Testimony

Statement by
Josefina G. Carbonell, Assistant Secretary for Aging, Administration on Aging
on
Fiscal Year 2004 President's Budget for AOA
before the
The House Committee on Appropriations, Subcommittee on Labor, Health and Human Services

March 25, 2003

Good morning, Mr. Chairman, and members of the Subcommittee. I am pleased to be here today to discuss the President's Fiscal Year (FY) 2004 budget request of $1.344 billion in discretionary budget authority for the Administration on Aging (AoA).

Longer life expectancies and a growing senior population have increased the challenge of meeting the needs of older Americans. Today, almost one-sixth of our nation's population, over 46 million people, are age 60 and older. This includes 4.4 million seniors age 85 and older, a number that is projected to triple by the year 2030.

As a career-long advocate for older Americans, I have seen first hand the dramatic way in which AoA programs affect the lives of elderly individuals. For example, data for FY 2001 shows that we help seniors to maintain their independence by providing over 40 million rides and over 13 million information and referral contacts; we foster health by providing 250 million meals and 2.5 million hours of nutrition education and counseling each year; and we help prevent unwanted institutionalization through 10 million hours of homemaker services and 1.3 million hours of chore services.

But AoA programs do not just provide services. They serve as a catalyst for the vast array of programs across the Federal government which focus on meeting the needs of seniors and their families. The President's budget makes a substantial investment in these programs, and our FY 2004 request will enable AoA to make important contributions to initiatives that seek to expand choices and improve the quality of services. In FY 2004, we will support efforts to "rebalance" the system of long-term care toward providing greater options for seniors to receive care in the community, build partnerships with other agencies which improve coordination of services and promote healthy and active aging, and maintain support for core home and community-based services which have demonstrated their effectiveness in serving older Americans.

SUPPORTING "REBALANCING" OF THE LONG-TERM CARE SYSTEM

AoA programs and the aging network's infrastructure provide a foundation for the Department's efforts to "rebalance" the system of long-term care toward relying less on institutional care and more on care in the community. We will use the resources of our complete network of State, local, and community service providers to do so. In addition to our Federal agency of 120 employees, our programs are administered by 56 State Units on Aging (SUA), 655 Area Agencies on Aging, and 243 Tribal organizations. They work with over 29,000 service providers and an estimated 500,000 volunteers across the country. And this does not include the estimated 23 million caregivers who help elderly family members, neighbors and friends every day.

The aging network is one of the nation's largest providers of home and community-based services and has a long history of partnering with other Federal, State, and local agencies to deliver long-term care services to seniors where they live. Thirty-one SUAs are responsible for managing one or more Medicaid waivers, and many States have designated their office on aging with lead responsibility for their home and community-based long-term care system.

AoA is actively working with other agencies to integrate service systems and develop information on options for expanding community-based care. We have worked with the Centers for Medicare and Medicaid Services (CMS) to make sure that older adults with disabilities were eligible for services under the Real Choice Systems Change Grants initiative, which helps States to redirect and integrate their systems of care to respond to older people's preference for care in the community. We also worked to ensure that the SUAs were eligible to be designated as the lead agencies for their States' Systems Change grants and could participate in their development and implementation.

In addition, we are working with the Office of the Assistant Secretary for Planning and Evaluation and others to identify State trends in long-term care; develop case studies on flexible service models that have been used to create more community options for older people; and evaluate projects that promote "Aging In Place" by providing services to seniors where they live. This information will provide a valuable resource for Federal and State efforts to rebalance the long-term care system, including the Department's five year, $1.75 billion "Money Follows the Individual" Rebalancing Demonstration, under which the Federal government will invest resources to provide incentives to States to transfer individuals from institutional to community care.

Our FY 2004 budget will help the aging network build the capacity to support this transformation through the establishment of Aging "One-Stop Shop" Centers. We will use part of our $28 million request for Program Innovations, which promotes new and innovative approaches to meeting the needs of seniors, for this effort. By serving as a visible and trusted resource for information on long-term care, these Centers will help to eliminate the confusion and frustration that families now face when confronted with a range of overlapping programs and multiple service providers. The Centers will also provide information on best-practices and model programs which States can use to reduce nursing home care and increase community-based care choices, which is what seniors prefer. A number of States, including Colorado, Oregon, Texas, Vermont, Washington, and Wisconsin, have already begun to implement these changes and have seen dramatic results. For example, the State of Washington increased the percentage of its Medicaid long-term care funds spent on home and community-based care from 22 percent to 48 percent over seven years, enabling it to serve twice as many seniors at home as in nursing homes, at a lower net overall cost.

BUILDING PARTNERSHIPS TO SERVE PEOPLE BETTER

Our efforts to expand options for home and community-based care represent just one of the areas in which AoA is collaborating with other agencies and levels of government to better meet the needs of seniors. These partnerships will help providers pool resources and coordinate services so that they can improve program performance and serve seniors better. For example:

  • AoA is working with the Centers for Disease Control and Prevention (CDC) on the Aging States Project, by pooling resources to support health promotion projects targeting seniors which promote physical activity, walking programs, improved diet, and healthy lifestyle choices.
  • We are collaborating with CMS to capitalize on the vast experience of the nation's over 13,000 volunteer ombudsmen by involving them in the Nursing Home Quality Indicator Initiative (QI). Ombudsmen were trained to provide information and assistance on how quality indicators can help consumers make informed nursing home placement and care decisions.
  • AoA is partnering with the Federal Transit Administration (FTA) to increase coordination of planning and funding for transportation services. Data shows that one-third of elders receiving transportation services rely on it for virtually all of their transportation needs. This equates to roughly one million elders who in all likelihood would become homebound were it not for this service. AoA and FTA will work to disseminate information on promising practices and conduct regional technical assistance sessions to promote models and new approaches for coordinating transportation resources.

In FY 2004, AoA will build on this track record of successful collaborations by partnering with CDC and other HHS agencies to support the Department's $125 million Steps to a Healthier U.S. Initiative, the goal of which is to help Americans live longer, better, and healthier lives. At the heart of this program lie both personal responsibility for the lifestyle choices Americans make and social responsibility to ensure that policy makers support programs that foster healthy behaviors and prevent disease. This initiative will focus on diabetes, obesity, asthma, heart disease and stroke, cancer and the lifestyle choices including poor nutrition, physical inactivity, tobacco use, and youth risk-taking. Many of these diseases have a significant impact on older Americans: between 15 and 23 percent of adults over 60 are obese; diabetes is the sixth leading cause of death for persons age 65 years or older; and 2 million people age 65 and older have asthma. AoA will work with our partners in this initiative to develop activities focused on the unique needs of seniors.

MAINTAINING SUPPORT FOR EFFECTIVE CORE PROGRAMS

The FY 2004 request provides funding for most of our core programs at levels which are about equal to both FY 2002 and FY 2003, including over $718 million for nutrition programs which provide meals to seniors at home and in congregate settings. These programs provided over 250 million meals to seniors in FY 2001, and preliminary outcome survey data shows that over 75 percent of elderly meal recipients are at "high nutritional risk". This request includes funding for the Nutrition Services Incentive Program (NSIP) which was transferred from the Department of Agriculture to AoA in the FY 2003 appropriations legislation. In FY 2004, NSIP funding will continue to be available exclusively for meals, States will retain the option to receive commodities in lieu of cash, and funds will continue to be distributed based on the number of meals served in the prior year. .

For other core programs, our budget includes $520 million for grants to States for home and community-based supportive services, including services to family caregivers and preventive health services. It allocates over $26 million to grants for nutrition and supportive services for Native Americans. And it provides almost $32 million for activities which protect and support vulnerable populations - including persons with Alzheimer's disease - and provide information and assistance to the aging network, seniors, and their families.

I am pleased to say that our report includes final performance data for FY 2001, including data for the family caregiver program. Our report also includes preliminary outcome data from six national surveys of major AoA services. This data shows that AoA programs continue to be effective in meeting the needs of seniors and producing the results sought by the Older Americans Act. For example:

  • States have reported serving over 275,000 caregivers, exceeding our proposed target of 250,000. Eighty-eight percent of caregivers reported that services enabled them to provide care longer than they otherwise could have.
  • 85 percent of elders and family members seeking information from the network reported getting the information they needed and expected.
  • Over 80 percent of transportation recipients rated the service as excellent or very good, and 76 percent said they would recommend it to their friends.

FOCUS ON THE CHALLENGE OF AN AGING POPULATION

Finally, we are requesting $2.8 million in three-year funding to cover start-up costs for a White House Conference on Aging. Historically, these conferences have served as catalysts for the development of aging policy and led to improvements in the programs which assist seniors and their families. In fact, the development of many of the programs which have fostered a better quality of life for older Americans were prompted by the recommendations of prior White House Conferences on Aging. This conference would be the first of the 21st century and the fifth overall.

I am proud of the successes that AoA and the aging network have achieved, but there is still more to be done. We must continue to foster better access to an integrated array of health and social supports, ensure that elders are encouraged to live active and healthy lives, help families to care for their loved ones at home, protect our most vulnerable seniors from abuse and exploitation, and promote effective and responsive management for all our programs. I am committed to these goals and I look forward to working with the members of this Committee to advance them in every possible way.

Thank you for inviting me here to address you this morning. I am happy to answer any questions you may have.