[Senate Report 108-265]
[From the U.S. Government Publishing Office]



108th Congress                                            Rept. 108-265
                                 SENATE
 2nd Session                                                   Volume 2
======================================================================


 
                  DEVELOPMENTS IN AGING: 2001 AND 2002
                                VOLUME 2

                               ----------                              

                                A REPORT

                                 of the

                       SPECIAL COMMITTEE ON AGING
                          UNITED STATES SENATE

                              pursuant to

               S. RES. 66, SEC. 17(c), FEBRUARY 26, 2003

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

 


                  May 14, 2004.--Ordered to be printed



108th Congress                                            Rept. 108-265
                                 SENATE
 2nd Session                                                   Volume 2
======================================================================


                  DEVELOPMENTS IN AGING: 2001 AND 2002
                                VOLUME 2

                               __________

                                A REPORT

                                 of the

                       SPECIAL COMMITTEE ON AGING

                          UNITED STATES SENATE

                              pursuant to

               S. RES. 66, SEC. 17(c), FEBRUARY 26, 2003

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

 


                  May 14, 2004.--Ordered to be printed

                                 -----

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108th Congress 



                       SPECIAL COMMITTEE ON AGING

                      LARRY CRAIG, Idaho, Chairman
RICHARD SHELBY, Alabama              JOHN B. BREAUX, Louisiana, Ranking 
SUSAN COLLINS, Maine                     Member
MIKE ENZI, Wyoming                   HARRY REID, Nevada
GORDON SMITH, Oregon                 HERB KOHL, Wisconsin
JAMES M. TALENT, Missouri            JAMES M. JEFFORDS, Vermont
PETER G. FITZGERALD, Illinois        RUSSELL D. FEINGOLD, Wisconsin
ORRIN G. HATCH, Utah                 RON WYDEN, Oregon
ELIZABETH DOLE, North Carolina       BLANCHE L. LINCOLN, Arkansas
TED STEVENS, Alaska                  EVAN BAYH, Indiana
RICK SANTORUM, Pennsylvania          THOMAS R. CARPER, Delaware
                                     DEBBIE STABENOW, Michigan
                      Lupe Wissel, Staff Director
            Michelle Easton, Ranking Member, Staff Director

                                  (ii)


                         LETTER OF TRANSMITTAL

                              ----------                              

                                       U.S. Senate,
                                 Special Committee on Aging
                                              Washington, DC, 2004.
Hon. Dick Cheney,
President, U.S. Senate,
Washington, DC.
    Dear Mr. President: Under authority of Senate Resolution 66 
agreed to February 26, 2003, I am submitting to you the annual 
report of the U.S. Senate Special Committee on Aging, 
Developments in Aging: 2001 and 2002, 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 2001 and 2002 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,
                                             Larry Craig, Chairman.

                                 (iii)


                            C O N T E N T S

                              ----------                              
                                                                   Page
Letter of Transmittal............................................   III
    Item 1. Department of Agriculture............................     1
    Item 2. Department of Commerce...............................    16
    Item 3. Department of Defense................................    38
    Item 4. Department of Education..............................    45
    Item 5. Department of Energy.................................    53
    Item 6. Department of Health and Human Services..............    59
    Item 7. Department of Housing and Urban Development..........   483
    Item 8. Department of the Interior...........................   496
    Item 9. Department of Justice................................   510
    Item 10. Department of State.................................   519
    Item 11. Department of Transportation........................   521
    Item 12. Department of the Treasury..........................   533
    Item 13. Consumer Product Safety Commission..................   553
    Item 14. Corporation for National and Community Service......   557
    Item 15. Equal Employment Opportunity Commission.............   595
    Item 16. Environmental Protection Agency.....................   637
    Item 17. Federal Communications Commission...................   640
    Item 18. General Accounting Office...........................   645
    Item 19. Legal Services Corporation..........................   701
    Item 20. Pension Benefit Guaranty Corporation................   702
    Item 21. National Endowment for the Arts.....................   748
    Item 22. Postal Service......................................   764
    Item 23. Railroad Retirement Board...........................   772
    Item 24. Social Security Administration......................   777
    Item 25. Veterans' Affairs...................................   789




108th Congress                                            Rept. 108-265
                                 SENATE
 2nd Session                                                   Volume 2
======================================================================

                  DEVELOPMENTS IN AGING: 2001 AND 2002

                                VOLUME 2

                                _______
                                

                  May 14, 2004.--Ordered to be printed

                                _______
                                

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

                              R E P O R T

              Report from Federal Departments and Agencies

                          ITEM 1--AGRICULTURE

                              ----------                              

    U.S. Department of Agriculture (USDA) agencies assist older 
Americans through a number of programs in areas such as 
housing; community facilities and services; health care; food 
safety education; food assistance; diet, nutrition, and health 
research; and use of information technology for lifelong 
learning. These agencies and their programs are highlighted 
below.

                         RURAL HOUSING SERVICE

    Programs of USDA's Rural Housing Service (RHS) of interest 
to older people and their families include those dealing with 
housing, community facilities, and rural economic development.

                          MULTI-FAMILY HOUSING

    USDA's Rural Housing Service offers several programs that 
provide funding for rental properties intended for very low-, 
low-, and moderate-income rural residents. More than $11.9 
billion in subsidized credit has been provided to developers of 
affordable rental housing. Two programs serve older American 
communities: the Section 515 Rural Rental Housing program and 
the Section 538 program.
    The Section 515 Rural Rental Housing (RRH) program was 
implemented in 1962 by the signing of the Senior Citizen 
Housing Act of 1962 (Public Law 87-723). The purpose of this 
program is to provide affordable rental housing for rural 
families and older people who have very low to moderate 
incomes. The RRH program also provides funds to build 
congregate housing and group homes, recognizing that the 
housing needs of older Americans change as they get older. 
Properties built for older Americans typically contain 
community rooms where the delivery of services at the property 
may be accomplished. In most instances, the Section 515 RRH 
program is responsible for the bulk of affordable rental 
housing in small towns. The program allows older Americans the 
opportunity to remain in their communities, close to family and 
friends.
    In fiscal year (FY) 2002, RHS provided more than 176,000 
rental assistance units for older Americans, and funding for 
renewals of rental assistance for older Americans exceeded $225 
million. A total of 72 new rental assistance units were 
available in FY 2002 to older Americans.
    RHS continues to increase outreach efforts to aid rural 
older Americans. An existing Memorandum of Understanding with 
the Administration on Aging currently is being amended to put 
greater emphasis on ensuring that the physical, mental, and 
emotional needs of older Americans residing in Multi-Family 
Housing complexes are met.
    The Multi-Family Housing section also appreciates the site 
managers of the complexes that are in the portfolio. Each year 
in both the family and elderly categories, site managers are 
nominated for the Site Manager of the Year award. In FY 2002, 
because of a tie, two site managers of elderly complexes 
received this award. The selection is based upon tenant 
satisfaction with the manager; the curb appeal of the property; 
accurate and complete record keeping, with no incidents of 
noncompliance; and whether the actions of the manager are 
consistently above and beyond what is required.
    The Section 538 program was first authorized in 1996. It 
provides guarantees to private and public lenders for loans 
made to developers of rental housing in rural areas. The 
program does not have deep tenant subsidies, and therefore the 
primary beneficiaries are low- and moderate-income rural 
residents. A significant segment of seniors has incomes that 
are too high for many affordable housing programs, yet too low 
to access market rate housing in appreciating markets. The 
Section 538 program provides a solution to this problem.
    In June 2001, the Agency entered into a Memorandum of 
Understanding with Freddie Mac, allowing Freddie Mac to partner 
in the development of a secondary market for the program. To 
date, the program has guaranteed funds to partner in the 
development of 2,285 units, with another 4,261 expected to be 
built.

                COMMUNITY FACILITIES DIRECT LOAN PROGRAM

    The Community Facilities Direct Loan Program provides loans 
to public bodies, Indian tribes, and nonprofit corporations to 
assist eligible rural communities in providing essential 
community facilities and services to citizens. Many of these 
loans provide facilities and services to older rural Americans. 
Funded projects that primarily provide assistance to older 
Americans are listed below.
    In 2001, the Agency provided direct loan financing for:
           Ten nursing homes, totaling $23,283,600
           Twenty-two assisted living facilities, 
        totaling $13,650,600
           Twenty-one hospitals, totaling $32,206,700
           Eight rehabilitation centers, totaling 
        $3,233,650
           Five medical office buildings, totaling 
        $3,972,000
           Three adult day care centers, totaling 
        $492,300
           Six special transportation vehicles, 
        totaling $1,164,880
    In 2002, the Agency provided direct loan financing for:
           Ten nursing homes, totaling $14,453,000
           Seventeen assisted living facilities, 
        totaling $9,786,500
           Twenty-two hospitals, totaling $50,500,150
           Two rehabilitation centers, totaling 
        $3,325,000
           Eight medical office buildings, totaling 
        $8,518,700
           Four adult day care centers, totaling 
        $610,970
           Two special transportation vehicles, 
        totaling $551,000

                   COMMUNITY FACILITIES GRANT PROGRAM

    The Community Facilities Grant Program makes grants to 
eligible public bodies, Indian tribes, and nonprofit applicants 
to assist in providing essential community facilities and 
services to residents. These are made as both stand-alone 
grants and in coordination with direct loans. Funded projects 
that primarily provide assistance to older Americans are listed 
below.
    In 2001, the Agency provided grant funds for:
           Five nursing homes, totaling $295,410
           Five assisted living facilities, totaling 
        $474,970
           Eight hospitals, totaling $741,180
           One rehabilitation center for $52,700
           Three medical office buildings, totaling 
        $707,500
           Four adult day care centers, totaling 
        $128,650
           Thirteen special transportation vehicles, 
        totaling $379,650
    In 2002, the Agency provided grant funds for:
           Four assisted living facilities, totaling 
        $172,900
           Eleven hospitals, totaling $692,420
           Three rehabilitation centers, totaling 
        $209,770
           Three medical office buildings, totaling 
        $2,761,400
           Six adult day care centers, totaling 
        $285,605
           Five special transportation vehicles, 
        totaling $95,470

              COMMUNITY FACILITIES GUARANTEED LOAN PROGRAM

    The Community Facilities Guaranteed Loan Program provides 
loan guarantees on loans provided by other lenders to eligible 
public entities, Indian tribes, and nonprofit applicants to 
finance essential community facilities and services in eligible 
rural areas. Guaranteed loan projects of substantial interest 
to aging Americans are listed below.
    In 2001, the Agency provided loan guarantees for the 
following:
           Five nursing homes, totaling $8,520,000
           Nine assisted living facilities, totaling 
        $7,657,000
           Ten hospitals, totaling $22,850,000
           One rehabilitation center for $650,000
           Two medical office buildings, totaling 
        $800,000
    In 2002, the Agency provided loan guarantees for the 
following:
           Four nursing homes, totaling $2,475,000
           Four assisted living centers, totaling 
        $3,945,000
           Eight hospitals, totaling $12,821,815
           Two rehabilitation centers, totaling 
        $400,000
           Three medical office buildings, totaling 
        $1,791,750

                ECONOMIC IMPACT INITIATIVE GRANT PROGRAM

    The Economic Impact Initiative Grant Program is a special 
allocation program that provides grants to eligible rural areas 
with extreme economic depression. Extreme economic depression 
is defined as a community having a Department of Labor "not 
employed" rate of 19.5 percent or greater. Eligible applicants 
compete nationally for funds. Those funded projects that 
primarily affect older Americans are listed below.
    In 2001, the Agency provided funds for:
           Two nursing homes, totaling $263,000
           One boarding home for the elderly for 
        $402,210
           Two assisted living facilities, totaling 
        $417,000
           One hospital, totaling $50,000
           One medical office building for $591,000
           One food preparation distribution center for 
        $75,000
           One planning grant for a nursing home of 
        $16,500
    In 2002, the Agency provided funds for:
           Two assisted living facilities, totaling 
        $133,900
           Four hospitals, totaling $345,000
           Two medical office buildings, totaling 
        $2,661,400
           Four adult day care centers, totaling 
        $265,605
           Two food preparation distribution centers, 
        totaling $71,600

SPECIAL DISASTER COMMUNITY FACILITIES LOAN AND GRANT PROGRAMS (LIMITED 
 TO AREAS OF NORTH CAROLINA AFFECTED BY HURRICANES DENNIS, FLOYD, AND 
                                 IRENE)

    Under a special funding allocation, the Agency provided 
direct loans and grants to assist in rebuilding eligible rural 
communities in North Carolina damaged by Hurricanes Dennis, 
Floyd, and Irene. The funded projects that assisted aging 
Americans in rural North Carolina are listed below.
    In 2001, the Agency made loans and grants as follows:
           One nursing home grant for $8,000
           Four hospital loans totaling $7,609,500 and 
        three grants totaling $440,000
           Two adult day care loans totaling $235,000 
        and one grant for $20,000
           One special transportation vehicle loan for 
        $62,180 and three grants totaling $80,250
    In 2002, the Agency made loans and grants as follows:
           One hospital grant for $87,500
           One rehabilitation loan for $2,725,000 and 
        one grant for $200,000
           One medical office building loan for 
        $886,000 and one grant for $100,000

     RURAL COMMUNITY DEVELOPMENT INITIATIVE-HOME-BASED HEALTH CARE 
                          COOPERATIVE PROJECT

    The Community Programs section is offering a new home 
health care demonstration program, currently under development, 
to encourage the establishment of home health care provider 
cooperatives. The goal of the program is to promote the 
creation of home health care service models that will improve 
working conditions for service providers, increase workforce 
stability, and establish new ideas for home health care 
services.
    Part One of the project is for preplanning grants to 
promote and develop home health care provider cooperatives. 
These grants will be awarded to eligible nonprofit 
organizations and public bodies. Competition will be at the 
national level.
    Part Two of the project is for grants to establish and fund 
revolving loans that will be awarded to eligible nonprofit 
organizations or public bodies to provide technical assistance 
to preplanning grantees and the cooperatives created from this 
program. The grantees also will process and administer 
revolving loans to these cooperatives for their start-up and 
operating costs. Competition will occur at the national level.

                         SINGLE FAMILY HOUSING

    RHS offers a grant program exclusively for homeowners over 
the age of 62 to help them make essential repairs to their 
homes. The Section 504 Home Repair grant program began serving 
elderly, limited-income households in 1950. Since that time, 
the program has provided more than one-half billion dollars to 
allow more than 130,000 older rural Americans to remain in 
their own-decent-homes.
    Section 504 grant funds may be used only to pay for 
essential repairs or improvements that remove health and safety 
hazards or improve access. Eligible homeowners must live in an 
eligible rural area and must have a Very Low Income (less than 
50 percent of the median for the area). They must be unable to 
afford a loan from RHS or other sources. Funds are most often 
used for replacing roofs, updating unsafe electrical systems, 
installing furnaces, and providing features such as wheelchair 
ramps and easily accessible bathrooms.
    The program provides assistance to rural residents with 
great need who are often seeking help for the first time. The 
average income of households receiving grants in FY 2002 was 
less than $8,900.
    Women and minorities receive a substantial share of the 
Section 504 grants. More than two-thirds (69.3 percent in FY 
2001, the latest year for which data are available) of the 
grantees are women. Many are widowed. A total of 38 percent of 
those receiving grants in FY 2002 were minorities. This 
compares to a rural minority population of 13.2 percent. (Note: 
This is based on the U.S. Census Bureau definition of 
``rural.'' ``Minority'' includes all persons, except those 
``white, not Hispanic or Latino,'' as reported by Census 2000.)

                   FOOD SAFETY AND INSPECTION SERVICE

    USDA's Food Safety and Inspection Service (FSIS) provides 
food safety education and advice that is designed to address 
the needs and concerns of older Americans. A variety of 
educational approaches are used to reach this group.

                    EDUCATIONAL PROGRAM FOR SENIORS

    In 2001 and 2002, the Food Safety and Inspection Service 
continued distribution of a unique consumer publication and 
companion video tailored to the needs of seniors. Developed 
jointly with the Food and Drug Administration, "To Your Health, 
Food Safety for Seniors" targets behaviors most likely to 
result in foodborne illness in seniors. It also provides basic 
information on safe food handling, including refrigerator 
storage charts and cooking temperature charts.
    The four-color, 17-page publication is printed in large 
(14-point) type and is designed to be read easily by older 
eyes. The format and presentation were developed with guidance 
from AARP and the National Institutes of Health.
    Since its release in 2000, approximately 500,000 copies of 
this publication and 50,000 copies of the video have been 
distributed. The document also is accessible on the Internet 
(http://www.foodsafety.gov/fsg/sr2.html). Printed copies are 
available in Spanish.

                 ONGOING FOOD SAFETY ADVICE FOR SENIORS

    To help communicate the importance of safe food handling 
for seniors, all news releases issued by FSIS include a boxed 
feature with safe food handling advice for at-risk audiences. 
The Food Safety Education staff also develops special features 
and fact sheets designed to help educate seniors about safe 
food handling. These materials can be accessed on the Internet 
(http://www.fsis.usda.gov/OA/pubs/consumerpubs.htm).

      COOPERATIVE STATE RESEARCH, EDUCATION, AND EXTENSION SERVICE

    The Cooperative State Research, Education, and Extension 
Service (CSREES) has provided $4.5 million to fund a project 
that represents the first multi-site, long term study to 
document- concurrently-the safety, effectiveness, and optimal 
dosage of soy isoflavone supplementation to prevent bone loss 
in postmenopausal women. The project will provide consumers and 
their primary care physicians with science based information to 
enable them to make an informed decision on the use of a 
dietary supplement to prevent osteoporosis. Preventing 
osteoporosis will, in turn, help to reduce health care costs.
    With approximately 20 million American women already 
afflicted with osteoporosis and approximately 76 million baby 
boomers reaching 50, the total cost of U.S. health care is 
projected to surpass $16 trillion in 2030. This phenomenal 
health care cost is driven largely by the expense of caring for 
older Americans who have lost the ability to live 
independently. Osteoporosis is among the major causes of loss 
of independence.
    Although hormone replacement therapy has been shown to be 
effective in reducing the risk of bone fracture, prolonged 
usage has been documented to increase the risks of breast 
cancer, endometrial cancer, and ovarian cancer. Soy 
isoflavones, with chemical structures similar to specific 
estrogen receptor modulators such as tamoxifen, have been shown 
to reduce bone loss in short term studies.
    Over the last 4 years, CSREES has supported studies of the 
prevention of degenerative diseases typically experienced by 
older Americans. A pair of projects at Kansas State University 
and one at the University of Maryland focused on the eye. Two 
projects tested the theory that increased antioxidant 
consumption reduces the incidence of age-related macular 
degeneration. The other examined how the eye repairs itself 
with an enzyme, protein kinase C gamma. This work has important 
implications for persons with diabetes, who are at increased 
risk of cataracts and blindness.
    Seniors in rural communities, where health resources are 
growing scarcer, are doing online assessments of their personal 
health situations. This Internet-based research helps seniors 
compare health behaviors identified by the U.S. Department of 
Health and Human Services with self-administered health 
profiles using the Internet. The research project is being 
supported by CSREES and the National Library of Medicine, 
working with State and local Cooperative Extension educators 
and 4 H youth who help seniors use the Internet-based health 
assessment and outreach system CyberHealth as well as with 
CyberSeniors.org. Early results suggest that senior and youth 
health behaviors are being influenced positively by 
participation in CyberHealth training.
    A program called CyberSeniors CyberTeens, sponsored by 
USDA, has helped thousands of seniors learn to use information 
technology to improve family communications and to provide 
access to lifelong learning through the Internet. The initial 
program originated with youth teaching seniors. Now 20,000 
seniors and youth make up Tech Teams that teach others in their 
communities to learn to use computers and the Internet. CSREES 
has provided national leadership to public-, private-, and 
nonprofit-sector partners, with ``tech-savvy'' 4 H members in 
21 States and American Samoa. National 4 H, USDA, the 
Department of Health and Human Services, the Department of 
Veterans Affairs, AARP, and CyberSeniors.org have partnered to 
build the CyberSeniors CyberTeens Intergenerational CyberSkills 
partnership.
    CSREES supported a ``Nutrition and Health Information 
Survey'' that was pilot tested, administered, and analyzed by 
the Pennsylvania State University Survey Research Center to 
assess (1) how nutrition and health resources and information 
reach the elderly in Appalachia and (2) attitudes of elderly 
persons toward nutrition/health and nutrition/health education. 
The information from this venture soon will be presented in 
national nutrition/health conferences for consideration by 
similar communities. This information also will be offered for 
publication in food, nutrition, and health journals.

                     AGRICULTURAL MARKETING SERVICE

    The Agricultural Marketing Services facilitates the 
accessibility of agricultural products to older Americans by 
promoting and developing wholesale, collection, farmers, and 
direct markets. The support provided for these markets has made 
fresh, nutritious foods available in communities where older 
Americans previously have not had access to such products. The 
number of farmers markets has increased from 1,755 in 1994 to 
more than 3,147 in 2003.

                       ECONOMIC RESEARCH SERVICE

    The Economic Research Service (ERS) identifies research and 
policy issues relevant to the elderly population from the 
perspective of rural development. Ongoing research looks at 
demographic and socioeconomic characteristics of the older 
population by rural-urban residence. Current research examines 
rural-urban differences in health and access to health care for 
the elderly, based on data from the Current Population Survey 
and National Health Interview Survey. In the past year, ERS 
participated in the Interagency Forum on Aging-Related 
Statistics and reviewed proposals for the Office of Rural 
Health Policy's Rural Health Analytic Research Center 
Cooperative Agreement Program.

              PUBLICATIONS ON THE ELDERLY IN RURAL AMERICA

    ERS released the following publications on issues faced by 
older Americans in rural America:
    Fugitt, Glenn V., Calvin L. Beale, and Stephen J. Tordell. 
``Recent Trends in Older Population Change and Migration for 
Nonmetro Areas, 1970-2000.'' Rural America, Volume 17, Issue 3, 
Fall 2002, pp. 11-20.
    Gale, Fred. ``The Graying of the Farm Sector: The Legacy of 
Off-Farm Migration.'' Rural America, Volume 17, Issue 3, Fall 
2002, pp. 28-31.
    Reeder, Richard J. and Samuel Calhoun. ``Federal Funding in 
Nonmetro Elderly Counties.'' Rural America, Volume 17, Issue 3, 
Fall 2002, pp. 20-27.
    Rogers, Carolyn C. ``Implications of Medicare Restructuring 
for Rural America.'' Rural America, Volume 17, Issue 2, Summer 
2002, pp. 37-43.
    Rogers, Carolyn C. ``Rural Health Issues for the Older 
Population.'' Rural America, Volume 17, Issue 2, Summer 2002, 
pp. 30-36.
    Rogers, Carolyn C. ``The Older Population in 21st Century 
Rural America.'' Rural America, Volume 17, Issue 3, Fall 2002, 
pp. 2-10.
    ERS also conducts research on policy issues relevant to the 
food choices, health, and nutrition of the elderly population. 
Current research identifies the dietary needs of older 
Americans, the changes in food consumption and expenditure that 
will arise from an aging population, food safety risks faced by 
the elderly, and ways in which USDA's food and nutrition 
assistance program can better serve older Americans.

           PUBLICATIONS ON DIET, HEALTH, AND NUTRITION ISSUES

    ERS released the following publications on diet, health, 
and nutrition issues faced by older Americans:
    Blisard, Noel, Biing-Hwan Lin, John Cromartie, and Nicole 
Ballenger. ``America's Changing Appetite: Food Consumption and 
Spending to 2020.'' FoodReview, Volume 25, Issue 1, Spring 
2002, pp. 2-9.
    Buzby, Jean C. ``Older Adults at Risk of Complications from 
Microbial Foodborne Disease.'' FoodReview, Volume 25, Issue 2, 
Summer/Fall 2002, pp. 30-35.
    Cromartie, John C. ``Population Growth and Demographic 
Change, 1980-2020.'' FoodReview, Volume 25, Issue 1, Spring 
2002, pp. 10-12.
    Guthrie, Joanne and Biing-Hwan Lin. ``Overview of the Diets 
of Lower and Higher Income Elderly and Their Food Assistance 
Options.'' Journal of Nutrition Education and Behavior, Volume 
34, March-April 2002, pp. S31-S41.
    Guthrie, Joanne F. and Biing-Hwan Lin. ``Older Americans 
Need to Make Every Calorie Count.'' FoodReview, Volume 25, 
Issue 2, Summer/Fall 2002, pp. 8-13.
    Harris, J. Michael and Noel Blisard: ``Food Spending and 
the Elderly.'' FoodReview, Volume 25, Issue 2, Summer/Fall 
2002, pp. 14-18.
    Nord, Mark. ``Food Security Rates are High for Elderly 
Households.'' FoodReview, Volume 25, Issue 2, Summer/Fall 2002, 
pp. 19-24.
    Rogers, Carolyn C. ``America's Older Population.'' 
FoodReview, Volume 25, Issue 2, Summer/Fall 2002, pp. 2-7.
    Wilde, Parke and Elizabeth Dagata: ``Food Stamp 
Participation by Eligible Older Americans Remains Low.'' 
FoodReview, Volume 25, Issue 2, Summer/Fall 2002, pp. 25-29.

                       FOOD AND NUTRITION SERVICE

    USDA's Food and Nutrition Service (FNS) addresses the needs 
of older Americans and their families through a number of 
programs, including the Food Stamp Program, the Commodity 
Supplemental Food Program, the Food Distribution Program on 
Indian Reservations, the Child and Adult Care Food Program, The 
Emergency Food Assistance Program, the Nutrition Services 
Incentive Program, and the Senior Farmers' Market Nutrition 
Program. Each is summarized briefly below.

                           FOOD STAMP PROGRAM

    The Food Stamp Program (FSP) provides monthly benefits to 
help low-income families and individuals purchase a more 
nutritious diet. In FY 2002, $18 billion in food stamps was 
provided to a monthly average of 19 million persons.
    Households with elderly members accounted for approximately 
19 percent of the total food stamp caseload. However, since 
these households were smaller, on average, and had relatively 
higher net income, they received only 7 percent of all benefits 
issued.
    The FSP has been at the forefront of efforts to reduce 
hunger and food insecurity among the elderly. Key 
accomplishments are highlighted below.
Program Changes in the Farm Bill To Benefit the Elderly
    During FY 2002, the Farm Bill (P.L. 107-171) reauthorized 
and made several changes to the FSP that will help elderly 
participants. The most direct benefit to the elderly came 
through the restoration of eligibility to disabled legal 
immigrants and all legal immigrants in the country for at least 
5 years. A number of important changes, such as simplification 
of income deductions, will help all participants, including the 
elderly. Other provisions, such as $5 million grants for access 
and outreach and having applications on the Internet, will help 
to improve access for elderly people.
One-Stop Application Demonstrations for Supplemental Security Income 
        (SSI) and FSP Participants
    FNS continues to work closely with the Social Security 
Administration (SSA) to meet the legislative objectives of the 
Combined Application Project (CAP) for SSI households. The CAP 
demonstrations improve the delivery of food assistance to the 
elderly and disabled by streamlining the food stamp application 
process for recipients of SSI. The initial CAP project, the 
South Carolina Combined Application Project (SCCAP), was 
implemented in 1995 and still is in operation. Under the 
demonstration, one-person SSI households have their eligibility 
for food stamps and their benefit amounts determined by 
automatic utilization of data collected by SSA during the SSI 
interview. This information is transferred electronically to 
the State food stamp office through SSA's State Data Exchange 
system. If the individual is determined eligible for SSI, a 
food stamp case is opened automatically for that person. 
Individuals, therefore, do not need to file a separate food 
stamp application or have any contact with the food stamp 
office. A recent evaluation of SCCAP indicates that the 
demonstration has been successful in increasing food stamp 
participation among the elderly.
    In 2001, FNS and SSA expanded the CAP demonstration to two 
additional States, Mississippi and Washington. A year later 
(September 2002), Texas implemented a variation of CAP-a 
Special Nutrition Assistance Project focusing on outreach. SSI 
applications are not automatically certified for food stamps 
based on their SSI data. Rather, the State agency uses SSA data 
to identify individuals who are receiving SSI but who are not 
participating in food stamps and provides them with streamlined 
food stamp application procedures (e.g., shortened application 
and no face-to-face interview).
    In December 2002, FNS and SSA began working on further 
expanding the number of State agencies operating CAP 
demonstrations. On December 31, 2002, plans were announced to 
expand the standard CAP projects to three additional States 
over the next year. In addition to these three, as many States 
as possible will be allowed to operate the modified version 
used in Texas.
Pilots of Alternative Approaches To Improve Service to Elderly 
        Participants
    Approximately $2 million in grants was awarded in 2001 to 
six State food stamp agencies (Florida, Maine, Michigan, 
Arizona, Connecticut, and North Carolina) to conduct elderly 
nutrition pilot projects. The purpose of these pilots is to 
test three different approaches to eliminate barriers to 
participation in the FSP by eligible persons age 60 years and 
older.
    The three approaches are: (1) simplification of eligibility 
and benefit determination rules, (2) one-on-one assistance with 
the application process, and (3) an optional commodity 
alternative that provides a monthly food package instead of 
food stamps. The pilots began operating in FY 2002 and will run 
until the end of FY 2004.
    Mathematica Policy Research is evaluating the pilots 
independently under a contract with the Economic Research 
Service. Early findings suggest that participation increased in 
the two pilots that began in early FY 2002. In the Florida 
counties testing the simplified rules approach, elderly 
participation grew by over 5 percent, adjusting for trends in 
comparison counties. In the Maine site testing the application 
assistance approach, elderly participation increased 29 percent 
over the comparison county.
Enhanced Efforts To Reach Elderly People as Part of Broader Access and 
        Outreach Initiatives
    FNS has a wide range of efforts underway, including:
           Development of a guide, ``Help for the 
        Elderly and Disabled: A Primer for Enhancing the 
        Nutrition Safety Net for the Elderly and Disabled,'' 
        which was distributed to appropriate agencies and 
        organizations. The purpose of this guide is to (1) 
        assist State policymakers and others in understanding 
        the special rules embedded in the Food Stamp Act of 
        1977 (as amended) and the FSP regulations for elderly 
        and disabled individuals, (2) assist States and others 
        in identifying participation barriers that elderly and 
        disabled people face in seeking nutrition assistance 
        through the FSP, and (3) assist States and others in 
        identifying possible outreach activities available to 
        increase participation among elderly and disabled 
        people.
           An educational campaign with the theme of 
        ``Food Stamps Make America Stronger'' to increase 
        awareness of the FSP among target audiences, including 
        the elderly. Bilingual posters and fliers, some 
        featuring elderly persons, are available free via an 
        easy-to-use online ordering form. CD-ROMs also are 
        available for local organizations that wish to 
        customize the materials for their community.
           A bilingual toll-free information number (1-
        800-221-5689), which is available 24 hours a day. 
        Callers are sent a packet of information about the 
        program and are connected to State toll-free numbers, 
        if available, for more detailed information.
           Award of $3 million in research grants in 
        January 2001 and $5 million in September 2002 to 
        improve FSP access through partnerships and new 
        technology. The purpose of the grants is to explore 
        various strategies to reach potentially eligible 
        households and to educate people eligible for food 
        stamps who are not currently participating in the FSP 
        about the benefits of the program and how to apply for 
        these benefits. One of the target populations for these 
        grants is the elderly.

                  COMMODITY SUPPLEMENTAL FOOD PROGRAM

    The Commodity Supplemental Food Program (CSFP) provides 
supplemental foods, in the form of commodities, and nutrition 
education to infants and children up to age 6; pregnant, 
postpartum and breastfeeding women; and elderly people (at 
least 60 years of age) 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 
exceeded those needed to serve women, infants, and children. In 
FY 2002, nearly $71 million was spent on the elderly component.
    About 72 percent of total program spending provides 
supplemental food to more than 350,000 elderly participants a 
month. Older Americans are served by 23 of the 23 eligible 
State agencies.

            FOOD DISTRIBUTION PROGRAM ON INDIAN RESERVATIONS

    The Food Distribution Program on Indian Reservations 
(FDPIR) provides commodity packages to eligible households, 
including households with elderly persons, living on or near 
Indian reservations. Under this program, commodity assistance 
is provided in lieu of food stamps.
    Approximately $26 million of total costs went to households 
with at least one elderly person in FY 2002. (This figure was 
estimated using a 1990 study that found that approximately 39 
percent of FDPIR households had at least one elderly 
individual.)
    The program serves approximately 43,000 households with 
elderly participants per month.

                   CHILD AND ADULT CARE FOOD PROGRAM

    The Child and Adult Care Food Program (CACFP) provides 
Federal funds to initiate, maintain, and expand nonprofit food 
service for children, the elderly, or impaired adults in 
nonresidential institutions that 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 for 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 FY 2002, $57 
million was spent on the adult day care component.
    Under the adult day care component of CACFP, nearly 45 
million meals and supplements were served to more than 82,000 
participants per day in FY 2002.
    In 1993, the National Study of the Adult Component of CACFP 
was completed. Some of the major findings of the study include 
the following:
           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 the Federal poverty guidelines.
           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.

                 THE EMERGENCY FOOD ASSISTANCE PROGRAM

    The Emergency Food Assistance Program (TEFAP) provides 
nutrition assistance in the form of commodities to emergency 
feeding organizations, including food pantries, which 
distribute food to low-income households for household 
consumption and to soup kitchens, which provide meals to low-
income households.
    In FY 2002, Congress appropriated $150 million for TEFAP-
$100 million for commodities and $50 million for administrative 
support for State and local agencies.
    A follow-up study on clients of TEFAP providers estimated 
that in 2001, approximately 25 percent of the 4.3 million 
households receiving food from food pantries contained an 
elderly member. Of the 1.1 million individuals served by soup 
kitchens, 15 percent were elderly.

                  NUTRITION SERVICES INCENTIVE PROGRAM

    The Nutrition Services Incentive Program (NSIP) rewards 
effective performance by States and Tribal organizations in the 
efficient delivery of nutritious meals to older individuals 
through the use of cash or commodities. As amended by the Older 
Americans Act of 2000, the NSIP is the new name for USDA's cash 
or commodity program, formerly known as the Nutrition Program 
for the Elderly.
    The NSIP is based on a new formula grant rather than the 
old reimbursement model. Under the 2000 amendments, the NSIP 
cash or cash and commodity allocation to a State agency on 
aging, or to a Tribal organization, is based on the number of 
meals actually served in the previous year in relation to the 
total number of meals actually served by all States or Tribes 
in the previous year.
    The Consolidation Appropriations Act (2003) amended the 
Older Americans Act of 1965 to transfer program appropriations 
for NSIP, as well as the responsibility for the allocation of 
resources in the program, from USDA to the U.S. Department of 
Health and Human Services. However, the legislation still 
allows participating NSIP local agencies to choose to receive 
all or part of their allocations in USDA commodities. USDA 
remains responsible for the ordering, purchase, and delivery of 
commodities to these agencies.
    In FY 2001, USDA provided reimbursement for an average of 
21 million meals a month at a cost of almost $150 million.

                SENIOR FARMERS' MARKET NUTRITION PROGRAM

    The Senior Farmers' Market Nutrition Program (SFMNP) is a 
new program in which grants are provided to States, United 
States territories, and Federally recognized Indian tribal 
governments to provide low-income seniors with coupons that can 
be exchanged for eligible foods (fresh, nutritious, unprepared, 
locally grown fruits, vegetables, and herbs) at farmers' 
markets and roadside stands and through community-supported 
agriculture programs. The SFMNP also is intended to increase 
the consumption of agricultural commodities by expanding, 
developing, or aiding in the development and expansion of 
domestic farmers' markets, roadside stands, and community-
supported agriculture programs.
    State agencies were awarded grants through the competitive 
grant process when the SFMNP was begun as a pilot program in FY 
2001 and in FY 2002. The SFMNP was given permanent status under 
Public Law 107-171, the Farm Security and Rural Investment Act 
of 2002, and the USDA Food and Nutrition Service is now 
developing regulations to establish the SFMNP as one of the 
agency's permanent nutrition assistance programs. This 
legislation also earmarks an annual $15 million out of 
Commodity Credit Corporation (CCC) funds for FY 2003-2007 and 
gives the Department of Agriculture authority to develop 
program regulations.
    In FY 2002, just over 500,000 seniors received and used 
SFMNP coupons to purchase eligible foods at authorized farmers' 
markets and roadside stands and through community-supported 
agriculture programs. In FY 2002, eligible foods were available 
from more than 10,000 farmers at 1,500 farmers' markets and 
1,000 roadside stands as well as through more than 200 
community-supported agriculture programs.
    Nutrition education, also an important component of the 
SFMNP, is provided in a variety of forms to all program 
recipients.

               CENTER FOR NUTRITION POLICY AND PROMOTION

    During calendar years 2001 and 2002, Center for Nutrition 
Policy and Promotion (CNPP) staff participated in a number of 
research activities related to the elderly. In particular, this 
research focused on diet quality, hydration status, physical 
activity, and health-related issues of aging.
    The following is a list of publications (P) and 
presentations (PR) prepared by CNPP staff to report this 
research:
    2001
    Gerrior, S.A. ''Fat Intake and Anthropometric Measures of 
Physically Active Older Women.'' American College of Sports 
Medicine Annual Meeting, Baltimore, MD. May 2001. (PR)
    Gerrior, S.A. ``Body Composition and Nutrient Intake of 
Older Male Exercisers.'' SCAN (Sports, Cardiovascular and 
Wellness Nutritionists) Annual Conference, Washington, DC. July 
2001. (PR)
    2002
    Basiotis, P.P., Carlson, A., Gerrior, S.A. Juan, W.Y., and 
Lino, M. (Authors in alphabetical order.) (2002). ``The Healthy 
Eating Index: 1999-2000.'' U.S. Department of Agriculture, 
Center for Nutrition Policy and Promotion, CNPP-12. December 
2002. (Section on people over 50 years of age.) (P)
    Gaston, N., and Munroe, S.G. ``Directory of Nutrition and 
Aging Web Sites.'' Journal of Nutrition Education and Behavior 
34: Supplement 1; S59-S64 March/April 2002. (P)
    Gerrior, S.A. ``The Nutrient and Anthropometric Status of 
Physically Active and Inactive Older Adults.'' Journal of 
Nutrition Education and Behavior 34: Supplement 1; S5-13 March/
April 2002. (P)
    Gerrior, S. ``Dietary Intake and Physical Activity in 
Women: Changes with Age.'' Annual Meeting of the Society for 
Nutrition Education, St. Paul, MN. July 2002. (PR)
    Hiza, H.A.B, and Juan, W. ``Categories of Reported Intakes 
and Prevalence of Chronic Disease Risk Factors in Adult 
Females.'' Meeting of the Society for Nutrition Education, St. 
Paul, MN. July 2002. (PR)
    Juan, W., and Hiza, H.A.B. ``Vitamin Supplementation and 
Health Indicators Among Elderly Women.'' American Public Health 
Association. Philadelphia, PA. November 2002. (PR)
    Hiza, H.A.B, and Juan, W. ``Categories of Reported Intakes 
and Prevalence of Chronic Disease Risk Factors in Adult 
Males.'' American Public Health Association. Philadelphia, PA. 
November 2002. (PR)
    Juan, W., and Basiotis, P.P. ``More Than One in Three Older 
Americans May Not Drink Enough Water.'' Nutrition Insights, 
Insight #27. September 2002. (P)



                     ITEM 3--DEPARTMENT OF DEFENSE

                              ----------                              


                               Healthcare

    During this reporting period, the Floyd D. Spence National 
Defense Authorization Act (NDAA) for Fiscal Year (FY) 2001 
significantly changed the healthcare coverage offered by the 
Department of Defense to its Medicare-eligible beneficiaries. 
The NDAA for FY2001 directed the implementation of TRICARE For 
Life and the TRICARE Senior Pharmacy Program, which are the 
most dramatic modifications to military health care coverage 
since the establishment of the Civilian Health and Medical 
Program of the Uniformed Services in 1965.
    TRICARE is the health plan for uniformed services 
beneficiaries. It is a regionally organized managed care 
program that integrates the military health facilities of the 
Army, Navy and Air Force and supplements the care that these 
facilities offer with civilian networks of providers.
    Prior to the NDAA for FY2001, the Department of Defense 
sought ways to enhance its services to its age 65 and over 
beneficiaries through four demonstration programs: TRICARE 
Senior Prime, the Federal Employees Health Benefits 
Demonstration Program, the TRICARE Senior Supplement 
Demonstration and MacDill 65. These programs tested 
alternatives to expand healthcare coverage to Medicare-eligible 
beneficiaries through Medicare reimbursement of military 
treatment facilities, opening access to the Federal Employees 
Health Benefits Program, expanding pharmacy options, and 
offering supplemental coverage to Medicare. More than 44,000 
beneficiaries participated in these programs. Many of the 
demonstration programs' benefits were incorporated into the 
implementation of TRICARE For Life and the TRICARE Senior 
Pharmacy Program.
    On April 1, 2001, the Department of Defense began offering 
senior beneficiaries age 65 and over a prescription drug 
benefit through the TRICARE Senior Pharmacy Program. Through 
this program, eligible beneficiaries may use the mail order 
pharmacy program, network retail and non-network retail 
pharmacies. Beneficiaries who turned 65 before April 1, 2001, 
do not have to be enrolled in Medicare Part B to receive 
benefits under the TRICARE Senior Pharmacy Program. Those who 
turn 65 on or after April 1, 2001, must be enrolled in Medicare 
Part B in order to use the mail order and retail pharmacy 
benefits under this program. Medications through the mail order 
and retail pharmacies require a nominal copayment of $3 for 
generic and $9 for branded medications; by mail order, patients 
may receive up to a 90-day supply for this amount, and in the 
network retail pharmacies they may receive up to a 30-day 
supply for this amount. The non-network retail pharmacies cost 
a bit more. In addition to the TRICARE Senior Pharmacy Program, 
senior beneficiaries age 65 and over may continue to use the 
military pharmacies at no cost to them, as they did before the 
new pharmacy program was implemented. Between April 1, 2001, 
and July 31, 2003, more than 39 million prescriptions have been 
filled for our Medicare-eligible beneficiaries at a value of 
approximately $2.1 billion.
    Beginning October 1, 2001, TRICARE For Life was implemented 
as a secondary payer program to Medicare. In most cases, 
TRICARE For Life beneficiaries have no additional payments or 
claims to process. To participate, these beneficiaries must be 
eligible for Medicare Part A and enrolled in Medicare Part B. 
They may continue to seek care from their Medicare providers 
and have TRICARE pick up the cost of their deductible, co-
payments and other costs not paid by Medicare. TRICARE also 
covers any TRICARE benefit that Medicare does not offer. Out-
of-pocket expenses for these beneficiaries include a nominal 
co-payment for medications and Medicare Part B fees. TRICARE 
For Life brings to the senior military retirees and their 
eligible dependents a health benefit that is unparalleled. It 
provides low-cost access to an extraordinary range of 
healthcare benefits, and offers choice in selection of 
providers. Since October 1, 2001, TRICARE For Life has received 
more than 63.1 million claims from more than 1.7 million 
individual beneficiaries. To date (September 8, 2003) during 
fiscal year 2003, 33.1 million claims have been field. As of 
August 2003, claims this fiscal year total approximately $1.1 
billion for Medical/Surgery (not including all adjustments).
    The National Defense Authorization Act for Fiscal Year 2002 
provided direction to the Department for a skilled nursing 
facility benefit and prospective payment system that would 
align with the Medicare benefit and payment system. We 
anticipate implementation of the Defense program in the 2003.
    For beneficiaries under age 65, TRICARE offers three 
choices for health care delivery: TRICARE Prime, TRICARE Extra, 
and TRICARE Standard.
    TRICARE Prime, a voluntary enrollment option, offers 
patients the advantage of primary care management, assistance 
in making speciality appointments, and additional preventive 
and primary care services. For eligible beneficiaries, TRICARE 
Prime is generally the least expensive option.
    TRICARE Extra allows eligible beneficiaries to receive an 
out-of-pocket discount when using preferred network providers. 
Eligible beneficiaries who do not enroll in TRICARE Prime may 
participate in Extra on a case-by-case basis just by using 
network providers. Beneficiaries selecting TRICARE Extra do 
incur deductibles and co-payments.
    TRICARE Standard offers comprehensive healthcare coverage 
from any authorized provider. Beneficiaries selecting this 
option incur deductibles and co-payments at a slightly higher 
rate than those selecting TRICARE Extra.
    All active duty members enroll in TRICARE Prime without 
cost to the member. Family members, survivors and retirees 
under the age of 65 may enroll in TRICARE Prime. Retirees and 
their family members pay a small enrollment fee and incur 
nominal co-payments for care received from network providers. 
Care received in military treatment facilities is without cost 
to beneficiaries; for those not enrolled in TRICARE Prime, care 
in military treatment facilities is received on a space-
available basis.

                       FEDERAL CIVILIAN PROGRAMS

    There are a number of Federal government-wide programs and 
flexibilities in place that are designed to support aging 
employees in the workplace and in preparation for retirement as 
well as to assist employees in concurrently managing their 
elder care and work responsibilities. In addition, many 
Department of Defense (DoD) Agencies provide tailored local 
programs. Below is a description of some of the Federal and DoD 
unique programs and flexibilities.
Government-wide Programs
    Elder Care.--The average of a Department of Defense (DoD) 
civilian employee is 46.5 years and the average of the Federal 
full-time civilian employee is 45.6 years. Moreover, an 
increasing number of these employees face the challenges and 
responsibilities of caring for an aging family member or 
friend. To assist employees in carrying out this task, the 
Office of Personnel Management developed a Handbook of Elder 
Care Resources for the Federal Workplace. This handbook was 
developed to introduce employees and their agencies to the 
various services and resources that are available to help 
individuals make informed elder care decisions. From choosing 
an assisted living arrangement to dealing with the complexities 
of social security income, this Handbook provides practical 
tips and solutions to these complicated aging issues.
    The Handbook describes a variety of community resources 
that are offered around the country to help older adults 
function independently and discusses housing options, financial 
and medical considerations, nursing homes, and home health care 
agencies. It also provides a listing of:
           Federal and National Elder Care 
        Organizations;
           Area Agencies on Aging; and
           State Long-Term Care Ombudsman Offices.
    The handbook is available at http://www.opm.gov/wrkfam/
elder02.asp.
    Alternate Work Schedule.--Alternate Work Schedule (AWS) 
programs enable managers and supervisors to meet their program 
goals while, at the same time, allowing employees more 
flexibility in scheduling their personal activities. AWS 
programs encompass both flexible work schedules and compressed 
work schedules. AWS programs allow employees to compress their 
work hours into eight or nine days of a 10-day work period. 
This permits employees to have one or two off-days during a pay 
period. Flexible work schedules permit employees to report to 
work at any time within a specific time period. Both compressed 
and flexible work schedules allow employees to gain greater 
control over their time. Employees can use that time to balance 
work and family responsibilities more easily, become involved 
in volunteer activities, and take advantage of educational 
opportunities.
    Telework.--Telework is an alternative work arrangement for 
employees to conduct all or some of their work away from the 
primary workplace. The work location might be a residence, a 
telecenter, an office closer to the employee's residence, or 
another acceptable location. The telework schedule may be fixed 
or episodic. Telework programs allow eligible employees to 
participate in telecommuting to the maximum extent possible 
without diminished employee performance. Telework allows 
employees greater flexibility to balance their personal and 
professional duties. It also allows both management and 
employees to cope with the uncertainties of potential 
disruptions in the workplace.
    Long Term Care.--The Federal Long Term Care Insurance 
(FLTCI) Program was implemented in 2002. This program allows 
employees, retirees and their eligible family members to 
include spouses, parents, parents-in-law and stepparents to 
purchase insurance at group rates to cover the costs of care 
needed for individuals with ongoing illnesses or disabilities. 
It also provides coverage for care needed by those with severe 
cognitive problems like Alzheimer's disease. FLTCI provides 
reimbursement for care provided by home health care aids, as 
well as care provided in a nursing home or assisted living 
facility. Employees who apply for and are approved for coverage 
can use the program to help them coordinate care for elderly 
relatives, receive discounts on certain long term care services 
or supplies, and provide advice and support to the employee as 
caregiver.
    Retirement.--Federal employees are covered under either the 
Civil Service Retirement System (CSRS) or the Federal Employees 
Retirement System (FERS) depending on when they entered Federal 
service.
           CSRS is a defined benefit system that 
        provides full retirement benefits at age 55 with 30 
        years' of service, at age 60 with 20 years' service, or 
        at age 62 with at leave five years' service. 
        Involuntary retirement can occur with reduced benefits 
        at any age after 25 years' service, or at age 50 with 
        20 years' service. In such cases, an employee's annuity 
        is normally reduced by 2 percent for each year under 
        age 55. An employee contributes 7.0 percent of pay to 
        the CSRS. Annuity benefits are based on an average of 
        the highest three years of salary. The annuity formula 
        provides for 1.5 percent of average salary for the 
        first five years of service, 1.75 percent of average 
        salary for the next five years, and 2 percent per year 
        for any remaining service up to a maximum 80 percent of 
        average salary.
           FERS is a three-tiered plan consisting of a 
        defined benefit element, social security, and thrift 
        savings plan (TSP). The defined benefit element under 
        FERS is calculated using 1 percent of the employee's 
        highest average pay over a three-year consecutive 
        period multiplied by the number of years' of service. 
        If the employee retires at age 62, or later, with at 
        least 20 years of service, a factor of 1.1 percent is 
        used rather than 1 percent. Employees who retire before 
        age 62 qualify for a Special Retirement Supplement that 
        equals the Social Security benefit they will receive 
        upon reaching age 62. This benefit is eliminated once 
        Social Security is received. FERS employees contribute 
        7.65 percent toward their defined benefit element and 
        Social Security with option to contribute more towards 
        TSP. Agency contributions to an employee's TSP account 
        amount to 1 percent of basic pay for each pay period. 
        Employees can contribute up to 13 percent of their 
        salary into TSP with agency matching funds up to 4 
        percent. Employees are eligible to retire with 30 years 
        of service.
    Thrift Savings Plan.--The Thrift Savings Plan is a 
retirement and savings plan for Federal employees and military 
members. The program is similar to the 401(k) programs offered 
by many private corporations. The program allows individuals to 
contribute a percentage of their salary tax-deferred to a 
savings plan that is managed by a proficient and well-managed 
government organization. The earnings on the TSP contributions 
are allowed to grow tax deferred.
           Employees covered by the Federal Employees 
        Retirement System (FERS) receive, each pay period, an 
        automatic contribution to their thrift savings account 
        equal to one percent of their basic pay. In addition, 
        the agency provides matching contributions, dollar-for-
        dollar for the first three percent of salary that 
        employees invest, and 50 cents on the dollar for the 
        next two percent of salary invested.
           The government match for FERS employee 
        contributions is considered quite generous and has 
        resulted in enhanced recruiting and retention within 
        the Department of Defense. Many experienced mid-career 
        individuals, who might otherwise not consider a Federal 
        career, have accepted Federal positions because of the 
        government contribution and matching TSP payments. 
        Participants in the program are able to amass 
        significant retirement savings that they might not 
        otherwise accrue. At retirement individuals have 
        several options for receiving their account balances or 
        they may leave their TSP funds in the program until age 
        70\1/2\, at which point they must begin making 
        withdrawals under Internal Revenue Service rules for 
        tax-deferred retirement savings plans.
DoD Programs
    Some DoD agencies such as the Air Force, Navy, Army and Air 
Force Exchange Service, Defense Threat Reduction Agency, 
Defense Logistics Agency, Defense Security Service, Uniformed 
Services University of the Health Sciences supplement the 
Federal Programs mentioned above with local programs and 
activities such as Eldercare fairs/seminars; monthly support 
groups with guest speakers who talk about adult care, medicare/
medicaid, retirement and estate planning; Employee Assistance/
Referral programs dedicated to assisting employees with elder 
care problems; flexible work schedules to better accommodate 
individual elder care needs; and, retiree councils and 
transition services.
    Air Force developed a comprehensive Eldercare section on 
the Air Force Crossroads website. (See http://
www.afcrossroads.com/html/eldercare/index.cfm.) The site was 
developed for older adults, concerned family members, or for 
those interested in the issues of eldercare and the elderly. 
The website includes information on topics ranging from 
Alzheimer's to Social Security. The website includes hyperlinks 
to National Hotlines, Eldercare organizations, resources 
available to the elderly, State contacts, and other selected 
sources related to aging.
    Defense Logistics Agency's (DLA) Quality of Life, Family 
Support Program offers a robust eldercare program to meet the 
needs of DLA military and civilian employees. DLA Life 
Connections, provided through Federal Occupational Health and 
the company Life Care.com, helps employees to more effectively 
manage their life events, to include a wide range of eldercare 
issues. Convenient for DLA employees, DLA Life Connections 
services are available 24 hours a day, seven days a week by 
either a 1-800 number answered by a professional-staffed call 
center or through internet web access. In addition to online 
tools, there are educational resources including printed 
material and kits to help manage eldercare issues. DLA Life 
Connections services include:
           Searches for elder care resources nationwide 
        including home health care agencies, long-term care 
        facilities, assisted living centers, and hospice care;
           Information on retirement communities;
           Information for caregivers including 
        assessing the needs of a loved one, evaluating care 
        options, home safety for seniors, respite care and 
        more;
           Checklists to help individuals evaluate 
        eldercare facilities and providers;
           A disease and conditions index that enables 
        users to access information on diseases that affect 
        seniors;
           Information on financing care including 
        government-sponsored programs such as Medicare, 
        Medicaid, Social Security, as well as private-pay 
        options. Referrals are provided for Elder Law 
        Attorneys, Hospice Facilities, Hospice Home Care and 
        Funeral Services;
           Educational materials on Retirement and 
        Estate Planning, Helping Others Cope with Grief, 
        Helping Children Cope with Grief, Grief and 
        Bereavement, Funerals: A Consumer's Guide; and
           Information on organizing personal affairs, 
        powers of attorney, healthcare treatment directives, 
        living wills, estate planning, and wills and trusts.
    Upon request, DLA Life Connections provides a popular adult 
care kit, which helps people manage eldercare issues. The kit 
contains helpful information and products designed specifically 
to help seniors or their family members manage their daily 
living.
    In addition to the services available through DLA Life 
Connections, the Quality of Life Family Advocacy Program (FAP) 
offers workshops and sessions that vary widely to fit the needs 
of DLA's diverse population. These sessions include information 
on recognizing and preventing elder care abuse, protecting the 
elderly, communicating with the elderly and adult development. 
Subjects of other workshops include Alzheimers, dementia, elder 
care law, and Grandparents Raising Grandchildren that explores 
and addresses the challenges and needs faced by grandparents 
raising grandchildren. The Family Advocacy Program also 
sponsors a caregivers support group that meets quarterly at 
which numerous eldercare topics are discussed.
    The Defense Distribution Depot Susquehanna, Pennsylvania 
(DDDSP) FAP offers monthly one-hour sessions for the military 
and DoD civilian community on eldercare issues. A FAP-
contracted eldercare expert who is on the Social Work faculty 
of a nearby college conducts these sessions, which vary from 
open-ended to topic-driven. Occasionally, guest speakers like 
elder law attorneys, financial planners, or funeral directors 
supplement these sessions. In addition to marketing these 
offering, the DDDSP FAP maintains a resources library of 
eldercare materials to assist personnel with their care giving 
challenges.
    Uniformed Services University of the Health Sciences 
(USUHS) has some unique benefits available to employees covered 
under its Administratively Determined (AD) pay system. The 
following are some of the benefits that are of particular 
interest to the aging:
           Faculty Retirement System. Specifically, 
        USUHS has a 403(b) retirement system similar to TSP, 
        except that the University contributes 10 percent of 
        the employee's salary. The retirement age and 
        provisions mirror those of an IRA. One provision of 
        this retirement system is a Salary Reduction Agreement 
        (SRA), which allows an AD employee covered under TIAA-
        CREF or Fidelity to make additional voluntary tax-
        deferred contributions to his/her retirement or 
        investment accounts through the SRA. Employees covered 
        under FERS or CSRS are not eligible.
           Long Term Disability: An AD employee covered 
        under TIAA-CREF or Fidelity is covered under the Long 
        Term Disability Insurance plan. The employer and the 
        employee share the cost (Agency pays 50 percent & the 
        employee pays 50 percent of the premium). Employees 
        covered under FERS or CSRS are not eligible.
           Continued Academic Affiliation after 
        Retirement: The University allows employees who have 
        retired to continue to participate and contribute to 
        the University as emeritus faculty. USUHS provides 
        office and laboratory space for these individuals and 
        other administrative support. Many retired faculty have 
        chosen to volunteer time at the University to remain 
        productive by providing research, mentoring, and 
        lecturing.
           USUHS, as a Health Sciences University 
        conducts research and makes this research available to 
        the public. In addition, USUHS periodically holds 
        public seminars and lectures on a wide variety of 
        health-related topics such as diabetes, hypertension 
        and weight management.
        
        

                      ITEM 5--DEPARTMENT OF ENERGY

                              ----------                              


                              INTRODUCTION

    The Department of Energy contributes to a better quality of 
life for all Americans by ensuring energy security, maintaining 
the safety, security and reliability of the nuclear weapons 
stockpile, cleaning up the environment from the legacy of the 
Cold War, and developing innovations in science and technology. 
After 25 years in existence, the Department now operates 24 
preeminent research laboratories and facilities and four power 
marketing administrations, and manages the environmental 
cleanup from 50 years of nuclear defense activities that 
impacted two million acres in communities across the country. 
The Department has an annual budget of about $23 billion and 
employs approximately 14,500 federal and 100,000 contractor 
employees.
    The Department of Energy is principally a national security 
agency and all of its missions flow from this core mission to 
support national security. The Department has four strategic 
goals toward achieving its mission:
           Defense Strategic Goal: To protect our 
        national security by applying advanced science and 
        nuclear technology to the Nation's defense.
           Energy Strategic Goal: To protect our 
        national and economic security by promoting a diverse 
        supply and delivery of reliable, affordable, and 
        environmentally sound energy.
           Science Strategic Goal: To protect our 
        national and economic security by providing world-class 
        scientific research capacity and advancing scientific 
        knowledge.
           Environment Strategic Goal: To protect the 
        environment by providing a responsible resolution to 
        the environmental legacy of the Cold War and by 
        providing for the permanent disposal of the Nation's 
        high-level radioactive waste.
    Science and technology are the Department's principal tools 
in the pursuit of its national security mission. The Department 
has amassed tremendous scientific and technical capabilities, 
serving America in ways never anticipated 25 years ago. These 
capabilities are applied to the overarching mission of ensuring 
the national security.

                       ENERGY EFFICIENCY PROGRAMS

    Weatherization Assistance Program.--The program's mission 
is to make energy more affordable and to improve health and 
safety in homes occupied by low-income families, particularly 
those with elderly residents, children, or persons with 
disabilities. Elderly residents make up approximately 40 
percent of the low-income households served by this program. As 
of September 30, 2002 about 5.4 million homes had been 
weatherized with federal, state, and utility funds; of these, 
an estimated 2.2 million were occupied by elderly persons.
    Low-income households spend an average 15 percent of income 
for residential energy--more than four times the proportion 
spent by higher income households. The weatherization program 
allows low-income citizens to benefit from energy efficiency 
technologies that would otherwise be inaccessible to them. 
Reducing the high energy cost burden faced by low-income 
Americans helps them increase their financial independence and 
provides them flexibility to spend household income on other 
needs.
    The Weatherization Assistance Program has become 
increasingly effective due to improvements in air-leakage 
control, insulation, water heater systems, windows and doors, 
and space heating systems. At current prices, a weatherized 
low-income household now saves approximately $218 per year, 
about one-third of its space heating costs. Program benefits 
are further described in the Progress Report of the National 
Weatherization Assistance Program, available through the 
National Technical Information Service, 703/487-4650, 5285 Port 
Royal Road, Springfield, VA 22161.
    States implement the program through community-based 
organizations. DOE and its state and community partners 
weatherize approximately 70,000 single- and multi-family 
dwellings each year. The program awarded $153 million in Fiscal 
Year 2001 and $230 million in Fiscal Year 2002 for grants to 
the 50 states, the District of Columbia, and six Native 
American tribal organizations. 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.
    State Energy Program.--The program provides grants to state 
Energy Offices to encourage energy efficiency and the use of 
renewable energy technologies and practices in states and 
communities through technical and financial assistance. In 
Fiscal Year 2001, $37.5 million was appropriated for the 
program and in Fiscal Year 2002, $45 million. States have broad 
discretion in designing their projects. Typical project 
activities include: public education to promote energy 
efficiency; transportation efficiency and accelerated use of 
alternative transportation fuels for vehicles; financial 
incentives for energy conservation/renewable projects including 
loans, rebates, and grants; energy audits of buildings and 
industrial processes; development and adoption of integrated 
energy plans; promotion of energy efficient residences; and 
deployment of newly developed energy efficiency and renewable 
energy technologies.
    Some projects target the elderly specifically, such as 
Louisiana's low-income/handicapped/ elderly/Native American 
outreach program which provides energy related assistance 
through a joint venture with utilities. The elderly also 
benefit from broader programs that provide energy audits, 
hands-on energy conservation workshops, and low-interest loans 
for homeowners. These can result in significant personal energy 
savings. Energy efficiency improvements in local and state 
buildings and services also indirectly benefit the elderly by 
freeing up state and local government tax revenues for non-
energy needs, as do energy efficient schools which place less 
of a burden on property taxes.

                INFORMATION COLLECTION AND DISTRIBUTION

    The Energy Information Administration collects and 
publishes comprehensive data on energy consumption and 
expenditures through the Residential Energy Consumption Survey 
(RECS). The RECS is conducted in households quadrennially and 
collects data from individual households throughout the 
country, including those headed by elderly individuals. Along 
with household and housing unit characteristics data, the RECS 
also collects the actual billing data from the households' fuel 
suppliers for a 12-month period.
    The results of the RECS are analyzed and published by the 
Energy Information Administration. The most recent survey data 
are from the 2001 RECS and are published on the Internet at 
http://www.eia.doe.gov/emeu/recs. The 2001 RECS public use data 
files will become available at this site in November 2003. 
These files will include demographic characteristics of the 
elderly such as age, marital status, and household income, as 
well as estimates of consumption and expenditures for 
electricity, natural gas, fuel oil, kerosene, and liquefied 
petroleum gas used in elderly households.
    In the 2001 RECS, 33.1 million, or 31 percent of all U.S. 
households, were headed by a person 60 years of age or older. 
Of these elderly households, 44 percent were one-member 
households (14.5 million people living alone) and 43 percent 
contained two people. In 23 percent of the two-member elderly 
households both members were under the age of 65; in 24 percent 
of these households, only one member was younger than 65; and 
in 53 percent, both members were over the age of 65. 
Comparisons of elderly versus non-elderly households reveal:
           The 2001 household income of elderly 
        households was generally lower than that of non-elderly 
        households. About one-seventh, 15 percent, of elderly 
        households had income of less than $10,000, compared to 
        9 percent of the non-elderly households. Nearly a 
        quarter, 23 percent, of the elderly households had 
        income of $50,000 or more, compared to 42 percent of 
        the non-elderly households. Of the 15 million U.S. 
        households whose income was below the poverty line, 37 
        percent were headed by a person 60 years or older.
           Despite having lower household incomes, the 
        aforementioned elderly households were more likely to 
        own their housing unit, 78 percent, than were non-
        elderly households, 64 percent. The elderly were also 
        more likely to live in a single-family house, 72 
        percent, than were non-elderly households, 68 percent.
           Elderly households were less likely to have 
        a personal computer or access to the Internet than were 
        households headed by persons less than 60 years of age. 
        Among elderly households, 34 percent had a personal 
        computer compared to 66 percent of the non-elderly 
        households. Only 27 percent of elderly households had 
        access to the Internet compared to 56 percent of the 
        non-elderly households.
           Elderly households were only marginally less 
        likely to have a microwave oven, 84 percent, than are 
        non-elderly households, 87 percent.
    Analysis of the 2001 RECS data shows that consumption 
patterns differed between the elderly and non-elderly for some 
uses of energy. The elderly used more energy to heat their 
homes but used less energy for air conditioning, water heating, 
and lighting and appliances. Expenditures followed the same 
pattern. Specifically,
           The average expenditures per household 
        member in elderly households in 2001 was $873. This 
        amount was higher than the comparable amount for all 
        other households, due to the fact that households 
        headed by persons 60 years or more are smaller than 
        those headed by persons under 60 years of age. The 
        average size of a household headed by persons 60 years 
        or more was 1.8 persons compared to an average 
        household size of 2.9 persons for those headed by 
        persons under 60 years.
    About 53 percent of total energy consumption and about 37 
percent of total energy expenditures in elderly households were 
for space heating. On the other hand, lighting and appliances 
accounted to 27 percent of consumption and 43 percent of total 
expenditures in elderly households. Energy costs for lighting 
and appliances are much higher relative to consumption than are 
energy costs for space heating because virtually all lights and 
appliances are powered by electricity, the most expensive 
energy source, whereas space heating is largely provided by 
other, less expensive, energy sources.

                       RESEARCH RELATED TO AGING

    During fiscal years (FY) 2001 and 2002, the Office of 
Environment, Safety and Health (EH) sponsored research to 
further understand the human health effects of radiation and 
beryllium exposure. The Department of Energy (DOE) sponsored 
epidemiologic studies concerned with understanding health 
changes over time as part of this research program. Lifetime 
studies of humans constitute a significant part of EH's 
research; and because the risks of various health effects vary 
with age, these studies take age into consideration. EH 
supports research to characterize late-appearing effects 
induced by chronic exposure to low levels of physical agents, 
as well as some basic research on certain diseases that occur 
more frequently with increasing age.
    Because health effects resulting from chronic low-level 
exposure to energy-related toxic agents may develop over a 
lifetime, they must be distinguished from health effects 
associated with the normal aging processes. To distinguish 
between induced and spontaneous changes, information is 
collected from both exposed and unexposed groups on changes 
that occur throughout their (**the sentence is vague--if 
``their'' is not the appropriate word--sentence needs to be 
changed**) life span. These data help characterize normal aging 
processes and distinguish them from the toxicity of energy-
related agents. Summarized below are specific research projects 
that the Department sponsored during FY 2001 and 2002.
    Long-Term Studies of Human Populations.--Through EH, DOE 
continued to support epidemiologic studies of health effects in 
humans who may have been exposed to chemicals and radiation 
associated with energy production or national defense 
activities. Information on life span 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, sponsored 
jointly by the United States and Japan, continues to work on a 
lifetime followup of survivors of atomic bombings that were 
carried out in Hiroshima and Nagasaki in 1945. Over 100,000 
persons are under observation in this study. An 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 observed.
    Multiple epidemiologic studies involving about 400,000 
contract employees at DOE facilities are being managed by the 
Department of Health and Human Services through a Memorandum of 
Understanding between the two agencies. These studies include 
assessments of health effects at older ages due to ionizing 
radiation and other industrial toxicants. A recent study 
indicated that workers who were occupationally exposed to 
radiation for the first time at age 45 or older might be more 
sensitive to health effects than workers who were exposed at 
younger ages. However, very few workers at DOE fit this 
profile. This finding is very preliminary and further research 
and analyses are being conducted to see if these results can be 
duplicated. Several other studies, currently under way, will 
look closely at workers who were first exposed at age 45 or 
older, assessing further the potential impact of late exposures 
in relation to the burden of chronic diseases that are common 
among older people. The average age of workers included in 
these studies is greater than 50 years.
    The United States Transuranium/Uranium Registry, currently 
operated by Washington State University, collects occupational 
data, including work, medical, and radiation exposure histories 
and information on mortality among workers exposed internally 
to plutonium or other transuranic elements. Most of the workers 
participating in this voluntary program are retirees.
    In response to the Defense Authorization Act of 1993, EH 
has established a program involving a number of ongoing 
projects across the DOE weapons complex to identify former 
workers whose health may have been placed at risk as a result 
of occupational exposures that occurred from the 1940s through 
the 1960s. The projects provide medical screening and 
monitoring for former workers to identify those at high risk 
for occupationally related diseases and to identify workers 
with diseases that may be reduced in severity by timely 
interventions. Over 30,000 workers have been notified of the 
availability of these free medical examinations since 1998. 
Approximately 4,500 workers have participated in the program. 
Medical screening of former workers at DOE's Paducah, Kentucky 
and Portsmouth, Ohio gaseous diffusion plants is now under way. 
Further expansion of medical screening is anticipated at the 
Oak Ridge, Tennessee Y-12 Plant, Oak Ridge National Laboratory, 
and among former workers at the Pantex Plant in Amarillo, 
Texas.
    In addition to its epidemiologic research and health 
monitoring programs, EH maintains the Comprehensive 
Epidemiologic Data Resource, a growing archive of data sets 
from the many epidemiologic studies sponsored by DOE. This 
public archive provides the research community with data that 
continues to be used to gain additional insights into the 
relationships between occupational exposures and a variety of 
health outcomes, including diseases of aging like cancer.

               OTHER DOE-FUNDED RESEARCH RELATED TO AGING

    Since the inception of the Atomic Energy Commission, the 
Department and its predecessor agencies have carried out a 
broad range of research and technology development activities 
which have impacted health care and medical research. The 
Medical Sciences Division within the Office of Biological and 
Environmental Research, Office of Science, carries out a 
Congressional mandate to develop beneficial applications of 
nuclear and other energy related technologies, including 
research on aging.
    The Aging Research involves study of a brain chemical, 
dopamine (DA), and its function in humans as they age. It has 
long been recognized that age brings a significant decline in 
the function of the brain DA system, but the functional 
significance of this loss is not known. Medical imaging 
studies, using radiotracers and positron emission tomography, 
are designed to investigate the consequences of age-related 
losses in brain DA activity in cerebral function and to 
investigate mechanisms involved with the loss of DA function in 
normal aging. The results of these studies to date have shown 
that healthy volunteers with no evidence of neurological 
dysfunction do experience a decline in parameters of DA 
function, which are associated with a decline in performance of 
motor and cognitive functions. The results of these studies 
also indicate that changes in life style, such as exercise, may 
be beneficial in promoting the health of the dopamine system in 
the elderly.



          ITEM 7--DEPARTMENT OF HOUSING AND URBAN DEVELOPMENT

                              ----------                              


   1U.S. HOUSING PROGRAMS FOR THE ELDERLY--FISCAL YEAR 2001 AND 2002

    The Department of Housing and Urban Development is 
committed to providing America's elderly with decent affordable 
housing appropriate to their needs. The Department's goal is to 
provide a variety of approaches so that older Americans are 
able to afford their housing costs, maintain their 
independence, remain as part of the community, and live their 
lives with dignity and grace.
    This report provides a brief overview of the programs and 
activities undertaken by the Department to assist the elderly 
with their housing needs during fiscal year 2001and fiscal year 
2002.

                          I. OFFICE OF 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. Eligible 
owners of Section 202 projects are private nonprofit 
corporations with tax exemption under IRS Codes 501(c)(3) or 
501(c)(4) and for Section 811 projects, eligible owners are 
nonprofit organizations with tax exemptions under IRS Code 
501(3) only. The American Homeownership and Economic 
Opportunity Act of 2002 amended the Section 202 and 811 
programs to expand project owner eligibility to include a for-
profit limited partnership with a nonprofit entity as the sole 
general partner if, and only if, the proposed project will be a 
mixed-finance project for additional units over and above the 
Section 202 or Section 811 units, as applicable.
    Since the passage of the National Affordable Housing Act of 
1990, there have been 85,150 units approved under the Section 
202 program and 22,573 units approved under the Section 811 
program. Of those amounts 6,041 Section 202 units and 1,570 
Section 811 were approved in fiscal year 2001. In fiscal year 
2002, there were 6,830 additional units approved under Section 
202 for $585,170,100 and 1,859 more units approved under 
Section 811 for $148,008,100.

     B. 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 substantial 
rehabilitation of market rate rental or cooperative projects. 
The programs are available to non-profit and profit-motivated 
mortgagors as alternatives to the Section 231 program. While 
most projects under the programs have been developed for 
families with children, projects insured under Section 221 may 
be designed for occupancy wholly or partially for the elderly, 
and the mobility impaired of any age. The Department does not 
have the actual statistics on the number of projects that have 
been designated for the elderly. The Section 221(d)(4) program 
is a very active and popular program and the number of projects 
designated for the elderly is quite small.

C. SECTION 232-MORTGAGE INSURANCE FOR NURSING HOMES, INTERMEDIATE CARE 
    FACILITIES, BOARD AND CARE HOMES, AND ASSISTED LIVING FACILITIES

    The Section 232 program authorized the Department to offer 
financing for 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 mortgage insurance to 
finance these facilities. The vast majority of the residents of 
such facilities are the frail elderly. In fiscal year 2001, HUD 
insured 194 projects worth $1.3 billion (133 nursing homes, 54 
assisted living facilities, and 7 board and care homes). In 
fiscal year 2002, HUD insured 309 projects worth $1.8 billion 
(214 nursing homes, 85 assisted living facilities, and 10 board 
and care homes).

                     D. SECTION 8 NEW CONSTRUCTION

    The Section 8 program sponsored the new construction of 
housing for families and for the elderly by attaching subsidies 
to the units being developed. That way the landlord was 
guaranteed a stream of income that would facilitate finding 
financing and that would guarantee the ability to make payments 
and operate the developments. The new construction program was 
active from 1974 until it was repealed by Congress in 1983. No 
new units have been approved since 1983 but units approved 
prior to that may still receive a subsidy. The maximum term of 
the housing assistance payments vary from 20 to 40 years, 
depending on how the project was financed. There are 1.4 
million private, project-based Section 8 units, about 50 
percent of which serve elderly households. About 193,000 of 
these 658,000 units were built under the Section 202 program 
before the restructuring of that program in 1990. That means 
that about 465,000 units developed with Section 8 project-based 
assistance serve elderly households. The Section 8 new 
construction program is no longer used to subsidize new 
development.

              E. SERVICE COORDINATORS IN ASSISTED HOUSING

    The National Affordable Housing Act authorized funding for 
service coordinators under the Section 202 program in 1990. 
Eligibility was expanded to cover Sections 8, 221(d)(3) Below-
Market Interest Rate (BMIR), and 236 projects in 1992. A 
service coordinator is a social service staff person who is 
part of the project's management team. The service coordinator 
is responsible for ensuring that the elderly individuals and 
persons with disabilities living in 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 as long as possible and avoid premature and unnecessary 
institutionalization.
    In fiscal year 2001, HUD awarded 217 grants worth 
$25,786,952. These grants serve 242 projects with a total of 
22,083 units. Of the 242 projects, 148 are Section 202, 45 are 
Section 8, and 26 are Section 236/221(d)(3).
    In fiscal year 2002, HUD made 223 grants for $30,374,307. 
These grants serve 242 projects with a total of 25.012 units. 
Of the 242 projects, 163 are Section 202, 28 are Section 
221(d)(3) or 236s, and 51 are Section 8.
    In fiscal year 2001 and 2002, HUD also provided 1-year 
extension funds to expiring Service Coordinator contracts. 
These extensions enable the Service Coordinator programs to 
continue operating without breaks. In fiscal year 2001, HUD 
made extensions to 314 contracts at a cost of $9,708,610. In 
fiscal year 2002, the Department extended 512 contracts with 
$15,831,440.
    Funding for service coordinators in public housing is 
discussed below.

               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 non-profit 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 Development Service.
    In fiscal year 2001, HUD extended 63 existing grantees for 
an additional year at a cost of $5,215,482. In fiscal year 
2002, HUD extended 87 existing grantees for an additional year 
at a cost of $8,504,677. There were no funds appropriated for 
new grants in fiscal year 2001 or fiscal year 2002.

    G. FLEXIBLE SUBSIDY AND LOAN MANAGEMENT SET ASIDE (LMSA) FUNDING

    The Flexible Subsidy Program (FLEX) is comprised of two 
components: (1) the Operating Assistance Program (OAP), which 
is designed to provide temporary funding to replenish project 
reserves, cover operating costs, and pay for limited physical 
improvements. The Operating Assistance (OA) is provided in the 
form of a non-amortizing ``contingent'' loan; and (2) the 
Capital Improvement Loan Program (CILP) is intended to assist 
projects with the cost of major capital improvements when 
funding such improvements cannot be done with project reserves. 
CILP assistance is provided in the form of an amortizing loan. 
Both programs are designed to restore or maintain the physical 
and financial soundness of eligible projects at the lowest 
possible cost to the Federal Government. Because of the limited 
funding, however, Flexible Subsidy funds are strictly reserved 
for the emergency needs of 202 projects. Such projects must 
have been in occupancy for at least 15 years and have emergency 
health and safety needs. No breakdown is available for fiscal 
year 2001 and fiscal year 2002.
    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. Funding has not been available 
for this program for several years.

                       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. No breakdown is 
available for fiscal year 2001 and fiscal year 2002

              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. No 
breakdown is available for fiscal year 2001 and fiscal year 
2002.

          K. HOME EQUITY CONVERSION MORTGAGE INSURANCE PROGRAM

    The Department has implemented a 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. No breakdown is 
available for fiscal year 2001 and fiscal year 2002.

     L. 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 aged 62 years or older, married or 
single. Nonprofit as well as profit-motivated sponsors are 
eligible under this program. The program is largely inactive 
and produced no units in fiscal year 2001 or fiscal year 2002.

                II. OFFICE OF PUBLIC AND INDIAN HOUSING

                   A. HOUSING CHOICE VOUCHER PROGRAM

    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 under the Housing Choice Voucher 
program.
    The Housing Choice Voucher program is HUD's largest 
assisted housing program. About 16 percent of the 1.8 million 
voucher program households, or 288,000, are headed by elderly 
persons.

                B. ELDERLY/DISABLED SERVICE COORDINATORS

    Section 673 of the Housing and Community Development Act of 
1992 authorized the Department to fund service coordinators in 
public housing developments to ensure that the elderly and non-
elderly disabled residents have access to the services they 
need to live independently. From fiscal year 1994 to 1998, the 
Department awarded 227 grants totaling approximately $62.8 
million for public housing authorities to hire service 
coordinators for their elderly and non-elderly disabled 
residents to provide general case management and referral 
services, connect residents with the appropriate services 
providers, and educate residents on service availability. 
Service coordinator grants that were previously awarded are 
being renewed annually to maintain the level of services for 
elderly residents and residents with disabilities.

                     C. TENANT OPPORTUNITY PROGRAM

    Section 20 of the U.S. Housing Act of 1937, as amended, 
authorized the Tenant Opportunities Program (TOP). The program 
enables resident entities to establish priorities and training 
programs for their specific public housing communities that are 
designed to encourage economic development, stability, and 
independence. The program began in 1988 and to date has awarded 
about 986 grants totaling approximately $80 million. Public 
housing developments with elderly residents are eligible to 
participate and perhaps 7 percent are primarily elderly 
grantees.
    As part of the implementation of Section 538 of the Public 
Housing Reform Act, the TOP program was consolidated into the 
Resident Opportunities and Self Sufficiency (ROSS) program. 
Section 538 authorizes a program to link services for public 
housing residents to promote self-sufficiency and economic 
empowerment. Many of the activities previously eligible under 
TOP are eligible under ROSS.

                 D. PUBLIC HOUSING DEVELOPMENT PROGRAM

    The Public Housing Development Program was authorized by 
Sections 5 and 23 of the U.S. Housing Act of 1937 to provide 
adequate shelter in a decent environment for families that 
cannot afford such housing in the private market. In 1998, the 
Quality Housing and Work Responsibility Act authorized the 
Capital Fund. A Public Housing Agency choosing to develop new 
public housing can do so using its annual formula grant of 
Capital Funds. Public housing elderly units may also be 
developed under the HOPE VI Program.
    In fiscal year 2001, 40 elderly units started construction 
and 320 became available for occupancy. In fiscal year 2002, 
116 elderly units because available for occupancy. Under the 
HOPE VI program, 123 units became available in fiscal year 2001 
and 72 became available in fiscal year 2002. (The elderly units 
only reflect the HOPE VI grants dedicated to elderly 
redevelopment. While there may be other elderly units produced 
under HOPE VI, HUD's current data system does not distinguish 
between units occupied by the elderly and families.)

           III. OFFICE OF COMMUNITY PLANNING AND DEVELOPMENT

  A. COMMUNITY DEVELOPMENT BLOCK GRANT (CDBG) ENTITLEMENT COMMUNITIES 
                                PROGRAM

    The CDBG Entitlement Communities program is HUD's major 
source of funding to large cities and urban counties for a wide 
range of community development activities. These activities 
primarily help low- and moderate-income persons and households; 
however, they can also be used to help eliminate slums and 
blight or meet other urgent community development needs.
    The Department normally does not ask grantees to report 
CDBG program beneficiaries by age. However, in reporting on 
their use of CDBG funds, two activity classifications do 
reflect funds used specially for activities that serve senior 
citizens: senior services and senior centers. The former are 
eligible as public services, and the information reported by 
all grantees shows that in both Federal Fiscal Year 2001 and 
2002, slightly more than 1 percent of the CDBG funds disbursed 
were used for public services targeted to senior citizens 
(about $41 million each year). Another 0.8 percent (about $27 
million) in 2001 and 0.9 percent (about $32 million) in 2002 
were spent for public facilities that were specifically 
identified as senior centers. In addition, senior citizens 
frequently benefit from local housing rehabilitation programs 
that are funded by CDBG, but when reporting on rehabilitation 
activities, there is no separate category that reflects the 
number of citizens that benefit from CDBG-assisted housing 
rehabilitation programs.

 B. CDBG STATE-ADMINISTERED AND HUD-ADMINISTERED SMALL CITIES PROGRAMS

    The CDBG State-administered program (and its predecessor, 
the HUD-administered Small Cities program, which still operates 
in Hawaii) is HUD's principal vehicle for assisting communities 
with populations under 50,000 that are not central cities of 
metropolitan areas. States provide grants to small cities, 
counties and other units of local government, which use the 
CDBG funds to undertake a broad range of activities. (HUD makes 
grants directly to counties in Hawaii.) As is also true with 
the Entitlement Communities program, these activities must 
primarily help low- and moderate-income persons and households 
though they can also be used to help eliminate slums and blight 
or meet other urgent community development needs.
    For most CDBG-funded projects, the Department does not 
require grantees to report program beneficiaries by age. 
However, there are two categories of eligibility in the CDBG 
Program that are senior-oriented: senior centers and senior 
services. Between 2001 and 2002, CDBG State-administered 
program grantees doubled the amount of CDBG program funds spent 
on senior centers, from 0.79 percent of total spending in 2001 
($9,615,604) to 1.43 percent of total spending in 2002 
($18,039,132). In that same time period, spending on public 
services targeted to seniors remained steady at 0.06 percent of 
total spending, from $668,642 in 2001 to $695,043 in 2002.
    In addition, HUD is aware of many other categories of 
eligibility within the CDBG program that directly benefit 
senior citizens, but for which grantees do not have to report 
age. Rehabilitation of single-unit residential housing, in 
particular, is a category of eligibility that often provides 
benefit to senior citizens. The true extent of benefit to the 
elderly in the State CDBG program is very likely high, since 
many small communities and rural areas have high concentrations 
of elderly persons.

             C. HOME INVESTMENT PARTNERSHIPS (HOME) PROGRAM

    The HOME Program continues to serve as a major resource for 
elderly housing assistance, particularly for the rehabilitation 
of deteriorating properties of low-income elderly homeowners, 
allowing them to remain in their own homes and keep those homes 
in standard condition. The figures below represent the number 
of HOME-assisted units that participating jurisdictions 
reported were completed and occupied by elderly residents 
during fiscal year 2001 and 2002 and the percentage of units in 
the category that these figures represent:

----------------------------------------------------------------------------------------------------------------
                                  Fiscal Year 2001-                           Total Units
          Tenure Type                    2002         Elderly Cumulative       Completed      Percentage Elderly
----------------------------------------------------------------------------------------------------------------
Homeowner Rehabilitation.......  8,634..............  42,579............  101,160...........  42%
Rental Units...................  11,118.............  31,264............  150,661...........  21%
New Homebuyers.................  1,260..............  4,970.............  180,807...........  3%
                                --------------------------------------------------------------------------------
      TOTAL Elderly Units......  21,012.............  78,813............  432,628...........  18%
----------------------------------------------------------------------------------------------------------------

    To date, HOME has assisted 78,813 low-income elderly 
households. This constitutes an investment of over 
$1,962,453,000 in HOME funds, which have leveraged another 
$6,768,128,000 in private investment and other non-HOME funds 
(which includes Federal, State and local funds) to provide 
housing for the elderly (estimates based on a weighted average 
of $24,900/per unit HOME subsidy for production, and 
conservative estimate of $3.45 per $1.00 of HOME as leverage).
    For data collection purposes, the HOME Program defines 
elderly as 62 or older. Therefore the above numbers do not 
reflect projects which are designed for seniors between 55 and 
62.

                  D. EMERGENCY SHELTER GRANTS PROGRAM

    The Emergency Shelter Grants (ESG) Program provides funds 
to States, metropolitan cities, urban counties, Indian tribes, 
and territories to improve the quality of emergency shelters, 
make available additional shelters, meet the cost of operating 
shelters, provide essential social services to homeless 
individuals, and help prevent homelessness.
    According to a 1999 Federal study entitled HOMELESSNESS: 
Programs and the People They Serve, about 2 percent of homeless 
persons are 65 years or older. Approximately 1 percent of the 
ESG funds go to seniors-only facilities for the homeless. 
However, the elderly homeless population often receives 
emergency housing and services at various shelter facilities 
that serve a range of age groups, although often targeted to a 
particular sex or family status.

                     E. SUPPORTIVE HOUSING PROGRAM

    The Supportive Housing Program (SHP) funds may be used to 
provide: (1) transitional housing designed to enable homeless 
persons and families to move to permanent housing within a 24 
month period, which may include up to 6 months of follow-up 
services after residents move to permanent housing; (2) 
permanent housing provided in conjunction with appropriate 
supportive services designed to maximize the ability of persons 
with disabilities to live as independently as possible within 
permanent housing; (3) safe havens supportive housing for hard 
to reach homeless persons with severe mental illness, who are 
living on the streets and are unwilling or unable to 
participate in services; (4) innovative supportive housing; or 
(5) supportive services for homeless persons not provided in 
conjunction with supportive housing.

            IV. OFFICE OF FAIR HOUSING AND EQUAL OPPORTUNITY

                        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 exempts from its provisions against 
discrimination based on familial status ``housing for older 
persons.'' The statutory exemption of ``housing for older 
persons'' comprises three categories of housing: (1) housing 
provided under any State or Federal program that the Secretary 
of HUD determines is specifically designated and operated to 
assist elderly persons; (2) housing intended for and solely 
occupied by residents 62 years of age and older; and (3) 
housing intended and operated for occupancy by at least one 
person 55 years of age or older per unit, provided various 
other criteria are met.

              B. THE HOUSING FOR OLDER PERSONS ACT OF 1995

    The Housing for Older Persons Act (HOPA) of 1995 amends the 
``55 and older'' housing exemption to the Fair Housing Act's 
prohibition against discrimination based on familial status. 
HOPA eliminates the requirement that housing ``55 and older'' 
have significant facilities and services and establishes a good 
faith reliance defense from monetary damages for individual 
real estate professionals on a legitimate belief that the 
housing was entitled to an exemption. In order to qualify for 
the ``55 and older housing'' exemption a housing community or 
facility must: (1) have at least 80 percent of its occupied 
units occupied by at least one person 55 years of age or older; 
(2) publish and adhere to policies and procedures which 
demonstrate an intent by the owner or manager to provide 
housing for persons 55 and older; and (3) comply with the rules 
issued by the Secretary for verification of occupancy through 
reliable surveys and affidavits.

                       C. AGE DISCRIMINATION ACT

    The Age of Discrimination Act of 1975 prohibits programs or 
activities receiving Federal financial assistance from directly 
or through contractual, licensing, or other arrangements, using 
age distinctions or taking any other actions which have the 
effect, on the basis of age, of: excluding individuals from, 
denying them the benefits of, or subjecting them to 
discrimination under a program or activity receiving Federal 
financial assistance; or denying or limiting individuals their 
opportunity to participate in any program or activity receiving 
Federal financial assistance. The Department's regulations 
implementing the Age Discrimination Act became effective on 
April 10, 1987, and are codified at 24 CFR Part 146.
    No breakdown is available for fiscal year 2001 or fiscal 
year 2002 on the number of complaints received or mediated.

                         D. DESIGNATED HOUSING

    The 1992 Housing and Community Development Act authorized 
HUD to approve Public Housing Authority plans to designate 
mixed population housing units (serving elderly and persons 
with disabilities) for elderly families only, disabled families 
only, or elderly and disabled families, if the plans met 
certain statutory requirements outlined in Section 7 of the 
United States Housing Act. The Housing Opportunities Program 
Extension Act of 1996 simplified and streamlined those 
requirements, but continued to require HUD to review and 
approve or disapprove designated housing plans.
    No breakdown is available for fiscal year 2001 or fiscal 
year 2002 on the number of units designated for elderly 
families.

              V. OFFICE OF POLICY DEVELOPMENT AND RESEARCH

                       A. AMERICAN HOUSING SURVEY

    The American Housing Survey for the United States, Current 
Housing Report Series Number H150 for the year 2001 contains 
special tabulations on the housing situations of elderly 
households in the United States. Chapter 7 of the regular 
report provides 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 non-metropolitan areas, and by urban and rural 
classification. The non-elderly chapters (total occupied, 
owner, renter, Black, Hispanic, central cities, suburbs, and 
outside MSAs) also contain data on the elderly. In addition, 
Current Housing Report Series Number H170 contains data on the 
elderly for the 47 largest metropolitan areas that are 
individually surveyed over four- to 6-year cycles. These 
reports are available in hardcopy versions for purchase or in 
electronic formats for downloading from the Internet. An 
elderly household is defined as one where the householder, who 
may live alone or head a larger household, is aged 65 years or 
more. Special information in these publications is provided on 
households in physically inadequate housing or with excessive 
cost burden, and on households in poverty.

   B. STUDY OF PROJECT SIZE IN SECTION 811 AND SECTION 202 ASSISTED 
                 PROJECTS FOR PERSONS WITH DISABILITIES

    Since the 1970's, there have been increasing efforts to 
reduce the number of persons with disabilities who live in 
institutional settings. Early on, the housing provided to 
people with disabilities-through HUD's Section 202 program-
tended to be in large congregate settings. These congregate 
facilities, containing anywhere from 30 to 120 units, offered a 
package of supportive services; residents were frequently 
required to use these services as a condition of tenancy.
    While congregate developments offer a less restrictive 
setting than hospitals or nursing homes, advocates for people 
with disabilities have argued that these facilities continued 
to segregate disabled people from their communities and that 
persons with disabilities would be better served in small 
settings that housed fewer than five people. Some advocates 
have further contended that housing and services should not be 
linked, and that receiving supportive services should not be a 
condition of tenancy.
    HUD's Section 811 program was developed to provide 
additional affordable housing options for persons with 
disabilities, particularly in small group homes and independent 
living facilities. The majority of the almost 1,600 projects 
that have been built since 1991 (65 percent) contain between 8 
and 24 units. Most of the remaining projects (32 percent) have 
fewer than 8 units. HUD has further expanded housing options by 
designating more than 60,000 vouchers for people with 
disabilities since 1994.
    While persons with disabilities have many more housing 
options today than they did thirty years ago, there continues 
to be a serious lack of affordable housing for persons with 
disabilities and many low income people with disabilities face 
severe rent burdens. In addition, there has been an ongoing 
debate over the appropriate size of projects for people with 
disabilities. On one hand, advocates contend that persons with 
disabilities prefer and are more independent living in small 
developments that blend in with the surrounding neighborhoods. 
On the other hand, it has been argued that larger projects are 
less expensive to build and operate, an issue that must be 
carefully weighed given the significant need for affordable 
housing for this population.
    The objective of this study is to investigate the social 
and economic impact of project size on Section 811 and 202 
projects, their residents, and the immediate neighborhoods. In 
addition, a congressional mandate requires that this study look 
specifically at:

           The benefits and problems associated with 
        providing Section 811 housing in projects that have 8 
        or fewer units, 9 to 24 units, and more than 24 units; 
        and
           The benefits and problems associated with 
        providing housing for non-elderly persons with 
        disabilities under Section 202, in projects having 30 
        to 50 units, 51 to 80 units, 81 to 120 units, and more 
        than 120 units.

      C. ``WHAT DO WE KNOW ABOUT HOW TO CREATE AFFORDABLE ASSISTED

    LIVING?'' Internal Report, Interagency Agreement Between 
the Office of the Assistant Secretary for Planning and 
Evaluation (U.S. Department of Health and Human Services) and 
the Office Of Policy Development and Research (U.S. Department 
Of Housing and Urban Development) for Developing a Policy and 
Research Agenda on Affordable Residential Supports with 
Services/Affordable Assisted Living (Completed 2002)
    Because the population of elderly persons who need long-
term care (LTC) will grow dramatically over the next several 
decades, Federal and State policymakers need a better 
understanding of how to combine supportive housing with the 
provision of LTC services in a way that will be affordable for 
low-income seniors and help them to avoid institutionalization 
for as long as possible.
    Individuals, their families, and increasingly, policymakers 
view assisted living as a potential alternative to nursing home 
care or as a means to forestall admission to a nursing home. In 
theory, assisted living is a desired alternative to traditional 
supportive housing with services--often called board and care 
or adult care homes--primarily because it offers privacy, 
autonomy, and, in many instances, a progressive level of 
services that allows people to stay in the same setting when 
their service needs increase; i.e., these settings are supposed 
to permit elderly persons to ``age in place.'' However, market 
rate assisted living--which can range from $30,000 to $60,000 
per year--is not affordable for many, if not the majority of 
elderly persons. Consequently, there is increasing interest 
among advocates for elderly persons and policymakers to 
determine how the market rate model of assisted living--a 
relatively new model of supportive housing with services--can 
be made affordable for low income persons.
    The price of market rate assisted living is based on two 
components: housing and services. While 38 States now cover 
services in some type of assisted living setting through their 
Medicaid programs, Medicaid does not pay for room and board in 
these settings. In most States, eligibility for the 
Supplemental Security Income (SSI) program confers eligibility 
for Medicaid. However, since 1990 SSI benefit levels have not 
kept pace with rising housing costs. People receiving SSI 
benefits have incomes that average 18.5 percent of median 
income nationally, and so need a long-term rental subsidy such 
as Section 8 in order to afford housing. Given this, it can be 
assumed that any assisted living property developed for people 
receiving Medicaid benefits will need a project based rent 
subsidy.
    For those not eligible for SSI, there are complex Medicaid 
provisions and Federal options that can enable persons with 
higher incomes to be eligible for services and have income left 
to pay for housing. However, there is considerable variation 
among States in their adoption of these options. Consequently, 
there are many older adults with low incomes who are 
financially ineligible for Medicaid but cannot afford to pay 
privately to reside in residential alternatives to nursing 
homes that provide privacy, autonomy, as well as the range of 
services they need to avoid institutionalization.
    Before deciding whether and what policy changes to make to 
increase the availability of assisted living for low-income 
elderly persons, more research and analysis may be required. To 
this end, the Office of the Assistant Secretary for Planning 
and Evaluation (ASPE) at the U.S. Department of Health and 
Human Services (HHS), in partnership with the Office of Policy 
Development and Research (PD&R) at the Department of Housing 
and Urban Development (HUD), have contracted with RTI to 
recommend issues and areas that require research and/or policy 
analysis in order to inform policy regarding the public 
financing of assisted living.
    Methods: To determine recommendations for future research 
and analysis, RTI identified and contacted 24 experts in 
Medicaid, home and community services, housing, and assisted 
living. These experts included academic researchers, policy 
analysts, a State policymaker, and those who represented 
provider and consumer views.
    Because very few people are experts in both housing and 
service programs, a paper was prepared to provide background 
information in each area--housing and services. The housing 
section detailed the difficulties faced in using public 
programs to subsidize the housing component of assisted living 
to make it more affordable. The services section was focused 
more broadly on service issues generally, and issues related to 
the Medicaid program specifically. The paper also identified 
key program and policy issues when combining housing and 
services for low-income elderly persons, and described key 
Federal housing subsidy programs. The primary purpose of the 
paper was to raise issues and stimulate thinking about issues 
that require research and analysis.

        D. ASSISTED LIVING CONVERSION PROGRAM (ALCP) EVALUATION

    Currently, PD&R is conducting an evaluation concerning the 
population of elderly persons who need long-term care will grow 
dramatically over the next several decades. In anticipation of 
this demographic change, the Department is interested in better 
understanding how supportive housing, such as affordable 
assisted living, can help low-income, frail older person avoid 
institutionalization for as long as possible. This evaluation 
of the Assisted Living Conversion Program presents an 
opportunity to take an exploratory look at a new HUD program 
that provides affordable aging-in-place to frail, low-income 
seniors. The study shall document strategies of successful 
grantees, identify barriers to full utilization of the program, 
describe the level of satisfaction with residents of recently 
converted assisted living facilities, and assess future need 
that can be met by the program. The objective of the study is 
to document how HUD's ALCP is working and to identify obstacles 
to the full utilization of the program.

                   ITEM 8--DEPARTMENT OF THE INTERIOR

                              ----------                              


      REPORT ON DEVELOPMENTS IN AGING CALENDAR YEARS 2001 AND 2002

               Departmental Office for Equal Opportunity

    The Departmental Office for Equal Opportunity (OEO) 
enforces various Federal anti-discrimination laws that prohibit 
discrimination on the basis of race, color, national origin, 
disability, sex and age in all aspects of the Department of the 
Interior's (DOI) operations. OEO is the focal point within DOI 
for ensuring compliance and enforcement of these laws including 
those addressing age discrimination. In calendar years 2001 and 
2002, OEO promoted an array of proactive diversity initiatives 
to ensure nondiscrimination in DOI's employment practices, 
i.e., diversity and strategic planning presentations, civil 
rights and equal employment opportunity training, etc. During 
the 2001 and 2002 year period, DOI provided equal employment 
opportunity counseling services through highly trained 
collateral duty Equal Employment Counselors. DOI continues to 
demonstrate commitment to non-discrimination in the workplace 
by: a) ensuring that individuals are not denied employment or 
career advancement opportunities because of their age or any 
other non-merit factor; and b) ensuring ``zero tolerance'' for 
any form of discrimination including age discrimination.
    Civil Rights Complaints.--The general public is apprised of 
how to file age discrimination complaints with DOI through a 
national public notification program. This public notification 
program requires recipients to prominently post DOI 
nondiscrimination posters in a reasonable number of places 
throughout all areas of their operations. As a part of this 
program, recipients are also required to proclaim DOI's 
nondiscrimination policy, which includes the procedures for 
filing age discrimination complaints, in all publications and 
other materials used by recipients to describe program 
availability.
    During the period, DOI processed four age discrimination 
complaints against DOI recipients of Federal financial 
assistance. DOI's complaint processing procedures incorporate 
routine determinations as to whether a complaint is within 
DOI's jurisdiction and covered by the Age Discrimination Act of 
1975. In 2001, DOI processed a total of 158 civil rights 
complaints of which two were age discrimination complaints. The 
complaints involved covered programs and activities of the U.S. 
Fish and Wildlife Service. Generally, the complaints did not 
relate to discriminatory age based policies, rather the focus 
was on problems of maltreatment and inaccessible programs 
encountered by ``senior citizens.'' As a matter of policy, 
complaints that are received by DOI that contain sufficient 
information which identify the recipient, the location of the 
program or activity, the policy or issue in question, and the 
approximate date the alleged discrimination occurred are 
routinely referred to the Federal Mediation and Conciliation 
Service (FMCS), as required by Departmental regulation. 
However, during 2001 and 2002, DOI did not refer any alleged 
age discrimination complaints to the FMCS.
    In 2002, out of a total of 117 civil rights complaints 
received by DOI, as in 2001 only two complaints alleged 
discrimination on the basis of age. One complaint was processed 
by the National Park Service and the other was processed by the 
Bureau of Reclamation. Both complaints concerned particular age 
distinctions in public recreation programs. The age 
discrimination complaint handled by the National Park Service 
was closed through voluntary compliance and by way of an 
alternative dispute resolution process. The complaint concerned 
an elderly cyclist who found that she was competing against 25 
year olds in an annual bicycle race. The complainant contended 
that this was unfair. In consideration of the complainant's 
concerns, the sponsors of the race voluntarily agreed to change 
the age ranges for future contests.
    The complaint processed by the Bureau of Reclamation 
alleged that preferential camping permit policies in a State 
park and recreation program afforded senior citizens unfair 
preferential treatment based on age. In consultation, with the 
Department of Health and Human Services, DOI found in the 
instant case that the Age Discrimination Act did not apply to 
the recipient because its policies and practices were special 
benefits to the elderly that was presumed to be necessary to 
the normal operation of the program.
    Compliance Reviews..--In 2001 and 202, compliance reviews 
of DOI's federally assisted programs were conducted in select 
program areas that covered age discrimination issues. These 
reviews were conducted to ascertain, in part, whether or not 
DOI's recipients of Federal financial assistance were in 
compliance with the requirements of the Age Discrimination Act. 
Three of DOI's bureaus have continuous civil rights compliance 
and enforcement programs that provide for conducting civil 
rights compliance reviews, complaints processing, training, and 
the provision of technical assistance in DOI's most service-
delivery oriented Federal assistance programs. All DOI civil 
rights compliance reviews are accomplished in consideration of 
the requirements of the Age Discrimination Act.
    In 2001, various DOI bureaus and offices conducted over 900 
civil rights compliance reviews of both applicants and 
recipients of Federal financial assistance. All civil rights 
compliance reviews conducted by DOI's bureaus and offices are 
accomplished in consideration of the requirements of the Age 
Discrimination Act. Pre-award reviews are conducted of all 
approved applicants of Federal financial assistance. These 
reviews, as do post-award reviews, incorporate compliance 
review criteria for determining whether or not applicants and 
recipients are in compliance with the Act. As a routine course 
of action, DOI provides expert technical assistance to its 
recipients on the requirements of the Act, during complaint 
investigations and compliance reviews.
    In 2002, DOI conducted a total of 72 civil rights 
compliance reviews of applicants and recipients of Federal 
financial assistance. During the conduct of these reviews, 
recipient operations were reviewed to determine whether or not 
they were in compliance with the requirements of the Age 
Discrimination Act. Moreover, during these reviews technical 
assistance was provided to aid recipients in complying with the 
Act. To date, the DOI's most user-oriented types of Federal 
assistance programs are covered by a continuous civil rights 
compliance review program that gauge whether recipients are in 
compliance with the Act.
    Civil Rights Assurances.--In 2001, DOI revised its 
Departmental Civil Rights Assurance form to include, among 
other nondiscrimination provisions, a specific provision 
barring age discrimination in any program or activity receiving 
federal financial assistance.
    Regulatory Development.--In coordination with the 
Department of Justice, DOI reviewed its current Departmental 
Age Discrimination Regulation at 43 CFR 17, Subpart C, and 
identified areas of the regulation for proposed modification 
for conformance with the standards of the Civil Rights 
Restoration Act of 1987. As a result, DOI published a proposed 
rule in the Federal Register and signed off on a final 
rulemaking document. The final rulemaking document was 
forwarded to the Department of Justice for prepublication 
clearance. This regulatory activity was accomplished by DOI in 
light of the Third Circuit decision in Cureton v. NCAA, No. 99-
1222, 198 F.ed 107. (1999).
    Coverage.--In 2001, DOI broadened its civil rights 
compliance and enforcement program to cover federally assisted 
programs and activities of the U.S. Geological Survey (USGS). 
The USGS developed an internal compliance and enforcement 
program in its Equal Opportunity Office to ensure that all 
programs and activities receiving Federal financial assistance 
are in compliance with the Act and other similar Federal civil 
rights laws. One full-time staff member was committed to the 
USGS's Equal Opportunity Office of carrying out this 
responsibility. DOI continues to operate ongoing civil rights 
compliance and enforcement programs in its most costumer-
oriented bureaus, i.e., the National Park Service, the U.S. 
Fish and Wildlife Service, the Office of Surface Mining, and 
the Bureau of Reclamation. Each bureau had established 
compliance and enforcement programs for ensuring continuous 
adherence to the requirements of the Act.
    Training.--During the period, DOI's OEO provided several 
instances of Departmentwide civil rights training for bureaus 
and offices charged with ensuring civil rights compliance in 
federally assisted programs and activities for which they are 
responsible. Experts from the Department of Health and Human 
Services were relied upon in making these training activities 
successful. Civil rights training was provided to all DOI equal 
opportunity personnel who are generally responsible for the 
enforcement of civil rights laws in their respective bureaus 
and offices. The training covered DOI's various civil rights 
compliance and enforcement responsibilities in federally 
assisted programs and activities, including the application of 
the Act. More specifically, the training covered such matters 
as the conduct of compliance reviews, complaint investigations, 
recipient public notification requirements, and the provision 
of technical assistance.
    Policy Guidance.--Policy guidance and procedural 
information were developed on the procedures for conducting 
complaint investigations. Comprehensive guidance was issued on 
DOI's civil rights public notification compliance requirements.

                       Office of Human Resources

    Older Americans Month.--Each May, DOI commemorates Older 
Americans Month. In observance of the month, DOI concluded that 
`` nearly one in four United States Households care for an 
older family member, and 64 percent of caregivers are 
employed.'' During this special month DOI hosted several elder 
care events for the benefit of its employees. In its employee 
cafeteria information and resources were disseminated and made 
available to employees and visitors on elder care issues such 
as health, Alzheimer's disease and housing. DOI's Employee 
Assistance Program conducted seminars on the process of aging, 
the psychological challenges present in that process, and 
information was made available regarding resources available to 
meet those challenges. The seminars addressed such topics as: 
(1) the various states of aging; (2) the processes for coping 
with stages of the aging process; (3) the affect of the aging 
process on individuals and families; and (4) resources and 
support systems available for coping with the aging process. 
DOI partnered with the Office of Personnel Management (OPM) in 
hosting ``lunch and learn'' discussions for both DOI and OPM 
employees on financial planning for one's ``golden years.'' 
Additionally, in consideration of the balancing and stress that 
are associated with ``work-life'' experiences in caring for 
elderly persons, DOI hosted an open house Stress Laboratory to 
aid its employees in ``developing the strength and stability to 
carry on on a myriad of responsibilities.''

                      Minerals Management Service

    The Minerals Management Service (MMS) continues to work to 
support programs for older Americans. The MMS work force 
statistics show that:
           Eighty-one percent of the MMS work force is 
        comprised of employees who are 40 and over (1,114 of 
        1,719);
           Older employees are well represented in a 
        variety of occupations within the MMS, including 
        accountants, auditors, computer specialists, engineers, 
        geologists, geophysicists, and physical scientists;
           The MMS has implemented and continues to 
        implement effective personnel management policies to 
        ensure that equal opportunity is provided to all 
        employees and applicants, including older Americans.
    The MMS continues to explore and implement initiatives to 
assist employees to care for elderly parents. Family support 
rooms have been established in our Herndon, Virginia, and 
Lakewood, Colorado offices. Rooms are available for employees 
to bring their elderly parents for short term care on an 
occasional basis, when necessary, in order to facilitate such 
events as ease in keeping medical appointments. Other family-
friendly initiatives, such as leave share and the Family and 
Medical Leave Act, have been implemented and used to benefit 
workers who have older relatives with medical situations. MMS 
supports the wellness of employees by subsidizing membership 
costs to health clubs. This is of great benefit to all 
employees, including older employees.
    The MMS continues to perform its mission-related functions 
in an outstanding manner. A major mission responsibility 
affecting large numbers of citizens is the mineral royalty 
payments to various landholders, including numerous older 
Americans who often depend heavily on these payments to meet 
their basic human needs and rely on the ability of the MMS to 
effectively discharge its financial responsibilities.
    The MMS offshore mission has the ultimate objective of 
managing domestic mineral production through offshore 
resources. Significant effects on the economic well-being of 
all Americans, including older Americans, occur if dependence 
on foreign mineral (e.g., oil and gas) imports is reduced.

          Office of Surface Mining Reclamation and Enforcement

    The Office of Surface Mining Reclamation and Enforcement 
(OSM) is steadfast in its commitment to provide equal 
opportunity to all persons in all matters of employment. OSM 
has a policy statement, signed by the Director, explaining that 
discrimination based on age (40 or older) will not be 
tolerated. This policy statement is displayed throughout all of 
OSM. In addition, older employees are represented in most OSM's 
occupational series. Basically, 19 percent of OSM's current 
workforce is eligible to retire immediately and an additional 
31.6 percent will be eligible to retire in the next 1-5 years.
    OSM is always trying to keep abreast of what is important 
to its employees and to improve their quality of work life. 
During the past two years, OSM sponsored seminars, including 
FERS Retirement, Heart Disease, Diabetes, Tax, Stress 
Management, and a seminar entitled ``Its Your Life, Live it''. 
These seminars were chosen because of their direct and/or 
indirect impact on OSM's workforce.
    Awards were given to many OSM employees for 25, 30, and 35 
years of continuous service during calendar years 2001 and 
2002.

                         Bureau of Reclamation

    Human Resources.--The Bureau of Reclamation conducts many 
activities throughout the year that affect and benefit aged 
individuals. Personnel offices maintain contacts and provide 
services to many retirees who need advice or have questions 
concerning their retirement and health benefits. Retirees and 
their spouses attend annual health insurance fairs where 
insurance representatives are available to discuss the 
provisions of their health care plans. Several of Reclamation's 
regional offices continue to mail out a monthly newsletter to 
all retirees. The newsletter contain about Reclamation's former 
and current employees and are highly regarded by retirees as a 
way to keep in touch. Additionally, retirement planning 
briefings and seminars are held for all interested employees as 
a retirement planning benefit.
    The Bureau of Reclamation established a Work and Family 
Team (WAFT) to advance a Presidential directive on Family-
Friendly Work Arrangements. Initiatives taken on behalf of 
older Americans and their families are principally addressed in 
this arena. The alternative work schedules in place throughout 
Reclamation allow employees to arrange their work schedules to 
address family needs. This is in addition to its telecommuting 
policy and support of the Family and Medical Leave Act of 1993.
    Employment Opportunities.--Reclamation's Weber Basin Job 
Corps Civilian Conservation Center in Ogden, Utah, has an 
agreement with the Easter Seals in accordance with Title V of 
the Older Americans Community Service Employment Act of 1973. 
The agreement serves to foster meaningful part-time employment 
opportunities in community service activities for unemployed 
low-income persons who are 55 years of age or older. Weber 
Basin currently employs these individuals as motor vehicle 
operators, warehouse labors and clericals.
    Reclamation's Collbran Job Corps Civilian Conservation 
Center in Collbran, Colorado continues to employ older 
Americans at the Center through a Senior Community Service 
Employment Program. Reclamation's Centennial Job Corps Civilian 
Conservation Center in Nampa, Idaho has an agreement with AARP, 
a nonprofit organization devoted to addressing the concerns of 
individuals who are 50 years of age and older. The agreement is 
intended to promote employment opportunities for older workers.
    Accessibility.--Through a ten-year plan the Bureau of 
Reclamation that was in an implementation phrase in calendar 
years 2001 and 2002, Reclamation's facilities, programs, and 
services were made readily accessible to the elderly and 
persons with disabilities. These evaluations are still in 
progress. As of the end of the reporting period, 680 to 957 
Reclamation facilities have been evaluated and consequently 
steps have been taken to remove all identified barriers.
    During the period, progress towards full accessibility has 
resulted in modifications to Reclamation offices, visitor 
facilities, restrooms, campgrounds, administrative offices, 
boating facilities, and picnic areas to provide access to the 
elderly and people with disabilities. The modifications that 
have been accomplished include the provision of: (1) access 
ramps; (2) handrails; (3) improved walkways and trail 
gradients; (4) accessible restrooms; and (5) wider entrance 
ways. In addition, modifications to Reclamation programs have 
resulted in captioned videos, brochures with large print, audio 
description of videos and films, and the use of signage to 
identify sites and facilities.
    These changes provide the elderly easier access to 
Reclamation's facilities and greatly improved information about 
the availability and location of Reclamation programs, 
activities, facilities, and services.
    To date, Reclamation has evaluated 173 of 242 work sites to 
determine whether or not they are readily accessible to older 
employees and individuals with disabilities.
    Great Plains Region.--The Region continues to consider the 
contributions of its older workers. Regional facilities have 
been made accessible. The following activities are 
representative of the results realized by the Great Plains 
Region during the period.
    1. The Region employed a total of 346 employees over 50 
years of age. Of those employees, 15 were 62 years or older. A 
breakdown by age group is illustrated below:

------------------------------------------------------------------------
                                                              Number of
                         Age Group                            Employees
------------------------------------------------------------------------
50-54 years................................................          165
55-59 years................................................          130
60-70 years................................................           51
------------------------------------------------------------------------

    In addition, the Region employed two reemployed annuitants 
who are still employed as of calendar year 2003.
    2. Recreational opportunities were enhanced at many 
reservoirs and recreational areas which have traditionally 
attracted many seniors citizens and retired individuals.
    3. The core of Reclamation's volunteer program was based 
upon retirees and senior citizens who were employed by 
Reclamation in various program areas.
    4. The Region has accessibility coordinators throughout all 
aspects of its operations to ensure program accessibility for 
the elderly and people with disabilities. There have been few, 
if any, complaints concerning reasonable accommodations or age 
discrimination in the provision of services.
    Lower Colorado Region.--After September 11, 2001, the 
Hoover Dam Visitor Center Volunteer Program had to end and 
tours were suspended. To date, this program and its related 
activities gradually are being reactivated. It is anticipated 
that the Hoover Dam Ambassador Program will open in early 
spring 2004. This new program will call on services of 
volunteers to welcome visitors, distribute materials, assist 
tourists, and serve as liaisons with the community. It is 
expected that many of the volunteers will be senior citizens 
who were formerly associated with Reclamation's volunteer 
activities.
    Boulder Canyon Operations.--Boulder Canyon updated its web 
site to provide the latest information on its policies and 
practices. The walkway approach to its Date Street Facility was 
improved for safety and accessibility reasons. The 
modifications proved to assist the elderly and people with 
disabilities substantially.
    Pacific Northwest Region.--The Pacific Northwest Region 
utilized older and retired citizens as camp and park hosts each 
year at various field locations in calendar years 2001 and 
2002. An elderly volunteer who was hired during the period as a 
temporary employee to accomplish clerical duties at the Area 
Office, remains an employee of the Bureau of Reclamation as of 
calendar year 2003.
    The Centennial Job Corps employed an older worker under a 
temporary contract and expects to employ her in the very near 
future as a permanent employee. The Employee Development Office 
studied the feasibility to providing elder care web training 
for the benefit of its employees. The Regional Office also 
provided speakers on the topic of elder care during brown bag 
employee lunch sessions.
    Upper Colorado Region.--In 2003, the Upper Colorado (UC) 
Region employed a total of 301 employees over 50 years of age. 
Of those employees, 58 were 62 years or older. A breakdown by 
age group is shown below:

------------------------------------------------------------------------
                                                              Number of
                         Age group                            employees
------------------------------------------------------------------------
51-54 years................................................          160
55-59 years................................................           83
60-70 years................................................           56
70-80 years................................................            2
------------------------------------------------------------------------

    The UC Region utilized five senior volunteers from the 
Green Thumb, Inc., organization during 2002. These volunteers 
donated their time and invaluable talents at the Weber Basin 
Job Corps in Ogden, Utah. In 2002, the UC Regional Office 
contracted with the Salt Lake County Aging Service and the 
Corporation for National Service to conduct the Retired and 
Senior Volunteer Program (RSVP). The RSVP matches skills, 
talents, and interests of individuals age 55 and over with 
Reclamation's volunteer staffing needs. The RSVP has proven to 
be invaluable in the recruitment of volunteers. The UC Region 
has participated in the Salt Lake County Aging Benefits Fair in 
calendar years 2001 and 2002 where information regarding 
employment opportunities were made available to individuals age 
55 and over in the greater Salt Lake area.
    The UC Region has two permanent members on Reclamation's 
Work Life Team. The team provides information to all employees 
on aging issues and family related issues. A newsletter also 
continues to be published that provides information regarding 
to aging, health and welfare among other concerns.
    Recreation facilities in the Upper Colorado Region were 
upgraded to improve accessibility for the elderly and people 
with disabilities. In 2002, the following facilities were 
renovated to improve access: Crawford Reservoir, Colorado; 
Navajo Reservoir, New Mexico; Deer Creek Reservoir; Utah; and 
Scofield Reservoir, Utah.

                     U.S. Fish and Wildlife Service

    The U.S. Fish and Wildlife Service (FWS) provides 
opportunities for all employees regardless of their age, but 
ensures that older individuals are utilized through special 
programs, volunteer programs, and employment opportunities. The 
Service reports the following activities on aging for 2001 and 
2002.

                                  2001

    The FWS employed 8,357 individuals during the fiscal year. 
There were 5,656 (68%) Service employees age 40 or over, which 
was an increase of 27 employees from the previous year. Of the 
FWS employees over the age of 40, there were 327 (4%) over the 
age of 60, and increase of 3 employees from the previous year.
    The majority of the FWS's mission related occupations, 
which include biologists, are in Professional positions. 
Demographic information regarding FWS employees over the age of 
40 is as follows:
           1,207 (14%) are in Administrative positions; 
        60 (0.7%) are over the age of 60;
           805 (10%) are in Technical positions; 67 
        (0.8%) are over the age of 60;
           346 (4%) are in Clerical positions; 40 
        (0.5%) are over the age of 60;
           13 (0.2%) are in Other positions; none over 
        the age of 60;
           630 (8%) are in Wage Grade positions; 65 
        (0.8%)--are over the age of 60.
    During the year, there were seven employment related 
discrimination complaints filed alleging discrimination on the 
basis of age (40 and above). Among the Federally Assisted 
Program related complaints filed, one contained an allegation 
of discrimination on the basis of age (40 and above).
    A total of 8,332 Golden Age Passports were issued by the 
FWS in 2001. The Golden Age Passport Program provides free or 
lower entrance fees to most national parks, monuments, historic 
sites, recreation areas and national wildlife refuges for any 
individual over the age of 62. The FWS provided senior citizens 
with educational activities and with the opportunity to do 
volunteer work ranging from construction work to habitat 
restoration. Volunteers over the age of 61 were involved in 
FWS's fish and wildlife management programs such as leading 
school groups through national wildlife refuges, helping sample 
fish populations, staffing information desks, maintaining 
vehicles and equipment, and conducting bird and wildlife 
censuring. The FWS has purchased passenger-carts that provide 
guided tours on the trail systems for people with limited 
mobility, also, special activities such as Trolley Tour, bird 
walks, duck identification workshops, and shellfish programs 
were organized for seniors and some recreational activities 
were provided free of charge. During the 2001 Older Americans 
Month, a speaker from the Senior Resource Center was invited to 
talk about issues related to aging and taking care of older 
parents.
    The FWS recognizes the numerous contributions of older 
individuals through various awards programs. There were 4,225 
FWS employees over the age of 40 who were recognized for their 
exceptional contributions through the FWS's Special Act or 
Service Awards.

                                  2002

    The FWS employed a total of 8,660 individuals. There were 
5,902 (68%) of Service employees over the age of 40, which was 
an increase of 246 employees from the previous year. Of the 
FWS's employees over the age of 40, 389 (5%) were over the age 
of 60; an increase of 62 employees from the previous year.
    The majority of the FWS's mission related occupations, 
which include biologists, are in Professional positions. 
Demographic information regarding FWS employees over the age of 
40 is as follows:
           2,834 (33%) were in Professional positions, 
        119 (1%) were over the age of 60;
           1,313 (15%) were in Administrative 
        positions, 78 (0.9%) were over the age of 60;
           762 (9%) were in Technical positions, 76 
        (0.9%) were over the age of 60;
           322 (4%) were in Clerical positions, 32 
        (0.4%) were over the age of 60;
           10 (0.3%) were in Other positions, none were 
        over the age of 60;
           661 (8%) were in Wage Grade positions, 84 
        (1%) were over the age of 60.
    During 2002, there were a total of 13 employment 
discrimination complaint alleging discrimination on the basis 
of age (40 and above) filed. Additionally, the FWS had three 
Federally Assisted Program related complaints alleging 
discrimination on the basis of age.
    Approximately 8,500 Golden Age Passports were issued in 
2002. The Golden Age Passport Program provides free entrance or 
lower entrance fees to most national parks, monuments, historic 
sites, recreation areas and national wildlife refuges for any 
individual over the age of 62. The FWS sponsored speakers that 
educated employees on issues related to health and aging during 
its Annual Diversity Day. The FWS also commemorated Older 
Americans Month with a host of activities in honor of elderly 
individuals. The FWS's Heritage Committee established a retiree 
organization. There are 2000 names on the list of the committee 
and the committee organizes and annual retiree union. Retirees 
have been integral to the FWS's history collection carrying out 
hundreds of oral histories and donating thousands of objects to 
the National Career Training Center archives. A 55-foot 
accessible ramp was added to the ``Old School House'' at 
Sherburne National Wildlife Refuge to provide access that 
benefits persons with limited mobility, many of which are older 
persons.
    The FWS continues providing senior citizens with 
educational activities such as the Elderhostel volunteer 
program to perform volunteer work ranging from construction of 
a wildlife loop observation platform, pine thinning, and pony 
fence repair work to habitat restoration. Elder volunteers also 
work spreading mulch on the environmental education trails and 
sandstone on woodland trails. Pre-retirement seminars are 
provided to FWS employees annually.
    The FWS recognizes the numerous contributions of older 
individuals through various awards programs. There were 3,790 
employees age 40 or over who received Cash and other Incentive 
Awards to recognize their exceptional contributions to the FWS. 
The FWS provided Long Term Health Care Briefings and 
informational materials to employees.

                         U.S. Geological Survey

    The U.S. Geological Survey (USGS) provides opportunities to 
all individuals throughout the bureau and ensures that the 
skills of older individuals are utilized through special 
programs and employment opportunities.

                                  2001

    In 2001, USGS employed a total of 10,279 individuals in 
permanent and temporary jobs. There were 6,927 (67.4%) USGS 
employees age 40 and over. Of USGS employees age 40 and over, 
there were 537 (7.7%) employees who were 60 years of age and 
older, and two employees over 80 years old.
    There was an increase of 229 (2.3%) in employment totals 
for permanent and temporary jobs and for employees ages 40 and 
over [increased by 68 (1.0%)] and 60 and over [increased by 31 
(6.1%)] from the last reporting period.
    The majority of USGS' mission related occupations, which 
include occupations such as Hydologists, Geologists, 
Cartographers and Biologists, are in the Professional category. 
Of the 6,927 USGS employees age 40 and over, there were 3,706 
(53.5%) in Professional positions, 311 (8.4%) of whom were age 
60 and over, and one employee over 80. Other demographic 
information regarding USGS employees age 40 and over was as 
follows:
           1,113 (16.1%) of employees 40 and over are 
        in Administrative positions with 65 (5.8%) of them age 
        60 and over;
           1,688 (24.4%) of employees 40 and over in 
        Technical positions with 120 (7.1%) of them age 60 and 
        over;
           286 (4.1%) of employees 40 and over in 
        Clerical positions with 34 (11.9%) of them age 60 and 
        over;
           25 (0.3%) of employees 40 and over are in 
        other positions with none of them age 60 and over; and
           109 (1.6%) of employees 40 and over are in 
        Wage Grade positions with 7 (6.4%) age 60 and over.
    There were two employees over the age of 80, one Wildlife 
Biologist and one Clerk Typist, both of whom worked full time.
    In 2001, USGS selected participants for the following 
career development courses:
           Executive Leadership Program: Of 4 
        participants, 3 are age 40 and over;
           Team Leadership Program: Of 7 participants, 
        5 are over the age of 40; and
           Federal Executive Institute: Of 22 
        participants, 21 are over the age of 40.
    Complaints 2001.--There were three (3) Federal equal 
employment complaints filed against the USGS based on age 
during calendar year 2001.

                                  2002

    In 2002, USGS employed a total of 10,441 individuals in 
permanent and temporary jobs. There were 7.048 (67.5%) USGS 
employees age 40 and over. Of USGS employees age 40 and over, 
there were 594 (8.4%) employees who were 60 years of age and 
older, and there were four employees over the age of 80.
    There was an increase of 162 (1.6%) in employment totals 
for permanent and temporary jobs and for employees ages 40 and 
over [increased by 121 (1.7%)] and 60 and over [increased by 57 
(10.6%)] from 2001 reporting period.
    The majority of USGS' mission related occupations, which 
include positions such as Hydrologists, Geologists, 
Cartographers and Biologists, are in the Professional category. 
Of the 7,048 USGS employees age 40 and over, there were 3,770 
(53.5%) in the Professional positions, 340 (9%) of whom were 
age 60 and over, and three employees over the age of 80. Other 
demographic information regarding USGS employees age 40 and 
over was as follows:
           1,182 (16.7%) of employees 40 and over are 
        in Administrative positions with 75 (6.3%) of them age 
        60 and over;
           1,711 (24.3%) of employees 40 and over in 
        Technical positions with 129 (7.5%) of them age 60 and 
        over;
           252 (3.6%) of employees 40 and over are in 
        Clerical positions with 37 (14.7%) of them age 60 and 
        over;
           25 (0.4%) of employees 40 and over are in 
        other positions with none of them age 60 and over; and
           108 (1.5%) of employees 40 and over are in 
        wage grade positions with 13 (12%) age 60 and over.
    There were a total of four employees over 80 years of age, 
a cartographer, a wildlife biologist, a hydrologist, and a 
clerk typist. All four were full time employees.
    In 2002, USGS selected participants for the following 
career development courses:
           Executive Leadership Program: Of 4 
        participants, 3 are over the age of 40; and
           Federal Executive Institute Program: 16 
        participants. All of the participants are over the age 
        of 40.
    Listed below are the numbers of individuals who retired 
from USGS, some of whom have continued to provide outstanding 
services to USGS and the public nationwide in a variety of 
capacities.


------------------------------------------------------------------------
                  Categories                        2001         2002
------------------------------------------------------------------------
Retirees......................................          161          162
Scientists Emeritus...........................          225          230
------------------------------------------------------------------------

    The USGS Scientists Emeriti are welcomed back to the USGS 
after retirement to continue important scientific research. The 
USGS benefits immeasurably from the accumulated knowledge, 
experience, and dedication from the scientists.
    Complaints -2002.--In 2002, there were 8 complaints filed 
based on age.
    Volunteer Programs.--USGS has over 9,000 volunteers a year 
that participate in the various volunteer programs. 
Approximately, one third of the volunteers were over the age of 
40.
    Volunteer Program of the USGS Hawaiian Volcano Observatory 
(HVO). Dozens of volunteers contribute thousands of hours each 
year to help HVO's staff monitor the active volcanoes of Hawaii 
and conduct research on various aspects of Hawaiian volcanism. 
The volunteers in turn gain experience working on active 
volcanoes and participating in scientific research--collecting 
and analyzing data, building and installing instruments for 
experiments and volcano and earthquake monitoring, taking 
photographs and conducting surveys, and working on team or 
individual research projects.
    Volunteers range from undergraduate students to retired 
educators, computer programmers to chemists, and writers to 
electricians. People come from around the world to volunteer at 
HVO. Hawaii's active volcanoes and natural beauty make the 
volunteer positions very popular and highly competitive.
    HVO provides free lodging for as many as 7 volunteers at a 
time in a fully-furnished house about 4 kilometers from the 
Observatory. Volunteers staying in our guest house must be 
willing to work for at least three months on a full-time basis. 
Transportation is provided between the house and HVO, but 
volunteers are responsible for all non-work-related travel 
expenses (travel to and from Hilo, Hawaii, and travel on the 
Big Island and neighboring islands). Volunteers are also 
responsible for all food and health-care costs. Many of the 
volunteer positions require work in the field, sometimes in 
remote areas of Hawaii Volcanoes National Park and other parts 
of the Big Island. For these positions, volunteers often must 
hike several kilometers over rough and irregular ground in hot, 
humid conditions, or sometimes in raw, bone-chilling cold and 
wet weather high on the volcanoes. Also, some of the field 
sites are near active fumaroles, and many sites are 
intermittently swept by the plume of sulfur dioxide gas from 
the Pu'u `O'ovent the noxious plume poses a health hazard by 
aggravating preexisting respiratory ailments.
    The North American Amphibian Monitoring Program (NAAMP) is 
a collaborative effort among regional partners, such as state 
natural resource agencies and nonprofit organizations, and the 
U.S. Geological Survey (USGS) to monitor populations of vocal 
amphibians. The USGS provides central coordination and database 
management. The regional partners recruit and train volunteer 
observers to collect amphibian population data, following the 
protocol of the NAAMP. Amphibian population data are collected 
using a calling survey technique in which observers identify 
local amphibian species by their unique vocalizations. Not all 
amphibian species make vocalizations, but many frogs and toads 
do. Observers are trained to identify their local species by 
these unique vocalizations of ``frog calls.''
    Earth Science Corps.--The Earth Science Corps (ESC) is a 
field component of the USGS Volunteer for Science Program where 
volunteers may participate in USGS projects. USGS has an 
ongoing map annotation project where volunteers collect new 
information for use in the National Mapping Program.
           ESC Volunteer Guide--provides Map annotation 
        instructions; and
           Assigned Quadrangles Map--shows USGS 
        quadrangles already assigned to volunteers.
    Listed below are some other programs that older Americans 
have made the following contributions to USGS operations: These 
programs can be found on the USGS' Web site (http://
interactive.usgs.gov/Volunteer/USGSActivities/PhotoIndex.asp)
    Volunteer sampling marsh sediments from a small boat; see 
Access USGS San Francisco Bay and Delta
    Volunteers conducting migratory bird surveys, Bird 
Monitoring in North America.
    Geologists and volunteer annotating a USGS map, see How to 
Read a Topographic Map and Earth Science Corps Volunteer Guide.
    Scientists and volunteers monitoring coastal processes 
using a USGS research vessel, see Environmental Quality and 
Preservation.
    Volunteer cooking in a remote field camp kitchen, see 
Geologic Information About Alaska and Alaska Biological Science 
Center.
    Geologist, teacher, and student volunteers, see USGS 
National Center Tour Information, and Major USGS Offices.
    Volunteer discovering a newly formed fault rupture, see 
This Dynamic Earth.
    Volunteer taking cross-sectional slab from a tree trunk to 
be used for dendrochronology (tree ring dating), see Tree Ring 
Images.
    Volunteers sampling glacier dust layer, see Global Change 
Research Program.
    Scientists and volunteers unloading supplies from a float 
plane at remote research camp, see USGS Western Region Geologic 
Information.
    Elderly Care Program. --There was a two-part Elder Care 
Workshop that was sponsored by the USGS Employee Assistance 
Program covering the options to be considered when creating a 
plan to serve aging family members in the best way possible. 
Information was provided about Medicare, Medigap, and Medicare 
HMO plans, and the legal issues related to elder care health 
needs.
    As a follow-on to the workshop, an Elder Care Support Group 
was established which has continued to the present. The group 
meets regularly every month.
    There were also workshops during 2001 and 2002 providing 
information on health issues related to aging including 
Alzheimer's disease, heart health, osteoporosis, and stroke.
    Health screenings for health issues related to aging have 
been offered through the National Center Health Unit including 
stroke, heart disease, and osteoporosis screenings.

                     ITEM 9--DEPARTMENT OF JUSTICE

                              ----------                              


            INITIATIVES RELATED TO OLDER AMERICANS 2001-2002

                              Introduction

    The Department of Justice's Office of Justice Programs is 
actively involved in a number of activities to protect older 
Americans. In Fiscal Year 2001, OJP awarded $6,049,425 for 
efforts to protect the elderly, and more than $9 million in 
Fiscal Year 2002. The work of the following Office of Justice 
Programs components (the Bureau of Justice Assistance, the 
Office for Victims of Crime, the Office on Violence Against 
Women, the Executive Office for Weed and Seed, the National 
Institute of Justice, and the Bureau of Justice Statistics) to 
protect older Americans is highlighted below.
Preventing Fraud Against the Elderly
    The Office of Justice Programs' Bureau of Justice 
Assistance (BJA) continued its activities under the 
Telemarketing Fraud Prevention and Public Awareness Program. 
This program began in 1997 and is supported by an annual $2 
million congressional appropriation for ``programs to assist 
law enforcement in preventing and stopping marketing scams 
against senior citizens.'' The program is intended to support 
federal, state, and local efforts among law enforcement, crime 
prevention, victim assistance, consumer protection, adult 
protective services, and programs that serve older people in 
implementing public education and training efforts.
    Under this program, BJA created a Telemarketing Fraud 
Training Task Force made up of the National Association of 
Attorneys General, the American Prosecutors' Research 
Institute, the National White Collar Crime Center and AARP. The 
Task Force's purpose is to develop and provide training for 
state and local investigators and prosecutors and to develop 
public awareness materials to thwart fraudulent telemarketers 
who prey on senior citizens. Since 1998, the Task Force has 
sponsored approximately 12 regional training conferences.
    In addition, the following activities were conducted. In 
Los Angeles, the California Department of Corporations 
continued Operation Tough Call, a command post and 
clearinghouse through which local, state, and federal law 
enforcement and regulatory agencies coordinate enforcement 
efforts against fraudulent telemarketing activity. In Atlanta, 
the Georgia Governor's Office of Consumer Affairs created a 
task force to fight telemarketing fraud, as did the 
Hillsborough County State Attorney's Office in Tampa. The North 
Carolina Office of the Attorney General in Raleigh hired an 
investigator to expand prosecution of fraudulent telemarketing 
companies and to educate the public and key industries on how 
to identify and stop telemarketing fraud. In Montpelier, the 
Vermont Office of the Attorney General increased its 
prosecutory and investigatory resources and continued to build 
ties with Canada by working with the National Association of 
Attorneys General to establish investigative liaison 
relationships.
    The task force also conducted training sessions in Seattle, 
Cleveland, and Durham, North Carolina, attended by prosecutors, 
investigators, and victim advocates from throughout the United 
States and Canada. In Illinois, the state police continued 
their innovative Financial Exploitation of the Elderly Unit. 
Investigators with the unit serve as advocates who help report, 
investigate, and prosecute perpetrators of financial crimes 
against the elderly. They also educate elderly people on what 
constitutes financial abuse.
    BJA funding for the National Consumers League (NCL) 
provided local law enforcement agencies with tools to conduct 
effective public education programs aimed at preventing 
telemarketing fraud. NCL's primary objectives are to empower 
consumers to avoid victimization, encourage victims to report 
fraud crimes, develop and disseminate a Telemarketing Fraud 
Education Kit to law enforcement agencies, and participate in 
public forums, such as radio programs, to heighten awareness of 
telemarketing crime.
    In addition, in FY 2001, the Office for Victims of Crime 
(OVC) continued to support state and local efforts to provide 
public education and training related to telemarketing fraud. 
Funded projects include:
           training and information (utilized 
        nationwide) on fraud for bank personnel throughout the 
        state of Oregon and services for older fraud victims;
          a national, coordinated public education and 
        awareness and training effort among the National 
        Sheriffs' Association and a range of organizations and 
        corporations, including the AARP, the National 
        Association of Attorneys General, the National District 
        Attorneys Association, Triad, state sheriffs' 
        associations, and Radio Shack; and
           a public education campaign by the National 
        Hispanic Council on Aging to combat telemarketing fraud 
        in the Latino community.
Preventing Elder Abuse
    Domestic violence and sexual assault affect victims in all 
age groups. However, older individuals who are victimized by 
these crimes face additional challenges in receiving the 
services they need to obtain safety. Law enforcement officers 
and other first responders may not recognize them as victims of 
intimate partner violence and consequently may not take 
necessary actions to ensure their safety. Appropriate 
interventions may be compromised by misconceptions that older 
persons are incapable of inflicting serious harm on their 
intimate partners or that the abuse is simply an expression of 
the stress associated with caring for an aging partner. Age or 
disability may increase the isolation of victims of domestic 
violence or their dependence on abusers for care or housing.
    In addition, an abuser may threaten institutionalization to 
prevent victims from seeking help or calling the police. These 
cases may go unnoticed because criminal justice system 
personnel may be less likely to perceive a victim's injuries as 
arising from aging, frailty, illness or disability rather than 
from abuse. For example, an older woman's broken bones may be 
attributed to disorientation or osteoporosis without any 
inquiry about violence in the home. The Office on Violence 
Against Women (OVW) is working to provide training from 
criminal justice system personnel to address these barriers and 
improve systemic responses to older victims and victims with 
disabilities.
    OVW awarded an FY 2001 grant of $500,000 to the Wisconsin 
Coalition Against Domestic Violence (WICADV) to continue 
operation of the National Clearinghouse on Abuse in Later Life 
(NCALL), which was established as a technical assistance 
project with an OVW award in FY 1999. With OVW support, NCALL 
has provided model materials, interactive training, and 
consultation on working with older victims. With the FY 2001 
award, the project worked to address the complex issues that 
arise from the intersection of the respective policies, 
protocols, and philosophies of domestic violence victim 
advocacy organizations and elder abuse agencies. These include 
addressing mandatory reporting laws, victim safety and autonomy 
concerns, issues specific to abused women with disabilities, 
and the development of response protoctols for domestic 
violence programs serving older victims. NCALL also continued 
to provide the services of its clearinghouse in collaboration 
with the American Bar Association (ABA), the National 
Association of Adult Protective Service Administrators 
(NAAPSA), and the Wisconsin Coalition Against Sexual Assault 
(WCASA).
    In Fiscal Year 2002, the Office on Violence Against Women 
implemented a new discretionary grant program to support 
training for law enforcement officers, prosecutors, and 
relevant officers of federal, state, tribal, and local courts 
that specifically addresses the obstacles encountered by 
victims of crimes who are older individuals or persons with 
disabilities. This program was authorized by the Violence 
Against Women Act of 2000, which states that:
    The Attorney General may make grants for training programs 
to assist law enforcement officers, prosecutors, and relevant 
officers of Federal, State, tribal and local courts in 
recognizing, addressing, investigating, and prosecuting 
instances of elder abuse, neglect, and exploitation and 
violence against individuals with disabilities, including 
domestic violence and sexual assault, against older or disabled 
individuals. [42 U.S.C. 14041(a)]
    Congress appropriated $5 million for the FY 2002 Training 
Grants to Stop Abuse and Sexual Assault Against Older 
Individuals or Individuals with Disabilities Discretionary 
Grant Program. After setting aside funds for evaluation, 
technical assistance, solicitation, peer review, and other 
management and administration costs, the Attorney General 
awarded approximately $4.5 million to 18 grantees for FY 2002.
    The Training Grants to Stop Abuse and Sexual Assault 
Against Older Individuals or Individuals with Disabilities 
program provides a unique opportunity for targeted training for 
law enforcement officers, prosecutors and relevant court 
officers to enhance their ability to recognize, address, 
investigate, and prosecute these serious crimes. The way 
individuals cope as victims may depend on their experiences 
following the crimes committed against them. As part of the 
civil and criminal justice system, law enforcement officers, 
prosecutors, and court officers are in a position to help 
victims cope with the immediate trauma of crime and ensure that 
offenders are held accountable as well as to help in restoring 
victims' sense of security and control over their lives. The 
training is designed to help civil and criminal justice system 
personnel understand that older victims or victims with 
disabilities both require compassionate and comprehensive 
services and also may face unique challenges.
    Using these Training Grants funds, the California District 
Attorneys Association developed and distributed a video-
formatted training on ``Forensic Wound Identification and Links 
to Successful Criminal Investigation and Prosecution.'' Vera 
House in New York City has supported a coordinated community 
response intervention for older individuals who are victimized. 
The Technical Assistance provider for this grant program, the 
Wisconsin Coalition Against Domestic Violence, is working with 
the National Clearinghouse on Abuse in Later Life to develop a 
directory of services available for victims of elder abuse and 
a guide for creating support groups for such victims.
    In addition, the Violence Against Women Act (VAWA) of 2000 
added a purpose area to OVW's Grants to Encourage Arrest 
Policies and Enforcement of Protection Orders Program and the 
STOP Violence Against Women Formula Grants Program that 
encourages grantees to develop or strengthen policies and 
training for police, prosecutors, and the judiciary in 
recognizing, investigating, and prosecuting instances of 
domestic violence and sexual assault against older individuals 
and individual's with disabilities. For example, one Arrest 
Program grantee, the local prosecutor's office in Skagit 
County, Washington, provided training for criminal justice 
personnel and domestic violence practitioners on investigating 
and prosecuting abuse and neglect cases.
    Domestic violence victims face formidable obstacles when 
attempting to leave abusive relationships, seek assistance, and 
obtain safety. For older victims and victims with physical and/
or mental disabilities, these tasks can prove especially 
daunting. Service providers and criminal justice personnel may 
lack experience meeting the specific needs of older and 
disabled victims. Also, these victims may be particularly 
isolated by communication barriers, physical barriers, and the 
exploitation of their age or disability by their abusive 
partners.
    With OVW support, including an FY 2001 award of $75,000, 
the Statewide California Coalition for Battered Women is 
developing two separate training curricula to enhance services 
to victims of both domestic violence and sexual assault who are 
older or disabled. The curricula will be used to train state 
domestic violence and sexual assault coalitions, STOP Violence 
Against Women Formula Grant program administrators, and STOP 
subgrantees in 13 states. The project features strong 
partnerships with organizations with the expertise necessary to 
successfully implement such an initiative.
Assisting Elderly Crime Victims
    Each year, the Office for Victims of Crime (OVC) awards 
Victims of Crime Act (VOCA) funds to states to support 
community-based organizations that serve crime victims. States 
subgrant these funds to support domestic violence shelters, 
rape crisis centers, child abuse programs, and victim service 
units in law enforcement agencies, prosecutors' offices, 
hospitals, and social service agencies. These programs provide 
services such as crisis intervention, counseling, emergency 
shelter, criminal justice advocacy, and emergency 
transportation.
    States and territories receiving VOCA funds are required to 
give priority to programs serving victims of domestic violence, 
sexual assault, and child abuse. Additional funds must be set 
aside for under-served victims, such as victims of elder abuse. 
In Fiscal Year 2001, VOCA victim assistance programs provided 
services to 31,240 victims of elder abuse. In Fiscal Year 2002, 
29,939 victims of elder abuse received services. Further 
information about OVC resources, including links to 
organizations that serve elderly crime victims, is available on 
the OVC Web site at www.ojp.usdoj.gov/ovc.
    OVC also directly supported a number of initiatives to 
assist elderly crime victims. In April 2002, OVC awarded grants 
of approximately $200,000 each to the Denver District 
Attorney's Office, Legal Services of Eastern Michigan, and Sam 
Houston State University in Huntsville, Texas, to help improve 
services for older victims of fraud. The grantees are 
developing innovative research, training, and materials that 
OVC will distribute to law enforcement officers, victim service 
providers, and other professionals who work with older adults.
    With OVC support, the Denver District Attorney's Office is 
partnering with faith-based organizations to serve 40,000 
elderly in the Denver area through efforts such as sending 
weekly financial crime prevention messages, training volunteers 
to work with victims, and improving financial crime reporting. 
It also hired a community advocate to work with the faith-based 
organizations to encourage the detection and reporting of elder 
fraud cases.
    Legal Services of Eastern Michigan, based in Flint, is 
developing a comprehensive elder fraud training program 
covering predatory lending, home solicitation, financial 
exploitation, and telemarketing fraud. The training can be 
modified for many different types of participants, such as law 
enforcement officers, bankers, and senior care center 
directors.
    Sam Houston State University's National Institute for 
Victim Studies is examining the relationship between natural 
disasters and elder financial exploitation, using Tropical 
Storm Allison in Texas and tornadoes in Kansas and Oklahoma as 
models. The University also is examining the types of 
information available to older people to warn them about fraud 
in the wake of natural disasters.
    OVC also awarded an FY 2001 grant to the American Bar 
Association, working in conjunction with the National 
Association of Adult Protective Services Administrators, for an 
initiative to enhance the development of multi-disciplinary 
fatility review teams in the area of elder abuse. The project 
will include support for four demonstration projects and 
development of a replication guide.
    Under OVC grants awarded in FY 2001 and 2002, the Baylor 
College of Medicine in Texas is developing and testing a 
curriculum to train physicians, medical students, and other 
health professionals working in fields such as emergency 
medicine, geriatrics, family practice, and internal medicine on 
elder abuse. The curriculum, which is being designed for 
national replication, covers the nature of victimization, 
screening, assessment, appropriate interventions, reporting, 
and working with adult protective services and the criminal 
justice system. The grantee is conducting training on this 
curriculum at all medical schools in Texas, as well as at least 
one additional medical school elsewhere in the country. The 
project also will generate a publication for the field 
highlighting the work that is being done by Baylor's TEAM 
Institute, a partnership between the medical school and adult 
protective services dedicated to identifying and responding to 
victims of elder abuse.
    OVC is supporting the update of a 1993 curriculum entitled 
``Improving the Police Response to Elder Abuse.'' The 
curriculum will be updated for reflect new research findings, 
the accumulated practical experience of criminal justice 
professionals and others in investigating and prosecuting abuse 
cases, and trainers' experiences in presenting the materials to 
law enforcement audiences.
    OVC also provided funding to the American Bar Association 
to develop two curricula relating to elder abuse. The first is 
for use in training lawyers on responding to elder abuse and 
domestic violence; the second is to train victim advocates in 
providing direct services to victims of elder abuse.
    In addition, OVC provided support for a December 2001 
national conference convened by the National Center on Elder 
Abuse which brought together national experts from a wide range 
of fields to develop a national agenda for addressing elder 
abuse. The summit was co-sponsored by the Administration on 
Aging of the U.S. Department of Health and Human Services.
Improving Safety and Services for Seniors
    Seniors citizens play an important role-both as volunteers 
and as consumers-in the more than 200 Weed and Seed programs 
operating throughout the country. Supported by OJP's Executive 
Office for Weed and Seed (EOWS), Weed and Seed is a strategy 
that aims to prevent, control, and reduce violent crime, drug 
abuse, and gang activity in targeted high-crime neighborhoods. 
The strategy involves a two-pronged approach: law enforcement 
agencies and prosecutors cooperate in ``weeding out'' criminals 
who participate in violent crime and drug abuse, attempting to 
prevent their return to the targeted area; and ``seeding'' 
brings human services to the area, encompassing prevention, 
intervention, treatment, and neighborhood revitalization. A 
community-orientated policing component bridges weeding and 
seeding strategies.
    The following are examples of Weed and Seed initiatives to 
improve safety and services for senior citizens:
           Midcoast Weed and Seed in Bath, Maine, is 
        working with the local TRIAD chapter to prevent elder 
        abuse and improve coordination of services to the 
        elderly. TRIAD encourages partnerships among senior 
        citizens, sheriffs, and police to address elder safety 
        issues and enhance delivery of law enforcement services 
        to seniors. Midcoast Weed and Seed and TRIAD formed the 
        Elder Abuse Task Force to raise community awareness of 
        elder abuse, teach the community how to report and 
        respond to such abuse, and develop and strengthen 
        systems that support elderly victims and their 
        families.
           The Santa Ana Interagency Neighborhood Team 
        (SAINT) in Santa Ana, California, operates the Corbin 
        SeedTech Computer Lab to help area residents gain the 
        technological skills they need to complete in the job 
        market. The lab offers morning classes for senior 
        citizens.
           As pastor of the World Fellowship 
        Interdenominational Church in Youngstown, Ohio, 100-
        year old Reverend Elizabeth Powell provides a number of 
        community services, including operating a Safe Haven 
        program for neighborhood youth. Because of her service 
        to Weed and Seed and other community efforts throughout 
        the years, in 2001, Reverend Powell was inducted into 
        Ohio's Women's Hall of Fame.
Evaluating Elder Abuse Interventions
    The National Institute of Justice (NIJ) is the research and 
evaluation arm of the Department of Justice. As such, NIJ 
commissions research projects in a variety of areas, including 
crimes against the elderly, and participates with federal 
partners, such as the National Academy of Sciences, on related 
research.
    In addition, NIJ is working to fulfill the requirements of 
the Protecting Seniors from Fraud Act (P.L. 106-534). In 
response to Section 5(b)(1), NIJ is developing the research 
methodology and is formulating a questionnaire to determine the 
scope and nature of crimes against seniors, paying particular 
attention to telemarketing, sweepstakes, and repair fraud. NIJ 
researchers will develop the questionnaire and contract with a 
survey research firm to conduct the survey. When the survey is 
completed, NIJ will analyze the data and report on the 
conclusions.
    NIJ is also represented on the Administration on Aging's 
study planning committee to define ``exploitation'' and 
``fraud'' so that AoA's congressionally-mandated study and 
NIJ's study complement rather than duplicate each other.
    In September 2001, NIJ issued a Research in Brief on 
``Results from an Elder Abuse Prevention Experiment in New York 
City,'' by Robert C. Davis and Juanjo Medina-Ariza. Support for 
this project was provided through a transfer of funds to NIJ 
from the Office of Community Oriented Policing Services (COPS). 
The brief discussed a field experiment of an intervention to 
reduce repeat incidents of elder abuse. Households in randomly 
selected public housing projects in New York City received 
educational material about elder abuse, while others did not. 
Some households that reported elder abuse to the police were 
selected by lottery to receive a follow-up home visit from a 
police officer and a domestic violence counselor. Data on post-
report abuse were collected at six and 12 months after the 
initial report to the police.
    The study found that new incidents of abuse were more 
frequent among households that both received home visits and 
were in housing projects that received public education. 
Households that received home visits also called the police 
significantly more often than controls, both in the housing 
projects that received public education and in those that did 
not. When households both received home visits and were in 
housing projects that received public education, victims of 
elder abuse reported significantly higher levels of physical 
abuse to research interviewers (compared with households that 
received neither intervention or only one of them). The 
researchers speculated that the study interventions actually 
incited abusers, rather than deterring them. Full study 
findings are available at the NIJ Web site at: www.ncjrs.org/
txtfiles1nij/188675.txt.
Improving Data Collection
    The Protecting Seniors from Fraud Act (P.L. 106-534) 
required the Bureau of Justice Statistics (BJS) to include in 
its National Crime Victimization Survey (NCVS) statistics 
relating to:
    (1) crimes targeting or disproportionately affecting 
seniors; (2) crime risk factors for seniors, including the time 
and locations at which crimes victimizing seniors are most 
likely to occur; and (3) specific characteristics of the 
victims of crimes who are seniors, including age, gender, race 
or ethnicity, and socioeconomic status.
    To meet the requirements of Section 5(b)(1)(A) and Section 
6 (data on nature and type of crimes against the elderly and 
NCVS statistics on crimes affecting seniors), BJS published 
Crimes Against Persons Age 65 or Older, 1992-97. This 
publication is available on the BJS Web site at 
www.ojp.usdoj.gov/bjs/. The report provides data from the NCVS, 
as well as from the FBI Uniform Crime Reports. It summarizes 
levels and rates of violent and property crimes against persons 
age 65 or older and provides information on the victimization 
of the elderly, but does not include the crime of fraud. BJS 
and NIJ are working to determine if fraud data can be obtained 
through the FBI's National Incident Based Reporting System 
(NIBRS).
    Section 5(b)(4) requires the Attorney General to determine 
``the feasibility of States establishing and maintaining a 
centralized computer database on the incidence of crimes 
against seniors that will promote the uniform identification 
and reporting of such crimes.'' This requirement is being 
addressed through NIBRS, BJS and the FBI are encouraging states 
to adopt NIBRS in place of the Uniform Crim Reports System 
because NIBRS is a more comprehensive crime reporting system. 
The agencies have provided grants to assist states in making 
this change.
    BJS and NIJ are also working together to determine how best 
to address the requirements of Section 5(b)(3), (5), and (6). 
Specifically the legislation requires the Attorney General to 
study ``the manner in which the Federal and State criminal 
justice systems respond to crimes against seniors''; the 
``effectiveness of damage awards in court actions and other 
means by which seniors receive reimbursement and other damages 
after fraud has been established''; and ``other effective ways 
to prevent or reduce the occurrence of crimes against seniors.
    Though these and other initiatives, the Office of Justice 
Programs is working to protect seniors and provide appropriate 
services for elderly victims of crime. Further information 
about OJP funding programs and other resources is available 
from the OJP Web site at www.ojp.usdoj.gov or by calling the 
Department of Justice Response Center toll free at 1-800-421-
6770.

                      ITEM 10--DEPARTMENT OF STATE

                              ----------                              


    ACTIVITIES IN CALENDAR YEARS 2001 AND 2002 IN SUPPORT OF OLDER 
                               AMERICANS

    The Department is pleased to report that we continued to 
support aging Americans and their caregivers during 2001 and 
2002. Department efforts focus on employee caregivers. Over the 
last decade the relationship between work and family has become 
more intertwined. Given that 25 percent of U.S. households are 
providing care to elderly loved ones, that 64 percent of 
caregivers are employed, and that 65 percent of caregivers are 
aged 35-64 while the average age of Department employees is 46, 
the Department recognizes that the burden of adult care is 
increasingly falling on employees in the workplace. To help 
employees be more effective at work and at home, the Department 
maintains an extensive Eldercare Program.
    In 1999 the Department of State established an Eldercare 
Coordinator position in the Office of Employee Relations to 
develop and promote a series of initiatives to significantly 
improve the level of support the Department offers to employees 
with caregiving responsibilities for parents and other elderly 
relatives. The Coordinator formed a working group to conduct a 
policy review that considered caregiving issues identified by 
the American Foreign Service Association, by the Associates of 
the American Foreign Service, Worldwide (AAFSW) at an AAFSW-
organized Eldercare Forum held at the Department, and the 
Director General of the Foreign Service and Director of 
Personnel of the Department.
    The Eldercare Working Group studied the unique needs of 
both Civil Service and Foreign Service employees as well as 
current rules, regulations and practices with a major impact on 
caregivers. It devised an Eldercare Mission Statement to guide 
the development of Department eldercare support policy and 
recommended the establishment of a dependent care resource and 
referral service, a reinvigorated information program at 
Washington headquarters, and several major regulatory changes 
that could help caregiving employees who serve at overseas 
posts.
    The Eldercare Mission Statement, which was accepted by 
unions that represent Department Civil Service and Foreign 
Service employees, continues to serve as a guide to developing 
a coordinated eldercare support program. The Statement says, 
``The Department recognizes that growing numbers of employees 
will have caregiving responsibilities for parents and other 
elderly relatives. To enable employees to make better decisions 
for the well being of their families, the Department will 
endeavor to provide information on available supports and 
services that affect the elderly. For employees serving abroad, 
it will also seek ways consistent with budget constraints to 
make available certain allowances and other benefits that 
assist in defraying additional eldercare costs due to service 
overseas. In Washington, the Department will provide a 
professionally-led eldercare support group, current and useful 
information on resources, and referral to community support 
services in the metropolitan area.''
    The two major innovations, a dependent care resource and 
referral service (known as IQ: INFORMATION QUEST since the fall 
of 2002) and a new travel benefit for Foreign Service employees 
when a parent faces a health crisis that may threaten 
continuing independence have both been well-received by 
employees. Since its implementation in January 2001, the 
Incapacitated Parent Emergency Visitation Travel benefit has 
been used by over 500 employees or their eligible spouses who 
are serving at American missions abroad. In many cases 
employees who combined the referral service and travel benefit 
were able to respond to a parent's health crisis quickly and 
put in place a plan of care using appropriate programs and 
services available in the community where their parents lived. 
These Department-provided tools relieve the stress of very 
long-distance caregiving and help needy parents who depend on 
their children working at American missions abroad.
    In May 2000, the Department contracted with LifeCare.com to 
provide dependent care resource and referral services to 
employees assigned both domestically and abroad. While this 
service provides referral service on a full range of dependent 
care issues, including child care, it has been a valuable 
source of assistance to employees called upon to make decisions 
concerning the care and well-being of aging parents. Over 2000 
Department employees have used the service to learn about 
creating an effective plan of care or to find adult care 
resources in the community where their parents live.
    The Employee Consultation Service, the Department's 
employee assistance program, continued to offer counseling and 
referral and facilitated an ongoing Eldercare Support Group 
with weekly meetings for employees in the Washington area. The 
Family Liaison Office advocated within the Department on behalf 
of Foreign Service employees and family members with caregiving 
issues arising out of high international mobility.
    The Office of Employee Relations organized a bimonthly 
lunchtime seminar series called ``Caring for Your Aging 
Parents'' which provided information on legal issues of aging, 
long-distance-caregiving, housing options for the elderly, 
coping with Alzheimer's Disease, respite care, and more, as 
well as promoted the use of IQ: INFORMATION QUEST, the 
dependent care referral service.

                 ITEM 11--DEPARTMENT OF TRANSPORTATION

                              ----------                              


   SUMMARY OF ACTIVITIES TO IMPROVE TRANSPORTATION SERVICES FOR THE 
                                ELDERLY

                              INTRODUCTION

    The following is a summary of significant actions taken by 
the U.S. Department of Transportation during calendar years 
2001 and 2002 to improve transportation for elderly persons.\1\
---------------------------------------------------------------------------
    \1\ Many of the activities highlighted in this report are directed 
toward the needs of persons with disabilities. However, one-third of 
elderly persons have disabilities and thus are major beneficiaries of 
these activities.
---------------------------------------------------------------------------

                           DIRECT ASSISTANCE

                  FEDERAL TRANSIT ADMINISTRATION (FTA)

    Under 49 USC 5310, the FTA provides assistance to private 
nonprofit organizations and certain public bodies for the 
provision of transportation services for the elderly and 
persons with disabilities. In FY 2001, $175 million was used to 
help 1,407 local providers purchase 2,212 vehicles and for 
contracted services. In FY 2002, $140 million was used to help 
1,447 local providers purchase 2,179 vehicles and for 
contracted service for the provision of transportation services 
for the elderly and individuals with disabilities. Most of the 
agencies funded under the elderly and persons with disabilities 
program are either disability service organizations or elderly 
service organizations, and service provided under the program 
is nearly equally divided between the two. Those agencies 
servicing the elderly are, however, more dependent on funding 
from the elderly and persons with disabilities program as 53 
percent of their vehicles are purchased with Section 5310 funds 
compared to 42 percent of vehicles purchased by agencies 
serving persons with disabilities. Vehicles purchased with 
these funds may also be used for meal delivery to the homebound 
as long as such use does not interfere with the primary purpose 
of the vehicles.
    Under 49 USC 5311, the FTA obligated $214 million in FY 
2001 and $275 million in FY 2002. 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 nonurbanized area 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 in nonurbanized systems is elderly, 
which represents nearly three times their proportion of the 
rural population.
    Under 49 USC 5307, the FTA obligated $4.1 billion in FY 
2001 and $4.3 billion in FY 2002. 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, many 
elderly individuals depend on public transportation in 
urbanized areas.
    Section 3038 of the Transportation Equity Act for the 21st 
Century authorized a program to fund the incremental capital 
and training costs of complying with DOT's over-the-road bus 
accessibility final rule. In FY 2001, $4.7 million was provided 
to 61 providers of intercity fixed-route service. These funds 
were used to make 138 vehicles wheelchair accessible and for 
training. In FY 2002, $7.1 million was provided to 73 providers 
of intercity fixed-route service and others, including charter 
and tour operators. These funds were used to make 217 vehicles 
wheelchair accessible and for training. Approximately 25 
percent of the over-the-road bus industry's ridership is 
elderly, and a large proportion of persons who use wheelchairs 
are elderly. Providers of over-the-road bus services are 
encouraged to use accessibility training resources developed by 
the National Easter Seal Society's Project Action, an FTA-
funded organization established to promote cooperation between 
the disability community and transportation industry.

                 FEDERAL RAILROAD ADMINISTRATION (FRA)

    The National Railroad Passenger Corporation (Amtrak) 
continued throughout calendar years 2001 and 2002 to provide 
discounted fares, accessible accommodations, and special 
services, including assistance in arranging travel for older 
citizens and passengers with disabilities. These passengers 
continue to represent a substantial part of Amtrak's ridership 
- in 2002 ridership among seniors age 62 or older totaled 
approximately 1.7 million travelers.
    Discounted Fares.--Amtrak has a system wide policy of 
providing elderly persons and persons with disabilities a 15 
percent discount on ticket purchases. During this period, 
Amtrak also offered a 15 percent discount to adult companions 
traveling with a passenger with a mobility impairment. This 15 
percent discount cannot be combined with any other discount. 
Amtrak also offered passengers with mobility impairments a 30 
percent discount on the standard fare for accessible bedrooms.
    Accessible Accommodations.--Amtrak provides accommodations 
that are accessible to elderly persons and passengers with 
disabilities, including those using wheelchairs, on all of its 
trains. Long-distance trains include accessible sleeping rooms 
as well as accessible coach seating and bathrooms. Short-
distance trains, including Northeast Corridor trains, have 
accessible seating and bathrooms. Existing cars have been 
modified to provide more accessible accommodations and all new 
cars, including the Acela Express high-speed rail cars, provide 
enhanced accessibility for passengers with mobility and other 
types of disabilities. Amtrak allows only passengers with 
mobility impairments to reserve an accessible bedroom up until 
14 days prior to the date of a train's departure from the city 
of origin.
    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 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 persons and passengers 
with disabilities, including aid in boarding and deboarding, 
special food services, written menus, special equipment 
handling, and provisions for wheelchairs. Amtrak has also 
improved training of its employees to enable them to respond 
better to passengers with special needs. It is recommended that 
passengers advise Amtrak of any special needs they may have in 
advance of their date of departure.
    Assistance in Making Travel Arrangements.--Amtrak has 
available publications describing its services and facilities 
for the benefit of passengers with disabilities. A pamphlet 
entitled ``Access Amtrak: A Guide to Amtrak Services for 
Travelers with Disabilities'' is available upon request. 
Persons may request special services by contacting the 
reservations office at 1-800-USA-Rail. This office is equipped 
with text telephone (TTY) service for customers who are deaf or 
hard of hearing. To ensure that passengers receive the 
assistance they need, Amtrak maintains a Special Services Desk, 
which supports its reservations agents seven days a week. This 
desk has completed successful responses to 162,000 requests for 
special services. Passengers may also inform their travel agent 
or the station ticket agent of their assistance requirements 
when making travel reservations.

                                RESEARCH

                    DEPARTMENT-WIDE AGING INITIATIVE

    Safe Mobility for a Maturing Society: Challenges and 
Opportunities.--To prepare the nation's transportation system 
for the near doubling of older Americans expected between now 
and 2030, the Department is developing strategies to advance 
safe mobility for older Americans in the first decades of the 
new century. The U.S. Department of Transportation Office of 
the Secretary, National Highway Traffic Safety Administration 
(NHTSA), Federal Highway Administration (FHWA), and Federal 
Transit Administration (FTA) are participating in this effort. 
The strategies are based on a national dialog on the 
transportation needs of an aging population. This dialog has 
included regional forums, workshops, professional society 
meetings, international conferences, and the work of a 
companion study done by the Transportation Research Board (see 
below). Its purpose has been to get the broadest possible 
viewpoint from those practicing in the field--transportation 
professionals, medical and social service providers, public 
officials, and the agencies and interest groups who deal with 
the elderly on a day-to-day basis. Concurrent with the regional 
forums a series of focus group discussions were held with older 
people and their lay care givers (usually adult children) to 
obtain their perspectives on elderly driving, the difficulties 
associated with driving cessation and the use of other 
transportation options. Several telephone surveys of older 
adults were also conducted.
    The result of this effort points out that there is no 
simple solution, nor is responsibility vested in one single 
organization. It has shown that a comprehensive set of 
strategies to manage safe transportation for our older adults 
is needed. Research has also indicated that there is an array 
of possible innovations and measures for maintaining 
transportation safety and quality of life for older adults: 
improved roads, safer cars, better driver screening and 
retraining, more access to non-driving alternatives, and 
dissemination of better information to the public. The 
Department is developing a source of guidance on the strategies 
that hold the most promise by transportation planning, law 
enforcement, social service, and medical agencies at all 
levels, as well as the private sector, and by older adults 
themselves and their advocates.
    Transportation Research Board (TRB) Report.--The TRB, with 
the support of the Department, is working to update a 1988 
report on needed research covering transportation for older 
adults. The update examines what has been done since 1988, what 
the requirements are for new work, and what the new research 
priorities should be for meeting the needs of an increasing 
elderly populace over the next 25 years. This report, 
Transportation for an Aging Society - a Decade of Experience 
will be published by TRB in late 2003.

                 FEDERAL AVIATION ADMINISTRATION (FAA)

    The Office of Aerospace Medicine's Civil Aerospace Medical 
Institute (CAMI) has contributed to the following research 
related to the needs and concerns of the aging population in 
aviation transportation.
    Cognitive Function Test.--Results of the study involving 
the administration of the CogScreen test to a group of older 
military aviators, including repatriated military aviations and 
a control group were presented during the XXV International 
Congress of Applied Psychology in 2002. The validation extends 
the age groups of the original CogScreen validation to include 
more aviators in the older age groups. The results were 
recently reanalyzed to combine several of the variablesusing 
factors identified in previous research on pilot age and 
performance. The general pattern of lowered CogScreen scores 
with advancing age was evident in the various factors.
    Age-60 Rule.--In response to a complaint filed under the 
Department of Transportation (DOT) Information Dissemination 
Quality Guidelines, CAMI scientists provided a response 
regarding the four Age 60 rule studies that were completed by 
CAMI scientists in 2000, in response to the Congressional 
request.
    To resolve issues that were raised regarding the Age 60 
studies, a research study was initiated to evaluate the 
methodology involved in the identification and selection of the 
pilot population in these investigations. The draft report of 
this study is currently under review. Preliminary findings of 
the study indicate that factors such as the criteria for pilot 
and accident inclusions, estimation of exposure, and the 
analytic strategy are extremely important in studies of the 
relationship of airplane accidents with age.
    Air Traffic Services-related Research.--As part of a 
continuing program of research on the effects of shift 
schedules on sleepiness, fatigue and performance in air traffic 
controllers, data were gathered from Certified Professional 
Controllers (CPCs) at a terminal radar control facility and an 
Air Route Traffic Control Center. Groups of controllers at the 
two facilities provided responses to questionnaires, logbooks, 
wrist activity monitors, and computerized tests assessed during 
the workday. A report from this research is currently under 
preparation. Outcomes were consistent with changes found in the 
general population; younger participants (<40 years of age) 
were significantly faster and had greater thruput on the 
computerized tasks that assessed Speed/Working Memory. Declines 
in subjective alertness of older controllers appeared to have a 
greater effect on speed/working memory task performance than in 
younger controllers. Results provide additional information to 
guide development of fatigue countermeasures for controllers 
and other personnel working rotating shift schedules.
    In response to Congressional language in a current draft of 
the appropriation bill, CAMI scientists have been asked by the 
Air Traffic Service to initiate research designed to determine 
whether the mandatory age 56 separation requirement for air 
traffic control specialists should be maintained. Following 
discussions with personnel from air traffic services, a set of 
research studies may be initiated.

                 FEDERAL HIGHWAY ADMINISTRATION (FHWA)

    Beginning in 1989, a High Priority Area for research was 
established to develop a clear understanding of older driver 
needs and capabilities with respect to the roadway environment. 
Research under this program started as problem identification, 
and quickly moved to focus on the specific areas that cause the 
greatest problems for older drivers and pedestrians.
    Research findings from this program are incorporated in an 
updated version of the Older Driver Handbook that was completed 
in October 2001. Besides including the most recent research 
findings, this document addresses a broad range of highway 
design areas. The new editions: (i.e., Highway Design Handbook 
for Older Drivers and Pedestrians (FHWA-RD-01-103) and 
Guidelines and Recommendations to Accommodate Older Drivers and 
Pedestrians (FHWA-RD-01-051)) now available in hard copy or in 
electronic form via the Internet.
    FHWA is participating in an international organization 
concerned with the older population (i.e., Organization for 
Economic Co-operation and Development (OECD)) via membership on 
``Human Factors of Technology for Elderly Users'' Working 
Group. FHWA is also participating in the OECD 2003 Symposium on 
``Human Factors of Transport Technology for Older Persons.''
    It should be noted that all human centered research, 
including Intelligent Transportation Systems initiatives, 
conducted by FHWA includes an older driver component to ensure 
the system's utility for all potential users.
    The FHWA is continuing work to fulfill a mandate issued by 
Congress that requires public agencies to maintain signs and 
pavement markings to minimum levels of retroreflectivity (i.e., 
brightness). In the process of establishing these minimum 
guidelines, research has been conducted to determine the 
brightness of signs and pavement markings necessary for older 
drivers to drive safely and comfortably at night. A recent 
study using older drivers as subjects, has determined an 
optimum brightness for overhead guide signs.
    Two laboratory simulator experiments and one field 
validation study on minimum retroreflectivity requirements and 
luminance trading relationships for pavement markings (i.e., 
center lines and edge lines) and retroflective raised pavement 
markers have been conducted utilizing older drivers. Two 
additional roadway delineation studies experiments are planned 
for next year. Both of these studies, which will examine driver 
performance as they navigate curves at night, will also utilize 
older drivers.
    The FHWA, in cooperation with Virginia Department of 
Transportation (VDOT), is also evaluating the ability of 
various pavement marking materials to provide adequate guidance 
to older drivers under wet night conditions. The experiment 
will be conducted on a new stretch of roadway at the Virginia 
Smart Road, by researchers at the Virginia Tech Transportation 
Institute.
    Research is presently underway that will examine the 
proportion of fluorescence to reflectance needed to attain 
enhanced visibility of signs in daytime, and to study the 
effects of sign color fading due to weather. Older drivers will 
be used exclusively as research participants in these studies.
    FHWA is also investigating the effectiveness of new 
automobile headlight systems, which have the potential to 
drastically improve the visibility of signs, pavement markings, 
and pedestrians at night. Older drivers have been included in 
the experiments involving ultraviolet and infrared headlighting 
systems, and other new headlamp technologies. Efforts are 
continuing on this project to evaluate driver visibility with 
these headlight systems under adverse weather conditions at the 
Virginia Smart Road, and to determine the possible impacts of 
glare on other drivers while using these new headlighting 
systems.
    The FHWA also used the Virginia Smart Road and its 
sophisticated fixed lighting test system to examine varying 
light types, levels, and placement to identify optimum lighting 
design for older drivers. Ninety older drivers have 
participated in field experiments, which measured their ability 
to see objects on the road under varying levels of street 
lighting and glare from on-coming vehicles. This effort is 
expected to validate new lighting design standards.
    The results of these studies and other research will be 
incorporated into the Manual of Uniform Traffic Control 
Devices, the Highway Lighting Handbook, and other documents 
used in highway design.

                     FEDERAL TRANSIT ADMINISTRATION

    The Federal Transit Administration and the U.S. 
Administration on Aging began working together in 2002 to 
assist our respective networks in the coordination of 
transportation services for older adults and to facilitate 
access to these services by older adults and entered into a 
Memorandum of Understanding (MOU) on January 9, 2003. The two 
administrations have developed initiatives that are targeted to 
make it easier for local transportation providers to serve 
older adults and help them remain independent and participating 
in their communities. We have focused on developing common 
sense transportation solutions as the key to promoting 
independence and opportunity for older adults. The key 
objectives of the MOU are focused in five areas: 1) Public 
awareness and outreach; 2) Data collection and promising 
practices; 3) Technical assistance to States and local 
communities; 4) Stakeholder input; and 5) Local and State 
transportation plan development.
    In FY 2002, the National Easter Seal Society's Project 
Action hosted a National Dialogue on Accessible Transportation, 
which brought together representatives from the disability, 
transportation and human services communities to jointly pursue 
solutions to the unmet transportation needs of people with 
disabilities and older adults. An action plan was prepared and 
presents a number of recommendations and specific steps that 
can be taken in the pursuit of this agenda. Some of the on-
going recommendations include: continue/expand the National 
Dialogue meetings on Accessible Transportation; integrate 
accessible transportation issues into existing grassroots 
community agendas; and publicize the availability of transit 
resource centers to the general public. Over the past few years 
Project Action has worked with a number of aging organizations 
in addressing accessible public transportation. Among the more 
than 100 products available free of charge from its 
clearinghouse are three publications that specifically focus on 
seniors and public transportation.
    Through the Transit Cooperative Research Program, FTA 
sponsored the research project begun in fiscal year 1999, 
``Improving Public Transit Options for Older Persons.'' This 
project examined the population of interest in detail and 
identified barriers to mobility and methods to overcome them; 
detailed best practices from transportation programs designed 
to improve transportation opportunities for older persons; and 
identified further innovations. The final report was issued in 
2002. The report describes exemplary transportation services 
and innovative transportation alternatives designed to enable 
older persons to maintain independence.

            NATIONAL HIGHWAY TRAFFIC ADMINISTRATION (NHTSA)

    Vehicle Design for Crash Avoidance.--NHTSA's crash 
avoidance research program addresses the relationship between 
vehicle design and driver performance and behavior. Emerging 
vehicle technologies could help reduce older driver crashes and 
enhance their mobility. For example, voice turn-by-turn in-
vehicle navigation systems may allow drivers to concentrate on 
watching for dangerous traffic conflicts instead of being 
distracted while searching for road signs. Similarly, 
collision-warning systems would alert drivers to potential 
crash situations. In this area, NHTSA continues development of 
crash warning systems for rear-end crashes, lane change 
crashes, road departure crashes, and intersection crashes. 
Other developments in driver interfaces could provide 
technology-based innovations that would help older, 
functionally less able people continue to drive by offering all 
drivers much wider adaptability to unique personal needs, say 
through programmable ``glass dash'' options where older drivers 
could improve contrast and font size programming rather than 
settling for current fixed-configuration designs, and could 
even control the nature of the information that is passed to 
them from the vehicle. NHTSA's research focus is thus to 
determine how the design and function of vehicle systems could/
should be adapted to better meet the needs of all drivers, 
including the unique capabilities and needs of older drivers.
    Pedestrian Safety Issues.--Older pedestrians, 65 and over, 
account for a smaller proportion (7.7 percent) of all 
pedestrian crashes than would be expected by their numbers in 
the population (12.8 percent). However, they account for more 
than one in five (22.4 percent) of pedestrian fatalities. In 
response to this problem, NHTSA and FHWA are continuing work 
aimed at preventing crashes involving pedestrians. In 2002, an 
analysis of pedestrian crash data from the previous five years 
was initiated. Based on these projects as well as public 
information projects, NHTSA participated in a forum to develop 
strategies on active aging that was sponsored by the Robert 
Wood Johnson Foundation in October 2002.
    Older Driver Safety.--The majority of older drivers do not 
constitute a major safety problem. Research has indicated that 
most older drivers adjust their driving practices to compensate 
for declining capabilities. They reduce or stop driving after 
dark or in bad weather and avoid rush hours and unfamiliar 
routes. There are, however, individuals who are at increased 
risk for crashes or who may not adequately change their driving 
habits. NHTSA is hard at work trying to identify those drivers 
through its research program and to make tools and information 
available to people who interact with them so that drivers will 
make better decisions. In 2001, NHTSA entered into an Inter-
Agency Agreement with the National Institute on Aging to 
identify the specific needs of caregivers for Alzheimer's 
disease patients. Also released that year, Family and Friends 
Concerned About an Older Driver identifies the information 
needs of the more general population of caregivers and provides 
direction to NHTSA and others who will fill those needs. Based 
on this research, a series of three web-seminars was developed 
with the American Society on Aging (ASA) to provide information 
to aging-network professionals. These seminars will be repeated 
in the Fall of 2003.
    In 2001, NHTSA released an analysis of the Utah Crash 
Outcome Data Evaluation System (CODES), Further Analysis of 
Drivers Licensed With Medical Conditions in Utah. This report 
followed an earlier study on the topic, but focused on crash 
involvement of individuals with different levels of license 
restrictions based on the severity of their medical conditions.
    In addition to conducting research in this area, NHTSA 
participated in the November 1999 Transportation Research Board 
(TRB) conference on Transportation in an Aging Society: A 
Decade of Experience. Participants at this conference 
identified research gaps in the knowledge base regarding older 
road users. In August 2001, NHTSA released a research plan for 
studies from that conference that fall under NHTSA's mission. 
Based on the problem statements identified in that report, two 
studies were initiated regarding polypharmacy, or multiple 
medications and their effects on driving. In the first study, a 
research design was developed for testing the effects of 
multiple medications on older drivers in a simulator. This 
internal project identified the challenges and safety issues 
surrounding research of that nature. A second project that was 
started in August 2002 is investigating the crash involvement 
rates of individuals over age 50 who have been prescribed 
medications, with particular emphasis on multiple medications. 
The contractor is examining a proprietary insurance database to 
determine what combinations of medications are most 
problematic.
    Because of a recognized gap in program activities, in 
September 2002, NHTSA began gathering information for a 
compendium of older driver programs that are operated through 
law enforcement agencies nationwide. Programs typically fall 
into three categories: officer training; officers training 
seniors; and, community partnerships to promote safety.
    Driver Assessment Activities.--Unsafe older drivers are not 
easily detected with standard licensing procedures. Further, 
there is some doubt as to whether most licensing staff have the 
skills necessary to detect problem drivers, even with training 
and state-of-the art testing techniques. Diagnostic tests 
currently in use have not been shown to be effective in 
identifying those older drivers who are at increased crash 
risk, but some tests of ``speed of attention'' and ``visual 
perception'' may have such potential, particularly at detecting 
the cognitively impaired. A study in the State of Maryland that 
was completed in 2002 promises to reveal which of these tests 
is most predictive of crash involvement. In addition, a project 
with the State of Florida aims to better identify and counsel 
cognitively impaired drivers. NHTSA is also investigating the 
degree to which rehabilitation is an option for drivers with 
certain medical conditions. The goal is to keep people driving 
for as long as it is safe for them to do so. In 2002, NHTSA and 
the American Occupational Therapy Association began a 
cooperative agreement that is designed to increase the numbers 
of occupational therapists who have training in older driver 
assessment or rehabilitation. A small expert panel was held in 
December 2002 to identify strategies for increasing the ranks 
of individuals with these skills.

          RESEARCH AND SPECIAL PROGRAMS ADMINISTRATION (RSPA)

    RSPA's Volpe National Transportation Systems Center 
researches issues related to aging drivers through its Operator 
Performance and Safety Analysis Division. The division resolves 
problems across all transportation modes by performing research 
to analyze the relationship between human behavior and 
transportation safety and productivity. The division has an on-
site laboratory, the Center for Human Factors Research in 
Transportation, operated collaboratively with the Massachusetts 
Institute of Technology (MIT). More information on aging-
related research may be found at: http://www.volpe.dot.gov/
opsad/index.html.
    RSPA manages the Department's University Transportation 
Centers (UTC) Program (http://utc.dot.gov/). Each center 
focuses its research on a specific theme or interest area. 
Several of the Centers conduct research linked to improving 
mobility for elderly citizens.
    The most significant research related to this topic is 
conducted at the Center for Transportation and Logistics at the 
Massachusetts Institute of Technology. Through MIT's AgeLab, 
the Center conducts research on the mobility needs of an aging 
populace and seeks to develop products to promote healthy 
independent living. More information on the Center may be found 
at http://web.mit.edu/ctl/www/research/research.html, and on 
the AgeLab website at http://web.mit.edu/agelab/.
    To a lesser extent, research on the impacts of an aging 
population on transportation systems and demand are conducted 
at several other UTCs. Further information on these Centers may 
be found as noted below:

------------------------------------------------------------------------
  University Transportation Center
                (UTC)                       For Further Information
------------------------------------------------------------------------
University Transportation Research                 http://www.utrc2.org/
 Center City University of New York.
National Transportation Center            http://www.eng.morgan.edu/ntc/
 Morgan State University............
Southwest Region University                       http://swutc.tamu.edu/
 Transportation Center Texas A&M
 University.........................
National Center for Transportation              http://www.nctr.usf.edu/
 Research University of South
 Florida............................
------------------------------------------------------------------------

    Searches for UTC research reports on this and other topics 
may be conducted through the UTC search engine at: http://
utc.dot.gov/results.html.

                       INFORMATION DISSEMINATION

                     FEDERAL HIGHWAY ADMINISTRATION

    A one-day workshop was developed to familiarize traffic 
engineers and highway designers with the Older Driver Highway 
Design Handbook. The workshop covers the needs and capabilities 
of older road users, reviews the recommendations of the 
Handbook in detail, and presents case studies as learning 
exercises. It was designed for federal, state, and local 
highway designers, traffic engineers, and transportation 
professionals. To date, over 95 workshops have been held in 
over 40 states, training approximately 2,500 traffic engineers. 
FHWA personnel from across the country have attended ``train 
the trainer'' sessions, thereby allowing FHWA to better meet 
the numerous requests for workshops. The workshop was revised 
to reflect information contained in the new edition of the 
Handbook that was published in 2001 entitled Highway Design 
Handbook for Older Drivers and Pedestrians.
    In 1999, the FHWA established the Pedestrian and Bicycle 
Information Center (PBIC) to provide technical assistance to 
localities on accommodating pedestrians, including older 
pedestrians. The PBIC is operated by the Highway Safety 
Research Center of the University of North Carolina, and offers 
a website (www.walkinginfo.org), an 800 number (877-925-5245), 
fact sheets and expert assistance. The PBIC enhances the 
effectiveness of the USDOT by providing additional technical 
expertise to individuals with questions about pedestrian and 
bicycle facilities and programs.
    As an implementing agency for the Americans With 
Disabilities Act (ADA), FHWA published a guideline Designing 
Sidewalks and Trails for Access--A Review of Existing 
Guidelines and Practices--Part 1. A Best Practices Guidebook 
was released in September 2001. This document explains the 
needs of pedestrians with disabilities, including the needs of 
older pedestrians, and provides guidance on how to design 
universally accessible pedestrian facilities. FHWA also 
initiated a project in 2000 focusing on Intelligent 
Transportation Systems-based pedestrian countermeasures, 
including some technologies (infra-red detection) that will 
benefit older pedestrians. Older pedestrian issues are included 
in all ongoing FHWA outreach activities, including the 
Intersection Hazard Index for Pedestrians and Bicyclists, and 
the University Pedestrian/Bicyclist Graduate Course, as well as 
other active work with State DOTs and other transportation 
agencies.

                    FEDERAL RAILROAD ADMINISTRATION

    Information about Amtrak accessibility is available to 
senior citizens and passengers with disabilities in a brochure 
entitled ``Access Amtrak'' which can be obtained by calling 1-
800-USA-RAIL or ordering from the Amtrak website at 
www.amtrak.com. Amtrak also works directly with a number of 
organizations each year on moving groups of passengers needing 
assistance and traveling together.

             NATIONAL HIGHWAY TRAFFIC SAFETY ADMINISTRATION

    A broad array of public information materials and resources 
were introduced in 2001 and 2002. Through partnerships with 
outside organizations and within DOT, NHTSA has been able to 
expand its outreach efforts and reach new audiences. One 
product of that cooperation, a booklet called Creating 
Communities for Active Aging, is a guide to developing a 
strategic plan within a community to promote bicycling and 
walking. It was produced with the Partnership for Prevention. 
Another booklet on senior pedestrian safety was initiated in 
2001.
    Because data at the time indicated that African-Americans 
have lower seat-belt use rates than the general population, 
NHTSA determined that addressing this safety problem was 
critically important. Materials aimed at African-American 
seniors were developed in 2002. Safety information on vision, 
reflexes, and cognition are included in the booklet.
    In 2001, an array of activities was initiated that focused 
on health care providers, both as recipients of information and 
as messengers. To capitalize on the success of the Emergency 
Nurses Association (ENA) TAKE CARE program, which uses nurses 
to train seniors on medication safety, NHTSA and ENA developed 
a module on driving safety. Emergency nurses now use this 
module to educate groups of seniors at public speaking events. 
The American Academy of Family Physicians and NHTSA conducted 
focus groups with physicians to determine the appropriate 
formats for materials regarding older driver safety. This 
information was used in a project with the American Medical 
Association (AMA). NHTSA and AMA have developed a physician's 
guide on medical conditions and how they relate to older driver 
safety. It also provides guidance on other assessments or 
referrals that might be appropriate. Another medical 
organization that NHTSA partnered with is the American 
Optometric Association (AOA). This partnership created a 
training workshop for practicing optometrists regarding older 
drivers and vision. NHTSA and AOA also initiated a partnership 
to develop patient materials regarding safe driving and eye 
diseases such as glaucoma and macular degeneration. Additional 
materials are under development which address other medical 
conditions that affect driving as we age: diabetes, stroke, 
Alzheimer's Disease, Parkinson's, arthritis, seizures, sleep 
apnea and sedating medications. A total of 11 such brochures 
are planned.
    In addition, NHTSA is currently testing a kit of materials 
designed to assist aging professionals advise and counsel their 
older clients about driving safety. The kit is being tested in 
5 demonstration sites around the country, with plans to 
distribute nationally after the demonstration phase is 
completed.
    NHTSA is also piloting a social marketing campaign in 
another 5 sites that is designed to improve older driver safety 
by initiating local and family conversations about driving 
safety. In many communities in America older drivers feel 
compelled to keep driving even after they become concerned 
about their declining skills because there are simply no 
alternatives available. The pilot seeks to involve local 
community leaders to ensure that transportation and other 
services are available so that older drivers may gradually 
begin to ``retire'' from driving when the need arises.

              RESEARCH AND SPECIAL PROGRAMS ADMINISTRATION

    The University Transportation Centers (UTC) Program 
integrates its products in a directory of University Research 
Results at: http://utc.dot.gov/results.html. The directory 
includes the title of each report and a contact that can 
provide further information on the research and the 
availability of documentation.
    Research results and other activities at RSPA's Volpe 
National Transportation Systems Center may be accessed at: 
http://www.volpe.dot.gov/ourwork/index.html.
    Results from UTC and Volpe programs may be found in the 
Transportation Research Information Services (TRIS) on-line 
database, operated jointly by the National Research Council's 
Transportation Research Board, and the Bureau of Transportation 
Statistics' National Transportation Library, at: http://
199.79.179.82/sundev/search.cfm.

                  ITEM 12--DEPARTMENT OF THE TREASURY

    7U.S. TREASURY ACTIVITIES IN 2001-2002 AFFECTING OLDER AMERICANS

    The Treasury Department recognizes the importance and the 
special concerns of older Americans.

                      SOCIAL SECURITY TRUST FUNDS

    The Secretary of the Treasury is the Managing Trustee of 
the two Social Security Trust Funds (Old-Age and Survivors 
Insurance and Disability Insurance). The Trustees issue an 
annual report on the short- and long-run financial status of 
these trust funds. In the March 2003 report, covering calendar 
year 2003, the Trustees projected that full benefits can be 
paid for about the next 39 years, one year longer than in the 
2002 report. A higher assumed rate of immigration contributed 
to the solvency of the trust funds. The 75-year actuarial 
deficit of the Social Security program in the 2003 report is 
estimated to be 1.92 percent of taxable payroll compared to 
1.87 percent in the 2002 report. The OASDI Trustees' Report is 
available at www.ssa.gov/OACT/TR/index.html.
    There was an automatic 2.6 percent benefit increase in 
December 2001, and an additional 1.4 percent in December 2002. 
The taxable wage base was increased to $80,400 in 2001, $84,900 
in 2002, and is $87,000 in 2003.

                          MEDICARE TRUST FUNDS

    The Secretary of the Treasury is the Managing Trustee of 
the Federal Hospital Insurance (HI) and Federal Supplementary 
Medical Insurance (SMI) Trust Funds. In their March 2003 
report, covering calendar year 2002, the Trustees projected 
that the HI Trust Fund will be exhausted in 2026, compared to 
2030 in the 2002 report. In the 2003 report the 75-year HI 
actuarial deficit is projected to be 2.40 percent of taxable 
payroll, compared to 2.02 percent in the 2002 report. The SMI 
Trust Fund is projected to remain adequately funded into the 
indefinite future because its funding, by law, comes almost 
entirely from general revenues and premium payments. The 
Medicare Trustees' Reports are available at www.cms.hhs.gov/
publications/trusteesreport.

                   PENSION AND RETIREMENT INITIATIVES

            Defined Contribution Plan Retirement Security Initiatives
    In February 2002 the Administration convened a Retirement 
Security Task Force in the wake of Enron Corporation's 
bankruptcy. Many Enron employees suffered substantial 401(k) 
retirement fund losses when the company stock in which they had 
invested for retirement became worthless. The task force 
included policy officials from the Treasury, Labor, and 
Commerce Departments as well as the National Economic Council. 
The Task Force examined defined contribution system rules to 
determine how they might be changed to improve employees' and 
retirees' retirement security without imposing unreasonable 
increases in administrative burden on sponsors or otherwise 
reducing employer incentives to continue operating these plans. 
Defined contribution plans, operated on a solely voluntary 
basis by employers, are an increasingly important part of 
workers' retirement income.
    The Task Force outlined four areas in which the defined 
contribution pension system could be improved: increasing 
diversification rights for 401(k) investors, providing timely 
information about 401(k) plan investments, notifying workers 
and retirees of blackout periods and restricting management 
trading of company shares during such periods, and lifting 
restrictions that prevent firms from providing investment 
advice to employees through third parties.
    The Sarbanes-Oxley Act of 2002, signed into law in July 
2002, addresses the Task Force recommendation on blackout 
periods. Provisions in the act require employers to provide 30-
day notice to plan participants of an impending blackout 
period. (Blackout periods are defined as periods of three or 
more consecutive business days in which the ability of a 
participant to direct or diversify assets, or to obtain loans 
or distributions is affected.) In addition, directors or 
executive officers may not trade company stock acquired as 
compensation during a blackout that affects more than 50 
percent of all participants.
    Administration endorsed legislation addressing the three 
other Task Force recommendations was passed by the House of 
Representatives in 2002 and reintroduced in February 2003 as 
H.R. 1000, the Pension Security Act of 2003, which passed on 
April 14, 2003. The Senate has yet to act on the bill.
    Provisions of H.R. 1000 allow participants to sell employer 
stock acquired in the form of matching contributions under one 
of two methods chosen by the employer. The first method allows 
for the sale of such stock by any employee who has participated 
in the plan for three years. The second allows any employee to 
sell shares of such stock three years after acquiring it.
    H.R. 1000 also allows employers to provide investment 
advice to plan participants through third party fiduciary 
advisers, including plan administrators. If plan administrators 
provide advice, then certain disclosures concerning potential 
conflicts of interest must be made to participants.
    Lastly, H.R. 1000 requires that employers provide quarterly 
statements for individual account plans reporting the 
participant's accrued and nonforfeitable (vested) benefits. The 
statement would also include the value of investments, 
reporting employer securities separately (a reminder of the 
importance of diversification), and a warning against holding 
more than 25 percent of one's assets in any single security.
            Defined Benefit Plan Retirement Security Initiatives
    The Treasury Department is involved in an initiative to 
reform defined benefit pension plan rules. This plan is being 
developed in conjunction with policy officials at the 
Departments of Labor and Commerce as well as the National 
Economic Council and the Pension Benefit Guaranty Corporation, 
which insures the benefits of most participants in tax 
qualified defined benefit plans. Treasury Under Secretary for 
Domestic Finance Peter R. Fisher announced this initiative in 
his July 15, 2003 testimony before the House of Representatives 
Subcommittee on Select Revenue Measures of the Committee on 
Ways and Means, and the Subcommittee on Employer-Employee 
Relations of the Committee on Education and the Workforce. The 
objectives of the initiative are to increase the measurement 
accuracy of pension assets and liabilities, increase 
disclosures of plans' financial status to participants and the 
funding positions of pension plans, and to ensure the long run 
solvency of the government's pension insurance system.
    First, the Administration recommends that pension 
liabilities be computed using a corporate bond yield curve 
rather than a rate based on the 30-year Treasury bond as 
required under current law. Use of a yield curve would 
explicitly recognize the time structure of each pension plan's 
future benefit payments resulting in liability calculations 
that are more accurate than any calculation based on a single 
discount rate. Accurate liability measurement must be the first 
step in any process that would improve pension plan funding.
    Second, the Administration recommends that all plan 
participants, not just those covered by certain financially 
distressed plans, be informed annually of the value of their 
plans' assets and liabilities. Information on assets and 
liability values of certain underfunded plans would be made 
public. These increased disclosure requirements would provide 
better incentives for plan sponsors to fully fund their plans, 
participants with important information to use in bargaining 
for pension benefit and salary increases, and investors with 
information on the demands that a firm's defined benefit plan 
is likely to place on future sponsor income and cash flow.
    Third, the Administration recommends that benefit growth be 
restricted in pension plans that are underfunded and whose 
sponsors are financially distressed. Under the Administration's 
proposal, if a plan sponsored by a firm with a below investment 
grade credit rating has a funding ratio below 50 percent of 
termination liability, benefit improvements would be 
prohibited, the plan would be frozen (no accruals resulting 
from additional service, age or salary growth), and lump sum 
payments would be prohibited unless the employer contributes 
cash or provides security to fully fund these added benefits. 
If a sponsor is undergoing bankruptcy the same restrictions 
would apply. In addition, the PBGC's guaranty limit would be 
fixed as of the date the plan sponsor files for bankruptcy.
    Finally, the Administration has undertaken a review of 
defined benefit pension funding rules and is developing a plan 
for fundamental reform.

                               TAX POLICY

            Income Tax
    Each year, the width of the income tax brackets and the 
personal exemption and standard deduction amounts are increased 
to reflect the effects of inflation during the preceding year.
    The personal exemption allowed for each taxpayer and 
dependent increased from $2,800 in 2000 to $2,900 in 2001 and 
to $3,000 in 2002.
    Taxpayers age 65 or over (and taxpayers who are blind) are 
entitled to larger standard deductions than other taxpayers. 
Each single taxpayer who is at least 65 years old was entitled 
to an extra standard deduction of $1,100 in 2000 and 2001, and 
$1,150 in 2002. Each married taxpayer age 65 or over was 
entitled to an extra standard deduction of $850 in 2000 and 
$900 in 2001 and 2002. Thus, married couples both of whom were 
at least age 65 were entitled to an extra standard deduction of 
$1,700 in 2000 and $1,800 in 2001 and 2002. Including the extra 
standard deduction amounts and the basic standard deduction 
amounts, taxpayers age 65 and over were entitled to the 
following standard deductions for tax years 2000 through 2002.

------------------------------------------------------------------------
             Filing Status                  2000       2001       2002
------------------------------------------------------------------------
Single.................................     $5,500     $5,650     $5,850
Unmarried Head of Household............     $7,550     $7,750     $8,050
Married Filing Jointly:
    One spouse age 65 or older.........     $8,200     $8,500     $8,750
    Both spouses age 65 or older.......     $9,050     $9,400     $9,650
------------------------------------------------------------------------

    The tax credit for the elderly (and permanently disabled) 
was retained throughout the period.
    In addition to the changes from these adjustments for 
inflation, significant changes were enacted as the result of 
initiatives from President Bush in 2001 and 2003. Changes 
enacted in the Economic Growth and Tax Relief Reconciliation 
Act of 2001 (EGTRRA) affected years beginning in 2001, and 
changes in the Jobs and Growth Tax Relief Reconciliation Act of 
2003 (JGTRRA), many of which accelerated phased-in tax 
reductions enacted in EGTRRA, affected 2003 and will affect 
2004.
    EGTRRA created a new 10-percent tax rate bracket beginning 
for 2002 that applied to the first $6,000 of taxable income for 
taxpayers with single filing status and the first $12,000 of 
taxable income for married taxpayers. For 2001, in lieu of the 
10-percent tax bracket, taxpayers received an equivalent 
benefit through a rate reduction tax credit of 5 percent of the 
first $6,000 of taxable income for single taxpayers and the 
first $12,000 of taxable income for married taxpayers. Many 
taxpayers received the benefit of the credit through advance 
payment checks sent out in the summer of 2001 on the basis of 
information on 2000 tax returns. EGTRRA also reduced all tax 
rates in tax brackets above the 15-percent tax bracket. Each 
tax rate of more than 15 percent was reduced by 0.5 percentage 
point for 2001 and by one percentage point for 2002. The former 
28-percent tax bracket was reduced to 27.5 percent for 2001 and 
to 27 percent for 2002. The 31-percent tax bracket was reduced 
to 30.5 percent for 2001 and to 30 percent for 2002. The 36-
percent tax bracket was reduced to 35.5 percent for 2001 and to 
35 percent for 2002. The former 39.6-percent tax bracket was 
reduced to 39.1 percent for 2001 and to 38.6 percent for 2002.
    JGTRRA provided additional tax relief for 2003 and 2004. 
The reductions in tax rates higher than 15 percent previously 
scheduled to take effect in 2004 and 2006 were made effective 
immediately. Tax rates in effect in 2002 were reduced from 27 
percent to 25 percent, 30 percent to 28 percent, 35 percent to 
33 percent, and from 38.6 percent to 35 percent, respectively. 
The 10-percent tax bracket was widened by $1,000 (to $7,000) 
for single taxpayers and by $2,000 (to $14,000) for married 
taxpayers. Tax rates were lowered on long-term capital gains 
and on dividend income. For dividends or capital gains that 
would have been taxable at a 10-percent or 15-percent marginal 
tax rate if they were ordinary income, the applicable tax rate 
was reduced to 5 percent. Otherwise, the applicable tax rate 
was reduced to 15 percent. Also, marriage penalty relief was 
provided for married taxpayers by increasing the standard 
deduction amount for married taxpayers to twice the amount for 
single taxpayers and by increasing the top of the 15-percent 
tax bracket for married taxpayers to twice the level for single 
taxpayers.
    Under current law, the 10-percent bracket revision, the 
reductions in tax rates higher than 15 percent, and the 
marriage penalty provisions of JGTRRA will expire after 2004, 
and the capital gains and dividends provisions will expire 
after 2008. The provisions of EGTRRA described above will 
expire after 2010.
    Under the Trade Adjustment Assistance Reform Act of 2002, a 
refundable tax credit is provided to eligible individuals for 
the cost of qualified health coverage. The credit is equal to 
65 percent of the amount paid by certain individuals between 
the ages of 55 and 64 who are receiving pension benefits from 
the Pension Benefit Guaranty Corporation as well as certain 
other individuals.
    The Administration has proposed an above-the-line deduction 
for the purchase of qualified long-term care insurance. Under 
the proposal, the deduction would be available for individuals 
that purchase long-term care insurance and for the employee's 
share of the cost of employer-provided coverage if the employee 
pays at least 50 percent of the cost.
    The Administration has also proposed that an additional 
personal exemption be provided to caregivers who provide care 
in their homes for qualified family members with long-term care 
needs. Qualified family members would include the taxpayer's 
spouse, parent, or grandparent. To qualify, the family member 
must be a member of the taxpayer's household for the entire 
year. Under the proposal, an individual would be considered to 
have long-term care needs if he or she were certified by a 
licensed physician as unable to perform at least two activities 
of daily living without substantive assistance from another 
individual for at least 180 consecutive days. Alternatively, an 
individual would be considered to have long-term care needs if 
he or she (1) required substantial supervision to be protected 
from threats to his or her own health and safety due to 
cognitive impairment and (2) was unable to perform at least one 
activity of daily living or was unable to engage in age 
appropriate activities.
            Estate and Gift Tax
    The estate, gift and generation skipping transfer (GST) 
taxes form a unified system of taxes on the transfer of 
property. Taxpayers are allowed a unified credit that exempts 
the first $1 million of total transfers from tax in 2002 and 
2003. Deductions are allowed for debts, marital and charitable 
bequests, and certain other items. There are special provisions 
designed to ease the burden of the estate tax on family-owned 
farms and businesses. After accounting for the unified credit, 
transfer tax rates range from 41 to 49 percent.
    The Economic Growth and Tax Relief Reconciliation Act of 
2001 (EGTRRA) included substantial changes to the transfer tax 
system. Under prior law, the amount exempt from transfer tax in 
2001 was $675,000. This was scheduled to increase to $700,000 
for 2002 and 2003, $850,000 for 2004, $950,000 in 2005 and $1 
million for persons dying in 2006. After accounting for the 
unified credit, transfer tax rates for 2001 ranged from 18 to 
60 percent. EGTRRA increased the exempt amount to $1 million 
for 2002 and 2003, $1.5 million for 2004 and 2005, $2 million 
for 2006 through 2008 and $3.5 million in 2009. EGTRRA reduced 
the top transfer tax rate to 50 percent in 2002. The top rate 
is further reduced by one percentage point per year from 2003 
though 2007 (when it reaches 45 percent). In 2010, the estate 
and GST taxes are repealed. The gift tax is retained with a 
lifetime exemption of $1 million and tax rate of 35 percent.
    For capital gains tax purposes, the basis of property 
acquired from a decedent is equal to the value of the property 
at the date of death. After repeal of the estate tax, property 
acquired from a decedent will receive the lesser of fair market 
value or the decedent's basis. Additions to basis will be 
allowed so that in general, estates that are not currently 
subject to estate tax will not be subject to capital gains tax 
in the hands of the heirs.
    After 2010, all of the transfer tax provisions enacted as 
part of the EGTRRA will expire. Thus, under current law, estate 
tax repeal and the carryover basis regime will be effective for 
only one year, after which the estate tax as it was under pre-
EGTRRA law will return. The exempt amount will be $1 million 
and the highest marginal tax rate will be 60 percent.
            Retirement and Healthcare
    The establishment and continued maintenance of retirement 
plans is of benefit to older Americans. The IRS and Treasury 
have issued guidance to assist employers in establishing and 
maintaining these plans and for plan participants to understand 
the rules regarding these plans. Guidance projects that 
directly impact older Americans include publications that 
provide information on the catch-up contribution, which allows 
plan participants who are age 50 or older to make an additional 
contribution to their 401(k), 403(b) or 457 plans, and issuance 
of regulations making it simpler for those over age 70\1/2\ to 
understand their obligations with regard to required minimum 
distributions from IRAs and other retirement plans. Treasury 
also began a project to address questions raised regarding 
``phased retirement,'' i.e., arrangements under which older 
Americans seek to begin pension payments as part of a plan to 
reduce hours worked.
    With regard to healthcare, Treasury has issued guidance 
explaining the tax rules surrounding health reimbursement 
arrangements (HRAs). By issuing this guidance, Treasury 
believes that employers may be more likely to offer these 
arrangements to their employees and retirees. The HRA can be 
used by employers to provide payments for health expenses 
(including insurance) to retirees.

                          EMPLOYEE ASSISTANCE

    As part of a comprehensive family-friendly Employee 
Assistance Program, the Department's bureaus support eldercare 
programs. Eldercare programs provide information on resources 
available to Treasury employees who care for elderly parents, 
spouses, or other family members. To help relieve what can be a 
burden for employees, the program helps Treasury employees 
identify needed eldercare services ranging from ``daycare'' for 
older persons to specialized medical attention. In addition to 
the Employee Assistance Program, Treasury makes available to 
its employees various human resources (HR) flexibilities such 
as alternative work schedules, leave transfer programs, and 
telework programs. This support demonstrates Treasury's 
commitment as a progressive and family-friendly employer. The 
Employee Assistance Program also reduces absenteeism and 
anxiety which employees may experience from caring for an 
elderly family member, thus enhancing their productivity and 
benefiting the Treasury Department.

                    BUREAU OF ENGRAVING AND PRINTING

            Tours and Exhibits
    The tours at the Bureau of Engraving and Printing's 
Washington, DC facility are accessible to the widest variety of 
visitors' possible. We aim to make the tour experience 
accessible to everyone, from international visitors to those 
with disabilities. Our main tour entrance is constructed with a 
ramp so that individuals in wheelchairs or with difficulty 
walking can easily enter the building. We also provide free 
wheelchairs upon request for individual use within the 
building.
    The galleries are accessible through the use of elevators 
for those visitors that cannot ascend or descend using the 
escalators. Our galleries are also equipped with television 
monitors that can present information identical to that given 
by the tour guides. These video programs are all subtitled to 
enhance the conveyance of tour information. The video programs 
are also available in a variety of foreign languages. The tour 
staff itself includes speakers of various languages including 
an American Sign Language Interpreter.
    There is a medical facility in the building as well to 
provide emergency services to visitors should that service be 
required. We aim to make the building and tour accessible and 
understandable to everyone and believe we can meet the needs of 
those who require extra attention and assistance.
    The tour and VC facility at the Western Currency Facility 
will include exhibits and displays that meet all ADA 
requirements upon it's completion in April 2004. Transportation 
vehicles will meet all local, state and Federal certifications, 
be ADA compliant and will be approved by the government prior 
to their use. In addition to all video and multimedia products, 
the Architectural and Transportation Barriers Compliance Board 
mandates that all multimedia presentations which support the 
agency's mission that contain speech or other audio information 
shall be closed captioned.
            Currency
    The National Academy of Sciences conducted a study on ways 
to assist the blind and visually impaired with currency 
transactions. Based upon the recommendations of the study, the 
Bureau of Engraving and Printing (BEP) redesigned $5, $10, $20, 
$50 and $100 Federal Reserve notes with several features to 
assist the elderly and visually impaired.
    In addition to several counterfeit deterrent features, the 
notes contain a large high-contrast numeral on the back, lower 
right corner. The large high-contrast numeral is designed to 
assist the more than 23 million Americans, mostly elderly, with 
varying degrees of vision impairment.
    With the introduction of the newly redesigned Series 2004 
$20 Federal Reserve note on October 9, 2003, the new notes now 
contain the addition of denomination-specific subtle background 
colors and symbols of freedom. In the case of the $20 note, the 
background colors are green, peach and blue, and the symbols of 
freedom are a large blue eagle and a small metallic green eagle 
and shield. These new features will help everyone, particularly 
those who are visually impaired and the elderly, to tell 
denominations apart.

                       BUREAU OF THE PUBLIC DEBT

            TreasuryDirect
    Public Debt launched its new TreasuryDirect system in 
October 2002. TreasuryDirect is an account-based system that 
currently offers paperless Series I and Series EE savings 
bonds. Customers establish an account and buy, manage, and 
redeem their securities over the Internet. Older investors can 
continue to enjoy the security of investing in savings bonds 
without making a trip to a local financial institution to 
purchase or redeem their holdings. A TreasuryDirect account 
provides a complete record of the investor's electronic 
holdings in one place. Purchases and redemptions are made 
through ACH debits and credits from a savings or checking 
account at a financial institution designated by the customer. 
There are no paper bonds to keep track of; no worry about lost 
or misdirected bonds in the mail; and holdings are accessible 
in an emergency, not at the bottom of a drawer or some other 
forgotten location. In the coming years we will add features to 
TreasuryDirect with the ultimate goal of offering all the 
securities Treasury sells to the public in a single account 
accessed over the Internet.
            Additional Toll Free Service Available to the Public
    Public Debt expanded toll free access to information and 
service in April 2003. Each of the five Federal Reserve savings 
bond processing sites now provides a toll free number to all 
their customers. The toll free numbers help older investors by 
providing easy access to savings bond information such as 
current interest rates, redemption values of bonds, and general 
information about savings bonds. They can also order redemption 
tables and various savings bond forms. In addition, a toll free 
number is available for customers holding marketable securities 
in our legacy book-entry system so they can access electronic 
services (purchase/reinvest securities, get account balances, 
or order statements), order forms, find out about auction 
results or upcoming auctions, or get general information. All 
voice menus for the toll free numbers were recorded with older 
investors in mind.
            Training and Customer Service
    All of our customer service employees are thoroughly and 
consistently trained to ensure investors are satisfied when 
they interact with Public Debt through the phone, web or mail. 
Employees receive special training on telephone etiquette, 
corresponding with customers by e-mail or postal mail, and how 
to meet the needs of the older investor.
    Public Debt recently developed an e-learning module as a 
continuing effort to supplement, and in some cases replace, 
traditional classroom training. This type of training allows 
employees to set their own pace and review courses as needed 
while providing lasting benefits to both Public Debt and our 
customers.
            Extended Operating Hours for Marketable Securities 
                    Electronic Services
    Public Debt began offering extended operating hours in 
August 2003 to investors using our Electronic Services for 
Treasury bills, notes, and bonds. In the past, customers could 
use telephone and Internet services from 8:00 a.m. until 8:00 
p.m. EST. Now the services are available from 8:00 a.m. until 
12:00 midnight EST. This extension of hours gives customers 
more time to use the suite of services that can be accessed by 
telephone or over the Internet. Some of the services offered 
are purchase and reinvestment, change of address and ordering a 
statement of account. These extended hours benefit all 
investors including older Americans.
            Continuous Improvement of Website
    Public Debt regularly updates its web pages to reflect 
changes in its products and services, and to improve the 
presentation of information in a logical and easy to access 
manner. Public Debt is in the process of redesigning its 
investor oriented website, where product information and 
services are offered, to improve its clarity, quality and ease 
of use. This new site, like our present web site, will fully 
comply with Section 508 of the Rehabilitation Act Amendments of 
1998 (regulations requiring web pages to be fully accessible to 
individuals with disabilities). Improving the website will 
streamline citizen-to-government communications and make it 
easier for customers to interact with Public Debt.
    In the spring of 2003, Public Debt provided online, 
fillable versions of savings bond and marketable securities 
forms used by the public. Fillable forms are electronic forms 
that users can download and complete using their own computer 
thus eliminating the need for users to complete paper forms by 
hand. Because fillable forms result in better legibility, 
Public Debt can more accurately service its customers. As of 
September 2003, Public Debt offers nearly 100 savings bond and 
marketable securities forms and brochures online. As part of 
this effort, Public Debt rewrote its forms and accompanying 
instructions to put them into plain language for ease of use by 
investors.
            Matured Unredeemed Bonds and Treasury Hunt
    Public Debt continues to work to increase investor 
awareness of savings bonds that are no longer earning interest. 
Since most of these bonds are at least 30 to 40 years old, many 
owners are senior citizens. Investors can use Public Debt's 
website to find out if they have any of these bonds by 
searching a database called Treasury Hunt; reviewing a general 
information page about whether bonds are still earning interest 
by the series and issue date; or, using the Savings Bond Wizard 
or Savings Bond Calculator to identify matured bonds. Also, 
through a special ``locator group,'' Public Debt actively tries 
to find owners of matured unredeemed bonds to let them know 
they are no longer earning interest.
    Treasury Hunt also helps the public identify other Treasury 
securities or interest payments that they may be due. This web-
based application identifies securities information for an 
investor when:
           They own a savings bond and haven't received 
        it in the mail.
           They have interest payments that we couldn't 
        deliver.
           They own a registered Treasury note or bond 
        that has matured and is no longer earning interest.
           They have not yet received their payments.
    Customers can search the Treasury Hunt database 24 hours a 
day, 7 days a week.

                      FINANCIAL MANAGEMENT SERVICE

    In FY 2002, the Financial Management Service (FMS) issued 
more than 918 million payments, including Social Security, 
Supplemental Security Income, Veterans benefits, and tax 
payments. Working under the mandate of the Debt Collection 
Improvement Act signed by President Clinton on April 26, 1996, 
Federal Departments and agencies are on the fast track to 
convert Federal payments to electronic funds transfer (EFT). 
The law required most payments to be made electronically by 
January 2, 1999, but also gave the Secretary of the Treasury 
broad authority to grant waivers. EFT significantly improves 
the certainty of payments reaching the intended recipients on a 
timely basis, and improves the ability of recipients to use 
those payments safely and conveniently. Payment inquiries and 
claims are significantly reduced under EFT.
    Payment by EFT has substantial benefits in terms of 
reliability, safety, and security that are especially important 
for the elderly. Recipients are much more likely to have a 
problem with a paper check than with an EFT transaction, and in 
FY 2002 Treasury received more than 1.4 million inquiries from 
recipients regarding checks not received. In FY 2002, the 
Federal Government experienced more than $69.1 million in 
forged checks, $2.2 million in counterfeit checks, and $4.3 
million in altered checks. Waiting days for a replacement check 
is an inconvenience and a burden on recipients, especially 
elderly persons living on low incomes. EFT payments are much 
more convenient and secure--misrouted EFT payments are never 
lost, and, if misrouted, the payments are typically routed to 
the correct bank account within 24 hours.
    During the past six years, Treasury has been overseeing 
government-wide implementation of the Debt Collection 
Improvement Act of 1996 by working with Federal agencies to 
identify and resolve the major issues confronting stakeholders. 
Significant progress has been made by Federal agencies to 
convert payments to EFT. The percentage of Treasury-disbursed 
payments, including tax payments made electronically, has 
increased from 53 percent in FY 96 to 73 percent in FY 02. More 
than 79 percent of Social Security payments were made 
electronically in FY 02, an increase of more than 18 percentage 
points since FY 96. Other Federal benefit agencies show similar 
increases in EFT payments. Approximately 14 million Federal 
benefit checks are still issued on a monthly basis.
    Federal payment recipients who elect to receive their 
payments via Direct Deposit enjoy the benefits of this simple, 
safe, and secure payment mechanism. Recipients who have not 
signed up for Direct Deposit do have choices, as described in 
31 CFR 208. Federal check recipients receiving salary, wage, 
benefit or retirement payments can chose to: (1) receive 
payment via Direct Deposit through a financial institution, (2) 
open a low-cost Electronic Transfer Account (ETASM) 
at a participating Federally insured financial institution, or 
(3) continue to receive a paper check, if receiving payment by 
Direct Deposit would cause the recipient a hardship.
    In 1999 Treasury developed a basic, low-cost account called 
the ETASM, which is available to individuals who 
receive Federal benefit, wage, salary, or retirement payments. 
Nearly 600 Federally insured financial institutions, at over 
18,000 branch locations nationwide, offer the ETASM 
on a voluntary basis, subject to published standards and terms 
set forth in an agreement between Treasury and the financial 
institution. These low-cost accounts are designed to meet the 
statutory mandate that recipients have access to an account at 
a reasonable cost and with consumer protections, comparable to 
other accounts at the same financial institution. Anyone who 
receives a Federal benefit, wage, salary, or retirement payment 
is eligible to open an ETASM, even if they have been 
unable to qualify for a checking or savings account in the 
past. The ETASM costs $3.00 a month or less and 
requires no minimum balance to open or maintain the account, 
except as required by law. As of July 2003, over 67,000 ETAs 
have been reported opened by financial institutions.
    Although EFT participation has been increasing each year, 
the rate of EFT growth has slowed to about 1 percent a year and 
FMS is exploring ways to significantly increase the EFT 
participation rate among Federal benefit recipients. Therefore, 
FMS, in collaboration with the Federal Reserve Bank of St. 
Louis and the Social Security Administration, initiated a study 
to conduct research into the reasons why some Federal benefit 
recipients choose checks over electronic payments, and to 
explore what delivery options might best meet the needs of 
benefit recipients. The results of this research will be used 
to identify ``motivational triggers'' to participation in 
electronic payment programs and to develop effective 
communication strategies for the development of a marketing and 
education campaign to entice current check recipients to 
convert to electronic forms of payment. It is anticipated that 
the results of the research will be available early in calendar 
year 2004.
    A variety of information on EFT and Direct Deposit is 
available on the FMS website. Information available includes 
publications, statistics, and contact information. The EFT 
website also includes topics on General Information, 
Regulations and Policy, Agency Assistance, News and Media, 
Education and Marketing, Vendor Information, and the 
ETASM. The site can be accessed at 
www.fms.treas.gov/eft.
            The Check Forgery Insurance Fund
    The Check Forgery Insurance Fund (CFIF) legislation was 
enacted into law on April 26, 1996, as part of the Debt 
Collection Improvement Act of 1996.
    The CFIF is a revolving fund established to settle payee 
claims of non-receipt where the original check has been 
fraudulently negotiated. FMS uses the Fund to ensure those 
innocent payees whose Treasury Checks have been fraudulently 
negotiated are promptly issued replacement checks. 
Reinstitution of the CFIF relieves the burden for recipients of 
forged checks by providing funding for expeditious issuance of 
replacement checks.
    Check forgery is a concern of FMS and individuals who 
receive paper check payments. FMS continues to consider and 
address this concern. On March 26, 1998, various Treasury 
Systems were enhanced to comply with the legislation and to 
modify both internal and external operational and system 
procedures required to process check forgery claims timelier, 
utilizing the CFIF. Reinstitution of the CFIF relieves the 
burden for recipients of forged checks, especially the elderly.
    The CFIF is a Fund, which benefits all payees of forged 
checks after the forgery has been substantiated. Although 
payment by electronic funds transfer (EFT) has substantial 
benefits, paper checks continue to be the desired method of 
payment by recipients of various Federal payments. The elderly, 
who represent a large portion of this group, continue to 
receive payments by check. Because of continued check issuance, 
forgery of these items is highly probable. Those elderly 
individuals affected by forgeries are largely low-income, 
unbanked, and rely on the monthly payment for their basic 
subsistence. The CFIF allows for immediate relief to the 
elderly and other payees after the claim of forgery has been 
substantiated.
    Implementation of the CFIF benefits the Federal Program 
Agencies (FPAs) by relieving the FPAs of the responsibility for 
issuing replacement checks out of their appropriations on 
forgery claims. Typically, the FPAs would not issue a 
replacement check on a forgery claim until after FMS had 
recovered the forged amount from the financial institution (FI) 
and credited the agency with the check amount. The FI has 60 
days to respond to FMS' request for refund. The CFIF provides 
for expeditious processing of these cases and does not make 
issuance of the replacement check contingent on whether 
recovery on the forgery is delayed or unsuccessful.
    FMS is continuing to use the CFIF to facilitate the timely 
issuance of replacement checks to the elderly and all check 
recipients on substantiated forgery claims.
            Debt Collection Improvement Act
    The Debt Collection Improvement Act of 1996 and the 
Taxpayer Relief Act of 1997 authorize the collection of 
delinquent debt through administrative offset and levy of 
Federal Payments, including Social Security benefits. Over the 
last several years, FMS has coordinated with the Internal 
Revenue Service and the Social Security Administration to 
collect $372 million annually in delinquent debt potentially 
available through levy and offset of benefit payments. FMS and 
SSA recently have agreed to begin phased in implementation of 
benefit payment offset in March 2001 and continuous tax levy in 
October 2001. Implementation will begin with the offset of 
Cycle EFT payments. The offset of Cycle Check payments and 
Third of the Month EFT and Check payments will be phased in 
following the Cycle EFT payments implementation. Supplemental 
Security Income payments are exempt from offset, as required by 
law. Old-Age Survivors and Disability Insurance benefit 
payments are offset internally by SSA.
    Based upon a preliminary test conducted by FMS in 1998, the 
number of potential offsets of SSA benefits payments matched 
against the FMS Debtor Database showed 35,670 for the month of 
February. If this pattern were to continue for the year, 
approximately 429,120 benefit payments would be offset annually 
with collections for the Government between $36 million and $61 
million. The amount of the offset of the Social Security 
benefit payment will be the lesser of 1) the amount of the 
debt, or 2) an amount equal to 15 percent of the monthly 
benefit payment, or 3) the amount, if any, by which the monthly 
benefit payment exceeds $750. Fifteen percent is the maximum 
amount that will be offset from an individual's benefit 
payment.
    FMS will provide the debtor with a notice of the intent to 
offset and an opportunity to review the basis for the debt by 
notifying the debtor twice in writing at both a 60-day and a 
30-day interval prior to the anticipated offset. The warning 
letters include the name of the agency that originated the debt 
and the name of a contact within that agency to answer 
questions regarding the delinquent debt. FMS will also send the 
debtor an offset notice that includes the amount and date of 
the offset in addition to the same information provided in the 
60-day and 30-day warning letters. The offset notice is sent to 
the beneficiary to coincide with the timing of the pre-
scheduled payment. The offset remains legal even if the debtor 
does not receive the notices.
    In the case of payment levies to collect delinquent tax 
debt, IRS will send each tax debtor a notice that includes the 
tax bill, a statement of the intent to levy, an explanation of 
an individual's appeal rights, and an IRS telephone number for 
inquiries and assistance. The notice, which will be sent by 
certified mail to the taxpayer's last known address, will also 
inform the debtor that if repayment arrangements are made 
within 30 days, the levy will not occur. Also, IRS will send 
tax debtors who receive Social Security benefit payments an 
additional notice of intent to levy. At the time of the levy, 
FMS will send a notice to the debtor explaining the reason for 
the reduced payment and giving a contact at IRS who will answer 
questions regarding the tax debt. At any time during this 
process, either prior to or after the levy process begins, a 
debtor may make repayment arrangements with IRS, which will 
then release the levy.

                        INTERNAL REVENUE SERVICE

            Publications
    The 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. The following 
publications, revised on an annual basis, are directed to older 
Americans. Each year, IRS reviews the publications to ensure 
that they are updated to reflect changes in tax law as well as 
to simplify the explanations in them.
    Publication 524, ``Credit for the Elderly or Disabled,'' 
explains that individuals 65 or older may be able to take the 
Credit for the Elderly or Disabled, reducing taxes owed. In 
addition, individuals under age 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, ``Older Americans' Tax Guide,'' explains 
the income conditions under which single taxpayers aged 65 or 
older, and married taxpayers filing jointly if at least one 
spouse is 65 or older, are generally not required to file a 
Federal income tax return. The publication also advises older 
taxpayers about eligibility for the earned income credit. The 
taxpayer may be eligible for a credit based on the number of 
qualifying children in the home or a smaller credit if the 
taxpayer has no qualifying children. The Guide serves as a 
primary source of tax information for older Americans.
    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,'' is a guide to issues of particular interest to 
persons with disabilities and to taxpayers with disabled 
dependents.
    Publication 915, ``Social Security and Equivalent Railroad 
Retirement Benefits,'' assists taxpayers in determining the 
taxability, if any, of benefits received from Social Security 
and Tier 1 Railroad Retirement.
    Publication 590, ``Individual Retirement Arrangements 
(IRAs),'' includes information about deductions and tax 
treatment of distributions for various retirement accounts.
    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 and post offices stock 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, and may have 
access to the Internet to download tax materials.
    Most forms and some publications are on CD-ROM and are on 
sale to the public through the National Technical Information 
Service on the Internet at www.irs.gov/cdorders, or by calling 
toll-free 1-877-CDFORMS (1-877-233-6767). Forms, instructions, 
and tax information are available by fax by calling (703) 368-
9694, using a telephone connected to a fax machine.
    Taxpayers may obtain most forms, instructions, 
publications, and other products via the IRS Internet website 
24 hours a day, 7 days a week, at www.irs.gov.
    The IRS has continued the availability of large-print 
versions of the Form 1040 and print versions of the Form 1040 
and Form 1040A packages earmarked for older Americans. These 
packages (designated as Publication 1614 and 1615, 
respectively) are newspaper-size and contain both instructions 
and forms (for use only as worksheets, with the amounts to be 
transferred to regular-size forms for filing).
    Finally, the IRS web site has several pages designed 
especially to address key concerns of the elderly. For example, 
the section for Individuals links taxpayers to information 
about the Tax Counseling for the Elderly (TCE) outreach program 
(see below for an overview of this program). A link is also 
provided there for retirees and senior citizens offering 
information about IRAs and pension plans.
            Volunteer and Outreach Programs
Volunteer Income Tax Assistance Program
    The Volunteer Income Tax Assistance (VITA) program has been 
offering FREE tax help to people who cannot afford to pay for 
professional assistance since the program was formed in 1969. 
VITA volunteers help prepare basic tax returns and answer 
simple tax questions at no cost for low- to moderate-income 
taxpayers, which often include persons with disabilities, 
limited English speaking and the elderly. Many sites offer FREE 
electronic filing. Volunteers from community organizations, 
colleges, professional organizations, religious organizations, 
military, retirement organizations as well as IRS employees 
participate in this program. Assistance is provided at or near 
community and neighborhood centers, libraries, schools, 
churches, shopping malls and other convenient locations across 
the nation.
    In 2001, over 44,000 VITA volunteers at more than 8,500 
sites assisted over 1.7 million taxpayers across the nation. 
For 2002, more than 1.7 million taxpayers received tax 
assistance from over 34,000 volunteers at approximately 5,200 
VITA sites across the nation. Statistics for these two years 
included assistance other than tax preparation. In 2003, tax 
preparation alone exceeded 840,000 returns, prepared by more 
than 36,000 VITA volunteers, at over 4,000 sites.
Tax Counseling for the Elderly (TCE) Program
    The Tax Counseling for the Elderly (TCE) Program offers 
FREE tax help to individuals who are age 60 or older. Congress 
first authorized the TCE Program in 1978 as part of the Revenue 
Act of 1978. The 1978 Act authorized IRS to enter into 
agreements with private or non-governmental public non-profit 
agencies and organizations, exempt under Section 501 of the 
Internal Revenue Code, which would provide training and 
technical assistance to volunteers who provide FREE tax 
counseling and assistance to elderly individuals in preparing 
their Federal income tax returns.
    The 1978 Act authorized an appropriation of special funds, 
in the form of grants, to provide tax assistance to persons age 
60 years of age or older. Grant funds are used to reimburse 
volunteers for out-of-pocket expenses including transportation, 
meals and other expenses incurred by them in providing tax-
counseling assistance at locations convenient to the taxpayers. 
In addition to volunteer out-of-pocket expenses, funds may be 
used by the sponsoring organization for salaries, wages, and 
benefits of clerical personnel; office supplies and equipment 
with a unit cost of less than $15; printing and postage costs; 
installation of telephone lines necessary to service a 
telephone answering site; rent, utilities, and custodial 
services when necessary; and costs for interpreter services.
    In 2003, nearly 33,000 volunteers participated in the TCE 
Program at over 9,000 site locations across the nation, helping 
taxpayers successfully file nearly 800,000 paper and electronic 
returns.
Outreach Program
    The Outreach Education Program provides individuals with 
information on a variety of tax topics. The IRS seeks to 
educate taxpayers on new tax law, available credits and other 
tax information that will assist them in filing a correct tax 
return. Outreach provides awareness of available deductions, 
credits, proper income reporting and other tax-related topics. 
Through the use of intermediaries and partners, targeted groups 
of taxpayers are provided with brochures, publications, bill 
inserts and other delivery methods to communicate information 
on topics of interest to that particular population. Partners 
who provide services to older Americans are called upon to 
provide messages to ensure related tax information is shared. 
Trained volunteers and IRS employees conduct tax related 
seminars for groups and individuals with common tax interests. 
For elderly taxpayers the IRS has focused on providing 
education around retirement issues and the Earned Income Tax 
Credit for those who may be raising second generation children 
in their home and other related tax issues.
    For Tax Year 2001, over 681,000 taxpayers received 
assistance through the outreach program by over 1700 volunteers 
at more than 7600 sessions. For Tax Year 2002, more than 69 
million taxpayers received educational information through the 
mail, media outlets, tax seminars, conventions, and community 
events. To date for Tax Year 2003, over 143 million taxpayers 
have been provided with educational information or attended 
seminars. More than 50,000 volunteers assisted taxpayers at 
over 18,000 outreach sessions. This tremendous increase was 
made possible by shifting the focus away from IRS employees 
providing the majority of direct outreach activities to 
establishing partnerships with community-based organizations, 
non-profit organizations, and other government agencies whose 
primary client base is similar to the audience being targeted 
for outreach. Through this alliance the IRS has been successful 
in reaching many more taxpayers than in the past.
Major Changes in Programs and Policies
    In October 2000, the IRS underwent a complete 
reorganization. This resulted in the creation of four new 
operating divisions developed to serve four distinct customer 
sets. The Wage and Investment (W&I) operating division serves 
approximately 122 million individual taxpayers who receive W-2 
and investment income only. Almost 15 million W&I filers are 
over age 60. Within the W&I operating division is the pre-
filing element that focuses on providing Taxpayers with the 
information, support and assistance they need in order to 
understand and fulfill their tax obligations. The Stakeholder 
Partnerships, Education and Communication (SPEC) function 
provides educational service through leveraged channels, such 
as community-based and non-profit organizations. This allows 
for delivery of tax-related materials and services to taxpayers 
who need assistance. Providing service and education to the 
elderly population is a key focus area for SPEC. Before the 
reorganization, a small department delivered outreach and 
education to a small number of taxpayers. The limited resources 
prevented a far-reaching initiative for large groups of 
taxpayers. Volunteer-sponsored programs have been in place for 
many years with enormous IRS support being provided to sustain 
them. The concept of operation within the SPEC function 
concentrates on establishing community and partner coalitions 
to provide much of the service previously offered by IRS 
employees. The elderly population is a taxpayer group that is 
targeted for tax-related education and free tax return 
preparation. Investment and pension income reporting 
requirements and credits available to the elderly are primary 
educational initiatives.
New Initiatives
    For fiscal year (FY) 2003, the W&I organization, through 
its SPEC function, developed a business objective to increase 
awareness among older taxpayers of retirement issues to prevent 
balance due situations. SPEC used their partnership channels to 
provide information about the most common retirement-related 
issues that could potentially cause a balance due situation. 
SPEC will again address compliance issues for older Americans 
as part of their FY 2004 business objectives, targeting 
military retirees.
Banks, Post Offices and Library (BPOL) Program
    During 2003, the BPOL program provided approximately 37,800 
locations with free tax preparation materials such as tax forms 
and publications to assist in preparing Federal income tax 
returns. In some areas, IRS recruited volunteers who worked at 
libraries, answering tax questions and directing taxpayers to 
the appropriate tax forms.

               OFFICE OF THE COMPTROLLER OF THE CURRENCY

    During 2001 and 2002, the Office of the Comptroller of the 
Currency (OCC) continued to enforce fair lending laws relating 
to age discrimination. The OCC has also continued to emphasize 
evaluating the performance of national banks with respect to 
the Community Reinvestment Act (CRA). The OCC Compliance 
Division specifically focuses on consumer compliance, the CRA, 
and fair lending.
    OCC examiners are alert to the potential for discrimination 
on the basis of age (as well as other bases covered by ECOA and 
Reg. B) when conducting fair lending examinations. During 2001 
and 2002, the OCC found evidence of age discrimination during 
four fair lending examinations. Two of the cases were referred 
to the Department of Justice for action. All four cases were 
resolved through administrative or corrective action. The 
addition of the cases identified during 2001 and 2002 brings 
the total number of OCC cases involving age discrimination to 
fourteen since 1993.
    During 2001 and 2002, Comptroller John D. Hawke, Jr., and 
First Senior Deputy Comptroller and Chief Counsel Julie L. 
Williams, met with representatives of 28 community and consumer 
organizations, including representatives from organizations 
that focus on issues dealing with aging and senior citizens 
such as the AARP. The OCC's Community Affairs division 
facilitated these meetings. The purpose of these outreach 
sessions was to learn first-hand about any concerns these 
organizations have about national banks and issues affecting 
bank customers, especially low- and moderate-income consumers, 
including predatory mortgage lending and payday lending 
practices, affordable housing, community reinvestment, and 
access to financial services for the unbanked. During 2001-02, 
the OCC also participated in an Interagency Predatory Lending 
Task Force, which drafted a brochure for consumers, ``Putting 
Your Home on the Loan Line is Risky Business.''
    The OCC's Customer Assistance Group (CAG) is responsible 
for the review, analysis and processing of complaints lodged 
about national banks including affiliates of national banks. 
Many of the complaints received by CAG are submitted by older 
Americans. During 2001, the CAG handled over 79,000 telephone 
contacts resulting in 80,000 new cases. During 2002, the volume 
slightly decreased to 78,000 telephone contacts producing 
79,000 new cases. The CAG maintains a toll-free national 
consumer hotline (1-800-613-6743) that is staffed with trained 
professionals, able to handle cases in languages other than 
English, providing callers with guidance and informal education 
on current banking laws, regulations and practices. Consumers 
may also avail themselves of CAG's services through the 
Internet (www.occ.treas.gov/customer.htm) and gain access to 
information about the OCC including its complaint resolution 
process.

                      OFFICE OF THRIFT SUPERVISION

    The Office of Thrift Supervision (OTS), along with the 
other Federal banking agencies, continues to enforce fair 
lending laws relating to age discrimination. OTS implemented 
new fair lending examination procedures for all examinations 
conducted after 1999. During 2001-2002, OTS examiners used 
these procedures when conducting fair lending examinations to 
assure that OTS-regulated institutions are not discriminating 
on the basis of age in the credit decision-making process.
    OTS has an active program for addressing complaints that 
consumers may have against the thrifts that OTS regulates. OTS 
provides a free nationwide consumer hotline (1-800-842-6929), a 
TDD line (1-800-917-2849), and an email address 
([email protected]). Professional staff is 
available to help people evaluate whether OTS regulations 
address their concerns. Senior citizens are frequent users of 
this service.
    OTS maintains a Customer Service Plan for consumer 
complaints and urges the institutions it regulates to give high 
priority to consumer relations. Over 20,000 complaints were 
filed with OTS in 2001 and 2002, 17 of which alleged credit 
discrimination based on age. In each case, the complaint was 
investigated, the complainant interviewed, and the 
complainant's loan file reviewed to determine appropriate 
resolution.
    Each of OTS's four regional offices has staff responsible 
for community affairs matters. Community Affairs staff serve as 
liaisons between the thrift industry, consumer and community 
groups, government agencies and others on housing and community 
development issues; provide education and training to the 
thrift industry on community development issues; and identify 
opportunities for thrifts to partner with others in helping to 
meet financial services needs in their communities. OTS 
Community Affairs staff interacts with many groups representing 
low- and moderate-income individuals, including older persons.
    In 2001 and 2002, Community Affairs staff, along with OTS 
senior management, participated in various forums with thrifts, 
community organizations and others across the country, 
including groups with particular emphasis on older persons. At 
these forums, OTS staff provided information on a number of 
topics such as reverse mortgages, banking needs of the elderly, 
predatory lending, and financial abuse of the elderly.
    For example, Community Affairs staff worked with police 
departments, financial institutions, and others in 2001 to hold 
a series of community outreach workshops throughout the 
Hispanic community focusing on crime prevention and the 
benefits of banking. Many of the victims of armed robberies and 
thefts in the Hispanic community are elderly. During 2001-2002, 
OTS partnered with the California Community Partnership for the 
Prevention of Financial Abuse to produce a training video. The 
video is designed to help educate the financial services 
industry about financial abuse of the elderly. Information 
about the development of the video was shared with lenders in a 
series of workshops, roundtables, and one-on-one meetings. OTS 
continues to work with the partnership to expand the video's 
distribution.
    OTS's Community Liaison newsletter highlights 
accomplishments in affordable housing and community 
development, many of which have benefited older Americans. In 
2001, the Community Affairs staff published four newsletters 
that were distributed to all thrifts and to several hundred 
community and consumer organizations. One of the articles 
spotlighted the efforts of FLAG (Financial Institutions, Law 
Enforcement and Government), a non-partisan partnership 
committed to protecting the elderly and persons with 
disabilities from financial exploitation.
    OTS hosted a thrift industry leadership conference for CEOs 
and directors of OTS-regulated institutions in April 2001. The 
conference focused on strategic planning for the future and 
developing new market opportunities. One of the sessions 
focused on the aging baby boomer population, and ways that 
banks can better serve the housing, credit and financial 
services needs of this group.
    OTS issued a CEO Letter in 2001 that provided interagency 
guidance to the thrift industry on subprime lending and 
predatory or abusive practices. Many low- and moderate-income 
elderly homeowners are vulnerable to predatory lending 
practices.
    OTS's Office of the Ombudsman has taken an active role in 
directing seniors that contact OTS to other resources that can 
provide assistance with a variety of elder consumer concerns. 
Some of the issues the Ombudsman deals with frequently are 
problems with Social Security benefits, income tax preparation 
and assistance, information about cashing Treasury obligations, 
Thrift Savings Plan accounts, and accounts held at federally 
chartered financial institutions. OTS also works with state 
government Ombudsmen to refer consumers with concerns about 
assisted living and long-term care programs. The telephone 
number for the OTS Ombudsman is (202) 906-7945; more 
information is available at www.ots.treas.gov.

                           UNITED STATES MINT

    The United States Mint continues to consider the needs and 
concerns of older Americans in its programs, activities, and 
operations.
            Employee Retirement Planning
    The United States Mint offers a variety of retirement 
planning courses and workshops for its employees. Several one- 
and two-day Civil Service Retirement System (CSRS) and Federal 
Employees Retirement System (FERS) training courses are open to 
Mint employees and as well as their spouses. The Mint also 
encourages its employees to use the resources available through 
the websites sponsored by the U.S. Office of Personnel 
Management and the Thrift Savings Plan. Links to these sites 
are located on the Mint's Intranet site.
            Employee Assistance Programs
    A full range of services provided by the Employee 
Assistance Program (EAP), managed by Federal Occupational 
Health, Department of Health and Human Services, is available 
to all Mint employees. Among these services are health, 
fitness, and nutritional information; psychological, family, 
and grief counseling; and time and stress management. Referrals 
for Elder Care service providers and legal assistance for the 
elderly are also available through EAP.
            Employee Training
    The Mint offers its employees a number of courses and 
workshops that provide the knowledge and skills needed to 
assist, effectively interact with, and be sensitive and 
responsive to the diverse needs of the aged and those with 
disabilities. Among these are courses on Equal Employment 
Opportunity Law and the Americans with Disabilities Act, and 
retirement training for HR professionals.

              ITEM 13--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 1.5 million people age 
65 and older are treated in hospital emergency rooms for 
injuries associated with products they live with and use every 
day. In 2002, the death rate for older people was approximately 
four times that of the younger population for unintentional 
injuries in home settings. Specifically, there are 35 deaths 
per 100,000 persons 65 and older, while there are about eight 
deaths per 100,000 persons under 65. Older adults-those over 65 
years of age-are the fastest growing segment of the U.S. 
population.
Hazards in the Home
           Slips and Falls:--Slips and falls are the 
        main source of injury and death for older people in the 
        home. In home settings in 2002, there were 
        approximately 6,500 deaths to victims 65 and older 
        (6,000 of these fatalities were to persons 75 and 
        older). When older people fall, their risk of serious 
        injury or death is much higher than that of the general 
        population. Falls occur in the bathroom, especially in 
        the bathtub and shower. Falls are also common on 
        stairs, stepstools, and floors with loose carpets. CPSC 
        recommends the use of grab-bars and non-slip mats by 
        the bathtub and shower, handrails on both sides of the 
        stairs, and slip-resistant carpets and rugs. CPSC 
        worked with industry to develop requirements for slip-
        resistant bathtubs and shower stalls. At CPSC's urging, 
        industry developed a standard for stepstools to improve 
        stability.
    Beginning in 2004, CPSC plans to initiate a project to 
identify opportunities to assist older consumers in their 
interactions with consumer products. Possible outcomes of this 
project are the development of best design practices, new 
technologies, safety standards, and educational materials.
           Fires/Burns:--Fires caused approximately 770 
        deaths to adults 65 and older in 1998. In comparison to 
        the rest of the population, older adults have 
        significantly higher fire death rates. CPSC is engaged 
        in a number of activities to reduce fire deaths and 
        injuries to older consumers:
                   Smoke Alarms.--CPSC recommends the 
                installation and maintenance of smoke alarms on 
                every floor and in every bedroom in the home. 
                However, the elderly tend to experience 
                diminished hearing, often making it difficult 
                for them to hear smoke alarms. CPSC is 
                evaluating smoke alarm sound effectiveness to 
                determine if improvements can be made.
                In addition, CPSC is evaluating current smoke 
                alarm and wireless technologies to determine 
                the feasibility of producing a battery-operated 
                smoke alarm that is interconnected by wireless 
                communication. Interconnection of smoke alarms 
                allows all the alarms to sound if any 
                individual alarm detects smoke. This provides 
                more time for occupants to escape from a home. 
                A large number of homes were constructed before 
                any smoke alarms were required, and protection 
                in these homes may be provided by battery-
                operated alarms that do not have the added 
                protection provided by interconnected alarms. 
                This may be of particular importance to senior 
                citizens, who frequently live in older homes.
                   Upholstered Furniture and 
                Mattresses/Bedding.--Older consumers are at 
                greater risk than average of dying from fires 
                involving upholstered furniture and mattresses 
                and bedding. CPSC is currently considering 
                possible mandatory safety standards to address 
                upholstered furniture and mattress flammability 
                and is evaluating the hazard presented by 
                bedding ignition. Based on 1998 data, 
                flammability standards could potentially 
                address 390 deaths and 2,090 injuries 
                associated with mattresses, and 420 deaths and 
                1,080 injuries associated with upholstered 
                furniture. Many producers of upholstered 
                furniture and mattresses support the 
                development of standards to reduce the 
                flammability of their products.
                   Ranges and Ovens.--In a special 
                study conducted by CPSC in 1999, over 30 
                percent of range/oven fire deaths involved 
                consumers aged 65 and older. Ranges and ovens 
                are a leading cause of fires and fire injuries 
                among the products within CPSC's jurisdiction. 
                An estimated 85,000 fires involving ranges 
                (including rangetops and ovens) were attended 
                annually by fire departments during 1994-1998. 
                These fires resulted in an average of 250 
                deaths, 4,080 injuries and $295.6 million in 
                property loss annually.
                As part of the CPSC effort to address fires 
                caused by ignition of food on a cooktop or 
                range, staff has demonstrated the feasibility 
                of technologies to detect a pre-fire condition 
                and shut a burner off before a fire occurs. 
                Further work is needed to develop these 
                technologies for commercial application. CPSC 
                also works with industry to provide consumers 
                with information on safe cooking practices.
                   Electrical Wiring in Older Homes.--
                Each year, there are an estimated 40,000 home 
                electrical wiring fires. These fires claim over 
                300 lives each year and cost society $2.2 
                billion annually. CPSC continues to raise 
                public awareness of hazards with older electric 
                wiring, and we work with fire departments, 
                electrical safety experts, and building code 
                officials to encourage electrical reinspections 
                and upgrades to home electrical wiring systems. 
                Many older consumers live in older homes and 
                these are the homes that are especially 
                vulnerable to electrical wiring fires.
                In addition, CPSC staff encourages the use of 
                Arc Fault Circuit Interrupters (AFCIs) to 
                mitigate the risk of fire associated with 
                certain electrical arcing conditions--
                particularly for existing homes that undergo 
                electrical service replacement. When combined 
                with overload and short circuit protection 
                afforded by circuit breakers and fuses, AFCIs 
                offer the best available safety for preventing 
                electrical wiring fires in homes.
                   Fire Safety Awareness/Clothing Burn 
                Injuries.--To reduce the risk of clothing burn 
                injuries, CPSC recommends that older consumers 
                look for nightwear that is made of more flame 
                resistant fabrics (flame resistant fibers, 
                wool, silk, nylon and polyester), and that is 
                close-fitting, and easy to remove (e.g., 
                clothes that have quick-release features such 
                as snaps, velcro, or a wrap-style). CPSC joined 
                the National Association of State Fire Marshals 
                and the American Association of Retired Persons 
                to produce a brochure: Fire Safety Checklist 
                for Older Consumers. This easy-to-read brochure 
                highlights fire and burn hazards from smoking, 
                cooking, heating, and electrical appliances. In 
                2003, CPSC distributed approximately 44,000 
                copies of this brochure.
                   Scalds.--Burns from hot tap water 
                are another cause of injury to many older 
                Americans. CPSC recommends that consumers turn 
                down the temperature of their water heater to 
                120 degrees Fahrenheit to help prevent scalds.
           Adult-friendly poison prevention 
        packaging.--Many young children are poisoned when they 
        swallow their grandparents' medicine. Child-resistant 
        (CR) packaging has saved children's lives. However, CR 
        packaging can only work if people choose it and use it 
        properly. To make it easier for all adults, especially 
        older ones, to use child-resistant packaging, CPSC in 
        1995 adopted a change in its rules for testing 
        packaging under the Poison Prevention Packaging Act. 
        The new regulation requires that packaging be tested by 
        panels of adults 50 to 70 years of age rather than 18 
        to 45 years old, as was previously the case. This 
        change assures that child-resistant packaging is more 
        ``adult-friendly.'' Industry has developed innovative 
        closures that rely on older people's ``cognitive 
        skills'' instead of their physical strength. CPSC 
        reminds all adults to keep medicines locked up and out 
        of reach of children.
Consumer Information
           In 2003, CPSC distributed approximately 
        116,000 copies of our 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.
           In 2003, CPSC distributed 12,800 copies of a 
        brochure developed jointly with the American Academy of 
        Orthopaedic Surgeons (AAOS), Keep Active and Safe at 
        Any Age. This brochure gives important tips to older 
        Americans on remaining safe while enjoying the many 
        benefits of exercise.
           These safety tips were based on a CPSC study 
        that found a 54 percent increase in the number of 
        sports-related injuries suffered by older Americans 
        between 1990 and 1996--from 34,400 to 53,000. The 
        brochure stresses that by getting regular exercise-and 
        doing it safely-you can enjoy a healthier life. The 
        brochure emphasizes the importance of wearing safety 
        gear for activities like bicycling and gives tips on 
        warming up and providing variety in exercise routines.
        
        

                ITEM 16--ENVIRONMENTAL PROTECTION AGENCY

                              ----------                              


                         EPA's Aging Initiative

    The population of people 65 years or older is at risk of 
developing chronic diseases and disabling conditions which may 
be caused or exacerbated by environmental pollution. Currently 
there are about 35 million people 65 years or older in the 
United States, and over the next 30 years that number is 
expected to double. Research is needed to determine whether 
there are special susceptibilities associated with older adults 
compared to healthy younger adults to meet legislative mandates 
concerning protection of susceptible sub-populations, and 
preventive measures are necessary to ensure that older 
Americans remain as healthy as possible.
    Due to the normal aging process, older Americans may have 
increased health risks from exposures to environmental 
pollutants. Different exposures patterns, age-related changes 
in metabolic processes, lifetime accumulations of persistent 
toxicants, and reduced reserve capacity in different organ 
systems are some of the critical characteristics that may make 
older adults a sub-population with special susceptibilities to 
toxicant-induced dysfunction or degeneration. We have learned 
that particular matter (PM), fine particles from particle 
pollution which is a mixture of microscopic solids and liquid 
droplets found in the air, can exacerbate existing heart and 
lung diseases among older Americans and is responsible for 
increased hospitalizations. PM has been linked to a range of 
serious respiratory and cardiovascular (heart and blood vessel) 
problems. It has been estimated that exposures to PM may result 
in tens of thousands of premature deaths per year and many more 
cases of illness. In addition, we know that Chronic Obstructive 
Pulmonary Disease (COPD) is one of the most common health 
conditions among older persons and can be exacerbated by 
environmental triggers such as second-hand smoke, Code Red and 
Orange air quality days, and other indoor air contaminants. The 
annual cost for treatment of COPD is $32 billion annually with 
75 percent directed to treatment of acute exacerbations.
    In October 2002, EPA launched a new Aging Initiative 
representing the Agency's first coordinated effort to address 
the environmental health issues of older persons. A key 
objective of the Aging Initiative is the development of a 
National Agenda for the Environment and the Aging to be 
released early in 2004. The National Agenda will: 1) identify 
research gaps in environmental health as it relates to older 
persons and practical interventions to prevent exposures to 
hazards; 2) examine the impact that a rapidly growing aging 
population will have on the environment, and 3) encourage 
volunteerism among older persons in their communities to reduce 
environmental health hazards. The National Agenda will lay out 
a strategy that combines research and educational programs that 
promote preventive actions.
    The framework for the National Agenda draws upon ongoing 
efforts throughout the EPA, including an inventory of 
approximately 75 aging-related research, outreach and 
intervention projects. Air quality issues and their impact on 
respiratory, cardiovascular and pulmonary health were the focus 
of most of the projects in the inventory. For example, the 
Baltimore, Maryland PM studies linked exposure to fine 
particulate matter to the health of older persons in a 
retirement community, and several projects have highlighted 
EPA's collaboration with aging and intergenerational 
organizations across the nation. There are projects in Utah as 
well as New York and Connecticut where volunteers with the 
Retired Senior Volunteer Program (RSVP) are involved in a 
variety of Superfund cleanup activities; another project in 
Illinois conducted by retired older volunteers to help identify 
contaminants in drinking water supplies; and a project with the 
Wyoming Energy Council that addressed health effects on older 
persons caused by exposure to radon, a know carcinogen, and 
potentially hazardous solid waste.
    Throughout the spring of 2003, EPA invited public comments 
and convened a series of six listening sessions across the 
United States (FL, TX, IA, PA, CA, and MD) to receive public 
input for the National Agenda. EPA's continuing efforts, the 
public comments, and the proceedings from a December 2002 
National Academy of Sciences Workshop on the differential 
susceptibility of older persons to environmental hazards will 
form the basis for the recommendations that will be included in 
the National Agenda for the Environment and the Aging that will 
help to chart a future that is environmentally healthy for 
older Americans.
    For more information on EPA's efforts to protect the health 
of older Americans, please visit www.epa.gov/aging.

   THE OFFICE OF HUMAN RESOURCES AND ORGANIZATIONAL SERVICES (OHROS)

    In honor of Older Americans Month observed in May 2001, the 
OHROS Senior Environmental Employment (SEE) Office sponsored 
participation in the District of Columbia's Office on Aging's 
37th Annual Senior Citizens' Day which celebrated the theme of 
``The Many Faces of Aging.'' The AARP 5-Alive Mature Driving 
Program, which is the first and most recognized nationwide 
course created especially for older drivers, was also offered.
    The SEE Program Manager presented a workshop on EPA's SEE 
Program at the 2002 Joint National Conference of the American 
Society of Aging/National Council of Aging. The workshop 
demonstrated how the SEE Program utilizes the wealth of talent, 
experience and skills possessed by retired and unemployed older 
Americans. The workshop also explained how bringing workers age 
55 and above into the workforce enriches the lives of the 
individuals in the program, infuses knowledge and experiences 
gained from prior work histories into the workforce, and 
supports government staff in administering programs. The work 
being done by the many SEE participants demonstrates the 
effectiveness of older Americans in helping to protect our 
environment.

             SENIOR ENVIRONMENTAL EMPLOYMENT (SEE) PROGRAM

    The Environmental Programs Assistance Act of 1984 (Public 
Law 98-313) authorizes the Environmental Protection Agency 
(EPA) to enter into grants or cooperative agreements with 
private non-profit organizations, as designated by the 
Secretary of Labor under Title V of the Older American Act. 
These cooperative agreements, administered by the EPA under the 
Senior Environmental Employment (SEE) Program, are in support 
of environmental programs, objectives, and initiatives 
utilizing the wealth of talent, experience, and skills 
possessed by retired and unemployed older Americans age 55 and 
over.
    There are six national aging organizations with whom 
cooperative agreements were funded by EPA with during calendar 
years 2001 and 2002: The National Association for Hispanic 
Elderly, National Asian Pacific Center on Aging, National 
Caucus and Center on Black Aged, Inc., National Council on the 
Aging, Inc., National Older Worker Career Center, Inc., and 
Senior Service American, Inc. Under the auspices of cooperative 
agreements, these organizations are responsible for recruiting 
qualified candidates for enrollment in positions that support 
federal, state and local environmental offices.
    SEE enrollees provide a wide array of technical assistance. 
These older workers are involved in every aspect of EPA's 
effort to improve our environment, from providing clerical 
support to performing radiation and air pollution monitoring. 
The SEE Program provides support to EPA where it is most 
needed, and enables older workers to remain active using their 
knowledge, skills, and life experiences to perform meaningful 
tasks that promote and support important agency environmental 
programs and initiatives.

               ITEM 17--FEDERAL COMMUNICATIONS COMMISSION

                              ----------                              


 REPORT ON ACTIVITIES AFFECTING OLDER AMERICANS DURING CALENDAR YEARS 
                             2001 AND 2002

    The following is a summary of Federal Communications 
Commission activities during 2001 and 2002 that affected older 
Americans. The activities are grouped by the Commission 
organizational units that had primary responsibility for them. 
While few Commission activities target older Americans 
specifically, some have had a significant impact on older 
Americans since they address matters that are of particular 
concern to them. As an example, the Commission has been working 
to increase access to telecommunications services for people 
with hearing or visual disabilities. Since it is likely that 
many Americans with these disabilities are elderly, the 
Commission believes that its actions in this area are providing 
a direct, tangible benefit to the elderly.
Wireless Telecommunications Bureau
    Emergency Access: Digital Wireless-TTY Compatibility.--
During 2001 and 2002, the Commission oversaw the successful 
implementation in digital wireless networks of the capability 
to transmit 911 calls from text telephone (TTY) devices. 
Previously, these calls could not be transmitted over digital 
wireless systems because the Baudot-encoded audio tones 
produced by TTY devices were unable to be passed through 
digital systems. Digital wireless service providers were 
required to begin transmitting TTY 911 calls by June 30, 2002, 
in accordance with the Commission's Order. The Order also 
imposed reporting requirements to enable the Commission to 
monitor the implementation. The majority of digital wireless 
service providers satisfied the implementation requirements in 
a timely manner; some small, rural service providers sought 
extensions or waivers due to their unique circumstances.
    Hearing Aid Compatibility with Digital Wireless Phones.--In 
order to preserve access to wireless telecommunications by 
individuals with hearing disabilities, the Commission reviewed 
its rules governing hearing aid compatibility with wireless 
phones during 2001 and 2002. The Hearing Aid Compatibility Act 
of 1988 requires most phones manufactured or imported for use 
in the United States to be hearing aid compatible. However, the 
statute exempted wireless phones from this requirement, and 
Section 68.4 of the Commission's rules implemented the 
exemption. In fulfillment of the statute's mandate that the 
Commission periodically review the exemption and in response to 
a consumer group's petition, the Commission initiated a 
proceeding to examine the issue.
    Although analog wireless phones do not usually cause 
interference with hearing aids or cochlear implants, digital 
wireless phones sometimes do because of electromagnetic energy 
emitted by the phone's antenna, backlight, or other components. 
Because digital wireless phones are technically superior and 
offer cheaper calling plans, they are vastly more popular than 
their analog counterparts. Access to them is essential to the 
safety and increased convenience that consumers demand. Based 
on the decline in analog service offerings coupled with the 
rise in more efficient, lower-cost, and feature-rich digital 
offerings, the Commission tentatively concluded that limiting 
the hearing aid compatibility exemption for wireless phones 
would serve the public interest. The Commission also 
tentatively concluded that continuation of the exemption 
without limitation would have an adverse effect on individuals 
with hearing disabilities.
Wireline Competition Bureau
    Universal Service.--The Telecommunications Act of 1996 
established certain principles for the Commission to follow in 
revising and expanding the scope and definition of ``universal 
service'' in telecommunications services for all Americans. Of 
particular note to older Americans, these principles include 
ensuring that all consumers, including low-income consumers, 
have access to affordable telecommunications services and 
ensuring that health care providers and libraries have access 
to advanced telecommunications services.
    Rural Health Care Support Mechanism and Support for 
Libraries.--Consistent with these principles, the Commission 
established new universal service support mechanisms for rural 
health care providers and libraries. The support mechanism for 
rural health care providers helps to link public and non-profit 
health care providers located in rural areas to urban medical 
centers so that patients living in rural America will have 
access, through the telecommunications network, to the same 
advanced diagnostic and other medical services that are enjoyed 
in urban communities. Rural health care support enables rural 
health care providers to obtain telecommunications services at 
rates available in urban areas and Internet access without toll 
charges. The support mechanism for schools and libraries 
implements Congress's mandate to ensure that the nation's 
schools and libraries receive access to the vast array of 
resources that are available through the telecommunications 
network. The schools and libraries program enables eligible 
schools and libraries to obtain discounts ranging from 20 to 90 
percent for eligible telecommunications services, Internet 
access, and internal connections. The discounts are based on 
economic need and whether the applicant is located in an urban 
or rural area.
    During 2001-2002, the Commission continued to implement 
these programs. In April 2002, the Commission released a Notice 
of Proposed Rulemaking seeking comment on ways of expanding the 
eligibility criteria for participation in the rural health care 
program. The proposed changes are intended to enable more 
Americans located in rural areas to have access to the most up-
to-date medical advice and treatment. In January 2002, the 
Commission also released a Notice of Proposed Rulemaking 
initiating a focused review of Commission rules governing the 
schools and libraries universal service mechanism.
    ``Lifeline and Link-Up'' Programs.--During 2001-2002, the 
Commission also continued to refine and expand its ``Lifeline'' 
and ``Link-Up'' programs, which help low-income consumers 
purchase affordable telecommunications services. The federal 
Lifeline programs provide up to $10.00 per month to reduce 
eligible low-income consumers' monthly telephone bills. 
Additional Lifeline support of up to $25 per month is available 
to eligible low-income consumers located on tribal lands. The 
Link-Up program helps low-income consumers pay the initial 
costs of commencing telephone service. Low-income consumers 
receive discounts up to $30 on initial connection charges. 
Enhanced Link-Up support provides an additional discount of up 
to $70 on initial connection charges for low-income consumers 
living on tribal lands.
    Broadband.--In 2002 the Commission issued a Notice of 
Proposed Rulemaking aimed at furthering broadband access to the 
Internet for all Americans. For a number of reasons, 
development of the Internet is of particular benefit to older 
Americans. Through the use of Internet e-mail, for example, 
older Americans can stay in touch with family and friends in 
distant locations. Through access to on-line news media 
outlets, they can keep up with local, national, and 
international news. Older Americans who wish to keep their 
minds active and engaged can take advantage of informational 
websites and on-line distance learning through colleges and 
universities. Finally, the Internet gives older Americans--and 
their doctors--in rural areas access to medical care and 
information from larger, more sophisticated medical facilities 
in distant locations.
Media Bureau
    Video Accessibility.--Older Americans with hearing and 
visual disabilities can be helped by a number of technologies 
related to television, including closed captioning and ``video 
description.'' Video description is the description of key 
visual elements in programming, inserted into natural pauses in 
the audio portion of programming designed to make television 
programming more accessible to the many Americans who have 
visual disabilities. In April 2002 Commission rules went into 
effect mandating that a certain amount of programming contain 
video description, but in November 2002 the United States Court 
of Appeals for the District of Columbia Circuit vacated those 
rules. The pending 2003 FCC Reauthorization Bill (reported by 
the Senate Commerce Committee) reinstates the Commission's 
rules implementing video description.
    Closed Captioning.--The Telecommunications Act of 1996 
directed the Commission to prescribe rules and implementation 
schedules for the closed captioning of video programming 
regardless of the entity that provides the programming to 
consumers or the category of programming. The Commission has 
established rules requiring that both analog technology and 
digital technology television programming contain closed 
captioning. In 2002, as part of the Commission's periodic 
review of the progress of the transition of the nation's 
television broadcast system from analog to digital, the 
Commission initiated an assessment whether additional actions 
are required to ensure the accessibility and functioning of 
closed captioning service for digital television.
    Emergency Information.--The Commission adopted rules in 
2000 requiring broadcasters or multichannel video program 
distributors (``MVPDs'') that provide local emergency 
information to make that information accessible to persons with 
hearing and visual disabilities. Emergency information is 
defined as that information intended to protect life, health, 
safety, and property, i.e., ``critical details'' about an 
emergency and how to respond to the emergency. Critical details 
include, among other things, specific details regarding the 
areas that will be affected by the emergency, evacuation 
orders, detailed descriptions of areas to be evacuated, 
specific evacuation routes, approved shelters or the way to 
take shelter in one's home, instructions on how to secure 
personal property, road closures, and how to obtain relief 
assistance. Under the Commission's rules, broadcast stations 
and MVPDs that provide local emergency information must make 
that information accessible to people with hearing disabilities 
through closed captioning or other method of visual 
presentation. Broadcast stations and MVPDs that provide local 
emergency information during regularly scheduled newscasts, 
unscheduled newscasts that preempt regularly scheduled 
programming, or during continuing coverage of a situation, must 
make that information accessible to people with visual 
disabilities through oral description of the information. 
Broadcast stations and MVPDs that provide local emergency 
information in other programs, such as through a crawl or a 
scroll, must sound a tone when they provide that information in 
order to alert persons with visual disabilities to turn to 
other media, such as a radio, to get the emergency information.
    During 2001 and 2002 the Commission continued to handle 
correspondence from the public regarding the obligations of 
broadcasters and MVPDs to provide emergency information to 
visually impaired viewers. In addition, in 2001 the Commission 
granted a waiver through 2004 to MVPDs that receive their 
emergency information from The Weather Channel (``TWC'') via 
Star III and Weather Star Jrs. of the requirement that they 
provide an aural tone before each crawl or scroll of emergency 
information. TWC sought the waiver based on its plans to 
upgrade and replace its computers in 2003/2004 which supply the 
aural tone. Without this waiver, the cost of complying with the 
Commission's rules in a timely fashion would have cost TWC 
approximately $34 million.
    Senior Citizen Discounts for Cable Service.--Senior citizen 
discounts benefit older Americans who may have limited incomes. 
By enacting Section 623(e)(1) as part of the system of rate 
regulation pursuant to the 1992 Cable Act, Congress intended to 
encourage cable operators to offer, and to continue to offer 
through existing franchise agreements, reasonable discounts to 
senior citizens or other economically disadvantaged groups. In 
2001 and 2002 the Bureau handled complaints on an ongoing basis 
regarding the provision of senior citizen discounts and 
provided assistance to cable customers who contacted the 
Commission on this issue.
International Bureau
    Mobile Satellite Service 911.--In 2002, the Commission 
continued its efforts to promote public safety by examining 
whether the rules that require wireless carriers to bring 
emergency assistance to wireless callers throughout the United 
States should be extended to certain non-traditional services. 
Among these services, the Commission proposed to require mobile 
satellite service (MSS) providers to establish call centers for 
the purpose of answering customers' 911 emergency calls. In 
addition, the Commission sought information regarding MSS 
enhanced 911 implementation (provision of caller phone number 
and location) and timelines for achievability. 911 services, 
including those deliverable by satellite, are particularly 
important to older Americans.
Consumer & Governmental Affairs Bureau
    Hearing Aid Compatibility.--In 2002 the Commission crafted 
an outreach plan to be implemented in 2003 in conjunction with 
the Hearing Aid Compatibility initiative. The outreach 
constituted contacting manufacturers and audiologists to work 
to bring the new policies and information to their customers 
and clients.
    Consumer Advisory Committee.--In November 2002 the 
Commission renewed the charter of the Consumer Advisory 
Committee (CAC), originally established in 2000 as the 
Consumer/Disability Telecommunications Advisory Committee. The 
Committee is comprised of representatives from industry and 
consumer groups, including consumers with disabilities and a 
representative from the AARP. The mission of the Consumer 
Advisory Committee is to make recommendations to the Commission 
regarding consumer issues within the jurisdiction of the 
Commission and to facilitate the participation of consumers 
(including people with disabilities and underserved 
populations, such as Native Americans and persons living in 
rural areas) in proceedings before the Commission.
    Telecommunications Relay Service (TRS).--Title IV of the 
Americans with Disabilities Act (ADA), which is codified at 
Section 225 of the Communications Act, mandates that the 
Commission ensure that interstate and intrastate TRS are 
available, to the extent possible and in the most efficient 
manner, to individuals in the United States with hearing and 
speech disabilities. Title IV aims to further Congress' goal of 
universal service by providing, to individuals with hearing or 
speech disabilities, telephone services that are functionally 
equivalent to those available to individuals without such 
disabilities. Since the establishment of this mandate, the 
Commission has taken numerous steps to increase the 
availability of TRS, and to ensure that TRS users have access 
to the same services available to all telephone service users. 
Throughout 2001 and 2002, the Commission also issued orders to 
streamline and refine the ability for more Americans with 
disabilities to access telecommunications.
    Conferences and Forums.--The Consumer and Governmental 
Affairs Bureau participates annually in the AARP conference and 
local functions in the Washington, D.C., area. In February 2001 
the Commission observed National Consumer Protection Week by 
focusing on the concerns of senior citizens and organizing 
three events to discuss telecommunications issues of particular 
interest to them. These issues included implementation of the 
Telephone Consumer Protection Act, procedures for filing a 
complaint, slamming and telemarketing rules, video description, 
and closed captioning.



                  ITEM 19--LEGAL SERVICES CORPORATION

                              ----------                              

    In 2001, LSC-funded programs served approximately 1 million 
clients. Fourteen percent, or just over 140,000 individuals 
served were age sixty or over. In 2002, LSC-funded programs 
served slightly fewer than 1 million clients. More than 100,000 
of those clients, or over 10 percent, were age sixty or over.
    Many of the type of cases handled by LSC funded programs 
directly impact the lives of seniors. Consumer cases, which 
include bankruptcy, repossessions, public utilities and unfair 
sales practices totaled more than 11 percent of the cases 
handled by federally funded legal services programs in 2001 and 
2002. Health cases, including Medicare and Medicaid cases, 
totaled approximately 3 percent of cases closed by legal 
services programs during that time period. In 2001 and 2002, 
housing cases, including landlord/tenant cases and public 
housing cases, made up nearly 25 percent of the cases closed by 
LSC-funded programs. Income Maintenance cases, including black 
lung, food stamps, Veterans benefits and Social Security, made 
up roughly 13 percent of the cases handled by legal services 
programs in 2001 and 2002. Seniors make up some portion of the 
clients served in each of these types of case.



                ITEM 21--NATIONAL ENDOWMENT FOR THE ARTS

                              ----------                              


      Summary of Activities Relating to Older Americans 2001-2002

                              Introduction

    The National Endowment for the Arts is an independent 
federal agency that exists to foster, preserve, and promote 
excellence in the arts, to bring art to all Americans, and to 
provide leadership in arts education. This agency 
enthusiastically seeks ways to involve older adults in the arts 
as creators, teachers, students, volunteers, patrons, and as 
audience members. Through its support, leadership initiatives, 
and technical assistance, the Arts Endowment assures the 
continued involvement of older Americans in the full spectrum 
of America's art.

                        Office for AccessAbility

    This Office serves as the advocacy and technical assistance 
arm of the Arts Endowment for people who are older, disabled, 
or living in institutions. The Office works in a myriad of ways 
to assist grantees and applicants in making arts programs 
available to these important segments of our citizenry. A broad 
range of cooperative efforts have been developed with Endowment 
grantees, arts service groups, private groups representing 
older and disabled populations, and with other Federal agencies 
to assist in achieving the Endowment's goal of increased access 
to the arts for all Americans. The focus of these efforts is 
inclusion--opening up existing programs and outreach to 
citizens who would not otherwise have opportunities to be 
involved in excellence in the arts.

                     Design for the Lifespan Forum

    As part of its efforts to educate and assist the practice 
of universal design, the Endowment convened a forum, ``Design 
for the Lifespan,'' in partnership with the American 
Association of Retired Persons (AARP) and the National 
Association of Home Builders (NAHB) on February 20-21, 2001. 
Universal design goes beyond minimum access standards and 
guidelines--to make spaces and programs usable by people from 
childhood into their oldest years. This meeting was the first 
time that remodelers, universal design experts, and consumers 
came together to look at ways to educate remodelers on 
incorporating universal design standards into the remodeling 
process of homes. The AARP's research indicates that Americans 
want to remain in their homes as they age, and the utilization 
of universal design principals in building and remodeling homes 
makes this possible. An action plan, developed by the 26 
participants, is being implemented by NAHB and AARP. One of the 
outcomes of this highly successful meeting was the development 
of an ``Aging In Place'' training certification program by 
NAHB's Senior Housing Research Center. More than 200 remodelers 
have been certified since the program was launched in April 
2002.

                National Accessibility Leadership Award

    The Arts Endowment developed a National Accessibility 
Leadership Award with the Coco-Cola Foundation and National 
Assembly of State Arts Agencies (NASAA) to recognize 
outstanding work of the State arts agencies. The $30,000 award 
must be used to advance the agency's access efforts. The first 
award was presented to the Ohio Arts Council on October 19, 
2002, at NASAA's conference in Detroit, Michigan--for its 
exceptional accessibility work to involve older artists and 
artists with disabilities in its planning process. The Ohio 
Arts Council is the only State arts agency to date that 
requires an older adult or a person with a disability serve on 
all application review panels and sponsors quarterly meetings 
of artists with disabilities and of all ages.

     Careers in the Arts for Citizens of All Ages and People with 
                              Disabilities

    The Arts Endowment joined with the Social Security 
Administration (SSA) and VSA arts to support a series of 
statewide forums on Careers in the Arts to assist artists and 
arts administrators with disabilities in increasing their arts 
training and career opportunities. During this reporting 
period, forums were convened in Minnesota, New Mexico, and 
Maryland. Representatives from the SSA, arts schools, arts 
organizations, and hundreds of older adults and people with 
disabilities participated in the forums. Most important, many 
follow-up projects have resulted to assist participants in 
realizing their career goals.
    On October 5, 2001, the AccessAbility Office received the 
``2002 Arts and Culture Award'' from the Corporation on 
Telecommunication and Disability for the ``Endowment's Careers 
in the Arts Leadership initiative and its ongoing work to make 
the arts fully accessible to people of all ages and 
abilities.''

                    Gallaudet University's Deaf Way

    As part of the second International Deaf Way Cultural Arts 
Festival, the Arts Endowment supported an Artists' Symposium 
that took place June 30-July 6, 2002, at Gallaudet University 
and at venues throughout the District of Columbia including the 
Kennedy Center, Smithsonian Institution, Clarice Smith 
Performing Arts Center at the University of Maryland, and at 
many art galleries. It was a unique opportunity for 
approximately 400 deaf artists of all ages and disciplines to 
come together to show and share their art--many for the first 
time. The artists exhibited and performed their art, and 
conducted master classes and arts workshops for festival 
participants. The Symposium served to increase public awareness 
of the abilities and accomplishments of deaf and hard-of-
hearing artists of all ages and to establish lasting 
collaborations between deaf or hard-of-hearing artists and arts 
organizations.

                       Creativity and Aging Study

    The Arts Endowment developed a partnership with the 
American Association of Retired Persons, the Guttman 
Foundation, and the U.S. Dept. of Health and Human Services 
(Administration on Aging and National Institutes of Health) to 
support a three-year study, ``The Impact of the Arts on Older 
Americans,'' to measure and evaluate the effects that 
professional arts programs have on the quality of life for 
older adults. The Endowment hosted an interagency signing 
ceremony on July 24, 2001, to formally recognize this alliance 
and the interagency committee that oversees the study.
    The purpose of this study is to examine the impact of 
community-based cultural programs on the physical health, 
mental health, and social functioning of older persons. The 
study involves older adults participating in a wide variety of 
cultural programs conducted by professional artists including 
visual artists, storytellers, poets, dancers, and theater 
artists. The research is being conducted in three locations 
that offer important population diversity and variation in art 
forms: Elders Share the Arts in Brooklyn, NY; Artworks in San 
Francisco, CA, and the Levine School of Music in Arlington and 
Alexandria, VA. Participants represent demographic diversity in 
terms of race and ethnicity. As needed, test instruments are 
translated into Spanish and Asian languages, and are 
administered by trained research assistants who speak that 
language.
    This is the first study of its nature in which an 
experimental design is employed using a large intervention 
group of older adults involved in community-based cultural 
programs conducted by professional artists that is compared to 
a large control group of older persons not participating in 
such programs. Although there are no definitive studies to 
date, experience has shown dramatic improvements in the lives 
of older adults when they are involved in structured programs 
conducted by professional artists over a period of time.
    Preliminary results of the study were presented to an 
enthusiastic audience at the April 2002 meeting of the American 
Society on Aging. Scientific and community service program 
interest in the study has been high as well. The outcomes 
anticipated in the study are on the whole expected to reflect 
changes in the direction of promoting sustained if not enhanced 
societal functioning and independence. The goal is to 
significantly increase the involvement of older Americans in 
high quality cultural programming.

                         The Arts in Healthcare

    The Arts Endowment continues its leadership initiative to 
infuse professional arts programming into healthcare including 
programs at hospitals, drug treatment centers, and hospices. 
During this reporting period, the Endowment supported the Arts 
in Healthcare Consultants' Program with the Society for the 
Arts in Healthcare, a national membership organization that 
includes medical professionals, arts administrators, artists, 
and business representatives.
    Seventeen arts administrators serve as consultants to 
advise and assist medical staff in planning, developing, and 
establishing arts programming in their facilities. Programs 
include concerts in hospital lobbies; strolling musicians in 
patients rooms; story tellers for children; drawing and 
painting instruction; art exhibitions in corridors and waiting 
rooms; and art carts where patients select framed art for their 
rooms. In addition, the AccessAbility Office convened workshops 
for state and regional arts agencies to assist them in 
expanding the arts into healthcare settings throughout the 
country.

                         Arts Endowment Funding

    The National Endowment for the Arts supports arts 
activities that benefit people of all ages. The projects 
described below specifically address arts programming for older 
adults.
    Please note that our report describes grants awarded for 
Fiscal Years 2001 and 2002.

                             FY 2001 Grants

                                 Dance

    Ririe-Woodbury Dance Foundation in Salt Lake City, Utah, 
offered a variety of dance workshops to people of all ages 
residing in Louisiana. Residencies ranged from Afro-Caribbean 
dance and creative movement workshops held in local schools to 
ballroom dancing for older adults.
    Stuart Pimsler Dance Theater in Minneapolis, Minnesota, 
collaborated with two healthcare organizations, Pathways and 
Virginia Piper Cancer Institute's Arts and Humanities program, 
on a new project, Stories to Die For, involving caregivers and 
persons with life-threatening illnesses.

                                 Design

    American Institute of Graphic Arts in Seattle, Washington, 
organized an intergenerational book project that brought 
together inner-city school children, older adults and graphic 
designers in a ten-week workshop. A set of books created by the 
participants was published and distributed to the community.
    Mississippi State University in Jackson, Mississippi, 
received funding for a consortium project about the design of 
affordable, innovative, prototype housing for a cooperative 
living arrangement. The project, implemented by the Jackson 
Community Design Center of Mississippi State University and 
Stewpot Community Services, brings together a living 
arrangement of low income, single parent families, older adults 
and individuals with disabilities.

                           Local Arts Agency

    Regional Arts and Culture Council of Portland, Oregon, 
organized the Arts in Healthcare Consortium that brings 
multifaceted, professional arts programs into healthcare 
facilities in the Portland metropolitan region. Media Rights, a 
radio piece on death and dying, focused on end-of-life issues. 
The Artist Repertoire Theater at the Well Arts Institute worked 
with veterans who told their stories and saw them dramatized in 
theater, and artists conducted programs at Emmanuel Children's 
Hospital and targeted children and their families.

                               Media Arts

    Film Arts Foundation of San Francisco, California, received 
funding for the production of an experimental documentary film 
by Ellen Bruno on aging, sickness, and death entitled ``Skin 
and Bones.''
    Jack Straw Foundation in Seattle, Washington, received 
support for its Blind Audio Project. The project consists of a 
series of workshops introducing people who are blind or 
partially sighted to the creative possibilities and latest 
techniques of audio production.
    L.A. Theatre Works in Venice, California, distributed audio 
plays to libraries for people who are blind or partially 
sighted, and provided organizations with promotional materials 
to enhance the collection.

                           Multi Disciplinary

    Arizona Theatre Company in Tucson, Arizona, received 
Endowment support for its consortium project, ARTability: 
Accessing Arizona's Arts. This statewide community outreach and 
professional training project expands and promotes accessible 
programming to individuals with disabilities.
    Arts for the Aging, Inc., in Bethesda, Maryland, expanded 
its Arts Workshop Program with support from the NEA. The 
project provides monthly instruction by professional artists at 
senior daycare centers in metropolitan Washington, DC.
    Danceworks, Inc., of Milwaukee, Wisconsin, organized its 
50-Plus Initiative, a dance and creative arts program for older 
adults. Workshops, classes, residencies, and performances 
include older adult with physical and cognitive disabilities.
    Elders Share the Arts in Brooklyn, New York, was awarded a 
grant to support its Center for Creative Aging, a national 
arts-in-aging training program that links cultures and 
generations. The project relies on its national networking 
program to develop model programs such as Generating Community, 
an intergenerational program that brings together older adults 
in nursing homes, community centers, and senior centers with 
pre-school to high-school aged youth. Their Pearls of Wisdom 
group is composed of elder storytellers who represent New 
York's older generation and its cultural diversity and performs 
in schools and senior facilities.
    Gallaudet University in Washington, DC, received Endowment 
support for The Deaf Way II, the University's second weeklong 
international festival that celebrates the experiences of 
people who are deaf and focuses on universal issues such as the 
arts, language, culture, technology, and human rights. The 
festival was held on July 8-13, 2002, at the Washington 
Convention Center. In addition, an elaborate arts festival was 
held at venues around the city, including exhibitions and 
performances by deaf artists.
    Sheboygan Arts Foundation, Inc., in Sheboygan, Wisconsin, 
received a grant for Connecting Communities, a series of 
community-based arts residencies that facilitate collaborations 
between visual and performing artists and older adults, 
industrial employees, youth at risk, and members of the Hmong 
and Hispanic communities of Sheboygan County.
    Society for the Arts in Healthcare in Washington, DC, was 
awarded funding for the second phase of the first national 
technical assistance project, an initiative that trains arts 
administrators and artists as consultants to healthcare 
institutions across the country. These consultants assist 
healthcare groups in establishing comprehensive, professional 
arts programming within their institutions.

                                 Music

    Flint Institute of Music in Flint, Michigan, created music 
outreach activities for underserved communities. Performances 
and other activities for children and adults were presented at 
senior centers, public housing projects, and recreation 
centers.
    Washington Chorus. Inc., in Washington, DC, was awarded a 
grant for an outreach and education program, including free 
concerts for older adults, school choir workshops, and 
distribution of free tickets to underserved groups throughout 
the Washington, DC, area.

                            Musical Theater

    American Music Theater Festival, Inc., in Philadelphia, 
Pennsylvania, brought diverse communities together with Project 
Open Doors, a multi-faceted project with complementary 
artistic, educational, and marketing components. Prince Music 
Theater widened access to musical theater through low or no-
cost performances by and for people with disabilities and 
people with low incomes. They also organized residencies in 
schools for artists of all ages who composed original work with 
the children.

                                 Opera

    Lyric Opera of Kansas City, Inc., in Kansas City, Missouri, 
received a grant to create educational programs for pre-K 
through 12th grade students, inmates in correctional 
facilities, and the families of both. In FY 2001-2002, programs 
included ``Lyric Opera Express'' and ``Opera for Teens.'' The 
opera also provided professional development opportunities for 
educators in Kansas and Missouri.

                    Resources for Change: Technology

    Deaf West Theatre Company, Inc., of North Hollywood, 
California, designed backstage communication systems for 
technicians who are deaf and hard-of-hearing, installed a 
computer-operated control board for technical effects, and 
developed lighting that robotically focuses on signing 
interpreters or actors with funds from the Endowment. The 
project trained technicians who are deaf or hard-of-hearing for 
jobs in the theater and worked to enhance the theater 
experience for audiences who are deaf and hard-of-hearing.
    Music and Arts Center for Humanity of Bridgeport, 
Connecticut, received a grant to develop online services for 
the National Resource Center for Blind Musicians. Using new 
Cake Talk software as a base, the center implemented a 
distance-learning course on the Web for students and teachers 
to interchange Braille music notation and scoring suited only 
for sighted individuals.

                                Theater

    Center Stage Associates, Inc., in Baltimore, Maryland, was 
awarded funding to support the adaptation and presentation of 
J.M. Barrie's Peter Pan. The production included actors and 
musicians of all ages who are both deaf and hearing.
    Contemporary American Theater Festival of Shepherdstown, 
West Virginia, purchased and installed infrared assistive 
listening systems. Systems were installed in two theaters and 
increased the participation and comfort of audience members who 
are hard-of-hearing.
    Deaf West Theatre Company, Inc., in North Hollywood, 
California, created a new theater piece and video. Mark Medoff, 
author of Children of a Lesser God, was commissioned to write 
the new theater piece that is accessible to audiences who are 
both deaf and hearing.
    Non-Traditional Casting Project, Inc., of New York, New 
York, received Endowment support for its Artist Files/Online 
and the National Forum on Diversity:The American Scene. These 
initiatives link theater producers with artists of color, older 
artists, and artists with disabilities to promote a national 
dialogue concerning diversity and inclusion.
    Seven Stages, Inc., in Atlanta, Georgia, received funding 
for the production and tour of Hush, the story of Blind Tom 
Wiggins. This world premiere, written by African-American 
playwright Robert Earl Price, was performed at Seven Stages in 
Atlanta and toured to select communities throughout the 
Southeast.
    Theater By the Blind Corporation in New York, New York, was 
awarded a grant to expand training and professional development 
for theater artists who are blind or partially sighted. Theater 
By the Blind increases access to play scripts and theater texts 
for people who are blind or partially sighted through its 
reading service and staged reading performance opportunities.
    Theater Development Fund, Inc., of New York, New York, 
organized Interpreting for the Theater, an intensive one-week 
course on theater sign-language interpretation. The Fund 
convened an advanced training program for certified 
interpreters nationwide to hone their skills as theater sign 
interpreters and to explore techniques for signing plays and 
musicals.

                              Visual Arts

    Richmond Art Center of Richmond, California, was awarded a 
grant to support the Quilt of Many Colors Project, a series of 
four curated exhibitions installed in the lobbies of Richmond's 
main public health facility. The project promotes the value of 
the arts in the healing process and provides access to the arts 
for approximately 30,000 people who enter the facility each 
year.

                             FY 2002 Grants

                                 Dance

    Caribbean Dance Company of the Virgin Islands, Inc., in St. 
Croix, Virgin Islands, received support for its 2002 Caribbean 
Dance Axis. The project provides performances at senior 
centers, universities, elementary schools, and public daycare 
centers.
    Dance Alive!, Inc., in Gainesville, Florida, received a 
grant to expand its touring into rural and underserved areas of 
Florida, Georgia, Alabama, and Louisiana. The dance programs 
include work by resident choreographers, George Balanchine, and 
commissioned work by contemporary choreographers.
    San Diego Dance Theater in San Diego, California, was 
awarded funding for the Dance Ability Project. This project 
partners dancers and choreographers of all ages with physical 
education teachers to create dances that generate performance 
opportunities for students with disabilities of the Oceanside 
School District.
    Tigertail Productions, Inc., in Miami, Florida, and Florida 
Dance Association presented danceAble III, a five-day series of 
performances, workshops, panels and symposia dedicated to 
exploring and promoting dance for people of all ages with 
disabilities, during the Florida Dance Festival in Miami on 
June 24-29, 2002. The danceAble strives to broaden the 
definition of dance and to expand the understanding of who has 
access to dance. It recognizes the many health and creative 
benefits of dance and is targeted to a general dance audience, 
attendees of the Florida Dance Festival, health professionals, 
artists and individuals of all ages from the community.

                                 Design

    Archeworks in Chicago, Illinois, was awarded a grant for 
the design and production of a prototype kitchen that is usable 
by everyone including individuals with physical disabilities. 
Archeworks is an alternative design school founded to initiate 
design solutions for intergenerational and underserved 
communities.
    Architects/Designers/Planners for Social Responsibility in 
Berkeley, California, was awarded funds to support New Village 
Journal, a publication that presents case studies of grassroots 
projects concerned with cultural heritage and neighborhood 
spirit. These projects serve older adults, immigrant 
communities, children and youth, and will feature examples of 
cultural and physical renewal in some of the most challenged 
urban neighborhoods in America.
    Mercy Housing in Flagstaff, Arizona, received funds on 
behalf of Indigenous Community Enterprises for a housing 
project designed for older Navajos that incorporates 
traditional Navajo dwelling designs with contemporary housing 
design features. Design workshops that include a variety of 
ages and cultural perspectives were conducted with older 
Navajos, tribal officials, community leaders, social service 
providers, facility managers, and family members.
    Rhode Island School of Design in Providence, Rhode Island, 
is developing a project, The Knowing Eye, which includes 
interactive learning spaces throughout the permanent collection 
of the RISD Museum. Its purpose is to encourage the active 
engagement of visitors of all ages with the exhibits.
    VSA arts of Massachusetts in Boston, Massachusetts, 
received funding for expansion of its National Cultural Access 
Initiative. This initiative demonstrates the principles of 
universal design and creates opportunities for broad 
participation in the arts through a national tour of 
JazzArtSigns, a group that includes musicians, an 
improvisational painter, American Sign Language (ASL) 
interpreters, live audio description and text captioning, and 
program information in Braille and large print. It also 
provides a training videotape that is open-captioned and audio-
described to introduce the concept of universal design to 
program presenters through affiliates in 28 states.

                       Folk and Traditional Arts

    Los Reyes de Albuquerque Foundation in Albuquerque, New 
Mexico, received support to maintain nuevomexicano folk 
traditions and to present specially arranged performances of 
the Fiesta de los Novios at urban, rural, and Pueblo senior 
centers and child daycare centers.
    Maine Indian Basketmakers Alliance in Old Town, Maine, was 
awarded funds for the Next Generation Project, an intertribal/
intergenerational initiative that engages tribal members 
between the ages of 13-30 in one-on-one apprenticeships with 
master weavers.
    Richmond Art Center in Richmond, California, received a 
grant for its Quilt of Many Colors Project, a series of four 
curated exhibitions installed in the waiting room of Richmond's 
main public health facility. The project promotes the value of 
the arts in the healing process.

                         Leadership Initiatives

    ARTREACH, Inc., in Philadelphia, Pennsylvania, was awarded 
a grant for its Outreach Project, an expansion of ARTREACH's 
ticketing program. ARTREACH, Inc., coordinates, distributes, 
and donates tickets at significantly discounted prices for 
music, dance, and theater performances. The agency increases 
outreach to agencies that serve older adults, people with 
disabilities, and individuals with low incomes.
    Asian Arts Initiative in Philadelphia, Pennsylvania, acting 
as the lead organization in consortium with other groups, 
received funds for the Artists in Communities Training Program. 
Two 50-hour training sessions are offered to artists for 
training in arts education to serve residencies in 
multigenerational community settings across Philadelphia.
    Class Acts Arts, Inc., in Silver Spring, Maryland, received 
a grant to expand outreach programs to underserved populations 
and develop access programs for people who are deaf or hard-of-
hearing. The project focuses on accessibility needs and 
includes workshops with master artists, new learning guides, 
and other support material for teachers.
    Elders Share the Arts in Brooklyn, New York, completed 
Level 2 of its consortium project at the National Center for 
Creative Aging, an arts-in-aging training program. Project 
activities include the maintenance of current arts-in-training 
programs in five regions of the country, expanded training to 
additional cities, creation of a network newsletter, and the 
development of an online component that highlights model arts 
programs involving older adults.

                               Literature

    National Book Foundation, Inc., in New York, New York, was 
awarded funding for its literary outreach programs that link 
National Book Award authors with underserved, intergenerational 
communities throughout the country. Programs include American 
Voices, which brings writers to Native American reservations 
nationwide, and a Summer Writing Camp for inner-city residents, 
whose ages range from 14 to 70.

                               Media Arts

    Detroit Educational Television Foundation in Detroit, 
Michigan, received support to develop a documentary on Vietnam 
War veterans as artists. Through the Green Door includes 
material from the National Vietnam Veterans' Art Museum in 
Chicago where more than 140 artists' works are exhibited.
    Jack Straw Memorial Foundation in Seattle, Washington, 
acting as the lead organization in a consortium with other 
groups, received funds to further its Blind Youth and Adult 
Audio Project. Arts and Visually Impaired Audiences presents a 
series of workshops that introduce people who are blind or 
partially sighted to the creative possibilities and latest 
techniques of audio production.

                           Multidisciplinary

    Community School of the Arts in Charlotte, North Carolina, 
created after-school and intergenerational arts programming 
with support from the Endowment. Children and adults from the 
Southside Homes public housing community participated in on-
site workshops and classes in visual art, drama, and music.
    Great Leap, Inc., in Los Angeles, California, received 
support for its multi-year project To All Relations: Re-
spiriting Detroit. This intergenerational project focuses on 
community efforts to rebuild, re-spirit, and redefine Detroit 
utilizing dance, music, and storytelling to create a work 
entitled, ``I Dream a Garden,'' a song written and performed as 
a community circle dance. Involving community groups, the Boggs 
Center, Detroit Summer, and the Matrix Theatre Company, the 
project engages older Americans as well as children and teens 
from the Asian American, African American, White, Latino, and 
Native American communities. Older adults are involved in the 
project's conception and implementation, serving as 
storytellers and dancers.
    Little City Foundation in Palatine, Illinois, organized 
Have Art, Will Travel, a series of mobile arts classes that 
provide children and adults with developmental disabilities 
with instruction in the visual, performing and media arts.
    Office of Human Concern, Inc., in Rogers, Arkansas, was 
awarded a grant on behalf of The Multicultural Center of 
Northwest Arkansas to support the Marshallese Traditional Arts 
Summer Program where older adults pass on dance, music, and 
handicraft traditions to their youth.
    Senior Arts Project in Albuquerque, New Mexico, was awarded 
a grant for its Senior Arts Festival International. The project 
features a day-long, inter-generational celebration for the 
350-member multigenerational audience, 95 percent of whom are 
older adults. Performances by six multi-ethnic performing 
groups, a series of workshops, and a social dance encourages 
broad audience participation.
    Sheboygan Arts Foundation, Inc., in Sheboygan, Wisconsin, 
received funding on behalf of the John Michael Kohler Arts 
Center to support Connecting Communities, a series of five 
community-based residencies that facilitate collaborations 
between visual and performing artists and older audiences from 
Sheboygan County, the Hmong and Hispanic communities, 
industrial employees, and youth at-risk.
    VSA arts of Washington in Seattle, Washington, received 
support for its Cultural Access Project of Washington State. 
The project increases access to arts organizations for older 
individuals and people with disabilities by assisting in the 
evaluation and education of organizations concerning access to 
all facets of their facilities and programs.
    Walt Whitman Cultural Arts Center, Inc., in Camden, New 
Jersey, received a grant to expand its artist residency and 
workshop program. Ten local and community teaching artists will 
work with underserved city residents including older adults.
    Washington Chorus, Inc., in Washington, DC, received a 
grant to support its outreach and education program. Activities 
include free concerts for older adults and school choir 
workshops.
    Young Audiences Inc., in New York, New York, was awarded 
funding for Family Link, a program providing underserved public 
school students and families with intergenerational arts 
education programming as well as access to New York City's 
cultural resources. The initiative provides public school 
students, teachers, and families with multicultural learning 
opportunities through in-school residencies, family workshops, 
and artist visits to performances.

                                Museums

    Museum of Photographic Arts in San Diego, California, 
organized the Regeneration Project, a 16-week collaborative 
creative process involving older adults and local artists. 
Working with professional photographers, actors, composers, 
designers and arts educators, older adults write, direct, and 
present a multimedia performance piece.
    Texas Fine Arts Association in Austin, Texas, was awarded 
funding to support ``Art on Tour,'' a statewide traveling 
exhibition program with accompanying catalogues and lectures. 
The program circulates exhibitions of contemporary art by 
emerging and mid-career American artists to small museums and 
university and community galleries throughout Texas, many in 
rural, culturally underserved communities.

                                 Music

    Billings Symphony Society in Billings, Montana, received a 
grant for its Yellowstone Music Project that includes the 
Senior Series, a program that takes small ensembles and 
soloists into lunch centers and transitional care facilities, a 
free Youth Concert that is accessible to everyone, and a free 
symphony in the park that reaches 10,000 people.
    Flint Institute of Music in Flint, Michigan, was awarded 
funding to support music outreach activities for local, 
underserved communities. Performances and other activities are 
presented at senior centers, recreation centers, and public 
housing projects.
    Grand Performances in Los Angeles, California, received a 
grant for its multidisciplinary series of hip-hop presentations 
including intergenerational hip hop poetry classes conducted by 
Watts Prophets, and a performance by Watts Prophets entitled 
``MMM: Music, and Movement and Meaning'' with post-performance 
facilitated discussions. Performances are advertised in the 
downtown senior centers, and open rehearsals for the orchestra 
are held in an outdoor facility. Focused on local roots, this 
free series broadens the involvement of young audiences in the 
arts and introduces intergenerational audiences to the artistry 
of hip-hop.
    Houston Grand Opera Association, Inc., in Houston, Texas, 
completed the seventh season of its Community Connections 
Initiative that demonstrates unique methods for developing new 
audiences for opera. The program offers free performances of 
three operas each year to schools and community centers, 
audiences at the Heinen and Miller Outdoor theaters, and in 
several branches of the Library. In addition, a special 
``Plazacast'' of a popular production is provided annually 
projecting a live performance onto a giant outdoor screen 
making it available to audiences of all ages.
    Houston Symphony Society in Houston, Texas, received 
support to further Community Connections, an outreach project 
for underserved communities. During 2002, the Houston 
Symphony's musicians performed at long-term care facilities, 
community centers, hospitals, and schools.
    Nashville Symphony Association in Nashville, Tennessee, 
received funding for its concerts in rural areas of middle 
Tennessee and southern Kentucky. The Nashville Symphony, in 
partnership with local community organizations, will tour to 
diverse and underserved communities.
    New Cleveland Opera Company in Cleveland, Ohio, sponsors an 
inter-generational initiative that encourages the inclusion of 
parents, extended families, and residents of local senior 
centers in programs with students. Using the company's core K-
12 programs as a model, the initiative reached an estimated 
21,000 underserved persons through programs in 26 schools in 
2002. The company estimates that 20 percent of the schools 
participating in its programs now regularly include activities 
with parents, grandparents, and friends.

                                Theater

    Capital Repertory Company in Albany, New York, expanded its 
efforts to provide accommodations for hard-of-hearing and deaf 
audience members. Plans include the installation of an infrared 
assisted listening system and professional sign language 
interpreters for designated performances.
    City Theatre Company, Inc., in Pittsburgh, Pennsylvania, 
was awarded funding for a community outreach initiative. 
Spearheaded by the Community Relations Department of City 
Theatre, the project was created to increase access to 
programming, events, and activities for underserved populations 
including communities with low household incomes, older adults, 
and people with disabilities.
    Creative Access in Philadelphia, Pennsylvania, received a 
grant to provide accessible programming at museums and venues 
featuring local and regional theater for people who are deaf 
and hard-of-hearing.
    Dallas Theater Center in Dallas, Texas, received a grant 
for a theater touring program that is accessible to all 
audiences. Dallas Theater Center will tour an adaptation of 
Sophocles' tragedy Antigone to regional schools with 
underserved populations, juvenile detention centers, senior 
centers, and other community organizations.
    Deaf West Theatre Company, Inc., in North Hollywood, 
California, organized the tour and production of professional 
deaf theater for new and diverse audiences in New York City 
with funding from the Endowment. Deaf West Theatre Company 
identified and secured a venue in New York to co-produce the 
musical production of Oliver! in American Sign Language.
    Dixon Place Theatre in New York, New York, received a grant 
for its Intergenerational Performance Workshops, a program that 
provided drama courses to underserved older adults, youth, and 
people residing at public housing facilities in the Rosehill 
section of Manhattan. Artists convene weekly workshops and 
instruct older adults in performing group scenes, monologues, 
and in writing their own solo pieces. Adults and youth perform 
the pieces at a three-day festival in October.
    El Teatro de la Esperanza in San Francisco, California, 
received a grant for a modern secular adaptation of Las Posadas 
Mojadas, a seasonal pageant and play about immigrants seeking 
refuge. The adaptation is designed as a touring production that 
brings theater to underserved audiences in San Francisco and 
nationwide.
    L.A. Theatre Works in Venice, California, received a grant 
to distribute two audio plays made for radio that are 
accessible to all audiences. The plays reached 2,500 
underserved public secondary schools and 700 public libraries, 
including many specifically designed for those who are blind or 
partially sighted.
    Non-Traditional Casting Project, Inc., in New York, New 
York, continues to present two accessibility initiatives, the 
National Diversity Forum and Artist Files/Online, with 
Endowment support. These initiatives link theater producers 
with artists of color, older artists, and artists with 
disabilities to promote a national dialogue concerning 
diversity and inclusion.
    Paper Mill Playhouse in Millburn, New Jersey, created an 
Access Program for this historic playhouse that includes 
services for people who are deaf or hard-of-hearing and 
barrier-free access for people with physical disabilities.
    Pasadena Playhouse State Theater of California, Inc., in 
Pasadena, California, organized an audience development 
initiative that provides increased arts access opportunities 
for people who are deaf or hard-of-hearing and for individuals 
with low incomes. The program includes signed performances, 
audio-described performances for people who are blind or 
visually impaired, and pay-what-you-can opportunities for 
individuals with limited financial resources.
    Penobscot Theatre Company in Bangor, Maine, received 
funding for a production of The Diary of Anne Frank and an 
accompanying outreach project. A series of multicultural and 
intergenerational initiatives for schools, libraries and 
centers for older adults will engage the theater's community in 
an examination of bigotry in the contexts of religion, 
ethnicity, and sexual orientation.
    Seattle Shakespeare Festival in Seattle, Washington, was 
awarded a grant for a Shakespeare festival involving all 
Seattle School District middle schools and older adults. 
Participants work with professional actors and production 
managers from Seattle Shakespeare Festival on rehearsing and 
performing 90-minute Shakespeare adaptations in a festival 
format.
    Shakespeare Project, Inc., in New York, New York, received 
a grant to support free outdoor performances of Shakespeare's 
Othello in parks and public spaces throughout New York City. 
The production will be targeted at non-traditional audiences 
and at the communities surrounding the park venues.
    Spanish Theatre Repertory Co., in New York, New York, was 
granted funds to support Teatro Acceso, a tour of theater works 
performed for multigenerational, underserved communities 
throughout the New York metropolitan, tri-state area, and the 
northeastern United States. The Company used grassroots 
promotional efforts to reach communities of older adults with 
limited access to the arts and students from underserved 
schools and Latino communities.
    Ten Thousand Things in Minneapolis, Minnesota, was awarded 
a grant for the presentation and tour of a production of 
Shakespeare's King Lear. The company toured 16 performances of 
a highly physical production of King Lear to audiences in 
correctional institutions, homeless shelters and adult 
education centers serving low-income people in Minneapolis and 
St. Paul.
    Theatre Development Fund, Inc., in New York, New York, 
organized Interpreting for the Theatre, an intensive one-week 
institute for proficient sign language interpreters. The 
program is designed to improve the skills of certified 
interpreters who have experience in signing plays and musicals 
and to maintain national standards of excellence in the field.
    Viet Olympiad in Garden Grove, California, staged 
performances of Cai Luong classical Vietnamese musical theater. 
Cai Luong expresses the deepest feelings of both old and young 
in the Vietnamese community, creating intergenerational 
connections with shared emotions of anger, pain, love, 
laughter, and sadness.
    VSA arts of Georgia, Inc. in Atlanta, Georgia, expanded its 
theatrical sign language interpreting program. The program 
offers discounted services to small and mid-sized theater 
companies in Georgia and professional development opportunities 
for current and new theatrical interpreters.
    Washington Theatre Awards Society in Washington, DC, 
received a grant to support the Washington Audience Development 
Initiative, a multimedia promotional campaign to identify and 
develop new audiences for all Washington theaters. The 
initiative will work toward developing theater audiences in 
metropolitan Washington that are representative of area 
demographics.
    Weston Playhouse Theatre in Weston, Vermont, received 
funding to expand the theater's education and outreach programs 
for intergenerational, rural, underserved audiences. An audio-
described production of Chicago was staged with a pre-show 
tactile exhibit for all audiences, including individuals who 
are blind or partially sighted.
    Young at Heart Chorus, Inc. in Northampton, Massachusetts, 
was awarded funding for the revival of an original musical 
about the French revolution, Louis Lou. The Young At Heart 
Chorus, an ensemble comprised of older performers, will revive 
the musical from its repertory.

                              Visual Arts

    Art Resources Transfer, Inc. in New York, New York, 
received funding for its audience development program that 
offers free books, museum catalogues, videos and other material 
about contemporary art to libraries across the nation with a 
special emphasis on rural and inner-city libraries.
    Asian American Arts Centre, Inc., in New York, New York, 
received a grant to support an intergenerational public art 
project, Stories of Chinatown, in an underserved community. 
Organized in collaboration with Elders Share the Arts, the 
program will bring Chinatown's older adults together with high 
school youth to create artwork that will present the untold 
stories of this aging immigrant population in a permanent 
ceramic tile installation.
    COSACOSA art at large, Inc., in Philadelphia, Pennsylvania, 
was awarded funding for its Healing Art Project, a project that 
brings individuals in pediatric and adult hospitals, continuing 
care facilities, local community clinics and social service 
agencies together with Philadelphia community members to create 
collaborative public art. Over 600 intergenerational project 
participants receive instruction each year in workshops with 
professional artists. Each workshop series identifies a 
community theme to explore through one of many possible 
artistic disciplines, including painting, theater, quilt-making 
and ceramics. Pieces resulting from the Healing Art Project are 
on display in libraries, schools, and other public places 
throughout Philadelphia, as well as the Philadelphia 
International Airport.
    Creative Growth, Inc., in Oakland, California, organized a 
yearlong series of professional studio arts instruction for 
adults with disabilities, created gallery exhibitions and 
supported extensive outreach activities with a grant from the 
Endowment. Professional artists with experience working with 
people with disabilities taught classes in printmaking, 
drawing, painting and wood and clay sculpture.
    Pyramid Atlantic, Inc., in Riverdale, Maryland, received 
funding to support a residency program, educational outreach, 
teacher training and mentorships. The program, designed to 
explore various media, imagery and the notions of community, 
will be intergenerational and bilingual, uniting artists, 
scholars, teachers and youth.
    Watershed Center for the Ceramic Arts in Newcastle, Maine, 
expanded the services of MudMobile, a statewide traveling 
ceramics program in a van. The MudMobile serves older adults as 
well as children and people with cognitive and developmental 
disabilities throughout the state of Maine. Mudmobile takes 
clay art activities to nursing homes, assisted living sites, 
and community organizations that serve older Americans. This 
unique program helps over 300 seniors each year to improve 
flexibility and coordination, provides a new medium to tell 
their stories, and allows them to create artistic products that 
they could share with friends and family.

                        ITEM 22--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 participant's 
mailboxes for mail accumulation which might signal illness or 
injury. Letter carriers report mail accumulations to their 
supervisors, who then notify a sponsoring agency, through 
locally developed procedures, for follow-up action. The program 
completed its 20th year of operation in 2002 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 upon 
hardship or special needs. This policy accommodates the special 
needs of 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 delivery 
receptacles can be obtained from local postmasters.

               SERVICES AVAILABLE FROM YOUR RURAL CARRIER

    Rural carriers continue to provide their customers with 
retail services they have come to expect from the rural ``Post 
Office on wheels.'' Retail services provided included 
registered and certified mail, accepting parcels for mailing, 
and taking applications for money orders. Rural carriers also 
provide customers with receipts for such services.
    Retail services are available to all customers served by 
rural carriers but are most beneficial to those individuals who 
are elderly or have physical limitations that adversely impact 
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.

                        PARCEL DELIVERY POLICIES

    For postal customers who are unavailable to receive 
parcels, but who normally are at home, our letter carriers will 
automatically redeliver the article the following day. In 
addition, if the mailer requests, uninsured parcels are left at 
customers' homes or businesses provided there is reasonable 
protection from weather and theft. Both of these policies make 
it easier for customers, particularly the elderly, to receive 
mail and minimize the need for trips to the Post Office.

                             ACCESSIBILITY

    The Postal Service is subject to the Architectural Barriers 
Act of 1968. The resulting standards for the design, 
construction, and alteration of leased and owned facilities, 
are published in Postal Service Handbook RE-4, Standards for 
Facility Accessibility by the Physically Handicapped.
    Significant progress continues to be made to increase the 
accessibility of 36,000 Postal Service facilities. Our 
commitment to barrier-free facilities is apparent through the 
enhanced facility features (such as automatic doors and van-
accessible parking) that are part of our national building 
design standards and are over and above the RE-4 requirements. 
These benefit physically challenged and elderly customers.
    The Postal Service values its elderly customers and 
believes they will benefit from our efforts to make facilities 
more accessible.

          CONSUMER EDUCATION AND FRAUD PREVENTION INITIATIVES

    The Mail Fraud Statute is the oldest and most effective of 
the consumer protection laws, and the U.S. Postal Inspection 
Service if the federal law enforcement agency mandated by 
Congress to enforce it. Educating the public on fraud schemes 
that involve the mail is an essential component to fulfilling 
this responsibility.
    Mail fraud investigations focus on a variety of schemes 
conducted through the mail in an effort to ensure the integrity 
of the mail and to ensure the confidence of government 
agencies, businesses, and U.S. Postal Service customers. The 
U.S. Postal Inspection Service works to protect the American 
public from such schemes, in part by educating people about 
fraud trends that target various groups, including some of the 
most vulnerable citizens, the nation's elderly.
    Inspectors have initiated a number of fraud prevention 
projects and participated with consumer protection agencies and 
other groups to help citizens protect themselves before they 
become victims of fraud.

         NATIONAL FRAUD AGAINST SENIOR CITIZENS AWARENESS WEEK

    In 2002, the U.S. Senate passed a resolution designating 
the week of August 25, 2002, as ``National Fraud Against Senior 
Citizens Awareness Week.'' On August 26, 2002, the Chief Postal 
Inspector joined forces with Postmaster General John E. Potter, 
Federal Trade Commission Chairman Timothy Muris, Department of 
Justice Assistant Attorney General Michael Chertoff, and 
representatives of the Royal Canadian Mounted Police to 
announce the campaign kick off. Betty White, a well-know 
actress who fits the age range of the targeted group, signed on 
as spokesperson for the campaign and was featured with the 
Chief Postal Inspector on CBS's Early Show. A total of 51 press 
events were held in cities nationwide. Public Service 
Announcements featuring Betty White were broadcast on 
television and radio stations; and fraud awareness flyers were 
mailed to roughly 3 million households of seniors and their 
families.

                       OPERATION IDENTITY CRISIS

    The U.S. Postal Inspection Service, in conjunction with the 
U.S. Postal Service, the Federal Trade Commission, the U.S. 
Secret Service, and various other government agencies and 
private companies sponsored a national consumer awareness 
campaign in the month of September 2003: ``Operation: Identity 
Crisis.'' The campaign focused on identity theft.
    The campaign is intended to educate consumers on identity 
theft schemes and ways to protect themselves and provide 
prevention tips to businesses to help protect consumer data and 
ensure privacy. This crime affects all age groups, including 
older Americans.
    The national campaign included the following:
           Posters in Post Office lobbies across the 
        country.
           A national press conference in New York to 
        kick-off the initiative on September 16, 2003.
           Newspaper ads appearing in Sunday editions 
        on September 14 and daily papers on September 16 in 
        markets with the highest number of identity theft 
        complaints (AR, CA, FL, GA, IL, MI, NJ, NY, PA, and 
        TX).
           A three million-piece mailing to residents 
        in the above-listed states.
           The use of Jerry Orbach of television's Law 
        and Order as the national spokesman in public service 
        announcements, video messages, and a satellite media 
        tour.
           Internal and external messaging via several 
        Postal Service vehicles, such as Web sites, USPS-TV, 
        and Postal Link.
           The use of inserts in selected mailings.
           A new Inspection Service consumer video on 
        Identity Theft entitled ``Identity Crisis.''
           A revised U.S. Postal Inspection Service 
        Publication 280 on Identity Theft.

                             CONSUMER FRAUD

    We recognize that fraud is one crime that must rely upon 
the victim to participate, therefore it is one crime that can 
be reduced or prevented with education. Accordingly, the U.S. 
Inspection Service established an unprecedented Consumer Fraud 
Fund to augment its already ambitious fraud prevention 
programs. The fund was created with monies received from 
criminal fines and forfeitures where victims could not be 
identified. The fund was initiated with the sanction of the 
court and the United States Attorney's offices in two districts 
in Nebraska and Southern Illinois. Last year marked the first 
year for the deployment of a $15 million fund that over 3 years 
will support fraud investigations and projects.

                        CONSUMER EDUCATION FILMS

    The U.S. Postal Inspection Service plans to focus its 
consumer protection program over the next three years on 
developing a fraud prevention series of programs to educate the 
American public and to create consumer awareness on the various 
fraud schemes being perpetrated against the public, including 
many schemes aimed at the elderly population. Working with a 
production company, the Inspection Service will produce three 
one hour television programs and nine short training videos for 
use by the Inspection Service and other agencies for education 
and prevention. The first in the series of short training 
videos is now finished and is titled ``Identity Crisis''.

                   NATIONAL CONSUMER PROTECTION WEEK

    In 1999 and 2000, the U.S. Postal Inspection Service and 
the Postal Service Consumer Advocate's Office joined the AARP, 
Consumer Federation of America, Department of Justice, Federal 
Trade Commission, National Association of Consumer Agency 
Administrators and National Association of Attorneys General to 
launch National Consumer Protection Week (NCPW).
    From 2001 through 2003, the U.S. Postal Inspection Service 
partnered with the U.S. Postal Service's Consumer Advocate's 
office to sponsor seminars and publicity campaigns during 
National Consumer Protection Week (NCPW). Educating consumers 
about various types of mail fraud, including identity theft, 
was the focus of these events.
    In 2001, the NCPW theme was ``If it's too good to be true, 
it probably is.'' Approximately 66,000 mail fraud complaints 
were received by the U.S. Postal Inspection Service during 
fiscal year 2001. An educational video news release was 
produced about in Internet scam that victimized an Ohio 
teenager when he failed to perceive an item he had ordered on-
line and paid for through the mail. Technological advances have 
provided new avenues for scams that were once perpetuated 
solely through the use of the U.S. mail.
    The NCPW theme for 2002 was ``Deceptive Mailings--Don't Be 
Duped.'' Over 84,000 mail fraud complaints were received by the 
U.S. Postal Inspection Service in fiscal year 2002. An 
education video news release was issued featuring Senators 
Susan Collins (R-ME) and Carl Levin (D-MI) speaking on the 
Deceptive Mail Prevention and Enforcement Act. The Act imposed 
various requirements on sweepstakes mailings, skill contests, 
facsimile checks, and mailings made to look like government 
documents; including requiring more clear and conspicuous 
disclosures displayed in a manner that is readily noticeable, 
readable, and understandable.
    In February 2003, NCPW focused on Identity Theft. Identity 
theft is currently the fastest growing crime. Government 
sources and privacy advocates estimate there will be over 1 
million victims of identity theft this year. Many victims don't 
realize their identity has been stolen until an average of 18 
months has passed. Also, jurisdictional issues often become a 
hindrance to the reporting of identity theft. Press events 
included providing prevention tips to postal customers on 
various steps they can take to help protect themselves from 
becoming a victim, and how to report identity theft.

                           DECEPTIVE MAILINGS

    Postal Inspectors worked closely with the Senate Permanent 
Subcommittee on Investigations regarding sweepstakes and 
deceptive mailings legislation. As a result, the Deceptive Mail 
Prevention and Enforcement Act was passed and signed into law 
on December 12, 1999. The new law protects consumers, 
especially seniors, against deceptive mailings and sweepstakes 
practices by:
           establishing standards for sweepstakes 
        mailings, skill contests and facsimile checks,
           restricting government look-alike documents, 
        and
           creating a uniform notification system 
        allowing individuals to remove their names and 
        addresses from all major sweepstakes mailing list at 
        one time.
    Additionally, disclosures will make sure that no purchase 
is necessary to enter a sweepstakes and that a purchase will 
not improve consumers' chances of winning a prize. The law also 
creates strong financial penalties for companies that do not 
disclose all terms and conditions of a contest.
    To make the most effective use of the new statute and 
protect consumers, the Inspection Service established a 
Deceptive Mail Enforcement Team, composed of Postal Inspectors, 
Inspector Attorneys and Inspection Service fraud analysts. The 
team reviews complaints related to promotional mailings to 
assess their compliance with the Act.
    Postal Inspectors have been encouraged by the finding that 
many promoters have modified their practices to comply with the 
law by providing notifications and clearer explanations for 
customers. Further, the U.S. Postal Service has noted a sharp 
decline in the number of sweepstakes mailings, as companies 
adopt new marketing strategies in response to the law. The 
following is an example of an action taken against a promoter 
of deceptive mailings this year.
    Boston Division Postal Inspectors filed a Consent Decree in 
New York to prohibit a businessman from making false or 
misleading representations in his mail order business. The man 
solicited consumers considered poor credit risks, offering an 
unsecured credit card with a $4,000 to $7,500 credit limit. 
Consumers believed they were calling a location in the United 
States, but Postal Inspectors determined the operation was 
actually in Quebec, Canada. Inspectors filed a Temporary 
Restraining Order (TRO) in October 2002, preventing the man 
from doing further business and freezing the company's assets. 
He was further restrained from selling or transferring any 
lists of consumers who had responded to his offer and from 
using any medium to solicit for credit cards. Approximately 
$500,000 was frozen by the court via the TRO and will be used 
to issue refunds to victims.

        ADMINISTRATIVE ACTIONS RELATED TO MAIL FRAUD SWEEPSTAKES

    In addition to criminal prosecution, Postal Inspectors 
frequently rely on civil or administrative actions to deter 
mail fraud. Below is a list of actions taken this year to help 
stem losses from various fraud schemes.
    A Withholding Mail Order (Title 39, USC 3003) enables the 
U.S. Postal Service to withhold an addresses' mail if they are 
using a false or assumed name, title or address to conduct or 
assist with activity that violates 18 USC 1302 (lottery), 1341 
(mail fraud) or 1342 (use of a fictitious name or address), 
until proper identification is provided and the person's right 
to receive the mail is established. Under 39 USC 3004, the 
Postal Service may withhold mail if the address is not a 
person's residence or business address, allowing them to remain 
anonymous. An example of a U.S. Postal Inspection Service 
Withholding Mail Order related to a 2003 administrative action 
follows:
    A Cease and Desist Order was issued on January 6 halting a 
scheme in which postal customers nationwide were solicited and 
offered a report advising of entry procedures for sweepstakes 
offering millions of dollars in possible winnings. The 
solicitation led customers to believe they were participating 
in a contest rather than purchasing a report about contests. 
The requested fee of $39.95 was to be mailed to an address in 
St. Louis, Missouri, which was actually a United Parcel Service 
store that forwarded the mail to Vancouver, Canada. The 
investigation revealed that, between March 2001 and February 
2002, approximately 58,000 mail pieces were forwarded to 
Canada. No contest reports were supplied to fee-paying 
customers.

                    FRAUDULENT FOREIGN LOTTERY MAIL

    False Representation Orders (FROs) enable Postal Inspectors 
to stop mailed-in responses to schemes (most of which contain 
checks) from leaving the United States and return mail to the 
senders, thereby preventing victim losses.
    To further combat illegal foreign lotteries, Postal 
Inspectors work with U.S. Customs Service officials to stop 
such offerings from entering the U.S. mail stream, and Customs 
agents contact Inspectors when they find such mail during 
border searches. Inspectors detain the mail and provide samples 
to the Postal Service's Law Department to determine if they 
meet mailing standards. If the pieces are considered 
nonmailable, the mailer is notified that the material is 
subject to destruction and may appeal the notice. If the mailer 
fails to appeal or loses the appeal, the detained mail is 
destroyed upon the issuance of a Destruction Order.
    Lottery promotions that promise large winnings for little 
effort target consumers and are often aimed at senior citizens 
who are most vulnerable to such scams. In one case, a major 
international lottery promoter was sentenced in Seattle to six 
months in prison, three years' probation and ordered to forfeit 
$12 million. Inspectors seized his assets for restitution to 
the victims and in partial satisfaction of a prior consent 
agreement.

                          TELEMARKETING FRAUD

    Americans receive thousands of unsolicited phone calls from 
telemarketers each year trying to sell a variety of products, 
with older citizens often the target. Many offers are 
legitimate, but unscrupulous telemarketers can be the smoothest 
of operators, successfully swindling people out of millions of 
dollars. Indeed, those on fixed incomes who fall prey to these 
schemes can lose their entire life savings. Telemarketing fraud 
robs Americans of billions of dollars annually.
    As a result of a multi-agency task force ``Project Colt,'' 
a United States and Canadian joint law enforcement effort to 
curb cross-border telemarketing fraud, on March 26, in the 
District of Massachusetts, a Quebec citizen was sentenced to 10 
years' imprisonment, three years' probation and ordered to pay 
over $1.2 million in restitution. The man was charged with 
directing the operation of a fraudulent telemarketing scheme in 
Montreal that victimized American citizens; largely elderly. 
The scheme involved telemarketers posing as attorneys or 
government officials claiming to have recovered money for 
persons victimized by previous lottery prize schemes. Victims 
were required to mail purported taxes and/or fees in advance to 
have the money released, which they never received. The 
defendant was also sentenced to two years and three months in 
prison in Florida for using his scheme to victimize a Florida 
resident.

                STAMPS BY AUTOMATED TELLER MACHINE (ATM)

    Stamps by ATM is a convenient way to purchase stamps at a 
bank's automated teller machine. There are currently over 
18,000 ATMs nationwide that dispense stamps. Because many ATMs 
are accessible 24 hours a day, our customers are able to do 
banking and buy postage stamps at their convenience. A 
specially designed sheetlet of 18 First-Class stamps is 
dispensed at the touch of a button. Financial institutions may 
add a surcharge to the face value of the stamps to cover their 
processing costs. The cost is debited from the customer's 
checking or savings account and treated like a cash withdrawal.

                             STAMPS BY MAIL

    Stamps by Mail is a service that allows customers to 
purchase stamps in booklets, sheets and coils along with other 
products such as post 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. Once the form is completed it can be 
returned to the carrier or dropped 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 convenient 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 MasterCard) to 
avoid trips to the Post Office. Customers utilizing this 
service can call a toll-free number (1-800-STAMPS-24), 24 hours 
a day, 7 days a week, and order from a menu of postal products. 
There is no minimum purchase amount and customers receive their 
orders within 3 to 5 business days.

                     ALTERNATE POSTAL RELIEF SITES

    Alternate postal retail sites including grocery stores and 
other retail stores that offer stamps for sale through a 
consignment agreement, and contract postal units that offer a 
wider variety of services. Stamps offered through consignment 
agreements are sold at no more than face value at retailer 
checkstands. Contract postal units provide more convenient 
locations for our customers to mail packages, purchase stamps 
and postal money orders, send registered mail, and obtain 
postal services.
    In 1998, the U.S. Postal Service began testing a 
partnership with Mail Boxes Etc. (MBE) to sell stamps and 
postal services at 250 MBE locations throughout the United 
States. In 2000, the test partnership expanded to 700 MBE 
locations. By providing services at numerous alternate 
locations, the U.S. Postal Service provides greater access and 
flexibility for all customers to obtain stamps and other postal 
services, which generally means less wait time to obtain these 
retail services. This enables customers to combine their 
mailing needs and other errands into a single trip to the 
neighborhood shopping center or grocery store, This is 
especially convenient for our elderly customers who may have 
limited access to transportation.

                     STAMPS VIA THE WORLD WIDE WEB

    On November 8, 2000, the U.S. Postal Service launched the 
new Postal Store, an online retail channel. Accessed through 
our homepage, www.usps.com. The Postal Store offers USPS 
customers an alternative channel for buying stamps and stamp 
products without having to visit a physical retail outlet. With 
just a click of their mouse, customers can browse through 
``aisles'' displaying a variety of stamps, stationery, Pro-
Cycling gear and phone cards. To provide ease of use, stamps 
and other products are organized and displayed according to 
categories and/or stamp release dates. As an added convenience, 
credit cards are processed and validated at the time orders was 
placed. Security is enhanced through the application of the 
Address Verification System, which verifies a customer's 
billing address through their credit card company. State-of-
the-art order processing and automated fulfillment equipment 
systems ensure the efficient delivery of orders within 3-5 
days.
    This convenient, secure, and easy-to-use web site 
especially benefits customers who, because of special needs, 
prefer to purchase postal and non-postal products from the 
comfort of their homes.

                    STAMPS HIGHLIGHTING AGING ISSUES

    On September 7, 2000, the U.S. Postal Service honored the 
memory and work of former U.S. Senator Claude D. Pepper of 
Florida by issuing a commemorative stamp bearing his image. The 
stamp, which is part of the Postal Service's Distinguished 
Americans stamp series, helped celebrate the life of a man who 
was known as a champion for the rights of Senior Citizens in 
his home state of Florida and across the country.

                   ITEM 23--RAILROAD RETIREMENT BOARD

                              ----------                              


          ANNUAL REPORT ON PROGRAM ACTIVITIES FOR THE ELDERLY

    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. Beginning in 2002, such annuities 
are also payable to workers with five years of service if 
performed after 1995. Full age annuities are payable at age 60 
to workers with 30 years of service. For those with less than 
30 years of service, reduced annuities are payable at age 62 
and unreduced annuities are payable at full retirement age, 
which is gradually rising from 65 to 67, depending on the year 
of birth. 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 widow(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 2002, retirement and survivor benefit 
payments under the Railroad Retirement Act amounted to $8.6 
billion, $232 million more than the prior year. The number of 
beneficiaries on the retirement-survivor rolls on September 30, 
2002, totaled 635,900. The majority (83 percent) were age 65 or 
older.
    At the end of the fiscal year, 297,700 retired employees 
were being paid regular annuities averaging $1,531 a month. Of 
these retirees, 132,100 were also being paid supplemental 
railroad retirement annuities averaging $42 a month. In 
addition, some 151,000 spouses and divorced spouses of retired 
employees were receiving monthly spouse benefits averaging $579 
and, of the 194,900 survivors on the rolls, nearly 160,500 were 
aged widow(er)s receiving monthly survivor benefits averaging 
$948. About 7,700 retired employees were also receiving spouse 
or survivor benefits based on their spouse's railroad service.
    Nearly 578,700 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 2002. Of these, 
563,800 (97 percent) were also enrolled for supplementary 
medical insurance.
    Gross unemployment and sickness benefits paid under the 
Railroad Unemployment Insurance Act totaled $137.4 million 
during fiscal year 2002, while net benefits totaled $98.6 
million after adjustments for recoveries of benefit payments, 
some of which were made in prior years. Total gross and net 
payments increased by approximately $9.9 million and $3.8 
million, respectively, from fiscal year 2001. Unemployment and 
sickness benefits were paid to 39,500 railroad employees during 
the fiscal year. However, only about $0.4 million (less than 1 
percent) of the benefits went to individuals age 65 or older.

                               FINANCING

    The Board's 22nd triennial actuarial valuation, submitted 
to Congress in June 2003, was generally favorable. The 
valuation concluded that, barring a sudden, unanticipated, 
large drop in railroad employment, or substantial investment 
losses, the railroad retirement system will experience no cash 
flow problems during the next 19 years. The long-term stability 
of the system, however, is not assured. Under the current 
financing structure, actual levels of railroad employment and 
investment return over the coming years will determine whether 
corrective action is necessary.
    The Board's 2003 railroad unemployment insurance financial 
report was also generally favorable, indicating that even as 
maximum benefit rates increase 44 percent from $52 to $75 from 
2002 to 2013, experience-based contribution rates are expected 
to maintain solvency. No new loans are anticipated even under 
the most pessimistic assumption. The report also predicted 
average employer contribution rates well below the maximum 
throughout the projection period, but there may be a periodic 
resumption of the surcharge required to maintain a minimum 
account balance.
    No increases in the tax rates provided under current law 
were recommended by the Board for the railroad retirement or 
unemployment insurance systems.

                              LEGISLATION

    The Board successfully completed implementation of the 
Railroad Retirement and Survivors' Improvement Act of 2001. The 
Act, based on joint recommendations negotiated by a coalition 
of rail labor organizations and rail freight carriers, was the 
most significant railroad retirement legislation in almost 20 
years and the first in almost three decades not to involve tax 
increases or benefit reductions.
    The legislation, signed into law December 21, 2001, 
liberalized early retirement benefits for 30-year employees and 
their spouses, eliminated a cap on monthly retirement and 
disability benefits, lowered the minimum service requirement 
from 10 years to 5-9 years, if at least 5 years were after 
1995, and provided increased benefits for some widow(er)s. 
Financing sections in the law provided for adjustments in the 
payroll tax rates paid by employers and employees, and the 
repeal of a supplemental annuity work-hour tax.
    The legislation also provided for the transfer of railroad 
retirement trust funds from the Railroad Retirement Accounts in 
the U.S. Treasury to a new National Railroad Retirement 
Investment Trust, whose Board of seven Trustees is empowered to 
invest Trust assets in nongovernmental assets, such as equities 
and debt, as well as in governmental securities. During 2002, 
Trustees and staff were appointed and the Trust officially 
began operations.
    For the Board, implementation of the Act included, among 
other things, significant changes to over 30 mainframe and PC-
based computer systems, the development of new automated mass 
benefit adjustment operations, and the release of over 255,000 
letters. Benefit increases were awarded to over 46,000 
widow(er)s and nearly 14,000 employees and spouses.

                               OFFICIALS

    On May 23, 2003, the Senate confirmed President Bush's 
appointment of Michael S. Schwartz as Chairman of the U.S. 
Railroad Retirement Board for a term expiring in August 2007. A 
long-time official with the State of Illinois, Mr. Schwartz 
previously served as the Director of the Illinois Department of 
Central Management Services which provides procurement, data 
processing and communication, personnel, property management, 
and administration of State employee benefit plans to State and 
local government agencies.
    V. M. Speakman, Jr. continues to serve as Labor Member of 
the Board. He was first appointed to the Board in 1992, 
reappointed to a second term of office in 1995, and then to a 
third term in 2000. Mr. Speakman previously served as President 
of the Brotherhood of Railroad Signalmen.
    Jerome F. Kever continues to serve as Management Member of 
the Board. He was first appointed to the Board in 1992, 
reappointed to a second term of office in 1995, and to a third 
term in 2000. Before his appointment, Mr. Kever was Vice 
President and Corporate Controller of the former Santa Fe 
Southern Pacific Corporation.

                      SERVICE QUALITY MEASUREMENTS

    Customer Satisfaction Survey.--In 2001, the Board 
participated for the first time in the American Customer 
Satisfaction Index, which surveys national customer 
satisfaction with corporate and government goods and services. 
Federal agencies use this survey to gauge their level of 
service and benchmark their performance for comparison with 
similar organizations in the private sector. In a 2001 survey 
focused on the Board's core constituency of recently retired 
rail workers awarded annuities, the Board earned a score of 82, 
which was 13 points higher than the overall Federal Government 
score and 11 points higher than the comparable private sector 
average. In a 2002 survey focused on railroad workers claiming 
railroad unemployment or sickness benefits, the Board earned a 
score of 75, which was 4.8 points higher than the overall 
Federal Government score and 3.2 points higher than the 
comparable private sector average.
    Web Site Survey.--The quality of the Board's Internet 
service was documented in a San Francisco State University 
survey that ranked the agency's Web site 12th out of 148 
Federal government Web sites studied for excellence, as defined 
by the quality of their site services, help features, 
navigation, legitimacy, and accessibility. The Board earned a 
total excellence score of 26, out of a possible 55, only 5 
points below the highest score of 31. The survey studied 
Federal Web sites between January and April of 2002, as part of 
broader research that analyzes government Web sites in 
comparison to other public-sector sites, attempting to improve 
the quality and the services provided to users through 
government Web sites.
    Through the Board's Web site at www.rrb.gov, anyone with 
Internet access can electronically download selected pamphlets, 
informational releases, financial reports, and other 
information on the agency's benefit programs and operations. 
During 2002, the Web site was enhanced to allow rail employees 
to view their service records online through a secure PIN 
password system.

                      OFFICE OF INSPECTOR GENERAL

    During fiscal year 2002, the Board's Office of Inspector 
General continued its efforts to ensure the integrity of agency 
programs, to combat fraud, waste and abuse and to ensure the 
agency provides the highest level of service to its 
constituents. Thirteen audit and management information reports 
issued during the year provided agency managers with 
recommendations for improvement in program operations.
    Investigative activities resulted in 53 criminal 
convictions, 37 indictments and informations, 36 civil 
judgments and $3,230,000 in recoveries, restitutions, fines, 
civil damages, penalties and prevention of overpayments.

                     PUBLIC INFORMATION ACTIVITIES

    The Board maintains direct contact with railroad retirement 
beneficiaries through its 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 sponsored by the Labor Member 
of the Board 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. A total of 2,526 
railroad labor union officials attended 47 informational 
conferences held in cities throughout the United States during 
2002. In addition, railroad labor unions frequently request 
that Board representatives speak before their meetings, 
seminars and conventions. In 2002, the Labor Member's Office 
was represented at 10 union gatherings attended by 3,229 
railroad labor officials. Field personnel addressed 163 local 
union meetings with 11,295 members in attendance.
    At seminars for railroad executives and managers, Board 
representatives review programs, financing, and administration, 
with special emphasis on those areas which require cooperation 
between railroad and Board offices. During 2002, the Board's 
Management Member's Office conducted seven seminars for 
railroad officials. It also conducted pre-retirement counseling 
seminars attended by railroad employees and their spouses, and 
benefit update presentations.
    The Board continued its Face-to-Face initiative, an effort 
to engage customers in an ongoing dialogue about improving the 
agency's customer service.
    The Board's headquarters is located at 844 North Rush 
Street, Chicago, Illinois 60611-2092, phone (312) 751-4500; the 
agency's Web site is www.rrb.gov. 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 25--DEPARTMENT OF VETERANS AFFAIRS

                              ----------                              


                            I. INTRODUCTION

    The Department of Veterans Affairs (VA) has the potential 
responsibility for a beneficiary population of over 25 million 
veterans. The median age of veterans is approximately 59 years 
old compared to a median age of approximately 36 years old for 
the general U.S. population. About 38 percent (or more than 9 
million) of the veteran population is age 65 and older. By the 
year 2005, about 4.9 million veterans will be 75 years or 
older. As of September 30, 2002, over 6 million veterans were 
enrolled in VA for health care. Of these, 2.3 million (47.3 
percent) were 65 and 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, as well as the need 
for long-term care services, 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, non-institutional, and community 
settings to ensure that the medical, psychiatric and 
socioeconomic needs of the patient are met. Special projects, a 
variety of innovative, medically-proven programs and individual 
VA facility 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 163 hospitals, 135 nursing home care units, 43 
domiciliaries, 75 home care programs and over 800 outpatient 
clinics. VA also contracts for care in non-VA hospitals, 
community nursing homes, adult day health care centers, and 
provides fee-for-service visits by non-VA home health care 
providers. In addition, VA supports care in the State Veterans 
Home Per Diem Grant Program for 114 programs that include: 
hospitals, nursing homes, domiciliaries and an adult day 
healthcare center in 46 States and Puerto Rico in FY 2002. 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 associated health schools. 
This affiliation program with academic health centers results 
in approximately 91,000 health professions students receiving 
education and training in VA Medical Centers each year.
    In addition to VA hospital, nursing home and domiciliary 
care programs, VA is increasing the number and diversity of 
non-institutional extended care programs. The dual purpose is 
to facilitate independent living and to keep the patient in a 
community setting by making available the appropriate 
supportive medical and health care services. These programs 
include Home-Based Primary Care (HBPC), Community Home Health 
Care (CHHC), Community Residential Care (CRC), Adult Day Health 
Care (ADHC), Psychiatric Day Treatment and Mental Hygiene 
Clinics, Geriatric Clinics, Homemaker/Home Health Aide (H/HHA) 
Services, and Hospice/Palliative Care.
    The Veterans Millennium Healthcare and Benefits Act, Public 
Law 106-117, November 1999, mandated nursing home care for 
veterans 70 percent service-connected and above and for 
veterans needing nursing home care for a service-connected 
disability. The Act also expanded veterans' access to a 
continuum of geriatric and extended care, including home and 
community based services, and provided authority for VA to 
conduct one Assisted Living (AL) Pilot Demonstration and three 
pilot demonstrations comparing different models of All-
Inclusive Care (AIC) for the Elderly. In December 2000, the 
pilot sites for these 3-year demonstrations were selected after 
competitive review. The AIC sites began enrolling veterans in 
July 2001 and the AL pilot began enrollment in January 2002.
    The need for both acute hospitalization and chronic care 
management 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. VA continues efforts to improve the outcomes of care 
for elderly patients with complex problems by supporting 
Geriatric Research, Education and Clinical Centers (GRECCs) and 
specialized clinical services such as Geriatric Evaluation and 
Management (GEM), Geriatric Primary Care, and programs for 
patients with Alzheimer's disease.

                   II. VETERANS HEALTH ADMINISTRATION

                   A. Office of Patient Care Services

    The Office of Patient Care Services comprises thirteen 
strategic healthcare groups. Each of these functional groups 
has contributed significantly to VA's efforts on behalf of 
older veterans.
Primary and Ambulatory Care Strategic Healthcare Group (SHG)
    The Primary and Ambulatory Care SHG and the Geriatrics and 
Extended Care SHG continue to maximize collaboration in 
transforming the veterans health care system from a bed-based, 
hospital inpatient system to one rooted in outpatient service 
delivery, including delivery of healthcare in the home setting 
through a combination of telecommunications and direct contact. 
The Primary and Ambulatory Care SHG has continued to focus 
efforts on truly delivering primary care to all veterans 
choosing to access VHA for their healthcare. Issues of 
productivity, panel identification, panel management, 
healthcare access and healthcare quality remain in the 
forefront of efforts. The duality of geriatrics practice, 
functioning as primary clinician for some elderly veterans and 
consultant clinician for others, and the challenges of properly 
identifying the relationship of provider and patient in a given 
interaction due to ramifications for continuity, access, 
quality, and billing among others was a key area that was 
clarified during 2002. Excellent publications, including those 
from the Institute of Medicine, point out the distinct 
advantages to the patient and to a healthcare system when 
healthcare is provided through primary care. Continuity with 
the same primary clinician and supporting team regardless of 
the physical location in which the veteran finds him or 
herself, access to the clinician and team, coordination of 
service delivery across loci and specialties, and provision of 
comprehensive health services remain extremely important 
parameters of primary care. Given the geographic dispersion of 
elderly veterans, as well as the economic and supply factors 
preventing any healthcare system in the United States placing 
geriatric specialty teams in every small town, both the Primary 
Care and Geriatric SHGs have provided models and training 
designed to increase the knowledge and awareness base of 
smaller practices, often located in Community Based Outpatient 
Clinics (CBOCs), as well as to improve the communication speed 
and quality between primary clinicians at any location and 
geriatric specialists supporting them. Work was underway in 
2002 to develop a model of primary care which incorporated a 
geriatrician in dual role of consultant and primary into a 
general medicine primary care practice.
    The Integrated Ambulatory Care Conference was not held in 
2002 due to travel budget restraints. In prior years, this 
conference provided a national forum, attended by over 500 
healthcare managers and providers at many levels and from many 
professions, in which health care models, field experiments and 
innovations enhancing access, quality, and productivity were 
examined and refined. In addition, the meeting furthered 
interaction and integration of service delivery by focusing on 
patient needs rather than program needs. In lieu of separate 
meetings by Women's Health, Mental Health, Geriatrics, Primary 
Care, and Prevention among others, all of these program offices 
designed a cooperative and collegial environment where stove 
piping of services was systematically dismantled. This effort 
recognized that veterans are not static, do not have a single 
diagnosis, and that the young veteran with mental health issues 
today also today has a need for preventive and medical services 
(and increasingly may be female), and may very well live to be 
considered geriatric.

              Acute Care Strategic Healthcare Group (SHG)

    The Acute Care Strategic Health Care Group (ACSHG) serves 
the elderly veteran in a variety of ways. In FY 2001, 54 
percent of the patients on inpatient medical services and 47 
percent on inpatient surgical services were over 65. This age 
group accounted for 58 percent of Intensive Care Unit (ICU) 
days and 50 percent of Outpatient Care (OPC) surgery. The ACSHG 
continues to serve as the primary source of physicians trained 
in medical specialities for the care of all veterans, including 
the elderly. Elderly patients tend to have move complex medical 
problems and require more frequent hospitalizations than other 
age groups. It is necessary that acute care services continue 
to be available and adequately staffed to meet these demands. 
This is particularly true in medical specialty areas such as 
cardiology, pulmonology, endocrinology, rheumatology, oncology 
and the surgical specialty areas of urology, cardiothoracic, 
vascular, and orthopedic surgery. Primary Care physicians on a 
general medicine ward can handle most medical problems 
afflicting the geriatric patient; however, there is also a need 
for areas such as Geriatric Medicine within the acute hospital 
setting to provide the specialized care needed by the complex 
geriatric patient. These Geriatric Medicine Sections not only 
emphasize clinical care, but also coordinate research and 
education efforts related to geriatrics. The integration of 
Primary Care within Acute and Ambulatory Care will facilitate a 
smoother transition for the elderly patient from outpatient to 
inpatient care as the need arises.

                Geriatric Primary Care Education Program

    The Employee Education System, Northport Center, sponsored 
a national conference for the purpose of providing an 
integrated Geriatric Primary Care Education Program that would 
allow each VHA Network to develop and implement a Geriatric 
Primary Care model. The emphasis was on continuity of care, 
care management, and assessment/triage, based on an 
interdisciplinary approach. The conference also provided a 
forum for discussion of a variety of successful VA and non-VA 
Geriatric Primary Care models of care.
    Conference participants included a multidisciplinary team 
composed of a geriatrician and various primary care providers 
(physician, physician assistant, nurse practitioner, clinical 
nurse specialist and social worker) from each Network. In 
addition, the Northport Center purchased Geriatric Assessment 
Pocket Guides developed by the Sepulveda VA GRECC and Geriatric 
Pocket Pals, a reference guide developed by VA, for all 
conference participants and for each VA facility.
    The Employee Education System, Northport Center, will 
continue to coordinate the activities of VHA's National Primary 
and Ambulatory Care Education. The Northport Center, in 
collaboration with Primary and Ambulatory Care, Geriatrics and 
Extended Care and Mental Health, is planning to present a 
Strategic Integration Conference in 2003.

                               Dentistry

    Oral/dental care for the geriatric patient involves the 
prevention of oral disease, the restoration of the dentition 
and the elimination of pain and suffering attributable to oral 
disease. Microorganisms originating in the mouth have been 
identified as potentially causative agents for life-threatening 
infections of the heart, brain, lung, kidney, spine, and 
joints. A growing body of evidence, much of it derived from 
longitudinal studies at VA facilities, suggests associations 
between chronic periodontal disease and cardiovascular disease 
and diabetes.
    Oral cancer is a disabling, disfiguring and potentially 
fatal disease that primarily affects middle-aged and older 
adults. Tobacco and alcohol are important risk factors in the 
development of this disease, and incidence rates increase 
steadily with age. In the United States, the five-year survival 
rate for oral and pharyngeal cancer is approximately 50 
percent. Through a long-standing program of oral screening 
examinations, VA dentists have been able to expeditiously 
detect incipient oral cancers in veterans. Such interventions 
minimize mortality rates and the need for ablative surgery, 
which often results in severe disfigurement and functional 
difficulties in eating, speaking, and swallowing.
    Mastication of a variety of foods is important for daily 
maintenance of caloric and nutritive intake, as well as for 
support of convalescence after surgery, chemotherapy, or other 
significant health care interventions. Elimination of the 
causes of oral pain and replacement of missing oral structures 
work to enhance the amount and diversity of foods that can be 
eaten. Interpersonal skills are enhanced by preserving or 
properly restoring teeth in order to maintain clarity of speech 
and facial contour. A comfortable, functional and esthetic 
dentition contributes substantially to quality of life.
    Destruction of tissues due to dental caries and the 
periodontal diseases are chronic and, in the elderly, usually 
asymptomatic. For this reason, public and private health care 
payers may perceive oral health care directed at dental and 
periodontal diseases as a low priority or even a luxury. In 
older patients, dental and periodontal diseases are often 
aggravated by coexistent medical problems; the oral disease in 
turn contributes to systemic illness, and in this way drives up 
health care costs. The relatively minor expense associated with 
preventive dentistry thus represents a net savings in overall 
health costs. Preventive modalities include the use of home-
applied fluoride solutions, anti-microbial mouth rinses, 
specially fabricated toothbrushes, instruction to patients, 
family or caregivers on oral hygiene techniques, and more 
frequent dental examinations.
    Many VA facilities have a Geriatric Evaluation and 
Management (GEM) Program. The goals for all disciplines 
involved in GEM--to maximize function and to foster 
independence--are reflected in dentistry's goals for elderly 
veterans.
    Patients are rehabilitated more rapidly with properly 
staged and coordinated care. To that end, dental services 
contribute to the interdisciplinary team effort by conducting 
admission oral assessments, collaborating on treatment 
planning, providing specialty consultations and necessary care, 
and preparing summaries of oral care protocols to be maintained 
after discharge. The VA Program Guide, ``Oral Health Guidelines 
for Long-Term Care Patients,'' developed by the Offices of 
Patient Care Services, the Office of Dentistry, and the Office 
of Geriatrics and Extended Care, continues to serve as the 
primary handbook for management of the geriatric oral health 
efforts. It describes the goals and strategies for 
implementation and monitoring of oral care provision for 
patients in VA long-term care programs.
    VA dentistry is an undisputed leader in geriatric oral 
healthcare training. VA-trained geriatric dentists have 
appointments on a majority of the dental school faculties in 
the United States. More than one fourth of all hospital-based 
general dentistry post-graduate education takes place in VA 
medical centers, where the residents devote much of their 
educational efforts to the clinical management of older 
veterans. GEMs and VA nursing homes provide resident training 
sites that are rich with experience in treating the most 
complex of older patients.
    The impact of VA programs in geriatric dentistry is not 
limited to VA's health care system, but extends to a broader 
level. VA dentistry is represented on National Institute of 
Dental Research reviews, a U.S. Surgeon General's workshop on 
oral health promotion and disease prevention, the development 
of the first Surgeon General's Report on Oral Health, and on 
review panels for programs in medical and dental geriatric 
education funded by the Department of Health and Human 
Services, Health Resources and Services Administration.
    VA dentists are and have been long involved at the highest 
levels of leadership in the professional organizations most 
heavily concerned with oral care issues for older adults 
(American Society for Geriatric Dentistry, American Association 
of Hospital Dentists, Federation of Special Care Organizations 
in Dentistry, American College of Prosthodontists, American 
Association for Dental Research, Gerontological Society of 
America). The American Dental Education Association (ADEA) 
developed guidelines for teaching concepts in gerontology and 
geriatrics to dental and dental hygiene students, and VA 
dentists have been noteworthy contributors to this process of 
defining geriatric educational objectives and identify source 
materials for dental faculty members.
    VA dentists have been leaders and active participants in 
recent projects involving health services and basic research 
relevant to the older adult. One investigator has developed 
measures to assess the relationship between oral health and 
overall quality of life in older patients. Longitudinal studies 
of older veterans in Massachusetts and Michigan have yielded a 
wealth of knowledge on the relationships between age, systemic 
disease, oral diseases, and diet. VA researchers have surveyed 
VA dental services to determine the effectiveness of smoking 
cessation interventions; others have investigated the education 
of both dental and non-dental health providers with respect to 
oral cancer risk factors and screening.
    Multicenter longitudinal clinical studies through VA have 
examined the efficacy of metal, ceramic, and ceramo-metal 
crowns. Another VA cooperative study has amassed the largest 
database in the world on the emerging alternative to 
toothlessness, osseointegrated implants, and the factors that 
predict their successful implementation. VA clinical studies on 
preventive strategies and materials in oral cancer patients 
have set the standards for management of such patients 
internationally. Finally, research, in collaboration with 
National Institute of Health, is ongoing to discover biological 
markers for the detection of oral cancer.
    In summary, VA dentistry and the Office of Dentistry 
continue to support efforts that will benefit older veterans in 
the three general areas that define the mission of the 
Department. First, the provision to elderly veterans of quality 
oral healthcare, of both preventive and restorative character, 
is recognized by and practiced within VA as an important and 
cost-effective component of total health maintenance. Second, 
education in geriatric oral health is critical on many levels, 
and will continue to be a VA focus directed at veterans; VA 
dental staff and residents; the dental profession and dental 
education communities; and non-dental providers such as nurses, 
physicians, and family members. Third, VA dental research has 
enhanced and will continue to broaden our understanding of oral 
disease, its relationship to general health, and its treatment 
in older adults.
Geriatrics and Extended Care Strategic Healthcare Group (SHG)
    Geriatrics and Extended Care has developed an extensive 
continuum of clinical services including specialized and 
primary care geriatric clinics, residential rehabilitation, 
community-based long-term care, nursing home care, and end of 
life care. The shared purposes of all geriatrics and extended 
care programs are to prevent or lessen the burden of disability 
on older, frail, chronically ill patients and their families/
caregivers, and to maximize each patient's functional 
independence and quality of life.
    The following is a description of VA's geriatrics and 
extended care programs and activities within each.

                          VA Nursing Home Care

    VA nursing home care units (NHCUs), which are based at VA 
facilities, provide skilled nursing care and related medical 
services. Patients in NHCUs may require shorter or longer 
periods of care and rehabilitation services to attain and/or 
maintain optimal functioning. An interdisciplinary approach to 
care is utilized in order to meet the multiple physical, 
social, psychological and spiritual needs of patients. In 
Fiscal Year 2002, more than 50,304 veterans were treated in 
VA's 137 NHCUs. The average daily census of veterans provided 
care in these units was 11,974.
    The system wide implementation of the Resident Assessment 
Instrument/Minimum Data Set (RAI/MDS) in VA NHCUs has been 
completed. (RAI/MDS) is a valid and reliable standardized 
multidisciplinary assessment database and treatment planning 
process. The RAI/MDS has been in use in community nursing homes 
since 1990 when it was mandated by the Center for Medicare and 
Medicaid Services (CMS), previously the Health Care Finance 
Administration (HCFA), as a provision of the Omnibus 
Reconciliation Act of 1987.
    Implementation triggers identification of problem areas 
that are highlighted to facilitate the development of 
individualized treatment plans. The interaction of the elements 
of the MDS also determines Resource Utilization Groups (RUGs). 
RUGs are used for identifying case mix and determining resource 
allocation to meet the needs of patients served. The RUGs can 
additionally serve as indicators of outcomes of care delivered. 
Finally, and perhaps, most importantly, the MDS will generate 
information regarding the quality of care patients receive. VA 
is providing NHCU leaders continuing education on enhancing the 
use of the RAI/MDS at the facility level.

                      Community Nursing Home Care

    This is a community-based contract program for veterans who 
require skilled 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 home 
care. Other veterans may be eligible for community placement at 
VA expense for a period not to exceed six months. Selection of 
nursing homes for VA contracts requires the prior assessment of 
participating facilities to ensure quality services are 
offered. Follow-up visits are made to veterans by staff from VA 
facilities to monitor patient programs and quality of care. In 
Fiscal Year 2002, more than 13,422 veterans were treated and 
the average daily census of veterans in these homes was 3,866.

                          VA Domiciliary Care

    Domiciliary care in VA facilities provides medical and 
other professional care for eligible 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-
oriented programs has provided a better quality of care and 
life for veterans who require prolonged domiciliary care and 
has prepared an increasing number 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 mentally and 
physically 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 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 2002, 26,550 veterans were treated in 43 VA 
domiciliaries resulting in an average daily census of 5,246. Of 
these numbers, nearly 5,000 veterans, were admitted to the 
domiciliaries for specialized care for homelessness.

                              State Homes

    The State Home Program has grown from 10 homes in 10 states 
in 1888, when the Federal government began providing assistance 
to States in care of veterans, to 114 state homes in 46 states 
and Puerto Rico in 2002. In 2002, a total of 26,448 state home 
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, nursing home or hospital 
care. 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 alteration of 
existing facilities, for domiciliary, nursing home, and adult 
day care. In fiscal year 2002, the average daily census of 
veteran patients in state homes was 3,772 for domiciliary care, 
15,909 for nursing home care, and 205 for hospital care.

                      Hospice and Palliative 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/palliative concept of care is 
incorporated into VA facility approaches to the care of 
veterans at the end of life. In FY 2001, VA took the lead in an 
innovative training model, establishing a pilot project for six 
VA facilities to establish interdisciplinary fellowship 
training programs in palliative care.

                     Home-Based Primary Care (HBPC)

    This program provides in-home comprehensive 
interdisciplinary care to veterans with complex, chronic 
illnesses. The family provides the necessary personal care 
under the coordinated support of a VA home-based 
interdisciplinary treatment team. The team prescribes the 
needed medical, nursing, social, rehabilitation, and dietetic 
regimens, and provides training to family members and the 
patient in supportive care.
    Seventy-eight VA medical centers are providing HBPC 
services. In fiscal year 2002, the average daily census was 
8,081 veterans receiving care in HBPC.

                      Adult Day Health Care (ADHC)

    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 17 ADHC centers in fiscal year 2002 with an average 
daily attendance of 417 patients. VA also continued a program 
of contracting for ADHC services in 83 medical centers. The 
average daily attendance in contract programs was 932 in fiscal 
year 2002.

                       Community Residential Care

    The Community Residential Care program provides residential 
care, including room, board, personal care, and general health 
care supervision to veterans who do not require hospital care 
but who, because of health conditions, are not able to resume 
independent living and have no suitable support system (e.g., 
family or 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, and is 
at the veteran's own expense. Veterans receive case management 
visits at least monthly from VA health care professionals. In 
fiscal year 2002, approximately 10,000 veterans were cared for 
in this program, utilizing nearly 2,000 homes.

                   Homemaker/Home Health Aide (H/HHA)

    VA provided H/HHA services for veterans needing nursing 
home care. These services are offered in the community by 
public and private agencies under a system of case management 
provided directly by VA staff. One hundred and eighteen VAMCs 
purchased H/HHA services in fiscal year 2002 with an average 
daily census of 4,180.

  Geriatric Evaluation and Management (GEM) and Geriatric Primary Care

    The (GEM) 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, an 
intermediate care unit of the hospital, or nursing home care 
unit, where an interdisciplinary health care team performs 
comprehensive, multidimensional evaluations on a targeted group 
of elderly patients who will most likely benefit from these 
services. 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 follow-up care for older 
patients to prevent their unnecessary institutionalization. GEM 
programs and Geriatric Primary Care clinics also provides 
geriatric training and research opportunities for physicians 
and other health care professionals in VA facilities. In 2002, 
there were 57 inpatient GEM Programs and more than 189,726 
visits to GEM and Geriatric Primary Care Clinics.

                              Respite Care

    Respite care is a program designed to provide the spouse or 
other caregiver temporary relief from the burdens of caring for 
a chronically disabled veteran at home. Public Law 106-117 
expanded the provision of respite services from VA hospitals or 
VA nursing homes to community nursing homes and non-
institutional settings including but not limited to services 
in-home. The long-range benefit of this program is that it 
supports the veteran's desire to delay or prevent nursing home 
placement. All VA facilities offer respite care. Respite care 
may be provided to eligible veterans for up to 30 days in a 
calendar year. The 30-day program limit includes the sum of 
respite specific resources and services received in the home, 
community nursing home, or other community-based or 
institutional settings in or outside the VA. A professional or 
team of professionals responsible for program management 
coordinates respite services.

                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 
Geriatrics and Extended Care SHG in VA Central Office. Veterans 
with these diagnoses participate in all aspects of the health 
care system.
    In fiscal year 2002, VA investigators were involved in 367 
funded research projects on Alzheimer's disease and other 
dementias. Funding was provided by VA as well as non-VA 
sources.
    In fiscal year 2002, VA provided a national training 
program called Advances in Home-Based Primary Care for End of 
Life in Advancing Dementia II (AHEAD II) to 20 competitively 
selected clinical teams from VA home and outpatient primary 
care settings in 13 Veterans Integrated Service Networks 
(VISNs). This six-month initiative included two in-person 
learning sessions plus ongoing collaboration through regular 
conference calls, a listserve and web site. The teams learned a 
rapid-cycle quality improvement process as well as information 
on dementia identification and diagnosis, symptom management, 
caregiver support, and staff education. This project built upon 
the AHEAD I training program, which began in fiscal year 2001 
with 20 VA Home-Based Primary Care teams.
    Also in fiscal year 2002, VA Upstate New York Healthcare 
Network (VISN 2) continued its data collection for ``Chronic 
Care Networks for Alzheimer's Disease'' (CCN/AD), a national 
demonstration project co-sponsored by the Alzheimer's 
Association and the National Chronic Care Consortium.
    In addition, the VA Central Office Geriatrics and Extended 
Care Strategic Healthcare Group and VA Medical Inspector's 
Office continued their Dementia Safety quality improvement 
project focused on issues of driving and gun safety in veterans 
with dementia. In fiscal year 2002, they pilot-tested a 
questionnaire and educational pamphlets for use in VA 
outpatient settings.

      Geriatric Research, Education, and Clinical Centers (GRECCs)

    GRECCs are designed to enhance VA's capability to develop 
state-of-the-art care for the elderly through research, 
training and education, and evaluation of alternative models of 
geriatric care. First established by VA in 1975, the GRECCs 
continue to serve an important role in further developing the 
capability of the VA healthcare system to provide cost-
effective and appropriate care to older veterans. In fiscal 
year 2002, there were 21 GRECCs in the VA system.
    In fiscal year 2002, GRECCs continued to make a number of 
contributions to the field of aging and care of the elderly. 
Some examples of these contributions are: coordination by the 
Durham GRECC of a randomized, controlled, multi-site trial of 
Geriatric Evaluation and Management (GEM) units and clinics, 
the results of which were published in the New England Journal 
of Medicine; a patent received by the Madison CRECC for 
standardized, radiopauge fluids that are used in video-
fluoroscopic evaluations of swallowing disorders; and mapping 
and cloning of a major melanoma skin cancer risk gene by the 
Salt Lake city GRECC. During fiscal year 2002, the VA 
Geriatrics and Gerontology Advisory Committee made site visits 
to Cleveland and to Pittsburgh, to evaluate the GRECCs that are 
hosted there. These site visits were made in accordance with 38 
U.S.C. Sections 7314 and 7315, requiring an evaluation within 3 
years of the date of establishment of a new GRECC. As a result, 
the Cleveland GRECC and the Pittsburgh GRECC were fully 
approved for continued funding.
Mental Health Strategic Healthcare Group (SHG)
    It is anticipated that the number of people older than 65 
years with psychiatric disorders in the United States will 
increase from about four million in 1970 to 15 million in 2030. 
In the year 2000 veterans age 65 or older numbered 9.6 million 
and are estimated to remain in the range of 8.7 to 9 million 
until the year 2020. Most of these will be veterans of WW II 
and the Korean conflict until approximately 2010, when aging 
Vietnam era and Gulf War veterans begin to augment that age 
group. By 2015, the latter two cohorts will account for the 
great majority of elderly veterans. Between 1999 and 2010 the 
number of veterans age 75 and over will remain stable between 
3.8 and 4.5 million. Although the reported prevalence of mental 
illness among the elderly varies, conservative estimates for 
those age 65 years or older include a minimum of 10 percent 
with dementia of any type, and an additional 15 to 30 percent 
with other psychiatric disorders. If a 30 percent estimated 
rate is used, it can be expected that over the next 20 years 
from 2.3 to 2.7 million veterans will need psychogeriatric 
care.\1\ Psychogeriatric services in VHA are integrated into a 
full service health care system that includes mental health and 
substance abuse treatment within the broader medical, surgical, 
and primary care environment and provides a continuum of care 
from hospital to home care settings. In FY 2002, while 48 
percent (2.1 million) of VA outpatients seen anywhere in VHA 
were 65 years or over and 26% (53,461) of VA patients with a 
diagnosis of psychosis were over the age of 65,\2\ only nine 
percent (188,708) of all VA outpatients were seen in specialty 
mental health clinics.\3\ Thus the majority of care for mental 
disorders in elder veterans is presumably performed in primary 
care or medical surgical settings. VHA has continued to press 
for integration of mental health and primary care for older 
veterans in facility clinics as well as in the growing numbers 
of community-based outpatients clinics. The MHSHG is working 
closely with the Geriatrics and Extended Care and Acute Care 
Strategic Healthcare Groups at the national level to insure 
that planning for elder veterans with mental health and 
physical problems is coordinated at all levels of our 
organization.
---------------------------------------------------------------------------
    \1\ Sadock and Sadock. Comprehensive Textbook of Psychiatry 7th Ed. 
Lippincott, Williams & Williams, 2002, p. 3141.
    \2\ SMITREC, Care for Veterans with Psychosis in the VHA, FY 02, 
Table 1A.
    \3\ SMITREC 
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    UPBEAT (Unified Psychogeriatric Biopsychosocial Evaluation and 
                               Treatment)

    This six-year clinical demonstration project at nine VA 
facilities screened elderly patients in acute medical and 
surgical VA settings for undiagnosed symptoms of depression, 
anxiety, and substance use disorders. Of 1,687 patients 
screened, 48 percent screened positive for symptoms of anxiety 
and depression and 26 percent for depression alone, despite an 
absence of past or recent psychiatry history. From a randomized 
half-sample of 839 of those veterans, 58.6 percent received a 
formal mental health diagnosis within an average of three 
months post-discharge. Of these,
    21.8 percent were diagnosed with an adjustment disorder,
    15.4 percent for anxiety,
    7.4 percent a mood disorder including depression, and
    14 percent for other disorders.
    The high occurrence of an adjustment disorder was not 
anticipated.

    Aging, Mental Health, Substance Abuse, and Primary Care Project

    This Primary Care Research in Substance Abuse and Mental 
Health for Elderly (PRISMe) study was funded jointly by the 
Substance Abuse and Mental Health Services Administration 
(SAMHSA), the Department of Veterans Affairs (VA), and the 
Health Resources and Services Administration (HRSA). It is 
randomized, multisite investigation comparing the effectiveness 
of either behavioral health systems that were integrated into 
primary care clinics or enhanced referral systems where 
patients were referred to specialty mental health clinics away 
from the primary care setting. Six study sites funded by SAMHSA 
and five study sites funded by the VA were selected that had, 
or had plans to develop both integrated and referral models in 
their primary care clinics. Clinical and cost outcomes were 
obtained at three, six and 12 months post enrollment. The 
PRISMe study has enrolled 1,610 patients with depression or 
anxiety and 634 with at-risk drinking conditions. Preliminary 
results suggest that a higher percent of patients were engaged 
in treatment who were randomized to the integrated sites, 
however the six-month and one-year treatment outcomes are not 
yet available. When completed, this study should guide VA 
policy with regard to effective ways to integrate mental health 
care into primary care sites nationwide.
Rahabilitation Strategic Healthcare Group (SHG)
    The Rehabilitation SHG has four separate and distinct 
services, Physical Medicine and Rehabilitation, Audiology and 
Speech Pathology, Blind Rehabilitation and Recreation and 
Creative Art Therapies.
Physical Medicine and Rehabilitation
    Physical Medicine and Rehabilitation services strive 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. Therapists utilize physical agents, therapeutic 
modalities, exercise, and adaptive equipment and provide 
treatment to enhance function in activities of daily living and 
vocational/avocational activities that facilitate the veteran's 
ability to remain in the most independent life setting. 
Rehabilitation personnel provide education to the veteran and 
family members about adjustment to a disability or physical and 
social limitations and instruct them in techniques to maintain 
independence despite disability.
    There are approximately 45 Comprehensive Integrated 
Inpatient Rehabilitation Programs, (CIIRPs) within VHA. 
Approximately half of the programs reside within long term care 
settings. Physicians with extensive rehabilitation experience, 
usually board certified physiatrists, lead interdisciplinary 
teams of professionals to focus on outcomes of functional 
restoration, clinical stabilization, or avoidance of acute 
hospitalization and medical complications.
    A uniform assessment tool, the Functional Independence 
Measure (FIM), is used 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 activities 
assist local and national rehabilitation clinicians and 
managers to maximize effective and efficient rehabilitation 
care delivery. An administrative database called the Uniform 
Data System for 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. Through a national contract with UDS/
mr, facilities with rehabilitation programs provide data and 
receive outcome reports as part of a national and international 
UDS/mr data bank. Use of the FIM as a functional assessment 
tool is available to all VA facilities through connectivity to 
the Functional Status and Outcomes Database (FSOD) for 
Rehabilitation housed at the VA Austin Automation Center, 
Austin, TX. The FSOD allows tracking of rehabilitation outcomes 
across the full continuum of care based upon a severity of 
illness index which classifies each patient into a specific 
Functional Related Group (FRG) based on his/her impairment. 
Rehabilitation therapists lead and participate in innovative 
treatment, clinical education, staff development and research. 
Rehabilitation professionals work within VA HBPC Programs, 
Independent Living Centers, GEM Units, ADHC Centers, Day 
Treatment Centers, Domiciliaries, NHCUs, GRECCs and Hospice 
Care Programs. Applying principles of health education and 
fitness, rehabilitation staff develops and provides programs 
aimed at promoting health and wellness for the aging veteran.
    Driver rehabilitation centers are staffed at 40 VAMCs to 
meet the needs of aging and disabled veterans. With the growing 
numbers of older drivers, VA emphasizes the training of the 
mature driver. Classroom education, updates on laws, and 
defensive driving techniques are supported with behind-the-
wheel evaluations by trained specialists.

                     Audiology and Speech Pathology

    In addition to traditional rehabilitation disciplines, the 
Rehabilitation Strategic Healthcare Group also includes 
Audiology and Speech Pathology. Audiology is primarily 
concerned with the identification and management of veterans 
with hearing and balance disorders. Most veterans with hearing 
loss receive hearing aids and other assistive devices. In 
FY2002, VA issued over 254,000 hearing aids. For veterans with 
more severe hearing loss, VA provided cochlear implants at ten 
designated cochlear implant centers. Speech Pathology is 
primarily concerned with identifying, treating, and managing 
veterans with speech, language, voice, and swallowing 
disorders. These disorders are frequently associated with 
disease in the elderly including stroke, degenerative 
neurological disease, and head/neck cancer. Speech-language 
pathologists play a key role in the early identification, 
treatment, and management of swallowing disorders that can lead 
to serious medical complications if left untreated. Speech-
language pathologists work collaboratively with ENT, GI 
Medicine, Neurology, Geriatrics, Primary Care, Nutrition and 
Food Service, and Nursing. Speech-language pathologists are 
also primarily involved in restoring voice function to veterans 
who have lost the ability to speak due to stroke, degenerative 
neurological disease, or cancer. VA and Department of Defense 
(DoD) worked collaboratively to develop joint clinical practice 
guidelines for the management of stroke. Speech-language 
pathologists supplement FIM-based functional assessments using 
the National Outcomes Measurement System (NOMS), a 
collaborative venture between VA and the American Speech-
Language-Hearing Association. NOMS allows speech-language 
pathologists to track clinical outcomes on specific disorders 
related to speech, language, and swallowing deficits. The NOMS 
data are available to all VA facilities through the Functional 
Status and Outcomes Database (FSOD) for Rehabilitation housed 
at the VA Austin Automation Center, Austin, TX.

                          BLIND REHABILITATION

    The program is designed to improve the quality of life for 
blinded and severely visually impaired veterans through the 
development of skills and capabilities needed for personal 
independence, emotional stability, successful integration into 
the community and family environment. It is comprised of 10 
Inpatient Blind Rehabilitation Centers, 92 Visual Impairment 
Services Team Coordinators, 20 Blind Rehabilitation Outpatient 
Specialists, 5 National Program Consultants, and Inpatient 
Computer Access Training programs at medical centers throughout 
the country and Puerto Rico. Services are provided using a 
multi-disciplinary team approach.

                   RECREATION/CREATIVE ARTS THERAPIES

    Recreation/creative arts therapists working in VA's long-
term care programs provide interventions and therapeutic 
programs to enhance attention, memory, perception and problem-
solving skills, improved social interactions skills, reduction 
of inappropriate behavior, and increases in perceived quality 
of life. Therapists treatment data is included in the Resident 
Assessment Instrument-Minimum Data Set (RAI-MDS). The 
instrument is a uniform set of items and definitions for 
assessing all resident in nursing facilities. Recreation 
Therapy in conjunction with VHA's Employee Education System 
sponsors a Distance Learning Program for recreation/creative 
arts therapists with up-to-date training on professional 
practice trends. In, 2002 Recreation Therapy National Program 
Office and the Department of Health and Human Services co-
sponsored training for professionals, family, and volunteer 
caregivers at the National Veterans Golden Age Games.
Pharmacy Benefits Management Strategic Healthcare Group (SHG)
    The Under Secretary for Health established the Pharmacy 
Benefits Management (PBM) Service line in 1996 to provide a 
focus within the VHA concerning the appropriate use of 
pharmaceuticals in the health care of veterans. A secondary 
goal was to decrease the overall cost of health care through 
achievement of the PBM's primary goal. As VHA has transitioned 
from an emphasis on inpatient care to ambulatory/primary care, 
pharmaceutical utilization has increased dramatically and will 
continue to do so.
    One of the key organizational elements of VHA's PBM is its 
group of field-based physicians called the Medical Advisory 
Panel (MAP). The MAP provides leadership and guidance to the 
PBM in addressing the five functions of the PBM. These 
functions are: (1) management of pharmaceutical costs; (2) 
management of drug utilization; (3) management of drug 
distribution systems; (4) promotion of best practices; and (5) 
education of clinical caregivers and patients.
    The PBM serves a qualitative and quantitative role in 
addressing the medication needs of older veterans. In a patient 
population that frequently has co-morbidities and multiple drug 
therapies, the actions of physicians, nurses and pharmacists to 
improve the drug use process are essential in realizing the 
goal of the appropriate use of pharmaceuticals. To date, twelve 
Pharmacologic Management Guidelines, twenty Drug Class Reviews, 
three Clinical Practice Guidelines, forty Criteria for Use 
documents, twenty-five Drug Monographs, four Pocket Cards, 
three News Alerts, and three Therapeutic Interchange documents 
have been developed and promulgated for use in the VA 
healthcare system. Many areas of interest and merit in 
addressing the health conditions of elderly patients are 
included in the published drug treatment guidelines; they 
include Depression, Chronic Heart Failure, Benign Prostatic 
Hyperplasia, Hyperlipidemia, Hypertension, COPD, Type 2 
Diabetes, Alzheimer's Disease, Erectile Dysfunction, GERD, and 
Criteria for Use for COX-2 Inhibitors.
    During FY 2002, increases in the utilization of 
pharmaceuticals and the dollars expended on pharmaceuticals 
continued to occur across VHA. Through the use of effective 
contracting strategies tied to the development of disease 
management guidelines, VHA provides quality medical care at an 
affordable price. Specifically, the average cost of a 30-day 
equivalent outpatient prescription remained essentially flat 
from FY 1999 through FY 2002.
Allied Clinical Services Strategic Healthcare Group (SHG)

                       NUTRITION AND FOOD SERVICE

    Research indicates that older Americans are the population 
most likely to have chronic and acute nutrition-related health 
problems. VA dietitians have developed initiatives that address 
such health problems of the elderly, hospitalized veteran 
patients who may be at high nutritional risk. An 
Interdisciplinary Task Group has developed a Nutrition 
Performance Monitor (NPM) that identifies nutrition indicators/
monitors for patient at risk for malnutrition. These nutrition 
indicators are an integral part of the VA electronic database 
and provide a screening tool for professional dietitians to 
respond promptly with nutrition assessment and intervention to 
such patients. These nutrition performance monitors provide a 
nutrition profile of acute care, chronic and elderly long-term 
care patients. This nutrition profile will be able to assist 
dietitians to make decisions about the level of care required 
to adequately accommodate elderly veterans' nutritional needs.
    VA dietitians provide meals to many community Meals-on-
Wheels programs and State Veterans Home through local contracts 
and sharing agreements. Also, more than 35 State Veterans Homes 
purchase their menu food items from the VA Subsistence Prime 
Vendor Contract. Dietitians continue to develop the pureed food 
products to enhance the appearance, taste, quality, 
palatability, and acceptability of food for geriatric patients 
with dysphagia.

                          SOCIAL WORK SERVICE

    Social Workers are an active, integral part of the 
interdisciplinary health care team in every program serving 
elderly veterans across the continuum of care. The full range 
of psychosocial treatment is available to veterans and families 
considering long term care to help them assess their needs, 
identify resources, select alternatives and coordinate 
referrals between VA and community programs. Each veterans 
subject to Long-Term Care Copayments will receive social work 
help in the application process and in finding and choosing 
appropriate health care options. Older veterans with changing 
physical conditions and circumstances may need assistance in 
adjusting to losses and limitations. Family caregivers also 
need support and help with the added responsibilities and 
changes they face.
    Key functions provided by social workers in long-term care 
include: Psychosocial Assessment; Treatment Planning; Discharge 
Planning; Community Liaison and Referral; Case Management; 
Crisis Intervention; Psychosocial Treatment; Mental Health 
Services; Family Liaison; Patient Advocacy; Patient and Family 
Education; End of Life Planning and Documentation. Social 
workers have knowledge and skills in community and family 
systems that prepare them to participate on management teams 
for long term care programs, developing, directing, 
coordinating, monitoring and improving services.

                            CHAPLAIN SERVICE

    Supporting the spirituality of aging veterans is essential 
to their wellness and wholeness. Their spirituality helps them 
respond to the potential fullness of life despite the problems 
that arise from illness and longevity. Failure to address the 
spiritual well being of aging veterans neglects an essential 
component of their lives and has strong consequences affecting 
their quality of life.
    It is crucial to gain an understanding of the spiritual 
journeys of aging veterans and these include the spiritual 
injuries incurred along the journey. With appropriate spiritual 
assessments, follow-up pastoral care focuses on the veterans 
and family members in helping them to use their religious/
spiritual resources to cope with matters of life review, 
meaning, and adjustment to loss.
    The challenge for aging veterans is to make sense of life 
at a stage when changes and losses occur with bewildering and, 
sometimes, overwhelming frequency and intensity. If a veteran 
sees aging as more loss than gain, then what is the value and 
meaning of added years? The sense of loss prompts the 
questions, ``Has it been worth it? Has my life meant anything? 
Does it mean anything now? Many aging veterans use their 
religious/spiritual beliefs to help them answer these 
questions. In an age and culture that emphasizes beauty, 
mobility, wealth, and power, all of which may be lost through 
the aging process, veterans need an effective means of coping 
with fraility, suffering, loss, loneliness, or dementia.
    As personal health begins to fail and dependency becomes 
more apparent, there is an increasing awareness of approaching 
death. Pastoral care can help aging veterans understand and 
accept death as a part of a larger picture that is meaningful 
and sacred. Research supports the importance of spirituality to 
well being and validates the efforts of those long term care 
facilities that provide a framework of care for services that 
include the spiritual dimension as an integral component of 
that care. As the chaplain provides care for the elderly in 
their search for meaning, several significant themes seem to 
emerge:
    First, the ability to face reality is strengthened and the 
likelihood of giving in to the limitations of aging are greatly 
diminished;
    Second, as the elderly search for meaning in their own 
personal values, the growth and self-exploration/acceptance 
that are embraced in the search enables them to experience 
themselves as fuller, richer persons;
    Third, through the sharing of stories elderly are able to 
reframe their life events in order to experience meaning and 
purpose rather than despair.
    Fourth, they experience a rite of passage that provides the 
opportunity to bring closure, and this includes both the 
passing on and receiving of a blessing.
Diagnostic Services Strategic Healthcare Group (SHG)
    The clinical services of Pathology and Laboratory Medicine, 
Radiology, and Nuclear Medicine constitute the Diagnostic 
Services Group. Each of these clinical services provides direct 
services to veteran patients and to clinician-led teams in 
ambulatory/primary care, acute care, mental health, geriatrics 
and long-term care, and rehabilitation medicine.
    Diagnostic Services staff are educated on special care of 
elderly. Pathology and Laboratory staff, for example, receive 
special training on phlebotomy with the elderly. In addition, 
normal values of various laboratory tests may be different in 
the elderly. These differences are incorporated into each VA 
facility's reference on normal ranges for tests.
Prosthetic and Sensory Aids Strategic Healthcare Group (SHG)
    The mission of the Prosthetic and Sensory Aids Service 
(PSAS) is to provide specialized, quality patient care by 
furnishing appropriate prosthetic equipment, sensory aids and 
devices in the most economical and timely manner in accordance 
with authorizing laws, regulations and policies. PSAS serves as 
the pharmacy for assistive aids and PSAS prosthetic 
representatives serve as case managers for the prosthetic 
equipment needs of the disabled veteran.
    Currently, the majority of geriatric veteran patients 
treated in VHA's primary care clinics receive some type of 
prosthetic appliance. PSAS furnishes such appliances as 
eyeglasses, canes, crutches, wheelchairs, hearing aids, 
orthopedic shoes, arch supports, artificial limbs, and home 
oxygen equipment. PSAS also arranges for training and 
instructions on the use of these prosthetic appliances.
    PSAS employees simplify the geriatric patients' 
communication difficulties with private home care durable 
medical equipment companies. They arrange for delivery and 
training on a variety of devices such as hospital beds, patient 
lifts, and environmental control appliances that the geriatric 
patient would have considerable difficulty in arranging 
themselves. Vendors must have in-depth prescription and unique 
needs of the patients explained to them by PSAS employees prior 
to delivery, installation and instructions.
    PSAS employees are also a vital link between the local VA 
clinic teams and geriatric veteran patients in developing the 
prescription needs of patients with catastrophic disabilities. 
Knowledge about appliances and available components in the 
private sector and in VA is used to complete the prosthetic 
appliance prescription in a manner that meets a veteran's needs 
as well as maximizes the VA resources.
Telemedicine Strategic Healthcare Group (SHG)
    The mission of the Telemedicine SHG is to further the 
innovative use of information and communications technologies 
to provide and support health care for veterans across distance 
and time barriers. VHA continues to play a leadership role in 
telemedicine that involves the use of different communication 
technologies to transmit diagnostic and therapeutic information 
to provide health care services to remote locations. 
Telemedicine plays an increasingly important role in improving 
health care for veterans and has been demonstrated to provide 
greater access to care, improve the continuity and timeliness 
of care, reduce travel costs. Clinicians in many clinical 
specialties are using telemedicine to improve the continuity of 
care for veterans at home, in ambulatory care clinics, and in 
hospitals. The Telemedicine SHG continues to evaluate the 
effectivenss of telemedicine and work with the VISN's and VA 
facilities to introduce new clinical processes based on 
information technologies to assist clinicians in meeting the 
health care needs of older veterans and reduce the barriers of 
distance and time that can sometimes restrict the availability 
of care.
Spinal Cord Injury/Disorders Strategic Healthcare Group (SHG)
    The Spinal Cord Injury and Disorders (SCI&D) SHG provides 
primary, specialty, and rehabilitation care for veterans with 
spinal cord injuries and disorders. Due to health care 
interventions and improved methods of disability management, 
life expectancies for persons with SCI continue to increase, 
but are still somewhat below life expectancies for those with 
no spinal cord injury. The average age of veterans with SCI has 
been estimated to be 12 years older than the average age in the 
general SCI population. Over 20 percent of the general SCI 
population is over the age of 61, and since the veteran 
geriatric population is proportionately larger than the general 
population, this percentage is also significantly larger. A 
recent program review, noted that 32 percent of veterans 
offered initial rehabilitation in VA for new SCI onset are over 
the age of 65 while only ten percent are over the age of 65 in 
other models of SCI&D care. There have been increases in the 
incidence of aging-related spinal cord problems and increasing 
survival rates for older persons with SCI in addition to basic 
demographic changes. Major clinical issues related to aging 
with a spinal cord injury being addressed in VHA include 
recurrent pressure ulcers, degenerative processes related to 
overuse syndromes, long-term urinary tract and gastrointestinal 
tract complications, cardiovascular changes and silent 
ischemia, pulmonary complications, home care services, and the 
psychological and social impact of losing caregiver support. 
The older person with SCI is at increased risk for developing 
these secondary conditions as well as other diseases. 
Performance measures are used to help assess the treatment of 
veterans with SCI and discharge to non-institutional, community 
living is tracked. Greater than 95 percent of discharges from 
the SCI Centers were to non-institutional settings in FY 02.
    VA is committed to planning for the extended care needs of 
this population through the CARES initiative and designation of 
extended care beds for priority use by veterans with spinal 
cord injury. Options in addition to extended care beds include 
respite care within the SCI Centers and bowel and bladder care 
through Fee Basis home health services.
    Research on aging and SCI&D is a high priority in VA. The 
SCI Quality Enhancement Research Initiative summarized 
important scientific and clinical knowledge gaps related to 
unique issues of aging with an SCI injury through consumer and 
provider focus groups.
Forensic Medicine Strategic Healthcare Group (SHG)
    The mission of the Forensic Medicine SHG is to act as a 
resource for the Under Secretary for Health and provide 
consultation and leadership in several areas in which legal and 
medical issues converge. The work of this SHG directly affects 
the quality and safety of medical care provided to veterans.
    Specifically, but not by way of exclusion, the Forensic 
Medicine SHG:
           Reviews all Veterans Health Administration 
        (VHA) medical facility requests for exchange visitor 
        (J-1 visa) physician waivers under the Immigration and 
        Nationality Act.
           Oversees the malpractice payment review 
        activities of the VHA Office of Medical/Legal Affairs.
           Reviews VHA contracts for adherence to 
        current laws, regulations and guidelines.
           Advises Veterans Benefits Administration 
        (VBA) on VHA issues related to claims processing 
        activities.

                     B. Office of Nursing Services

    Office of Nursing Services in support of VHA's Vision 20/
20, continues to rank care of the elderly veteran as a major 
priority. Nurses at every level of the organization are 
committed to leadership in the clinical, administrative, 
research, and educational components of gerontological nursing. 
Powerful societal forces in both the Federal Government and the 
private sector require even greater collaboration and teamwork 
as nursing strives to integrate advances in technology and 
information management. Nursing participates in the transition 
from inpatient to outpatient healthcare within the managed care 
model.
    Nurses continue to provide patient care expertise in 
preventative care and health promotion initiatives, to preserve 
both the veterans' and their significant others' independence. 
Team approaches to improving the health status of aging 
veterans have fostered optimum levels of self-care, improved 
productivity, and enhanced quality of life. Health screening, 
education, primary care and referral of elderly veterans are 
critical functions necessary to manage health care needs and 
place the veteran in the most appropriate level of care. Level 
of care may range from enhanced HBPC, including Home Tele-
Health as the least restrictive setting to inpatient nursing 
home care in the most restrictive environment. Nurses have 
facilitated interdisciplinary leadership to create and 
strengthen programs to help keep patients in their homes as 
long as possible. Program expansions include ADHC, HBPC, Care 
Coordination and home Tele-Health Program. Nurses in wellness 
clinics provide supervision, screening and health educational 
programs to assist veterans and their significant others in 
fostering and maintaining healthy lifestyles.
    Effective utilization of advanced practice nurses (APN) in 
the provision of health care services is a critical component 
of VHA's mission to provide cost effective quality primary care 
across a continuum of care. This continuum of care for aging 
veterans includes primary care, acute care, long-term care, 
palliative care, respite, and community agencies. 
Gerontological advanced practice nurses provide primary care 
and continuity of care as the V.A. expands the care 
coordination of veterans. Nursing Palliative Care is a 
systematic and rational approach to caring for the most complex 
patients in the hospital setting. Through sustained patient 
partnerships, APNs provide health care for aging patients in 
diverse settings, minimizing illness and disabilities and 
focusing on health promotion, disease prevention and health 
maintenance.
    Primary care is provided to aging veterans by either a 
physician or a nurse practitioner, often in collaboration with 
a care team, including psychiatry, psychology, social work, 
dietitian, chaplain, rehabilitation therapy, pharmacy and 
others. Primary care services are based on the long-term care 
needs of aging patients including those with multiple and 
chronic medical problems, functional disabilities, cognitive 
impairments and weakened social support systems. Services are 
provided across the continuum from health promotion and disease 
prevention to screening for community services including 
hospice care evaluation.
    Nurses facilitate the restoration of functional abilities 
of veterans with chronic illnesses and disabilities. Programs 
for the physically disabled and cognitively impaired are 
administered by nurses and advanced practice nurses in settings 
representing ambulatory care, inpatient care and home care. 
These patient centered treatment programs and rehabilitation 
teams are goal-directed with physical and psychosocial 
reconditioning or retraining of patients. Patient and family 
teaching are a major component of each program.
    Family/significant others have a key role in providing 
support to veterans. Both are assisted in learning and in 
maintaining appropriate patient/caregiver rights and 
responsibilities. VA nurses contribute to planning, 
implementing and evaluating services for veterans in the 
community-at-large.
    Committed to leadership in education, VA nurses provide 
creative learning experiences for both undergraduate and 
graduate nursing students. Nursing education initiatives 
including ``distance learning'' are being developed to provide 
skills and competencies necessary to function in primary and 
managed care settings. Students are able to work and study with 
VA nurses who have clinical and administrative expertise in 
aging and long-term care. These include nurses in various 
organizational and leadership roles. Nurses have responded to 
the growing emphasis upon end-of-life issues by providing 
training and local programs for palliative care, including 
hospice programs.
    To assist facilities in meeting performance measures, 
nurses have been involved in developing creative alternatives 
to acute inpatient care. This includes chronic ventilator 
programs, which extend into nursing home and even home 
settings. There is also increased emphasis upon defining VA 
NHCU programs as transitional and rehabilitative services 
providing a realistic discharge option for patients continuing 
to require nursing intervention. VA NHCU's continue to 
demonstrate a significant restraint reduction. Decreased 
restraint usage is attributed to interdisciplinary reassessment 
of the patient's treatment. Each patient/resident has a 
comprehensive interdisciplinary plan of care, which facilitates 
reduced restraint usage. Resident outcomes include a decrease 
in the number of falls and injuries with an increase in 
resident's alertness, happiness, muscle strength, independence 
and pride. Nurses and other members of the interdisciplinary 
team are proud of these clinical outcomes and VA NHCU's success 
in reducing the use of chemical and physical restraints in care 
of the elderly. Such an environment enhances resident behaviors 
in independence, decision-making and socialization.
    Multi-arts programs have been developed including Tai Chi, 
Dance, Art Appreciation, Hands-on Art, Sign Language, and 
Creative Writing. Patient outcomes include an increase in 
mobility, functions, and an increase in spontaneity and 
happiness as measured by standardized instruments.
    Committed to research, VA nurses continue to change and 
reshape clinical nursing practices. Nursing research is 
improving care delivery and health promotion in the following 
areas:
           Alternative to Institutional Care
           Wound Care and Effectiveness of Treatment 
        Regimens
           Risk Assessment for Falls
           Restraint Minimalization and Alternatives to 
        Restraints
           Interdisciplinary/Assessment Tool 
        Effectiveness
           Patient Education, Health Promotion and 
        Maintenance
           National Minimum Data Set Implementation
           Pain Assessment in Cognitive Impaired
           Assessment of Pain/Implementation of Pain as 
        the 5th Vital Sign
    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. Quality of life is an 
essential component for evaluating the effects of nursing care 
in both research and clinical practice. Research by nursing as 
a discipline and in collaboration with other members of the 
healthcare team continues to focus on specific patient care 
outcomes including quality of life, assessment of pain, 
effectiveness of care interventions, cost effectiveness, and 
patient satisfaction.

                 C. Office of Research and Development

    VA's Medical and Prosthetic budget funds a vigorous 
research effort that investigates aging and its affects from a 
number of directions that reflect the multi-faceted nature of 
that condition.
    The Office of Research and Developments' commitment to 
research on aging veterans resulted in its establishment as one 
of 17 Designated Research Areas (DRA) under which virtually all 
VA research and development programs and projects fall. 
Moreover, aging receives the highest funding of any DRA. For 
clarity, a DRA is defined as an area of research in which VA 
has a particularly strong strategic interest because of the 
prevalence of conditions within the VA patient population, the 
uniqueness of a specific patient population and its disease 
burden to the VA system or the importance of the question to 
health care delivery within VA. Clearly, veteran aging and its 
associated problems fall within this definition. VA research 
that is considered to fall primarily within the Aging DRA 
includes:
           Normal age-related changes in the body's 
        structure and function.
           Aging syndromes, such as frailty, 
        immobility, falls, cognitive impairment.
           Compound problems and co-morbidities, such 
        as dementia and hip fractures.
           Care of elderly veterans.
           End-of-life issues--hospice care, ``quality 
        of dying'', and similar areas.
    Below are highlights of recent advances in research on 
aging veterans from each of the Office of Research and 
Development's programs: Medical Research, Rehabilitation 
Research and Development, Health Services Research and 
Development, and the Cooperative Studies Program.
Cooperative Studies Program
    The Cooperative Studies Program (CSP) is a component of the 
Office of Research and Development and supports multi-center 
clinical studies where multiple VA medical centers (and 
potentially non-VA center) study collectively a selected 
medical problem. CSP consists of four Coordinating Centers 
(CSPCCs), a Clinical Research Pharmacy, and three 
Epidemiological Research and Information Centers (ERICs). CSP 
exists to provide credible, consistent, and effective answers 
to major scientific questions that determine evidence-based 
medical practice in VA and in the country.

                        A. Aging-related Studies

             DEEP BRAIN STIMULATION FOR PARKINSON'S DISEASE

    This landmark VA clinical trial is comparing two promising 
surgical treatments for Parkinson's disease among patients who 
are no longer responsive to the best medical therapy. The trial 
will assess the effectiveness of surgically planted electrodes 
that provide stimulation to two regions of the brain (the 
subthalamic nucleus and globus pallidus) that have shown 
promise in mediating the physical tremor associated with 
Parkinson's Disease, and compare each to usual medical therapy. 
Prior to initiation of the trial, the NIH, National Institutes 
for Neurological Disorders and Stroke approached the VA and the 
VA agreed to partner with the NIH in the collaborative conduct 
of the trial.

                  GLYCEMIC CONTROL IN TYPE II DIABETES

    A quarter of the patients treated in VA have type II 
diabetes. The treatment costs for diabetes care and management 
is extremely high. The VA has initiated the largest US clinical 
trial among type II diabetics (1700 patients) to determine 
whether glycemic control, achieved through intensification of 
pharmaceutical treatment, is effective in preventing major 
organ complications among patients no longer responsible to 
oral agents alone.

                         SHINGLES VACCINE TRIAL

    Shingles in older people is extremely painful and 
disabling. There exists no effective treatment for people who 
suffer from shingles nor an effective method to prevent the 
condition. This study will test a promising new vaccine to 
prevent shingles and reduce its severity and complications. The 
randomized, controlled trial will enroll 35,000 older veterans 
for a minimum of three years. If the vaccine proves successful, 
it will supply a safe and cost-effective means for reducing the 
severe impact of shingles and its complications on the health 
of older veterans.

                            PROSTATE CANCER

    Prostate cancer is the most common cancer among men and 
second leading cause of death in men. CSP is conducting three 
programs that seek to learn more about this disease.
    The Prostate Cancer Intervention Versus Observation Trial 
(PIVOT) is a 15-year, randomized study involving 2,000 men. VA, 
in collaboration with the National Cancer Institute (NCI) and 
the Agency for Health Care Policy and Research (AHCPR), is 
addressing questions remain concerning long-terms outcomes for 
prostate cancer treatment through a landmark study that 
compares the two most widely used treatment methods: radical 
prostatectomy, in which the prostate is surgically removed, and 
expectant management or ``watchful waiting,'' in which only the 
disease symptoms are treated.
    VA has entered collaborations with the NCI and the 
Southwest Oncology Group to study the effects of Vitamin E and 
Selenium in the primary prevention of prostate cancer. The 
proposed Selenium Vitamin E Cancer Prevention Trial (SELECT) is 
a randomized, double-blind, placebo controlled, factorial 
design trial among 30,000 healthy men without prostate cancer.
    Another study on prostate cancer will look at the racial 
differences in the incidence and mortality of the disease. 
Among African Americans, the incidence and mortality from 
prostate cancer is highest. This research will provide insight 
into genetic-environmental interactions that initiate and 
promote prostatic neoplasia, as well as address whether there 
are differences in patterns of care that impact morbidity and 
survival.

                           COLORECTAL CANCER

    The relative five-year survival for colorectal cancer is 
approximately 40 percent among veterans, substantially lower 
than the general population of 61.7 percent (colon) and 59.3 
percent (rectum). Colorectal cancer is preventable through 
screening, and, if diagnosed in an early stage, is curable.
    This is the first study to examine factors that may explain 
the worse prognosis for veterans with colorectal cancer. If 
modifiable factors such as physician and patient delay in 
diagnosis, or poverty explain the increased mortality among 
veterans, educational programs and interventions that improve 
the process of care associated with screening and diagnosis can 
be instituted.

            HEALTH SERVICES RESEARCH AND DEVELOPMENT SERVICE

    Research supported by the Health Services Research and 
Development Service (HSR&D) is designed to enhance veterans' 
health and functional status and the quality of care provided 
to elderly veterans. Elderly veterans and their special health 
care needs have always been a major focus of HSR&D activity. 
HSR&D researchers focus on identifying effective strategies for 
the organization and delivery of health services and for 
optimizing patient- and system-level outcomes. They employ the 
expertise and perspectives of clinicians, social scientists, 
and managers to advance the field of health services research 
and answer practical questions that are important both inside 
and outside VA.
    Various funding mechanisms are used to promote health 
services research in aging. These include investigator-
initiated research, service (HSR&D) initiated research, and the 
VA management consultation. In addition, HSR&D in collaboration 
with the Nursing Strategic Healthcare Group, encourages 
research on nursing topics. Several of the nursing projects are 
directly related to aging, especially long-term care. All 
proposals funded by HSR&D undergo rigorous peer review to 
assure scientific/technical merit and important to VA. Funded 
projects range in duration from one to five years.
    Supporting HSR&D's researchers is an infrasture of 13 
Centers of Excellence (CoEs), 8 Quality Enhancement Research 
Initiative Groups (QUERI), 9 Research Enhancement Award 
Programs (REAPs), 6 Targeted Research Enhancement Programs 
(TREPs), and 4 Resource Centers. Many of these programs and 
centers specifically focus on aging-related topics.

                        A. Aging-related Studies

    Through its various programs, HSR&D supports research that 
is either pertinent to aging veterans or addresses aspects 
unique to aging. In the first case, a large proportion of HSR&D 
projects that were active in 2002 addressed health care for 
chronic diseases and conditions that are especially common in 
the elderly. For example, in the Investigator-Initiated 
Research (IIR) program, 17 projects focus on treatment and 
outcomes for cardiac disease, including congestive heart 
failure, hypertension, ischemic heart disease, and pulmonary 
disease. Two IIR projects focus on cancer, emphasizing 
colorectal cancer screening and skin cancer outcomes. 
Additional IIR projects as well as projects funded under other 
HSR&D programs such as the Nursing Research Initiative and 
QUERI address health care for depression, diabetes, pressure 
ulcers, dementia, and other conditions for which elderly 
veterans seek or receive care. In this research, HSR&D 
investigators examine access to care, clinical decision making, 
health care costs, utilization patterns, and a wide range of 
patient outcomes, including quality of life and functional 
status.
    Several ongoing Service-Directed Research (SDR) projects 
focus on issues relevant to aging veterans. These include 
diabetes care and guidelines education and training for 
physicians managing post myocardial infarction cardiac 
patients.
    In FY 2003, the management consultation program funded four 
studies related to aging. Three were funded at the request of 
VA's Office of Geriatrics and Extended Care and are related to 
the Veterans Millennium Health Care and Benefits Act (PL 106-
117). These three studies address the following topics:
           demonstrating three models of long-term care
           evaluating the use of assisted living 
        services for elderly veterans as an alternative to 
        nursing home care
           determining the effect of PL 106-117 on 
        costs and access to VHA extended care
    An unrelated study evaluates a demonstration hospice 
program. Interim results indicate that this delivery model can 
expand access to hospice care for veterans while maintaining 
quality of services.

                 B. HSR&D Research Centers and Programs

    HSR&D's Center of Excellence conduct research and support 
the integration of research and practice. Six centers are 
currently conducting research on issues that directly involve 
an elderly veteran study population.
    The Northwest Center for Outcomes Research in Older Adults 
in Seattle, Washington, has as one of its foci the preservation 
of independence in older adults. Research on aging addresses 
chronic diseases that are common among the elderly, including 
heart disease, depression, chronic obstructive pulmonary 
disease, and diabetes; diagnosis and treatment of osteoporosis; 
predictors of community residential care outcomes; and 
facilitating use of advance care directives by older adults. 
The Center for Health Quality, Outcomes and Economic Research 
based in Bedford, Massachusetts, emphasizes research related to 
improving the quality of health care for elderly veterans. 
Ongoing projects focus on the quality of long-term care and 
seizures in the elderly. The Center for Practice Management and 
Outcomes Research in Ann Arbor, Michigan, emphasizes outcomes 
research and studies to improve the quality of clinical 
practice. Aging research at the Ann Arbor Center addresses 
quality improvement, especially on issues related to diabetes 
care. The Sepulveda, California, Center for the Study of 
Healthcare Provider Behavior seeks to build a knowledge base 
that will help researchers, policymakers, and health care 
managers design, implement and evaluate policies and programs 
to improve health outcomes. Research relevant to aging 
addresses interventions for delivering quality care to the 
elderly, improved adherence to smoking cessation guidelines, 
pressure ulcers, and delivery of care for vulnerable elderly 
groups such as veterans with Alzheimer's and Parkinson's 
Disease. The Center for Chronic Disease Outcomes Research at 
Minneapolis, MN, has a broad-based research portfolio, with 
programs in prevention, treatment outcomes, quality of care, 
and gender issues. HSR&D research underway at Minneapolis 
includes a comparison of the effectiveness of prostate cancer 
screening education tools, osteoporosis treatment and 
prevention, and strategies to improve smoking cessation. The 
Rehabilitation Outcomes Research Center for Veterans with 
Central Nervous System Damage in Gainesville, Florida, focuses 
on veterans who have suffered central nervous system damage as 
the result of stroke. Topics include evaluating the benefit of 
technology for elderly patients and utilization of community-
based nursing homes.
    In addition to the activities of the CoEs, HSR&D funds 
REAPs and TREPs that have a specific focus on aging. The Tampa 
REAP conducts research pertaining to safe mobility for frail 
elderly and persons with disabilities and the San Francisco 
REAP has as its core mission improving care for older veterans. 
In addition, the Denver TREP has a research agenda focused on 
improving the quality of long-term care for veterans.
Medical Research Service
    Medical Research Service (MRS) funds basic and clinical 
research on the etiology, pathogenesis, diagnosis and treatment 
of diseases relevant to veterans. As the veteran population 
ages, much of our research is dedicated to understanding the 
aging process and the relation of the aging process to onset 
and treatment of disease. During 2002 MRS funded 446 aging 
research programs at a cost of $50.9 Million.
    The MRS portfolio in aging research is very strong 
considering the expanse of topics covered and the different 
types of programs funded. Virtually all research portfolio 
areas within MRS include studies related to the aging process 
or diseases of aging. Recently, special emphasis has been made 
in attracting scientists to aging research; in fact, the 
mentored training awards are funded at a cost of $3.75 million, 
representing a significant investment in future aging research. 
The following are topical summary statements relative to the 
portfolio areas supporting aging research:
           Fifteen programs are devoted to 
        understanding cellular senescence, metabolic changes 
        with age, and difference in the musculoskeletal system.
           Efforts in neuroscience related to aging 
        include 167 ongoing programs. 93 Merit Review awards 
        are focussed on the neural substrates of 
        neurodegenerative diseases prominent with increasing 
        age: cellular functioning, factors influencing the 
        advance of neurodegeneration, and ways to decrease cell 
        death. Many of our REAPs have a specific focus on 
        Parkinson's disease, stroke, Alzheimer's disease, and 
        ischemia.
           $3 Million in research support funds 
        immunology research relative to aging, with a 
        particularly strong emphasis on arthritis. The majority 
        of investigative efforts are directed at understanding 
        the mechanisms of immune response, regulation, 
        mediators involved and the signaling pathways via which 
        the mediators exert their biologic effect.
           In the area of oncological disorders, MRS 
        funds a high number of programs in prostate disease, 
        with $5.0 Million in funding. The focus of the various 
        programs on prostate cancer is very diverse, but 
        includes more sensitive screening techniques and 
        delineating basic mechanisms by which prostate cancer 
        frequently metastasizes to the bone with the hope of 
        developing and testing effective therapies to prevent 
        cancer spread. Other ongoing research in oncology is 
        directed towards understanding the relationship between 
        age and skin cancer, and the basic biology of colon 
        cancer.
           The endocrine research program related to 
        aging remains strong, with $10.4 million dollars in 
        2002. This area of research is particularly pertinent 
        as it encompasses the regulational changes affecting 
        many areas, e.g. bone, metabolism, obesity, etc. 
        Studies are directed to delineating the cellular basis 
        of bone formation, regulation, and density; assays and 
        function of hormonal systems, and osteoarthritis.
           Diseases of the cardiopulmonary system are 
        being supported at a cost of $13.3 million. These 
        studies include the use of state-of-the-art 
        biochemical, molecular and genetic approaches to 
        understand atherosclerotic plaque formation and 
        ischemic injury and basic electrophysiology research. 
        Some promising new approaches being studied by VA 
        investigators in this area include tissue engineering, 
        multisite pacing, and measurement and activation of 
        brain natriuretic peptide (BNP).
           $3.8 million is directed to behavioral and 
        psychiatric disorders studies related to aging, 
        including cognitive status in neurodegenerative 
        disease, aging brain function, age-dependent effects of 
        alcohol, sleep disorders, and depression that may 
        accompany disease such as coronary heart disease or 
        bone loss.
Rehabilitation Research and Development Service
    Rehabilitation Research and Development (Rehab R&D) is an 
intramural program for improving the quality of life of 
impaired and disabled veterans through a full spectrum of 
research activities. As the population of aging veterans with 
chronic disease expands, in part because of improved survival 
following catastrophic events, the need for research increases. 
Rehabilitation's fundamental clinical goal is to maximize 
functional recovery, which often means teaching compensatory 
techniques and providing adaptive technology. The long-term 
effects on outcomes of many traditional approaches remain 
unproven and, as rehabilitation moves forward, researchers must 
examine efficacy to allow medical practice to be truly 
evidence-based.
    This is why nearly 75 percent of Rehab R&D's portfolio of 
funded projects relates to some aspect of aging. This includes 
neurological disease, spinal cord injury, mobility issues, 
prosthetic and orthotic devices, orthopedic interventions, 
communication disorder interventions, as well as sensory and 
cognitive aids. Centers of excellence and a community of 
scientists, clinicians, and engineers are engaging in 
innovative research that will not only assist veterans to 
manage their disease and impairment, but also play an integral 
role in restoring function. In addition to supporting 
scientific inquiry, Rehab R&D cultivates partnerships with 
nationally recognized organizations such as the Rosalynn Carter 
Institute for Human Development, National Institutes of Health, 
and National Science Foundation to sponsor consensus 
conferences and seminars to set the research agenda in 
rehabilitation medicine.

                        A. Centers of Excellence

    Eight of twelve centers of excellence are the sites of 
innovative rehabilitation research seeking solutions to the 
needs of aging veterans with disabilities. Within each center 
Investigators and clinicians, in complimentary research areas, 
conduct collaborative studies to create multidimensional 
rehabilitation solutions. Across the nation, our investigators 
and clinicians are working on tangible ways to enhance aging 
veterans' quality of life. The eight centers of excellence are:
Vision/Hearing Loss
    Two Rehabilitation Research Centers currently focus on low 
vision. The Atlanta center has recently narrowed its focus to 
rehabilitation for aging veterans with vision loss. Their work 
includes establishing outcome measures for blind rehabilitation 
therapies and incorporating orientation and mobility techniques 
into diverse physical environments. The Boston center brings 
nanotechnology expertise to the science of developing retinal 
prostheses for persons with age-related macular degeneration. 
Investigators are committed to restoring vision, minimizing 
invasive surgery, and optimizing ophthalmic care.
    Investigators at the Portland center have contributed to 
current guidelines associated with early detection of hearing 
loss due to ototoxicity and are respected for their therapeutic 
work in ameliorating tinnitus. Other areas of work include 
establishing parameters for hearing aid use and developing 
methods of creating public awareness for preventing hearing 
loss.
Mobility
    At the Human Research Engineering Laboratories in 
Pittsburgh, investigators are dedicated to transferring 
research findings into devices and clinical practices, which 
serve the mobility needs of veterans. Wheelchair manufacturers, 
government agencies, and consumer organizations utilize 
Pittsburgh's wheelchair-testing program to improve wheelchair 
design. Currently, investigators in collaboration with the 
Atlanta research center, are developing a robotic walker for 
frail elderly with visual impairment. The device uses sensor 
information combined with user input to negotiate safely around 
obstacles.
Arthritis
    Arthritis is a common skeletal disease in the elderly and 
annually costs the U.S. more than $55 billion for treatment. 
For these reasons, researchers at the Center for bone and joint 
rehabilitation in Palo Alto, focus on preventing and restoring 
loss of function in individuals with osteo-, rheumatoid-, and 
traumatic-arthritis. Their efforts include the identification 
of new design concepts for longer lasting joint replacements, 
cartilage repair and regeneration, and the development and 
evaluation of devices and therapy protocols.
Stroke
    Constraint-induced therapy to recover function after stroke 
is a promising rehabilitation therapy for stroke and other 
paralyzing disease states. Researchers are capitalizing on new 
knowledge about brain plasticity to bring about recovery in 
paralyzed limbs through forced use. However, appropriate timing 
of therapy, intensity of therapy, and adjunct pharmacotherapies 
are all open-ended questions. Researchers at the Gainesville 
center are addressing these issues. They work closely with the 
Rehabilitation Outcomes Center for Stroke, jointly funded 
through VA Health Services Research and Development and Rehab 
R&D.

                 B. Research Enhancement Award Program

    The Research Enhancement Award Program (REAP) supports 
collaborations between funded VA investigators with 
complimentary backgrounds, skills, and training. They function 
in ways similar to a center, but on a small scale.
    The Tampa VA has a REAP focused on technology to prevent 
adverse events in rehabilitation directed toward patient safety 
and solutions to manage patient falls, pressure ulcers, and 
pain. These area impact both veterans with disabilities and 
those who have disabilities as a consequence of aging. Data 
derived from this REAP could identify low- and high-technology 
solutions to significantly reduce adverse events in 
rehabilitation, speed a patient's recovery, and decrease 
healthcare costs.
    A tissue engineering-based rehabilitation REAP located at 
the Boston VA will build on tissue culture, molecular biology, 
and collagen and proteoglycan biochemistry research. 
Investigators hope to develop a method for tissue and organ 
regeneration, which would supplant the use of prosthetic and 
orthotic devices. This would aid veterans affected by traumatic 
injury, disease, or aging. Tissue and organ regeneration holds 
promise to revolutionize rehabilitation and provide 
opportunities for more complete recovery.
    A REAP in Mountain Home, TN adds a great deal to Rehab 
R&D's portfolio in hearing loss and vestibular dysfunction. 
Understanding speech in adverse listening environments is a 
major problem for those with hearing loss. Researchers want to 
gain a more complete understanding of this problem and 
developing solutions to overcome it. As with hearing loss, 
vestibular dysfunction, which can be manifested as dizziness 
and balance problems, also affects the aging veteran 
population. Researchers are exploring therapies to ameliorate 
this problem.

                   C. Office of Academic Affiliations

    All short- and long-range plans for the Veterans Health 
Administration (VHA) that address the healthcare needs of the 
Nation's growing population of elderly veterans include health 
professional training activities supported by the Office of 
Academic Affiliations (OAA). Clinical experiences with 
geriatric patients are an integral part of healthcare education 
for approximately 76,000 HVA health trainees, including 28,000 
resident physicians and fellows, 16,000 medical students, and 
32,000 nursing and associated health students. Each year these 
residents and students train in VA medical centers 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 increasing 
size of the aging veteran population, VHA continues to promote, 
coordinate, and support geriatric education and training 
activities for physicians, dentists, nurses and other 
associated health professional trainees.

                           GERIATRIC MEDICINE

    The VA healthcare system offers clinical, rehabilitation, 
and follow-up patient care services as well as education, 
research, and interdisciplinary programs. These constitute core 
elements required for the training of physicians in geriatric 
medicine. The demand for physicians with special training in 
geriatrics and gerontology is growing because of the rapidly 
growing numbers of elderly veterans and aging Americans.
    Since the last Congressional Report in 1999, OAA has 
continued its support for Accreditation Council for Graduate 
Medical Education (ACGME)--accredited subspecialty training in 
geriatric medicine and geriatric physchiatry. In AY 2002, OAA 
supported 176 geriatric medicine positions and 27 geriatric 
positions.
    In addition to its ongoing support for geriatric medicine 
and geriatric psychiatry positions, OAA began a new Special 
Fellowship in Advanced Geriatrics in AY 2000. This program is 
for post-residency physicians who have completed ACGME-
accredited subspecialty residency training in geriatric 
medicine or geriatric psychiatry and want to lead geriatrics in 
academic centers and health systems. Fellows receive two years 
of additional training in geriatric research, advanced 
education, and advanced clinical care. Fellows spend 
approximately 75 percent of their time in geriatrics research 
and education and 25 percent in advanced clinical care.
    In AY 2002, OAA supported eight fellows at five Geriatric 
Research, Education, and Clinical Center (GRECC) sites. During 
the last year, OAA also supported a total of 12 physicians 
pursuing post-residency fellowship education in geriatric 
neurology.

               NURSING AND ASSOCIATED HEALTH PROFESSIONS

    Based on its large number of elderly patients, VA offers 
all affiliated students clinical opportunities in the care of 
the elderly. VA also has special programs that focus on 
geriatrics.

 GERIATRIC EXPANSION PROGRAM AND THE GERIATRIC RESEARCH, EDUCATION AND 
                        CLINICAL CENTERS (GRECC)

    A special priority for geriatric education and training is 
recognized in the allocation of associated health training 
positions and funding support to VAMCs hosting GRECCs and to 
VAMCs offering specific educational and clinical programs for 
the care of older veterans. In FY 2002, a total of 229 
associated health students received funding support in the 
following disciplines: Social Work, Psychology, Audiology/
Speech Pathology, Clinical Pharmacy, Advanced Practice Nursing, 
Dietetics, and Occupational Therapy.

               POSTDOCTORAL PSYCHOLOGY FELLOWSHIP PROGRAM

    In 2002-2003, the psychology postdoctoral fellowship 
program at six facilities offered geropsychology as an area of 
emphasis for eight fellows. In addition, five facilities 
offered neuropsychology as an area of emphasis for five 
fellows. Much of the neuropsychology content relates to the 
care of elderly veterans.

        INTERPROFESSIONAL FELLOWSHIP PROGRAM IN PALLIATIVE CARE

    In AY 2002, VA facilities at six location (Bronx, Los 
Angeles, Milwaukee, Palo Alto, Portland, and San Antonio) 
initiated the new Interprofessional Fellowship Program in 
Palliative Care. This is the first interprofessional palliative 
care fellowship program in the country. The Palo Alto facility 
was selected as the hub site to coordinate fellowship 
activities across all sites. Each fellowship site is allocated 
four full-time equivalent paid trainee positions with no more 
than two positions being post-residency physicians. In AY 2002, 
seven physicians, seven nurses, three psychologists, nine 
social workers, two chaplains, and one pharmacist were fellows 
for a total of 29 fellows.

                   Summary of Training in Geriatrics

    Through its fellowship, residency, and associated health 
training, VA continues to make outstanding contributions to the 
Nation's health professions workforce and to foster excellence 
and leadership in the care of elderly veterans.

                    D. Office of Employee Education

    The Employee Education System (EES) supports the mission 
and vision of the Department of Veterans Affairs by offering a 
variety of learning opportunities to personnel working in the 
specialty of geriatrics and extended care. The goal of such 
learning activities is to enhance the care delivered to the 
elder VA patient by increasing the skills and knowledge of VA 
staff that provide care to the geriatric population. EES works 
in collaboration with VA Central Office, VISN (Veterans 
Integrated Service Network), and VA medical center staff to 
develop educational initiatives that are relevant and 
responsive to the needs of the healthcare professionals 
throughout the system. EES provides funding for programs at the 
local, VISN and national levels.
    During the past year, EES supported approximately 52 
national, medical center, and VISN level programs in geriatrics 
and provided services and products in the specialty. While 
several programs have been interdisciplinary in nature, 
collaborating with mental health and primary care, the 
geriatric component has been a major focus. Programs that have 
had a system-wide scope include, but are not limited to, the 
following: Hospice and Palliative Care Education, Care Issues 
in Alzheimer's Disease and Other Dementing Illnesses, Community 
Nursing Home Programs: Introduction to Oversight Standards, 
Community Residential Care, Geriatric Skills in a Community 
Based Outpatient Clinic Setting and Late Life Cognitive and 
Geriatric Disorders. Also during 2002, EES worked closely with 
the Office of Geriatrics and Extended Care in their efforts to 
place emphasis on end of life programs to prepare VA staff in 
providing quality care to veterans in this transitional stage 
of life.

                      E. Chief Information Office

                        OFFICE OF COMMUNICATIONS

    The widespread education and training activities in 
geriatrics have generated system wide requirements for 
information throughout VA. Local library services continue to 
perform hundreds of on-line searches on databases such as 
MEDLINE and other bibliographic databases, and continue to add 
books, journals, and audiovisuals on topics related to 
geriatrics and aging. During FY2000, two titles on geriatrics 
were purchased and distributed to the VA Library Network 
(VALNET).

                 III. Veterans Benefits Administration

                      A. Compensation and Pension

    Disability and survivor benefits such as pension, 
compensation, and dependency and indemnity compensation 
administered by the Veterans Benefits Administration (VBA) 
provide all, or part, of the income for 1,463,350 persons age 
65 or older. This total includes 1,074,519 veterans; 381,592 
spouses; 6,495 mothers; and 744 fathers as of end of month 
September 2002.
    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 acknowledgment of the need for economic security of the 
nation's oldest veterans. The current amount added to the basic 
pension rate is $2,197 as of December 1, 2002.

                              B. Outreach

    VBA Regional Office personnel maintain an active liaison 
with local nursing homes, senior citizen homes, and senior 
citizen centers in an effort to ensure that older veterans and 
their dependents understand and have access to VA benefits and 
services.
    This liaison is enhanced by VA's Fiduciary Program. VBA 
Regional Office staff provide oversight in the management of VA 
benefits paid on behalf of incompetent beneficiaries. Many of 
these beneficiaries are elderly and have been found mentally 
incapable of handling their financial affairs. This oversight 
includes appointment of a fiduciary and supervision of the 
fiduciary and beneficiary, which includes periodic personal 
visits with the beneficiaries to ensure that their needs are 
being met and VA funds are being used properly.
    Regional office staff visit these facilities as needed or 
when requested by the service providers. VA pamphlets and 
application forms are often provided to the facility management 
and social work staff during visits. State and Area Agencies on 
the Aging have been identified and are provided pamphlets and 
other materials about VA benefits and services through visits, 
workshops and pre-arranged training sessions. When requested, 
senior citizen seminars are conducted for nursing home 
operations staff and other service providers who assist and 
provide service to elderly patients. Regional office staff 
participate in senior citizens fairs and information events, 
thereby visiting and participating in events where the audience 
is primarily elderly citizens. Regional office outreach 
coordinators continue to serve on local and state task forces 
and represent VA as members of special groups that deal 
extensively with the problems of the elderly.

                                 
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