grants have been made under two categories:

(1) developmental grants to support the establishment
of multidisciplinary centers, or alternatively to
assist recently established institutes on aging in
realizing their potential for becoming Multidisci-
plinary Centers of Gerontology;

(2) operational grants to already well established multi-
disciplinary centers of gerontology to expand and
strengthen their activities consistent with the pro-
visions of Title IV-C.

By FY 1978 a total of 43 projects were being funded, some 28 in their developmental, formative stages, 15 as operational centers. Nineteen (13 developmental, 6 operational) had been supported since FY 1976, 24 (16 developmental, 8 operational) since FY 1977.

Perhaps the most revealing statistic is that over the course of their Title IV-E funding, as many as 32 of the 43 Center projects received Title IV-A Career Training grants to support faculty, students, curriculum development and other purposes closely akin to that of the Center grant. At present 25 institutions of higher education receive AoA support for their gerontology programs under both Title IV-A and Title IV-E.

o Expansion of Title IV-A Program Responsibilities

Also dating from about the mid-1970's, there has been a significant expansion in Title IV-A Program functions beyond that of preparing persons for careers in aging through undergraduate and graduate training and education. In particular, Title IV-A has responded to the burgeoning need for "in-service" training and retraining manifested by the rapid growth from 1973 of State, Area, and community-based agencies working on behalf of the aging, and by a parallel growth in interest among service providing agencies, professions, planners, and practitioners in the field of aging.

For the span of years FY 1973 to FY 1978 there was a rapid rise in Title IV-A appropriations which were applied toward a general, relatively unstructured, development of training, education, and technical assistance resources to meet the personnel needs. of aging service and planning programs under the Older Americans Act. As late as FY 1973, there was but $3 million to carry out IV-A training program responsibilities. By FY 1975, the IV-A budget reached $8 million, by FY 1976 $14 million, and for FY 1978 the figure was $17 million. These funding increases. made possible not only an allocation of $6 million to State Agencies on Aging for in-service training but also a doubling

Depending on the year, balances include other items such as conferences, dissertations, evaluations, BLS, etc.

over FY 1975 - FY 1978 in career training program expendi-
tures. (The accompanying table shows the distribution of
IV-A funds for the past four years).

AoA Interest in Educational and Training Programs Related
to Minority Aging

Starting in 1971 AoA has funded gerontology programs in
minority institutions of higher education, primarily black
colleges and universities. Six minority schools were awarded
grants in 1971; now 9 minority institutions are supported by
Title IV-A Career Training Grants, while a few other schools
have focused their gerontology programs on minority aging.

These beginning efforts notwithstanding, it became apparent
in recent years that neither AoA nor institutions of higher
education had, in terms of gerontology education and training,
responded adequately to the needs of racial and ethnic minor-
ity communities (Asian Americans, Blacks, Hispanics, and Native
Americans). As a result, beginning in 1977 specific criteria
measuring the institution's resources and commitment to minority.
aging concerns were made a substantial part of the evaluation
of gerontology program applications under both the Title IV-A
and Title IV-E programs. One aim is to encourage educational
institutions to increase the number of minority researchers,
educators and practitioners concerned with problems of the
elderly by increased recruitment, training, and placement of
minority faculty and students. Another aim is to ensure that
curriculum content concerning the special needs of the minority
elderly is developed and made more widely available as part of
the course offerings available to all persons preparing to
work in the field of aging.

2) AoA Education and Training Program Objectives, FY 1979 - FY 1981

a) Overarching Concerns

The Administration on Aging faces several challenges in planning and implementing education and training programs that will, both now and in the future, use the finite resources available under the Older Americans Act to prepare personnel at Federal, State, and local levels capable of skilled, knowledgeable, and dedicated efforts to serve the rapidly increasing population of older persons.

One challenge is to fully recognize that the extraordinary growth in recent years of public and private programs and agencies to serve the elderly has raised to critical proportions the issue of how the large number of qualified practitioners, planners, and administrators to carry out these new and expanded efforts can be recruited, trained, and committed to service on behalf of the elderly. While the fields of aging and gerontology clearly range well beyond the province of the Older Americans Act and far beyond the scope of one agency of the Federal government, nonetheless AoA is responsible for undertaking a leading role in responding to the current and future need for qualified personnel to work with and in behalf of older people.

Thus, another contemporary challenge is to determine where and in what manner AoA can exercise that leadership role. For that role to gain sustained acceptance, it must be scaled within the limits of the Older Americans Act and linked directly to the program authority and priorities set forth in the new 1978 Amendments. Measured in dollar terms alone, AoA is responsible for administering programs whose appropriations level is now in excess of $500 million. Its program responsibilities, especially those aimed at developing community-based comprehensive services for the aging, and the requisite skilled personnel to carry out those responsibilities, constitute a dominant claim on AoA's education and training program efforts. A third challenge confronts AoA in establishing the priority directions of its education and training programs. The choice of maintaining certain programs with or without major revisions, or of initiating still other education and training programs, depends upon a blend of policy and budgetary considerations. The Older Americans Act, AoA policy mandates and program priorities, prescribe what should be done by way of education and training for service to older persons. What can be done is, however, a function of the amount of education and training program funds that AoA might reasonably expect to have available over the coming years. In that regard the Title IV-A appropriation of $17.0 million and the Title IV-E appropriation of $3.8 million has held constant over the past three fiscal years (FY 1977 - FY 1979) and is not anticipated to increase in the near term (FY 1980 FY 1981). Thus, the bottom line is a careful weighing of where and how AoA's finite educational and training resources can be focused strategically on meeting its principal program responsibilities under the Older Americans Act.

In July 1978, Secretary Califano in testimony before the Senate Special Committee on Aging listed as one of the Department's major objectives the building of a national, comprehensive, efficient, and humane system for delivering health and social services to older people. In that effort, the Administration on Aging has an important role in developing community-based health and social services which are responsive to the varying needs of older perThe new 1978 Amendments have expanded that role, thereby setting forth an agenda of substantive AoA program priorities. These program priorities in turn provide the overall framework for new education and training initiatives.

b) Changes in the Structure of Older Americans Act Programs

The 1978 Amendments make a concerted effort toward strengthening the development begun in 1973 of Federally supported, State administered, community based service systems for older persons. The social services program, the nutrition program, and the multipurpose senior center program were consolidated under a revamped Title III of the Older Americans Act. Another provision of the Amendments is aimed at extending the range of Area Agencies on Aging so that by the end of 1980 they will be in operation throughout the nation. The Amendments further delineate the structure for providing and delivering services to older persons by requiring Area Agencies to designate, where feasible, a focal point (e.g. multipurpose senior center) for comprehensive service delivery in each community.

c) Constructs of a Comprehensive, Community-Based Service System

The Administration on Aging is now developing regulations to implement the 1978 Amendments to the Older Americans Act. Those regulations will define the comprehensive and coordinated service systems mandated by the Act as being comprised of:

services for persons in care-giving institutions, with a
heavy emphasis on reinforcing their ties to the community
access services to ensure the right match between the needs
of older persons and direct services to meet those needs.

d) Focus on a Continuum-of-Care for the Vulnerable Elderly

In a major policy initiative, the 1978 Amendments link the Title III programs. for building comprehensive community-based service systems to the provision of a continuum of care for the vulnerable elderly. That priority on meeting the needs of the chronically impaired elderly was given added impetus by a new Section 422 of the Act which authorizes Special Projects in Comprehensive Long-Term Care. In the President's budget for FY 1980, $15 million is earmarked for AoA to start these projects. A like amount has been proposed for the Health Care Financing Administration for similar projects; HCFA and AoA are now making plans to collaborate on the implementation of their respective efforts.

These projects are intended to result in the development of systems which will place special emphasis on services designed to support alternatives to institutional living and on improving access to those services. Such systems will accomplish these objectives through a continuum of care -- assessing needs, developing plans for care, and making referrals in the delivery of long term care services in both non-institutional and institutional settings where appropriate.

The statute suggests that a continuum of care might include such services as:

0 adult day care;

monitoring and evaluation of services effectiveness;
supported living in public and private non-profit housing;

family respite services;

home health, homemaker, and other rehabilitative and
maintenance in-home services; and

preventive health services;

o geriatric health maintenance organizations

The amendments also call upon AoA to fund, within 10 states, innovative programs of coordinated services to the homebound elderly, blind, and disabled. These special coordination projects will be integrated with a selected number of the Section 422 Special Projects in Comprehensive Long-Term Care.