periods of rising inflation. Often the elderly of the city are faced with such hard choices as meeting housing and food costs at the expense of health care or some other necessity.

In the absence of, or in addition to, increased levels of cash assistance to older Americans, local efforts to alleviate this income deficiency center on affirmative action relative to job retention and provision, consumer advocacy, and such income supplements as special utility tax rates and discounts on goods and services.

A second area of major concern is housing, as both elderly homeowners and renters face considerable difficulties in maintaining suitable shelter. Elderly homeowners-48.5 percent of the elderly-often find property taxes, utility rates, and maintenance costs beyond their means. Even simple home repairs may require physical or fiscal strains on limited resources. Often the neighborhoods where older persons have lived for years have deteriorated; lack of mobility forces these older persons to continue living in unsafe or unsuitable conditions.

Older renters often live in unsafe dwellings which landlords fail to maintain. Elderly tenants fear to request improvements which might result in indiscriminant rent increases. Rents often consume 50 to 70 percent of an elderly person's income, unless the individual participates in a rent-subsidy program. Urban renewal and the renovation of many older neighborhoods have caused considerable dis placement of elderly renters. Many face constant fear of eviction and the difficulty of finding affordable, habitable new housing. This fear is exacerbated by anticipated difficulties in relocation-packing, cleaning, and moving possessions, often without assistance.

Among solutions being pursued, or explored, for older persons with housing problems are expanded congregate housing, the provision of rent subsidies to occupants of both congregate housing and standard units, and the provision of low-interest rehabilitation loans and home repair programs for elderly homeowners.

Older persons in the city continue to identify transportation as their most critical service need, recognizing it as a vital link to both the basic necessities of life-health and social service destinations, food stamp offices and nutrition centers, grocery shopping as well as to civic, educational, religious, and cultural activities in the com munity.

A majority of the elderly must depend on either public mass transit or special transportation for their mobility, as many older persons don't own or cannot operate-or cannot afford to operateautomobiles, and have no one to transport them on a regular basis.

Our public mass transit system-New Orleans Public Service, Inc. -operates in all parts of the city and provides generally excellent service to the working man, with routes and operational procedures geared to this group. Although a half-fare rate is in effect for per sons 65 years of age and older during offpeak hours, utilization of the service by the elderly is limited somewhat by the physical, oper ational, and psychological barriers to its use which many older people experience. Although taxi service is available, it is, by its very nature, expensive and thus does not constitute a regular mode of transit for many elderly.

Special transportation services, on a demand-responsive basis, ar provided through a number of voluntary agencies utilizing Older

Americans Act and Social Security Act funding. One private organization provides service to the disabled on a fee-basis. A number of organizations operate vehicles purchased under the Urban Mass Transportation Act-UMPTA-Section 16 (b) (2). However, these systems have neither the capacity to meet the large demand for service, nor are they coordinated to assure maximum utilization by the elderly and handicapped.

Among local approaches to these problems currently under consideration are improved access to public mass transit for the elderly and handicapped, the coordination of special transportation resources and the linkage of special systems to mass transit, and the exploration of special-rates and services to the elderly by cab companies.

Another area of concern is nutrition. As you know, the elderly have been characterized by the U.S. Senate's Nutrition Committee as "the most uniformly malnourished segment" of our society. This tendency among the elderly is closely associated with the poverty many face, with the isolation and apathy many experience following the loss of family and friends, and with the infirmities of age which inhibit grocery shopping, food preparation, and even the processes of eating and digestion.

Yet health specialists contend that perhaps more than any other aspect of living, good eating patterns and proper nutrition are critical to health and well-being. In order to counter the deleterious effects of poor nutrition in the elderly, a title VII nutrition program is operated in the city by the New Orleans Council on Aging. The project provides hot noon meals, 5 days a week, to 1,400 persons in 23 congregate settings throughout the city. Leisure time activities and supportive services are also provided.

A limited number of meals are home-delivered to participants temporarily unable to visit the meal sites. In addition, a homedelivered meals program operated by Associated Catholic Charities under Title XX, Social Security Act, utilizes friendly visitors to deliver meals to 80 home-bound elderly each weekday.

As demand for participation in both the congregate and homedelivered meals program far exceeds capacity under available resources, local advocacy to expand nutrition programs through participation by public and parochial school cafeterias is warranted. Health Care is another area of great concern to the city's elderly. We know that 85 percent of the elderly have at least one chronic illness and that older persons average twice as many doctor visits per year as the general population. But health care for the elderly is both costly and hard to secure. Although a large percentage of the elderly are medicaid eligible-Title XIX, Social Security Act-and many receive medicare benefits (title VIII, Social Security Act), these plans do not cover many health-related costs-dentures, certain medications, transportation for health facilities, many in-home services. Other persons whose incomes are high enough to make them ineligible for special benefits may suffer great hardship when inflicted by chronic illness. According to Ethel Shanas, thê—

Possibility of extended illness is the greatest single threat to the peace of mind of the elderly."

In seeking health care, older persons find that many area physicians refuse medicaid assignment; finding those willing to treat medicaid patients is often problematic. Charity Hospital's vastness is intimidating to the elderly; at Charity, as at other area hospitals, geriatric escorts and advocates are needed to cut through the bureaucracy and assure that older persons get needed services. Mental health care facilities, participating community mental health centers, are underserving the elderly and have few programs geared toward their special needs. Nursing home care in the city is primarily custodial, although some skilled beds are available.

Local efforts to assure better health care for the elderly therefore empha size health screening and prevention, strengthening of activities to secure physician and hospital services, and stimulating the provision of community mental health services to this group.

Another need expressed by elderly New Orleanians is for adequate suppor tive services. Ethel Shanas has established at the national level that 14 percent of the noninstitutionalized elderly require, due to delibilitating chronic illness, supportive services in order to continue living at home. The waiting lists locally for such services as homemakers, home-delivered meals, and adult day care certainly attest to the demand. In addition to the supportive services needed by this vulnerable population, other programs and services benefit older persons who are physically fit but need companionship and involvement. These include congregate meals programs and senior centers. Legal and protective services should also be available under the Older Americans Act and the Social Security Act to support such activities and a special State appropriation provides funding for senior center operations, the demand again outstrips available resources. The Area Agency on Aging reports that we are meeting only a maximum of 8 to 10 percent of the estimated need for any of these priority services.

Local efforts to expand service delivery are concerned with pulling in addi tional funding from the public and private sectors to better meet service demand. But in addition to meeting the basic needs of the elderly, I am concerned that we also provide them with opportunities for meaningful involvement. Opportunities for leisure time activities will be available through 12 senior centers in the city (as of January 1978) as well as in nutrition sites and NORD Golden Age Clubs. Other recreatonal programs which afford intergenerational activity should be encouraged. The strengthening of programs for the elderly through community schools would afford opportunities for continuing education. Further, affirmative action to involve older persons on policy and advisory boards would encourage the active participation by this group in those areas of community life which most affect them.

That portion of the material up to the point where I begin iden tifies the needs of the elderly in New Orleans and the service responses to these needs either now being pursued or formulated by local aging service agencies, interested public officials, and concerned citizens.

However, despite these cooperative efforts, we recognize that these pressing needs will only be met in part until vital policy, resource, and organizational issues are resolved through Federal leadership.

The policy and resource issues appear closely aligned. We must determine, as Dr. Robert Butler has suggested, what we as a nation want for ourselves when we are old and what we want for all those who are old today. Many public policy specialists contend that in order to provide adequate income and supportive services to a growing, largely dependent population, we must drastically reorder our priorities and our resource allocation patterns. Others have advocated that we establish new patterns of work and leisure that would extend productivity among all able citizens during the later years of life.

Although the development of a major national policy which sets forth our expectations for the quality of life older persons will ex

perience in this country must be forged over time, such considerations appear particularly relevant during deliberations over the reauthorization of the Older Americans Act during the next few months.

I should therefore like to take this opportunity to express briefly some local concerns relative to this significant legislation. The aging network established under the amendments to the act in 1973 has made notable progress toward the development of a comprehensive service delivery system for the elderly. The Area Agency on Aging, district I, has worked closely with the New Orleans Council on Aging in this regard (Parish Councils on Aging predated the establishment of the Area Agencies on Aging in the State of Louisiana; they have traditionally served as a focal point for elderly concerns). While the Area Agency has discharged its mandate to plan, coordinate, and administer needed services under contract and stimulate the commitment of other resources to the elderly through advocacy and pooling, the Council on Aging continues to serve as the focal point for service delivery to the elderly in the parish. In addition to providing such vital services as information and referral and outreach, nutrition, homemakers, and housing assistance to the elderly, the council provides the leadership and case advocacy necessary to assure that older persons negotiate the still fragmented systems of assistance and services which shape their lives. Although relationships among the elements of the aging network are still being formulated elsewhere, in New Orleans the symbiotic working relations of these two offices have resulted in the pulling-in of significant Federal, State and local resources (over $800,000 in nonOlder Americans Act funding was "pooled" in District I last year alone) and enhanced responsiveness by voluntary agencies and organizations to the needs of the elderly.

Nevertheless, efforts of our aging service agencies at the local level are often hampered by constraints on the authority and capacity of the network at the Federal level. Therefore, the following recommendations are respectfully posited (many of which are supported by network agencies):

1. To lend additional authority to the network's efforts:

The Administration on Aging should be made an independent agency within the Department of Health, Education, and Welfare with the Commissioner on Aging reporting to the Secretary.

All programs authorized under the Older Americans Act should be administered through the Administration on Aging, the State units on aging, and the area agencies on aging.

The aging network at all levels should have review and comment on plans for implementation at their respective levels which could have significant impact on older persons.

2. To increase the capacity to effectively meet needs of the elderly: Funding levels under the Older Americans Act should be increased to allow for inflation and program growth.

The allocation of funding on a block-grant rather than categorical approach under the act should be explored (local aging agencies feel that allocation of funds among services would not change dramatically but more flexibility would be allowed to utilize these funds to meet priority needs in concert with local resources).

The Federal level of the network should provide leadership in establishing standards for service delivery and initiating formal impact evaluations of major services.

Additionally, the older persons in New Orleans would be better served through the following federal initiatives:

The raising of the ceiling on title XX, Social Security Act funding above the current $2.5 billion; The provision of incentives to States to balance the flow of medicaid (title XIX, Social Security Act) funding between institutional and in-home services;

The initiation of a major Home-Delivered meals program in conjunction with title VII, Older Americans Act;

The provision of additional funding for legal and protective services.

In conclusion, it would appear that we in this country have now developed sufficient technology to assure that most older persons live out their lives in dignity and relative independence. The challenge before us, at all levels of Government, is to work toward establishing the necessary policy resolutions and resource commitments that will make the potential of the later years a reality.

Senator EAGLETON. Thank you, Mr. Morial. [Applause.] I think your concluding recommendations, points 1 and 2 with the various subparts are very, very well considered. Some of these we have recommended previously, but we did not have the ear of the previous administration and I am not sure whether we have the ear of the present administration. For instance, I think it is your first one, yes, at the bottom of page 5:

The Administration on Aging should be made an independent agency within the Department of Health, Education, and Welfare with the Commissioner ou Aging reporting to the Secretary.

We have found that at least in the past years, the Commissioner of Aging is so far down the ladder of success, as it were, in the Department of Health, Education, and Welfare, it is sort of shunted over to the side.

You have seen those flow charts. You have the President up here and the Secretary of HEW over here and then undersecretaries and assistants and the poor old aging was down in the lower righthand corner. It was pretty hard to figure out to whom he did report or whether his message finally got up to the secretary of Health, Education, and Welfare. I subscribe to your recommendation that programs relating to aging are a significant part of the Department of Health, Education, and Welfare, and that the Commissioner-and we have a new nominee for that post-should have direct access to the secretary.

I don't know whether we will be able to persuade the new administration as to the wisdom of that any more than we were able to with the predecessors, but I subscribe to that and several of your recommendations.

Let me just ask one question, if I may, because it was touched on by Mayor Landrieu and mentioned on page 2 of your prepared statement, that part which was included in the record, specifically regarding transportation for the elderly. As a backdrop to my ques tion, let me mention a personal experience of mine.

For several years I was chairman of the Senate District of Columbia Committee, the least coveted assignment in the United States Senate, I might add. In the early days of my being chairman, there was a subway, and still is, being built in the District of Columbia called Metro.