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**AoA Update**

**Volume 2Issue****6-Administration on Aging - June****1997**

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#### AoA Holds Aging Network FieldForums - Consumer Rights, Managed Care Are Topics of ConcernAoA’s Information Network Aids AgingNetwork and ConsumersOlder Americans Act Priorities Fraud and Abuse TargetedWelfare Reform Act Still Poses UnansweredQuestionsManaged Care Poses Many Unanswered QuestionsCaregivers Resource Fair Offers Help toFederal WorkersStakeholders Meeting Offers Ideas forthe Future AoA Teams Up With EPA and Others to Save theEnvironmentAoA Staff HonoredHHS Secretary Launches HealthfinderWeb SiteBladder Control Kits AvailableOlder Americans Month PresidentialProclamation****

### AoA Holds Aging Network Field Forums -Consumer Rights, Managed Care Are Topics of Concern

The Administration on Aging (AoA) held the first of sevenaging network field forums on April 24 in Washington, D.C. Theforums provide an opportunity to present AoA’s prioritiesand positions on key topics to aging network members. They alsooffer AoA staff the chance to learn about other issues beingdiscussed by aging network members, and to address the broaderissues of the aging network and the Older Americans Act (OAA).

Acting Principal Deputy Assistant Secretary for Aging, WilliamBenson, opened the Washington, D.C. forum, attended byapproximately 100 members of the aging network. He emphasizedAoA’s responsibility to help the vulnerable elderly andstressed that consumer empowerment and protection are AoApriorities. "We are committed to focusing on the role ofolder people as consumers--promoting their participation inplanning, managing and delivering the services they need;enhancing the ability of older people to safeguard themselves,their rights, and their property; and helping older consumers tomake informed choices," Benson said.

Protecting vulnerable older Americans also involves the statelong-term care ombudsman programs, the prevention of elder abuse,and the promotion of state elder rights and legal assistanceprograms, as well as outreach, counseling and assistance. TheseTitle VII programs are central to the advocacy role mandated bythe Older Americans Act.

In addition to consumer advocacy efforts for the vulnerableelderly, the AoA views continued focus on affordable andaccessible home and community-based care, which is preferred bymost older Americans, as a major priority.

It was noted that the national network of state and areaagencies on aging, tribal organizations and service providerscontribute to the flexibility and responsiveness that makecommunity-based services so effective.

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#### AoA’s Information Network AidsAging Network and Consumers

A third AoA focus is information collection anddissemination, especially best practice models which can bereplicated by other aging network members. The AoA is working tomeet the challenges of being the federal focal point, provider,broker and disseminator of information related to the field ofaging, serving consumers, researchers, practitioners, and theaging network.

The AoA web site, an employee initiative, now serves some 500users each day. The address is: http://www.aoa.dhh.gov

The Eldercare Locator is another example of AoA support forinformation and referral services that meet the needs of olderAmericans and their caregivers, while the National AgingInformation Center, now an AoA in-house service, focuses on theneeds of planners, researchers, and practitioners.

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### Older Americans Act Priorities 

Speaking about priorities under the Older Americans Act,Benson said that the AoA wants "to strengthen home andcommunity-based care; consumer protection and advocacy, andprovisions in the Act for public education and information toempower older Americans to make good choices and decisions."

The Administration on Aging applauds congressional efforts tostreamline the operation of state programs under the Act, provideflexibility to the states by eliminating unnecessary federalrequirements, and enhance customer orientation, in attemptsduring the 104th Congress, to reauthorize the OAA.

As we begin debate in the 105th Congress, the AoA alsosupports:

> - distinct program and funding authorization for            Disease Prevention and Health Promotion;
- enabling authority for public-private partnerships            that encourage the private sector to contribute its            experience and resources;
- retention of Title VII for the development of state            systems to protect the rights of vulnerable older            persons and consolidation of the four separate            authorizations so that states have greater            flexibility in allocating funds in keeping with their            local needs;
- development of comprehensive information and            counseling systems in the states to help vulnerable            populations make informed choices about health care            systems and issues; and
- increased flexibility in administering Title VI,            which considers the subsistence needs, local customs,            and other characteristics that are appropriate to the            unique cultural, regional, and geographic needs of            the native elder population being served.

Emphasis also was placed on consumer health care fraud, theGovernment Performance and Results Act (GPRA), Alzheimer’sdisease, welfare reform and managed care. 

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### Fraud and Abuse Targeted

President Clinton has made combating health care fraud apriority not only because it costs billions each year but becauseit affects the integrity of the Medicare and Medicaid programs.Since Operation Restore Trust was instituted in 1995, nearly $190million has been identified for restitution, fines, settlementand recoveries due the federal government. 

Through the shared resources of the AoA, the Office ofInspector General, and the Health Care Financing Administration(HCFA), in collaboration with state and local support, fraud,waste, and abuse were targeted in the areas of home healthagencies, nursing facilities, and durable medical suppliers instates with the highest concentrations of elderly.

These efforts will be expanded to additional states under theHealth Insurance Portability and Accountability Act of 1996.

Under a separate, but related, initiative, AoA will announce,in June, 10 to 12 grant awards--the Anti-Fraud Waste and AbuseCommunity Volunteers Demonstration Projects--that use retiredprofessionals to combat Medicare/Medicaid fraud, waste and abuse.

In discussing the GPRA, Benson noted that the AoA and theaging network have been hampered by a lack of definitiveinformation regarding how program dollars are spent, the purposesthey serve, and the results of the services provided.

Now, the AoA has Office of Management and Budget (OMB)approval to collect basic information on clients and servicesprovided under Titles III and VII of the OAA through the National Aging ProgramInformation System (NAPIS). The NAPIS will serve as thefoundation for compliance with the GPRA which calls forjustification of expenditures under the OAA budget.

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### Welfare Reform Act Still Poses UnansweredQuestions

In discussing the WelfareReform Act, it was noted that the AoA is working on aDepartment of Health and Human Services Immigration Work Groupand a Coordinating Group that reviews all proposals being sent tothe Secretary, OMB, and the White House.

The AoA is concerned about noncitizens who are not eligiblefor SSI and Foods Stamps and is following determinations made bythe states regarding the continued eligibility of elderlynoncitizens for Medicaid and the Social Services Block Grant.

With respect to the OAA, the major issue is the eligibility ofnoncitizens who are not legal residents to participate inprograms. The welfare act provides an exemption for in-kindbenefits that are not means tested, and are necessary for theprotection of life or safety. The law gives the Attorney Generalresponsibility for interpreting these provisions. In apreliminary specification, the Attorney General has exemptedsenior nutrition program, transportation, and protectiveservices. A ruling to the contrary would require states todetermine the citizenship and alien status of anyone seeking aservice.

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### Managed Care Poses Many Unanswered Questions

Since managed care for acute and post-acute care greatlyinfluences access to, and the types of, long-term care available,it is of vital interest to members of the aging network. Somestudies have reported that individuals with chronic conditionshave fared well in managed care, but there are also reports ofless than satisfactory service.

Many elderly are viewed as bad risks because they already havea compromised health status and pose a severe test ofaffordability in a managed care program. "A keyquestion," Benson said, "is, if the system fails thevulnerable, who will care for them? What happens to those inmanaged care arrangements who get less than adequate care? Who isgoing to address these problems? Who controls access to care andunder what conditions? If managed care organizations accept onlythe healthier elderly and disabled population, who is going tocare for the most frail and vulnerable? Will the aging network beleft with the task of caring for the poor, those with the mostserious health problems and those without a caregiving supportsystem?"

The AoA is vitally interested in assuring that managed carearrangements are flexible, user-friendly and consumer directed.With the many new arrangements for care in the community such asassisted living, day care, and expanded in-home services, newconcerns surface regarding costs. For these new service systemsto be successful, health care arrangements must be interwovenwith long-term care services and individuals need to be able tomove among the services to retain maximum independence.

There is a need for basic principles concerning managed careincluding: assuring access to care, providing expert counselingto consumers, advocating for those unable to speak forthemselves, ensuring consumer involvement in the planning andimplementation of the strategies developed, developing measuresfor judging outcomes and the quality of care, and establishingmonitoring which assures quality care and follow-up.

The AoA has released principlesof managed care which were sent as an Information Memorandum(IM) to the aging network. Copies of the IM are available from:

Irma Tetzloff Administration on Aging 330 Independence Ave.,S.W. Washington, DC 20201 (202) 619-3268

Additional forums have been conducted in Atlanta, Georgia;Seattle, Washington; Chicago, Illinois; San Francisco,California; Portland, Oregon during May and Kansas City, Missouriin June. Field forums also are planned for Connecticut andVermont.

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### Caregivers Resource Fair Offers Help toFederal Workers

Amid a room filled with red, white, and blueballoons, the AoA kicked off this year’s Older AmericansMonth Celebration on May 1. Acting Principal Deputy AssistantSecretary for Aging, William Benson, opened the Fair which washeld in the Great Hall of the Hubert H. Humphrey Building, sayingthat this year’s theme of "Caregiving: Compassion inAction" had been chosen "to honor and give specialrecognition to the 22 million persons who care for millions ofolder persons throughout this nation."

A proclamation officially naming May as Older Americans Monthwas issued by the President on May 1. (See below.)

William Corr, Chief of Staff for the Department of Health andHuman Services, was the keynote speaker. The Chief of Staffreflected on his own caregiving experiences when he worked tohelp his aunt who lived in another city. Mr. Corr said that hisexperience gave him a clear understanding of and, a deepappreciation for, the challenges that caregivers face each day intrying to help their loved ones. He also said that caregiverresource fairs, such as this one, can help caregivers find theinformation and agencies they need to care for their elderlyrelatives and friends. 

An estimated 500 federal employees and congressional staffmembers attended the day-long fair which offered a wealth ofmaterials and assistance on caregiving and information about themany national organizations and agencies in the greaterWashington, D.C. metropolitan area that are available to helpthem.

Some 49 agencies and organizations, ranging from state andarea agencies on aging to federal agencies and nationalorganizations, offered materials on a range of subjects relatingto caregiving. The materials included publications onAlzheimer’s disease, occupational therapy, assistivedevices, hospice, homemaker home health aide and day care centerservices, and legal assistance for caregivers and the vulnerableelderly.

The day-long event also included short talks by specialists inthe field on a range of subjects relating to caregiving. Membersof the audience were able to have their personal concernsaddressed during question and answer sessions following each ofthe presentations which included lectures on alternative housingarrangements, the types of long-term care facilities available,home care, adult day care, hospice services, and the impact ofcaregiving on the workplace.

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### Stakeholders Meeting Offers Ideas forthe Future 

In an effort to serve the future needs of the nation’selderly, who are not only growing in numbers but in diversity,the AoA launched the Fast Cycle Full Participation Work SystemsDesign process (Work Design). The Work Design, developed by AoAstaff, recognizes that the AoA must create internal and externalenvironments that call for input from all members of the agingnetwork. These environments should foster creativity in meetingthe crucial goals supporting independence for the at-risk elderlyand their caregivers while enhancing, as well, the independenceof active older Americans.

A critical part of the Work Design is to meet the expectationsof stakeholders who include members of the aging network, olderpersons, and their caregivers. On April 25, over 50 stakeholderrepresentatives and 40 members of the AoA staff came together toshare ideas which will enable the AoA to gain a betterunderstanding of the needs and expectations of its stakeholders. 

Following an opening session that featured Kevin Thurm, DeputySecretary for Health and Human Services, the stakeholders and AoAstaff members broke up into small groups. Those taking partincluded state agencies on aging, area agencies on aging,national aging organizations, service providers, Title VI tribalorganizations and contractors, representatives from business andthe religious sector, older Americans, and other federalagencies.

While the report on the groups’ recommendations andexpectations is not yet available, preliminary review points to adesire by stakeholders for AoA to have a strong leadership role;to broaden its partnership base with stakeholders, particularlywith other federal agencies, the business community and othermembers of the private sector; to make flexibility a benchmark ofits relationships; and to enhance its visibility at the national,state, and local levels.

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### AoA Staff Honored

At a May 14 ceremony, held in the Great Hall of the Hubert H.Humphrey Building in Washington, D.C., four members of the AoAcentral office staff were honored by the Secretary of theDepartment of Health and Human Services, Donna E. Shalala, withthe Secretary’s Award for Distinguished Service for theirvaluable contributions to the Department and the nation’selderly.

Those honored included Moya Benoit Thompson and Harry Posmanwho were recognized for their contributions to theDepartment’s Immigration Working Group. Jean Lloyd, CarolCrecy, and Yvonne Jackson also were honored for their efforts indeveloping the criteria and managing the evaluation of the OlderAmericans Act Elderly Nutrition Program.

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### HHS Secretary Launches HealthfinderWeb Site

Donna E. Shalala, Secretary of Health and Human Services, haslaunched the healthfinder web site, a new government gateway siteon the Internet, that will make it easier for Americans to findhealth information on the World Wide Web. The internet addressis: http://www.healthfinder.gov.

Healthfinder joins, under one umbrella, a range of consumerhealth information resources produced by the federal governmentand its partners. Its resources include:

> - hyperlinks to over 550 web sites, including more than            200 federal sites and 350 state, local,            not-for-profit, university and other consumer health            resources;
- links to nearly 500 links to frequently-asked            selected on-line documents;
- questions on top health issues of concern to the            public;
- links to databases and web search engines by topic            and agency; and
- graphical and text versions to accommodate all users.

Healthfinder combats information overload by organizingresources in a subject index.

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### Bladder Control Kits Available

The National Institute of Diabetes and Digestive and KidneyDiseases, an agency of the National Institutes of Health, hasissued a series of educational pamphlets on bladder control aimedat women of different ages.

Half of all elderly women suffer from urinary incontinence andover $16 billion is spent each year on incontinence-related care.Incontinence is one of the major causes of institutionalizationof the elderly. Treatment of the condition can result in enormoussavings for the elderly, and, in 80 percent of all cases,treatment can improve bladder control significantly.Nevertheless, fewer than half of all women discuss the conditionwith their doctor, and doctors, themselves, sometimes think thatincontinence is a normal part of the aging process.

The new materials are helpful to those working with olderwomen who suffer from incontinence, as well as older women. Freeconsumer and health care provider kits are available by calling1-800-891-5388.

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### AoA Teams Up With EPA and Others to Save theEnvironment

The AoA has joined with the Environmental ProtectionAgency (EPA) and several other federal agencies and nationalorganizations in agreeing to a Memorandum of Understanding (MOU)designed to draw on the resources of senior volunteers in helpingto protect and improve the nation’s environment. The MOU,signed on May 16 in Washington, D.C., calls for a collaborativeeffort between the AoA, the EPA, the Corporation for National andCommunity Service, the National Council on the Aging (NCOA), andthe Environmental Alliance for Senior Involvement. 

The purpose of the MOU is to develop partnerships amongagencies and organizations to identify environmental needs thatcan be met by senior volunteers and to increase olderAmericans’ awareness of opportunities for volunteering inthe environmental area.

Economic realities are forcing major funding cuts at alllevels of government, as well as in the private sector, andresponsibility for resolving environmental problems restsincreasingly with local communities. The MOU states that,"Our nation’s senior generation represents a reservoirof talent and experience for solving our nation’senvironmental problems."

Initial joint activities include a number of importantenvironmental protection activities involving senior volunteersand the AoA.

The EPA’s Office of Ground Water and Drinking Water andits American Indian Environmental Office, the EnvironmentalAlliance for Senior Involvement, the Retired Senior VolunteerProgram (RSVP), the NCOA, and the AoA will collaborate ininitiating a 15-state pilot project that will recruit, train, anduse retired volunteers with technical backgrounds to serve asauxiliaries to rural ground water technicians and work withcommunities to help them develop and implement wellheadprotection programs.

The Office of Wetlands, Oceans, and Watersheds will providethe AoA, the NCOA, the RSVP, and the Environmental Alliance forSenior Involvement with information to encourage seniorinvolvement in programs around the country in which volunteers ofall ages work with agencies, organizations, and educationalfacilities to collect information on water quality conditions andparticipate in beach cleanup, stream restoration, and tidalestuary protection. For additional information, please contact:

Kenton Williams Administration on Aging Washington, DC 20201(202) 619-3951 

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### Older Americans Month 1997By the President of the United States of AmericaA Proclamation

Each year, we set aside the month of May as a special time topay tribute to Older Americans and to acknowledge their manycontributions to our national life. For the better part of thiscentury, through tough times and good times, these Americans haveraised families, strengthened our economy, defended our Nation,and reaffirmed our deepest values. All of us who are heirs totheir service and sacrifice owe them a profound debt ofgratitude.

The theme of this year’s observance, "Caregiving:Compassion in Action," reminds us of one of the mostimportant ways in which we can repay that debt. Each day acrossAmerica, some 22 million caregivers and volunteers dedicatethemselves to improving the quality of life for older familymembers, friends, and neighbors. By providing personal care,housekeeping, transportation, and innumerable other services andassistance, these caregivers enable many older Americans toremain in their own homes and communities, maintaining a preciousmeasure of dignity and independence.

As America’s population of older Americans continues togrow in number, we will have an even greater need to call on theskills and compassion of caregivers. In keeping with the spiritof service that is sweeping across our Nation today, I ask thatall Americans--every day, but especially during Older AmericansMonth--reach out to an older person in need, sharing time,talents, and attention with someone who has already shared somuch with us. By putting our compassion in action to serve ourolder citizens, we can build a more promising future for all ourpeople.

Older Americans deserve our respect and support for they haveworked diligently in so many ways to enrich and preserve the wayof life we all enjoy. Our senior citizens have woven the fabricof our Nation to exemplify the values and beliefs that have madeour country great.

NOW THEREFORE, I, WILLIAM J. CLINTON, President of the UnitedStates of America, by virtue of the authority vested in me by theconstitution and laws of the United States, do hereby proclaimMay 1997 as Older Americans Month. I call upon Governmentofficials, businesses, communities, volunteers, educators, andall the people of the United States to honor our older Americansand acknowledge the important contributions made by theircaregivers, this month and throughout the year.

IN WITNESS WHEREOF, I have hereunto set my hand this first dayof May, in the year of our Lord nineteen hundred and ninety-sevenand of the Independence of the United States of America the twohundred and twenty-first.

**WILLIAM J. CLINTON**

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AoA Update

**WilliamBenson**Acting Principal Deputy Assistant Secretary for Aging

**JudySatine**Director, Executive Secretariat

**JuneB. Faris**Editor

**AoAUpdate**Administrationon AgingU.S. Department of Health & Human ServicesWashington, DC 20201(202) 619-0724TDD: (202) 401-7575 FAX: (202) 260-1012E-mail: [email protected]Internet Web Site: http://WWW.AoA.DHHS.Gov