[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
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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\
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\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.
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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.
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\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.
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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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