y f NEEDS FOR SERVICES REVEALED BY OPERATION MEDICARE ALERT HEARING BEFORE THE SUBCOMMITTEE ON FEDERAL, STATE, AND COMMUNITY SERVICES | OF THE SPECIAL COMMITTEE ON AGING UNITED STATES SENATE EIGHTY-NINTH CONGRESS SECOND SESSION || A b d i ia DA Cat for Flic. JUNE 2, 1966 : ) Healy h Morera a Printed for the use of the Special Committee on Aging U.S. GOVERNMENT PRINTING OFFICE 66-547 O WASHINGTON : 1966 For sale by the Superintendent of Documents, U.S. Government Printing Office Washington, D.C. 20402 - Price 30 cents ~ | HEAL! re CAT PUBL SPECIAL COMMITTEE ON AGING [Pursuant to S. Res. 189, 89th Cong.] GEORGE A. SMATHERS, Florida, Chairman HARRISON A. WILLIAMS, JRr., New Jersey EVERETT McKINLEY DIRKSEN, Illinois MAURINE B. NEUBERGER, Oregon FRANK CARLSON, Kansas WAYNE MORSE, Oregon WINSTON L. PROUTY, Vermont ALAN BIBLE, Nevada HIRAM L. FONG, Hawaii FRANK CHURCH, Idaho GORDON ALLOTT, Colorado JENNINGS RANDOLPH, West Virginia JACK MILLER, Iowa EDMUND S. MUSKIE, Maine JAMES B. PEARSON, Kansas EDWARD V. LONG, Missouri FRANK E. MOSS, Utah EDWARD M. KENNEDY, Massachusetts RALPH W. YARBOROUGH, Texas STEPHEN M. YOUNG, Ohio J. WiLLiaAM NORMAN, Jr., Staff Director JoHN GUY MILLER, Minority Staff Director SUBCOMMITTEE ON FEDERAL, STATE, AND COMMUNITY SERVICES EDWARD M. KENNEDY, Massachusetts, Chairman ALAN BIBLE, Nevada JAMES B. PEARSON, Kansas RALPH YARBOROUGH, Texas EVERETT McKINLEY DIRKSEN, Iliinois STEPHEN M. YOUNG, Ohio II HV145 A3la PUBLIC HEALTH LIBRARY CONTENTS CHRONOLOGICAL LIST OF WITNESSES Opening statement Of the Chairman. . . «www mm we wm wm mm mi im sb oon von moe Sargent Shriver, Director, Office of Economic Opportunity; accompanied by Hyman H. Bookbinder, Assistant Director, National Councils and Organizations; Donald Hess, Assistant Director, Policy Planning; Walter Williams, Economist, Research and Plans Division, R.P.P. & E.; Robert MecCan, Consultant on Aging, Community Action Program___________ Dr. Harold Sheppard, member, Advisory Committee on Older Americans , and member, OEO Task Force on Programs for Older Persons________ MY Lillian Allan, chairman, Hudson City Senior Citizens Club, Jersey SN ol tion i gr opal st hg cg oe mf Ms Fulton Hines, Greater Plainfield Senior Citizens Center, Plainfield, Walter Newburgher, president of the Congress of Senior Citizens of Orenter NOW York... ..ccurmiumtiot swe nein h srg sme mp sgn gi Tams ms LeRoy Reed, Greater Plainfield Senior Citizens Center, Plainfield, N.J___ Mrs. Frances Maletz, Operation Medicare Alert program of the National Council of Senior Citizens, Washington, D.C. ____________ Lawrence Cook, Operation Medicare Alert Program of the National Council of Senior Citizens, Washington, D.C________________________ John A. Algee, M.D., Adult Health and Geriatrics Clinic, District of COIL, osetia wm pA wR a sig rm So Fo 0 Mr. and Mrs. Henry I. Gilman, Florida League of Senior Citizens, Miami BAH, Fl J ob ta i borers me patie be et rots ep a al he iro James Carbray, Steelworkers International Union, Whittier, Calif. ______ Edward L. Robinson, Detroit, Mich., vice president of the Detroit Metro- politan Council of Senor CIlIZENS..... vo «uv om om waist mim soma mi 0 om 30 TH, Lynch, DUgUEsTIE, Pile oom ce ore mim sm si mm mm mm mie mmm oF mw Arthur Capone, Revere, Mass. _ ooo. ADDORHIRL «oF ih sms amram sigan od Rs iss asses 881 7 Spee he Teh alr 2atl - ¢ og r Ad x NEEDS FOR SERVICES REVEALED BY OPERATION MEDICARE ALERT THURSDAY, JUNE 2, 1966 U.S. SENATE, SuBcoMmMITTEE ON FEDERAL, STATE, AND COMMUNITY SERVICES OF THE SPECIAL COMMITTEE ON AGING, Washington, D.C. The subcommittee met at 10 a.m., pursuant to call, in room G-308 (auditorium), New Senate Office Building, Senator Edward M. Kennedy (chairman of the subcommittee) presiding. Present: Senators Kennedy, Yarborough, Young, Randolph, Prouty, and Allott. Committee staff members present: J. William Norman, staff direc- tor; John Guy Miller, minority staff director; and Patricia G. Slinkard, chief clerk. Senator KeNNepY. The subcommittee will come to order. Today, this Subcommittee on Federal, State, and Community Services of the Special Committee on Aging is pleased to welcome Mr. Sargent Shriver, Director of the Office of Economic Opportunity, Dr. Harold Sheppard of the Upjohn Research Institute and member of the Office of Economic Opportunity Task Force on Programs for Older Persons, and the many public spirited elderly citizens who par- ticipated in Medicare Alert. Both the Office of Economic Opportunity and the thousands who were involved in Medicare Alert are to be complimented on the success of the program. As the Medicare books closed last Monday night, it was estimated that 90 percent of the eligible citizens were enrolled in the voluntary Medicare program. This special session of the subcommittee was called today for many interrelated reasons. Basically, it is important for this committee, and indeed the Senate, to hear from the elderly the problems of the elderly with less than adequate financial means. We have representatives with us today of the 14,000 older persons who entered the homes, the rooms, and even the shacks of the 7 million poor over the age of 65. What the Medicare Alert people saw and experienced is worth telling not only because it may be dramatic and emotional but also because we have yet to shake the belief that the American aged are provided for by one means or another. The picture that many of us have of the elderly is more influenced by what we hope is the case than what is in fact the case. One out of five of all the poor are elderly. These poor are quiet, more hidden, 1 2 NEEDS REVEALED BY OPERATION MEDICARE ALERT and cause fewer overt social problems than the rest. If their con- dition resulted in crime, or demonstrations, or was considered detri- mental to technological advance or the growth of the economy, the Nation would take notice and action would result. Of equal importance today are the questions of what can be done with the older Americans who took part in Medicare Alert and how the experience gathered under that program can be utilized. Through Medicare Alert we have discovered a new source of dedicated and capable people that could be directed for the public good. It is fair to say that Medicare Alert has not only done more for the elderly than any other Federal service activity, but it has also raised the hopes of the elderly that they, too, can participate in the national program to eliminate poverty. It is important that their hopes not e lightly treated and that we move ahead and call for greater elderly assistance in meeting our national needs. This committee recently concluded extensive hearings on the War on Poverty as it affects older Americans. A committee report * will soon be released containing many recommendations which, if followed, would constitute a major advance in this area. Yet the nagging question of the role of the elderly in the poverty program remains. In my own view, the Office of Economic Opportunity has been one of the most outstanding agencies of Government since its inception in 1964. The problems that it has faced would have crippled lesser agencies and men, yet the War on Poverty continues—and it continues with great success. But the elderly have always felt an exclusion from this national effort, despite statements to the contrary from the OEO, and continuous congressional interest. It 1s my hope that our first witness, Mr. Shriver, will once again clarify the position of the OEO on this matter. If the lack of full emphasis on the elderly in the poverty program is a matter of inade- qate financing then it 1s the responsibility of Congress to rectify that situation. If OEO feels that regardless of funding, the elderly poor should be treated in other agencies and by other legislated means, that, too, will clarify congressional responsibility. Whatever the approach oa it is apparent that a basic decision must be made in the very near future to assure us that the concerns and needs of a major segment of our population will be met. I want to state that en committee 1s delighted to have Mr. Shriver, the Director of the Office of Economic Opportunity, once again before the committee and also Harold Sheppard, who is the staff social scien- tist of the Upjohn Institute for Employment Research in Washington. We welcome you to the committee. We appreciate the interest that you have demonstrated in the past and we are particularly delighted to welcome you and your associates. Mr. Shriver, would you be kind enuogh to introduce your associates who are with you here today. 1%“The War on Poverty As It Affects Older Americans,” S. Rept. 1287, June 20, 1966, available from the Senate Special Committee on Aging, Washington, D.C. NEEDS REVEALED BY OPERATION MEDICARE ALERT 3 STATEMENT OF SARGENT SHRIVER, DIRECTOR, OFFICE OF ECO- NOMIC OPPORTUNITY; ACCOMPANIED BY HYMAN H. BOOK- BINDER, ASSISTANT DIRECTOR, NATIONAL COUNCILS AND ORGA- NIZATIONS; DONALD HESS, ASSISTANT DIRECTOR, POLICY PLAN- NING; WALTER WILLIAMS, ECONOMIST, RESEARCH AND PLANS DIVISION, R.P.P. & E.; ROBERT McCAN, CONSULTANT ON AGING, COMMUNITY ACTION PROGRAM Mr. Suriver. Yes, Mr. Chairman. Let me express my pleasure at being here personally and introduce to you on my right Mr. Hyman Bookbinder, who is Assistant Director of OEO in charge of our relationships with national organizations and councils, public officials, the poor, and of existing groups of that type in our national life. On my left is Don Hess, who is in charge of program planning within the community action part of the War Against Pry Next to him is Walt Williams, who has been for quite a while work- ing for us in this particular area of the aging, and next to Walt is Bob McCan, who has also been serving at OEO on the problems of the aging and related matters. Senator Kennepy. Very good. (Mr. Shriver’s prepared statement follows :} PREPARED STATEMENT OF DIRECTOR R. SARGENT SHRIVER Mr. Chairman, President Lyndon Johnson proclaimed May as Senior Citizen's Month. At the close of this period of special emphasis, I join with others in pay- ing respect to 18% million older Americans. All of us need to be appreciative of the contributions of our seniors and sensitive to the special needs of this age group. Across the land the American people are thinking about the problems of aging. America cares, America is concerned, America is dedicated to improving the lot of its senior citizens. But most of all, as Director of the Anti-Poverty Program, I am concerned with the unmet needs of the millions of Americans over age 65 who are economically deprived and often socially alienated. When one is older and poor, he tends to be rejected by those in the mainstream of life. All of us too easily overlook this vast group of the hidden poor. I wish to do three things, Mr. Chairman, in my testimony today: I shall report on progress being made within OEO in providing for older Americans. I shall set the prob- lems of older poor Americans in a larger perspective. I shall share with you the present emphasis on programming for this age group which our staff feels is appropriate for the present circumstances. The Office of Economic Opportunity has been doing a great deal since my last report to you on January 19. Let me share some highlights of what is being accomplished for older Americans. HEALTH AIDE PROGRAM The Community Action Program is about to embark on a major Health Aides Program. The project which is just beginning will be funded for approximately $20 million. This is a program to recruit, select, train, and place nonprofes- sional workers. The project will employ poor persons who are 45 years and older, including a large number of the older poor. Moreover, a significant pro- portion of the services provided by the health aides will be directed to the senior citizens who are home-bound. 4 NEEDS REVEALED BY OPERATION MEDICARE ALERT The nonprofessional health aide could work not only in the home, but in other settings as well in the neighborhood health center and in multipurpose centers as family agents helping families to locate and obtain needed health services; in health departments as assistants to health educators, social workers, sani- tarians, laboratory workers, family planning workers; in a variety of institu- tions and agencies as aides to those working with the mentally retarded, with crippled children, with alcoholics or narcotics addicts. And this list represents only the beginning of the possibilities for new career opportunities. OPERATION MEDICARE ALERT As you know, Mr. Chairman, this program was designed to use older persons as aides in a massive effort to tell older Americans about Medicare. We worked in closest cooperation with the Social Security Administration in a joint venture. This program, by older persons and for older persons, is the largest single program we have sponsored within Community Action apart from Head Start. This is true in terms of the number of Community Action Agencies that partici- pated and in terms of the number of recipients directly benefited. There were 467 Operation Medicare Alert projects in 47 states, Guam and Puerto Rico. Eleven of these were on Indian reservations. This was an army of 12,471 paid older workers, along with 21,178 other senior persons who volunteered their services. These dedicated and active elders con- tacted 4,300,027 older persons to suggest that they consider signing for Medicare benefits. These workers arranged 9,356 meetings, which were attended by 308,375 older persons. Finally, they referred 55,597 persons to other anti-poverty pro- grams for needed help. Our staff is making a detailed analysis of reports from all of the Operation Medicare Alert projects. The social knowledge that is gained can help govern- ment agencies form realistic public policy. 2 The program made us aware of two basic needs: The desire of large numbers of senior persons for meaningful part-time employment, and the plight of many older persons who face the prospect of illness and dependency without anyone who can be counted on to care. A specific problem most often mentioned to Medicare Alert teams was the high cost of drugs that they needed. From a preliminary report, it is evident that workers often experienced shock, surprise, and dismay at conditions they observed. Mary Stamper, a Kentucky woman, expressed a widely shared feeling when she said, “Although we got into some funny situations, others were sad, and some nights it was difficult to get to sleep remembering some of the things we had seen.” Out of the 218 reports examined to date, 809% of the agencies reported a ferment in their thinking about the traditional institutional ways to meet the problems among the aged in their communities. The most pressing needs appear to be in the area of health programs, neighborhood centers with friendly visitors, hous- ing, and employment programs. "ns Medicare Alert workers proved that they were resourceful and productive. One project director described the workers’ problems as one of “too much dedi- cation” so that they would ‘“over-extend themselves at times.” The Director of the Social Services Agency of Greater Trenton in New Jersey said, “One of the few short-comings we found in their performance was their lack of fear for their own safety.” The experience of meaningful activity, even for a limited time, had beneficial effects on their personalities. A California director described these effects as follows: “Although the canvassers had great difficulties, they had a purpose and the experience was good for them physically, and having a job to do was up- lifting mentally.” Adverse circumstances were almost overwhelming. The project was conducted during the ice and snow of February and March. Yet, the elderly workers walked and drove thousands of miles on the back roads of Maine and Arkansas, as well as the glazed streets of New Haven and Tulsa. They climbed millions of drafty stairs in the tenements of New York and San Francisco. Operation Medicare Alert disproved the oft-quoted saying: “An aged man is but a paltry thing : A tattered coat upon a stick” NEEDS REVEALED BY OPERATION MEDICARE ALERT 5 FOSTER GRANDPARENT PROGRAM Now, Mr. Chairman, let me speak about Foster Grandparent Program. This program employs poor persons above the age of 60 to work on a personal basis with emotionally deprived, mentally retarded, and physically handicapped chil- dren. Many of these projects are experimental and go outside of full care institu- tions into public school settings and day care facilities. As of my last report to you, there were 21 funded projects with a total of 2.7 million dollars in grants, employing more than 1,100 older persons. Since then we have funded an additional 12 Foster Grandparent projects for $2.5 million. These projects will employ 1,067 older persons and will bring the total funded projects to 33. Money has been allocated through Section 205 discretionary funds so that there would be a total dollar amount of 11.5 million for this Fiscal year. We have contracted with an independent research organization to evaluate the program. An interim evaluation has indicated that the Foster Grandparents Program has given many older persons a new sense of usefulness and an increased self-esteem. The earning of money was especially satisfying, but the social meaning of the work was most important to these older citizens. Of course, they derived immense emotional gratification from the children’s attachment to them. Now, as to the impact of Foster Grandparents Program on the children. A competent researcher in the socio-health field reported seeing Foster Grand- parents handle infants with a care and understanding that exceeded average hospital staff members. These substitute grandparents are able to get responses from infants who lay in cribs all day without moving. Children who ordinarily would not walk or talk because there was nobody with the time to devote to them are now walking and talking. Although these are preliminary and informal impressions only, the report is definitely positive in the value of the Foster Grandparent program to both its beneficiaries and our senior citizens. Two anecdotes from the Denton, Texas program illustrate what is happening. “Ned spent his time facing into a corner and cried when approached. He had to be dragged kicking and crying to the dining room. The first change observed after his contacts with a foster grandparent was that he sat in the corner, facing the room. He has now learned to patty-cake, reach out his hands and goes to the dining room quietly, holding Foster Grandma’s hand.” “Keith was known as ‘the screamer.” It was an all day pattern. After contact with the foster grandparent, the screaming gradually stopped. He has begun to eat with a spoon and shows marked improvement. The staff has now revised its opinion and believes he may have a high potential.” Has the program been well received by the host institutions? Yes, A report from Denver, Colorado is typical : “Both our hospitals have said that they antici- pated far more problems than have occurred. We felt that we had ‘arrived’ when doctors at Colorado General were writing on their orders: “Please assign a grandparent to this child.” This report continued, “Stevie, a bright two-year old, in Colorado General was admitted with the diagnosis of “battered child syndrome.” He had a skull fracture and massive skin lesions, which were treated like burns. He had to have painful treatment and had to have someone hold his hand when he walked for fear that a fall might injure his head again. After substained contact with a foster grandparent, he seemed to stabilize his affection. * * *” Mr. Thomas A. Tucker, President of the National Association for Retarded Children, has appraised the program in this way : “Reports received at our headquarters from various parts of the nation indi- cate that the Foster Grandparents Program is meeting a vital need. Many mentally retarded children are, through no fault of their own, the victims of neglect and apathy. Your programs help to provide the individual care, affection and understanding necessary to help many of these mentally retarded children become productive, well-adjusted tax-paying citizens.” OPERATION GREEN THUMB This project was designed to employ retired poor farmers in highway beauti- fication and is in operation. Green Thumb workers have planted more than 30,000 trees and shrubs and have worked on dozens of roadside parks in Oregon, 6 NEEDS REVEALED BY OPERATION MEDICARE ALERT Minnesota, Arkansas, and New Jersey. The average income of these men before coming into the program was $900 per year, and the average age is 67. Many are in their mid-seventies; the oldest worker is 88. Most of them are able to put many younger people to the challenge with the amount of work they pro- duce. State agencies have been most cooperative in supplying materials and equipment ; the cost of this project is being equally divided between OEO and State highway departments. Look at a typical Green Thumb worker: Mr. Ray Pake, in Oregon, has farmed most of his life. He was receiving $35 per month Social Security and $50 from Welfare. He is now off the welfare rolls. His eyesight had been poor, but through this project Mr. Pake was examined and provided with new glasses. Mr. Pake is finding new hope in life through his job. OTHER COMMUNITY ACTION PROGRAMS Most Community Action Programs are developed at the local community level in response to the felt needs. CAP has been providing Technical Assistance and giving encouragement to communities which choose to include components specifically designed to serve older Americans. Here are some representative projects that have been funded through regular Community Action Agency chan- nels: (A) Boston, Massachusetts has recently been funded to establish Senior Citizens Centers in six target areas. (B) Dayton, Ohio has a Senior Citizens Recreation Project in a public housing project with 1,124 participating who are over 65. They are using a team approach—nurses, doctors, counselors, and recreation leaders for arts and crafts. Their services are also available to 40 older persons who do not reside in the housing project: (C) In Chicago, a grant provides Senior Citizens Centers where 3,500 per- sons over 60 years of age are offered adult education, trips, creative arts, health education, and counseling at a rate of $6 per beneficiary per month. (D) In West Virginia, Monongalia County, the CAP has a grant to establish a recreation center in the basement of the City library, and five part-time cen- ters in outlying areas. (BE) In New York (ity, the Economic Opportunity Committee of New York has a funded program, sponsored by the Federation of the Handicapped, called PATH (Personal Aides to the Handicapped) in which 250 older persons are participating. Mr. Chairman, what I have just described to you are some of the specialized separate programs requested by communities and sponsored by the Office of Economic Opportunity specifically for the elderly poor. PROGRAM SERVING ALL AGES Our concept of the community action programs is to provide a comprehensive set of assistance and benefits for all the poor regardless of age. The older poor, as well as the young, are participants and beneficiaries in such community action programs as health services, homemaker services, food distribution, consumer in- formation, legal services, social and recreational services, and adult basic literacy. Many of these components when put together with their outreach efforts are the main elements of our multi-purpose neighborhood center program of which we expect to have a total of 600 funded by June 30. We are assuring that the multi-purpose neighborhood centers are giving consideration to the poor senior citizens who are especially in need of the Centers’ services. VISTA VOLUNTEERS Of course, we must not forget that 12% of VISTA volunteers are age 65 or over. This is a pioneering effort to utilize constructively the talents of older people. Some of the volunteers are — (a) Edgar Slater, an 85 year old man, teaching Crow Indians a com- prehensive manual arts course. (b) George Cottell, 71, working with the Department of Welfare in Hartford, Connecticut, assisting in job placement and providing encourage- ment to other elderly persons. (¢) Margery Dritea, 68, working in a State mental hospital in West Vir- ginia helping patients through music. NEEDS REVEALED BY OPERATION MEDICARE ALERT 7 (d) Mrs. Maurice Frink, 75, teaching preschool children at Fort Defiance, Arizona. Now, let me share with you a perspective from which we view problems of the older poor American. While there is much that remains to be done for the poor senior citizen, our Nation is making a major effort in meeting the economic and social needs of the aged. For example, in the Fiscal 1967 budget, it is esti- mated that the Federal government poverty expenditures will total $21 billion. Of this amount, it is estimated that more than 40% will benefit persons over 65 years of age. To give a sharper focus on this, let us look at 1964, the last year for which detailed data on the number of poor are available. In that year, the 5.4 million aged poor represented % of the total poor. While we do not have sufficient data to show how much of the Federal poverty dollar went to this group, it was at least twice the proportion of the poor population. This was prior to the land- mark enactment of Medicare and the OASDI and OAA increases of 1965. Fur- ther, in 1964, other poor groups’ needs were even greater than those of the aged. For example, the income deficit—the amount of income needed to reach the poverty level—of all families with children under 18 was 214 times that of all of the aged poor. Older people have special maintenance and assistance needs. Many older people are very poor. But, in our concern for all poor people, we must recog- nize the existence of competing needs relative to a limited supply of poverty dollars. While our nation is doing a great deal for older Americans relative to other poor groups, much remains to be done. In order to bring all older people out of poverty by our minimum standards, we would have to spend in calendar 1966 an estimated additional $2.7 billion. To bring all of our poor above the poverty income line, we would have to spend nearly $12 billion a year. Congress charged the Administration on Aging of the Department of Health, Education, and Welfare with the general responsibility for older Americans. We believe that the new Commissioner, Mr. William Bechill, and his staff are highly qualified. I am confident the Congress will assure that this agency’s authoriza- tion and appropriation will be adequate. We are cooperating with and support- ing other agencies of the government that have responsibilities for the aged such as the Social Security Administration, the Welfare Administration, and the Pub- lic Health Service. A final aspect of the perspective which must be considered is the fact that OEO has a primary mission of attacking the causes of poverty. We want to prevent poverty rather than merely treating poverty’s symptoms.” Prevention of poverty in the older years is much more difficult to achieve. The Administration has supported legislation to broaden benefits of Social Security and we have encouraged full participation in the Medicare program. The Congress has already taken a first step by blanketing in people over 72 and making them eligible for benefits. ‘While the Congress has placed emphasis on youth-type programs in the OEO legislation, such as Head Start, Job Corps, and Neighborhood Youth Corps, the Congress has recognized that the OEO program is not just a youth program, but it must serve all who are poor. In fact, the Smathers Amendment has given spe- cific legislative direction to include the elderly. Section 610 of the Act reads: “It is the intention of Congress that whenever feasible the special problems of the elderly poor shall be considered in the development, conduct, and administration of programs under this Act.” A summary of all Community Action Programs reveals that we will spend approximately $50 million for programs that benefit the older Americans this fiscal year. These include 561 separate grants, employing about 19,000 older per- sons and benefiting some 4.4 million. These figures include the Operation Medi- care Alert Program. We consider this number of participants and beneficiaries, along with the dollar value of programs, to be a fair proportion considering the appalling magnitude of the needs for programs by the 32 million poor we are trying desperately to help with a mere budget of $1.5 billion for Fiscal Year 1966. At this point, Mr. Chairman, I would like to interject a comment about our FY 1967 program. The effect of the House Committee Bill which was reported out on May 17, is to reduce funding for the Community Action Programs by more than $100 million below the President’s Budget request. The changes have a restric- tive effect on the proposed Fiscal Year 1967 program for the aged. We proposed 8 NEEDS REVEALED BY OPERATION MEDICARE ALERT a modest $70 million for FY 1967, which corresponds to the $50 million program provided in Fiscal Year 1966. In summary, we have developed specific projects designed to serve older per- sons. Our local CAA’s have used their initiative and allotted their guideline funds for programs in many instances. Finally, most CAA’s include those in later life in the entire gamut of program activities. Now let me move to the third general area : the direction of our efforts for the neat fiscal year. We shall make every effort to include older persons in existing programs. We are re-evaluating existing programs with this in mind and we are studying new methods which will insure larger participation by older Americans. We shall participate in a high level conference at Notre Dame University in August, meeting with selected authorities in the field of aging, to further refine our long range goals in this area. By memos, surveys and on-site visits we shall assist CAA’s in establishing meaningful and effective programs for older Americans to the maximum extent feasible, consistent with local initiative and available dollars. We shall continue to make private and public agencies who also have responsi- bilities for the aged aware of the special problems faced by older Americans. We shall increase our efforts to make all of our staff at the local, regional and federal levels aware of the needs to include older persons in a great variety of programs. We shall continue to work with other federal agencies to alleviate the special conditions of older Americans which prevent them from having eco- nomic security and social support. The President on April 8 asked the Secretary of Health, Education, and Wel- fare, to study the possibility of improving Social Security across-the-board, for the aged as well as other groups. We will continue to work with Health, Edu- cation, and Welfare, and other agencies which have primary responsibility for the income maintenance, health, housing, and other programs which represent the bulk of the $26 billion the Federal Government will spend in Fiscal Year 1967 for the aged. CONCLUSION In conclusion, Mr. Chairman, we are concerned for older Americans in poverty. We are aware of the problems and special needs of this age group. We shall do all that we can within the perspective of our orientation and the dollar limita- tion imposed upon us. The greatest assistance for the elderly must come from the primary mission agencies, especially those providing income maintenance. Only when we restore the dignity of sufficient income will the aged poor begin to rejoin the community. The local Community Action Agency may help them in this process through health centers, legal aid, neighborhood centers, and other components of Community Action Programs. Thus, money income is part of a broader strategy to help the aged rejoin the community. We, therefore, will certainly support these agencies in developing their programs, to serve older poor Americans, and we shall make every effort to integrate this special age group into the total efforts of the War on Poverty. Senator Kennepy. We have your testimony. Would you proceed ? Mr. SHRIVER. Yes. Mr. Chairman, I welcome this chance to discuss with you and the other members of the committee the questions involved with poverty and older Americans. As you well know, President Johnson proclaimed May as “Senior Citizen’s Month.” At the close of this period of special emphasis, T would like to join with others in paying particular respect to 1814 million Americans over 65 years of age. All of us need to be ap- preciative of the contribution of our seniors and sensitive to the spe- cial needs of this age group. The present administration has been keenly aware of the problems of our older Americans. Let me cite some statistics here to point up the accomplishments so far on behalf of the aged : . = 1965 Federal programs for the aged totaled more than $19 illion. In 1966, they will total nearly $22 billion. NEEDS REVEALED BY OPERATION MEDICARE ALERT 9 In 1967, with the full impact of Medicare and increased Social Security, they will reach $25 billion. The sum of $25 billion is four times greater than the entire Federal budget in 1940, just a generation ago. Twenty-two major measures enacted for the benefit of our senior citizens capped by the Medicare Act and the Older Americans Act. On April 11,1965, President Johnson said : The aged must be integrated into American life as full partners in the Great Society. The statistics I have cited above show how much of that promise has already been fulfilled. As Director of the Antipoverty Program, I am concerned with the unmet needs of the millions of Americans over age 65 who are eco- nomically deprived and often socially alienated. When a person 1s olaet and poor, he tends to be rejected by those in the mainstream of life. All of us too easily overlook this vast group of the hidden poor, which you referred to yourself. And so today, Mr. Chairman, 1 would like to do three things in this testimony. I would like to try to report on the progress we have been making in OEO with respect to the older poor Americans and I shall try to set the problems of the older poor Americans in a larger perspective, and I shall try to share with you the present emphasis on programing for this age group which our staff feels is appropriate under the existing circumstances. We have been doing some things, not as much as we would like to do, but some things since I last testified before this committee on the 19th of January. Let me share some of these highlights with you. First of all, our Community Action Program, which is represented here by Mr. Hess on my left, is about to embark on a major health-aide program involving the elderly. This project which is just beginning will be funded we hope for approximately $20 million. This is a program to recruit, select, train, and place nonprofessional workers. The project will employ many poor persons who are 45 years and older, including a large number of the older poor. Moreover, a significant proportion of the services provided by the health aides will be directed to the senior citizens who are homebound. The nonprofessional health aide could work not only in the home, but in other settings as well: in the neighborhood health center and in multipurpose centers as family agents helping families to locate and obtain needed health services; in health departments as assistants to health educators, social workers, sanitarians, laboratory workers, family planning workers; in a variety of institutions and agencies as aides to those working with the mentally retarded, with crippled chil- dren, with alcoholics or narcotics addicts. And this list represents only the beginning of the possibilities for new career opportunities opening up, we hope, through the health aides program which, as I said, will employ a large number of older persons. One might ask at this point why we start at age 45 rather than at a more elderly age if we are really focusing on the elderly poor. The reason is that a number of the jobs which we hope to develop in the health-aide program do require a substantial amount of physical strength. 10 NEEDS REVEALED BY OPERATION MEDICARE ALERT For example, in a hospital with the strength needed to actually lift a patient and move a patient on or off of a stretcher or to carry a heavy weight some distance in the work that is required in the hospital, we believe that by starting at 45 we have a chance, therefore, to get a number of persons who would have that physical capacity, but by starting at 45 we do not mean to imply that we are going to emphasize the age groups, let us say, from 45 to 55. We are looking forward to emphasizing, as I said earlier, the elderly poor rather than just those at that earlier age. The second thing, which you just referred to, Mr. Chairman, is the Operation Medicare Alert. As you know, this program was de- signed to use older persons as aides in a massive effort to tell other older Americans about Medicare. We worked in closest cooperation with the Social Security Administration in a joint venture. This program, by older persons and for older persons, is the largest single program we have sponsored within community action, apart from Headstart. This is true in terms of the number of community action agencies that participated and in terms of the number of recipi- ents directly benefited. For example, there were 467 Medicare Alert projects in 47 States, Guam, and Puerto Rico. Eleven of these were on Indian reservations. We had an army of 12,471 paid older workers, along with 21,178 other senior persons who volunteered their services. These dedicated and active elders contacted 4,300,027 older persons to suggest that they consider signing for Medicare benefits and to help them to sign up for those benefits. These workers arranged for 9,356 meetings, which were attended by 308,375 older persons. Finally, they referred 55,597 persons to other antipoverty programs for needed help. Our staff 1s now making a detailed analysis of reports from all of the Operation Medicare Alert projects. The social knowledge that is pin 2 | can help Government agencies form realistic public policy. The program made us aware of two basic needs: the desire of large numbers of senior persons for meaningful part-time employment, and the plight of many older persons who face the prospect of illness and dependency without anyone who can be counted on to care. A specific problem most often. mentioned to Medicare Alert teams was the high cost of drugs that they needed. From a preliminary report, it is evident that workers often ex- Rerisnced shock, surprise, and dismay at conditions they observed. ary Stamper, a Kentucky woman, expressed a widely shared feel- ing when she said : Although we got into some funny situations, others were sad, and some nights it was difficult to get to sleep remembering some of the things we had seen. Out of the 218 reports examined to date, 80 percent of the agencies reported a ferment in their thinking about the traditional institutional ways to meet the problems among the aged in their communities. The most pressing needs appear to be in the area of health programs, neighborhood centers with friendly visitors, housing, and employment programs. Medicare Alert workers proved that they were resourceful and pro- ductive. One project director described the workers’ problems as one of “too much dedication,” so that they would “overextend themselves NEEDS REVEALED BY OPERATION MEDICARE ALERT 11 at times.” The director of the Social Services Agency of Greater Trenton in New Jersey said : One of the few short-comings we found in their performance was their lack of fear for their own safety. The experience of meaningful activity, even for a limited time, had beneficial effects on their personalities. A California director de- scribed these effects as follows: Although the canvassers had great difficulties, they had a purpose and the experience was good for them physically, and having a job to do was uplifting mentally. Adverse circumstances were almost overwhelming. The project was conducted during the ice and snow of February and March. Yet, the elderly workers walked and drove thousands of miles on the back- roads of Maine and Arkansas, as well as the glazed streets of New Haven and Tulsa. They climbed millions of drafty stairs in the tenements of New York and San Francisco. Operation Medicare Alert disproved the oft-quoted saying: An aged man is but a paltry thing, A tattered coat upon a stick. Now, Mr. Chairman, let me speak about our Foster Grandparent Program. This program employs poor persons above the age of 60 to work on a personal basis with emotionally deprived, mentally re- tarded, and ity handicapped children. Many of these proj- ects are experimental and go outside of full care institutions into pub- lic school settings and day care facilities. As of my last report to you in January, I said there were 21 such projects which we had funded for a total of $2.7 million, employing more than 1,100 older persons. These programs, as I said, have operated now for about 6 months. On the basis of what we found out through those programs we recently funded an additional 12 foster grandparent projects for $2.5 million. These projects will employ 1,067 older persons and will bring the total funded projects to 33. Money has been allocated through section 205 discretionary: funds so that there will be a total dollar amount of 11.5 million for this fiscal year. The current pressure on CAP funds, however, make it necessary to defer a portion of the planned funding until July. We have contracted with an independent research organization to evaluate the program. An interim evaluation has indicated that the Foster Grandparents Program has given many older persons a new sense of usefulness and an increased self-esteem. The earning of money was especially satisfying, but the social mean- ing of the work was extremely important to these older citizens. Of course, they derived immense emotional gratification from the chil- dren’s attachment to them. We also made some investigations of the impact of the work done by older people on the children. Let me just say in parenthesis here that when we started this program there was a substantial amount of authoritative opinion which believed that older persons—that is, peo- ple over 60—should not be encouraged to go to work and help out these small children, especially infants. 1 Yeats, Willlam Butler, “Sailing to Byzantium,” 1928. 12 NEEDS REVEALED BY OPERATION MEDICARE ALERT It was believed by some experts in that field of social welfare work that younger women and younger men should be employed, that peo- le over 40 were not really qualified emotionally and otherwise to a with these foundlings and other young children. So when we started the Foster Grandparent Program it was not as if there was no opposition to it. he opposition may not have been very vocal, but there was a pro- fo ee that the foster grandparents idea would be a success- ful one. Consequently, the preliminary research that we have done is extremely encouraging to us. One competent researcher reported that foster grandparents handled infants with a care and understanding that exceeded in some cases average hospital staff members. These substitute grandparents are able to get responses from infants who lay in cribs all day without moving with nobody practically to handle them. Children who ordinarily would not walk or talk be- cause there was nobody with the time to devote to them are now walk- ing and talking. Although these are preliminary and informal im- pressions only, the report is definitely positive in the value of the Foster Grandparent Program to both its beneficiaries and our senior citizens. Two anecdotes from the Denton, Tex., program illustrate what is happening: Ned spent his time facing into a corner and cried when approached. He had to be dragged kicking and crying to the dining room. The first change observed after his contacts with a foster grandparent was that he sat in the corner, facing the room. He has now learned to patty-cake, reach out his hands and goes to the dining room quietly, holding Foster Grandma’s hand. Keith was known as “the screamer.” It was an all day pattern. After contact with the foster grandparent, the screaming gradually stopped. He has begun to eat with a spoon and shows marked improvement. The staff has now revised its opinion and believes he may have a high potential. We have examples from up in New England from foster grand- parents who are making clothes for these babies, and the foster grand- parents, no question about it, look upon these children almost as though they were their own. Has the program been well received by the host institutions? Yes; a report from Denver, Colo., is typical : Both our hospitals have said that they anticipated far more problems than have occurred. We felt that we had reached the apogee when doctors at Colorado General were writing on their orders: Please assign a grandparent to this child. This report continued : Stevie, a bright two-year old, in Colorado General was admitted with the diagnosis of “battered child syndrome.” He had a skull fracture and massive skin lesions, which were treated like burns. He had to have painful treatment and had to have someone hold his hand when he walked for fear that a fall might injure his head again. After substained contact with a foster grandparent, he seemed to stabilize his affection. * * * Mr. Thomas A. Tucker, president. of the National Association for Retarded Children, has appraised the program in this way: Reports received at our headquarters from various parts of the nation indicate that the Foster Grandparents Program is meeting a vital need. Many mentally NEEDS REVEALED BY OPERATION MEDICARE ALERT 13 retarded children are, through no fault of their own, the victims of neglect and apathy. Your programs help to provide the individual care, affection and under- standing necessary to help many of these mentally retarded children become productive, well-adjusted tax-paying citizens. A third program that we have started, not on a very large scale yet, but it was an experimental program, as many of our programs are, is called Operation Green Thumb. This project was designed to employ retired poor farmers in high- way beautification and is in operation. Green Thumb workers have planted more than 30,000 trees and shrubs and have worked on dozens of roadside parks in Oregon, Minnesota, Arkansas, and New Jersey. The average income of these men before coming into the program was $900 per year, and the average age is 67. Many are in their mid- seventies; the oldest worker is 88. Their average income, which a few short months ago was $900 per annum has now been increased by $1,500. Most of them are able to put many younger people to the challenge with the amount of work they produce. State agencies, I might say, have been most cooperative in supplying materials and equipment; the cost of this project is being equally divided between OEO and State highway departments. Some people who became Green Thumb workers are now off of welfare rolls, where heretofore they were on welfare rolls, and they have found a great new meaning to life. They have gotten medical assistance they didn’t have before. Look at a typical Green Thumb worker: Mr. Ray Pake, in Oregon, has farmed most of his life. He was receiving $35 per month Social Security and $50 from welfare. He is now off the welfare rolls. His eyesight had been poor, but through this project Mr. Pake was exam- ined and provided with new glasses. Mr. Pake is finding new hope in life through his job. One thing that 1s often overlooked that we do is the general work that reaches older people through Community Action Programs. That phrase “community action” is such a vague phrase that it 1s difficult for everybody immediately to understand it. Community action affects not just younger people or middle-aged people, but it affects all people, including i people. ost Community Action Programs are developed at the local com- munity level in response to the felt needs. CAP has been providin, technical assistance and giving encouragement to communities whic choose to include components specifically designed to serve older Americans. Here are some representative projects that have been funded through regular community action agency channels: (a) Boston, Mass., in your own State, has recently been funded to establish senior citizens centers in six target areas, one in the north end, one in the south end, one in Roxbury, one in Charlestown, one in East Boston, and one in Parker Hill. These six centers will provide adult education, information, and referral services of other social agencies and health services for the elderly, retraining many elderly for employment, and homemaker services. Those are services whereby somebody goes out into the homes of the elderly to help them. This comes under our title of community action, and unless it were specifically pointed out as a method of get- 66-547 0—66——2 14 NEEDS REVEALED BY OPERATION MEDICARE ALERT ting to the elderly, many people might think that community action has no or very little significance for the elderly. It has great significance and can have even greater significance pro- vided local Community Action Agencies request this type of financing which Boston has requested and received. (6) Dayton, Ohio, has a senior citizens recreation project in a pub- lic housing project with 1,124 participating who are over 65. They are using a team approach—nurses, doctors, counselors, and recreation leaders for arts and crafts. Their services are also available to 40 older persons who do not reside in the housing project. (¢) In Chicago, a grant provides senior citizens centers where 3,500 persons over 60 years of age are offered adult education, trips, creative arts, health education, and counseling at a rate of $6 per beneficiary per month. (d) In West Virginia, Monongalia County, the CAP there, Senator Randolph, has a grant to establish a recreation center in the basement of the city library, and five part-time centers in outlying areas spe- cifically for the elderly. (e) In New York City, the Economic Opportunity Committee of New York has a funded program, sponsored by the Federation of the Handicapped, called PATH (Personal Aides to the Handicapped) in which 250 older persons are participating. Mr. Chairman, what I have just described to you are some of the specialized separate programs requested by communities and sponsored by the Office of Economic Opportunity specifically for the elderly oor. - P There are many, many more of these specific programs within the umbrella of community action which do reach the elderly, but they are not under some simple title like say Headstart and, therefore, they are not as easy to dramatize, but the work that they do in our judgment is extremely important. Our concept of the Community Action Programs is to provide a com- prehensive set of assistance and benefits for all the poor regardless of age. The older poor, as well as the young, are participants and bene- ficiaries in such Community Action Programs as health services, home- maker services, food distribution, consumer information, legal services, social and recreational services, and adult basic literacy. Many of these components when put together with their outreach efforts are the main elements of our multipurpose neighborhood center Dignan of which we expect to have a total of 600 funded by June 30. e are assuring that the multipurpose neighborhood centers are giving consideration to the poor senior citizens who are especially in need of the centers’ services. A neighborhood center doesn’t serve just young people or adults in the 30- to 40-year age group. It serves all the people in the commu- nity, including, of course, the senior citizens, so that those 600 centers all over America will be helping. These also are financed through community action funds. Finally, I think we ought to recognize the outstanding work done by older people who have become VISTA volunteers. Of course, we must not forget that 12 percent of VISTA volunteers are age 65 or over. There are 350 VISTA volunteers over 65 years of age right now. This is a pioneering effort to utilize constructively the talents of older people. Some of the volunteers are— NEEDS REVEALED BY OPERATION MEDICARE ALERT 15 (a) Edgar Slater, an 85-year-old man, teaching Crow Indians a comprehensive manual arts course. (6) George Cottell, 71, working with the department of wel- fare in Hartford, Conn., assisting in job placement and providing encouragement to other elderly persons. (e¢) Margery Dritea, 68, working in a State mental hospital in West Virginia helping patients through music. (d) Mrs. Maurice Frink, 75, teaching preschool children at Fort Defiance, Ariz. Now, let me share with you a perspective from which we view prob- lems of the older poor American. While there is much that remains to be done for the poor senior citizen, our Nation is making a major effort in meeting the economic and social needs of the aged. For example, in the fiscal 1967 budget presented to Congress, it is estimated that the Federal Government poverty expenditures as a whole, not just what we do in our agency, will total $21 billion. Of this amount, it is estimated that more than 40 percent will benefit per- sons over 65 years of age. To give a sharper focus on this, let us look at 1964, the last year for which detailed data on the number of poor are available. In that year, the 5.4 million aged poor represented one-sixth of the total poor. While we do not have sufficient data to show how much of the Federal poverty dollar went to this group, it was at least twice their proportion of the poor population. This was prior to the landmark enactment of Medicare and the OASDI and OAA increases of 1965. Further, in 1964, other poor groups’ needs were even greater than those of the aged. For example, the income deficit—the amount of income needed to reach the poverty level—of all families with children under 18 was 214, times that of all of the aged poor. In other words, the income deficit. for the aged poor was $2.7 billion, whereas the income deficit for all of the poor was $12 billion. In other words, for all the poor to get out of poverty, their income deficit was $12 billion. Older people have special maintenance and assistance needs. Many older people are very poor. But, in our concern for all poor people, which is our responsibility, we must recognize the existence of com- peting needs relative to a limited supply of poverty dollars, certainly with respect to our agency. While our Nation is doing a great deal for older Americans relative to other poor groups, much remains to be done. In order to bring all older people out of poverty by our minimum standards, we would have had to spend in calendar 1964 an estimated additional $2.7 bil- lion. To bring all of our poor, as I said a minute ago, above the pov- erty income line, we would have had to spend nearly $12 billion a year, for the aged poor approximately $2.7 billion. Congress has charged the Administration on Aging of the De- partment of Health, Education, and Welfare with the general re- sponsibility for older Americans. We believe that the new Commis- sioner, Mr. William Bechill, and his staff are highly qualified. I am confident the Congress will assure that this agency’s authoriza- tion and appropriation will be adequate. We are cooperating with and supporting other agencies of the Government that have responsi- 16 NEEDS REVEALED BY OPERATION MEDICARE ALERT bilities for the aged, such as the Social Security Administration, the Welfare Administration, and the Public Health Service, to the best of our ability. A final aspect of the perspective which must be considered is the fact that OEO has a primary mission of attacking the causes of pov- erty. We want to prevent poverty rather than merely treating pov- erty’s symptoms. Prevention of poverty in the older years is much Hore difficult to achieve than prevention of poverty among the chil- ren. This Administration has supported legislation to broaden the bene- fits of Social Security and we at OEO have encouraged full participa- tion in the Medicare program. We even, as I testified back in Jan- uary, urged that Social Security be improved as a way of helping the elderly. The Congress has already taken a first step by blanketing in people over 72 and making them eligible for benefits. While the Congress has placed emphasis on youth type programs in the OEO legislation, such as Headstart, Job Corps, Neighborhood Youth Corps, and college work-study, the Congress has recognized that the OEO program is not just a youth program, but it must serve all who are poor. In fact, the Smathers amendment has given specific legislative direction to include the elderly. Section 610 of the act reads: It is the intention of Congress that whenever feasible the special problem of the elderly poor shall be considered in the development, conduct, and adminis- tration of programs under this Act. A summary of all Community Action Programs reveals that we will spend approximately $50 million for programs that benefit the older Americans this fiscal year. These include 561 separate grants, em- ploying about 19,000 older persons, and benefiting some 4.4 million. These figures include the Operation Medicare Alert program. We consider this number of participants and beneficiaries, along with the dollar value of programs, to be a fair proportion considering the appalling magnitude of the needs for programs by the 32 million nr we are trying desperately to help with a mere budget of $1.5 illion for fiscal year 1966. At this point, Mr. Chairman, I would like to interject a comment about our fiscal year 1967 program. The effect of the House Educa- tion and Labor Committee bill, which was reported out on May 17, is to reduce funding for the Community Action Programs by more than $100 million below the President’s budget request. The changes have a restrictive effect on the proposed fiscal year 1967 program for the aged. We proposed, for example, a modest $70 million for fiscal year 1967, which corresponds to the $50 million pro- gram provided in fiscal year 1966, but if we don’t even have the $70 million we are not going to be able to do as much in 1967 as we have done in 1966. In summary, we have developed specific projects designed to serve older persons. Our local CAA’s have used their initiative and allotted their guideline funds for programs in many instances. Finally, most CAA’s include those in later life in the entire gamut of program activities. Now let me move to the third general area: the direction of our efforts for the next fiscal year. NEEDS REVEALED BY OPERATION MEDICARE ALERT 17 We shall make every effort to include older persons in existing pro- grams. We are reevaluating existing programs with this in mind and we are studying new methods which will insure larger participa- tion by older Americans. We shall participate in a high-level conference at Notre Dame Uni- versity in Ags, meeting with selected authorities in the field of aging, to further refine our long-range goals in this area. By memos, surveys and on-site visits we shall assist CAA’s in estab- lishing meaningful and effective programs for older Americans to the Fagin extent, feasible, consistent with local initiative and available dollars. ‘We shall continue to make private and public agencies who also have responsibilities for the aged aware of the special problems faced by older Americans. We shall increase our efforts to make all of our staff at the local, regional, and Federal levels aware of the need to include older persons in a great variety of programs. We shall continue to work with other Federal agencies to alleviate the special conditions of older Americans which prevent them from having economic security and social support. The President on April 8 asked the Secretary of Health, Education, and Welfare to study the possibility of improving Social Security across the board, for the aged as well as other groups. We will con- tinue to work with Health, Education, and Welfare, and other agencies which have primary responsibility for income maintenance (including Social Security), health, housing, and other programs which represent the bulk of the $26 billion the Federal Government will spend in Fiscal year 1967 for the aged. In conclusion, Mr. Chairman, we are concerned for older Americans in poverty. We are aware of the problems and special needs of this age group. We shall do all that we can within the perspective of our orientation and the dollar limitation imposed upon us. The greatest assistance for the elderly must come from the primary mission agencies, especially those providing income maintenance. Only when we restore the dignity of sufficient income will the aged poor begin to rejoin the community. The local Community Action Agency may help them in this process through health centers, legal aid, neighborhood centers, and other components of Community Ac- tion Programs. Thus, money income is part of a broader strategy to help the aged rejoin the community. We, therefore, will certainly support these agencies in developing their programs to serve older poor Americans, and we shall make every effort to integrate this special age group into the total efforts of the War on Poverty. We will do everything that we know how to do within the limits of the moneys that are available to us in this coming Fiscal year. I can’t conclude, however, without saying that the bulk of the work that has to be done for the elderly I am afraid will have to be done by other agencies as long as we have as little money as we have to meet the needs of all the poor. Income maintenance is, let us say, objective No. 1. The serv- ices through our multipurpose centers of health services, legal aid, and other components of community action will be helpful, but money, in- come, is a much more important part of the Foniet strategy to help the'aged. 18 NEEDS REVEALED BY OPERATION MEDICARE ALERT We, therefore, support all these other agencies which are testifying before you now and will testify in the future and we hope that we will be able to offer constructive assistance to them in bringing new hope to the aged poor in our Nation. Thank you very much. Senator Ken~Nepy. Mr. Shriver, I want to thank you for an ex- tremely comprehensive presentation, as always. I would first of all like to discuss with you some of the administra- tive and institutional problems which are presented by the program and then review briefly some of the things which have been outlined in your testimony. One of the recommendations made by the Special Committee on Aging is that the OEO, by administrative action, establish a better priority system by appointing an individual in OEO who would have complete responsibility for the aging programs. What would be your reaction to such a recommendation made by the Aging Committee? Mr. Sariver. We favor that recommendation, Senator Kennedy. We, in fact, have requested a number of people to take on that respon- sibility for us and we have had a little difficulty from time to time, but I am happy to say that Dan Schulder, who is up in the State of New Jersey and who has proved to be very effective in that State working in the antipoverty program, has accepted our invitation and is coming down to do exactly that at OEOQ. He starts, in fact, next month. 5 on gtor Ken~epy. What would be his access to the Director of the Mr. Suriver. He would be a part of the community action opera- tion in OEQO; the Director of Community Action is himself a Presi- dential appointment, so the line of command would be to the Director of Community Action and from that man to the Director of OEO. Senator Kennepy. He will be under the Director of Community ction? Mr. Suriver. That is correct. He would be within Community Action where most of the work that we do with respect to the elderly is concentrated. For example, Medicare Alert was in Community Action. Medicare Alert was carried out by 460, I think it was, 467, Community Action Agencies across the country. It is a vehicle for doing a great many things. For example, our legal service programs, Headstart, Upward Bound, and all of those work out of the Community Action operation. Senator KennNepy. The recommendation that would come from the committee would be for an Assistant Director. I would observe from your comment that the person who would assume that responsibility would not have that title, or would he ? Mr. SurivEr. No, sir; the Assistant Directors of OEO are like Mr. Bookbinder. We try to keep the assistant directors of operational units in the operational units, and the staff personnel like the general counsel or public affairs or Mr. Bookbinder’s office at the staff level. Let me give you an idea of what I mean. The people who are in- terested in the rural problem would like to have somebody who is a specialist in rural affairs report directly to the Director of OEO. The NEEDS REVEALED BY OPERATION MEDICARE ALERT 19 older people want that. The young people want that. The Indians want that. Everybody seems to want to have a person who reports directly to the Director of OEO. We have tried to make those persons operational rather than staff and we have placed them in the operational line of command rather than in the staff, so you have in Community Action a Director of Head- start who reports to the head of Community Action and through the head of Community Action to the Director of OEO. You have a director of Upward Bound. You have a director of legal services. The analogy has been drawn to the Defense Depart- ment where you have the Polaris missile project, for example. It has its own budget, its own director, its own policies, but it is, I think, within the Navy Department and reports up through that Department. We have a comparable structure in OEO. Senator Kexnepy. How many people are working generally with- in OEO on the problems of the elderly poor? Mr. Suriver. There never would be too many, I would hope. We have had no more than two or three at any one point in our history, but let me indicate that we have had only three people working on the problems of the American Indians. Yet the program that OEO has mounted with respect to the American Indians has been extremely ef- fective we believe, certainly has been extremely popular and well re- ceived by the American Indians, so it is not primarily the number of people who work on the staff. It is what they do, and in the case of the Indian program, which is in a sense comparable, there are about 700,000 Indians I think, reservation Indians, and two people today are handling the entire OEO program with respect to the Indians. Senator Ken~epy. I think there is no question that it would be much easier to departmentalize the Indian program than the program Jinscted toward the elderly poor. I think there is a notable distinction there. Mr. Sariver. There are a variety of ways of doing these from an administrative point of view. We have a program now which will be very popular called Upward Bound. It is a program which this year will reach an expenditure of about $26 million and it will bring 25.000 high school students to campuses of various universities this summer and then we stay in touch with them all the next academic year. That program within OEO has been handled by, I am almost sure, not more than five people. What was done there was this. We have five people on our staff, but we contracted with a new or- ganization called Educational Services Organization and they did a great deal of the leg work that was needed to be done. They had a great many people who were experienced in academic operations. Similarly, here with the elderly poor we have contracted with the Administration on Aging over in HEW to do a substantial amount of the work for OEO. My theory has been to try and keep OEO in terms of personnel as small as possible and when there is an agency of the Government like the Administration on Aging established by Congress to utilize it to the maximum. 20 NEEDS REVEALED BY OPERATION MEDICARE ALERT Senator Kexnepy. Ithink certainly the goal is a worthy one. What is of concern to many of us is the nature md the sense of priorities which have been given to the problems of the elderly poor versus the decrees of priorities which have been given to the other programs. We raise the question of the sense of priorities which are given to staff personnel because we wonder whether there is a sufficient priority being given to needs of the elderly poor. In your testimony you talked about the various programs which have taken place, Medicare Alert, Foster Grandparents Program, Green Thumb, and VISTA. In Medicare Alert program, which, I understand, was extremely suc- cessful, there were some 14,000 elderly people involved. Another program which you mentioned is the Foster Grandparent Program. In this case we are talking about figures from a thousand to perhaps as high as 2,000 if the new funding is realized in the not too distant future. It is difficult to get a figure of the involvement of those that have been active in the Green Thumb, and in VISTA. TI believe you mentioned some 350 people. Now, from the testimony that we have heard it seems that there are 1 million elderly poor that are prepared and are competent to assist in some way. What is of concern to all of us is the fact that we are not just talking about a few hundred people undertaking a variety of programs. And when we raise the question of staff and priority systems we do it to a considerable extent because of the apparent inadequate utilization of these senior citizens. Mr. Suriver. Well, I share the frustration. As I said when I was over here the last time, I plead guilty to the fact that we have not been able to think up simple ways or effective ways to utilize these 1 million aged people that you just referred to. Let me explain that at $3,000 a year if you were to give them employ- ment at the poverty, so-called, cutoff, statistical cutoff, that would cost the Congress $3 billion. If you gave them part-time employment which was only, let us say a thousand dollars a year in income for services rendered, those million people, that would cost Congress a billion dollars. I am not opposed to that. Don’t misunderstand me. It just is that we don’t have anything like that kind of a budget nor anything like that kind of an authorization. I don’t mean for money, but I mean even for programs. Senator KENNEDY. On page 11 you say in your testimony : Now, let me share with you a perspective from which we view problems of the older poor American. While there is much that remains to be done for the poor senior citizen, our Nation is making a major effort in meeting the economic and social needs of the aged. For example, in the Fiscal 1967 budget, it is esti- mated that the Federal government poverty expenditures will total $21 billion. Of this amount, it is estimated that more than 40% will benefit persons over 65 years of age. The problem that concerns me is that, on the one hand, your testi- mony reveals that there is an extraordinary expenditure of Federal funds, and, on the other hand, you testified that the principal reason for the inadequacy of these programs is a lack of money. If there is NEEDS REVEALED BY OPERATION MEDICARE ALERT 21 a dramatic need because of the lack of funds that information ought to be presented to Congress and explained. ft we were to read just this testimony and the following pages about the great amount of money that is being expended and used I think there are those who would interpret this to mean that we are doing a sufficient amount at the present time. Mr. SurIvER. I agree with that statement. Let me, however, just submit for the record, if I might, what that $21 billion is composed of, and $21 billion still in my judgment is a major effort by the Federal Government. Now, of the $21 billion, $12.7 billion goes to employment of direct cash benefits to the elderly. Senator KEnNepy. Is that $12.7 direct cash? Are you talking about Social Security ? Mr. Sariver. That is right. Senator Kennepy. I would certainly say that a reasonable case could be made with regard to Social Security, that it represents a return of funds to A who have made payments over a considerable period of time. In one sense, the Social Security Administration is under or is within the Federal Government, but I think it certainly would mislead one to think that this is an effort which is really being made by the Federal Government as such. I think the expenditure of that $12.7 billion is money which quite rightfully belongs to these individuals. Mr. Sariver. I don’t disagree with that either. All I was trying to do was to itemize what there is in the budget that the Congress already passed on which constitutes, at least in some people’s minds, a major effort. It is $21.4 billion. I am not saying that it isn’t justified. I think it is justified personally. There ave $2.8 billion in health benefits. There are $2.8 billion in educational benefits. There are $3.1 billion in other benefits which I could get all itemized for you. I am not trying to say that that is enough. All I am trying to say is that there is that amount of money and that is what I was referring to when I said that the Federal Government, you as the Congress, are already using a lot of money in this field. Now, the second part of the question is, well, what about the million people who are elderly who would like to do something part time or full time. They are not reached except indirectly by all these programs and they could do more. There is no question about that. But, when we are talking about a million people I think we just have to stand still for a second and say, “Now, what can you do for a million people that will be of any significance to the individuals involved.” ’ If you are talking about $500 a year or if you are talking about a thousand dollars a year added income for a million people in return for work performed, part time or full time, you are talking about one, two, or three billion dollars. Senator Kexnnepy. If that is what is needed—and I think there are few people in the Federal Government who really understand what is needed—then I think that those recommendations certainly should be forthcoming so the Congress can understand and fulfill its responsi- bilities in solving the problem. 22 NEEDS REVEALED BY OPERATION MEDICARE ALERT If the question really is funds or money then we should have a recommendation in that area. Congress could then make the deter- mination. Mr. Suriver. I, on page 12 of my statement, did express the opinion that in order to bring a ie people out of poverty by our minimum standards, you have to spend in calendar 1967, let us say, $2.7 billion additional. Now, we are not proposing that that is a proper thing to do, in the first place because it is not within the President’s budget and we don’t have the authority to make any such proposal; second, because how that money would be expended has not been studied in the Executive Branch, so far as I know, in any great detail although we try to work in OEO with other agencies. It hasn’t so far as I know been studied, but by arithmetic, if you are going to take so many elderly people of a certain income over into a ifferent income bracket, you are going to have to spend $2.7 billion - to do that. Senator Kennepy. I have some other questions, but I would like to yield to Senator Young. Senator Youna. Mr. Chairman, thank you. Director Shriver, I really have no questions to ask of you. I want to tell you, you made a most impressive statement and I am simply wondering if you are going to continue to do all you can to encourage this VISTA volunteer program. Iie It seems to me that is a very fine program, that you should enroll more people if possible into it. Mr. SHRIVER. Once again I agree. We are trying to increase that program as rapidly as we can, again within the money that we have. There will be on the 30th of June 3,500 people in VISTA actively in the field or in training. About 2,200 are in the field right now. Again, it depends on what we are able to obtain from Congress in terms of appropriations. The House bill has increased the suggested authorization for VISTA substantially—up to $31 million from only $17.5 million this year. That is a pretty substantial jump, but it still won’t do all that I am sure you would like to have it do or that I would. Senator Youne. Also your Community Action Programs in my State and elsewhere, I think, are going great. I want to compliment you on that. Mr. Suriver. Thank you. Senator Youne. Ihave no other questions. Senator Kennepy. Senator Allott? Senator Prouty ? Senator Randolph ? Senator Ranvorru. Thank you, Mr. Chairman. Mr. Shriver, on May 24 in Jefferson County, W. Va., the annual meeting banquet of the Jefferson County Chamber of Commerce was held at Harpers Ferry. Addressing that meeting was Holmes Alexander. He is a colum- nist. Do you know Mr. Alexander personally or do you know that he is a newspaper columnist ? Mr. Suriver. Yes, sir; I do. I do know him as a columnist and I happen to know him personally. NEEDS REVEALED BY OPERATION MEDICARE ALERT 23 Senator RanpoLpr. Mr. Alexander said in speaking of the War on Poverty : “The cure is worse than the disease.” He also said, and I quote from the Spirit of Jefferson-Farmers’ Advocate, issue of May 26,1966 : The War on Poverty is for the warriors and not the poor. Mr. SurivER. Lawyers? Senator RanpoLpa. Warriors. Mr. Suriver. Oh, warriors. I thought you said lawyers. Some people have said that. Senator Ranporpu. I have given you these two quotes from his speech. Of course, in the State of West Virginia we feel that gener- ally the War on Poverty has been a successful program. We believe that the results have been in the affirmative. Would you care to comment on these two statements that I have read to you which were given in the State of West Virginia last week at an important business banquet ? Mr. Suriver. Well, I would say that they are typical of a certain gronp of journalists who have been saying things comparable to that or quite a while. I would inquire frankly whether Mr. Holmes Alexander had the time when he was in Harpers Ferry to go to the Job Corps camp next to Harpers Ferry and talk to some of the youhgsiers who are poor and who are being helped by the War against Poverty in Harpers Ferry or in the area surrounding Harpers Ferry. I think if he had done that he might have had a different attitude about the effect of the War on Poverty because in the Job Corps Center just outside of Harpers Ferry there is a substantial number of poor kids who are getting a new chance and they are profiting by it. I don’t know frankly what War against Poverty projects Holmes Alexander has personally inspected. I wouldn’t be surprised if he hadn’t seen any. He could, on the other hand, have seen some and some of them are not as successful as they ought to be. But I think if he would take out a week and come with me which I would be happy to invite him to do, I can show him a lot of results with the victims as well as the warriors. Senator Ranporpr. Mr. Shriver, this news article which I have quoted is on the front page of the Spirit of Jefferson issue of May 26. Also on the front page is a photograph in connection with a story which deals with the Job Corps Center at Harpers Ferry to which you made mention. The headline is “Driver Training Course Inaugurated at Job Corps Center; Corpsmen Are Promoted; Relations Council Formed.” There was some opposition to the location of a Job Corps Center in Jefferson County. But we today feel that the Job Corps Center now established in that county is a successful project and we believe that the very large majority of the citizens in the county are not only appreciative of the work being done, but are cooperative with the project. The work being done there, of course, is very important to the development of the Harpers Ferry National Historical Park, and I am grateful for your comment today. I have usually had an invita- tion to that annual banquet, but this year with Holmes Alexander as a speaker I didn’t receive the invitation. There might have been 24 NEEDS REVEALED BY OPERATION MEDICARE ALERT a feeling that they knew what he was going to say and didn’t want to embarrass the Senator from West Virginia who has supported the program, although at times calling your attention to mistakes and errors which I felt were being made. Mr. SHRIVER. As you know, Senator, I have some relatives in Harp- ers Ferry myself, one of whom serves in the State Legislature of West Virginia even now, and I have visited there many times and like it very much in Harpers Ferry although it is true, as you know, that in Harpers Ferry there always has been a difference of opinion about things. I think Harpers Ferry was the scene of the hanging of John Brown and maybe Holmes Alexander was down there anticipating something like that, but maybe next year you and I can both get down to that Jefferson County dinner and if invited I would be happy to go with you. Senator RanvoLru. John Brown wasn’t hung in Harpers Ferry, but in Charles Town. Mr. Suriver. Excuse me. You are right; nearby, Charles Town, right across the river. Senator Ranporpu. The county across the river a few miles away. But when TI first introduced the bill to establish the historical park there, of course, there were persons who said that I was simply at- tempting to immortalize the spirit of John Brown, so you do have dif- ferences of opinion, and the park came into existence. We had almost 800,000 persons that visited that park during 1965. I am glad we can, oh, in a sense be facetious this morning in refer- ence to some of this subject matter, but I think it is important to you to know that there are some persons who are very active in opposition in the spoken and written word to the War on Poverty. It is highly important that you as the director and your associates and those of us within the Congress recognize that there are these differences of opin- ion. Where we find reasons to comment or to criticize it is our respon- sibility as elected legislators to do that. I wish to say again that I am glad that I had the opportunity and that I accepted the responsibility of supporting with my voice and vote the program on poverty. In the State of West Virginia I think the results are on the plus side. I might add that at the present time we have about 50 workers in the VISTA program. We will have between 80 and 100 in the near future. Mr. Suriver. May I add one other thing just for the record, Mr. Chairman ? On this business about the War against Poverty being more for the benefit of the warriors than for the poor, there has been a great deal of inaccurate information put out about that. Just for the purpose of this hearing it might be helpful to note that we have surveyed about 75 percent of all the Community Action Agen- cies in America. In those agencies, which I think number 586 out of 700, it turns out that there are 175 people who receive more than $15,000 a year. Of the 175, half of them are in the 7 largest cities of the United States, so when we hear about people being paid ex- orbitant salaries or that the warriors are getting all the monev, I think it is well to remember that there are only 175 people in all the Community Action Agencies in the United States receiving more than $15,000 and half of them are in 7 big cities. NEEDS REVEALED BY OPERATION MEDICARE ALERT 25 Another charge was made not long ago that there were something like 15 or 30, or some figure like that, people in the War against Pov- erty making more money than General Westmoreland. That was an- other total fabrication. There isn’t anybody in the War against Pov- erty making more money than General Westmoreland. don’t think that anybody should be making any more money than he is making, but the fact 1s that nobody is. Yet that charge, that calumny, was repeated across the country in newspapers and on the radio and television, and those kinds of statements which have a rather dramatic and emotional appeal are the kinds that it is extremely difficult to kill. They keep getting repeated and repeated and repeated, but they are not true, so those are the kinds of things, alleged facts, on the basis of which some people come along and make statements like Holmes Alex- ander made there. Thank you. Senator Ranporpu. Thank you, Mr. Director, and thank you, Mr. Chairman. Senator KENNEDY. Senator Yarborough. Senator YareorouegH. Mr. Chairman, I want to congratulate the chairman of this special subcommittee for this hearing that he has called and I think it is very helpful here in this Subcommittee on Federal, State, and Community Services to coordinate action. I think it is very timely. I want to congratulate the able Director of the Office of Economic Opportunity. I think with the small amount of money that he has received he has done a terrific job. I note here that he had a budget for the Fiscal year 1966 of a mere billion and a half dollars to try to help 32 million poor to earn more money to help themselves. A billion and a half dollars, Mr. Chairman, is a lot of money, but when we break it down it is less than $48 a person and $48 a per- son for the poor with all the administrative costs is very, very little money to raise the living standards of these people. Of course, this Office of Economic Opportunity covers many things. There are some 80 Conservation Job Corps Centers. I never see any- thing about them in the press. Senator YarBorouGH. That is the first time I ever heard of an attack on the Conservation Job Corps Center. They have been so successful. All of the attacks I had previously read had been on the urban type Job Corps, but when you take the total number of attacks in the county there have been very few they have been able to single out for attacks. I recall when this Economic Opportunity Act was passed a great deal of gibing had gone on over the country, a great deal of slurs cast at it. I predicted within 5 years the people that cast those slurs would be eating those words. Some of the very people in the communities that I have been in who slurred at it at first have stopped now and some are serving on local committees. I have had business leaders, who first were critical of it, phone me and say, “Why on earth aren’t they allocating funds for this city. We need it desperately for this city.” Through VISTA volunteers, the adult educational program, and many other ways this Economic Opportunity Act with a small amount 26 NEEDS REVEALED BY OPERATION MEDICARE ALERT of less than $48 per person has done, I think in many fields, a fabulous job, a great beginning. Above all it has stirred the imagination of the people. * I think, Mr. Shriver, that you are getting over to the people of this country that something can be done about poverty. I am convinced that when this act passed most people read in the Bible that you will have the poor with you always and they thought nothing could be done. I believe that it is coming, and if there is not a majority opinion on that side now there will be shortly with the progress you have made with this limited amount of money per person, that the majority of the American people are realizing that something can be done about poverty, and the work you started in my opinion will never end with this Government. I think that enough people are interested in their local services, and through the community action programs and the youth programs, that this work will be carried on. Now, in the field of the elderly I want to congratulate you for these programs that you have set out here, the points of how you can work on this. I will not take time to repeat them. You have summarized them. I deplore with you the action of the House committee in re- ducing the amount of money and particularly in cutting that modest $70 million that is proposed. They cut this poverty program $100 million below the President’s budget, which, in view of our overseas commitment, the Budget Bureau itself had a very, very low budget for the great work that is being undertaken. I hope we in the Senate can restore that and I would like to see more done in this regard. I note talking about the problems of the elderly that some say lack of concern or lack of respect of whether the elderly are wanted or not. I have never seen a wealthy elderly person who wasn’t wanted, so I things some of the want that people have for the elderly depends on wealth. Maybe it is money that talks instead of people, but I have never seen a very wealthy elderly person, regardless of how elderly, shunted aside. They get more and more attention as they get old, so I feel there is a little bit of monetary advantage. I want to relate here a personal experience I had. I was in a very difficult political campaign in Texas one time and we had a day’s workshop and symposium and I was speaking before the eastern region of the State to stir our supporters up. It was just 2 weeks before the election. At the end of this day-long session—and we had the campaign managers and we had publicity men, and they were young and supposed to be pretty brilliant—I had a 91- year-old man come up to me and say, “Judge, I have listened all day. You haven’t covered this.” And nobody had thought of it. It was one of the most vital points in that campaign, and when that 91-year-old man came up and gave us one of the vital things that had been overlooked—this was in the middle of a second primary—I decided then if I could just get all the people over 65 on my side we could do all right with the rest of the people. NEEDS REVEALED BY OPERATION MEDICARE ALERT 27 We were losing campaigns, so I learned from it. That is just one experience of how brilliant people are often. You cannot tell by the age of a man what his intellectual capacity is. Some people age much faster than others. Some have a high mental activity at very late ages, and we need to capture that intellectual activity. We don’t expect any Olympic champions of people after 65, but that doesn’t mean that the intellectual capacity has declined so greatly, and if we can capture that mental capability of people past 65 and turn it into productive channels, use many of them, those people over 65, in these antipoverty programs, I think that we will capture a lot of talent the Nation is now losing. I congratulate you on what you are planning for the elderly, not just for them, but for the country, to utilize their talents and capa- bilities in this whole program, but I congratulate you above all on the overall direction. The VISTA volunteers program is catching the imagination of people more and more. On the Headstart program, I have had uniform approbation of it everywhere. Everyone that has ever been in contact with the Head- start program is thrilled by it and what it promises for the future. I see the whole American educational system 1s so impressed it is now saying we must begin the education of the young at the age of 4 in- stead of the age of 6 years. I think some of their experience in the VISTA volunteer program is one reason why the American educa- tional part of our economy has come to this conclusion. Thank you, Mr. Chairman. Senator KeNNED¥. Senator Prouty ? Senator Proury. Thank you, Mr. Chairman. I might say first that, while I am a member of the Special Commit- tee on Aging, I am not a member of this particular subcommittee. However, I am grateful to the Chairman for permitting me to ask a question or two. When you appear before the Labor and Public Welfare Committee, Mr. Shriver, I shall have many questions with respect to various aspects of the activities of the OEO. his morning we are concerned primarily with the problems of the aged so I shall confine myself to that particular field. I had ex- pressed the opinion in the past that this particular program is not designed primarily to help the elderly citizens in this country. I have felt that they can receive a much higher [degree of benefit and real help through the Social Security program. This year I offered an amendment in the Senate which was ap- proved by one vote and which would place everyone 70 years of age or older whether they qualified or not under the Social Security Sys- tem. The minimum benefit for Social Security beneficiaries would be $44 in the case of the single person, $66 in the case of a married couple. That is by no means ample. I might point out that in the Dominion of Canada every person who reaches the age of 70 receives $75 a month. That is little enough, but it seems to me that we in this country, a great wealthy nation such as ours, can do far more than we have in the past. Now, what the elderly citizen in this country needs more than any- thing else is money in their pockets, money with which to buy the 28 NEEDS REVEALED BY OPERATION MEDICARE ALERT °* bare necessities of life. I think the best means of accomplishing this is through the Social Security program. I offered this amendment which passed the Senate. It went to con- ference where it was watered down considerably. When it was re- turned to the Senate, it provided a minimum of $35 a month or $52.50 for a married couple, which would be reduced, however, by the amount of any public pensions they might be receiving. I might point out that many retired schoolteachers have been receiving as little as $15 or $20 a month which is obviously ridiculous if we think that anyone can sustain himself and maintain the bare necessities of life on an amount as small as that. Also, the conferees provided that only those persons who are or who will attain age 72 before 1968 will be eligible to receive benefits without any requirement of Social Security coverage. We made a first step, however, and the Senate and the House finall approved that version. I intend to offer other legislation before this session is over which will increase the Social Security benefits substan- tially and bring everyone under the Social Security program at age 70. I think that is the only way we are going to help our elderly citi- zens, and I think in the past, Mr. Shriver, you have been frank and honest enough to say that under the present provision of the OEO it is not possible for as much to be done for the poor as both of us would like to see done. I think if we are going to be realistic, what we need to do in this country is to provide ample retirement benefits for our elderly citizens so that they can maintain at least a reasonable standard of living. I think that is the only way we are going to solve this problem. This may do a lot to help some of our younger people. I hope it will. But in my judgment it is not going to be very beneficial to our elderly citizens, at least in its present form. Thank you. Senator KENNEDY. Senator Allott. Senator Arrorr. Thank you, Mr. Chairman. Like my colleague, I am not a member of this subcommittee, though I am a member of the Special Committee on Aging. I would like to make a remark or two underscoring some of the things that Senator Prouty has said because I, too, feel very strongly about the lack of income for elderly people. I supported the amendment which he offered in the Senate earlier this year. This goes back many, many years in my own State to my support of old-age pension systems which for many years were the highest in the country, as you well know. I don’t know whether at the moment it is the highest old-age pension system in the country or not, but for many years it was the highest pension system in the country. I felt that certainly out of our sales tax and out of certain other excise taxes which we earmarked by con- stitutional amendment, we could take care of our elderly in a decent manner. I think we did and have done, as far as that particular system is concerned, an excellent job as well as providing a medical program for our aged who were under this old-age pension system. I must say that I have tried to interest some people in this committee ina study, especially since the passage of Medicare. Ihave talked with the chairman of the Labor and Public Welfare Committee, of which I was formerly a member, as well as others in trying to produce a sys- tematic study as to the programming of the brick and mortar, the doc- NEEDS REVEALED BY OPERATION MEDICARE ALERT 29 tors, technicians, and others that will be needed to implement that sys- tem. So far we have not been able to get that help. As I look at your statement and the discussion here this morning—and I will not take long because I have a meeting at 11 :30—it seems to me that without an adequate income, which the Government has temporarily placed at $3,000, you can’t expect the elderly to live in any kind of decency. I wish I could, without exposing the names of the people, present some of the letters I have received from some of our older people com- plaining bitterly about the rise in the cost of living while we expect them to live on the benefits of Social Security or public welfare. I think the needs of the elderly go beyond this. Congress has placed the cutoff on Social Security earnings at $1,500. When I was on the Labor Committee 12 years ago, I sponsored legislation to increase it— it was then $1,200—but I was unsuccessful in doing it. It seems to me the aged fall into certain categories. First of all, there are those who have been forced to retire by the retirement rules or regulations of their own company, or their pension rules, union contracts or whatever. Many of these people do not wish to retire. Therefore, in this category it seems to me one of the efforts we should make is to enable these people to earn enough above their pensions or Social Security in order that they can come up to a decent and respectable living income. This is a place where I think Congress could make a very constructive effort. Then there are those who are retired who really have no desire to do anything else but retire. I wouldn’t attempt to estimate the per- centage, but they are all human, and they are all different. There are those who just wish to retire. But there are also those who have a definite spiritual need or “inside need” to do something constructive in their community. These are the people I admire most. They are not willing to be shoved aside from the mainstream of community life. The Foster Grandparents Program I think is one of the greatest opportunities that has been demonstrated to give them an opportunity to be a part of the mainstream of the community. There are other things in community life. We found, for example, that when we raised the nonpenalty Social Security earnings ceiling from $1,200 to $1,500, people who had been working every day just in order to be a part of their community for $1,200 a year found that their wages suddenly went up to $1,500. They do contribute and they are able to contribute and will contribute a substantial part to not only the economic life but the spiritual life of a community. In summing this up, it all comes down to two things: first of all, I think we would all agree that we have no right to ask the elderly to live on a starvation income. I have suggested one or two ways that I think will help. The second in is that we should find a way—and it ties into the first—of increasing the amount they can earn. But more importantly, we must find ways to permit them to be a part—a vital and active part—of the total community, thereby affording us the opportunity to draw upon their experience and wisdom. It is the wisdom which comes with age that must be imparted in the younger generation, to temper the younger generation, if you will, with the experience and 30 NEEDS REVEALED BY OPERATION MEDICARE ALERT wisdom that they have acquired through their long years of service, to their etaployers, to the communities, to their churches. I Hone these things are all vital. It breaks down into two parts, an adequate income, and an adequate opportunity for those who are capable of doing so, who wish to do so, of participating in the main- stream of their community life. Would you like to comment on this? Mr. Suriver. Only to say, Senator, that is what we are trying to do. Yes; I would agree. What we are trying to do through the Foster Grandparents and other programs is to come up with some ways in which people can be given constructive work that will provide money to those who, as you said, are capable of doing it. Senator ArLorr. What do you think, Mr. Shriver, about your pro; gram, for example, as compared with rather drastic reform—at least 1t is drastic in the minds of most people—of the Social Security Sys to attack the first problem—the raising of income through Social Security or other means? Mr. Suriver. Well, I testified earlier here to the effect that I feel that to the extent that income of the elderly can be increased, while retaining the character of the Social Security Administration, I feel that is what everybody would be in favor of doing. I certainly am. But the Social Security System, as you know better than I, is an insurance system and in order for it to have fiscal integrity it has to be maintained in a certain way and I am sure that you would be among the first to want to keep it fiscally responsible. Senator Avrorr. I have made my attempt to keep it fiscally respon- sible, but the chief actuary of the Social ote ystem testified be- fore the House committee that it would take $322 billion in cash con- tributions to bring the Social Security fund into an actuarial balance. Of course, you and I know that serving on the Appropriations Com- mittee I have had a vital interest in this. The same thing is true with the Civil Service Retirement Fund where, as of July 1, the Federal Government will owe the fund $43 billion in cash. So I do have a general interest in these things, but on the subject before us, I would sincerely hope that we could take some substantial steps to permit our elderly citizens to earn enough so that they could raise themselves out of the poverty situation which many of them find themselves in. : As far as your Foster Grandparents Program, I think it is a fine idea. It is one way by which we can give these people an opportunity to contribute ; where they are not just contributing economic assistance or economic aid to SIT, but are fulfilling a spiritual need to feel that they are a part of the community, and are contributing to it. Thank you, Mr. Chairman. Senator KENNEDY. I would just make one comment on what has been said by Senator Prouty and Senator Allott. I think, that if we are really serious about the utilization of the Social Security System, that we have to be prepared to recognize that the way that this is going to be done is through general contributions, general tax contributions to the Social Security system. We can talk and say that we want to use the Social Security system to see that this thing is done. I support that idea and I am certainly going to be in the front ranks of the fight. However, I think we are also going to have to be pre- NEEDS REVEALED BY OPERATION MEDICARE ALERT 31 ared to recognize that it is going to change the whole concept of Borel Security and that there are going to have to be general contribu- tions to it from the general tax revenues. I certainly hope that those who want to see this program realized are prepared to agcept increasing it froagh the Social Security system. Senator Arrorr. May I say this, Mr. Chairman? Senator KENNEDY. Ne Senator Arrorr. I agree with you that drastic or major increases in the Social Security system can only be made, at this point, through general tax contributions, because we are very near the saturation point with respect to the usual methods of financing. Senator Kexnnepy. I had just one final question I wanted to ask you because it is relevant to what has been talked about here and I think perhaps you touched on it on page 12 of your testimony in that second paragraph near the bottom where you said “in order to brin all older people out of poverty by our minimum standards, we woul have to spend in calendar 1966 an estimated additional $2.7 billion. To bring all of our poor above the poverty income line, we would have tos | nearly $12 Billion a year.” ere you referring at that point to some of the matters which have been discussed here in the last half hour or so with regard to raising income levels by direct contributions? Mr. Suriver. I was just citing the economic fact that if you had—— Senator Kexnepy. How would you spend that? When you say, “to bring all of our poor above the poverty income line, we would have to spend nearly $12 billion a year,” were you talking about direct con- tributions or were you referring to services ? Mr. Suriver. $12 billion, that figure would include all the poor, both the young and the old, and, second, it is merely an arithmetical com- putation based on the average income of all the people who are poor and what would be necessary to raise that income above the cutoff, the statistical cutoff point of $3,000 for a family of four. Senator KenNepy. I would interpret your formal presentation to be an acceptance of the usefulness of the approach of making direct con- tributions to individuals to SUEDlement a income, to raise it to the minimum poverty line standard. Mr. SHRIVER. I certainly recognize the usefulness of it, Senator, but actually that is not within the scope of my responsibility. Our respon- sibility in the War Against Poverty is to Sn ways in which people can be assisted to help themselves out of poverty. This statistics, therefore, is merely a method of describing what the deficit is in terms of finances. Let me put it another way. If you actually spent $12 billion a year and you just had what we call transfer payments, at the end of any one year—if you stopped doin that—the people who had been getting the money would lapse b into poverty. Our effort is to try to develop techniques whereby, even if you did stop, they would not fall into poverty because they had gained the job skills, the education, the attitude, et cetera, which will enable them to keep themselves out of poverty. ‘We call that the reentry problem. For example, after World War II, after a big defense boom, a lot of people had to be laid off. They slipped back into poverty. We are trying to take some steps that would minimize that reentry. 32 NEEDS REVEALED BY OPERATION MEDICARE ALERT Senator Ranvorpr. Mr. Chairman, with Director Shriver present, I want to make a concluding comment. We have approximately 400 persons in the audience today. These people are senior citizens of our country. There has grown up in the Nation a rather stereotyped, let’s say, charge against older persons that they are living in idleness and dependency and unproductivity. This isn’t really true because there is an alertness of mind, not so much strength of body often, but there is a sensitivity of spirit in our older population. When we have the charge thrown at our senior citizens that they are unproductive, we must realize that, of the total income of the senior citizens of the United States, one-third of that amount comes through work that these people are doing. T think this is very important. I am grateful for the opportunity to be at the hearing this morning. I am not a member of this subcommittee, but I am chairman of the Subcommittee 2 Employment and Retirement Incomes of the Special Committee on ging. I would like to say especially for our guests that our subcommittee has held extensive hearings on the subject of increasing employment opportunities for the elderly. I would suggest that you write, 1f you are interested as individuals, to our Special Committee on Aging and have the value of testimony which was set forth in these hearings. We have made a report from the subcommittee and then from the Special Committee on Aging on this specific problem of increasing employment opportunities for the elderly. Mr. Chairman, I am very grateful that you gave me this opportunity to bring this matter to the attention of our guests at today’s hearing. Senator Kenxnepy. I want to thank you very much, Senator Randolph. Senator YarsBoroucH. Mr. Chairman, the statement has been made here this morning that some of the elderly receive in Federal pensions, as I understand the statement, $15 a month. I don’t mean you wit- nesses here. It was made from the bench up here. The lowest pension that retired Federal workers receive is that for the widows of retired Federal workers and some of those who retired ‘before 1948 under the then imperfect retirement systems, were receiv- ing very low pay, some very low pensions. So, we passed a law here 2 years ago raising the pay of any widow of a retired Federal employee to a minimum of $50 a month, or $600 a year. The Post Office and Civil Service Committee has just reported out a bill with an amendment not in the House bill to raise again the pensions of all widows of retired Federal employees because of the low- ness, some being as low as $50 a month or $600 a year and that goes up. We can add 10 percent to that. Sargent Shriver’s statement points out that in this fiscal year 1967 the Federal Government will spend $26 billion on programs for the aged and that there are 1814 million aged in the country. That represents an average expenditure by the Federal Government, as I get it, of about $1,405 a year on the average person of the aged. That does not include State expenditures. That does not include the private income of the aged from other sources. I do not mean that it is enough. I am just pointing out that from the Federal stand- point, Federal employees, the Federal Government is not paying any of its retired employees as low as $15 a month and I have heard that NEEDS REVEALED BY OPERATION MEDICARE ALERT 33 statement made here this morning by one of my colleagues, but T didn’t have an opportunity to go into it at that time. We are doing better than that and we will do better. I am support- ing legislation to increase payments to the elderly on old age pensions. Those in most States have a welfare level, and my State, unfortun- ately, is one of the low ones, but it averages about $80 a month and there are very few States in the Union where that level monthly pay- Bent Te less than $80 a month; very, very few States in the nion. That isn’t enough. We are working to increase that, with the old age assistance, with retired Federal employees and other matters, but I take it that is not the main thrust of the poverty program, anti- poverty program. In the Office of Economic Opportunity that you direct, Mr. Shriver, you are trying to give these people greater opportunities in life, to use their creative and their productive capabilities only to earn money outside of these stipends of payments b the Federal Government. Whether it be Old Age Assistance, Social Security, retired Federal employee, or by whatever means the payment comes, I think the thrust of your effort is to give them intellectual encouragement and hope that they can use their productive talents to the end of their days and that is where I think the great benefit of your program comes and I congratulate you on this leadership for it. I think your statement shows you fully realize that. You are add- ing to the payments, made a hope for productive life and that is a great thing. Senator Kennepy. Mr. Shriver, we want to thank you and your staff. You have been generous with your testimony. We have kept you now for a considerable period of time. You have been extremely responsive to the questions and I want to thank you and every one of you in behalf of the members of the committee for coming and for your helpful presentations. I think every member of this committee is a complete supporter of the poverty program. We appreciate the new priorities you are giving within the poverty program to the particular problems of our senior citizens. Your testimony today indicates that some progress has been made. We are anxious about future progress and we understand that you share this anxiety. We hope that we can continue to see in the weeks and months ahead similar progress made in a wide variety of forms. Thank you very much for appearing today. Mr. Suriver. Thank you very much, Senator. In leaving, I would like to express my appreciation to the people who are here today who participated in ni Alert. That certainly is one of the most exciting and successful programs that we inaugurated. I would like to also say that I appreciate the work which has been done for us by the special committee that has been working with us under the chairmanship of Chuck Odell and his successor, I hope, Dr. Hal Sheppard. Senator Kennepy. Very good. We have Dr. Harold Sheppard, the staff social scientist of the Upjohn Institute for Employment Research in Washington. 34 NEEDS REVEALED BY OPERATION MEDICARE ALERT We are delighted to have him here. To those of you who have been kind enough to come and participate, I want to say how much we appreciate your interest and your attendance here today. r. Sheppard, we want to welcome you to this committee. You are no stranger to the chairman and to the members of the committee and we appreciate your coming here today and want you to proceed with your testimony. STATEMENT OF DR. HAROLD SHEPPARD, MEMBER, ADVISORY COMMITTEE ON OLDER AMERICANS AND MEMBER, OEO TASK FORCE ON PROGRAMS FOR OLDER PERSONS Dr. Suepparp. Thank you, Senator. Senator KexNepy. We have your prepared statement. It will be included in the record, if you would like to summarize. Dr. Suepparp. Thank you. I will do my best because I think it is more important to hear from the people in the audience than to listen to another so-called expert. First of all, let me say that my prepared testimony will have to be interpreted in light of Mr. Shriver’s testimony and whatever modifi- cations it calls for because I think—and I am very happy to see that that the comments made by Mr. Shriver today were—and I hope he takes it in the right spirit—much better than the presentation made in January when they were just beginning to take an interest 'in this problem—they have come a long way. I also want to mention that there are other pasple in the audience who might be able to answer some questions relating to my testimony much better than I as we go along, but I will try to hurry. The major points in my testimony today are— (1) That because of its earmarked appropriations and because of its severe limitation in staff, OEO is not presently capable of launching a meaningful attack on problems of the older poor; (2) That even without such restrictions, there is a possibility that its basic philosophy and orientation work against such a hope, although I do see some changes now in the light of Mr. Shriver’s testimony ; and (83) That the recent experiences under Medicare Alert warrant a serious revaluation of OEO’s philosophy and orientation. . Some of that was described by Mr. Shriver himself. Now in my testimony is something that relates to that perspective and I would like to quickly go through some factual items. This relates to the fact that it is not completely true that the causes of poverty lie only in infancy and youth. It 1s possible to attack it at other levels in the life cycle. Only 9.4 percent of poor family heads, including men and women, age 55 to 64 were working at all in 1964. We, therefore, need to know much more about the 2.7 million people in that age group who are poor; what are their earning potentials and their training potentials. This means that the chances for low income of individuals in late middle age—say the 55 to 64 age group—threatens poverty in what we ordinarily call the aged years. There are explanations for this NEEDS REVEALED BY OPERATION MEDICARE ALERT 35 that I won't get into. Let me mention another factual point, or at least a proposition, that forced early retirement also increases the threat of poverty in old age. Even for today’s Joumger workers, as another point, we do not cope with the possibility that their training received while they are young may become obsolete when they become older. I would argue that such training is an additional form of social insurance beyond, say, unemployment compensation before their re- tirement years. I should also point out that 45 percent of the recipi- ents of the temporary long-term unemployment compensation program in 1961-62 were people 45 years of age or older. This means that the older unemployed worker exhausts his Fogler unemployment compensation to a greater extent than younger workers. Here, too, is a cause of poverty. Senator YarBoroueH. Doctor, what percentage was that ? Dr. Suepparp. Forty-five percent. In last Sunday’s Washington Post, there was an article that revived public interest in the term, “The Establishment.” The article was about foreign affairs and the personnel in America who constitute The Establishment in that domain of human problems. Today we might also speak of an Establishment in the war against poverty, although in this context it is possible for one man’s Establish- ment to be another man’s outgroup. One of the main themes in my testimony is that in the opinion of many representatives of older Americans, and older Americans themselves, gerontologists are def- initely not part of the OEO Establishment. At times I have attributed this exclusivism to a cultural bias against the aged, but such an explanation i: really too difficult to verify when stated in general terms. A better, but somewhat similar, explanation may be found in the fact that a substantial number of the drafters, dreamers, and designers of the original ideas and proposed legisla- tion for the war against poverty—starting in the early part of the 1960’s and coming into 1964, and here I might mention that I was part of that group—were dedicated men and women who were pre- occupied with the problems of juvenile delinquents; with the felt need of young college students to serve some useful social purpose in de- veloping societies overseas; with the role that could be played by modern-day CCC camps for less privileged youths. Many of these individuals naturally found themselves employed in the war against poverty that was finally declared by the President and Congress. t In a word, the architects and the ultimate operators of the machinery for the War Against Poverty were primarily recruited from the ranks of professionals and others who had trained themselves—through class work or through experience—in the facts, figures, theories, and solutions related to essentially only one segment of American society. It was thus inevitable, I suppose, that such individuals—the mem- bers of the youth Establishment—should develop what the philosopher, John Dewey, called an occupational psychosis, or what the economist Thorstein Veblen, called a trained incapacity to see anything beyond what they were trained in their occupations to see. When confronted after long, sometimes unwelcome and persistent reminders about the 36 NEEDS REVEALED BY OPERATION MEDICARE ALERT existence of poverty among older Americans, the Establishment’s youth professionals are quick to point—or paint—with a broad brush, and I should perhaps qualify that to say at least until recently—to the peculiar age distribution and the low labor force participation rates of senior citizens as a total proof that the problem of America’s aged poor is a pure and simple one of income maintenance. In other words, they argue that providing economic opportunities to the over-60 population is out of the question, and that the total solu- tion, therefore, is in the direction of substantial, radical improvements in Social Security benefit levels. I am, of course, not arguing against such improvements. I, too, believe that our current income maintenance amounts are far too below the floor of security they were originally designed to be. And our current system for financing the benefits may need some basic revisions, as the Senator has already pointed out. What I am trying to say is that the trained incapacity of the youth Establishment seems to prevent its members from becoming sophisti- cated regarding the nuances and qualifications of—the exceptions to— the broad generalization about the age distribution and labor force participation of older Americans. We are all ignorant, Will Rogers once said, only about different things. For some time OEO seemed to persist in its ignorance about the field of social gerontology. Before I go any further in this type of discussion, Mr. Chairman, I want to add hurriedly that in addition to this as an explanation for some of the shortcomings cited by senior citizen’s organizations, I think we might have to find another explanation—in Congress which, by earmarking funds for certain purposes only—and Mr. Shriver has pointed this out—may have prevented OEO from doing more for the aged in the first place, even if it had energetically sought to do so. And since the original authorization and appropriations, these cate- gorical mandates have been even further delimited. This is especially true in the CA program. The one broad area in which there was some potential for dealing with older Americans, namely, the Community Action Program, has apparently been restricted in its discretionary ability to cope with pov- erty among the aged. Let me return to my previous line of discussion. Gerontologists would, of course, agree that for most older Americans, there is either no desire, or no ability, to seek employment as a means of solving their poverty income problem. But this does not justify the hasty, sloppy conclusion that, therefore, the only solution is some sort of improvement in retirement income maintenance. The aged poor are not one big homogeneous mass of humanity in this respect. In this connection, the Task Force on Programs for Older Persons nearly 1 year ago, in August 1965, estimated very carefully that at least 1 million older Americans could work if jobs and training were made available, including part-time jobs. The Task Force report, was submitted at that time to OEO, with very little, if any, feedback. I consider 1 million to be a large number, and in these days when there is much talk about labor shortages and unmet social, public needs, the figure represents, to me, an untapped manpower source for our economy and society. NEEDS REVEALED BY OPERATION MEDICARE ALERT 37 Finally, if there is any doubt about the potentials of such older poor, the experience under Medicare Alert should suffice to quell and silence them. You will no doubt hear more about this later on in these hearings, from the actual participants in Medicare Alert themselves. I have been told that altogether 14,000 senior citizens with low incomes responded enthusiastically and worked effectively to find and instruct other older men and women about their rights and benefits under the new health care program. OEO itself was surprised, to put it mildly, by the number of com- munities seeking funds to enlist their older citizens in this reach-and- teach-out to other older citizens. OEO originally scheduled a small number of such projects, with a $2 million budget. They finally ended up with about 480 projects, spending more than $7 million for this program, To repeat, this was a surprising experience within OEO. There was no surprise, however, among the officers of such organiza- tions as the National Council on Aging, the National Council of Senior Citizens, and the American Association of Retired Persons. It only confirmed their understanding and expectations about the nature of hundreds of thousands of senior citizens—that many of them want to serve, that many of them want to and can work. The limited experience under Foster Grandparents also testifies to such potentials and, as you know, this was an extremely limited program. I hope, very urgently and seriously, that current plans for an exten- sive home health aide program, under OEO auspices, will not fail to concentrate on similar sources in the older poor population for the much needed manpower in this long neglected area of human services. This hope should not be left to chance. Medicare Alert not only demonstrated what is possible regarding the useful contributions that senior Americans can make in the form of actual, paid employment for them while at the same time performing a needed social purpose: it also exposed to these Medicare Alert em- ployees the rn le conditions of living for the many older poor persons they contacted in the course of their door-to-door reaching out to such persons. Many of the reports I have seen indicate this very strongly. I would like to cite from one report, by an Arizona organization responsible for a local Medicare Alert program, what it, had to say about the kinds of unmet needs revealed in the course of the project: Among other things, a need for— b The coordination of planning and programing for the aged. 2 An effective means for communicatiing with the needy aged. 83) An effective neighborhood based case-finding effort. (4) Employment of capable aged persons desiring to supple- ment their low incomes. (5) The provision of services not now available through exist- ing agencies such as— Hi Shopping services; b) Homemaking services; Home maintenance services; d) Friendly visiting services; (e) Protective services re wills, legal services, guardian- ship, et cetera. 38 NEEDS REVEALED BY OPERATION MEDICARE ALERT Also the daily diaries or logs of the participants in this program contain some provocative experiences. I leave out the names here: Could not sign, R B was very ill, nobody was taking care of him so I talked to Reverend A so that the county nurse would come after him. I checked to see—yes, the county nurse came after him. Today they called the neighbors to come after him but neighbors refused to take him back because they are unable to take care of him. His age, 87 years old. Another report, from a Negro: When I visited many homes in the northern area, I was assisted by many white neighbors in finding houses, addresses, and street numbers. These mothers, chil- dren and next-door-neighbors all pitched in and helped. To me, this represented good public relations and friendly cooperation because I am a Negro aide worker. The report also mentioned, and I think this is important for the committee, the lack of cooperation from some nursing homes which would not allow Medicare Alert aides to discuss Medicare benefits with atients. On the positive side, the report goes on to comment ver avorably about the extensive support given the project by radio, TV, and the newspapers, along with other community organizations. Here again is definitive demonstration that 1f Washington agen- cies once make a decision to do something worthwhile for our coun- try’s aged, the local communities will respond with positive interest. This leads me further to comment that it is time to stop demon- strating this or that project idea on a small-scale basis, and I call this to the attention of not only the agences, but Congress, and move on decisively to making a large-scale, permanent institution out of what has already been learned from demonstration pilot projects. This not only applies in the field of aging, but in other programs. Project FIND—a proposal submitted to OEO many months ago by the National Council on Aging—is one example of what could be de- veloped into such an institution, with ry as high as that of Operation Headstart. Indeed, many of the Medicare Alert aides have already indicated a willingness to continue in some type of Community Action Program dealing with the elderly. Such continuity cannot be maintained on a hit-or-miss volunteer basis, however. And it cannot be launched by a one-man staff within OEO either. I want to comeback to this later. If along with other persons active in the field of gerontology, I seem to be harping and harping on an old tune, it is only because we seek to convert problems into solutions. Many people seem to accept the deeply imbedded notion that because of the many deficiencies that be- set older Americans, they cannot have any potentials. I would rather submit that many deficiencies attributed to various types of individuals are but one side of a coin—the other side be- ing the deficiencies of society and its institutions. Such deficiencies consist of governmental and community failure to provide concrete recognition—in the form of structured opportuni- ties—of the continued useful function that can be performed by many, many older Americans. The time is ripe, I repeat, given the great demand for more manpower and given the admission of so many unmet public needs, to create these opportunities. I have already mentioned that SEO still has, after its 2 years of operations, only one staff person, to my knowledge, devoted to proj- ects for older citizens. And just as serious, the position itself, in my NEEDS REVEALED BY OPERATION MEDICARE ALERT 39 opinion, is too far down the totem pole of authority and communication to make any impact on top-level policy and decisionmaking. The person in such a position can say or do little, if anything, about VISTA, title V, ol | other programs outside of CAP, and very little within CAP. Perhaps Congress could provide Mr. Shriver with the authority and the lh to remedy both shortcomings. Oth- er jetions have speculated, incidentally, as to whether or not it might be better to give this assignment to the Department of Labor as an adult version of a Neighborhood Youth Corps. I am also aware of the legislative proposals of Senator Williams, of New Jersey, and of Senator Smathers, both of whom have intro- duced two different versions of a Senior Citizens Community Service Corps. I might add that this idea was an early recommendation of the Committee on Aging in its first year, under the chairmanship of the late Senator McNamara, and when Senator John F. Kennedy was also a member of that committee. Because of the professional interest of the Administration on Aging, it might be best to lodge the basic operation of such a program in that new agency, with some effective—I repeat, effective—prodding on OEO to make sure that older poor get their fair share of participation in the Service Corps. Mr. Chairman, this completes my basic testimony, but I would like to request that a recent article on the 1959-64 changes in the composi- tion of the poor in America be included as part of my testimony. It was written by Miss Mollie Orshansky of the Social Security Ad- ministration, and published in the April 1966 issue of the Social Security Bulletin.? As you know, Miss Orshansky is the recognized authority on the definition and measurement of poverty as used by OEO. The article is important because it singles out the subgroups in our population which have increased or decreased in numbers and proportions as far as poverty is concerned, in the 5 years since 1959. It reveals, for example, that while the total number of poor declined in that period, the number of unrelated aged individuals and families with an aged head made up less than one-third of all the Door. Five years later, they constituted nearly 36 percent of all the poor. The data once again show the vital need for truly meaningful levels of income maintenance for older Americans, and I know that Senator Kennedy of Massachusetts is deeply concerned about that. But since the aged are not one homogeneous mass, I would also ur a serious look at the significant minority of older citizens who could still be engaged in useful and remunerative activities, if only we came forward with appropriate programs to provide such activities. I am sure that the men and women who will follow me today in these hearings, some or all of them associated with the National Council of Senior Citizens, can give you a much more direct and personal account, from an eyewitness standpoint, of the experience gained from Medi- care Alert—and of what it proves about the continuing potential of major segments of our country’s aging population. Thank you. Senator KenxNEpY. I want to congratulate you on a yey fine state- ment. I think it was responsive, it was concise, it was based upon 1 The article is reproduced in the appendix, beginning on p. 79. 40 NEEDS REVEALED BY OPERATION MEDICARE ALERT years of interest and extraordinary background and experience in this area. I think that you have certainly shed light on a number of the questions and problems that this subcommittee is considering. I want to mention how impressed I was with the content of the pres- entation. I just have a few questions because the hour is getting extremely late. ; You are a member of the Citizen’s Task Force. Could you describe the relationship between the Citizen’s Task Force and OEO ? Senator YarsorougH. Mr. Chairman, may I interrupt one moment ? The Labor and Public Welfare Committee has just gone into execu- tive session to vote on bills and I must go. May I make one statement ? Pardon the interruption for just a moment. Senator KENNEDY. Yes. Senator YArsoroueH. Dr. Sheppard, I think this is a very stimu- lating statement. I benefited greatly by it. If you do not have com- piled now, I hope we may have compiled a list of works by authors over 65 years of age that have been written, say, in the past 20 or 25 years, or 10, paintings considered worthy of being good art of the value of $1,000 apiece we will say and all inventions by people over 65 years of age in the last 10 years. I agree with your point. From my experience the aged people just prove it to the public through works of art, inventions, and maybe other fields. Thank you, Mr. Chairman. I regret I have to leave. I want to congratulate the chairman on the meeting that I think is going to do great good in this field. Senator Kexnepy. Thank you. Dr. Suepparp. I will try to answer it quickly and at the risk of in- dulging in some generalizations myself that need qualifications. I think I am correct in reflecting the feelings of frustration on the part of 2 if not all of the members of that Task Force on the older poor in OEO. Many of these people came from all parts of the country to meet in Washington and devoted a lot of time and effort in preparing the re- port along with the valuable assistance of a man named Louis Ravin, who was assigned by HEW to us for 90 days. We feel we just didn’t get enough feedback after having submitted that report and that there was not enough interplay with enough peo- ple in OEO to discuss some of our basic project recommendations and to assure that the kind of orientation I talked about in my testimony became assimilated into the thinking and the behavior of the people in that agency. Let me repeat that I want to qualify that with the feeling that may- be a little of it has finally rubbed off in the light of what Mr. Shriver had to say today, but that is the purpose of this kind of hearing. I think you ought to have them every month—that is a partly facetious remark—in order to make sure that agencies do their jobs. This is the name of the game as far as I can tell and TI hope that the Task Force in the future will be called upon to play a much more im- portant role in the operations of that agency. Senator KeNNEpY. One of the things that you mentioned in your testimony is the importance of increasing the incomes of elderly citi- zens. I imagine you are also including the need for services as well. Is this a dual approach as far as you are concerned ? Dr. Suepparp. You mean services to the aged? NEEDS REVEALED BY OPERATION MEDICARE ALERT 41 Senator KEnNEDY. Yes, services for the elderly provided by them. As I understand it, you are not only concerned with the importance of supplementing income to senior citizens, but you are also concerned with the importance of providing services for them as well as provid- ing opportunities for seniors to assist the rest of society. Dr. Suepparp. Yes. I might mention that I am also a member of the HEW Advisory Committee on Older Americans, and also on a review panel for grants from that agency, the Administration on Aging, for senior citizens centers, for example, and they are coming in by the hundreds. It reflects a vacuum in so many local communities of community service centers or senior citizens centers, multiservice centers. Senator KenNEDY. Are you satisfied with the present machinery which involves several departments with the problems of the elderly ? Some problems are dealt with in HEW, some in OEQO, some through- out the other departments. Do you think that effective programs can be developed under the present organization structure, or would you recommend a separate department to handle the affairs of the aging? Dr. Suepparp. You are almost giving the answer, Senator. I re- member that when I was on the Fone on Aging we had hoped that there would be an agency reporting directly to the President. It became resolved in the form of the present Administration on Aging in HEW. I also have to say that I was once a bureaucrat myself in the Depart- ment of Commerce in ARA, as you remember. One of our assign- ments was to coordinate the activity of the other agencies insofar as they bear on the problems of depressed areas. It is awfully hard to get one agency coordinated by another agency. It is very frustrating. I wish there were some way, given the fact we have crossed the Rubicon, that we could give some authority, for example, to the Administration on Aging to have effective prodding clout on the decisionmaking and the fund allocations and operations and activities of other agencies relating to the problems of the aged. I don’t know how you solve that legislatively, but certain mandates could be written into the law with stronger teeth perhaps. Senator Kex~Nepy. So it is really not just a question of emphasis, but also of content. I hope you will review the current state of the law to find out whether there are ways of improving it. Could you comment on the effectiveness of the Administration on Aging in the Department of Health, Education, and Welfare? Dr. Surpparp. I first have to say it is a rather young organization and if it fails to be effective it will partly be a result of the failure of the advisory committee to prod them to prod others, and I will try to do my best in that respect. Senator KENNEDY. Let me ask you one question: you mentioned in your testimony about the statistics that show a growing number of aged poor. Could you elaborate a little bit on this? Dr. Suepparp. Yes. This is very briefly in the article by Miss Orshansky. From 1959 to 1964 there was an increase in numbers, of 2.7 to 3.2 million aged persons now living in poverty, whereas the total poverty population went down from 54.7 in 1959 to 49.8 in 1964. The general poverty population went down. Using the criteria we all know about for the total population of poor, it went up for the aged population. 42 NEEDS REVEALED BY OPERATION MEDICARE ALERT Senator Ken~Nepy. It went up from, is that it, 2.3 to 2.77 Dr. Surprarp. 2.7 to 8.2, and I think there is only one other major group in the poverty population that increased and that was the children in large families. It was those two opposite age groups, the over 65 and children in large families. Well, in another document I have written, Senator, I said that only millionaires can afford to have large families. The only adverse effect is a lower amount of inheritance for the millionaire’s children, but families in the low-income groups in our present society simply cannot afford to have four or five or more children. Senator Kex~epy. I want to thank you very much, Dr. Sheppard, for appearing here and for your responses to our questions. I appre- ciate your coming here to testify. Both in the field of aging, in which you have been so deeply inter- ested, and in the other area you mentioned, you have developed a broad background which has been extremely helpful to all the Mem- bers of Congress and I want to express our appreciation to you. Dr. Suaeprarp. I have to run to the Civil Rights Conference now. I’m in a panel discussion there. Senator Kexxeoy. OK. Good luck to you. (Dr. Sheppard's prepared statement follows :) PREPARED STATEMENT OF DR. HAROLD LI. SHEPPARD, MEMBER, ADVISORY COMMITTEE ON OLDER AMERICANS, HEW ; OEO TAsk FORCE ON PROGRAMS FOR OLDER PER- 80NS ; EXECUTIVE COMMITTEE, NATIONAL COUNCIL ON AGING Mr. Chairman, the major points in my testimony today are: 1) that because of its earmarked appropriations and because of its severe limitation in staff, OREO is not presently capable of launching a meaningful attack on problems of the older poor; 2) that even without such restrictions, its basic philosophy and orienta- tion work against such a hope; and 3) that the recent experiences under Medi- care Alert warrant a serious revaluation of OEO’s philosophy and orientation. In last Sunday's Washington Post, there was an article that revived public in- terest in the term, The Establishment. The article was about foreign affairs and the personnel in America who constitute The Establishment in that domain of human problems. Today we might also speak of an Establishment in the War Against Poverty, although in this context it is possible for one man’s Establish- ment to be another man’s Outgroup. One of the main themes in my testimony is that in the muffled opinion of many representatives of older Americans, gerontolo- gists are definitely not part of the OEO Establishment. At times I have attributed this exclusivism to a cultural bias against the aged. but such an explanation is really too difficult to verify when stated in general terms. A better, but somewhat similar, explanation may be found in the fact that a substantial number of the drafters, dreamers, and designers of the original ideas and proposed legislation for the war against poverty—starting in the early 1960’s—were dedicated men and women who were preoccupied with the problems of juvenile delinquents ; with the felt need of young college students to serve some useful social purpose in developing societies overseas; with the role that could be played by modern-day CCC camps for less privileged youths. Many of these individuals naturally found themselves employed in the war against poverty that was finally declared by the President and Congress. In a word, the architects and the ultimate operators of the machinery for the war against poverty were primarily recruited from the ranks of professionals and others who had trained themselves—through classwork or through experi- ence—in the facts, figures, theories, and solutions related to essentially only one segment of American Society. It was thus inevitable, I suppose, that such individuals—the members of the Youth Establishment—should develop what John Dewey called an occupational psychosis, or what Thorstein Veblen called a trained incapacity to see anything beyond what they were trained in their occupations to see. When confronted, after long, sometimes unwelcome and persistent reminders about the existence of poverty among older Americans, the Establishment’s youth professionals are NEEDS REVEALED BY OPERATION MEDICARE ALERT 43 quick to point—or paint—with a broad brush—to the peculiar age distribution and the low labor force participation rates of senior citizens as a total proof that the problem of America’s aged poor is a pure and simple one of income main- tenance. In other words, they argue that providing economic opportunities to the over-60 population is out of the question, and that the total solution, therefore, is i the direction of substantial, radical improvements in Social Security benefit evels. I am, of course, not arguing against such improvements. I, too, believe that our current income maintenance amounts are far too below the floor of security they were originally designed to be. And our current system for financing the benefits may need some basic revisions. What I am trying to say is that the trained incapacity of the Youth Establish- ment seems to prevent its members from becoming sophisticated regarding the nuances and qualifications of—the exceptions to—the broad generalization about the age distribution and labor force participation of older Americans, We're all ignorant, said Will Rogers, only about different things. And OEO seems to persist in its ignorance about the field of social gerontology. Before I go any further, Mr. Chairman, let me hasten to state that in addi- tion to this trained incapacity, another explanation must be found in Con- gress which, by earmarking funds for certain purposes only, may have prevented OEO from doing more for the aged in the first place, even if it had energeti- cally sought to do so. And since the original authorization and appropriations, these categorical mandates have been even further delineated. The one broad area in which there was some potential for dealing with older Americans, namely, the Community Action Program, has apparently been restricted in its discre- tionary ability to cope with poverty among the aged. Let me return to my previous line of discussion. Gerontologists would, of course, agree that for most older Americans, there is either no desire, or no ability, to seek employment as a means of solving their poverty income problem. But this does not justify the hasty, sloppy conclusion that therefore, the only solution is some sort of improvement in retirement income maintenance. The aged poor are not one big homogeneous mass of humanity in this respect. In this connection, the Task Force on Programs for Older Persons nearly one year ago, in August 1965, estimated very carefully that at least one million older Americans could work if jobs and training were made available, including part- time jobs. The Task Force report was submitted at that time to OREO, with very little, if any, feedback. I consider one million to be a large number, and in these days when there is much talk about labor shortages and unmet social, public needs, the figure represents an untapped manpower source for our economy and society. If there is any doubt about the potentials of such older poor, the experience under Medicare Alert should suffice to quell and silence them. You will no doubt hear more about that in these hearings, from the actual participants in Medicare Alert themselves. I have been told that altogether 14,000 senior citizens with low incomes responded enthusiastically and worked effectively to find and instruct other older men and women about their rights and benefits under the new health care program. OEO itself was surprised, to put it mildly, by the number of communities seeking funds to enlist their older citizens in this reach-and-teach-out to other older citizens. OREO originally scheduled a small number of such projects, with a $2 million budget. They ended up with about 480 projects, spending more than $7 million. To repeat, this was a surprising experience within OEO. There was no surprise, however, among the officers of such organizations as the National Council on Aging, the National Council of Senior Citizens, and the American Association of Retired Persons. It only confirmed their understanding and expectations about the nature of hundreds of thousands of senior citizens—that many of them want to serve, that many of them want to and can work. The limited experience under Foster Grand- parents also testifies to such potentials. I repeat that this program is an extremely limited one. I hope, however, that current plans for an extensive Home Health Aide pro- gram, under OEO auspices, will not fail to concentrate on similar sources in the older poor population for the much needed manpower in this long neglected area of human services. This hope should not be left to chance. Medicare Alert not only demonstrated what is possible regarding the useful contributions that senior Americans can make in the form of actual, paid employment for them while at the same time performing a needed social pur- pose: it also exposed to these Medicare Alert employees the deplorable condi- 44 NEEDS REVEALED BY OPERATION MEDICARE ALERT tions of living for the many older poor persons they contacted in the course of their door-to-door reaching out to such persons. Many of the reports I have seen indicate this very strongly. Let me cite from one report, by an Arizona organization responsible for a local Medicare Alert program, what it had to say about the kinds of unmet needs revealed in the course of the project: Among other things, a need for— (1) The coordination of planning and programming for the aged. (2) An effective means for communicating with the needy aged. (3) An effective neighborhood-based case finding effort. (4) Employment of capable aged persons desiring to supplement their low incomes. (5) The provision of services not now available through existing agencies such as— (a) Shopping services. (b) Homemaking services. (¢) Home maintenance services. (d) Friendly visiting services. (e) Protective services re: wills, legal service, guardianship, ete. The daily logs of the participants in this program contain some provocative experiences, for example: “Could not sign, R B was very ill. Nobody was taking care of him so I talked to Reverend A. so that the County Nurse would come after him. I checked to see—yes, the County Nurse came after him. Today they called the neighbors to come after him but neighbors refuse to take him back because they are unable to take care of him. His age, 87 years old.” Another report, from a Negro : “When I visted many homes in the northern area, I was assisted by many white neighbors in finding houses, addresses and street numbers. These mothers, children and next-door neighbors all pitched in and helped. To me, this repre- sented good public relations and friendly cooperation because I am a Negro aide worker.” i The report also mentioned the lack of cooperation from some nursing homes which would not allow Medicare Alert aides to discuss Medicare benefits with patients. However, the report goes on to comment very favorably about the extensive support given the project by radio, TV, and the newspapers, along with other community organizations. Here again is definitive demonstration that if Washington agencies once make a decision to do something worthwhile for our country’s aged, the local communities will respond with positive interest. This leads me further to comment that it is time to stop demonstrating this or that project idea on a small-scale basis, and move on decisively to making a large-scale, permanent institution out of what has already been learned from demonstration, pilot projects. “Project FIND” is one example of what could be developed into such an institution, with acceptability as high as that of Operation Head Start. Indeed, many of the Medicare Alert Aides have already indicated a willingness to continue in some type of Community Action Program dealing with the elderly. Such continuity cannot be maintained on a hit-or-miss volun- teer basis, however. And it cannot be launched by a one-man staff within OEO either. I'll return to this point shortly. If, along with other persons active in the field of gerontology, I seem to be harping and harping on an old tune, it is only because we seek to convert prob- lems into solutions. Many people seem to accept the deeply imbedded notion that because of the many deficiencies that beset older Americans, they cannot have any potentials. I would submit that many deficiencies attributed to vari- ous types of individuals are but one side of a coin—the other side being the deficiencies of society and its institutions. Such deficiencies consist of govern- mental and community failure to provide concrete recognition—in the form of structured opportunities—of the continued useful function that can be performed by many, many older Americans. The time is ripe, given the great demand for more manpower and given the admission of so many unmet public needs, to create these opportunities. I regret very much that OEO still has, after its two years of operations, only one staff person, to my knowledge, devoted to projects for older citizens. And just as serious, the position itself, in my opinion, is too far down the totem pole of authority and communication to make any impact on top-level policy and decision-making. He can say or do little, if anything, about VISTA, Title V, and other programs outside of CAP, and very little within CAP. Perhaps NEEDS REVEALED BY OPERATION MEDICARE ALERT 45 Congress could provide Mr. Shriver with the authority and the funds to remedy both shortcomings. I am also aware of the legislative proposals of Senator Williams of New Jersey, and of Senator Smathers, both of whom have introduced two different versions of a Senior Citizens Community Service Corps. I might add that this idea was an early recommendation of the Committee on Aging in its first year, under the chairmanship of the late Senator McNamara, and when Senator John F. Kennedy was also a member of that Committee. Because of the pro- fessional interest of the Administration on Aging, it might be best to lodge the basic operation of such a program in that new agency, with some effective— I repeat, effective—prodding on OEO to make sure that older poor get their fair share of participation in the Service Corps. Mr. Chairman, this completes my basic testimony, but I would like to request that a recent article on the 1959-1964 changes in the composition of the poor in America be included as part of my testimony. It was written by Miss Mollie Orshansky of the Social Security Administration, and published in the April, 1966, issue of the Social Security Bulletin. As you know, Miss Orshansky is the recognized authority on the definition and measurement of poverty as used by OEO. The article is important because it singles out the subgroups in our population which have increased or decreased in numbers and proportions as far as poverty is concerned, in the five years since 1959. It reveals, for exam- ple, that while the total number of poor declined in that period, the number of unrelated aged poor individuals increased. In 1959, unrelated aged indi- viduals and families with an aged head made up less than one-third of all the poor. Five years later, they constituted nearly 36 percent of all the poor. The data once again show the vital need for truly meaningful levels of income maintenance for older Americans, and I know that Senator Kennedy of Mas- sachusetts is deeply concerned about that. But since the aged are not one homogeneous mass, I would also urge a serious look at the significant minority of older citizens who could still be engaged in useful and remunerative activities, if only we came forward with appropriate programs to provide such activities. I am sure that the men and women who will follow me today in these hearings, some or all of them associated with the National Council of Senior Citizens, can give you a much more direct and personal account, from an eye-witness standpoint, of the experience gained from Medicare Alert—and of what it proves about the continuing potential of major segments of our country’s aging population. Thank you. Senator Kexnepy. The first panel includes Mr. Walter Newburgher of New York City, president of the Congress of Senior Citizens of Greater New York, Mrs. Lillian Allan, Jersey City, N.J., chairman of the Hudson City Senior Citizens Club, Mr. Leroy Reed and Mrs. Yuteon Hines, Greater Plainfield Senior Citizens Center, Plainfield, oJ. Mrs. Allan, would you be kind enough to begin with your presenta- tion? I welcome all of you. You have been extremely patient in re- maining with us this noontime. I am sure this will be an extremely interesting part of the hearing, and we hope you will bear with us for the remainder of the hour. Mrs. Allan, if you will, proceed. STATEMENT OF MRS. LILLIAN ALLAN, CHAIRMAN, HUDSON CITY SENIOR CITIZENS CLUB, JERSEY CITY, N.J. Mrs. Artan. Mr. Chairman, my name is Mrs. Lillian Allan, and I am the chairman of Hudson City Senior Citizens Recreation Club in Jersey City, N.J. We are an affiliate of the National Council of Sen- ior Citizens. ’ Senator Kennedy, the idea of urging the older people to sign up for part B of Medicare through house-to-house visits was begun in my 66-547 O—66——4 46 NEEDS REVEALED BY OPERATION MEDICARE ALERT club long before the Operation Medicare Alert project was announced by the Office of Economic Opportunity. My club responded to an appeal by President John W. Edelman of the Bottenst a of Senior Citizens who was a member of the OEO task force which recommended the Medicare Alert idea last Au- gust. I believe Mr. Edelman despaired of OEO initiating this pro- ram so he asked clubs to try and do it on a voluntary basis. As you Ea! the OEO program finally did not begin until January or February 1966. : I want to show you this page of our national council newspaper, Senior Citizens News, dated last November. It is headed “Urge All Elderly Sign Up for Supplementary Insurance Plan.” One small paragraph says, “Reach the shut-ins. However, in every community there are shut-ins or others outside elderly club life who need helpful advice about this complicated legislation.” Mr. Edelman urged us to put this article up on club notice boards and he asked us to go out and find the “shut-ins” in the community and tell them to sign up for Medicare. Our people went out into the streets in rain hy J snow. They were often blue with the cold—and Sons tees, thank goodness, they got coffee from the old people they visited. Some of these club members—who were all unpaid volunteers at that time—were later invited to join the official Community Action Program for Medicare Alert which started in February 1966. Loneliness, loneliness, loneliness—this is the word which best de- scribes what our club members came up against when they sought to locate the old people to urge them to sign up for Medicare. We found people hidden away in cold, lonely rooms, deserted by their children, often ignored by their neighbors. They were frightened old people—and they yearned for Sompsnionshis. I want to tell you, Senator Kennedy, about the sad experience of one of our club members. She found an old gentleman who was just so happy to have a visitor that he was very distressed when she had to leave to visit others. He urged her to come back to visit him. She intended to do so as soon as she could—and she explained to him that when her Medicare Alert project was over she would call again and chat with him. She said he seemed intensely lonely. Imagine her distress when she read a newspaper shortly after the Medicare Alert ended. She was actually getting herself ready to go and visit the old man when she read in the newspaper that he had hanged himself. This is a terrible example of the effect of loneliness on the aged. The members of my senior citizens club hope that you and your committee—as well as Senator Harrison A. Williams, of New Jersey, another good friend of older people, will urge the Congress to take the necessary steps to help the elderly by appropriating money for effective programs. Older people need more income, to be sure—but, they also need vital services. The Nation is not doing enough in this direction—and we feel that Congress is doing too much talking about this and not taking enough action. Congress should get after the agencies of Government to be imaginative in devising good programs for the elderly—and they should see that these agencies get money appropriated for this necessary work. NEEDS REVEALED BY OPERATION MEDICARE ALERT 47 Senator Kex~epy. Mrs. Allan, I want to thank you for your very moving testimony. From your experience in Medicare Alert, did you find that some of those who participated in the program had the oppor- tunity to help provide services for other seniors Mrs. Anan. Yes. I would like to cite one example. I received a telephone call and they said, “Mrs. Allan, a member of our church had a stroke. Do any of your senior citizen members want a job” I said, I believe I had one of our members who had some training as a nurse and I called her. The person that has a stroke required 24 hours a day service. My member now helps this woman by being there from 11 p.m. to 7 a.m., 7 days a week, and she has been working at this job for 2 weeks. I would say that friendly visitors are a very necessary part of the senior citizens corps program. I would also like to say that health aides are another. There are peo- ple living in hospitals who have had strokes that do not get fed their meals. The food is placed on a table beside the bed and there is nobody there to feed them. This is a service that the senior citizens could do very easily. They could also be in the children’s wards of the hospitals. When children are sick they need love and security, someone to play with them and make them forget that they are in a hospital. In conclusion, I would like to agree with Sargent A that this should be a Community Action Program. We have a very good Com- EXivily Action Program, the Hudson City Neighborhood Drsaniestion ouncil. I am chairman of the committee on aging in this council. I will go back to Jersey City and tell my hundred members to get busy and write letters to Congress and tell them to release money for jobs for senior citizens. I make no bones about it. That is what I came to Washington for. Senator KennNepy. Mrs. Hines, would you like to make any com- ment ?# I think Mrs. Allan has spoken extremely eloquently and with a good deal of candor. STATEMENT OF MRS. FULTON HINES, GREATER PLAINFIELD SENIOR CITIZENS CENTER, PLAINFIELD, N.J. Mrs. Hines. Senator Kennedy, my name is Mrs. Fulton Hines. I live in Plainfield, N.J.; I am 63 years old, and I am an assistant teacher at the Kings’ Daughters Day Nursery in Plainfield. I have worked with Medicare Alert and survey for housing for senior citizens. Hav- ing lived in Plainfield all of my life, I felt I knew a little bit about the conditions in Plainfield, but in that survey I was shocked at what I found in the living conditions amongst the poor elderly citizens. There were older women that were living under constant fear, fear that you would approach their landlord or you would approach the real estate dealer to tell of this survey that we were making and you could see they just would not communicate with you, some of them, and you would go to the landlord and the landlord would retort, “If they are not satisfied, why don’t they move?” I said, “From one hole in the wall to another #” A lot of the places are not fit for human beings of any kind. The landlords refuse to repair them. They leak. They have electric wires running all around. The people paint and try to paper themselves. One woman works 2 weeks to pay her rent and the response from these 48 NEEDS REVEALED BY OPERATION MEDICARE ALERT women is that they would be tickled to death to have senior housing for themselves where they could feel like human beings. They are able to work, not full time, but what they are paying in the places that they live would more than adequately pay for senior housing. I also visited a man who is 70. He is a master carpenter and a stonemason. He is retired. He is living in a cellar, not a basement apartment, but a cellar, that he had made into a little place for himself, and he is willing and was tickled to death that we suggested that he start a class for the younger people to display the skills that he has and the training because he is a master worker. There are so many conditions that you can just go on and on and relate the conditions. So we are here to appeal to those in authority to do something for the senior citizens because they need it. They are not in a position to ask for these themselves, all of them, but they have talent, they have ability, they have vision, and they have experi- ence. So please give them a chance and do something for them. Senator Kennepy. Do you feel that if incomes were raised to the minimum figures which have been outlined in the poverty program, do you feel that a number of the conditions which you described with regard to housing, would be eliminated or modified? Could you comment on that? Mrs. Hines. You mean in their Social Security or retirement ? Senator Kexnepy. Yes. Mrs. Hines. That, as I see it, is well and good. That would supple- ment it, but I feel just to give them more money and to tell them to stay in a back room or just be isolated and lonely is not the solution because they have talents and they should be allowed to use them. Let them earn. Let them get out and act. They want to do that. Senator Kennepy. As Dr. Sheppard has testified, the question of supplementing income is one extremely important and fundamental aspect of a comprehensive program. The other aspect includes programs to provide services for the seniors as well as opportunities for them to participate in construc- tive, positive, and imaginative ways in the society of which they are a part. Mrs. Hines. Yes, sir. Senator Kexnepy. I want to thank your group very much for their appearance here before the committee. I think your testimony has been extremely helpful. (Mrs. Hines’ prepared statement follows:) PREPARED STATEMENT OF MRS. FurroNn HINES (AGE 63) PLAINFIELD, N.J. (AsSISTANT TEACHER AT KING'S DAUGHTERS DAY NURSERY) Mr. Chairman, my name is Mrs. Fulton Hines. I live in Plainfield, N.J.; I am 63 years old, and I am an Assistant Teacher at King’s Daughters Day Nursery. I served as a Community Aide in the Medicare Alert Operation and I am continuing in the extended program which we have been using in order to study the housing problems and the needs of our elderly citizens. I have spent practically all my adult life in Plainfield and I thought I knew something of the conditions and the way people lived in our community but, Mr. Chairman, I knew nothing of the very bad living conditions of the elderly poor in Plainfield. Our survey has us interviewing these older poor people and trying to learn of their interest in low-cost housing for senior citizens. Time and again I found that these poor people were actually afraid to discuss the conditions in which they NEEDS REVEALED BY OPERATION MEDICARE ALERT 49 were living. They were afraid that the landlord, the owner or the agent, would learn of their discomfort and their unhappiness and might force them out. Two such senior citizens told me that they would not talk to me and that I should talk to the landlord. I was brushed off by him. These people in my community are being penalized because they are old and poor. The rents they have to pay are higher than those paid by younger people. And, Mr. Chairman, some of these quarters are really fire traps. One lady told me that she worked two weeks to pay her rent—or half of her income. The attitude of the landlord was: “Why doesn’t she get a better job?” Mr. Chairman, our senior citizens do need help. They need low-cost housing where they would have no fears of being run out on the streets because some landlord doesn’t like their right to free speech. These people need new hope. They are entitled to this hope. We found that for the older people working for Medicare, and even those whom we interviewed, that hope was renewed. Mr. Chairman, people need something to do. One man I know who is 70, lives in a cellar. He has turned this cellar into his living quarters. He is a master carpenter, he is a stonemason. In short he has skills. He still does odd jobs, but would it not be a fine thing if these skills could be taught to younger people? The difference between retirement, even with Social Security and a pension, and part-time work is the difference between living and dying. Thank you. Senator Kennepy. Would either Mr. Newburgher or Mr. Reed care to comment ? STATEMENT OF WALTER NEWBURGHER, PRESIDENT OF THE CONGRESS OF SENIOR CITIZENS OF GREATER NEW YORK Mr. NewBurGHER. Yes, I would like to make a statement, Mr. Chairman. My name is Walter Newburgher. I am president of the Congress of Senior Citizens of Greater New York. I appreciate the opportu- nity to bring to you the views expressed by our membership. The Congress of Senior Citizens, the largest organization of the aged in the New York area affiliated with the National Council of Senior Citizens, is composed of the members of a cross section of New York senior citizen centers, sponsored by church groups, unions, and social agencies. There are 97 individual clubs affiliated with us with a total member- ship of over 60,000 older people. The officers of our organization are all volunteers. We have no paid staff. We devote ourselves to the well-being of the older adults in our community and one of our prin- cipal aims is to provide a means through which the skills, experiences, talents, and wisdom of elderly people can be used productively for the benefit of the larger community. It is obvious, therefore, that we are deeply concerned with those among our membership who are financially depressed and because of their age find themselves excluded from productive employment in our modern economy. Naturally, we hailed the project Medicare Alert, not only as a means of enrolling many thousands into the Medicare program but also because it gave the very poor among the aged an opportunity to earn a few much-needed dollars. We felt that Medicare Alert was intended to supplement their meager income and would be a limited but salutary weapon in the War on Poverty. Because of our role in the city, a number of our leaders, including myself, were appointed to the citywide committee that planned the implementation of this program. Regrettably, only some 22 pockets of poverty were set as priority areas for funded Medicare Alert programs. 50 NEEDS REVEALED BY OPERATION MEDICARE ALERT In other areas, where many older people live who are also of very limited means, no official program was organized. The Congress of Senior Citizens, however, recognized the urgency of ferreting out the many unaware of Medicare and, cognizant of the limited time to meet the original deadline, immediately activated itself. We sent speakers into every affiliated club, made arrangements with representatives of social security to attend some of these rallies, and I can truthfully say that our totally voluntary activities brought a great influx of senior citizens into Zs Medicare fold. Both Medicare Alert programs, the one implemented by official agencies, and the voluntary one, emphasized the value of this pro- gram to the recipient and the dispenser of the advice. Many hun- reds of elderly received income from the program, hundreds more received the personal gratification of participating in a worthwhile effort, of being useful to their fellow man, and, of course, thousands were enabled to enroll in the Medicare program. It should be noted, however, that for many, just having a visitor who took an interest in their welfare was also of great value. In com- munity after community reports came back from people who were told, “No one has knocked on my door for 6 months.” This program helped us reach many of the loneliest of our elderly, the most needy and isolated. The overwhelming majority of our senior citizens abhor the thought of charity. These are the people who throughout their working days have been able to support themselves and their families and who now on the eve of their lives find the door closed to permanent employment. These are the people who have weathered the great depression and who are now facing an inflationary spiral, so it cannot be considered surprising that senior citizens today comprise 20 percent of all the poor in the Nation. What is, however, surprising, is that the poverty program is com- pletely disregarding their obvious needs. There has been response in our area for these needs neither from the local organization—the New York City Economic Opportunity Committee—nor from the regional OEO, and we must accept the concept that the discrimination against the aged originates with the National Office of Economic Opportunity. It is a shocking fact that with the exception of Medicare Alert, which is now ended, and the Foster Grandparents project which only employed a few dozen people—not a single significant permanent pro- Jam as been funded to this day to serve the elderly of New York ity. This in spite of the fact that some of the proposals were suggested and submitted almost 2 years ago. I do not believe that the project mentioned by Mr. Shriver, the Project PATH, could be classified as a significant project. Actually, it trained about 50 people in a city of almost a million people over 65. The OEO simply does not respond to the suggestions of the senior centers, of the settlement houses, or of the organizations of the elderly, to the many requests for employment opportunities and services, nor has it acted on a fine project suggested by the National Council on the Aging as a permanent followup to Medicare Alert, a project mentioned several times here today, called Project FIND. NEEDS REVEALED BY OPERATION MEDICARE ALERT 51 It is reasonable to say, therefore, that as far as the aged are con- cerned, the War on Poverty has not yet produced a battle ; no, not even a skirmish, The Community Council of Greater New York has functioned for more than 40 years as a citywide association of over 1,000 health and welfare organizations. Its focus has been the coordination and joint planning of services to meet old and new needs. In the field of aging, responsibility is given to the Citizens Committee on Aging. have recently been elected to serve on the executive board of that committee. This fine organization comprised of leading citizens in New York, Cy concerned with the well-being of the aged, was recently given to understand, as they pressed for programs for the elderly, that the regional OEO did not want to finance aged pro- grams out of Community Action Program funds. Mr. Chairman, the senior citizens do not aspire to preferential treatment ; however, they believe they are entitled to equal treatment and that is what I believe they ought to get. I am firmly convinced that they can never achieve equitable status unless they are involved in the poverty program. It is my belief that it is imperative that they be given opportunities to serve on the boards of the program. If this becomes a reality they could be of great value to formulate the policy of the program, not only in relationship to the older groups but ip in solving the prob- lems of all poverty groups in the Nation. Another phase of the {ar on Poverty in relation to the aged, and Bening in mind that they represent 20 percent of all the poor in the land, should be immediate action to substantially increase the present inadequate social security benefits. This would be a salutary method to strike a major blow toward eradicating poverty in our Nation. Mr. Chairman, all older people require services and programs to meet their economic and social needs. I have emphasized here par- ticularly the special problems that confront our ar older people because they need priority in getting our help. e look to you to help us achieve this. Sot Kenxnepy. I want to thank you for a forceful and forth- right statement. id you have a comment, Mr. Reed? STATEMENT OF LEROY REED, GREATER PLAINFIELD SENIOR CITIZENS CENTER, PLAINFIELD, N.J. Mr. Reep. My name is Leroy Reed. I was born in West Virginia, Charles Town. I was working on the senior citizens Medicare Alert Program and have been in Plainfield for 55 years and I myself, Sen- ator, did not know of these conditions in Plainfield, that houses were worse than I can describe and the people are being misused so that the money they get for welfare or social secuity, the landlord gets most of the money and I am satisfied that the welfare department knows about this and that these people are living under those conditions. They can’t say anything about it. Some of the people, three of the women I know in particular, live in one house, $95 a month. They use one bathroom, one stove, and they have to live. 52 NEEDS REVEALED BY OPERATION MEDICARE ALERT Not by choice, but circumstances put them in that condition. That is only one. There are people that have cold-water flats, cooking on coal stoves to heat and to cook with. When Medicare came about they thought something was coming. They were so proud because they thought that the community leaders would take over and do something, and I am speaking particularly of the churches. We went with these pamphlets just asking them to tell the senior citizens what is going on, what to do to sign up for Medicare or per- taining to houses. Not one of the ministers in my town I am speaking of had the time to do it. They weren't interested, but these are the people that put the brick in that church and poured the mortar, but they are past now and they are not thought of by the leaders. Our trouble—mostly my people I am speaking of—is in the church leaders. They are being taken over. They pay. In one particular church, and I have to say this, the minister charges his own members $50 to marry the couple and they went to another minister and he said $25, but this minister says, “Well, he can’t come to my church and marry, so you will have to give me the $50 or marry outside.” So that teaches us why we are not getting over to the poor people because our community leaders when we go to them they don’t have time to talk to us and they are bleeding the people and the people are ignorant. These are some of the things that are happening to our people. Senator Kennepy. I want to thank you very much, Mr. Reed. That is what we are attempting to do today. We want to listen to the seniors themselves who work, who are interested in and who have provided some degree of leadership in their communities. I think the testimony today has been most beneficial. I want to thank all of you on the panel for your appearance and for your helpful testimony. Mr. NewBureHER. Thank you. (Mr. Reed’s prepared statement follows :) PREPARED STATEMENT OF MR. LEROY REED, MEDICARE ALERT TEAM CAPTAIN Mr. Chairman, my name is Leroy Reed. I am 69 years old; I was born in West Virginia and I have lived in Plainfield, New Jersey, for the last 55 years. I was a Team Captain in the Medicare Alert program and I continued to work on the extension. We are surveying both the need and the interest for low- cost housing among the senior citizens. I am, Mr. Chairman, myself a poor man, but you can believe me I did not know or even understand how really bad the living quarters of our old people are until I saw with my own eyes their so-called homes. I found old people living in cold-water flats with coal stoves for heating and cooking, conditions I thought went out after the depression. Many of these senior citizens were paying rent for just plain dumps. That is the best way I can describe some of the places I saw. And, Mr. Chairman, I saw the fear in their eyes when they talked of their problems to an outsider like me. Many of those I talked to had to pay more rent than public welfare allows in the grants. And I am sure the welfare department knows very well what is going on. And I am equally sure that they close their eyes to these conditions. Some of these old poor live with relatives or even with friends and they told me that they had little or nothing left either from their welfare checks or from their small Social Security allowance. And those people with whom they have been living take those allotments for their rent and their board, leaving nothing for these poor people. They do not have the means to buy under- NEEDS REVEALED BY OPERATION MEDICARE ALERT 53 clothes. They live like animals in our rich nation. I think that many business men who deal with these older citizens do their best to get as much out of them as they can. I found these old poor sharing bathroom and kitchen facilities with others. They don’t live this way by choice, they just do not have the means to live any better. That is all they can afford. I am now getting about five ‘phone calls a week from some of those I talked to during the survey. They ask me what they can do to get better living conditions. They want to know when the housing program will be started. This is a small hope for some of them. These people were hopeful that with the Medicare Alert program, the com- munity leaders would really take an interest in their problems. To my surprise I found little support from the churches and yet, Mr. Chairman, these were the people who put the bricks and mortar into those buildings where younger and more comfortable groups of people now worship. Our older people need to feel free. They should not have fear. We see too many leaders using them for their own selfish purposes. They can only be free if they have enough money to take care of their needs in their old age. I wonder if you or I could take the punishment that is given these people under similar conditions? Their needs are not great but they do need to be helped. They don’t need and don’t want charity, they need and want the com- munity to care. Senator KEnNEpY. Our second panel is made up of Mrs. Frances Maletz and Mr. Lawrence Cook, Washington, D.C., Operation Medi- care Alert Program of the National Council of Senior Citizens, and John A. Algee, M.D., Adult Health and Geriatrics Clinic, District of Columbia. . Since the hour is getting late and we have two additional panels, I would like to request that your statements be included in their en- tirety in the record. If you would be kind enough to summarize briefly the contents of your statements, I would appreciate it. STATEMENT OF MRS. FRANCES MALETZ, OPERATION MEDICARE ALERT PROGRAM OF THE NATIONAL COUNCIL OF SENIOR CITI- ZENS, WASHINGTON, D.C. Mrs. Marerz. Mr. Chairman, my name is Mrs. Rueben Maletz. I am 73 years of age and I live at 3808 Jennifer Street N.W., Washing- ton, D.C. Do you wish me to continue? Senator KenNepy. Could you summarize and I will put your state- ment in the record. Mrs. Maerz. I was born in Boston as were all my children. Senator KENNEDY. You were born in Boston, Mass. ? We extend a special warm welcome. Do you still have some rela- tives up there? Mrs. Macrerz. Oh, yes, yes, quite a number. Senator Kennedy, I would like to say at this time that I remember very well the wedding of your parents. I remember how exciting it was to see the lovely brides- maids in their flowing dresses and their big hats. I was a spectator outside the church. Senator, my father knew “Honey Fitz” Fitz- gerald, your grandfather. I have been concerned with Medicare legislation for some time. I am a member of the National Council of Senior Citizens and, like many others, when the opportunity to participate in Medicare Alert arose, I was eager to join. 54 NEEDS REVEALED BY OPERATION MEDICARE ALERT First, may I say that I wanted to earn the several additional quar- ters I needed for my Social Security. Like many other older people, I do not ever expect to be dependent on my children, even though they have assured me that I have no worries. For anyone who is ill, or has had a severe accident, the value of Medicare for older people is obvious. Spending 60 or 70 days in the hospital recovering from an unfortunate accident can drain off finan- cial resources completely. In my experience as a team captain in the far northwest of Wash- ington, D.C., we found that loneliness and withdrawal among older people knew no social or economic standards. The community aides went from home to home, apartment to apartment, and reported each more beautiful than the previous one, and the loneliness of the elderly people more pathetic in each case. Our community aides, white and Negro alike, were welcomed by these elderly citizens regardless of their racial or economic back- grounds; and, Mr. Chairman, the community aides working in my area were primarily poor who needed the additional income. There was no evidence of discrimination or prejudice among the many thousands they visited. On the contrary, they were cordially welcomed and invited in, and, during the winter months (I started in February) they were offered hot drinks and other refreshments in the most cordial way. In fact, they had to excuse themselves in order to continue their work rather than to spend a pleasant 2 or 3 hours socially with them. For myself, I recognize that I, too, had begun to withdraw, I had always been active; I raised a family. But with my family grown, I began to recognize that some mornings I didn’t want to get up. This work gave me a new lease on life. I renewed my interest in people and the community. Our people do not want this program to end. They have regained their spark and they feel the need to be a part of the community in the fullest meaning. We want more work. We do not desire—and I think I speak for most of the people who work on Medicare Alert— any high pay. We want 10 hours per week and we would be quite happy with the $1.50 per hour or whatever the minimum wage is. We want to feel independent and we want to feel useful. The question is always asked: “What can we do for older Ameri- cans?” I suppose in a way the answer is: “It depends on where they live.” In the area in which I live, Mr. Chairman, there is little eco- nomic poverty. But there are great pockets of poverty of the spirit, and the result is loneliness and withdrawal. There is no doubt in my mind that the problem of loneliness is one of the most difficult human problems. We need programs to handle this problem and research to overcome it. If you can stay active, you forget your aches, your pains, and your loneliness. Older people must somehow be drawn back into the mainstream. Mr. Chairman, I thank you. Senator Kexnepy. I want to thank you, Mrs. Maletz, for your ap- pearance here and your presentation. I think that you summarized very well the sentiments which I know are held by many hundreds of thousands and even millions of seniors. I want to say how much this committee appreciates your appearance here. NEEDS REVEALED BY OPERATION MEDICARE ALERT 55 STATEMENT OF LAWRENCE COOK, OPERATION MEDICARE ALERT PROGRAM OF THE NATIONAL COUNCIL OF SENIOR CITIZENS, WASHINGTON, D.C. Mr. Cook. Mr. Chairman, my name is Lawrence Cook. I am 67 and a retired Government worker. I worked as a team captain of the Medicare Alert program. Senator KENNEDY. We can include your statement if you would like to summarize it very briefly. } Mr. Cook. As an older rites who has a mother, aged 93, living with him and a wife who works part time, primarily to contribute to the support of her 88-year-old father, whose sole income is his $44 Social Security check, I was keenly aware of the problems of many of the people we contacted in our survey. First, with Social Security benefits ranging from $44 to $80 a month, we found people who were paying rents alone averaging $65 to $80 a month, which leaves them nothing for other expenses. Second. Many were confined to their homes with pitifully little outside communication. They were eager and grateful for the few moments of contact our survey afforded them. The solution in my judgment is assurance of adequate income suf- ficient for a decent living, free of absolute dependence upon children who, though anxious to help them live in dignity, are often financially unable to 5 so. Establishment of services designed to bring some personal contact to those confined to their homes. Provide more recreation centers conveniently located, senior citi- zens’ clubs, social centers in the churches for these people who need to be returned to the land of the living. Senator Kennepy. Thank you, Mr. Cook. (Mr. Cook’s prepared statement follows :) PREPARED STATEMENT OF MR. LAWRENCE COOK Mr, Chairman, my name is Lawrence Cook ; I am 67 and I live at 1208 Tewkes- bury Place, NNW. I am retired from the Government; I was an engineering technician at the Bureau of Standards. I retired last December and was fortunate in being able to join the Medicare Alert program in February as a Community Aide. In May, on the extension of the program, I was named a Team Captain for the Northeast. I am one of the growing number of older Americans who has a mother living with them. She is 93. My father-in-law, aged 89, lives with my sister-in-law, my wife's sister. His income is $40 which he receives from Social Security bene- fits. In principle then, we support our parents. Thus when I joined the Medi- care Alert program, I had already been personally involved in the problems of the elderly poor. My mother is reasonably active. So is my father-in-law. But the fact is that they are both house-ridden. My early experience with Medicare Alert took me into the northwest area in the vicinity of the Walter Reed Hospital. It was obvious then that the major problem for senior citizens was a lack of financial resources. Social Security did not give them sufficient benefits and they had to look to their own children for additional support, obviously creating great personal hardships on both the parents and the children. Being dependent, Mr. Chairman, strips people of self-respect. They lose pride and they grow old in the twilight of their lives, turning away from the world in which they had made their contribution faithfully and honestly. In the northeast, the loneliness of poverty creates a vacuum. There is a lack of communication as well as poverty of the spirit. These people did not even know of Medicare. They were completely cut off from the community. There was a total lack of communication. Housing, diet, living conditions were awful. 56 NEEDS REVEALED BY OPERATION MEDICARE ALERT We found they suffered from poor medical services. If they had money for public transportation to go to the public clinics, they had long and difficult wait- ing periods and seemed to receive little satisfaction. The problems in the north- east are really acute. Our workers themselves had serious financial problems as well as serious health problems. The elderly poor in the lower income brackets are caught in a jam. These are the people whose income is too high for Public Assistance, but too low to enjoy any of the comforts we have been taught to expect in this affluent society. In the northwest, where many of the southern migrants settled, it was bad. But the far northeast is truly dreadful. Again, we found that in the northwest Social Security benefits were around $40-$80 per month, with rent $65-$80 per month. Obviously, Mr. Chairman, living for the elderly poor is harsh. ‘What are some of the solutions? In my judgment communication is primary : The establishment of social centers in churches, and recreation areas convenient to these people who need to be returned to the land of the living. Senior citizens clubs must be formed. And still, the lack of financial resources must be recognized. STATEMENT OF JOHN A. ALGEE, M.D., ADULT HEALTH AND GERI- ATRICS CLINIC, DISTRICT OF COLUMBIA Dr. Avgee. Mr. Chairman, I am Dr. John Algee. In summary of my statement I in effect said that, as a result of being affiliated with people who worked on Medicare Alert, in examining some of the patients or personnel we felt that it was of great help to them to work again. Also, as a result of working in geriatrics we are best concerned with some of the problems of the elderly and it is very interesting to hear speakers who preceded me say that one of the problems that they noted was a considerable amount of depression that is seen in elderly eople. I feel that I have been quite concerned with this and I feel that one of our big problems is the fact that we do not offer anything to bring the people out of their homes or any kind of a program in the com- munity which will make the people respond to the environment. I think that as a result of some of the persons working on Medicare Alert we were able to note that the incidence of their coming to the doctor was decreased. They were much better. They had less physi- cal and psychological problems, so on the whole I felt that Medicare Alert to the people who I was affiliated with was a good venture, but I do feel that more moneys are needed by the community to support and bring our elderly citizens back into the mainstream of community life. I thank you. . Senator Kennepy. You are aware of Operation FIND and the pro- gram of Operation FIND? Dr. Arcee. Yes; I am aware of Operation FIND. Senator Kexnepy. Do you think this is the kind of program that helps mobilize the efforts and the interests of many of the seniors who worked in Operation Medicare Alert? Do programs such as this en- courage seniors to be active, productive, and helpful to other seniors? Dr. Arcee. I think at this time that this is one step in the right direction. As a result of Medicare Alert I think that the entry was made into making people more aware of what is actually happening with our senior citizens. I think with Program FIND we can supplement and implement some of the thinking and some of the problems. We can sort of allevi- ate the problem if we want these people back into our work force. NEEDS REVEALED BY OPERATION MEDICARE ALERT 57 (Dr. Algee’s prepared statement follows :) PREPARED STATEMENT OF DR. JOHN A. ALGEE Mr. Chairman, my name is John Alfred Algee. For the past two years, I have been with the District of Columbia Adult Health and Geriatrics Clinic. I am 34 and was born in Kentucky. I received my Bachelor of Science degree from Langston University, Oklahoma, my Master of Science degree from the University of Illinois, and my M.D. in internal medicine from Howard University. I served as an intern and resident at Freedmen’s and D.C. General Hospitals. Because of background in geriatrics, it was inevitable that we in the Clinic should become involved in the Medicare Alert program. . We recommended people for Community Aides in the program. We found, speaking purely from a professional point of view—and Mr. Chairman, may I point out at this time that I speak only as a doctor vitally concerned with the dis- cipline of geriatrics—that older people in our care needed less attention and less medication once they were engaged as Community Aides in Medicare Alert. We found, for example, that many were just too busy to see the doctor. Be- cause they were back working again, they had no time for aches and pains. The need for psychological and medical support diminished as the work load of these Community Aides involved them in the community life. I was invited to speak at public meetings and on TV and radio on the Medi- care Alert program. I said on these occasions and I say now the Medicare Alert program had great therapeutic value for the elderly. Again and again, the Community Aides working on Medicare Alert told me of their shock at finding so many elderly persons living in abject poverty worse than their own and, bear in mind, Mr. Chairman, most of the Community Aides in Medicare Alert were the elderly poor. I might add that seeing so many people worse off than they themselves were gave the Medicare Alert workers a deep feeling of compassion and made them recognize their own plight could be worse. Speaking as a public health physician, I would like to say that the problems highlighted by Medicare Alert are not unknown to officialdom, that solutions are being sought to these problems. However, there is a question of available resources. I would like now, Mr. Chairman, to give you examples. One Community Aide who worked as a team captain is a retired Government Supervisor. She is 71, suffering from arthritis which was residual from an earlier bout with polio. Psychologically, until she entered into the Medicare Alert program and directed the work of a team in the Southeast section of Washington, she was a regular patient of mine. She needed no medical support during the time she was engaged in Medicare Alert. She got about and enjoyed her activities and returned to the mainstream. Now, her work has ended and geriatric problems have again returned. In the Northwest section of Washington, a patient of mine suffering from diabetes and glaucoma complicated by the effect of a colostomy needed working time under Social Security to qualify for Social Security benefits. By working as a Community Aide on Medicare Alert, she gained the needed qualifying time and is now eligible for desired Social Security benefits. She worked well and is already much better off physically and mentally as well as financially. Hence she is now much less a burden to the welfare department. Mr. Chairman, as a medical man, I would like to say, based on my experience, that those people who were directly involved as Community Aides in Medicare Alert were greatly improved in their personal outlook. The need for medical care diminished because these elderly poor were back in the work force. There is a tendency, as we in geriatrics know, to sit in a closet and reminisce about the world as it was and withdraw from the world as it is. There is some- thing deadening about looking back too much, but we tend more and more to look backward as we become less capable of dealing with the world of the present. Mr. Chairman, in my humble opinion, not enough is being done to help people over 40 cope with the alterations time brings. Senator Kexnnepy. I want to thank all of you very much for your appearance here. I appreciate your taking the time to appear and for being as patient with us as you have been. I thank you both. Mrs. MaLerz. Thank you. 58 NEEDS REVEALED BY OPERATION MEDICARE ALERT Senator KenNepy. I want to express my great appreciation for the splendid attendance and compliment everyone who is here for their courtesy to the witnesses who have appeared before the subcommittee and to the Members of the Senate. You have been an extremely in- terested and attentive group. I think having your participation at this meeting has added immeasurably not only to the atmosphere but also has served to call attention to the degree of interest which exists in this area. I personally want to express my appreciation to each and every one of you who has given of your time to attend this meeting. Let me just say as well that one of our splendid witnesses mentioned congressional action. Certainly this is something I am deeply inter- ested in. I think you have heard spoken the sentiments of a number of my colleagues. I agree with you that this is a time for action. I am happy to have the opportunity to work with you who represent many hundreds of thousands of seniors around the country to assure that speedy action is taken. I know some of you have to leave. It is getting late. This is our final panel this morning. I understand our third and fourth panels are here. They include Mr. and Mrs. Henry Gilman from the Florida League of Senior Citi- zens; Mr. Edward Robinson, who is from the Detroit Metropolitan Council of Senior Citizens; Mr. James Carbray, who represents the Steelworkers International Union, Huntington Park, in Los Angeles; Mr. Arthur Capone of Revere, Massachusetts, and Mr. T. H. Lynch of Duquesne, Pa. I understand that each of you has submitted a statement which we will include in the record. If you would like to make a brief summary comment or additional personal comment we would be delighted to hear them. We can start with Mrs. Gilman. Mrs. Gilman. STATEMENTS OF MR. AND MRS. HENRY I. GILMAN, FLORIDA LEAGUE OF SENIOR CITIZENS, MIAMI BEACH, FLA. Mrs. Gruman. Mr. Gilman will do the talking. Mr. Grtman. Iam Henry I. Gilman. I am going to try to condense 3 to 4 months on our Medicare Alert program within 3 minutes and if T possibly can I will let you know. Senator KENNEDY. Mrs. Gilman, you just come right in now if you think he is missing a relevant point. Please feel free to interrupt. Mrs. Gruman. I will do that. Mr. Giuman. Mr. Chairman, Senator Kennedy and members of the committee, it is through the efforts of James Cuff O’Brien, execu- tive director, Older and Retired Workers, United Steelworkers of America, and assistant to the president of the National Council of Senior Citizens, who has done so much to unite the senior citizens, that I am here today and feel highly honored to represent the State of Florida and Miami Beach for the Medicare Alert program. I am Henry I. Gilman, 79 years of age and chairman of several senior citizen groups in south Florida. I was raised in Roxbury and Brookline, Mass., a graduate of Boston English High, and I spent 2 years at Harvard. I came to Florida 30 years ago for my health. For weeks, we carried on our car a homemade car top sign for NEEDS REVEALED BY OPERATION MEDICARE ALERT 59 Medicare Alert, a copy which you will notice on our right, long before Mrs. Gilman was a captain of this program. On her appointment, I donated my services to this cause. We worked as a team and had 10 paid workers. We contacted and enrolled for the supplementary medical plan over 1,000 people 65 or older, and have signed 97 percent of the senior citizens participating in Miami, Fla. Knocking door to door for a 6-week period, we contacted over 21,000 senior citizens and ran into some real experiences that presented a true Plosme of poverty. Many hotels, motels, and apartment homes refused us entry. One small community even threatened to put our whole crew in jail, but we were told that if we brought a signed letter from OEO, they would permit us in the town. This is one of the striking cases that we had. Case No. 714—Mrs. Gilman and I entered an apartment building, and after contacting several residents, we came to an apartment where the door was partially open. We knocked and were told to enter. It was an efficiency apartment on the ground floor and seemed to be in a tidy condition. As we approached the resident, we noticed he was in a wheelchair with a blanket over the lower part of his body—I knew he evidently had no legs—looking around f saw a pair of artificial legs in a corner. We told Mr. X who we were and why we were there. He then told me he would be happy to sign up for Medicare as he was 72 years of age, had a Social Security number, but had no way of getting to the office to sign up. Upon further inquiry, we found out that at one time he had quite a bit of money, but hospitals, doctors, and surgeons had consumed all but a few dollars which he used to buy the artificial legs. When I asked him why he was not using them, he said that after he purchased them, he found out that he needed several hundred dollars for rehabili- tation, which he did not have. He said he would rather die than ask for charity. We found a way to help this unfortunate man. I have several other cases but those will go on record. Thank you, Senator Kennedy. Senator KENNEDY. You have touched on the problems of the Medi- care program. I'm sure you all realize that it is a part of the law and there are a number of wonderful features of that legislation. Of course there are a number of other provisions which have to be strengthened, expanded, or developed. We are talking this morning about the need for a comprehensive program of assistance. Certainly your contribution in demonstrat- ing the needs in the health care field was significant and important. This is a matter which we in Congress have to constantly review. I am delighted with your statement. Mr. Giman. Thank you, thank you, Senator. (Mr. Gilman’s prepared statement follows :) PREPARED STATEMENT OF MR. HENRY J. GILMAN Mr. Chairman and Members of the Committee, I am Henry I. Gilman, 79 years of age and chairman of several Senior Citizens groups in South Florida. I was raised in Roxbury and Brookline, Mass., a graduate of Boston English High, and I spent two years at Harvard. I came to Florida 30 years ago for my health. For weeks, we carried on our car a homemade car top sign for ‘Medicare Alert”, long before the appointment of my wife, Goldie, as a Captain of this program. On her appointment, I donated my services to this cause. We worked as a team and had 10 paid workers. We contacted and enrolled for the supplementary medical plan over 1,000 people 65 or older. 60 NEEDS REVEALED BY OPERATION MEDICARE ALERT Knocking door to door for the 6-week period, we contacted over 21,000 senior citizens and ran into some real experiences that presented a true picture of poverty. Many hotels, motels and apartment homes refused us entry. One small community even threatened to put our whole crew in jail, but we were told that if we brought a signed letter from OEO, they would permit us in the town. Here is one case history : Case 7T14—Mrs. Gilman and I entered an apartment building, and after con- tacting several residents, we came to an apartment where the door was par- tially open. We knocked and were told to enter. It was an efficiency apartment on the ground floor and seemed to be in a tidy condition. As we approached the resident, we noticed he was in a wheel chair with a blanket over the lower part of his body—I knew he evidently had no legs—looking around I saw a pair of artificial legs in a corner. We told Mr. X who we were and why we were there. He then told me he would be happy to sign up for Medicare as he was 72 years of age, had a Social Security number, but had no way of getting to the office to sign up. Upon further inquiry, we found out that at one time he had quite a bit of money, but hospitals, doctors and surgeons had consumed all but a few dollars which he used to buy the artificial legs. When I asked him why he was not using them, he said that after he purchased them, he found out that he needed several hundred dollars for rehabilitation, which he did not have. He said he would rather die than ask for charity. We found a way to help this unfortunate man. There were, of course, many other equally poignant cases of older people— proud older people—who needed help but who were not being helped because nobody knew what they needed. It is a desperate shame that this great nation of ours does not have better programs to help these poor people who have helped build America and made it great and who now find themselves cast aside like an old shoe. I don’t want to take up more of your time—but I would like to submit, for the record of these hearings, a brief report of four other case histories which develop the crying need for outreach services to the elderly. The fact is, Senator Kennedy, that Operation Medicare Alert all over the country enabled us to bring many thousands of these tragedies to light. But for every one that we discovered—there were probably many more we failed to see. It would be folly for America to ignore the needs of the elderly which have been so clearly demonstrated by “Operation Medicare Alert.” OTHER CASE HISTORIES Case 924: Mrs. R. lives in an efficiency with two other women. When we asked her if she had signed up for the B supplementary plan, she said she did not as the Social Security office was too far away for her to walk to, and she said she may have received a card to sign, but must have thrown it away as she could not read. We asked her what she was receiving from the Social Security office and she said $60.00 and that she had to take a certain tablet three times daily which cost her 90¢ a day, leaving her with little money. I contacted her doctor, received a new prescription and found out that we could get these tablets from our wholesale druggist at 12¢ each, which gave her a little extra money to use for essentials. Case 642: This case was about a husband in a nursing home—he was a victim of strokes and he asked us to contact his wife, which we did. At first she was reluctant to talk as she did not want to antagonize the management of the nurs- ing home since she had to work to try to take care of all the expenses. She told us that it cost her $300 per month to take care of him and that she had sold practically all of her furnishings in order to pay her bills and she was very much discouraged. The management of the nursing home finally reduced her monthly rate $50, so she was paying $250 per month and that helped her as all she was making was $80 a week. Case 371: This is a most unusual case as the man is 82 years old—a man with citations from hospitals and children’s homes for the large donations he had contributed to them. He was a very successful businessman and after giving away the greatest part of his life savings, suddenly had a stroke and a heart attack. In the past 14 years, doctors and hospitals have taken what little he had left—he needs home treatment and can’t afford it. He refuses to accept charity. This man can’t live long without therapeutic treatment. We signed NEEDS REVEALED BY OPERATION MEDICARE ALERT 61 him up for the supplementary B plan. He has a Social Security number but has never received any Social Security checks as he was self employed. Case 722: This case is of a couple—husband 74 and crippled with rheumatoid arthritis, hardly able to walk; wife 72, who has glaucoma and is 80 percent blind. How they manage to take care of one another is almost a miracle. They have a little savings left and friends are trying to get them into a convalescent home, but so far no success as they do not have sufficient funds to pay for any length of time. Doctors and hospitals have consumed most of their life savings. This case is being investigated by Welfare and I am sure they will be taken care of. STATEMENT OF JAMES CARBRAY, WHITTIER, CALIF. Mr. CarBray. Mr. Chairman, my name is James Carbray. I am a resident of Whittier, Calif., an official of the Steelworkers Interna- tional Union. I am going to present to you, Senator, a copy of the Feedback Re- port compiled in Los Angeles County, compiled by the penis in charge of the Medicare Alert program, which I think you will find sets forth the needs of the family, the needs of the elderly in particu- lar, the problems they are confronted with in relation to family serv- ices, health services in particular, and included herein is an eight-page document of conditions that were discovered by the people who were registering under the Medicare Alert program. Some of these, frankly, are Hobe tire I won’t quote them. But California, like some other States, is one of those areas wherein some of the people on public assistance, for example, all people on public assistance who received a 7-percent increase in Social Security under the amended act had the same equivalent amount of money deducted from their State-aid contribution checks. This immediately threw a roadblock into the hearts of many peo- ple. They felt no matter what they did, they were jeopardizing their present, State-aid subsistence payment. Senator Ken~epy. I think this is a very important point. I would like to make part of the record those States which followed that practice. I think it is important to know the States that made these kinds of deductions. You could submit it at a later time if you have that information handy. Otherwise our staff can compile it. Mr. CarBray. I don’t have it all. Senator Kennepy. The staff will have that and we will put it in the record at this point. (The information was given in an article in the Senior Citizens News, for July 1966, pp. 4 and 5, the official newspaper of the National Council of Senior Citizens, which article follows:) STATES STILL DENY AGED BENEFITS GRANTED BY CONGRESS LAST YEAR WASHINGTON, July 1.—A half million elderly poor are still being denied the benefit of the 7 per cent increase in their Social Security checks enacted by Con- gress a year ago this month, John W. Edelman, president of the National Council of Senior Citizens, has charged. Social Security checks that go to an estimated 1,000,000 men and women are so small the recipients must ask for relief, Bdelman points out. Their Social Security increases averaged from $4 to $5 a month. Congress tried to protect these men and women, Edelman said, by providing in the 1965 Social Security amendments that States may disregard up to $5 a month of income used in determining eligibility for relief. The income factor is important because it can affect what the Federal Govern- ment grants the States to help them finance public assistance. 66-547 0—66——5 62 NEEDS REVEALED BY OPERATION MEDICARE ALERT ELDERLY HURT IN 24 STATES Edelman said 15 States lend their less fortunate citizens a helping hand by taking advantage of the $5 monthly income exemption under the 1965 Social Security amendments. Another 24 States have notified the National Council of Senior Citizens they do not intend to avail themselves of this provision of the law and have slashed public assistance payments in the amount of the Social Security increase for relief clients who collect Social Security, Edelman revealed. To justify their position, relief administrators in the States that withhold the Social Security increase from relief clients argue that to do otherwise would be unfair to their clients who get no Social Security, Edelman noted. He had this comment : “That argument may hold water for States that have spread some or all the increase among relief recipients generally but, by their own admission, 17 of the 24 States reporting to the National Council of Senior Citizens, have not done so. “In other words, these States believe in economizing at the expense of their poorest citizens.” NCSO ASKED THE STATES Reports by relief administrators on what they are doing about the Social Secu- rity increase resulted from a questionnaire distributed by the National Council of Senior Citizens to 33 States. The 33 States are listed by the Department of Health, Education, and Welfare as having decided to withhold the amount of the Social Security increase from relief clients. The Senior Citizens’ Council heard from 24 of the 33 States. States Which Hindered In their replies to the questionnaire, these States reported withholding the Social Security increase from relief clients without making any substantial com- pensatory adjustment : Alaska, Arizona, California, Illinois, Louisiana, Maryland, Minnesota, Mis- sissippi, Montana, New Mexico, New Jersey, North Carolina, North Dakota, Ohio, Oregon, Texas and Utah. States Which Helped While withholding the amount of the Social Security increase, these States reported making substantial compensatory adjustments in recognition of the increase : Alabama, Colorado, Kansas, Kentucky, Maine, New Hampshire, and Rhode Island. In its report on the Social Security increase, the Department of HEW’s Bureau of Family Services said these States have taken advantage of the $5 monthly income exemption allowing relief clients to keep their Social Security increase: Arkansas, Delaware, Florida, Georgia, Hawaii, Idaho, Indiana, Massachusetts, Missouri, Nevada, Pennsylvania, South Dakota, Vermont and Wyoming. Iowa was added to this group after issuance of the HEW report. Made No Decision According to this report, these units had made no determination on withhold- ing the Social Security increase from relief clients when the HEW report was issued: District of Columbia, Michigan, Oklahoma, South Carolina, Tennessee and Wisconsin. In addition to the 25 States that answered the senior citizens’ questionnaire, the Department of HEW’s Bureau of Family Services listed these units as report- ing they withhold the Social Security increase from relief clients: Connecticut, Nebraska, Puerto Rico, Virgin Islands, Virginia, Washington and West Virginia. However, these States and territories failed to reply to the Senior Citizens’ Council questionnaire which was directed to them on two separate occasions. Below are comments of relief administrators who answered this questionnaire. Shown in parentheses is HEW’s estimate of the number of Social Security bene- ficiaries on relief in each State : Alabama (43,602), Ruben K. King, Commissioner of the Department of Pen- sions and Security: “Although we have not been able to disregard income, the monthly allowance for old age pensions and aid to the permanently and totally disabled was increased by $4.” Arizona (5,296), John O. Graham, Commissioner of Public Welfare: “This department cannot make any adjustments under State law to disregard any income. NEEDS REVEALED BY OPERATION MEDICARE ALERT 63 “The State law provides a grant-plus-income maximum of $100 for one person, $155 for two persons and $220 for three or more persons in the same household. In event the Social Security benefit is increased, the old age assistance would be decreased in like amount . . . Undoubtedly, a bill will be introduced in the 1967 legislature to disregard $5 of income.” California (159,808), Thomas Pyott, Chief, Aged Services Bureau: ‘State statutes do not permit implementation of any program (to disregard extra in- come for relief clients) except in the case of aid to the blind. . . . However, California law does provide for annual cost of living adjustments in all adult assistance programs and adjustments were made effective Dec. 1, 1965 . . . “During the last four years, basic and maximum old age assistance grants have increased $13.50 a month. Basic and maximum aid to the blind grants have increased $17.70 a month. Similar increases have been made in the program of aid to the disabled. “The Legislature last year defeated a bill to take advantage of the 5 addi- tional income exemption. A similar bill is pending in the Legislature now.” Colorado (21,124), Department of Public Welfare: “An interpretation of the State Constitution indicates all (relief clients’ extra) income must be deducted. However, the old age pension grant was increased $2 to $118 a month and grants in other categories were increased.” Illinois (21,782), Harold O. Swank, Director, Department of Public Aid: “Illinois does not intend to disregard the $5 allowable under the (1965 Social Security) amendments. “This State was and is operating its old age assistance program on the basis of 100 per cent payment of its budgetary standard which is designed to meet full needs of all recipients. “To disregard any item of income would create an indefensible discrepancy between recipients of Social Security benefits and those not on Social Secu- oity «ui “It (Illinois’ standard of assistance) has been revised upward on several occa- sions and in several respects since the Federal amendments permitting States to disregard income. For example, the amount allowed for food has been adjusted upward in accordance with our rule that a 3 per cent increase in prices calls for a similar increase in budgets. This has happened once in the past year and will probably occur again shortly.” Kansas (8,341), Department of Social Welfare: “Kansas will not implement the Federal law allowing States to disregard $5 additional income but we granted increases in allowances effective Aug. 1, 1966.” Kentucky (18,635), C. Leslie Dawson, Commissioner, Department of Economic Security : “Kentucky did not implement the option to disregard the $5 a month of income in determining need of public assistance recipients. “It would appear inequitable to disregard their income if comparable increases could not be made for the needy aged who fail to qualify for this benefit. “However, we have implemented many program improvements within the past six months. More sizeable increases in cases of individuals with special needs will be effectuated by removal of all maximums on payments and granting 100 per cent need. “We are extending the option for disregarding earned income of the aged from $10 and half the balance of the first $50 to $20 and half the balance of the first $80 as we believe recipients gain both monetary and social value from an earning situation.” Louisiana (54,602), Department of Public Welfare: “Because of inadequate funds, we will not implement the Social Security provision permitting States to disregard up to $5 of any income in determining need of public assistance recipients.” Maine (5,876), Pauline A. Smith, Director of Family Services: “We took ad- vantage of the 7 per cent increase in (Social Security) benefits by adding a house- hold maintenance allowance to our standard budget for each recipient in our aid to the aged, blind and disabled category and each family in the category of aid to families with dependent children. The amount was $5 a month. “However, we have not implemented the Federal exemption of income up to $5 a month and do not contemplate doing so.” Maryland (3,216), Raleigh C. Hobson, Director of the Department of Public Welfare: “In Maryland, we have not been able to revise the policy so as to dis- regard up to $5 a month in income of public assistance recipients since available funds did not make this possible. 64 NEEDS REVEALED BY OPERATION MEDICARE ALERT . “Effective Jan. 1, 1966, because of funds available from revised Federal match- ing in public assistance categories, we were able to increase allowable standards for clothing, fuel and household items . . .” Minnesota (17,658), Department of Public Welfare: “We have not imple- mented the authorization for an increase up to $5 a month in income of public assistance recipients. It is our intention to ask the Legislature next year to implement fully the 1965 amendments to the Social Security Act.” Mississippi (26,925), Evelyn Gandy, Commissioner of Public Welfare : “We will not implement the Social Security provision allowing States to disregard up to $5 in income of public assistance recipients because of a lack of funds and be- cause State law does not include this provision. “We will make effective in December, 1966, an increase of $5 for each recipient or each person in the budget by means of a wholesale change in adult category assistance checks . . .” Montana (2,345), Department of Public Welfare: “We will not implement the Social Security provision permitting States to disregard up to $5 a month in relief recipients’ income as we would have to also disregard the $5 for recipients not on Social Security and we would not have funds to do so . . .” New Hampshire (2,095), George E. Murphy, Director of the Division of Welfare: “We have not implemented the Federal exemption because this re- quires legislative action. Food standards have been adjusted upward in assist- ance programs by 8 per cent.” New Mexico (2,964), Leo T. Murphy, Director of Public Welfare: “The State appropriation to this department in 1965 and 1966 was not sufficient to meet the additional cost of implementing the Federal exemption. “The cost of disregarding the first $5 a month of any income in determining need for public assistance will be included in our next budget request.” New Jersey (6,243), Irving J. Engleman, Director of the Division of Welfare: “New Jersey has not adopted the policy of disregarding up to $5 a month of in- come in determining need of public assistance recipients. “Our standards for public assistance grants were increased last year shortly before the Federal action to increase Social Security and permit certain income exemptions. We are currently reviewing, updating and costing standards, taking into account increased living costs . . .” “We believe the existing Federal system which permits artificial ceilings, percentage reductions, outdated, unpriced standards and consequent inadequate grants, should concentrate on correcting the gross existing inequities rather than on devices which serve to perpetuate and increase such inequities.” New York (24,009), Department of Social Welfare: “New York does not dis- regard extra income up to $5 a month for public assistance recipients. To do so would be inequitable to those not receiving Social Security benefits. However, basic needs of public assistance recipients have been increased to allow 5.9 per cent more for fuel and utility allowance.” North Carolina, (10,933), Mrs. Myra J. Mitchiner, Director, Division of Public Assistance: “The State Board of Public Welfare has decided not to implement the authorization to disregard up to $5 a month of income in determining the need of public assistance recipients. “We are in the process of updating public assistance budget for recipients in all categories with a view to increasing payments to all individuals receiving assistance.” North Dakota (1,729), Donald K. Johnson, Director, Division of Public As- sistance: “All States are required to go into a simplified (public assistance) budgeting procedure by July 1, 1966 . . . From preliminary studies, it now appears grants in aid to the blind will increase at least 8 per cent and grants in aid for dependent children will increase at least 10 per cent on the average. “We believe in view of this very substantial increase we were justified in not electing the option to disregard up to $5 per month of public assistance recipients’ income. We also felt an increase for Social Security beneficiaries on public assistance would be unfair to other public assistance recipients.” Ohio (34,870), Department of Public Welfare: “We do not intend to use the . authority given States to disregard up to $5 a month in the income of public assistance recipients. Requirements for all recipients were increased $4 a month last November.” Oregon (5.659), Andrew F. Juras, Administrator, Public Welfare Commission : “We feel strongly that to disregard $5 a month income for those fortunate enough to be entitled to it would be unfair to other public assistance recipients. NEEDS REVEALED BY OPERATION MEDICARE ALERT 65 “We have announced we intend to urge the next Legislature to give us enough money to increase the standards for all our grants. Our food standards have not been raised for 13 years and are highly unrealistic in terms of today’s prices . . .” Rhode Island (3,086), Augustine W. Riccio, director, Department of Social Welfare: “In our assessment of the 1965 Social Security Act amendments, we concluded it would be far more significant to concentrate on an overall increase in assistance to all public assistance recipients than exclude up to $5 a month in the determination of need for Social Security benefits. To this end, $1,656,725 has been provided to increase standards of assistance to all public assistance recipients. The increases are based on guidelines of approximately $7.50 per adult recipient and $1.90 per child recipient.” Texas (87,864), Department of Public Welfare: “State law requires considera- tion of all income and resources with Social Security benefits being considered like any other income. As a result, the 1965 Social Security exemption of income up to $5 a month for public assistance recipients is not being implemented.” Utah (1,764), Ward C. Holbrook, Chairman, Department of Public Welfare: “Grants to Utah public welfare recipients are fixed by state law. Provisions of our law do not provide for cost of living increases. An increase of $2 a month was granted our old age recipients July 1, 1965, and we are planning to make another increase of $2 a month July 1, 1966. This is the only leeway we have to meet the problem of enabling Social Security beneficiaries to realize something from the 1965 increase in their benefits.” Mr. Carray. I felt that this was one of the most important things that we ran into out on the coast. Senator Kennepy. Is California one of those States? Mr. Careray. California is one of those States. I might indicate to you, Mr. Chairman. that there is presently a bill before the State legislature to alleviate this particular problem, but until the ballots are counted following next Tuesday’s primary, you know, nobody is going to do any work on legislation. However, I think that this is one of the instances where we find without any equivocation where State or local statutes or ordinances are serving only to defeat the purposes of Federal legislation and the intent of Congress, and I think that whatever influence the Ad- ministration has in eliminating this particular problem ought to be utilized. I am going to present all of this to you, Senator Kennedy. It gives you a breakdown of the half million doors that were knocked on in Los Angeles County, the 70,000 elderly who were contacted, the regis- tration in excess of 30,000, and the majority of this I can assure you was done by volunteers. When I received a call from Mr. Edelman requesting that I give him some information regarding the program on the west coast which could be used by his office and the National Council of Senior Citizens, I was more than happy to contact the friend that I have in the agency out there and request this. I will make all of this available for your record, Senator Kennedy, and thank you very much for the opportunity of making this ap- pearance. Senator Kennepy. I will look forward to reading through that. The point that you raised is extremely worthwhile and obviously such legislation runs completely at odds with the intent of Congress. Mr. Carsray. That is right. Senator Kennepy. I think that is a matter which we should not only consider, but it is something that we should really act on as well. Mr. CarBray. You will notice in the report of the community aides the reaction to this policy by the people involved. 66 NEEDS REVEALED BY OPERATION MEDICARE ALERT Senator Kennepy. I understand that Massachusetts is not one of those States. Mr. CarBray. Itisnotone of those. Neither is Florida. Mrs. Gruman. Florida is one. (Mr. Carbray’s prepared statement and report follow :) PREPARED STATEMENT OF MR. JAMES CARBRAY Mr. Chairman, my name is James Carbray and I live in Whittier, California. I am the West Coast coordinator for retired steelworkers activities—an official of the Steelworkers International Union. The retired steelworkers association clubs provided volunteer registrars for the Operation Medicare Alert program in Los Angeles County. Consequently I am able to talk about our experiences in this program, and I was in constant touch with the Economic and Youth Opportunity agency in Los Angeles which operated the program. A check of individuals and agencies who participated in the recent “Medicare Alert” program brought to light many facts heretofore unrecognized as related to the fears, anxieties and apprehension of thousands of our senior citizens throughout California which are generally applicable throughout other Western States. Specifically in California, we find that seniors who are recipients of State or County Aid and who, due to prevailing State laws or local ordinances were sub- jected to a reduction in their Aid check in the amount of the 7% increase in their Social Security benefits. The reaction to this policy by those seniors affected when contacted during the Medicare Alert program was one of fear and doubt. Many felt registration for Medicare would in some way jeopardize their present Aid status and in many cases, in spite of detailed explanation and assurances by the “Alert” representative, these people would refuse to register and in many instances refused to be interviewed. This is a glaring example of where pre- vailing State laws or local ordinances serve only to defeat the purpose of Federal social legislation and the intent of Congress. We found several complaints by those interviewed that Social Case Workers employed by Local Public Assistance Agencies actually discouraged recipients from registering for Medicare. We found that the older poor receiving public assistance are, due to totally in- adequate resources, forced to live in sub-standard housing located in “blighted” areas. Some of our “Alert” registrars found wholly inadequate facilities for the preparation of food such as open gas burner plates, no oven facilities and in many instances, no facilities for heating water. Some registrars were advised by neighbors of those they sought to interview, not to waste time by trying to make contact as no one would respond to a “Knock at the Door” as they feared any form of interview as a probable threat to their public assistance. Mr. Chairman, for the printed record of these hearings, I would like to submit the following documents : A copy of Operation Medicare Alert feedback in Los Angeles which, in capsule form, tells why elderly people want to work and what their greatest needs are. It also tells in a few words what the elderly thought about Medicare Alert. Comments of community aides—highlights of some of the experiences of those who worked on the program. Report of volunteers Robacker and Hinkson. OPERATION MEDICARE ALERT FEEDBACK Project objectives: 1. Register persons 65-4 years old throughout Los Angeles County for Medicare by 3/31/66. 2. Employ 300 part-time elderly poor as registrants. 3. Seek out needs of elderly. Base of operations : Operation Medicare Alert centers throughout Los Angeles County. Twenty centers opened between February 17 and March 3. Field activities : 1. Knocked on 500,000 doors. 2. Contacted 70,000 elderly people 65+ years old. NEEDS REVEALED BY OPERATION MEDICARE ALERT 67 3. Registered approximately 30,000 for Medicare. Greatest needs of elderly : . Medical care including hearing aids, dental and optical needs. . Financial and employment. Homemaker services. . Isolation. Housing. Language barrier. Lack of information regarding resources for the elderly. Why elderly people want to work : 1. Forced to because of need to supplement income. 2. For something to do, but want to be compensated. They want to feel they are useful and needed. 3. A need for something to do that is constructive other than recreation type of activity. What elderly thought about Operation Medicare Alert : . I feel useful. . It helped me financially. . I feel better mentally and physically. . I’m still employable. . Found others who were in greater need. NS UR WN QW COMMENTS OF COMMUNITY AIDES I visited a family of nine members last week. The house had only five rooms. Sanitary conditions were very poor, clothing very dirty and worn, and the children seem to have been undernourished. I learned later the father has been out of work for two years, and doesn’t get enough help from the social agencies to live a more normal life—Exposition Area Most of the aged are lonely and want to talk to someone. I found one lady alone in her apartment crying. She said that she had no close friends in Cali- fornia. Language barrier is the number one cause of loneliness since it impedes communication with others. Many are blind, sick, living in one room with no one to help them.—Culver City Area. I found a lady with cataracts in both eyes. She could only see light and dark. This lady needed surgery.—Hollywood Area I found a man, age 88, with a sign on his door which read as follows: Knock and walk in I cannot hear. I found this man to have an urgent need for hearing aids.—Hollywood Area There was a woman, age 87, living with her sick and helpless sister. They were not getting proper food due to the fact they could not go out to the store. They depended wholly on their neighbors which is a hit and miss arrangement. The worst needs I found were loneliness, medical and surgical needs and poor living conditions.—Hollywood Area In Redondo Beach I found an elderly woman occupying a single room in a rather swank beach-front house. They told me that she was paying $185 a month in rent, including board. She appeared very unhappy and was suffering from arthritis in her hands and legs. Although she had both television and radio in her room, her landlady was very reluctant in letting her have an electric heater in her room. There was no one to take her to see a physician.—Culver City Area A couple, Mexican-American, was living in a very old dilapidated house. They spoke no English and were not able to sign their names on the Medicare application. The house was very sparsely furnished, but they appeared to be quite satisfied with conditions as they were.—Culver City Area This man lives in zone 16. Ever since I met him he stays on my mind. He lives with his daughter. When she opened the door, I found an old man with- out legs, without artificial limbs, sitting in a wheel chair in a small dark hall. His head was bent down, his eyes closed, and saliva running out of his mouth. When I explained that I needed a signature from him for Medicare, she rolled him to, the kitchen table. She was harsh and impatient with the man. After the man made his mark, the daughter explained how hard it is for her to take care of the senile man. She did it because “after all he brought me up.” But she is bitter about it and the old man knows it. I wonder if this man had 68 NEEDS REVEALED BY OPERATION MEDICARE ALERT artificial legs and proper care, whether he could not come back to an almost normal life.—Exposition Park Area This is a family of Mexican origin. A boy nine years old opened the door. With him were three pre-school children. The mother had gone to General Hospital for the day. The nine year old had missed school to take care of the three younger children. Resumé of most urgent needs : (1) Medical help, especially money for drugs (2) Education of persons who have to take care of mentally or physic- ally ill relatives (3) Baby-sitting service when mothers have to visit hospitals and children are unattended or places where children could be taken for free care for that day—Exposition Park Area I visited a real old lady who lives with her daughter and son-in-law. She told me that her daughter and son-in-law just don’t care about her. When she told me her story, she was in tears. She begged me to find out if there was any way of getting someone to help her with her needs; such as helping her to take a bath or going to the store and helping her to do her cooking. This lady is really sick. lendale Area I met a lady who was so sick that she couldn’t talk. She didn’t have anybody to take care of her.—Glendale Area I went to a home where a lady couldn’t hear very well. She told me that she was very sick and all alone in the daytime. Her husband worked during the day. She also told me that she doesn’t understand anything about this Medi- care, and she wanted me to come back at night when her husband is home. I believe this person needs legal aid and Medicare.—Glendale Area A lot of people need glasses and dental work. Some do not know where to get help. I called on a woman yesterday who was 83 years old. She was get- ting widow pension from the Veterans Association. She had a daughter who is forty years old. The mother said her daughter is an imbecile, and she was getting money from the Veterans Association for her upkeep. But all of this was not enough. She was applying to the County for help. She had the papers but no one to fill them out. I filled them out for her which took about three-fourths of an hour. Then I signed her up for Medicare and she thanked me for doing this.—Hollywood Area A feeble old lady lives alone in a very old house that was condemned. She received eviction notice and had no place to go. She was so nervous she was unable to fill out her Medicare card or look for another place to live.—Watts Area Mr. C. is nearly blind, hard of hearing, has had a stroke, can hardly walk, lives alone and has difficulty in shopping and paying bills.—Watts Area One old lady lives with relatives and cares for her invalid grandchild. She is in need of food, clothing, and money for rent.—Watts Area Mr. and Mrs. are old. Their house is in bad condition and needs cleaning. Neither is able to manage the home and they need transportation and help.— Watts Area In the majority of cases I find most of them are very lonely. Daily company would give them a big lift. Daily contact, in person or phone or some other means, would alleviate a large percentage of this condition. Outside of tele- vision and radio, which helps considerably, a local COmTIIRLY service could probably be established.—Culver City Area In my recent contacts I have come across the husband past 65 but still work- ing. The wife will be 65 later this year. / She is totally blind and needs help in cleaning the apartment. — Exposition Park Area On a call I found that the man was unable to work because of heart condi- tion. He said that the case worker said he lives in too good an apartment so his welfare was reduced by $15 to $18 a month. He checked the welfare and Social Security and found that he was already covered by Medicare, but it was necessary for him to sign for it.—Exposition Park Area Most of the people have complaints about glasses and dental care. They are not so interested in Medicare, because they cannot afford to pay $3 a month for it. Many have very little furniture in their homes.—Culver City Area I met two bedridden men. One lives in one room which is in need of repairs and better sanitary conditions. He refused help. The other lives in better quarters. He said he has private hospitalization, but he would consider Medi- care.—Exposition Park Area I met a wealthy man who blessed the Government for its effort to care for the poor and helpless.—Exposition Park Area NEEDS REVEALED BY OPERATION MEDICARE ALERT 69 I found grandparents supporting their three grandchildren who said they could use more financial aid. They are not receiving enough from the State.— Exposition Park Area Some homes that I visited could stand repairs; others have beautiful homes. Most prevalent needs are medical, better housing and financial.—Exposition Park Area While working on spot calls the last few days of the first program, a call made in Lawndale discovered a woman living in a home with her son. She was in a wheel chair and, apparently, for this reason, there were no rugs on the floor. She was obviously being neglected in personal care. Her body was covered with sores. She needed someone to clean up the dirty dishes, feed her and help her to keep clean. She was shut in with her windows overlooking fences and broken down cars, to say nothing about the garbage cans in the other yards. She had lived there several years, yet did not know the people who live two doors down by name.—Culver City Area The most common and interesting need of the elderly of the foreign speaking families was their need for outside of the home activities. One in particular was Japanese and had no recreational outlets because she could not speak English. She wanted to know if there was a Senior Citizens Center where some of the persons spoke her language.—Culver City Area A woman eighty years old lives with her grandchildren who work everyday leaving her alone to care for herself. She attempts to care for herself but in so doing she caught a dishtowel on fire and sustained a bad burn, and she ruined the carpet after turning the faucet on letting the water overflow. The grandchildren can find no one to care for her for the small sum they can afford to pay.—Central Area An elderly couple both are partially disabled. The wife is very heavy and can hardly get around due to trouble with her feet. The husband is very weak from several operations. They need someone to shop for them and help with the housework.—Central Area Both are very depressed feeling life is no longer worth living. One man living alone in the most unsanitary conditions, spends most of his time in bed. He doesn’t have arequate personal or bed clothing. He has a dog and cat who lives in the one room with him. He is not physically able to clean the place and once in a while a neighbor fixes him something to eat.—Central Area The most urgent needs seem to be help in the home, personal counseling, companionship and reassurance to feel it’s worthwhile living.—Central Area Mrs. R. went to the mail box to mail a letter before going on a Senior Citizen Bus Trip and fell breaking her hip. She was rushed to the hospital leaving a blind sister at home. Now they say both sisters will have to go to a rest home. The blind sister is able to cook and do everything around the house. They feel if they can contact someone or some agency to help them out during the day, they will be able to stay in their apartment. Although the sister that is hurt will probably be in a wheel chair for many months, they figure they will be able to manage.—Exposi- tion Park Area I visited a man 72 who lives in a house made of boards and stones. Inside the house were a bed on boxes, a broken table, broken chairs, repaired lamp with a broken cord. He asked me if I could go over to the store to buy something for him. I did. When I came back, he asked me how much I spent. I told him 52 cents. Actually I spent about $1.75. I knew he had no money because he counted out every penny he had. It was about 80 cents. He was waiting for his Social Security check. I figured he needed the food more than I needed the few cents I spent.—Glendale Area The claims that I have processed during the past three weeks have mostly been patients in a nursing home or Convalescent hospital who are well taken care of by Old-Age Security, private funds or relatives.—Culver City Area Prior to March 31, 1966 while working out of the senior citizens office in Tor- rence, I encountered homes that were in bad need of repair, elderly men and women living alone who could use help with keeping their homes clean, and with the preparation of a well-balanced meal. One case, in particular, an elderly lady had a mentally retarded son. She was quite deaf, her hands and feet were crippled, and she was getting around in a broken-down wheel chair. The house was filthy and run down. Their clothing was both worn and soiled.—Culver City Area Extreme poverty is most prevalent in one area. The meager income is from either Social Security or the State. The housing is dilapidated. The filthy tena- 70 NEEDS REVEALED BY OPERATION MEDICARE ALERT ment dwellings are in need of many repairs. Many should be condemned as a residence. People residing there, in many cases, are disillusioned and bitter about their existence and critical of any assistance at present. In better areas, people on Social Security, who own their homes, bitterly complained about high taxation and their inability to meet these conditions. Sickness is prevalent in many cases and there are many complaints about the high cost of medication. Some residential hotels for these people are in very bad condition, and are in need of inspection.—Watts Area A 95 year old man living alone needs clothes, food, and dentures. He seems healthy. The neighbors feed him. His house needs painting and plumbing work.—Watts Area A lady in her seventies had a stroke. She needs someone to help with her housework and shopping.—Watts Area Two sisters both quite aged live alone. The day I visited them one was ill and could hardly move about. The other had fallen down that morning and hurt her back. They need someone to care for them.— Watts Area This 76 year old lady was almost blind and almost deaf. She had very little assistance and should use a wheel chair.—Exposition Park Area One gentleman, 71 years old, appeared very nervous and was living in a small house which had few conveniences. On other calls, I have noticed few utilities and poor housekeeping.—Exposition Park Area A diabetic victim with both legs amputated living alone certainly needs help with house cleaning and buying food.—Culver City Area A woman living on public assistance needs better and more reasonable rent. She pays $76 monthly in a hotel room. I would suggest Mar Vista Gardens for this particular lady where housing is nicer and cheaper.—Culver City Area A woman receiving public assistance is an alcoholic, and she has dropsy.— Culver City Area I recall one subject who was greatly provoked. An increase of $4 monthly in Social Security benefit resulted in reduction of pension from another source of $25 monthly.—Exposition Park Area An oriental subject was not available when I called on him. His neighbor told me he was in an insane institution, although he did not know where. Intelligent communication with the neighbor was extremely difficult.—Exposition Park Area It appears that about one-half of the people receiving Social Security are still working.—Exposition Park Area I met an elderly man living alone with his retarded son. He applied for Medi- care, and asked if there was any way his son could obtain help.—Glendale Area There is an elderly foreign woman, living alone and in very poor health. She said she was very lonely because her son and neighbors paid no attention to her.— Glendale Area At one house, a mother living with a daughter had no glasses. She used her daughter's glasses to make the cross necessary for the application signature. Her daughter signed her own name and I witnessed her signature. When I turned and asked the mother if she had glasses, she told me “No.” (the daughter interpreting). Her eyes were tearing from the use of the daugh- ter’s glasses, and I noticed they were red and blurry. The daughter said, “How can she be fitted for glasses when she cannot read the chart one is asked to read?” I am sure there is a way to fit foreign people although they cannot read the chart.—Hollywood Area The most crying need that I found was for help in cleaning up the dark, dirty, unaired homes of people who live alone. Yards are uncut, trash piled high, screens torn or broken. The whole place is in a state of dilapidation. These people are not well enough to do for themselves and either have no one to help or their families are neglecting them. I do not know if they are properly fed or clothed or are in need of medical attention, but I would assume as much.—Culver City Area I found one lady, crippled with arthritis, not on Social Security or Old-Age Security, who was cutting her own lawn when she could hardly walk on her stiff limbs. She hires someone to take her to the doctor once a month and bring her groceries. She was mentally alert and took pride in her place, but she could surely use a little help.—Culver City Area A World War I veteran and retired postal worker wanted to get into veterans housing to live. His nerves are shattered and he lives with his daughter, her husband and three small children under eight years of age. The noise, dirt and condition of the home was deplorable.—Glendale Area NEEDS REVEALED BY OPERATION MEDICARE ALERT 71 A lady of 74 years wants someone to live with her. She will give room and board free for help; such as shopping, cooking meals, cleaning and general com- panionship from the party. She has arthritis, but is not helpless.—Glendale Area I met an old man staying in a rest home. The owner or caretaker threatened to put him out if he signed for Medicare.—Watts Area One woman lives in a house behind store buildings who uses a wood stove which is very dangerous.— Watts Area I visited small and large homes for senior citizens. The larger of these homes consisted of sixty-eight patients with two persons per room. Some were senile, some couldn’t write to sign their names, seventy-five percent of them were depressed and confused and all complained about the food. In a smaller home, there were about eight elderly women. The facilities were good and the food was good. One woman in her late eighties started crying when asked to sign a Medicare form due to being confused. I estimate that twenty-five percent of those called on seemed to think Medicare would not work due to the large flood of people to see doctors July 1. They said they have trouble now getting medical care, particularly in getting doctors to call at their homes.—Culver City Area I found this place in a terrible condition. From the outside one would think no one lived there. The windows were broken and fixed with boards. The weeds were knee high. This man needs surgical appliances as he is unable to go to the rest room.—Watts Area Some of the people I contacted need medical aid, teeth, glasses, companion- ship and help, such as helping them to dress and bathe. One lady was sixty- nine years of age. She is a registered nurse who works nights. She takes care of her paralyzed sister. She said she had been swindled out of a lot of money left by her parents. Eventually she intends to retire from work, but would like some help to care for her sister. She signed for Medicare.—Exposi- tion Park Area I have been working in Bel Air, West Los Angeles and Pacific Palisades. I found most of the people I called on did not wish to sign up for Medicare.— Culver City Area Most of the people I called on were in the wealthy class. A brother and two sisters all over eighty years of age were living together. Neither had ever been married.—Culver City Area I called on a person that had broken both hips and was in the hospital for five months. She now lives with her sister. She is also blind but she gets around in a wheel chair. She signed up for Medicare. She is ninety-two years old.—Glendale Area REPORT OF “MEDICARE ALERT” (Volunteers: Carl Robacker and Richard Hinkson, of Senior Steelworkers Association) Beginning on March 10, 1966, and continuing thru March 29, 1966 we contacted those individuals indicated on the list provided us by Mr. Lorine Reader of Bell Gardens-Social Security office. The area of operation was the cities of Maywood, Bell, Cudahy, Bell Gardens and Huntington Park and involved in excess of 300 miles of driving. A majority of those contacted were very cooperative and responded accord- ingly when the program was explained to them. However, we found considerable apprehension on the part of many Senior Citizens who are recipients of County and State Aid, some of whom refused to register due to fear that it would in some way endanger their County and State Aid and the fact that many had been subjected to the deduction of their 79 Social Security increase from their checks. We found an obvious sense of fear among many due to this practice even to the extent that some would refuse to come to the door. We found considerable confusion among many due to lack of information as to the merits of the program. CARL ROBACKER. RIicHARD HINKSON. Date April 1, 1966. 72 NEEDS REVEALED BY OPERATION MEDICARE ALERT STATEMENT OF EDWARD L. ROBINSON, OF WYANDOTTE, MICH, VICE PRESIDENT OF THE DETROIT METROPOLITAN COUNCIL OF SENIOR CITIZENS Mr. Rosinson. Mr. Chairman, my name is Ed Robinson, Vice Presi- dent of the Detroit Metropolitan Council of Senior Citizens and I was a team captain in Operation Medicare Alert in Wyandotte. Senator Ken~epy. Didn’t I have a chance to meet you when I was out at the hearing which we had in Saginaw not long ago? Mr. RoBinson. Yes, I was there. Senator Kennepy. That is right. I recognized you.! Mr. Ropinson. You remember that little old man who said that So- cial Security checks were the biggest payroll around Saginaw, Mich., for there were so many of us but the checks were too small ? Senator Kennepy. That’s right. Mr. Rosinson. This little 4 foot 6 inch man said if we didn’t do some- thing we were all going to move out and Saginaw would lose its biggest business. enator Kexxepy. Iam delighted to welcome you back. Mr. Rosinson. I would like, Mr. Chairman, to tell of the need for decent housing for thousands of low income senior citizens living in the Detroit area. Vast areas in Detroit have been cleared under the urban renewal program. However, no low-cost housing projects have been erected on the cleared land. Instead, a number of high rise apartment build- ing occupy this land. Rents in these buildings start at $125 and go to $250 a month or higher, far too high for people who once lived in the cleared areas. Even the nonprofit Four Freedoms high rise apart- ment, sponsored by the United Auto Workers, charges from $85 to $135 a month rent. After building four freeways through Detroit, they have now started condemning property for a fifth, the Jefferson freeway, which will run right through the northwest section, an area largely populated by senior citizens. We finally got the Detroit City Council to consider building two or three senior citizens’ low-cost housing projects in this area so retirees could continue to live where they had put down roots. Opposition, based largely, in my opinion, on racial prejudice because of the possibility of some nonwhite families living in these buildings, has appeared, but we are still hopeful. When I left Detroit coming out here, I heard that the Detroit City Council had decided not to put any project in this area. We had a terrific fight there last week. When I got up facing 400 of them, I said, “I know that down deep in your heart the reason you are down here is because you are afraid some senior citizens of wrong color will get this.” I said, “I have lived out there in that northwest section for 43 years, and I have been approached by these clubs, and they asked me to con- tribute $5 a year and they would keep the colored people out.” Now 1 Pp. 313-315, pt. 4, “Services for Senior Citizens,” hearings of Subcommittee on Federal, Tats, 3d Sopmunity Services, Senate Special Committee on Aging, 88th Cong., 2d sess. ar. 2, . NEEDS REVEALED BY OPERATION MEDICARE ALERT 73 I advised these clubs they should change the purpose of their clubs to read, “to keep the colored out and also the poor senior citizens.” Mr. Chairman, large numbers of senior citizens are losing their homes due to urban renewal and most of them cannot afford to buy new homes at today’s prices or pay the rents charged in the new high rise apartments. Workers in the Medicare Alert program in the Wyan- dotte area talked to many senior citizens in this situation. I can cite as an example the case of Anna Cada and Margaret De Coster, widows living together in a tiny house at 1231 Cedar Street, Wyandotte. Here is a letter I received from them recently. With your permission, Mr. Chairman, I would like to quote from the letter. It is written in their own handwriting, as you can see : DEAR SIR: Am writing to ask if you can tell me when the senior citizens will be able to get some help with their rents. : I am living in a little house that is very close to the ground and is very damp and is much worse when it rains. There is no hot water or bath tub, so we have to do the best we can without hot water or tub. The people we rent from are on Social Security, too, and cannot fix the house as it will cost too much money, something they haven't got, so when we move they are going to tear it down. The Government acts very much like they don't want to help people that need it in this country, but let some other country ask for help and they go all out to help. And look at the money they are throwing away trying to get to the moon. For what? The man in the moon or the people from other countries didn’t put these men in office. It was the senior citizens and their familys. I think charity should start at home, and that we should get a little help here. Thank you for any help you can get for us. ANNA CADA, MARGARET DE COSTER. I would like to put in that copy and send the original to President Johnson. Iam sure he would be glad to get that. These two ladies, Mr. Chairman, would have moved into a cooper- ative apartment house for senior citizens recently erected in Wyan- dotte, but the lowest rent there for a studio apartment is $75 a month. Many other seniors living on small incomes would also like to move to this apartment, but they simply can’t afford the rent. It is difficult, Mr. Chairman, to find a suitable place to put low-cost housing. I mentioned opposition to development of low-cost housing for senior citizens displaced by the Jefferson Freeway. Just the other day, Supervisor Papp of Taylor Township, in the Detroit area, said he tried to get low-cost housing for seniors, but ran into violent opposition wherever a site was proposed. Garden City, in the Detroit area, has had the problem. We seniors still have hope, however, for we have a friend who comes from Texas. I was born and raised in Texas. I know that west of the Pecos River is a vast area inhabited mostly by rattlesnakes and jack- rabbits. I am sure we could get permission to build low-cost housin for senior citizens west of the Pecos, but many of us seniors are har of hearing and it would, in my opinion, be necessary for Congress to appropriate enough to round up those west Texas rattlesnakes and put on bigger and louder rattlers so we seniors could hear them before they strike. Seriously, Mr. Chairman, since it is difficult to find a suitable place to put low-cost. housing, I think rent supplements are most important. I know of a number of churches, cooperatives, and labor unions that 74 NEEDS REVEALED BY OPERATION MEDICARE ALERT might be willing to sponsor construction of small housing units for seniors in neighborhoods where the needy low-income seniors live. I have spoken of the Wyandotte cooperative apartment house which the two ladies now living in substandard housing, might move to if they could pay more rent. This is an 11-story building containing 160 apartments. It was opened a few weeks ago. Senator Phil Hart officiated at its dedication. He gave a fine dedication speech in which he expressed the hope that many more apartments like it could be built in the De- troit area for the benefit of our senior citizens. When the Rent Supplement Act was passed, the manager of the Wyandotte cooperative apartment house told Wyandotte senior citi- zens the legislation might make it possible for them to rent apartments there. When Congress failed to appropriate sufficient funds for the rent subsidy program, he had the 5 duty of telling the seniors the deal was off. Many seniors were bitterly disappointed. Twenty apartments in this building are still unrented. Mr. Chairman, I hope the chances for a continuing rent subsidy program are now improving. I see that the House of Representatives has passed the rent subsidy appropriation bill for the coming year and that is now before the Senate. I hope the Senate will do its part and pass this urgently needed appropriation. Thank you, Mr. Chairman. (Mr. Robinson’s prepared statement follows:) PREPARED STATEMENT OF MR. EDWARD L. ROBINSON, OF WYANDOTTE, MICH. Mr. Chairman, my name is Edward L. Robinson. I am Vice-president of the Detroit Metropolitan Council of Senior Citizens and was a team captain in Operation Medicare Alert. Until forced to retire because of illness, I was a salesman. During a routine medical examination, my doctor found I was suf- fering from duodenal cancer. The operation he recommended saved my life. I would like, Mr. Chairman, to tell of the need for decent housing for thou- sands of low income senior citizens living in the Detroit area. Vast areas in Detroit have been cleared under the urban renewal program. However, no low cost housing projects have been erected on the cleared land. Instead, a number of high rise apartment buildings occupy this land. Rents in these buildings start at $125 and go to $250 a month or higher, far too high for people who once lived in the cleared areas. Even the non-profit Four Freedoms high rise, sponsored by the United Auto Workers charges from $85 to $135 a month rent. After building four freeways through Detroit, they have now started con- demning property for a fifth, the Jefferson freeway, which will run right through an area largely populated by senior citizens. We finally got the Detroit City Council to consider building two or three senior citizens’ low cost housing projects in this area so retirees could con- tinue to live where they had put down roots. Opposition, based largely, in my opinion, on racial prejudice because of the possibility of some non-white families living in these buildings, has appeared, but we are still hopeful. . Mr. Chairman, large numbers of our senior citizens are losing their homes due to urban renewal and most of them cannot afford to buy new homes at today’s prices or pay the rents charged in the new high rise apartments. Workers in the Medicare Alert program in the Wyandotte area talked to many senior citizens in this situation. I can cite as an exmaple the case of Anna Cada and Margaret De Coster, wid- ows living together in a tiny house at 1231 Cedar Street, Wyandotte. Here is a letter I received from them recently. With your permission, Mr. Chairman, I would like to quote from it. They wrote: NEEDS REVEALED BY OPERATION MEDICARE ALERT 75 “We live in a house that is very close to the ground and very damp, especially when it rains. There is no hot water or bathtub. The people we rent from are on Social Security like us and just haven't the money to fix our house, which is badly in need of repair. The owners say, when we move, they will tear the house down. “We think it is time our Government helped its senior citizens find proper places to live. When some foreign country asks for help, this country comes to their aid and, while we don’t object to helping foreign people in need, the men in Washington ought to remember they weren't elected by foreigners. U.S. voters, our senior citizens, elected them.” Mr. Chairman, I asked these ladies what rent they could afford. They told me that together they pay $25 a month and could not afford to pay a great deal more. These two ladies could, Mr. Chairman, move into a cooperative senior citizens apartment house recently erected in Wyandotte, but the lowest rent there, for a studio apartment, is $75 a month. Many other seniors living on small incomes would also like to move into this apartment house, but simply can’t afford to. It is difficult, Mr. Chairman, to find a suitable place to put low cost housing. I mentioned opposition to development of low cost housing for senior citizens displaced by the Jefferson freeway. Just the other day, Supervisor Papp of Taylor Township, in the Detroit area, said he tried to get low cost housing for seniors, but ran into violent opposition wherever a site was proposed. Garden City, in the Detroit area, has had the problem. We seniors still have hope, however, for we have a friend who comes from Texas. I was born and raised in Texas. I know that west of the Pecos River is a vast area inhabited mostly by rattlesnakes and jackrabbits. I am sure we could get permission to build low cost housing for senior citizens west of the Pecos, but many of us seniors are hard of hearing and it would, in my opinion, be necessary for Congress to appropriate enough to round up those West Texas rattlesnakes and put on bigger and louder rattlers so we seniors could hear them before they strike. Seriously, Mr. Chairman, since it is difficult to find a suitable place to put low cost housing, I think rent supplements are most important. I know of a number of churches, cooperatives and labor unions that might be willing to sponsor construction of small housing units for seniors in neighborhoods where the needy low income seniors live. I have spoken of the Wyandotte cooperative apartment house which the two ladies now living in sub-standard housing might move to if they could pay more rent. This is an 11-story building containing 160 apartments. It was opened a few weeks ago. Senator Phil Hart officiated at its dedication. He gave a fine dedication speech in which he expressed the hope that many more apartments like it could be built in the Detroit area for the benefit of our senior citizens. When the rent supplement act was passed, the manager of the Wyandotte cooperative apartment house told Wyandotte senior citizens the legislation might make it possible for them to rent apartments there. When Congress failed to appropriate sufficient funds for the rent subsidy program, he had the painful duty of telling the seniors the deal was off. Many seniors were bitterly disappointed. Twenty apartments in this build- ing are still unrented. Mr. Chairman, I hope the chances for a continuing rent subsidy program are now improving. I see that the House of Representatives has passed the rent subsidy appropriation bill for the coming year and that is now before the Senate. I hope the Senate will do its part and pass this urgently needed appropriation Thank you, Mr. Chairman. Senator Kennepy. I want to thank you, Mr. Robinson. The matters which you related about seniors being disclocated by urban renewal programs, highway programs, and other programs, is a matter of deep concern to me. We have in Massachusetts the west end project which was one of the earlier projects under urban renewal. It dislocated countless numbers of families. The statistics were ex- tremely compelling and indicated that when citizens are dislocated by urban renewal or a highway program, the amount of money which 76 NEEDS REVEALED BY OPERATION MEDICARE ALERT is necessary for rent increases by an extraordinary amount. We were able to document this quite dramatically in recent programs. As you point out, a number of those people who are displaced are seniors who are living on a rather fixed budget and such displacement does work to their disadvantage. This past week I introduced amendments for the Public Works Committee to consider concerning the setting up of a relocation agency to make adjustments both with regard to individuals and businesses which are displaced. The amendments are designed to help and assist individuals and businesses which are displaced by these kinds of programs. I share your concern with regard to the practical experiences of relocation. I want to thank you. I am going to have to ask if both you gentle- men would be kind enough to submit your statements for the record. If you would do that I certainly would appreciate it. STATEMENT OF T. H. LYNCH, DUQUESNE, PA. Mr. Ly~ncu. Mr. Chairman, my name is T. H. Lynch, 77 years of age. I am an ex-railroad worker, retired railroad worker. I was on the Medicare Alert program as a volunteer in Allegheny County, Pa. I submit this statement to you. (Mr. Liynch’s prepared statement follows) PREPARED STATEMENT OF MR. T. H. LYNCH, DUQUESNE, PA. Mr. Chairman, my name is T. H. Lynch. I am 77, my address is 46 North Street, Duquesne, Pa. I have been a miner and a roustabout. I have worked on railroads in the northwest. I am a retired railway worker and a member of the United Steel Workers Union. I was a volunteer in the Medicare Alert program in Allegheny County, Pa. Our experience showed that the program received cooperation as well as distrust. Early in the Medicare Alert program there was some confusion; people just didn’t understand the benefits that they would receive from Medicare. But I think I could say that 909% of the aged cooperated. The elderly could see a future which would relieve many of their worries and it was obvious that they had been living in bad conditions for a long time. In the heart of one of the towns I visited a building in which two old people, a man and a woman, lived in separate apartments. There was a store on the ground floor. There was an office above it, and down the hall, which was dimly lit, these people lived. There were no fire escapes and this was a brick structure. This building is just a fire trap and the old people would just be cremated. When that door leading to the office above the store is locked at night, that’s it. The old man who lives alone, uses crutches and I watched him and it took him five minutes to get outside to the street. This is how some elderly poor live. 1 visited a two-story shack which was heated by a gas space heater on the first floor. There were no vents and the fumes were so overpowering that I had to leave because I felt that I would be overcome. On another street there was an old lady living alone, I imagine she was in her 80's. I learned that twice, when she was sick she had made her way out into the street and asked people to help her because she needed a doctor. When I suggested that maybe a visiting nurse could help, she said she didn’t want any nurse visiting her and yet I could see she needed help. The visiting nurse had never been there. She had stacks of papers from Social Security. I looked over them and found among these papers her Medicare card. She had not realized that she had signed for it and was covered. At another home, where a man and wife lived, the place was so dilapidated that termites had eaten out the doors. After the Medicare Alert program ended, I went back to see if I could help repair that home. I put my ladder down and climbed up and could see that the porch was not safe either on top or beneath. It was an eyesore to the community, but officials had done nothing about it. NEEDS REVEALED BY OPERATION MEDICARE ALERT 77 In McKees’' Rocks, one of our Aides visited a lonely old lady who was con- vinced that the water was really gasoline, and she would not drink it. The Aide took a hearty drink of the water and this poor old lady was so relieved when she found out that she could drink the water. Senator Kennepy. Thank you very, very much. STATEMENT OF ARTHUR CAPONE, REVERE, MASS. Mr. Capone. And I have nothing to add, Senator Kennedy. I think what I would have said has been well covered. There is only one part, however, that I think I ought to mention. We have a segment of the elderly in Revere who are satisfied with their lot. I was on the Medicare Alert program, as you probably know. They were quite satisfied with their lot. Everybody has painted a depress- ing picture, but we did find some who were satisfied and were quite content. Senator Kennepy. They were living, I imagine, a rather balanced life. Mr. Capone. That is right. Usually those are ones who live with their children, by the way, not the isolated ones. We had the isolated ones, of course, who had exactly the same problems as were reported here, loneliness, lack of companionship, and one thing I want to say is our workers, especially volunteer workers that we have had, would like to get additional work. They really appreciate that kind of work and would if the budget permitted earn a little extra money. I was a little confused at the termination of Mr. Shriver’s evidence and your questioning of certain parts of his testimony regarding the place of the Social Security program and the OEO program. My personal view of the work of both these agencies does not appear to create any kind of conflict. Actually, I feel the two programs comple- ment one another. Social Security, to my mind, is a means of supplying an adequate or minimum financial aid to the retired and the aged, whereas OEO is concerned with the social and psychological up-grading of the retired and the aged. Our concept of OEO at “CAPRI,” Community Action Programs of Revere, Inc., is to help people help themselves, to reacti- vate them into the normal stream of life and make life more meaning- ful to themselves and the community. As the result of the Medicare Alert program, we were deeply im- pressed at the desire of our aides and volunteers who worked with us to become involved in the problems of the needy and the aged. (Mr. Capone’s prepared statement follows :) PREPARED STATEMENT OF MR. ARTHUR CAPONE (AGE 68), 161 PROSPECT AVENUE, REVERE, MASSACHUSETTS (RETIRED PROBATION OFFICER AND FORMER TEACHER) Mr. Chairman, during the Operation Medicare Alert program I served as Project Director in Revere, Mass. I still serve as Assistant Director in the Community Action Program in Revere. I don’t have to tell you, Senator Kennedy, that Revere is far down the economic ladder. The results of our house-to-house canvasses revealed loneliness, poverty and dejection among the elderly, who lived alone. Those who were able to live with their children were, of course, much more contented with their lot. I can honestly tell you, Senator, that while we are not unfamiliar with the problems of the elderly, we didn’t really understand the depths of loneliness— and the widespread need for companionship which exists among older people— until our work on “Operation Medicare Alert”. 66-547 0—66——6 78 NEEDS REVEALED BY OPERATION MEDICARE ALERT We found—just as we understand others found in different parts of the coun- try—that many older people were afraid to open their doors. They are so disengaged from society they rarely leave their homes. They live in pitiful isolation and are not even aware of the community services which are available and could be helpful to them. When our workers did get inside to speak with them—and they seemed to appreciate the fact that their visitors were older people like themselves—they showed themselves as being literally starving for companionship. Our workers knew they were helping these old people just by talking to them. These people could in many cases—with the proper programs—be encouraged to rejoin the fellowship of community life. We found elderly living in lonely rooms almost adjoining each other—yet they had little or no contact. Revere Community Action Program is now seeking funds to initiate a program of outreach so that we can bring a little happiness to these sad, lonely people. Fortunately, in our community we have no shortage of active elderly who are willing to work to help those less fortunate older people. But we need money to operate these programs. Many of the active elderly are also poor and they are eager to earn the $1.50 per hour even if it is only for three or four hours a day. We hope, Senator Kennedy, that you can help us in urging the Federal Government to provide adequate financing for useful pro- grams on behalf of the Senior Citizens. Many of them, as you well know, need increased Social Security and increased public assistance. But many others need only involvement in society—and we must help these Senator Kennepy. I want to thank all of you. You have been here now for some 3 hours. You have been most kind and generous and I appreciate your giving us the benefit of your understanding in all of these areas. It has been extremely helpful and interesting and the session this morning has certainly been worthwhile. I want to commend all of you for your interest and your help in developing a good deal of this information. T find these panels ex- tremely informative and helpful in relating what the true situation is and the needs, desires, and hopes of the people who are being affected. I want to thank each and every one of you and express my apprecia- tion for all the members of the committee. There being no further business, the subcommittee stands in ad- journment subject to the call of the Chair. (Whereupon, at 1:20 p.m., the subcommittee adjourned, to recon- vene subject to call of the Chair.) APPENDIX RECOUNTING THE PooR—A FIVE-YEAR REVIEW * By Mollie Orshansky * Reprinted from the Social Security Bulletin, April 1966, U.S. Department of Health, Education, and Welfare, Social Security Administration In 1965 the Social Security Administration developed two criteria of poverty to assay the relative economic position of different types of households in the United States. The derivation of these criteria and the characteristics of the population they defined as poor in terms of 1963 income have been reported in the Social Security Bulletin? The present article reviews the trend from 1959 to 1964 in the num- bers identified by these criteria and offers some detail about the pov- erty roster for 1964. Because the lower of these criteria is being used as the current working definition of poverty, the somewhat less stringent measure has now been designated as the “near poor” level. Persons rated poor or near poor by these measures can be said to be in the “low-income” category. The level of living represented by the low-income threshold is still substantially below the ‘modest but adequate” level described by the city worker's family budget developed and priced by the Bureau of Labor Statistics. Further data and discussion of the characteristics of the poor and the near poor will appear in subsequent issues of the Bulletin. By 1964, an extended period of continued economic expansion had brought the income of American households to new highs. Families now had a median money income of $125 a week compared with $104 in 1959. Even after allowing for rise in prices, the Nation's families, though on the average no larger, had about $8 to spend in 1964 for every $7 available to them 5 years before. In- dividuals living alone rather than as part of a family unit did as a group even better. Their median income in 1964 was about $38 a week, about one-sixth higher than it was in 1959 after discounting for higher prices. But the general satisfaction at this impressive record was tempered by reali- zation that there were still many among us living far below acceptable standards. If one could point with pride, there was yet much to view with alarm. Poverty that never was a random affliction by 1964 had become even more selective, and some originally highly vulnerable were now even more so. The ranks of the poor were crowded with those who through age, disability, or other handicaps could not find or hold a job. But many households were counted poor even when the worker at the head had not been unemployed. THE OVERTONES OF POVERTY Of the 60 million households in March 1965—counting as a separate unit every family group and every person living alone or with nonrelatives only—12 million or 1 out of every 5 had incomes in 1964 so low as to be considered poor by the Social Security Administration’s basic poverty index. An additional 4% million units above this poverty line nevertheless had incomes low enough to be border- 1 Submitted by Dr. Harold L. Sheppard, See p. 39. 20ffice of Research and Statistics. The data were compiled with the assistance of Marcella Swenson. 3 Mollie Orshansky, “Counting the Poor: Another Look at the Poverty Profile,” Social Security Bulletin, January 19 and “Who’s Who Among the Poor: A Demographic View of Poverty,” Social Security Bulletin, July 1965. 79 80 NEEDS REVEALED BY OPERATION MEDICARE ALERT ing on dire poverty if not already in it. There were thus in the midst of plenty a minimum of 34 million Americans and possibly as many as 50 million who lived with privation as their daily portion. Included in this group were from 21 per- cent to 31 percent of the Nation's children and from 31 percent to 43 percent of our aged. These measures of poverty and low income are based on the amounts needed by families of different size and composition to purchase nutritionally adequate diets at minimum cost when no more than a third of the family income is used for food. The lower of the two measures, now generally adopted as the poverty level, is based on the restricted variety of foods suggested in the Department of Agriculture economy food plan for emergency use or when funds are very low. The near-poor level averages about one-third higher in dollar cost. The low-cost food plan from which it is derived has long been used by public and private welfare agencies as a benchmark in developing standards of need. As a concept, the overall term “low income” may be even less precise than the designation “poor” in connoting a particular level of living. But perhaps no phrase can do this as well as the numbers, which suggest the wide gap be- tween the group identified and those above the threshold. The designation “minimum adequate” might seem more descriptive but is avoided because of the potential confusion with the BLS “modest but adequate” city worker's family budget, which is 50 percent higher than the SSA low-income level. For many of the poor it was the inability of the family breadwinner to find or keep a job that caused their plight. But 214 million households, including 6 million children, were on the poverty roll even though the family head worked steadily at a full-time job throughout the year. To be sure, there has been and continues to be improvement : Five years earlier, with a total population less by some 13 million, the number judged poor by the same poverty index (allowing only for differences in price) was almost 5 mil. lion greater. On the other hand, the number with incomes above the poverty index yet below the low-income level—still a far from generous measure— remained almost unchanged. And no upward adjustment was made in either of the measures to take account of the higher standard of living that a rising real income makes possible for the majority. The Nation's poor then are now fewer in number but the difference between what they have and what the rest of us enjoy is greater. Today's poor, as we count them, are accordingly farther away from the mainstream of American good living than those in the poverty inventory 5 years ago. Even by the stringent definition of poverty, the record of progress is not equally encouraging for all. The nonwhite population, though, along with the majority now in better straits, are barely holding their own—they are surely not catching up: Today no less than in 1959 they experience poverty at a rate more than 3 times that of their white fellow Americans. Indeed for nonwhite youngsters in large families the prospects of a childhood free of poverty are dimmer than they used to be. The financial fate of the aged who live alone is better than once it was, but it still spells poverty for the majority. Compared with 1959, when aged unrelated individuals accounted for every fifth household on the poverty roster, 1 out of 4 households judged poor in 1964 was that of an aged person—usually a woman— living alone. This shift did not signify that as a group such persons now had less income than formerly but rather that more of them were seizing the opportunity to live alone. 8 Although the chances that a household headed by a woman will be poor are now less than they used to be, the improvement has not been so marked as for units headed by a man. Moreover, the proportion of families with children but without a father in the home has been growing. Thus the persons in poor house- holds with a woman at the head numbered 5% million in 1964, about the same total as in 1959; but though such households accounted for 40 percent of those labeled poor in 1959, the proportion had risen to 46 percent by 1964. The farm population continues as another persistent pocket of poverty, and the number of children and other members of large families living in poverty was even greater in 1964 than it had been earlier. In aggregate dollar terms, the amount required to close the poverty gap— that is, the estimated difference between the actual income of the poor and the income required—was $11.7 billion in 1964 or about $2 billion less in 1964 than in 1959. But the improvement reflected chiefly the fact that there were now fewer poor than before, not that those in poverty were any less needy than the poor of earlier years. NEEDS REVEALED BY OPERATION MEDICARE ALERT 81 One exception was the aged, for whom the dollar gap of those in poverty did tend to be smaller than in 1959. Persons aged 65 or older as a group de- rive a sizable share of their income from public programs rather than earn- ings. The expanding program of social security with higher benefits has helped some move out of poverty and others not quite so fortunate are nevertheless rendered less poor. For many of the younger population depending for their livelihood pri- marily on their own employment or that of other family members, the difficulties of the large or broken family, the problems of unemployment or employment at low pay, the inhibiting effect on earning power of inadequate education, and the special disadvantage of the Negro continued to consign them to poverty status. For some situations corrective programs were only getting under way ; for others, none had yet been devised. TRENDS IN POVERTY, 1959-64 As the official War on Poverty gains momentum, measuring the effectiveness of the various weapons becomes important. One phase involves setting the target for action by determining the extent of poverty today among the various population groups. Another aspect will be estimating how much improvement special programs add to what might take place anyway. For this purpose it is necessary to see what has happened in the past. The relevant income data for such analysis are available in sufficient detail only as far back as 1959. Choosing the Criterion Drawing the poverty line is not yet a task in which it is pessible to achieve consensus, particularly when the line is above the level of mere subsistence, as it is in the United States. The difficulties are increased when the definition is to be used to measure progress over a span of time. Statistical nicety will be better served if the criterion selected remains invariant. The realities of everyday living suggest it cannot be—at least not for very long. Though the change in consumption patterns from any Ay year to the next might be minuscule, over the long run the upgrading that goes with the developing United States economy will be too great to be ignored. Research in consumer economics is not yet at a stage precise enough to specify just how long the long run is. For the present analysis of trends in poverty during the period 1959-64, the poverty thresholds were adjusted only to take account of price change in the per capita cost of the food plans that are their core. The measure of poverty used is defined by the SSA variable income criterion, taking into account family size, composition, and farm-non-farm residence, and the proportions of income required to purchase a minimum adequate diet. Indexes have been computed at two standards, one for poverty and one for low-income status re- quiring approximately a third more in funds. The poverty level index has been adopted by the Council of Economic Advisers and the Office of Economic Op- portunity as a rough guide pending further research. Under this scale, four- person nonfarm families in 1964 as a group are defined as poor if their money income for the year is less than $3,130 and in low-income status if they have less than $4,075. For farm families the poverty line is 70 percent lower. The poverty index priced at the level for 1964 implied an average expenditure for food of 70 cents a day per person—2.2 percent higher than in 1959. The low-cost index in 1964 implied about 90 cents a day for food outlay per person or 5.3 percent higher than the earlier figure. The weighted averages of the poverty and low-income thresholds in 1960 and in 1964 for different types of families are shown in table 1: 82 TABLE 1.— Weighted average of poverty and low-income criteria for families of different composition, by household size, sex of head, and farm or nonfarm residence, March 1960 and 1965 NEEDS REVEALED BY OPERATION MEDICARE ALERT 2 SREERB2228228 ERREZRRERRE 2% Free aol eed Frm ei oles ede 0 3 B= > gle 2 SBRBEESREER B38338R2521 s 5 SE Frm eee ed Fri elie of =~ E : 3 RBERFEEREES ABR23BR55E8 5 Gree eles ed EENGERNIA= f) If : g a 3x RBE¥ESERESE Z22BZ8828RE S 88 FANN ES Frm NEES % = fd 3 £| 2 BEcB222R0ES B838RE8E828: |g | 58 Frac dS Foire BZ Cd E 3 2 RSEESRERR2S : $SREEERERSS g | Fr-cdNSGsS § | gr-ddassS = 2 3 | § | S8838K5%538 | £ | 258R3RELEES £8 F | grr ddees | 8 | See ele eed = g 2 3 g g z & =| E| 53 SSERCREEEEE ZEgEIREERE E 2 Sg @ OOO 03 Ee este o 2 2 3 82283RE285% 28823822858 2 g PR Erm eels S 5 5 ix GE8325232258 883535388 $ 52 attested Grim old edi =~ = L > «3 2 | EB 25 £28883385882 28322888388 t= SE Frio olod od FF Frc Need 312° = 3 E3555288282 E253ERFREIE s er OF OF 0 0 Fr eed = > § HHH HH 8 SEERA EERE E pig idg bd ESRERE z SRRERER ENE Pili | Saal ile pe i hts £ ig dig ili isis > 185 85 185 185 | 2 gs gsi ig g% gs E HEL EEE idede | z SS EELERRERE ESESTE | CEEE EE ee Eggigaaise £332332 Erm ERD EEEEE Emm Ein B § E GEBEEES gk BE ~— 3] OW Or- i «aN om 1 Required income in 1959 or in 1964 according to SSA poverty or low-income index for a family of given size and composition. Family incomes weighted together in accordance with percentage distribution of total units, by number of related children and sex of head, as of Current Population Survey, March 1960 and March 1965. NEEDS REVEALED BY OPERATION MEDICARE ALERT 83 Between 1959 and 1964 both the income received by consumers and the prices of goods they bought continued to climb, but the income went up faster. In- evitably then the poverty thresholds, adjusted only to the extent of price change, were farther below the general levels of income at the end of the period than at the beginning. The median income of four-person families in 1964, was $7,490, nearly 2% times the poverty nonfarm threshold of $3,130. In 1959, by contrast, the median income of $6,070 for four-person families was just twice the poverty index criterion. Accordingly, the poverty line for a nonfarm family of four, which in 1959 was half the median income for all families this size, by 1964 was 58 percent less than what the average family had in the way of income. Many of the poor, of course, had incomes considerably below the poverty threshold. Because prices and standards of living tend to move with prevailing income, families in poverty in 1964 could thus find themselves more readily outbid and outspent than families labeled poor in 1959. To this extent comparing the poor in 1964 with those in 1959 may overstate the reduction in their number and understate the degree of deprivation. Measures of Change Really to know how well we do in combating poverty would imply knowing about changes in the content of living and the increased opportunities for escaping poverty made possible for particular kinds of families. The only indi- cator currently available as a gauge, however, is the size of the poverty roster. There are other difficulties in evaluating progress in the fight against poverty simply by looking at numbers. As economic and social conditions change, family living arrangements change also. With a little more income, or better prospects for earnings, some who once shared the home of another may be encouraged to take up housekeeping on their own—electing privacy even at the risk of poverty. Persons may be counted poor as members of units thus formed who previously were considered members of the nonpoor families whose households (and income) they shared. Are they indeed poorer now that they are on their own than they were then, or do we need a better way to identify those with financial resources too little for adequate self-support? The fact that fewer family groups, particularly those with young children, now live as a subfamily in a relative’s home typifies the changes that are difficult to adjust for in counting the poor. Ome out of two parent-child groups living as a subfamily in 1964 had insufficient income to meet the poverty standard on their own. The majority of these were among our hidden poor—that is, they were living with a family above the poverty line. In 1959, 3 out of 5 parent- child subfamilies had too little income to meet the poverty level criterion. But what may be equally significant is that the total number of subfamilies decreased during the period as the number of families increased. In 1959, among every 1,000 families with any young children in the home there were included 40 parent-child groups living as relatives of the head or his immediate family. By 1964, such parent-child families numbered 33 per 1,000 of all families with children. Fewer young families were thus obliged to com- pensate for their own inadequate income by sharing with a relative, but, as with the aged, it is not possible to say for how many the new status added a poor family to the roster in place of a subfamily whose poverty was not registered before. The Poverty Tally For the 1959-64 period as a whole, the incidence of poverty measured by the poverty index declined from 22 percent to 18 percent of the population, the equivalent of six-tenths of a percentage point a year. From 1959 to 1962, a period which included a recession, the poverty tally declined by an average of 633,000 persons a year. During the subsequent 2 years of expansion the average decrease was 1,450,000 a year. The temporary reverse in 1960 reflects in part that this was the trough of the depression, but it must be remembered that the statistics are derived from small population samples. ‘Changes from one year to the next thus can reflect some sampling variability in the basic data as well as a real difference in the economic pulse. + Annual Report of the Council of Economic Advisors, January 1966, page 112. 84 NEEDS REVEALED BY OPERATION MEDICARE ALERT With the single exception of the year 1960, the ranks of the poor decreased steadily between 1959 and 1964, as indicated below: Persons in households with low income— Totalnumber Poor Near poor Year of persons ! (in millions) Number Percent Number Percent (in millions) (in millions) 176.5 38.9 22.1 15.8 9.0 179.5 40.1 22.3 14.7 8.2 181.4 38.1 21.1 14.8 8.2 184.4 37.0 20.1 15.8 8.5 187.2 35.3 18.9 15.7 8.4 189.2 34.1 18.0 15.7 8.3 1 Noninstitutional population as of March of following year. What is perhaps more striking than the steady reduction in the number of the very poor is the failure to reduce the number just above the minimum poverty line: There are today, just as there were in 1959, about 15% million persons in households with income that is above the poverty level but still below what might be considered a reasonable minimum. It will be noticed that from 1959 to 1960, as the count of the poor rose, the number just above the poverty line did drop, only to climb again the following year as the poverty rolls started down. This reciprocal trend suggests that there may be a sizable group in the population living always on the margin—wavering between dire poverty and a level only slightly higher but never really free from the threat of privation (tables 2 and 3) : TABLE 2.— Trends in poverty and low-income status, 1969-64: Number and percent of noninstitutional population who are poor or near poor NEEDS REVEALED BY OPERATION MEDICARE ALERT « WORN MNEMNeEONLD ON NODOHNMND z | 2° | SHC RRIEBPIEPEOCRECRIACIERT 5 wn 3 # = « {SO a yr arOaTaNANS 2 8 5 | R|R°|FFCEITBBCR/EPIATRRCKREYIN i I=3 8 & 8 8 & a © 0 ONDE HOFNOSNDODIVWMONMODON E [8 | namew mug wn enanmanaanase = 2 | 8] 8 KR? |BIRITSSTRECIRCRAKRTESCRRS — 1 g Q I=3 > [=] 5 a on oy MOON HONOR HNHIHNDOMNMMOMNN mm Mm BE | mine |erooomatant yun nnn tmmnnn Eg | Z| #[d% 99 du~dEcnd-Rucgi Runge 218% 5 Ru & © — o g " w ma MONO NMOID DM DOI= rm 00MM z 31 39 || 00 wh iB mi SURI Hm Oo 401300 2 of 00 3 g | §|8% | 2g Eg REC RRIR HNC Ew GK 5] S