through 
the mail.
    The Stamps by Mail program benefits a wide variety of people and is 
particularly beneficial to elderly or shut-in customers who cannot 
travel to the post office. Stamps by Mail provides order forms 
incorporated in self-addressed postage-paid envelopes to customers for 
their convenience in obtaining products and services without having to 
visit a Postal Service retail unit. The form is available in lobbies or 
from the customer's letter carrier. The customer fills out the order 
form and returns it to the carrier or drops it in a collection box. 
Orders are normally returned to the customer within 2 or 3 business 
days.

                            Stamps by Phone

    Stamps by Phone is a convenience program that is intended to target 
business, professional, and household customers who are willing to pay 
a service charge for the convenience of ordering by phone and paying by 
credit card (VISA or Master Card) to avoid trips to the post office. 
The customer calls the (1-800-STAMPS-24) toll-free number, 24 hours a 
day, 7 days a week, and orders from a menu of postal products. There is 
no minimum amount and customers will receive their order within 3 to 5 
business days.

                 Window Automation at Retail Facilities

    The Postal Service is installing automated systems called 
Integrated Retail Terminals at the service windows in retail facilities 
in all medium to large cities. These terminals use video screens to 
display information about each transaction for the customer. The 
screens show some mailing restrictions and required mailing forms, 
total amount due, and change from the amount tendered. The display of 
this type of information is useful to many customers with hearing 
impairments, including some older Americans.

                     Alternate Postal Retail Sites

    Alternate postal retail sites include Contract Postal Units, and 
stamp consignment outlets (grocery stores, etc.). Providing alternate 
sites for routine postal retail transactions benefits both the Postal 
Service and our customers.
    Contract postal units provide more convenient locations available 
for our customers to purchase stamps, which generally means less wait 
time for them to obtain these retail services. Purchasing stamps and 
postal money orders, registering a letter, and other postal errands, 
can be combined with a trip to the neighborhood shopping center. This 
is particularly advantageous to the elderly.

                         Stamps on Consignment

    The Postal Service consigns stamps to supermarkets, drug stores, 
and other large retail chains for resale to customers at no more than 
face value. This provides our customers who need stamps an alternative 
to window service. This is especially convenient for our elderly 
customers who may have limited access to transportation and can 
purchase stamps while at the grocery or drug store.

                   ITEM 28. RAILROAD RETIREMENT BOARD

 ANNUAL REPORT ON PROGRAM ACTIVITIES FOR THE ELDERLY--FISCAL YEAR 1994

    The U.S. Railroad Retirement Board is an independent agency in the 
executive branch of the Federal Government, administering comprehensive 
retirement-survivor and unemployment-sickness benefit programs for the 
Nation's railroad workers and their families under the Railroad 
Retirement and Railroad Unemployment Insurance Acts. The Board also has 
administrative responsibilities under the Social Security Act for 
certain benefit payments and railroad workers' medicare coverage.
    Under the Railroad Retirement Act, the Board pays retirement and 
disability annuities to railroad workers with at least 10 years of 
service. Annuities based on age are payable at age 62, or at age 60 for 
employees with 30 years of service. Disability annuities are payable 
before retirement age on the basis of total or occupational disability. 
Annuities are also payable to spouses and divorced spouses of retired 
workers and to widow(er)s, divorced, or remarried widower(er)s, 
children, and parents of deceased railroad workers. Qualified railroad 
retirement beneficiaries are covered by Medicare in the same way as 
social security beneficiaries.
    Under the Railroad Unemployment Insurance Act, the Board pays 
unemployment benefits to railroad workers who are unemployed but ready, 
willing and able to work and pays sickness benefits to railroad workers 
who are unable to work because of illness or injury.

                       Benefits and Beneficiaries

    During fiscal year 1994, retirement and survivor benefits amounted 
to almost $8 billion, and unemployment and sickness benefits totaled 
$66 million. The number of beneficiaries on the retirement-survivor 
rolls on September 30, 1994, totaled 812,000. The majority (85 percent) 
were age 65 or older.
    At the end of the fiscal year, 363,000 retired employees were being 
paid regular annuities averaging $1,095 a month. Of these retirees, 
175,000 were also being paid supplemental railroad retirement annuities 
averaging $44 a month. In addition, approximately 201,000 spouses and 
divorced spouses of retired employees were receiving monthly spouse 
benefits averaging $441 and, of the 258,000 survivors on the rolls, 
220,000 were aged widow(er)s receiving monthly survivor benefits 
averaging $652. Approximately 10,000 retired employees were also 
receiving spouse or survivor benefits based on their spouse's railroad 
service.
    Railroad retirement annuities, like social security benefits, 
increase in January 1995 to reflect a 2.8 percent increase in the 
Consumer Price Index (CPI) during the 12 months preceding October 1994. 
Cost-of-living increases are calculated in each of the two tier 
portions of a railroad retirement annuity. Tier I portions, like social 
security benefits, increase in January 1995 by 2.8 percent, which is 
the percentage of the CPI rise. Tier II portions increase 0.9 percent, 
based on 32.5 percent of the CPI rise. In January 1995, the average 
regular railroad retirement employee annuity rises $24 to $1,119 a 
month and the average spouse benefit increases $9 to $450 a month. For 
aged widow(er)s, the average monthly benefit rises $16 to $668.
    Some 737,000 individuals who were receiving or were eligible to 
receive monthly benefits under the Railroad Retirement Act were covered 
by hospital insurance under the Medicare program at the end of fiscal 
year 1994. Of these, 721,000 (98 percent) were also enrolled for 
supplementary medical insurance.
    Unemployment and sickness benefits under the Railroad Unemployment 
Insurance Act were paid to 41,000 railroad employees during the fiscal 
year. However, only about $0.02 million (less than 1 percent) of the 
benefits went to individuals age 65 or older.

                           Benefit Financing

    By the end of the 1994 fiscal year, the equity balance in the 
railroad retirement trust funds was $13 billion, an increase of $725 
million over the preceding year.
    The Board's 19th triennial actuarial valuation, submitted to 
Congress in June 1994, was favorable concerning intermediate-term 
railroad retirement financing and showed results similar to those in 
the previous valuation and recent annual financial reports. It 
concluded that, barring a sudden, unanticipated, large drop in railroad 
employment, the railroad retirement system will experience no cash-flow 
problems during the next 20 years. However, the long-term stability of 
the system, under its current financing structure, is still dependent 
on future railroad employment levels. The valuation did not recommend 
any change in the rate of the railroad retirement payroll tax imposed 
on employers and employees.
    The Board's 1994 railroad unemployment insurance financial report, 
submitted to Congress in June 1994, was also favorable, indicating that 
experience-based contribution rates will keep the system solvent, even 
under the most pessimistic assumptions, while average employer 
contribution rates will remain below 1 percent through 1995. The report 
also noted that the balance of the Railroad Unemployment Insurance 
Account's 13-year debt to the Railroad Retirement Account was repaid in 
June 1993 and that, with current projections indicating the railroad 
unemployment insurance system will remain solvent under all employment 
scenarios, no new loans will be required during the projection period. 
No financing changes were recommended for the unemployment insurance 
system.

                              Legislation

    A provision in the Social Security Administrative Reform Act of 
1994 enacted August 15, 1994, extended the transfer to the Railroad 
Retirement Account of revenues from Federal income taxes on tier II 
railroad retirement benefits.
    The Social Security Act amendments of 1983 subjected social 
security level railroad retirement tier I benefits to Federal income 
taxes on the same basis as social security benefits, and subsequent 
Railroad Retirement Act amendments also subjected railroad retirement 
tier II benefits, paid over and above social security levels, to income 
taxes. Although the tax revenues from social security and social 
security equivalent tier I railroad retirement benefits are returned to 
the trust funds on a permanent basis, the transfer of tier II revenues 
(and revenues from tier I benefits in excess of social security 
equivalent levels) was placed on a temporary basis. Despite being 
extended three times, the legislative authority for these transfers 
expired at the close of fiscal year 1992.
    This authority was extended on a permanent basis by the August 15, 
1994, legislation, and a payment of $389 million covering the period 
October 1, 1992, through September 30, 1994, was made to the Railroad 
Retirement Account.

                Service and Administrative Improvements

    During 1994, the Railroad Retirement Board began effecting some of 
the governmentwide Administration initiatives aimed at creating a 
government that works better, costs less, and is more responsive to its 
customers. These initiatives included the establishment of customer 
service standards based on customer satisfaction surveys and service 
benchmarking studies, a streamlining of agency operations in order to 
more effectively utilize a smaller workforce while simplifying internal 
organizational and administrative processes, and a substantial 
reduction in internal management regulations.
                         customer service plan
    The Board's new Customer Service Plan for railroad retirement 
beneficiaries is posted in every Board office and is also described in 
a leaflet available at any Board office.
    The standard for answering letters under the plan requires that the 
Board reply to letters within 10 working days of receiving them. If for 
any reason the letter cannot be answered within that time frame, the 
Board will acknowledge the letter and advise how long it will be before 
the questions can be answered fully.
    The plan also provides standards for the processing of claims. 
Persons filing for a railroad retirement employee or spouse annuity in 
advance can expect to receive their first payment, or a decision within 
45 days of their date of retirement. Those filing for a railroad 
retirement disability annuity can expect to receive their first 
payment, or a decision, within 120 days from the date they filed their 
application.
    Those filing an application for unemployment or sickness insurance 
benefits can expect to receive their first claim form, or a decision, 
within 15 days of the date their application is received. Likewise, 
persons filing a claim for unemployment or sickness insurance benefits 
can expect to receive their payment, or a decision, within 15 days of 
the date the Board receives their claim form.
    While the Board's employees will strive to meet all of the criteria 
established in its Customer Service Plan, they may not always be 
successful; but the Board expects that its service will progressively 
improve to meet or exceed the Plan's standards of service and to 
demonstrate openness, accessibility and accountability.
                      management improvement plan
    In fiscal year 1994, the Board met or exceeded all of its goals 
under a management improvement plan agreed upon with the White House 
Office of Management and Budget as part of a 5-year, $14 million 
commitment to the agency by the Office of Management and Budget and the 
Congress. The Board has been using this commitment of funds to reduce 
claims processing backlogs, enhance debt collection activities, expand 
fraud controls, improve tax accounting operations, increase 
verification of payroll tax receipts, enhance automated claims 
processing systems and make other improvements in its administrative 
management operations.
                           other initiatives
    The Board also implemented a number of other initiatives to improve 
operations, make the most of financial resources and provide the best 
possible service to the public. These included improvements in claims 
operations, the implementation of direct deposit for unemployment and 
sickness benefits, a single source medical exam procurement system, the 
consolidation of Chicago-area facilities, and energy conservation 
improvements.

                      Office of Inspector General

    President Clinton appointed Martin J. Dickman as Inspector General 
of the Railroad Retirement Board and his appointment was confirmed by 
the Senate in October 1994. As Inspector General, Mr. Dickman is 
responsible for promoting economy, efficiency, and effectiveness and 
for detecting any waste, fraud, or abuse in the programs and operations 
of the Board.
    Before his appointment to the Board, Mr. Dickman served from 1991 
as prosecutor for the Cook County, Illinois, State's Attorney's 
Financial and Governmental Crimes Task Force. His responsibilities 
included the investigation, indictment and prosecution of criminal 
cases involving governmental and white collar crimes. Mr. Dickman 
succeeded William J. Doyle III, the Board's first Inspector General, 
who retired from Federal service in April 1994.
    During 1994, the Office of Inspector General continued to focus its 
efforts on long-term concerns and to address the major issues that 
affect overall service to the railroad community. The Office of 
Inspector General also continued its activities to identify and refer 
cases for prosecution of individuals who commit fraud against the 
Board's benefit programs, and to ensure that accurate and timely 
benefits are paid to railroad annuitants. Audit and investigative 
efforts resulted in monetary benefits totaling approximately $80 
million during fiscal year 1994.
    The Inspector General's Office of Audit issued 24 reports with 
actual and potential monetary benefits totaling $62 million. Additional 
financial benefits of $10.4 million were realized from interest and 
adjustments that resulted from prior audit reports. Actions by the 
Inspector General's Office of Investigations resulted in 260 criminal 
convictions, 116 indictments/informations and $7.4 million in court-
ordered restitutions, fines recoveries and prevention of erroneous 
payments.

                     Public Information Activities

    The Board maintains direct contact with railroad retirement 
beneficiaries through its 86 field offices located across the country. 
Field personnel explain benefit rights and responsibilities on an 
individual basis, assist railroad employees in applying for benefits 
and answer any questions related to the benefit programs. The Board 
also relies on railroad labor groups and employers for assistance in 
keeping railroad personnel informed about its benefit programs.
    At informational conferences held for railroad labor union 
officials, Board representatives describe and discuss the benefits 
available under the railroad retirement-survivor, unemployment-sickness 
and Medicare programs; and the attendees are provided with 
comprehensive informational materials describing in detail the benefit 
provisions as well as the administration and financing of the programs.
    At seminars for railroad executives and managers, Board 
representatives review programs, financing, and administration, with 
special emphasis on those areas which require cooperation between 
railroads and Board offices. The Board also conducts informational 
seminars on benefit programs for employees at the request of railroad 
management.
    The Board's headquarters is located at 844 North Rush Street, 
Chicago, Illinois 60611-2092, phone (312) 751-4500. In addition, the 
Board maintains an Office of Legislative Affairs in Washington, DC as a 
liaison for dealing with Members of Congress on matters involving the 
Railroad Retirement and Unemployment Insurance Acts and legislative 
issues that affect the Board. The Office of Legislative Affairs is 
located at 1310 G Street, NW, Suite 500, Washington, DC 20005-3004, 
phone (202) 272-7742.

                 ITEM 29. SMALL BUSINESS ADMINISTRATION

    The SBA is charged with the responsibility to create, implement and 
deliver technical and financial assistance programs for the benefit of 
the Nation's small business community. We currently do not have a 
program that gives specific focus to older Americans.
    However, the SBA is the sponsoring Federal agency for the Service 
Corps of Retired Executives (SCORE) program. SCORE is an organization 
of nearly 13,000 business men and women who volunteer their time to 
provide management counseling and training to small businesses. They 
have extensive business experience, either as entrepreneurs and 
business owners or as former corporate executives. Their counseling is 
confidential and free of charge and is provided at more than 800 
locations in the United States and its territories.

                       ITEM 30. VETERANS AFFAIRS

 REPORT ON THE DEPARTMENT OF VETERANS AFFAIRS ACTIVITIES ON BEHALF OF 
                    OLDER VETERANS--FISCAL YEAR 1994

                            I. Introduction

    The Department of Veterans Affairs has the potential responsibility 
for a beneficiary population of nearly 27 million veterans whose median 
age is approximately 56 years. Nearly 30 percent of the veteran 
population is age 65 and older. By the year 2005, almost 4\1/2\ million 
veterans will be 75 years or older.
    This demographic trend will require VA to redistribute its 
resources to meet the different needs of this older population. 
Historically, older persons are greater users of health care services. 
The number of physician visits, short-term hospital stays, and number 
of days in the hospital all increase as the patient moves from the 
fifth to seventh decade of life.
    VA has developed a wide range of services to provide care in a 
variety of institutional, noninstitutional, and community settings to 
ensure that the physical, psychiatric and socioeconomic needs of the 
patient are met. Special projects, a variety of innovative, medically-
proven programs and individual VA medical center (VAMC) initiatives 
have been developed and tested that can be used for veteran patients 
and adapted for use by the general population.
    VA operates the largest health care system in the Nation, 
encompassing 172 hospitals, 128 nursing home care units, 37 
domiciliaries, and 366 outpatient clinics. Veterans are also provided 
contract care in non-VA hospitals and in community nursing homes, fee-
for-service visits by non-VA physicians and dentists for outpatient 
treatment, and support for care in 78 State Veterans Homes in 41 
States. As part of a broader VA and non-VA network, affiliation 
agreements exist between virtually all VA health care facilities and 
nearly 1,000 medical, dental, and associate health centers. This 
affiliation program with academic medical centers results in 
approximately 100,000 health profession students receiving education 
and training in VAMCs each year.
    In addition to VA hospital, nursing home and domiciliary care 
programs, VA is increasing the number and diversity of noninstitutional 
extended care programs. The dual purpose is to facilitate independent 
living and keep the patient in a community setting by making available 
the appropriate supportive medical services. These programs include 
Hospital-Based Home Care, Community Residential care, Adult Day Health 
Care, Respite Care, and Psychiatric Day Treatment and Mental Hygiene 
Clinics, and Homemaker/Home Health Aide Services.
    The need for both acute and chronic hospitalization will continue 
to rise as older patients experience a greater frequency and severity 
of illness, as well as a different mix of diseases, than younger 
patients, Cardiovascular diseases, chronic lung diseases, cancers, 
psychiatric and mental disorders, bone and joint diseases, hearing and 
vision disorders, and a variety of other illnesses and disabilities are 
all more prevalent in those persons age 65 and older.

               II. Geriatrics and Extended Care Programs

                          va nursing home care
    Nursing Home Care Units (NHCU), which are based at VA medical 
centers, provide skilled nursing care and related medical services. An 
inter-disciplinary approach to care is employed, which encourages 
diverse professional staff, working together, to meet the multiple 
physical, social, psychological, and spiritual needs of the patients. 
Nursing home patients typically require a prolonged period of care and/
or rehabilitation services to attain and/or maintain optimal 
functioning.
    In fiscal year 1994, more than 31,550 veterans were treated in 128 
VA nursing homes, generating a total Average Daily Census (ADC) of 
13,504.
    VHA has contracted to fund a National Training Program to prepare 
staff to better meet the needs of the mentally ill in the nursing 
homes. At the same time, individual facilities continue efforts to 
reduce the incidence of both polypharmacy and restraint use, which is 
in keeping with the regulations of the Omnibus Reconciliation Act of 
1987 (even though VA is not required to follow those regulations). A 
directive allowing VA nursing homes to develop psychogeriatric sections 
within each nursing home has resulted in the establishment of six such 
units. Eight test sites have continued implementation of a uniform 
minimum data base (known as the Minimum Data Set) which VHA hopes to 
introduce throughout the nursing home program.
                      community nursing home care
    This is a community-based, contract program for veterans who 
require skilled or intermediate nursing care when making a transition 
from a hospital setting to the community. Veterans who have been 
hospitalized in a VA facility for treatment, primarily for a service-
connected condition, may be placed at VA expense in community 
facilities for as long as they need nursing care. Other veterans may be 
eligible for community placement at VA expense for a period not to 
exceed 6 months. Selection of nursing homes for a VA contract requires 
the prior assessment of participating facilities to ensure they meet 
our standards of care. Follow-up visits are made to veterans by teams 
from VA medical centers to monitor patient programs and quality of 
care.
    In fiscal year 1994, 29,104 veterans were treated in the program. 
The number of nursing homes under contract was 3,500 and the average 
daily census in these homes was 8,783.
                          va domiciliary care
    Domiciliary care in VA facilities provides necessary medical and 
other professional care for eligible ambulatory veterans who are 
disabled by disease, injury, or age and are in need of care but do not 
require hospitalization or the skilled nursing services of a nursing 
home.
    The domiciliary offers specialized interdisciplinary treatment 
programs that are designed to facilitate the rehabilitation of patients 
who suffer from head trauma, stroke, mental illness, chronic 
alcoholism, heart disease and a wide range of other disabling 
conditions. With increasing frequency, the domiciliary is viewed as the 
treatment setting of choice for many older veterans.
    Implementation of rehabilitation programs has provided a better 
quality of care and life for veterans who require prolonged domiciliary 
care and has prepared increasing numbers of veterans for return to 
independent or semi-independent community living.
    Special attention is being given to older veterans in domiciliaries 
with a goal of keeping them active and productive as well as integrated 
into the community. The older veterans are encouraged to utilize senior 
centers and other resources in the community where the domiciliary is 
located. Patients at several domiciliaries are involved in senior 
center activities in the community as part of VA's community 
integration program. Other specialized programs in which older veterans 
are involved include Foster Grandparents, Handyman Assistance to senior 
citizens in the community, and Adopt-A-Vet.
    In fiscal year 1994, 18,236 veterans were treated in 35 VA 
domiciliaries resulting in an average daily census of 6,051. Of these 
numbers, approximately 3,300 veterans and an average daily census of 
more than 1,200 were admitted to the domiciliaries for specialized care 
for homelessness. This latter group had an average age of 43 years, 
while the overall average age of domiciliary patients was 59 years.
                              state homes
    The State Home Program has grown from 10 homes in 10 States in 1888 
to 78 State homes, including 2 annexes, in 41 States. Currently, a 
total of 22,006 beds are authorized by VA to provide hospital, nursing 
home, and domiciliary care. VA's relationship to State Veterans Homes 
is based upon two grant programs. The per diem grant program enables VA 
to assist the States in providing care to eligible veterans who require 
domiciliary facilities. The other VA grant program provides up to 65 
percent Federal funding to States to assist in the cost of construction 
or acquisition of new domiciliary and nursing home care facilities, or 
the expansion, remodeling, or alternation of existing facilities.
                              hospice care
    VA has developed programs that provide pain management, symptom 
control, and other medical services to terminally ill veterans, as well 
as bereavement counseling and respite care to their families. The 
hospice concept of care is incorporated into VA medical center 
approaches to the care of the terminally ill. All VA medical centers 
have appointed a hospice consultation team, which is responsible for 
planning, developing, and implementing the hospice program.
                        hospital-based home care
    This program provides in-home primary medical care to veterans with 
chronic illnesses. The family provides the necessary personal care 
under the coordinated supervision of a hospital-based interdisciplinary 
treatment team. The team prescribes the needed medical, nursing, 
social, rehabilitation and dietetic regimens, and provides the training 
of family members and the patient in supportive care.
    Seventy-seven VA medical centers are providing hospital-based home 
care (HBHC) services. In fiscal year 1994, home visits were made by 
health professionals to an average daily census of 5,069 patients.
                         adult day health care
    Adult Day Health Care (ADHC) is a therapeutically-oriented 
ambulatory program that provides health maintenance and rehabilitation 
services to veterans in a congregate setting during the daytime hours. 
ADHC in VA is a medical model of services, which in some circumstances 
may be a substitute for nursing home care. VA operated 15 ADHC centers 
in FY 1994, with an average attendance of 420 patients. VA also 
continued a program of contracting for ADHC services at 83 medical 
centers. The average daily attendance in contract programs was 737, and 
2,508 patients were treated in FY 1994.
                       community residential care
    The Community Residential Care home program provides residential 
care, including room, board, personal care, and general health care 
supervision to veterans who do not require hospital or nursing home 
care but who, because of health conditions, are not able to resume 
independent living and have no suitable support system (e.g., family, 
friends) to provide the needed care. All homes are inspected by a 
multidisciplinary team prior to incorporation of the home into the VA 
program and annually thereafter. Care is provided in private homes that 
have been selected by VA, at the veteran's own expense. Veterans 
receive monthly follow-up visits from VA health care professionals. In 
FY 1994, an average daily census of 10,388 veterans was maintained in 
this program, utilizing approximately 2,800 homes.
              homemaker/home health aide services (h/hha)
    In FY 1994, VA initiated a pilot program of health-related services 
for veterans needing nursing home care, implementing provisions of 
Public Law 101-336. These services are provided in the community by 
public and private agencies under a system of case management provided 
directly by VA staff. For the purpose of the initiative, health-related 
services are defined as homemaker/home health aide services only. 
Eligibility for H/HHA is limited to those in need of nursing home care 
who have a service-connected disability rated 50 percent or more, or 
those in need of nursing home care primarily for treatment of a 
service-connected disability. 108 VAMCs were purchasing H/HHA services 
by FY 1994. The average ADC for each contracted H/HHA service was 228 
veterans.
           geriatric evaluation and management program (gem)
    The Geriatric Evaluation and Management Program includes inpatient 
units, outpatient clinics, and consultation services. A GEM Unit is 
usually a functionally different group of beds (ranging typically in 
number from 10 to 25 beds) on a medical service or an intermediate care 
ward of the hospital where an interdisciplinary health care team 
performs comprehensive geriatric assessments. The GEM unit serves to 
improve the diagnosis, treatment, rehabilitation, and discharge 
planning of older patients who have functional impairments, multiple 
acute and chronic diseases, and/or psychosocial problems. GEM clinics 
provide similar comprehensive care for geriatric patients not in need 
of hospitalization, as well as provide follow-up care for older 
patients to prevent their unnecessary institutionalization. A GEM unit 
also provides geriatric training and research opportunities for 
physicians and other health care professionals in VA medical centers.
    Results from a controlled, randomized study of GEM efficacy that 
was conducted at the VA Medical Center Sepulveda, CA, and published in 
the New England Journal of Medicine in 1984, showed significant 
benefits such as improved survival, decreased rehospitalization rates, 
improved functional status, and decreased nursing home placement 
following admission to GEM units.
    Currently, there are 133 VA medical centers with established 
Geriatric Evaluation and Management Programs.
              care of the acute and critically ill elderly
    In 1994, VA Central Office had its third printing of a supplemental 
guide for medical center staff who care for the acutely-ill veteran 
(Geriatric Pocket Pal). This guide is used by residents, nurses, and 
allied health personnel in all VA medical centers. Many requests have 
been received from non-VA clinical staff for this popular VHA 
publication, developed by VA Central Office and field staff, and is now 
being revised to update reference materials and incorporate additional 
information.
                              respite care
    Respite Care provides planned, periodic, short-term care for a 
disabled person in order to temporarily relieve the caregiver from the 
physician and emotional burden of providing the needed care and 
supervision. VA provides respite care by admitting a veteran to a 
hospital or nursing home bed for up to 30 days a year. This 
institutionally based program not only supports the caregiver's role in 
caring for the veteran at home, but also provides an opportunity for VA 
staff to evaluate and treat the veteran's health care needs and offer 
guidance to the caregiver in the home treatment plan. In FY 1994, 132 
VA medical centers provided this care to veterans and their families.
                alzheimer's disease and other dementias
    VA's program for veterans with Alzheimer's disease and other 
dementias is decentralized throughout the medical care system, with 
coordination and direction provided by the Office of Geriatrics and 
Extended Care. Veterans with these diagnoses participate in all aspects 
of the health care system including outpatient programs, acute care 
programs, and extended care programs. Approximately 56 medical centers 
have established specialized programs for the treatment of veterans 
with dementing illnesses.
    In order to advance knowledge about the care for veterans with 
dementia, VA investigators conduct basic biomedical, applied clinical 
and health services research, much of which occurs at Geriatric 
Research, Education, and Clinical Centers (GRECCs), and which is 
supported through the Office of Research and Development. 
Rehabilitation Research and Development Service develops and evaluates 
new technologies and techniques designed to minimize disability 
associated with dementia. Continuing education for staff is provided 
through training classes sponsored by Regional Medical Education 
Centers, GRECCs, and Cooperative Health Manpower Education Programs.
    VA Central Office has disseminated a variety of dementia patient 
care educational materials in the form of publications and videos to 
all VA medical centers. In FY 1990, all VA libraries received a revised 
edition of guidelines for diagnosis and treatment of dementia, a series 
of 21 dementia caregiver education pamphlets developed by the 
Minneapolis GRECC, and 3 videotapes on Alzheimer's disease developed by 
the Bedford Division of the Boston GRECC. In FY 1993, VA libraries 
received a series of 3 geriatric health care videotapes that are 
relevant to dementia patient care. A comprehensive instructional 
program, ``Keys to Better Care,'' was made available to all VA medical 
centers through regional audiovisual delivery sites. This 14-part 
training package for health care providers caring for patients with 
Alzheimer's disease and other dementias addresses a wide range of 
issues related to quality care. Also, an audiovisual videotape on 
rehabilitation of the cognitively-impaired patient, produced by the 
Northeast VA Learning Resources Service, was made available at all VA 
libraries.
    During 1990 and 1991, VA Central Office surveyed a sample of VA 
medical centers with established inpatient units for patients with 
dementia. A summary report of these dementia unit site visits was 
published by VA in September 1993, and has been disseminated widely 
throughout the VA system and to the non-VA community. The report 
details the organization and delivery of inpatient services to dementia 
patients from admission to discharge. Results of these site visits will 
aid in planning future dementia programs and services, with information 
addressing such issues as dementia unit staffing patterns, programming, 
and overall organization. Criteria and standards for VA dementia units 
are currently under development and are now in draft form.
    In FY 1994, VA conducted a teleconference that featured national 
experts on Alzheimer's disease. Presented were state-of-the art 
strategies or diagnosis and treatment of this devastating disease from 
a primary care perspective. Staff at both VA and non-VA sites, 
including State Veterans Homes, participated in this educational 
teleconference. In FY 1994, Va conducted a nationwide satellite 
teleconference on ``Diagnosis and Treatment of Alzheimer's Disease.''
      geriatric research, education, and clinical centers (greccs)
    The Geriatric Research, Education, and Clinical Centers assume an 
important role in further developing the capability of the VA health 
care system to provide cost-effective and appropriate care to older 
veterans. First implemented in 1975, GRECCs are designed to enhance the 
system's capability to develop state-of-the-art care in geriatrics 
through research, education, and clinical care. The goals of the GRECCs 
are to develop new knowledge regarding aging and geriatrics, to 
disseminate that knowledge through education and training to health 
care professionals and students, and to develop and evaluate 
alternative models of geriatric care.
    GRECCs have developed many innovative approaches to educate and 
train VA clinical staff who care for elderly veterans. In 1994, GRECC 
staff expanded their outreach education and training to provide 
expertise to VA staff, particularly in the area of geriatric evaluation 
and management. Also, GRECCs have developed individual topic-specific 
education programs for the region they serve and have collaborated with 
other GRECCs to present this information to clinical staff in other 
regions of the country. This provides a significant number of clinical 
staff with state-of-the-art information on specific issues concerning 
care of the elderly.
    Each GRECC has developed an integrated program of basic and applied 
research, education, training, and clinical care in select areas of 
geriatrics. Current focal areas include cardiology and prevention of 
cardiovascular disease; cognitive and motor dysfunction and 
neurobiology; endocrinology, swallowing disorders, metabolism and 
nutrition; geropharmacology; immunology, cancer and infectious 
diseases; osteoporosis and arthritis; falls; exercise physiology; 
geriatric rehabilitation; sensory impairment; depression; bio-ethical 
aspects of medical discisionmaking in the elderly; and cost-
effectiveness and quality of geriatric care. Using an integrated 
approach, the GRECCs are developing practitioners, educators, and 
researchers to help meet the need for training health care 
professionals in the field of geriatrics; providing information for, as 
well as establishing models on, cost-effective approaches to care of 
the elderly; and researching better methods to diagnose and treat 
health care problems of the older person, as well as finding answers to 
fundamental questions on the processes and consequences of aging.
    At present there are 16 GRECCs. Fifteen are fully operational and 
are located in VA medical centers at Ann Arbor, MI; Bedford and 
Brockton/West Roxbury, MA (2 divisions); Durham, NC; Gainesville, FL; 
Little Rock, AR; Madison, WI; Miami, FL; Minneapolis, MN; Palo Alto, 
CA; San Antonio, TX; St. Louis, MO; Salt Lake City, UT; Seattle/
American Lake, WA (2 divisions); Sepulveda, CA; and West Los Angeles, 
CA. One new GRECC was designated in FY 1992 at the Baltimore, Maryland, 
VA Medical Center and is almost fully operational. Public Law 99-166, 
``Veterans Administration Health Care Amendments of 1985,'' increased 
from 15 to 25 the maximum number of facilities that the VA Secretary 
may designate for GRECCs.

                    III. Office of Clinical Programs

                            medical service
    Medical Service in VAMCs serves as the primary source of physicians 
for the care of elderly patients. Due to the aging of the population, 
Medical Service is increasingly involved in all aspects of the delivery 
of health care to the aged. Acute and intermediate medical wards, 
coronary and intensive care units, nursing homes and outpatient clinics 
are all seeing an increased proportion of elderly patients with acute 
and chronic illnesses.
    Some subspecialty areas are particularly impacted, such as 
cardiology, endocrinology (diabetes), rheumatology and oncology. 
Medical Service provides necessary subspecialty care in inpatient and 
outpatient settings in addition to participating in Geriatric 
Fellowship Training, GRECCs, Geriatric Evaluation and Management (GEM) 
Programs, Hospice, Respite, Nursing Home, and Hospital-Based Home Care. 
The specialized care that is required by the elderly has been 
recognized by Medical Service at a number of medical centers, by their 
establishment of a Geriatric Medicine Section, which emphasizes 
clinical care, as well as coordinating research and education efforts 
related to geriatrics.
    Age alone is less frequently used as a determinant of an individual 
patient's care. Geriatric patients undergo invasive diagnostic 
procedures as well. For example, the Sunbelt is experiencing an 
increasingly heavy cardiac catheterization workload. The average age of 
patients treated in coronary and intensive care units is increasing, 
producing a concomitant demand for cardiac rehabilitation and physical 
fitness programs that are targeted to the frail elderly and the 
physically handicapped of all ages. The special interest and 
involvement of Medical Service in geriatrics has also resulted in 
participation by internists in such programs as Adult Day Health Care, 
as well as in research problems in nutrition and treatment of 
hypertension.
    Smoking cessation has been shown to benefit even elderly patients. 
Thus, the role of Preventive Medicine for this patient population has 
expanded. The Medical Service has been active in implementing 
preventive strategies in smoking cessation, immunization (influenza and 
pneumococcal vaccines), and colorectal screening (for cancer).
    Evaluation and treatment of elderly patients by interdisciplinary 
teams during intermediate-length hospital stays will be an increasingly 
important role for the physicians of the Medical Service.
                          social work service
    Meeting the biopsychosocial health care need of an aging population 
of veterans and caregivers continues to be a major priority of Social 
Work Service and the Veterans Health Administration. The need to be 
competitive in a challenging and changing health care environment, as 
well as cost-effective and efficient in addressing the social 
components of health care, has led to a re-examination of social work 
priorities and their relevance to the VA health care mission, with 
special reference to the needs of chronically ill, older veterans. 
Without a support network of family, friends, and community health and 
social services, and with providers and agencies focused on integrating 
and coordinating care and providing access to the broad network of 
community services and resources, health care gains would be lost and 
VHA acute care resources would be over-utilized and in some cases 
overwhelmed. It is frequently not the degree of illness that determines 
the need for hospital care, but rather the presence or absence of 
family and community resources.
    The expansion of homemaker/home health aide services, coordinated 
by VA in collaboration with the community health and social services 
network, is evidence of the importance of noninstitutionalized support 
networks in maintaining the veteran in the community. Social workers, 
as members of the veterans' health care team, continue to coordinate 
discharge planning and to serve as the focal point of contact between 
the VA medical center, the veteran patient, his family and the larger 
community health and social services network. The veteran and his 
family have, in many respects, become the ``unit of care'' for social 
work intervention. It is this ``customer'' focus which will undergird 
social work programming for vulnerable populations, including older 
veterans who are demanding that VHA be more responsive and sensitive to 
their psychosocial needs and those of their caregivers.
    The role of the caregiver as a member of the VA health care team 
and as a key player in the provision of health care services continues 
to be a major area of social work practice and, will continue to be in 
the immediate future. This is consistent with the recognition that 80 
percent of nursing care is provided in the home by family, neighbors, 
etc., and that the family, ordinarily the veteran's wife, is the key 
decisionmaker concerning health insurance issues and, most probably, 
access to health and community support services.
    As VHA transitions from an acute care to a primary care/community 
interactive health care delivery system, Social Work Service has placed 
increased emphasis on its pivotal role in community services 
coordination, development, and integration. The development of a 
``seamless garment of care,'' with case management services as its 
centerpiece, is being given increased emphasis by Social Work Service 
and its National Committee. The National Committee functions in an 
advisory capacity concerning social work and systems issues, 
priorities, and practice concerns. While case management services have 
been a central component of social work practice in VHA, this service 
modality is being ``re-discovered'' by the VA health care system as an 
essential component of services provided to ``at-risk'' veterans and 
their caregivers. Case management, also known as ``care coordination,'' 
was identified in veterans' discussion groups as a very important 
ingredient in meeting the veterans' health care needs and those of 
their caregivers. During 1994 and beyond, VHA, and particularly Social 
Work Service, will be challenged to expand case management services in 
concert with other community providers and to provide a perspective 
that addresses this critical ingredient of care in terms of its 
absolute relevance to successful health care outcomes. In a revitalized 
and reconfigured VA health care system, issues of coordination, access, 
cost, and appropriateness of VA and community services will be 
determined not only by the needs of the customers, but also by the 
experience and expertise of the providers.
    Older Indians, including veterans, are at significant risk for the 
development of health care problems related to geographic isolation, 
economic deprivation, and cultural barriers. The Interagency Task Force 
on Older Indians continues to address issues of concern related to the 
provision of services to a population that has been underserved by the 
Federal sector. The Department of Veterans Affairs, represented by 
Social Work Service, has been an active member of this consortium. In 
March 1994, the interagency task force subcommittee on health met at VA 
Central Office for an orientation to the Department. The Executive 
Director of the Chief Minority Affairs Office and other key VA staff 
provided an orientation to programs and priorities of special interest 
to Native Americans. Social Work Service also served as resource staff 
and faculty in planning an interagency seminar held in November 1994 in 
Minneapolis, MN on ``Meeting the Health Care Needs of Older Indians.'' 
This seminar, which included representatives from VA, Indian Health 
Service, State Veterans Affairs offices and consumers, focused on 
developing realistic action plans to address health care priorities in 
Minnesota and adjacent States.
                rehabilitation research and development
    The mission of the Rehabilitation Research and Development (Rehab 
R&D) Service is to investigate and develop concepts, products, and 
processes that promote greater functional independence and improve the 
quality of life for impaired and disabled veterans. Aging, particularly 
the aging of persons with disabilities, is a high priority of the 
service. Efforts in this area include:
          A national VA program of merit-reviewed, investigator-
        initiated research, development and evaluation projects 
        targeted to meet the needs of aging veterans with disabilities.
          Support of a Rehabilitation Research and Development Center 
        on Aging at Decatur (Georgia) VA Medical Center.
          Transfer into the VA health care delivery system of developed 
        rehabilitation technology and dissemination of information to 
        assist the population of aging veterans and those who care for 
        them.
    In addition to specific projects on aging, many of the 
investigations supported through the Service's nationwide network of 
research of VAMCs and at four Rehabilitation Research and Development 
Centers have relevance for impairments commonly associated with aging.
    Some examples of investigator-initiated studies currently being 
carried out are:
          A Low-Vision Enhancement System (LVES)
          Liquid Crystal Dark-Adapting Eyeglasses
          Electronic Travel Aid for the Blind
          Non-Auditory Factors Affecting Hearing Aid Use in Elderly 
        Veterans
          The Influence of Strength Training on Balance and Function in 
        the Aged
          Epidemiologic Study of Aging in Spinal Cord Injured Veterans
    The Rehab R&D Center on Aging is structured around five 
interdisciplinary research sections to address the multidimensional 
nature inherent to problems of aging and disability: Environmental 
Research; Vision Rehabilitation; Neuro-Physiology; Engineering and 
Computer Science; and Social, Behavioral, and Health Research. Areas of 
study include:
          Design-related problems that affect the quality of life of 
        older people, including least restrictive environments, falls, 
        independence and safety.
          Orientation and mobility for the blind, low vision, and 
        rehabilitation outcomes measurement for older persons with 
        visual impairment.
          The neurologic and physiologic changes that accompany aging 
        and behavioral coping problems.
          Development and application of new technologies to a variety 
        of prototypes for the design of assistive devices and assistive 
        software.
    Special programs in 1994 included the sponsorship of 13 research 
studies funded by the Rehabilitation Research and Development Service 
in conjunction with the 1994 National Veterans Golden Age Games at the 
Hines VAMC. The Associate Chief of Staff for Extended Care and 
Geriatrics at Hines initiated and steered this program to discover 
better methods of promoting rehabilitation and health for elderly 
veterans.
    In April 1994, the Decatur R&D Center sponsored an International 
Conference on Aging and Vision Impairment in Atlanta. This conference 
drew over 300 participants, including presenters and attendees from 
seven countries. The meeting marked the first major conference on aging 
and vision impairment in over 10 years. A follow up research forum 
identified needs in aging and vision impairment.
              physical medicine and rehabilitation service
    Physical Medicine and Rehabilitation Service (PM&RS) strives to 
provide all referred older veterans with comprehensive assessment, 
treatment and follow-up care for psychosocial and/or physical 
disability affecting functional independence and quality of life. The 
older veteran's abilities in the areas of self-care, mobility, 
endurance, cognition and safety are evaluated. Professional therapists 
utilize physical agents, therapeutic modalities, exercise, and 
prescription of adaptive equipment, to facilitate the veteran's ability 
to remain in the most independent life setting.
    The extent of rehabilitation services available at any VA medical 
center varies. Inpatient rehabilitation bed units, usually directed by 
a board-certified physiatrist, exist within approximately 75 medical 
centers. Current data indicates that the average age of veteran 
patients discharged from those rehabilitation bed units continues to 
increase (currently 69 years). Recognizing the special needs of the 
elderly patient, rehabilitation professionals routinely collect and 
analyze outcome date to assist in determining appropriate functional 
goals and lengths of stay for each admission. The patient is an 
integral member of the interdisciplinary treatment team that plans his/
her care.
    A uniform assessment tool, the Functional Independence Measure 
(FIM) has been implemented throughout the VA rehabilitation system. 
Patients are evaluated on 18 elements of function at the time of 
admission, regularly during treatment and at discharge. Application of 
FIM results to quality management activity will assist local and 
national rehabilitation clinicians and managers to maximize effective 
and efficient rehabilitation care delivery. An administrative database 
called the Uniform Data System of Medical Rehabilitation (UDS/mr) 
monitors outcomes of care and increases the accuracy of developing 
predictors and ideal methods of treatment for the older veteran with 
various diagnoses. A centralized, national contract with the UDS/mr 
service permits 75 facilities with PM&RS bed units to provide data and 
receive outcome reports as part of the national and international UDS/
mr data bank.
    Rehabilitation therapists are leading and participating in 
innovative treatment, clinical education, staff development and 
research. Rehabilitation professionals work with patients who are home-
bound, work in independent living centers, Geriatric Evaluation and 
Management Units, Adult Day Health Care, Day Treatment Centers, 
domiciliaries, Interdisciplinary Team Training Programs, Geriatric 
Research, Education, and Clinical Centers, and also in hospice care 
programs.
    Driver training centers are staffed at 40 VA medical centers to 
meet the needs of aging and disabled veterans. With the growing numbers 
of older drivers, the VA has put emphasis on the training of the mature 
driver. Classroom education and defensive driving techniques are 
supported with behind-the-wheel evaluation by driver specialists.
                            nursing service
    Care of the elderly veteran continues to be one of the highest 
priorities for Nursing Service. Nurses at every level of the 
organization are committed to providing leadership in the clinical, 
administrative, research, and educational components of gerontological 
nursing.
    Professional nurses function as part of interdisciplinary teams to 
coordinate and provide care in settings beginning with GEMS and 
progressing along many care settings including ambulatory care, acute 
care, intermediate care, long-term care, and community agencies. 
Gerontological nurse practitioners and clinical nurse specialists 
provide primary care and continuity of care as clinical care managers 
and coordinators of care.
    Preventive care and health promotion incentives continue to 
preserve independence, foster self-care, improve productivity, and 
enhance the quality of life by improving the health status of aging 
veterans. Proper screening, education, and referral of elderly veterans 
are vital to meeting their health care needs in the least restrictive 
environment. Nurses in wellness clinics and other ambulatory care 
settings provide supervision, screening, and health education programs 
to assist veterans in maintaining healthy life styles.
    Nurses play a key role in restoring the functional abilities of 
aging veterans with chronic illness and disabilities. Programs for the 
physically disabled and cognitively impaired have been established and 
are administered by nurses and nurse practitioners in home care, 
ambulatory care settings, and inpatient units. Treatment programs are 
goal-directed toward physical and psychosocial reconditioning or 
retraining of patients with biological and psychosocial disturbances. 
Patient and family teaching is a major part of each program. Family and 
significant others have a key role in providing support to aging 
veterans and are assisted in learning and in maintaining appropriate 
caregiver responsibilities. VA nurses contribute to planning and 
implementing health care services for the elderly in the community-at-
large. They serve on task forces and participate in self-help and 
support groups related to specific diseases such as Alzheimer's. Nurses 
are also advisors to local health planning councils, and share VA 
educational activities and research seminars with other health care 
professionals.
    Nursing leaders continue to collaborate with schools of nursing to 
offer positive learning experiences in both undergraduate and graduate 
nursing education. Nursing schools are encouraged to focus more 
attention on programs in geriatrics, rehabilitation, and chronic care. 
An affiliation agreement between three VAMCs (Fargo, ND; St. Cloud, MN; 
Minneapolis, MN) and the University of Minnesota School of Nursing is 
an example of the collaboration needed to address the critical shortage 
of nurses in geriatric care. Graduate nursing students receive clinical 
experiences in Geriatric Evaluation and Management Programs, Nursing 
Home Care Units, and Hospital Based Home Care programs. Nursing Service 
is committed to leadership that will ensure the patient care needs of 
aging veterans are addressed. The preceptorship training program for 
the position of Associate Chief or Supervisor Nursing Home Care Unit 
continues to receive priority. Other opportunities to enhance career 
development for leadership in long-term care include the following 
examples:
          Nursing Service, in collaboration with the Office of Academic 
        Affairs (OAA), presented a program entitled, ``Charting a 
        Vision for Nursing Leadership,'' for 150 nurse leaders of VA 
        nursing home care units. Follow-up to the program includes 
        action plans with strategies for implementation by cluster 
        groups within VHA regions.
          Recommendations from the task force to enhance recruitment, 
        retention and leadership/executive development are being 
        implemented at the Central Office, regional, and local levels.
    Continuing education is essential to ensure that all levels of 
staff have knowledge and skills to meet the needs of this rapidly-
growing age group. The sixth national training program, ``Long Term 
Care of the Mentally Ill,'' was presented for interdisciplinary teams 
from 15 Nursing Home Care Units in April 1994. Outcomes of this program 
have improved the quality of care and quality of life of aging patients 
and include the following:
          Enhancement of the interdisciplinary teams;
          Formation of consultation teams to assess and assist in 
        providing improved therapeutic care to aging patients in other 
        areas of the medical center;
          Reduction of physical and chemical restraints; and
          Projects to establish more therapeutic environments.
    The interdisciplinary program to improve the quality of life of 
aging patients in VA nursing home continues. Significant decreases in 
the number of medications prescribed for patients in VA nursing homes 
have been documented. The project will continue with the goal to reduce 
the number of prescribed medications to four or less.
    A new program at the VA Medical Center, Washington, DC, NHCU 
illustrates an innovative approach to restorative care and improving 
the quality of life of patients. The NHCU received regional funding in 
1992 to foster patient creative expression through the use of the 
multi-arts. Based on the success of the first year, the program was 
refunded in 1993 and a position was created through Nursing Service for 
a full-time Restorative Care/Creative Arts Therapist. The Creative Arts 
Therapist now coordinates the efforts of volunteers, NHCU nursing 
staff, and area artists and therapists in an expanded program to meet a 
broad range of patient rehabilitative, supportive, and comfort care 
needs. A variety of art inventions include:
          Art Appreciation
          Hands on Art
          Creative Movement
          Ballroom Dancing
          Rhythm and Music
          Sign Language
          Creative Writing
          Discussion of Great Ideas
          Museum Trips
          Patient Care Displays and Performance
    In FY 1994, the program received funding to prepare a video to 
assist other long-term care practitioners to develop a therapeutic 
creative art program. Information on this program was also shared at a 
nursing leadership conference, and at three other professional 
conferences.
    Nursing Service has established the goal to create restraint-free 
environments throughout the VA health care system. This initiative will 
begin with multi-site proposals for nursing home care units leadership 
conference. One nursing home care unit opened restraint-free in 1992. 
It remains restraint-free and serves as a model for others.
    Several NHCUs responded to a request from the Office of Quality 
Management (OQM) to submit interventions that had improved the quality 
of care. Interventions submitted will be published and shared 
throughout the system by OQM. Many of the interventions submitted 
improved the quality of life of patients as well as the quality of 
care. These include the following:
          Interdisciplinary walking rounds resulting in more active 
        involvement of patients in their care and enhanced patient and 
        staff interactions.
          Grouping patients on the unit by their activities of daily 
        living (ADL) potential, resulting in therapeutic groups to 
        address specific patient populations and more effective patient 
        and family education.
          Implementing an outdoors program for physically and 
        cognitively challenged residents has resulted in their 
        increased social interaction, and improvement in their 
        appetite, and sleep habits.
          Consultations by psychiatrists with professional nurses and 
        nursing assistants on the care of patients with behavior 
        problems, resulting in a reduction in the frequency and 
        intensity of disruptive behaviors and increased empathy and 
        tolerance of the staff caring for these patients.
          Implementation of protocols to reduce the use of physical and 
        chemical restraints resulting in a reduced number of falls, 
        reduction in restraints and more appropriate use of 
        psychotropic drugs.
          Evaluation of high risk patients by an interdisciplinary 
        dysphagia team, with a reduction in choking episodes at meal 
        times and the resultant aspiration pneumonia.
    Professional nurses are encouraged and supported in their efforts 
to conduct research, especially in clinical settings. Nine VA Nursing 
Home Care Units are participating in the Minimum Data Set (MDS) 
Demonstration Project. This project provides the opportunity for the VA 
NHCUs to collect and compare data with community nursing homes 
nationwide.
    Research is needed to advance health care for older persons and to 
improve gerontological nursing practice. Areas in which nursing 
research is urgently needed to improve the quality of care include:
          Urinary incontinence;
          Common eating patterns programs and nutrition;
          Falls;
          Enhancing socialization skills;
          Care of Alzheimer's patients;
          Wandering behavior;
          Dementia;
          Exercise and mobility;
          Medications, including effectiveness of psychotropic 
        medications, types and incidence of medication abuse among the 
        elderly;
          Health promotion;
          Frail elderly in the home setting;
          Alternatives to institutional care; and
          Coping mechanisms of patients, families, and caregivers.
    Studies are needed to enhance the quality of life for aging female 
veterans in a health care system largely focused on a male model of 
care. Osteoporosis is a serious metabolic bone disease which affects 
postmenopausal women to a greater degree than men. Women veterans who 
served during and prior to the Korean War are a prime risk group for 
this disease. Timely application of research findings to clinical care 
in all practice settings will improve the quality of care and quality 
of life to aging veterans.
                            dietetic service
    Medical nutrition care saves money, improves patient outcomes and 
enhances the quality of life for our older veterans. To better serve 
the veteran and identify his/her nutritional needs, many VA health care 
professionals are now using Determine Your Nutritional Health Checklist 
and Level I and II Nutrition Screen developed by the American Dietetic 
Association's American Academy of Family Physician's and National 
Council on Aging's National Screening Initiative. The Checklist or 
Level I Screen identifies those at high risk for poor nutritional 
status, while Level II Screen provides provides specific diagnostic 
nutritional information. In FY 1994 the National Screening Initiative 
emphasized educating the physician in nutritional care. The booklet, 
Incorporating Nutrition Screening and Interventions into Medical 
Practice, has been nationally disseminated to doctors. This information 
complements the handbook, Geriatric Pocket Pal, our service developed 
with the Office of Geriatrics and Extended Care.
    Many medical centers have Geriatric Nutrition Specialist positions. 
Dietitians in these positions have developed easy-to-read educational 
materials for their audience and shared this information with other 
medical centers. Several medical centers are providing outreach 
services for the elderly in their community. For example, the Bronx 
VAMC provides outreach to local senior centers and the Dallas VAMC has 
bimonthly visits by their health screening team to facilities in their 
area. A variety of nutrition education programs have been offered for 
health care providers and patients. Salisbury VAMC offered a workshop 
on ``Dining Skills: Practical Interventions for the Caregivers of the 
Eating-Disabled Older Adult.'' Chillicothe VAMC just completed its 14th 
annual multidisciplinary Gerontological Seminar.
    Dietetic Service continues to provide guidance on quality care. In 
response to an Office of the Inspector General's audit of VHA 
activities for assuring quality care for veterans in community nursing 
homes, Dietetic Service proposed revisions to M-5, Part II, Chapter 3, 
Community Nursing Homes to strengthen the frequency of dietitian 
follow-up visits to assess nutrition. Several practice guidelines have 
been distributed to all the medical centers to ensure quality care for 
our elderly. In addition, Tomah VAMC has developed interdisciplinary 
guidelines for the care of dysphagia. The clinical indicator to ensure 
that the patient not only receives his food, but is fed, will be 
released soon. Northampton VAMC developed an indicator for high-risk 
geriatric patients who are underweight. VAMC Alexandria's geriatric 
dietitian completed her research on the acceptability of pureed foods 
thickened with selected products. Another geriatric dietitian at Little 
Rock VAMC recently presented her research to the American Dietetic 
Association on the nutritional status of people seen at their 
outpatient geriatric evaluation clinic.

                        IV. Office of Dentistry

    Dental care for the geriatric patient involves restoration of 
function through rehabilitation of the dentition, and elimination of 
pain and suffering attributable to oral disease. It is important that 
older adults are able to effectively masticate a variety of foods so 
that convalescence after surgery, chemotherapy, or other significant 
medical interventions is expedited.
    Interpersonal skills, which are highly dependent upon physical 
appearance and effective communication, can be enhanced by improving 
the teeth's appearance and by properly aligning and restoring the 
anterior teeth to maintain clarity of speech. The goals of dental care 
are consistent with those of all disciplines involved in geriatrics--to 
maximize function and foster independence in living. Dentistry should 
be an integral part of any comprehensive health care program for the 
elderly.
    The nature of dental disease in late life--chronic, asymptomatic 
(even in advanced stages), aggravated by coexistent medical problems, 
and perceived as a low priority by health funding agencies--requires an 
increased emphasis on preventive services. Innovative, individualized, 
preventional dental programs are often necessary for each patient. 
Preventive modalities include the use of home-applied fluoride 
solutions, anti-microbial mouth rinses, specially fabricated 
toothbrushes, instruction to family or caregivers on oral hygiene 
techniques, and more frequent dental examinations. These are low-cost 
yet effective measures that can obviate the need for future expensive 
or invasive dental care. VA has been a world leader in developing 
preventive dental therapies and field testing them for clinical 
efficacy.
    Oral cancer is a disabling and disfiguring disease that primarily 
affects middle-aged and older adults. Ninety-five percent of all cases 
occur in those over 40. Alcohol, tobacco, and advanced age are 
important risk factors in the development of this disease. Early 
detection of frequently asymptomatic lesions can significantly reduce 
the disease's morbidity. Through a long-standing program of oral 
screening examinations, VA dentists have been able to expeditiously 
detect incipient oral cancers. Such interventions minimize the need for 
ablative surgery, which may precipitant swallowing and eating 
difficulties, and can also significantly reduce mortality rates.
    Most VA medical centers have established Geriatric Evaluation and 
Management Programs. Dental Services contribute to the GEM's 
interdisciplinary team effort, conducting admission oral assessments, 
collaborating on treatment planning, providing specialty consultations 
and needed care, and preparing summaries of oral care protocols to be 
maintained after discharge. Oral examinations conducted during GEM 
admissions commonly identify problems previously undetected that can 
impede chewing efficiency, safe swallowing, and clearly articulated 
speech. Interdisciplinary treatment planning takes advantage of the 
synergy associated with group efforts. Patients are rehabilitated more 
rapidly with properly staged and coordinated care. Unexpected outcomes 
of a specific discipline's therapies or newly exposed problems often 
warrant expedited specialty consultation. For matters involving the 
oral-dental complex, dentistry has responded with timely assessments, 
definitive diagnosis, and recommended treatment. At discharge, a review 
of the patient's response to treatment, plan for maintenance, and 
guidance for future care are prepared. The GEM Program has been an 
ideal environment for dentistry to demonstrate its relative merit and 
range of contributions to the interdisciplinary team.
    The VA Program Guide, Oral Health Guidelines for Long Term Care 
Patients, developed by the Offices of Dentistry, Clinical Programs, and 
Geriatrics and Extended Care, continues to serve as the primary 
handbook for management of the multidisciplinary oral health efforts. 
It describes the goals, implementation, and monitoring of oral care 
provision for patients in VA long-term care programs.
    The VA Dentist Geriatric Fellowship Program has proven to be an 
excellent recruitment source for dentists who have been uniquely 
trained in the care of the elderly. Approximately 30 graduated fellows 
currently serve as staff dentists throughout the VA system. Others have 
assumed leadership positions in geriatric dentistry at academic 
institutions. They have enhanced patient care and other geriatric 
initiatives at their own, as well as regional, medical centers, and 
have also contributed to the geriatric efforts at affiliated health 
centers and in the community. Nationally, former fellows have made 
significant contributions to the professional literature and are 
actively involved in geriatric dental research.
    The impact of VA programs in geriatric dentistry is not limited to 
its own health care system, but extends to a broader level. VA 
dentistry is represented on both National Institute of Dental Research 
(NIDR) reviews and the U.S. Surgeon General's workshop on oral health 
promotion and disease prevention. The American Association of Dental 
Schools (AADS) has an ongoing Geriatric Education Project that has 
developed curricular guidelines for teaching concepts in gerontology 
and geriatrics to dental and dental hygiene students. VA dentists have 
been noteworthy contributors to these efforts to define geriatric 
educational objectives and identify resource materials for dental 
faculty members.
    In December 1994, the VA Office of Research and Development's 
Health Services Research and Development Service sponsored the national 
conference, ``Oral Health for Aging Veterans--Making a Difference: 
Priorities for Quality Care.'' The conference convened in Washington, 
DC, with 110 VA and non-VA clinicians, managers, policymakers, and 
researchers represented. An important outcome of the program was 
publication of an ``Oral Health for Aging Veterans'' research agenda. 
This document identifies areas of oral health services research that 
are critical to improving the delivery of oral health care to veterans.
    In summary, the Office of Dentistry continues to support efforts 
that will benefit older veterans in three general areas. First, 
optimizing the quality of care received by elderly patients at VA 
facilities is a priority. Second, education in geriatric oral health 
will continue to be made available to patients, dental staff, and 
nondental care providers such as nurses, physicians, and family 
members. Third, research to broaden our understanding of oral disease 
and its treatment in older adults will be encouraged.

                 V. Office of Research and Development

                  va medical research service (vamrs)

                           Research on Aging

    VA Medical Research Service (VAMRS) strives to meet the health care 
needs of the veteran population. As the needs of the veteran population 
change, so must the areas of research and development funded by VAMRS. 
Aging is fast becoming a vital area of research in the VA system. 
Currently, 50 percent of the veteran population (about 13.2 million) 
are over age 56. It is estimated that 37 percent of the veteran 
population will be 65 or older by the year 2000. Medical problems 
specific to this population, such as dementia, prostate cancer, lung 
cancer, and heart disease are crucial areas of study.
    VAMRS has met these rising needs with successful biomedical 
research on the neurobiology of Alzheimer's disease (AD), hormone 
regulation in prostate cancer, larynx preservation in advanced 
laryngeal cancer, and drug therapy and/or vitamin supplementation for 
prevention of heart disease and stroke.
    In 1994, over 35,000 veterans age 65 or older were hospitalized 
with primary diagnoses of congestive heart failure, prostate cancer, 
pneumonia, and lung cancer. In the same year, VAMRS spent over $37 
million on research focusing on heart disease, pulmonary disease, and 
cancer. Additionally, investigators on 169 VA research projects 
specifically designated their work as crucial to health concerns of the 
aging. Their research expenditures totaled $14.7 million (some of which 
is included in the aforementioned $37 million).
    Age-related dementia, which affects 10 percent of people over age 
65, is a major health concern of the elderly. VHA predicts that 600,000 
veterans will suffer from dementia by the year 2000. Currently, VA 
investigators are stepping up efforts to understand and treat this 
devastating disorder. The following are three examples of investigator-
initiated, merit-reviewed VA research projects on Alzheimer's disease 
(AD)-related dementia:
          Proper diagnosis is a frequent problem in treating 
        Alzheimer's disease. Dr. Richard Mohs, of the Bronx VAMC, is 
        researching the cognitive changes associated with Alzheimer's 
        disease and has developed the Alzheimer's Disease Assessment 
        Scale. This diagnostic tool aids early diagnosis and identifies 
        risk factors associated with AD.
          Dr. Patricia Prinz, of the American Lake/Tacoma VAMC, is 
        working on early diagnosis of AD by examining sleep 
        electroencephalogram patterns. This protocol can predict 
        dementia outcomes over a 6-8 year period with an accuracy rate 
        of 80-90 percent.
          Research into the cause of AD has led Dr. Lissy Jarvik, a 
        researcher at the West Los Angeles VAMC, to postulate that a 
        microtubule system impairment may cause deficient cellular 
        functioning. Continued examination of this system may lead to 
        insights into the cause of AD, as well as lead to improved 
        diagnostic abilities.
    Osteoporosis is a crippling disease that affects millions of post-
menopausal women. VA studies concentrate on various aspects of this 
disease, from early detection methods to prevention and treatment 
procedures. Working out of the Indianapolis VAMC, Dr. Stavros Manolagas 
and Dr. Robert Jilka have discovered that the lack of the female 
hormone estrogen, a consequence of women completing menopause, causes 
an overproduction of bone scavenger cells. These cells, called 
osteoclasts, produce pits and craters in bones, weakening their basic 
structure. The knowledge gained by this work will open the door to 
improved therapies for female veterans. Other researchers from the 
Indianapolis VAMC are also making progress in the treatment of 
osteoporosis. They have found that when female hormones are depleted 
due to menopause, a substance called interleukin-6 is overproduced and 
leads to the breakdown of bones. Control of this substance may someday 
lead to treatment for this disabling disorder.
    VAMRS achievements in aging research take the form of new medical 
inventions, improved treatment therapies, and improved understanding:
          Dr. Steven Linder, a pulmonary specialist at the Palo Alto, 
        California VAMC, has invented a device to induce coughing, 
        designed for those who may be unable to perform this ordinary 
        and vital function, such as elderly persons, quadriplegic 
        persons, and persons with spinal cord injuries. The device is a 
        sort of abdominal corset which delivers a mild electrical 
        stimulus to the wearer, provoking a cough reflex. The device 
        greatly reduces the risk of retained secretions, pneumonia, and 
        death due to impaired respiratory function.
          Dr. Frederick L. Brancati, et al., of the Pittsburgh VAMC, 
        have found that elderly patients with pneumonia are almost as 
        likely to benefit from aggressive treatment as are their 
        younger counterparts, and that age should not be the sole 
        criterion for withholding aggressive treatment of pneumonia in 
        older patients.
          In her study of aging patients at the Tucson VAMC, Dr. 
        Margaret Kay has discovered the chemical marker on red blood 
        cells that single out the cells for destruction. This work has 
        led to a better understanding of the natural aging process, and 
        the effect of aging on cellular function.
    Research is the backbone of health care, and researchers and 
clinicians agree that treatments and cures that exist for major 
diseases could not have been developed if not for medical research. VA 
physicians and clinician/nonclinician Ph.D. investigators comprise the 
VA medical research team conducting research at over 100 VA medical 
centers nationwide. Advances in VA research are applied to the veteran 
population throughout the 172 VA medical centers, as well as the entire 
U.S. population once results have been established and reported.
    New breakthroughs in treatment occur continuously. In only the past 
few years, we have seen such VA research achievements as laser surgery 
for prostate cancer, improved treatment for patients with Post 
Traumatic Stress Disorder, and a new drug therapy for high blood 
pressure. Research not only leads to advances in patient care, it also 
saves money in long-term health care costs. The National Institutes of 
Health predicts that for every dollar spent on medical research, $8 are 
saved in medical care costs. Progress in health care begins with 
medical research. It is vital that the importance of medical research 
is kept in mind and also its impact on health care for the aging 
veteran.
                health services research and development
    Health Services Research and Development (HSR&D) is an area of 
research designed to enhance veterans' health by improving the quality 
and cost effectiveness of the care provided by the Department of 
Veterans Affairs. The focus of VA HSR&D is on (1) advancing the state 
of knowledge about health services in VA and the Nation and (2) 
disseminating that knowledge for practical use. The large number of 
aging veterans and their increasing health care needs make this 
population particularly important for HSR&D to study. The Service's 
four major program areas emphasized aging during FY 1994.
    (1) The Investigator Initiated Research (IIR) Program encourages 
and supports projects proposed and conducted by VA researchers, 
clinicians, and administrators from throughout the Nation. In this 
intramural program of HSR&D, VA staff conduct merit-reviewed and 
approved projects in VA medical centers with oversight and advice from 
Central Office. The IIR Program also includes career development, which 
encourages interested clinicians and researchers to pursue careers in 
VA by guaranteeing salary support.
    Forty-nine percent of the 57 HSR&D investigator-initiated projects 
addressed questions important to aging veterans. New projects initiated 
in FY 1994 included studies of the home measurement of peak expiratory 
flow rate in Chronic Obstructive Pulmonary Disease; social factors in 
the occurrence of cardiac events; the effects of exercise training in 
the frail group of elderly veterans; rehospitalization following 
surgery; the magnitude, costs, and prevention strategies of diabetic 
foot problems; and Simulated Presence Therapy (SPT), a new 
nonpharmacologic technique, to reduce problem behaviors in Alzheimer's 
disease patients.
    Ongoing geriatric-related investigations included studies of the 
benefits of arthritic knee-joint rehabilitation; risk assessment for 
cardiac complication after noncardiac surgery; follow-up strategies for 
home oxygen programs; the potential demand for bone marrow 
transplantation, resource use, and effectiveness; institutional long-
term care and hospital utilization; and factors that influence 
mortality and inpatient health care utilization 1 year following 
admission to a medical intensive care unit (ICU).
    Eleven IIR projects related to aging were completed in FY 1994. 
These projects included studies of coronary artery disease because of 
elevated serum cholesterol levels; the effect of physical therapy on 
nursing home patients; methods to improve glycemic control; low-vision 
rehabilitation programs; nonpharmacological means of lowering 
cholesterol; disruptive behavior of the cognitively-impaired elderly; 
behaviors and characteristics of Alzheimer's disease patients and the 
effects on caregivers; post-treatment management for lung cancer; 
abdominal aortic aneurysm surgery outcome; an identification screening 
method for patients who may experience complications during their 
hospital stay; and comparison of the cost structure of VA and non-VA 
hospitals.
    (2) The HSR&D Cooperative Studies in Health Services (CSHS) 
projects are multi-site health services research studies based on the 
model of VA's Cooperative Studies Program. Because of VA's health care 
system size, complexity, and data availability, it offers unique 
opportunities to conduct large-scale research projects, such as the 
CSHSs. These studies are expected to yield more definitive findings 
than may be available in other health care research environments. Three 
Centers for Cooperative Studies in Health Services (CCSHS) provide 
scientific, technical, and management support to the CSHS 
investigators. In addition to six ongoing CSHS projects relevant to the 
concerns of the aging population, preparations for two new CSHS 
Geriatric Evaluation and Management (GEM) trials began in February 
1994.
    (3) The HSR&D Field Program is a network of core VA staff assigned 
to selected medical centers. In FY 1994, the Service funded nine 
ongoing HSR&D Field Programs. Field Program staff conduct independent 
research projects and collaborate with community institutions in 
support of program objectives.
    Field Programs serve as Centers of Excellence in selected subject 
matter areas. While all Field Programs have research interests in the 
health care issues affecting aging veterans, four include aging as a 
primary research focus. The Northwest Center for Outcomes Research in 
Older Adults at the Seattle VAMC continues to provide leadership in 
geriatric care issues. The Midwest Center for Health Services and 
Policy and Research at the Hines VAMC in Illinois emphasizes 
gerontology and rehabilitation issues. The Field Program at the VAMC 
Bedford, Massachusetts, is a Center of Excellence for Health 
Maintenance for Aging Veterans, and it is examining such issues as 
nursing home care, quality life, and use of advance directives. The 
Great Lakes HSR&D Field Program at the Ann Arbor VAMC emphasizes 
service delivery and quality of care research with a special focus on 
the older veteran. A new HSR&D Field Program, the Center for the Study 
of Healthcare Provider Behavior, was founded in November 1993, at the 
Sepulveda VAMC. The Center is dedicated to the improvement of health 
care quality and outcomes in VA and non-VA health systems.
    Field Program investigations during FY 1994 included the Normative 
Aging Study (NAS), a multidisciplinary and longitudinal investigation 
of human aging, and the Dental Longitudinal Study, a companion study 
addressing oral health and risk factors for oral disease in an aging 
population; the impact of polypharmacy on health-related quality of 
life; the effectiveness of managed care for improving the health status 
and quality of care of aging veterans; and the impact of rehabilitation 
services on inpatients newly diagnosed with a disabling disorder. 
Recently funded Field Program projects include studies of pressure 
ulcer development in long-term care, as well as malnutrition among 
elderly patients.
    (4) The Special Projects Program encompasses the HSR&D Service 
Directed Research (SDR) Program, the Management Decision Research 
Center (MDRC), and special activities such as conferences and seminars. 
Special projects may include evaluation research, information 
syntheses, feasibility studies and other research projects responsive 
to specific needs identified by Congress, other Federal agencies, or 
Department of Veterans Affairs executive and management staff. This is 
a centrally directed program of health services research conducted by 
VA field staff, VA Central Office staff, and/or contractors engaged to 
analyze specific problems.
    Five ongoing HSR&D Service-Directed Research projects focus on 
issues relevant to the aging veterans population. These projects 
include an interactive videodisk project aimed at an educational 
intervention for primary care physicians working in the outpatient 
setting: an examination of the National Nursing Home Resident 
Assessment Instrument Minimum Data Set for potential use in VA extended 
care facilities; a study of health-related quality of life; and a study 
of the care of acute myocardial infarction (AMI) patients. 
Additionally, four SDR Program initiatives are currently focusing on 
prostate cancer. Two projects are emphasizing education--one is 
assessing the impact of an educational intervention on patent 
preferences for prostrate cancer treatment, and other project is 
examining the impact of education on prostate cancer screening 
decisions. Two other studies include an investigation of familial 
patterns in prostate cancer and patient preference in end-state 
prostate cancer.
    A new HSR&D Service-Directed Research investigation initiated in FY 
1994 relevant to geriatrics is evaluating the diagnosis, treatment, and 
outcomes of veterans hospitalized for acute ischemic stroke. One 
project, designed to teach patients about advance directives, was 
completed.
    In addition to these special research initiatives, the HSR&D 
Service Management Decision and Research Center convened the first 
research agenda-setting conference, in December 1993, to improve the 
delivery of oral health care to veterans. As a result of the 
conference, an 11 page research agenda on oral health was distributed 
systemwide; an overview of dental health services research activities 
and resources available to investigators was published in the October 
1994 Special supplement of FORUM, the HSR&D Service newsletter; and a 
follow-up supplement of the conference will be published in the 
Journal, Medical Care in the spring of 1995.

                     VI. Office of Academic Affairs

    All short- and long-range plans for VHA that address health care 
needs of the Nation's growing population of elderly veterans include 
training activities supported by the Office of Academic Affairs (OAA). 
The training of health care professionals in the area of geriatrics/
gerontology is an important component for a variety of programs 
conducted at VA medical centers in collaboration with affiliated 
academic institutions. Clinical experiences with geriatric patients is 
an integral part of health care education for the nearly 100,000 health 
trainees, including 35,000 resident physicians and 45,000 nursing and 
associated health students. These residents and students train in VA 
medical centers annually as part of affiliation agreements between VA 
and nearly 1,000 health professional schools, colleges, and university 
health science centers. Recognizing the challenges presented by the 
ever-increasing size of the aging veteran population, the OAA has made 
great strides in promoting and coordinating interdisciplinary geriatric 
and gerontological programs in VA medical centers and in their 
affiliated academic institutions.
    The Office of Academic Affairs, in VHA, supports geriatric 
education and training activities through the VA Fellowship Programs in 
Geriatrics for Physicians and Dentists.

                           Geriatric Medicine

    The issue of whether or not geriatrics should be a separate medical 
specialty or a subspecialty was resolved in September 1987 when the 
Accreditation Council for Graduate Medical Education (ACGME) approved 
Geriatric Medicine as an area of special competence. Effective January 
1988, the American Board of Internal Medicine and the American Board of 
Family Practice specified procedures for the certification of added 
qualifications in geriatric medicine. VA played a critical role in the 
development and recognition of geriatric medicine in the United States, 
and since 1989, any VA medical center may conduct fellowship training 
in geriatrics, providing an ACGME-accredited program is in place.
    The demand for physicians with special training in geriatrics and 
gerontology continues unabated because of the rapidly advancing numbers 
of elderly veterans and aging Americans. The VA health care system 
offers clinical, rehabilitation, and follow-up patient care services, 
as well as education, research, and interdisciplinary programs that 
constitute the support elements that are required for the training of 
physicians in geriatrics. Since FY 1978-79 this special training has 
been accomplished through the VA Fellowship Program in Geriatrics 
conducted at VA medical centers affiliated with medical schools. The 
initial 12 training sites increased to 20 in FY 1986 and to 40 in FY 
1993-94.
    These fellowships are designed to develop a cadre of physicians who 
are committed to clinical excellence and to becoming leaders of local 
and national geriatric medical programs. Their dedication to innovative 
and thorough geriatric patient care is expected to produce role models 
for medical students and for residents. The 2-year fellowship 
curriculum incorporates clinical, pharmacological, psychosocial, 
education, and research components that are related to the full 
continuum of treatment and health care of the elderly.
    During its 16-year history, the program has attracted physicians 
with high quality academic and professional backgrounds in internal 
medicine, psychiatry, neurology, and family practice. Their genuine 
interest in the well-being of elderly veterans is apparent from high VA 
retention rate after completing the fellowship training. Many of the 
fellows have published articles on geriatric topics in nationally 
recognized professional journals, and several fellows have authored or 
edited books on geriatric medicine and medical ethics. The number of 
recipients of important awards and research grants (AGS/Pfizer, AGS/
Merck, Kaiser, National Institutes on Aging and VA) increases each 
year.
    As of June 1994, 390 fellows had completed special training in 
geriatric medicine. About 40 percent remain in the VA system as full- 
or part-time employees. Close to 50 percent of all graduates hold 
academic appointments. The VA fellowship alumni/ae continue to 
represent the largest single agency contribution to the pool of trained 
geriatricians in the United States.

                          Geriatric Dentistry

    In July 1982, a 2-year Dentist Geriatric Fellowship Program 
commenced at five medical centers that are affiliated with Schools of 
Dentistry. The goals of this program are similar to those described for 
the Physician Fellowship Program in Geriatrics. In FY 1988, the number 
of training sites increased to six for a final 3-year cycle. As of June 
1992, 45 Dentist Fellows had completed their special training. About 75 
percent of the program alumni have accepted offers of post-fellowship 
employment in the VA system.
    The format of these fellowships, however, has changed from 
predesignated sites to individual awards. Candidates from any VA 
medical center with the appropriate resources may compete for 
postdoctoral fellowships for dental research. In FY 1994, seven fellows 
participated, four elected to do a third year of research, and five 
program alumni are pursuing academic careers.

              Geriatric Psychiatry and Geriatric Neurology

    In FY 1990-91, the Department of Veterans Affairs established a 2-
year Fellowship Program in Geriatric Psychiatry to develop a cadre of 
physicians with expertise in two areas: (1) Specialized knowledge in 
the diagnosis and treatment of elderly patients with dementia and other 
psychiatric problems; (2) innovative teaching and research skills for 
academic potential.
    Two competitive review cycles (FY 1990 and FY 1991) selected nine 
VA medical centers that are affiliated with U.S. medical schools as 
training sites for these fellowships. The FY 1991 review also added 
four sites for geriatric neurology. As of June 1994, 34 psychiatrists 
and 3 neurologists have completed special training in geriatrics.
    The American Board of Psychiatry developed criteria for ACGME-
accredited training in geriatric psychiatry, and the approval of 
Geriatric Psychiatry became official on September 28, 1993. VA expects 
to continue funding for fellow-level training at the current fellowship 
sites during the transition to accredited program status. This is 
another example of VA's initiative in establishing programs in areas of 
need. Beginning in FY 1995-96, any accredited VA training site may 
request positions in Geriatric Psychiatry as part of the residency 
allocation.
               nursing and associated health professions

                Interdisciplinary Team Training Program

    The Interdisciplinary Team Training Program (ITTP) is a nationwide 
systematic educational program that is designed to include didactic and 
clinical instruction for VA faculty practitioners and affiliated 
students from three or more health professions such as physicians, 
nurses, psychologists, social workers, pharmacists, and occupational 
and physical therapists. The ITTP provides a structured approach to the 
delivery of health services by emphasizing the knowledge and skills 
needed to work in an interactive group. In addition, the program 
promotes an understanding of the roles and functions of other members 
of the team and how their collaborative contributions influence both 
the delivery and outcome of patient care.
    The ITTP has been activated at 12 VA medical centers. Two sites 
located at VA Medical Centers (VAMCs) Portland, Oregon, and Sepulveda, 
California, were designated in 1979. Three additional VA sites at 
Little Rock, Arkansas; Palo Alto, California; and Salt Lake City, Utah, 
were selected in 1980; and VAMCs Buffalo, New York; Madison, Wisconsin; 
Coatesville, Pennsylvania; and Birmingham, Alabama, were approved in 
1982. In the spring of 1983, three sites were selected at VAMCs Tucson, 
Arizona; Memphis, Tennessee; and Tampa, Florida.
    The purposes of the ITTP are to develop a cadre of health 
practitioners with the knowledge and competencies that are required to 
provide interdisciplinary team care to meet the wide spectrum of health 
care and service needs for veterans, to provide leadership in 
interdisciplinary team delivery and training to other VA medical 
centers, and to provide role models for affiliated students in medical 
and associated health disciplines. Training includes the teaching of 
staff and students in select VA priority areas of health care needs, 
e.g., geriatrics, ambulatory care, management, nutrition, etc.; 
instruction in team teaching and group process skills for clinical core 
staff; and clinical experiences in team care for affiliated education 
students with the core team serving as role models. During FY 1994, 
more than 168 students from a variety of health care disciplines were 
provided monetary support at the 12 model ITTP sites.

                       Advanced Practice Nursing

    Advanced Practice Nursing, i.e., master's level clinical nurse 
specialist and nurse practitioner training, is another facet of VA 
education programming in geriatrics. The need for specially trained 
graduate nurses is evidenced by the sophisticated level of care needed 
by VA patient populations, specifically in the area of geriatrics. 
Advanced nurse training is a high priority within VA because of the 
shortage of such nursing specialists who are capable of assuming 
positions in specialized care and leadership.
    The master's level Advanced Practice Nursing Program was 
established in 1981 to attract specialized graduate nursing students to 
VA and to help meet requirement needs in the VA priority areas of 
geriatrics, rehabilitation, psychiatric/mental health, adult health and 
critical care, all of which impact on the care of the elderly veteran. 
Direct funding support is provided to master's level nurse specialist 
students for their clinical practicum at the VA medical centers that 
are affiliated with the academic institutions in which they are 
enrolled. During FY 1994, 126 master's level advanced practice nursing 
student positions were supported at 48 VA medical centers: 35 in 
geriatrics, 1 in rehabilitation, 32 in psychiatric/mental/health, 25 in 
critical care, and 33 in adult health/med-surgery.

               VA Gerontological Nurse Fellowship Program

    Gerontological nursing has been a nursing specialty since the mid-
1960's. As society changes, particularly in terms of the demographic 
trend in aging, more attention is being focused on both the area of 
gerontological nursing and the education of nurses in this specialty. 
Doctoral-level nurse gerontologists are prepared for advanced clinical 
practice, teaching, research, administration, and policy formulation in 
adult development and aging.
    In FY 1985, a 2-year nurse fellowship program was initiated for 
registered nurses who are doctoral candidates, and whose dissertations 
have clinical research foci in geriatrics/gerontology. The first 
competitive review was conducted in 1986. One nurse fellow was selected 
for the FY 1986 funding cycle. Since that time, two nurse fellowship 
positions are available for selection at approved VA medical center 
sites each fiscal year.
    Initial appointments for nurse fellows are for 1 year. 
Reappointments of 1 additional year are subject to satisfactory first 
year's performance evaluations. It is anticipated that at least half of 
the participants who complete this VA fellowship will be recruited into 
VA.

         Expansion for Associated Health Training in Geriatrics

    A special priority for geriatric education and training is 
recognized in the allocation of associated health training positions 
and funding support to VA medical centers hosting GRECCs, and to VA 
medical centers (non-ITTG/GRECC sites) that offer specific educational 
and clinical programs for the care of older veterans. In FY 1994, a 
total of 211 associated health students received funding support at 71 
VA facilities in the following disciplines: Social Work, Psychology, 
Audiology/Speech Pathology, Clinical Pharmacy, Advanced Practice 
Nursing, Dietetics, and Occupational Therapy.

                     Employee Continuing Education

    In support of the VA's mission to provide health care to the aging 
veteran population, education and training continues to be offered to 
enhance VA medical center staff skills in the area of geriatrics. These 
educational activities are designed to respond to the needs of VA 
health care personnel throughout the entire Veterans Health 
Administration. Annually, funding is provided for employee education 
and distributed to two levels of the organization for support of 
continuing education activities in priority areas.
    First Level.--Funds are provided directly to each of the VA medical 
centers to meet the continuing education needs of its employees. VA 
Central Office also allocates funds for VAMC-initiated programs to 
allow health care facilities, with assistance from the Employee 
Education Network, to conduct education programs within the hospital to 
meet locally identified training needs. VAMC-initiated funds were used 
to support 23 separate activities specifically having geriatrics as the 
primary content.
    Second Level.--The Office of Academic Affairs, through the Employee 
Education Network, meets education needs by conducting programs at the 
regional and local medical center level. Examples of recent programs 
are:
          Dementia, Depression, and Addiction
          JCAHO-Long Term Care Standards
          Alzheimer's Dementia
          Nursing Role in Caring for the Older Adult
          Geriatric Treatment Update
          Suicide and Depression in the Elderly
          Identification and Treatment of Depression in the Elderly
          Issues Facing Older Women
          Elder Abuse
          Myths of Aging
          Geropharmacology
          Geriatric Care--Unresolved Problems
    Employee education programs are also conducted in cooperation with 
the GRECCs, which received $276,835 in training funds in fiscal year 
1994 to support their identified needs. This collaborative effort 
ensures the efficient use of existing resources to meet the increasing 
demands for training in geriatrics/gerontology.
    In response to systemwide training needs, National Training 
Programs were conducted during the year. Workshops were held for VA 
medical center health care staff on ``Medication Management in the 
Elderly,'' ``Long Term Care in Psychiatric Hospitals,'' and ``Nursing 
Home Care of the Mentally Ill.'' A ``Hospice Medicine'' medical 
videotape was produced and was released to all VA medical centers in 
December 1994.
    In addition, funds are provided to support continuing education 
experiences for the Geriatric Fellows and the Interdisciplinary Team 
Training Program staff members.
    The Office of Academic Affairs continues to work cooperatively with 
the Office of Geriatrics and Extended Care. A collaborative initiative 
was the printing and distribution of the updated ``Geriatric Pocket 
Pal,'' a supplemental reference guide for clinicians.

                Health Professional Scholarship Program

    The Scholarship Program was established in 1980 and funded from 
1982 through 1985 to assist in providing an adequate supply of nurses 
for the VA and the Nation. Beginning in 1988, the Scholarship Program 
was reactivated to provide scholarships to students in full-time 
nursing and physical therapy baccalaureate and master degree programs 
in certain specialties specified by VA.
    By FY 1990, additional scholarships were available to students 
enrolled in baccalaureate and master's degree occupational therapy 
programs, and students enrolled in their final year of associate degree 
nursing programs. In FY 1992, scholarships were available for students 
enrolled in master's degree nurse anesthetist programs. Beginning in 
1994, Respiratory Therapy scholarships became available through this 
program.
    Since the beginning of the program, 94 awards have been given to 
students studying for advanced master's degrees in gerontological 
nursing and occupational therapy. Of this number, 44 students have 
completed degrees and fulfilled their obligations by working as 
professionals in VA medical centers. Thirty of these professionals are 
still employed by VA. The remaining students are in the process of 
completing their degrees, completing their service obligations, or 
beginning their service obligation in the near future.

                           Learning Resources

    The widespread education and training activities in geriatrics have 
generated a broad spectrum of requirements for learning resources 
throughout the VA system. Local medical media services continue to 
provide thousands of audiovisual products that meet educational and 
clinical needs in the areas of geriatrics and gerontology. Local 
library services continue to perform hundreds of on-line searches on 
data bases such as MEDLINE and AGELINE (available through Bibliographic 
Retrieval Services), and continue to add books, journals, and 
audiovisuals on topics related to geriatrics and aging. OAA has 
produced and/or sponsored a number of satellite programs on Alzheimer's 
and other dementias. Taped copies of three of these satellite programs 
(``Diagnosis and Treatment of Alzheimer's Disease,'' ``Dental Care of 
Cognitively Impaired Older Adult: Prioritizing Service Needs,'' and 
``Progressive Aphasis: Overview and Case in Point'') can be obtained 
from the local Library Service at every VA medical center.

                 VII. Veterans Benefits Administration

                   compensation and pension programs
    Disability and survivor benefits such as pension, compensation and 
dependency and indemnity compensation administered by the Veterans 
Benefits Administration provide all, or part, of the income for 
1,720,880 persons age 65 or older. This total includes 1,247,117 
veterans, 453,758 surviving spouses, 17,705 mothers and 2,300 fathers.
    The Veterans' and Survivors' Pension Improvement Act of 1978, 
effective January 1, 1979, provided for a restructured pension program. 
Under this program, eligible veterans receive a level of support 
meeting a national standard of need. Pensioners generally receive 
benefits equal to the difference between their annual income from other 
sources and the appropriate income standard. Yearly cost of living 
adjustments (COLAs) have kept the program current with economic needs.
    This act provides for a higher income standard for veterans of 
World War I or the Mexican border period. This provision was in 
acknowledgement of the special needs of the Nation's oldest veterans. 
The current amount added to the basic pension rate is $1,819 as of 
December 1, 1994.
                      veterans assistance service
    Veterans Services Division personnel maintain liaison with nursing 
homes, senior citizen homes, and senior citizen centers in Regional 
Office areas. Locations are visited as the needs arises. Pamphlets and 
application forms are provided to personnel at these homes during 
visits and through frequent use of regular mailings. State and Area 
Agencies on Aging have been identified and are provided information 
about VA benefits and services through workshops and training sessions. 
Seminars are conducted for nursing home operators and other service 
providers that assist and serve elderly patients. Regional Office 
coordinators continue to serve on local and State task forces that deal 
extensively with the problems of the elderly.
    The elderly, as a group, encounter problems with transportation due 
to rising costs, limited income, and most importantly, physical 
ailments. Thus, Veterans Assistance Service continues to emphasize to 
veterans and dependents the use of the toll-free telephone service--
(800) 827-1000--as a means of contacting VA offices for information and 
assistance.
    A special list of aged beneficiaries has been furnished to Regional 
Office Veterans Services Divisions for individualized outreach use. 
Veterans and/or dependents are being contracted and provided with 
information and claims assistance on any additional VA benefits that 
may be applicable to them. One of the reasons for this outreach program 
is VA's concern that large numbers of older veterans who are ``at 
risk'' and, as such, may be unaware of the higher income limitations 
available under the pension program, i.e., housebound status and aid 
and attendance. VA is convinced that many are unaware of the impact of 
unreimbursed medical expenses on pension eligibility. The change 
resulting from the Omnibus Budget Reconciliation Act, regarding a 
veteran, without dependents, who is eligible for Medicaid and is in a 
Medicaid-approved nursing home, and may not receive improved pension in 
excess of $90 monthly, requires extensive explanation to the veterans, 
his or her family and the care provider. The Veterans Benefits Act of 
1992 has extended these same provisions to a surviving spouse without 
children. This law was signed on October 29, 1992, and has resulted in 
an increased amount of inquiries and requests from veterans and 
dependents to Regional Office Veterans Services Divisions for an 
explanation of their changed benefits.

               ITEM 31. TRANSMITTAL LETTERS FROM AGENCIES

                                                January 31, 1995.  
    Dear Mr. Chairman: I am pleased to submit to you the Federal 
Council on the Aging's Annual Report, the twenty-first such document 
provided to you and your predecessors.
    While the accompanying report may be lengthy and detailed, it 
reflects just a few of the many challenges we face with the aging of 
our society. Your leadership on the 1995 White House Conference on 
Aging underscores your commitment to seeking effective solutions to 
these challenges.
    Briefly, the Federal Council on the Aging is making our citizens 
conscious of the need to continue to be productive, no matter what the 
age. At the same time, we are identifying those instances where 
vulnerable older persons and their families may need assistance so that 
they are better able to help themselves live with dignity and respect.
    Your interest in our work has been of great help and we are 
grateful. We are making progress and with your encouragement we shall 
continue to do so.
            Respectfully Yours,
                                      John E. Lyle,
                                                  Chairman,
                                          Federal Council on Aging.
                                 ______
                                 
                                                January 18, 1995.  
    Dear Mr. Chairman: Enclosed is the information requested on the 
Department of Agriculture's activities or initiatives on behalf of 
older Americans and their families. If we can be of any further 
assistance, please feel free to contact us.
            Sincerely,
                               Richard E. Rominger,
                                          Acting Secretary,
                                         Department of Agriculture.
    Enclosures.
                                 ______
                                 
                                                  January 30, 1995.
    Dear Mr. Chairman: We are enclosing our report for 1994 for 
inclusion in Developments in Aging. The report includes programs 
relevant to the older population.
    If you need further information, please have a member of your staff 
call Mr. Anthony Black, Chief, Congressional Affairs Office, Bureau of 
the Census, on (301) 457-2171.
            Sincerely,
                                   Ronald H. Brown,
                                            Department of Commerce.
    Enclosure.
                                 ______
                                 
                                                  January 19, 1995.
    Dear Mr. Chairman: This is in response to your letter of November 
25, 1994, requesting information on what the Department of Defense has 
done on behalf of older Americans.
    I have enclosed a summary of eldercare activities that the 
Department of Defense has undertaken this past year. These activities 
are part of a continuum of special initiatives, developed over the past 
several years, to increase informational resources for military members 
and families facing eldercare issues. The summary also describes health 
care efforts for our elder beneficiaries.
    I hope that this information is helpful to you and to the Special 
Committee on Aging.
            Sincerely,
                                Carolyn H. Becraft,
                     Deputy Assistant Secretary of Defense,
               (Personnel Support, Families and Education),
                                             Department of Defense.
    Enclosure:
                                 ______
                                 
                                                January 13, 1995.  
    Dear Mr. Chairman: This is in reference to the Committee's letter 
of November 25 requesting the Department of Education's FY 1994 report 
chronicling activities on behalf of older Americans.
    I am pleased to transmit this summary to you for inclusion in the 
Committee's annual report entitled, Developments in Aging.
    If the Office of Legislation and Congressional Affairs can be of 
further assistance, please let me know.
            Sincerely,
                                    Kay Casstevens,
                                       Assistant Secretary,
                                           Department of Education.
    Enclosures
                                 ______
                                 
                                                  January 11, 1995.
    Dear Mr. Chairman: In response to your letter of November 25, 1994, 
the Department of Energy is providing a report of its current and 
planned activities of interest to older Americans. Our efforts focus on 
energy efficiency, information collection and dissemination, and 
research into the biological and physiological aspects of aging.
    The Department is proud of its activities and contributions on 
behalf of older Americans.
            Sincerely,
                                  Hazel R. O'Leary,
                                              Department of Energy.
    Enclosure.
                                 ______
                                 
                                                  January 30, 1995.
    Dear Mr. Chairman: On behalf of Secretary Shalala, I am submitting 
the Department of Health and Human Services' annual report for 1994 
summarizing the Department's activities on behalf of older Americans. 
We are pleased that we could be of assistance in developing this 
material for inclusion in Volume II of the Committee's annual report, 
Developments in Aging.
    I hope the enclosed information will be of value to the Committee. 
Should your staff need further assistance, the point of contact on my 
staff is Barbara Clark on 690-6311.
            Sincerely,
                                  Jerry D. Klepner,
                       Assistant Secretary for Legislation,
                           Department of Health and Human Services.
    Enclosures.
                                 ______
                                 
                                                    March 20, 1995.
    Dear Mr. Chairman: I am pleased to send you HUD's accomplishments 
in providing activities and initiatives to assist older Americans and 
their families during Fiscal Year 1994 for inclusion in Developments in 
Aging.
    With the elderly population the fastest growing group in the United 
States, the programs HUD develops and administers today are important 
for the future comfort of this expanding population. The Department is 
quite proud of the variety of approaches available in HUD programs 
which allow older Americans to maintain their independence, remain a 
part of the community, and live their lives with dignity and grace.
    If you have any questions regarding the attached information, 
please call William J. Gilmartin, Assistant Secretary for Congressional 
and Intergovernmental Relations at 202-708-0005.
            Sincerely,
                                 Henry G. Cisneros,
                       Department of Housing and Urban Development.
    Enclosure.
                                 ______
                                 
                                                    March 27, 1995.
    Dear Mr. Chairman: On behalf of Secretary Babbitt, I am submitting 
the Department of the Interior's report summarizing the Department's 
activities in support of older Americans. The Department is aware that 
the elderly make up the fastest growing segment of America's 
population. We at Interior believe that the welfare of our Nation's 
older citizens must be a matter of particular concern to each of the 
Department's employees. The Department's policies and practices are 
designed to assist older Americans in maintaining a comfortable and 
dignified life style so that they may remain an active part of their 
communities.
    I hope the enclosed information will be of help to our senior 
citizens and their families.
    I appreciate the Committee's interest in the programs of the 
Department of the Interior. Should your staff have any questions 
concerning the enclosed descriptive materials, please do not hesitate 
to contact E. Melodee Stith, Director, Office for Equal Opportunity at 
(202) 208-5693.
            Sincerely,
                                   Bonnie R. Cohen,
                               Assistant Secretary, Policy,
                                     Management and Budget,
                                            Department of Interior.
    Enclosure.
                                 ______
                                 
                                                   January 6, 1995.
    Dear Mr. Chairman: I am pleased to transmit in response to your 
request the submission of the Department of Justice for the Annual 
Report of the Special Committee on Aging entitled, Developments in 
Aging.
    The Office of Justice Programs (OJP) is the Department's primary 
resource for innovative programs to address the problem of crime 
against the elderly and to encourage older Americans to become involved 
in efforts to prevent crime in their communities. In addition, OJP's 
research and statistical bureaus work to increase our knowledge about 
the impact of crime on the elderly and the most effective ways to 
prevent and treat victimization. Two other OJP bureaus also sponsor 
programs related to the elderly. The Office for Victims of Crime (OVC) 
sponsors programs to improve the treatment of elderly and other crime 
victims, and the Office of Juvenile Justice and Delinquency Prevention 
(OJJDP) provides support for the National Alzheimer's Patient Alert 
Program.
    These and other initiatives are described in the enclosed report. 
If I can provide additional information or assistance, please contact 
this office.
            Sincerely,
                                 Sheila F. Anthony,
                                Assistant Attorney General,
                                             Department of Justice.
    Enclosure.
                                 ______
                                 
                                                    March 20, 1995.
    Dear Chairman: Enclosed is a summary of the programs and activities 
of the Department of Labor for Fiscal Year 1994 related to aging.
    Described in this report are programs administered by the 
Employment and Training Administration, the Pension and Welfare 
Benefits Administration, the Bureau of Labor Statistics, the Womens' 
Bureau, and the Employment Standards Administration.
            Sincerely,
                                   Robert B. Reich,
                                               Department of Labor.
    Enclosure.
                                 ______
                                 
                                                 December 30, 1994.
    Dear Mr. Chairman: I am writing in response to your November 25 
request for information about programs undertaken by the Department of 
State on behalf of older Americans. Foreign Service families face 
unique challenges when caring for elderly parents or other older 
relatives. Assisting mobile families as they attempt to provide 
adequately for their relatives, both those residing in the United 
States and those who have accompanied a member of the Service on an 
overseas assignment, is the focus of much of our programming. In 
addition, several programs and extensive counseling exist for Civil 
Service employees and Foreign Service personnel assigned to Washington, 
D.C. who have concerns about their elderly family members or who are 
themselves facing the need for additional care.
    Programs for older Americans are vitally important; I am pleased to 
have this opportunity to inform you of those offered by the Department 
of State.
    I hope this report is useful to you. Please do not hesitate to 
contact me if we can be of further assistance.
            Sincerely,
                                  Wendy R. Sherman,
                   Assistant Secretary Legislative Affairs,
                                               Department of State.
                                 ______
                                 
                                                   January 3, 1995.
    Dear Mr. Chairman: I am pleased to forward to you the enclosed 
report, which summarizes significant actions taken by the Department of 
Transportation during 1994 to improve transportation facilities and 
services for older Americans. The report is being sent in response to 
your letter to Secretary Pena, requesting information for Volume II of 
the Committee's annual report, ``Developments in Aging.''
    I hope you will find our submission helpful. Any questions about it 
can be directed to Dr. Ira Laster of my staff ((202) 366-4859).
            Sincerely,
                                   Frank E. Kruesi,
             Assistant Secretary for Transportation Policy,
                                      Department of Transportation.
    Enclosure.
                                 ______
                                 
                                                 February 10, 1995.
    Dear Mr. Chairman: I am pleased to submit, for inclusion in 
Developments in Aging, the Treasury's report on the Department's 
activities during 1994 which affected the aged. I hope our report will 
be of use to the Special Committee on Aging and others studying the 
challenges faced by older Americans.
            Sincerely,
                                   Robert E. Rubin,
                                            Department of Treasury.
    Enclosure.
                                 ______
                                 
                                                  January 19, 1995.
    Dear Mr. Chairman: This is in response to the letter from the 
Special Committee on Aging requesting information from the U.S. 
Commission on Civil Rights for the annual report entitled Developments 
in Aging.
    During FY 1994, the Commission continued to process complaints 
received from individuals alleging denials of their civil rights. 
Specifically, 33 complaints alleging discrimination on the basis of age 
were received by the Commission and referred to the appropriate agency 
for resolution.
    Should you or your staff desire any additional information from the 
Commission in preparation of the Aging Report, please do not hesitate 
to contact me on 202-376-7700.
            Sincerely,
                                   Mary K. Mathews,
                                            Staff Director,
                                        Commission on Civil Rights.
                                 ______
                                 
                                                 December 15, 1994.
    Dear Mr. Chairman: Enclosed, as you requested, is a report by the 
U.S. Consumer Product Safety Commission on activities to improve safety 
for older consumers.
    I appreciate the opportunity to submit this information to your 
committee.
            Sincerely,
                                         Ann Brown,
                                Consumer Product Safety Commission.
    Enclosure.
                                 ______
                                 
                                                  January 27, 1995.
    Dear Mr. Chairman: Thank you for your letter of November 25, 1994, 
requesting the Corporation for National and Community Service's report 
on our 1994 accomplishments for Volume II of the Senate Special 
Committee on Aging's annual report, Developments in Aging.
    Fiscal year 1994 was another very successful one for the Retired 
and Senior Volunteer Program (RSVP), Foster Grandparent Program (FGP), 
and Senior Companion Program (SCP) as these programs were merged into 
the new Corporation for National and Community Service created by 
passage of the National and Community Service Trust Act of 1993.
    In 1994, the Corporation continued cooperative efforts with a 
nationwide network of over 1,200 public and private sector agencies and 
organizations which operate projects at the local level. Almost half a 
million volunteers contributed approximately 115 million hours getting 
significant things done for their communities. Our accomplishments this 
year include:
          Participation at a White House Human Needs Forum,
          Launching the Senior Summer Corps which focused on issues of 
        public safety,
          Convening a Leadership Roundtable of prominent leaders in the 
        fields of aging and service to consider the future of senior 
        service in America, and
          Participation with the Administration on Aging to conduct 
        Leadership Training Institutes for representatives of 
        community-based organizations having a mission in service and 
        aging.
    The Corporation is very proud to submit the enclosed report on 
these programs.
            Sincerely,
                                      Eli J. Segal,
                                   Chief Executive Officer,
                    Corporation for National and Community Service.
    Enclosure.
                                 ______
                                 
                                                  January 28, 1995.
    Dear Mr. Chairman: This is in response to a November 25, 1994, 
letter from former Chairman David Pryor requesting an update on 
activities at the U.S. Environmental Protection Agency (EPA) for the 
annual report, ``Developments in Aging.'' As reported last year, EPA 
began a collaborative effort in 1988 with the World Health Organization 
(WHO) to review the existing knowledge on the effects of chemicals on 
the elderly. This effort, involving many international scientists, 
culminated in 1993 with the publication of the WHO Environmental Health 
Criteria 144, Principles for Evaluating Chemical Effects on the Aged 
Population. The report concluded that it is likely that the aged 
population is more susceptible to the harmful effects of environmental 
chemicals even though very few chemicals have been specifically tested 
for this outcome. This is likely for a variety of reasons including the 
intrinsic deterioration of physiological and psychological processes 
associated with aging, increased susceptibility because of age-
associated diseases, and other lifestyle changes (e.g., diet).
    Results from recent EPA research support the conclusion of the WHO 
report that the aged population is likely to be more susceptible to the 
harmful effects of environmental chemicals. These and other research 
results that address two primary issues in environmental health 
research, namely the direct effects of toxic chemicals on the aged and 
the effect of environmental exposures on the aging process, are 
summarized in the enclosure. This research is conducted at the EPA 
Health Effects Research Laboratory in Research Triangle Park, North 
Carolina.
            Sincerely,
                                  Carol M. Browner,
                                   Environmental Protection Agency.
    Enclosure.
                                 ______
                                 
                                                 December 15, 1994.
    Dear Mr. Chairman: On behalf of Chairman Casellas, I am responding 
to your November 25, 1994 request for the Equal Employment Opportunity 
Commission's (EEOC) submission for the committee's annual report, 
Developments in Aging.
    Enclosed are copies of fiscal year 1993 annual reports from EEOC's 
Office of General Counsel and Office of Program Operations. These 
reports contain information on EEOC's compliance and litigation 
enforcement efforts on behalf of victims of employment discrimination.
    Please call me at 663-4900 if I can be of further assistance.
            Sincerely,
                                   Claire Gonzales,
        Director of Communications and Legislative Affairs,
                           Equal Employment Opportunity Commission.
    Enclosures.
                                 ______
                                 
                                                  January 10, 1995.
    Dear Ms. LaRocca: This is in response to your letter requesting a 
summary of the activities undertaken by the Federal Communications 
Commission (FCC) on behalf of older Americans. I am pleased to report 
that we have expanded our outreach to recruitment activities. Through 
our contacts within organizations such as Forty Plus of Greater 
Washington we have been successful in employing several individuals who 
have brought great breadth of experience to the FCC.
    I hope this information is helpful and encourage you to call Sandra 
Canery, Chief of the EEO Staff, at (202) 418-0128, if you have any 
questions.
            Sincerely,
                                     Andrew Fishel,
                                         Managing Director,
                                 Federal Communications Commission.
                                 ______
                                 
                                                    March 31, 1995.
    Dear Mr. Chairman: I am pleased to forward the enclosed staff 
summary of Federal Trade Commission activities on behalf of older 
consumers and their families for fiscal year 1994. This report reflects 
the extent to which many of our law enforcement initiatives, while not 
specifically aimed at the older population, provide special benefits to 
this group.
    I hope this information will be helpful to the Committee. Please 
let me know if we can provide any additional assistance.
    By direction of the Commission.
                                   Donald S. Clark,
                                                 Secretary,
                                          Federal Trade Commission.
    Enclosure.
                                 ______
                                 
                                                 December 29, 1994.
    Dear Mr. Chairman: This report was prepared in response to the 
Committee's November 25, 1994, request for a compilation of our fiscal 
year 1994 products and ongoing work regarding older Americans and their 
families.
    As arranged with your office, we are sending copies of this report 
to interested congressional committees and subcommittees. Copies will 
also be made available to others on request.
    This report was prepared under the direction of Jane L. Ross, 
Director, Income Security Issues, who may be reached at (202) 512-7215 
if you have any questions. Other major contributors are listed in 
appendix V.
            Sincerely yours,
                                  Janet L. Shikles,
                             Assistant Comptroller General,
                                         General Accounting Office.
                                 ______
                                 
                                                 February 21, 1995.
    The Legal Services Corporation (LSC) is a private nonprofit 
corporation established by Congress to help provide equal access to 
justice under the law for all Americans. It receives funds annually 
from Congress and makes grants directly to local programs that provide 
civil legal assistance to those who would otherwise be unable to afford 
it.
    LSC currently provides funds to 323 programs operating in over 900 
neighborhood law offices. Together they serve every county in the 
Nation. Programs funded by LSC serve 1.7 million poor Americans a year 
in the areas of family, housing, income maintenance, and consumer law, 
to name just a few.
    However, please do not hesitate to contact me it you have any 
questions. Thank you once again.
                                James R. Lamb, Jr.,
                                Director of Communications,
                                        Legal Services Corporation.
                                 ______
                                 
                                                   Dec. 23, 1994.  
    Dear Chairman: I am pleased to report to you on the Fiscal Year 
1994 activities of the National Endowment for the Arts involving older 
Americans. Through technical assistance and funding, the Arts Endowment 
seeks to ensure that older adults have opportunities to participate in 
and enjoy the best of our Nation's art as creators, educators, 
administrators, volunteers, students and audiences.
    This year marked the first government sponsored nationwide arts 
conference, ART-21: Art Reaches Into the 21st Century, that was 
convened in Chicago on April 14-16, 1994. Over 1,100 artists, arts 
administrators, educators, foundation leaders and government policy 
makers at the Federal, State, and local levels from across the country 
came together to discuss the status of American culture. This landmark 
forum included breakout sessions on a variety of topics, all centered 
around moving the arts into the 21st century. One such session, 
``Reaching Special Constituencies,'' featured artist Eleanor Schrader 
from Elders Share the Arts (ESTAR) in Brooklyn, New York. She 
emphasized the critical need for older adults to be involved in the 
best art, and discussed ESTAR's wide variety of programs including. 
``Pearls of Wisdom,'' their senior theater group.
    Further, the Endowment worked in partnership with the National 
Assembly of State Arts Agencies (NASAA) to produce the most 
comprehensive arts access book published to date, Design for 
Accessibility: An Art Administrator's Guide. The overall theme of the 
book is universal design: designing spaces and programs that 
accommodate individuals throughout their lifespan. This 700-page Guide 
should help thousands of cultural organizations in making their 
facilities and programs more available to older adults and citizens 
with disabilities. We are distributing 3,500 free copies of the Guide 
to grantees through the State arts agencies, and it is being marketed 
by NASAA.
    The report that follows provides a description of our efforts to 
support increased participation in the arts by older Americans. I am 
grateful for the opportunity to present the Special Committee on Aging 
with this overview of the Arts Endowment's work in progress for older 
adults.
            Sincerely,
                                    Jane Alexander,
                                                  Chairman,
                                   National Endowment for the Arts.
    Enclosure.
                                 ______
                                 
                                                    March 14, 1995.
    Dear Mr. Chairman: I am pleased to enclose a report summarizing the 
activities of special significance to older Americans supported by the 
National Endowment for the Humanities in fiscal year 1994.
    Many of the projects that received Endowment support during the 
past year involved older Americans as grant recipients or project 
contributors or were of particular interest to them. Several NEH-
sponsored programs for the general public specifically addressed older 
persons as an audience, but most of the programs for television and 
radio, the museum exhibitions, and the reading and discussion programs 
in local libraries that the Endowment supported were conveniently 
accessible to older Americans for their personal enjoyment and 
enrichment.
    The state humanities councils have also been very active in 
developing programs for or about the aging, and a number of their 
efforts are summarized in the report. Anyone wishing further 
information on the State councils' activities in this area is invited 
to contact NEH or any one of the councils.
    I hope that you and your Committee will find this material useful. 
Please let me know if we can be of any further assistance.
            Sincerely,
    Enclosure.
                                   Sheldon Hackney,
                                                  Chairman,
                             National Endowment for the Humanities.
                                 ______
                                 
                                                 January 9, 1995.  
    Dear Mr. Chairman: This is in response to your November 25, 1994, 
letter to Dr. Lane.
    The Foundation's activities related to aging have not changed 
materially since I reported to you last year. As you may recall, I 
mentioned that the National Science Foundation does not have any 
research programs focused specifically on problems confronting the 
older members of our population. However, I also went on to say that 
some projects funded at NSF have implications for enhancing the well-
being of this population. In particular, most of the projects having a 
tangential bearing on aging would tend to be supported through the 
Division of Integrative Biology and Neuroscience in the Directorate for 
Biological Sciences; the Social, Behavioral and Economic Sciences 
Directorate; and the Division of Bioengineering and Environmental 
Systems in the Engineering Directorate.
    I have enclosed a copy of the report submitted last year which 
discusses in more detail our activities related to aging. As indicated 
above, this report is still up to date.
    If you have additional questions, please do not hesitate to call 
me. I look forward to receiving a copy of the annual report on aging.
            Sincerely,
                                   Cora B. Marrett,
                                        Assistant Director,
                                       National Science Foundation.
    Enclosure.
                                 ______
                                 
                                                    March 30, 1995.
    Dear Mr. Chairman: I am pleased to send you the enclosed copy of 
the Pension Benefit Guaranty Corporation's Annual Report for Fiscal 
Year 1994.
    For PBGC and the working people it protects, 1994 was a very 
productive and successful year. Under the leadership of President 
Clinton, and with the bipartisan support of the Congress, our yearlong 
efforts in support of comprehensive pension reforms were rewarded with 
enactment of the Retirement Protection Act. Our negotiations and 
enforcement efforts led to notable successes. PBGC's deficit fell and, 
with the new reforms, the Corporation will remain on a sound financial 
basis.
    Now that the reforms are law, workers and employers can have 
greater confidence in a stronger pension system and in PBGC.
            Sincerely,
                                      Martin Slate,
                                        Executive Director,
                              Pension Benefit Guaranty Corporation.
    Enclosure.
                                 ______
                                 
                                                 December 29, 1994.
    Dear Mr. Chairman: This responds to your letter requesting 
information from the Postal Service on activities and programs which 
assist elderly Americans.
    The enclosed document describes Postal Service programs which are 
designed to meet the mailing needs of older Americans and prevent them 
from being victimized by mail fraud.
    The Postal Service is pleased to contribute to this endeavor and 
will continue to develop programs to assist in improving the quality of 
life for the aging.
            Best regards,
                                     Marvin Runyon,
                                                    Postal Service.
                                 ______
                                 
                                               December 23, 1994.  
    Dear Mr. Chairman: In response to your letter of November 25, 1994, 
we are enclosing a report summarizing the U.S. Railroad Retirement 
Board's program activities for the elderly during fiscal year 1994.
    We look forward to your committee's report, Developments in Aging: 
1994. If we can be of further assistance, please feel free to contact 
the Secretary to the Railroad Retirement Board, Bea Ezerski, at (312) 
751-4920.
            Sincerely,
                                   Glen L. Bower,
                                   V. M. Speakman, Jr,
                                   Jerome F. Kever,
                                         Railroad Retirement Board.
    Enclosure.
                                 ______
                                 
                                                 December 22, 1994.
    Dear Mr. Chairman: Thank you for asking the U.S. Small Business 
Administration (SBA) to provide information to the Special Committee on 
Aging's annual report, Developments in Aging (DIA). The mission of this 
Agency has not changed since our report to you last year. The SBA is 
charged with the responsibility to create, implement and deliver 
technical and financial assistance programs for the benefit of the 
Nation's small business community. We currently do not have a program 
that gives specific focus to older Americans.
    However, the SBA is the sponsoring Federal agency for the Service 
Corps of Retired Executives (SCORE) program. SCORE is an organization 
of nearly 13,000 business men and women who volunteer their time to 
provide management counseling and training to small businesses. They 
have extensive business experience, either as entrepreneurs and 
business owners or as former corporate executives. Their counseling is 
confidential and free of charge and is provided at more than 800 
locations in the United States and its territories.
    I hope the information provided is beneficial in the development of 
the Committee's annual report for 1994.
            Sincerely,
                             Dorothy D. Kleuchulte,
       (For Mary Jean Ryan, Associate Deputy Administrator,
                           Office of Economic Development),
                                     Small Business Administration.
                                 ______
                                 
                                                     March 6, 1995.
    Dear Mr. Chairman: Enclosed is a report of the Department of 
Veterans Affairs' activities on behalf of older persons for the fiscal 
year 1994.
    VA has developed a high quality system that provides health care 
for thousands of elderly veterans every day. Meeting the medical needs 
of older veterans constitutes one of VA's current greatest challenges.
    Thank you for allowing us the opportunity to share this information 
with you.
            Sincerely yours,
                                       Jesse Brown,
                                                  Veterans Affairs.
    Enclosure.

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